Hypertension Outcomes Research Articles

Sudden Shift to Telehealth in COVID-19: A Retrospective Cohort Study of Disparities in Use of Telehealth for Prenatal Care in a Large Midwifery Service.

The coronavirus disease 2019 (COVID-19) pandemic created disruption in health care delivery, including a sudden transition to telehealth use in mid-March 2020. The purpose of this study was to examine changes in the mode of prenatal care visits and predictors of telehealth use (provider-patient messaging, telephone visits, and video visits) during the COVID-19 pandemic among those receiving care in a large, academic nurse-midwifery service. We conducted a retrospective cohort study of those enrolled for prenatal care in 2 nurse-midwifery clinics between 2019 and 2021 (n = 3172). Use outcomes included number and type of encounter: in-person and telehealth (primary outcome). Comparisons were made in frequency and types of encounters before and during COVID-19. A negative binomial regression was fit on the outcome of telehealth encounter count, with race/ethnicity, age, language, parity, hypertension, diabetes, and depression as predictors. When comparing pre-COVID-19 (before March 2020) with during COVID-19 (after March 2020), overall encounters increased from 15.9 to 19.5 mean number of encounters per person (P < .001). The increase was driven by telehealth encounters; there were no significant differences for in-person prenatal visit counts before and during the pandemic period. Direct patient-provider messaging was the most common type of telehealth encounter. Predictors of telehealth encounters included English as primary language and diagnoses of diabetes or depression. No differences in the frequency of in-person prenatal care visits suggests that telehealth encounters led to more contact with midwives and did not replace in-person encounters. Spanish-speaking patients were least likely to use telehealth-delivered prenatal care during the pandemic; a small, but significant, proportion of patients had no or few telehealth encounters, and a significant proportion had high use of telehealth. Integration of telehealth in future delivery of prenatal care should consider questions of equity, patient and provider satisfaction, access, redundancies, and provider workload.

Disparities in Hypertension Prevalence, Awareness, Treatment, and Control Among Women Living With and Without HIV in the US South.

Hypertension-related diseases are major causes of morbidity among women living with HIV. We evaluated cross-sectional associations of race/ethnicity and HIV infection with hypertension prevalence, awareness, treatment, and control. Among women recruited into Southern sites of the Women's Interagency HIV Study (2013-2015), hypertension was defined as (1) systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg according to clinical guidelines when data were collected, (2) self-report of hypertension, or (3) use of antihypertensive medication. Awareness was defined as self-report of hypertension, and treatment was self-report of any antihypertensive medication use. Blood pressure control was defined as <140/90 mm Hg at baseline. Prevalence ratios for each hypertension outcome were estimated through Poisson regression models with robust variance estimators adjusted for sociodemographic, behavioral, and clinical risk factors. Among 712 women, 56% had hypertension and 83% were aware of their diagnosis. Of those aware, 83% were using antihypertensive medication, and 63% of those treated had controlled hypertension. In adjusted analyses, non-Hispanic White and Hispanic women had 31% and 48% lower prevalence of hypertension than non-Hispanic Black women, respectively. Women living with HIV who had hypertension were 19% (P = .04) more likely to be taking antihypertension medication when compared with women living without HIV. In this study population of women living with and without HIV in the US South, the prevalence of hypertension was lowest among Hispanic women and highest among non-Hispanic Black women. Despite similar hypertension prevalence, women living with HIV were more likely to be taking antihypertensive medication when compared with women living without HIV.

Single-handed versus multiple-handed general practices: A cross-sectional study of quality outcomes in England.

As general practice increasingly moves towards large group practices, there is debate about the relative benefits, safety and sustainability of different care delivery models. This study investigates the performance of single-handed practices compared to practices with multiple doctors in England, UK. Practices in England with more than 1000 patients were included. Workforce data and a quality control process classified practices as single-handed or multiple-handed. Outcomes were (i) GP patient survey scores measuring access, continuity, confidence in health professional and overall satisfaction; (ii) reported diabetes and hypertension outcomes; and (iii) emergency department presentation rates and cancer detection (percentage of cancers diagnosed by a 2-week wait). Generalised linear models, controlling for patient and practice characteristics, compared outcomes in single and multiple-handed practices and assessed the effect of GP age in single-handed practices. Single-handed practices were more commonly found in areas of high deprivation (41% compared to 20% of multiple-handed practices). Single-handed practices had higher patient-reported access, continuity and overall satisfaction but slightly lower diabetes management and cancer detection rates. Emergency department presentations were higher when controlling for patient characteristics in single-handed practices but not when also controlling for practice rurality and size. Increased deprivation was associated with lower performance in seven out of eight outcomes. We found single-handed practices to be associated with high patient satisfaction while performing slightly less well on selected clinical outcomes. Further research is required to better understand the association between practice size, including increasing multidisciplinary working, on patient experience and outcomes.

Exercised-based cardiac rehabilitation associates with lower all-cause mortality in patients with primary pulmonary hypertension.

Despite pharmacological therapies to improve outcomes of pulmonary hypertension (PH), poor long-term survival remains. Exercised-based cardiac rehabilitation (ExCR) may be an alternative strategy to improve prognosis. Therefore, using an electronic medical record (EMR) database, the objective of this study was to compare mortality between patients with primary PH with ExCR vs. propensity-matched PH patients without ExCR. The retrospective analysis was conducted on February 15, 2023 using anonymized data within TriNetX, a global federated health research network. All patients were aged ≥18 years with primary PH recorded in EMRs with at least 1-year follow-up from ExCR. Using logistic regression models, patients with PH with an EMR of ExCR were 1:1 propensity score-matched with PH patients without ExCR for age, sex, race, and comorbidities, and cardiovascular care. In total, 109,736 patients with primary PH met the inclusion criteria for the control group and 784 patients with primary PH met the inclusion criteria for the ExCR cohort. Using the propensity score-matched cohorts, 1-year mortality from ExCR was proportionally lower with 13.6% (n = 101 of 744 patients) in the ExCR cohort compared to 23.3% (n = 174 of 747 patients) in the controls (OR 0.52, 95% CI 0.40-0.68). The present study of 1,514 patients with primary PH suggests that ExCR is associated with 48% lower odds of 1-year mortality, when compared to propensity score-matched patients without ExCR.

Comprehensive management for the improved outcome of persistent pulmonary hypertension of the newborn in a one-day-old baby girl: a case report

Comprehensive management for the improved outcome of persistent pulmonary hypertension of the newborn in a one-day-old baby girl: a case report

Association Between History of Adverse Pregnancy Outcomes and Coronary Artery Disease Assessed by Coronary Computed Tomography Angiography

(JAMA. 2023;329:393–404) Some lifestyle and genetic risk factors for coronary artery disease (CAD) are common between women and men, but others affect only women, such as preeclampsia, gestational hypertension, preterm delivery, and other adverse pregnancy complications and outcomes. Each of these has been linked to an increased risk in CAD, which has long been a leading cause of death. Risk factors for CAD associated with pregnancy outcomes are often overlooked because they tend to occur in younger women who may have otherwise good cardiovascular health. One method used to analyze and diagnose risks related to CAD is coronary computed tomography (CT) angiography; it is a noninvasive technique used to visualize the coronary arteries and screen for occlusion or other markers of subclinical CAD. Previous research has been unclear about the effect of cardiovascular complications during pregnancy on overall later cardiovascular health. This study aimed to understand associations between subclinical CAD as examined by coronary CT angiography and a history of adverse pregnancy outcomes.

The one-minute sit-to-stand test (1-min STST) and its relationship to quality of life (QoL) in patients with pulmonary hypertension (PH)

Abstract Introduction Patients with pulmonary hypertension (PH) have a decreased functional capacity and poor quality of life (QoL). The one-minute sit-to-stand test (1-min STST) can be potentially used for functional capacity assessment, but there is no data to date on its relationship to QoL in PH patients. Aims Our aim was to find out if 1-min STST performance correlates to patient-reported QoL. Methods 106 PH patients (mean age 66 ± 15 years, 57% female) were prospectively assessed for cardiorespiratory fitness using the 1-min STST. The patients had to stand-up and sit-down from a chair as many times as possible within one minute. Patients QoL was evaluated with the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) questionnaire. Results Mean number of 1-min STST repetitions was 16 ± 6.5 and mean CAMPHOR score was 26 ± 19. Patients with worse 1-min STST performance reported significantly worse QoL concerning the total score and all the sub-scores of the CAMPHOR questionnaire: They had a higher total score (r = -0.533, p &amp;lt; 0.001) and regarding sub-scores more symptoms: (r = -0.457, p &amp;lt; 0.001), worse functioning (r = -0.524, p &amp;lt; 0.001) and decreased QoL (r = -0.505, p &amp;lt; 0.001). Also, in multivariable linear regression analysis, adjusted for age, sex and BMI, lower 1-min STST performance was an independent predictor for worse QoL (β⁠ = -1.5, p &amp;lt; 0.001). Conclusion Our results indicate that regardless of age, sex and BMI the 1-min STST performance is associated with QoL in patients with PH.

Abstract 14793: Relationship Between Self-Rated Health and Clinical Outcomes in Hypertension: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT)

Background: Self-rated health (SRH) is a well-known independent predictor of mortality. However, the association of SRH with clinical outcomes in patients with hypertension remains uncertain. SPRINT investigated the benefit of intensive (vs. standard) blood pressure treatment in patients with high-risk hypertension. Objective: To examine the association between SRH and the primary SPRINT outcome, which was defined as the composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, and cardiovascular death. Methods: A trained study personnel administered a questionnaire to assess SRH. Each participant rated their overall health as excellent, very good, good, fair, or poor (E, VG, G, F, P). We categorized SRH into excellent, very good, good and fair/poor. Multivariate Cox regression was used to examine the association of SRH and clinical outcomes in SPRINT. Results: We included 9,319 participants (aged 67.9±9 years, 35.6% women, 57.6% White) who had available data on SRH. After a median follow-up of 3.8 years, 724 and 500 primary outcome and all-cause mortality events occurred, respectively. Relative to SRH of excellent, the risk of the primary outcome (HR 95% CI) associated with very good, good, and poor/fair SRH was 1.11 (0.78-1.56; p=0.555), 1.45 (1.03-2.05; p=0.036) and 1.87 (1.28-2.75; p=0.001), respectively. Similarly, relative to excellent, the risk of all-cause mortality (HR 95% CI) associated with very good, good, and poor/fair SRH was 1.13 (0.73-1.76; p=0.581), 1.72 (1.12-2.64; p=0.014) and 2.11 (1.32-3.38; p=0.002), respectively. Poorer SRH was also associated with a higher risk of each component of the primary outcome and adverse events ( Table). Conclusion: In the SPRINT cohort, SRH was independently associated with the risk of cardiovascular outcomes, mortality, and adverse events. Further studies are needed to explore the utility of incorporating SRH in the assessment of risk in patients with hypertension.

Abstract 17965: Hypertension Cascade and Social Determinants of Health in Women of Reproductive Age

Introduction: Studies examining hypertension (HTN) among women of reproductive age (18-44 years) are sparse. We sought to evaluate HTN awareness, diagnosis, treatment, and social determinants of health among women aged 18-44 years, in a national registry. Methods: We analyzed cross-sectional data from participants enrolled in the American Heart Association Research Goes Red (RGR) Registry, an online platform powered by Verily, who responded to the Project Baseline and RGR enrollment questionnaires. HTN outcomes were examined as self-report awareness of blood pressure (yes/no), HTN diagnosis (yes/no), and current HTN medication use (yes/no). Multinomial logistic regression models were used to assess the association between HTN cascade outcomes and social determinants of health, adjusting for age. Results: In a sample of 2,422 adult women (mean age 36 ± 6 years); non-Hispanic Black women were 3-times more likely have HTN (adjusted Odds ratio [aOR] 3.08; 95%CI 1.67-5.66) and be treated (aOR 3.21; 95%CI 1.67-6.03) compared to non-Hispanic White women ( Table ). The odds of HTN prevalence were higher (aOR 1.82; 95%CI 1.11-2.94) and HTN awareness lower (aOR 0.62; 95%CI 0.39-0.98) among Hispanic women compared to non-Hispanic White women. Compared to college graduates, high school graduates had 43% lower odds of HTN awareness, 85% high odds of HTN diagnoses. Persons with lower income were more likely to have HTN diagnoses and treatment and less likely to be aware. Conclusions: Social determinants of health including race, education and income were associated with HTN cascade outcomes. Tailored public health interventions and policies for improving HTN outcomes among women of reproductive age must address social needs.

Abstract 13407: Long-Term Outcomes of Chronic Thromboembolic Pulmonary Hypertension Treated With Pulmonary Endarterectomy and Balloon Pulmonary Angioplasty: Results From the Japanese Prospective CTEPH Registry (CTEPH AC Registry)

Introduction: In Japan, balloon pulmonary angioplasty (BPA) is more commonly adopted in patients with chronic thromboembolic pulmonary hypertension (CTEPH) compared to European countries or US due to their expertise. However, there are no reports from regions where BPA is extensively practiced. Aims: This study aims to explore the treatment outcomes in Japan. Methods: The study involved a nationwide, prospective, observational registry that included all patients diagnosed with CTEPH from August 2018 to February 2023 in Japan. Patients were categorized as naïve or prevalent cases based on their previous reperfusion therapy (pulmonary endarterectomy and/or BPA) at the time of enrollment. Each case was further classified as operable or BPA group. The primary outcome measure was morbidity and mortality (MM) events since enrollment, which comprised all-cause death, CTEPH-related hospitalization, rescue reperfusion therapy, initiation of parenteral pulmonary vasodilators, and worsening of CTEPH characterized by a decrease in 6-minute walk distance greater than 15% and deterioration of the WHO functional class. Results: A total of 1194 patients, including naïve cases (operable: n = 54, BPA: n = 293) and prevalent cases (operable: n=125, BPA: n = 532), were identified. Among the naïve cases, there were no significant differences in age or disease severity between the operable and BPA groups. Among the prevalent cases, the BPA group was older (63 ± 13 vs. 58 ± 14 years old, p &lt; 0.0001) and had higher pulmonary vascular resistance (364 ± 279 vs. 293 ± 206 dyne*sec/cm5, p = 0.001) compared to the operable group. The results of primary outcome measures were comparable between both the groups (Figure). Conclusions: BPA as well as pulmonary endarterectomy is considered as safety and effective therapeutic option in CTEPH patients.

Abstract 19197: Cardiopulmonary Outcomes and Disparities in Long-Term Anticoagulant Use in Secondary Pulmonary Hypertension Patients: A Nationwide Analysis

Introduction: The use of anti-coagulation in pulmonary hypertension patients has shown to improve mortality. Our aim was to characterize patient demographics, analyze disparities and investigate the effect of long-term anti-coagulant (AC) use on outcomes in secondary pulmonary hypertension (PAH) patients. Methods: This was a retrospective cohort study using the 2019 Nationwide Inpatient Sample database to identify admissions in adults with diagnoses of secondary PAH and long-term AC use. Multivariate linear and logistic regression models were adjusted for demographic variables and comorbid conditions. Primary outcome was all-cause mortality, and secondary outcomes were outcomes of long-term AC use in secondary PAH patients and length of stay (LOS). Results: Out of 1,141,870 secondary PAH patients, 287,940 had long-term AC use. The AC-PAH cohort when compared to the Non-AC-PAH cohort had lower in-hospital mortality (3.35% vs 5.18%, p&lt;0.001) and shorter LOS (6.04 days vs 7.03 days, p&lt;0.001). The AC-PAH cohort had older patients (mean age 74.46 vs 69.55 years, p&lt;0.001), more White patients (73.10% vs 64.76%, p&lt;0.001) and fewer Black patients (15.62% vs 20.10%, p&lt;0.001). The AC-PAH cohort when compared to the Non-AC-PAH cohort had lower odds of pulmonary embolism (PE)(OR 0.92, 95% CI 0.86-0.98, P&lt;0.05), acute respiratory failure (RF)(OR 0.73, 95% CI 0.71-0.75, p&lt;0.001), ventilator dependence (OR 0.46, 95% CI 0.38-0.55, p&lt;0.001), systemic HTN (OR 0.91, 95% CI 0.83-0.99, p&lt;0.05), cardiac arrest (OR 0.65, 95% CI 0.59-0.72, p&lt;0.001), ischemic cardiomyopathy (OR 0.94, 95% CI 0.90-0.98, p&lt;0.005), STEMI (OR 0.31, 95% CI 0.22-0.42, p&lt;0.001), NSTEMI (OR 0.52, 95% CI 0.49-0.55, p&lt;0.001) and acute ischemic stroke (OR 0.71, 95% CI 0.66-0.77, p&lt;0.001). The AC-PAH cohort had higher odds of chronic RF (OR 1.07, 95% CI 1.02-1.12, P&lt;0.005) and atrial fibrillation (A.Fib)(OR 2.79, 95% CI 2.72-2.86, p&lt;0.001). Conclusion In secondary PAH patients, the long-term use of AC was associated with lower in-hospital mortality, shorter LOS and lower odds of having PE, acute RF, ventilator dependence, systemic HTN, ischemic cardiomyopathy, STEMI, NSTEMI and acute ischemic stroke. More extensive research is required in this area to investigate outcomes further.

Abstract 15082: Novel Imaging/Hemodynamic Based Right Ventricular Phenotypes in Patients With Pulmonary Hypertension

Introduction: Right ventricular function and ventricular dynamics associate with outcomes in pulmonary hypertension (PH). Measures of RV strain describe ventricular mechanics but are not included in RV function assessments. This study aimed to develop novel RV imaging-hemodynamic phenotypes using unsupervised machine learning. Methods: Participants with cardiac magnetic resonance (CMR) and right heart catheterization data were identified from The Ohio State University CMR PH registry (n=81). RV areas were segmented from CMR 4-chamber images and used to determine RV free wall (RVFW) and septal strain. K-medoids clustering was used on imaging features, RV hemodynamics, and RV function (Figure A). Correlation analysis was used to reduce collinearity. Significance was measured with Kruskal Wallis and chi-squared tests. A p-value &lt; 0.05 was considered significant. Results: Participants were assigned to three clusters and top contributors to cluster assignment were RVEF, RVFW strain, and Ea. RV phenotypes progress from mild/no RV dysfunction (Cluster 1) to severe RV dysfunction (Cluster 3) (Figure A). Cluster 1 had normal RV function with high RVEF and PA compliance, preserved LVEF, low RVSP, and low Eed. Compared to cluster 1, cluster 2 demonstrates more RV dysfunction with reduced RVEF, stroke volume, and PA compliance with an increase in RVSP but no change in Eed. In addition to more RV dysfunction (decreased RVEF and stroke volume), cluster 3 had increased RA pressure and Eed. In terms of RV strain, (Figure B), cluster 2 had less negative RVFW and septal strain compared to cluster 1. In cluster 3, RV septal strain is similar to cluster 2 but with decreased RVFW strain. Conclusions: Imaging and hemodynamic RV variables contribute to identification of novel RV-centric phenotypes and should be included in phenotyping efforts to better describe altered ventricular dynamics contributing to RV dysfunction in PH.

Abstract 15182: Evaluation of an Electronic Clinical Decision Support Tool for Incident Elevated Blood Pressure in Adolescents

Introduction: The PedsBP Clinical Decision Support (CDS) is an electronic health record-linked tool developed in an urban health system that aims to improve the quality of blood pressure (BP) measurement and recognition of hypertension in children. Aims: To describe the feasibility of implementing the PedsBP tool for use in a rural health system, and to describe repeat BP measurement among patients 6-17 years with an incident hypertensive BP at high-intensity clinics using the PedsBP CDS. Methods: This is a 3-arm, parallel group, cluster randomized controlled pragmatic trial in 40 community-based primary care clinics in a rural Midwestern health system (Essentia Health). Clinics were randomized 1:1:1 to usual care, low-intensity implementation (PedsBP CDS only), or high-intensity implementation (Peds BP CDS plus in-person training, monitoring CDS use, and feedback). The PedsBP CDS includes an alert to re-measure a hypertensive BP at that visit, an alert that a hypertensive BP should be repeated in 1-3 weeks, and patient-specific order sets. Study outcomes include repeat BP measurement at an index visit and diagnosis of hypertension within 6 months of meeting clinical criteria. Safety outcomes include stroke, transient ischemic attack, acute renal failure, uncontrolled hypertension within 6 months of index visit. Results: Among 22,238 (50.9% female, mean age 11.7 years, SD=3.5 years) patients with visits between 8/1/22-1/31/23 at participating clinics, 4008 (18.0%) had an incident hypertensive BP and 239 (1.1%) met clinical criteria for hypertension. Among those who met clinical criteria for hypertension, there were no cases of uncontrolled hypertension or other safety outcomes. Of 7974 patients with encounters at 13 high-intensity clinics and with a BP measured, the initial BP was elevated for 1307 (16.4%) and remeasured in 628 (48.1%). Among 1265 patients at high-intensity clinics with a BP elevated and with body mass index (BMI) information, 482 (38.1%) were obese (BMI percentile ≥95%), 209 (16.5%) were overweight (BMI percentile 85% to &lt;95%), and 574 (45.4%) were not overweight or obese (BMI percentile &lt;85%). Conclusions: The PedsBP CDS is feasible to implement in a new health system and has the potential to improve the quality of pediatric BP care.

Abstract 13852: Sex Differences in Blood Pressure Reduction and Cardiovascular Outcomes in Patients With Resistant Hypertension Undergoing Radiofrequency Renal Denervation: Global SYMPLICITY Registry DEFINE

Introduction: Hypertension (HTN) prevalence and outcomes differ by sex. Radiofrequency renal denervation (RF RDN) safely reduces blood pressure (BP) in patients with resistant HTN. Hypothesis: After RF RDN, there are no sex-based differences in BP changes and cardiovascular (CV) outcomes. Methods: The Global SYMPLICITY Registry (GSR) DEFINE is an all-comer registry of patients with uncontrolled BP undergoing RF RDN. BP changes (analysis of covariance [ANCOVA] adjusted for baseline BP and age), CV death, stroke, myocardial infarction (MI) rates at 3yrs were compared between sexes with office systolic BP (OSBP) ≥140mmHg, prescribed ≥3 anti-HTN drugs. Results: Patients enrolled up to March 2023 were included (N=2502, female=1062). Females were older (62 vs 59 y; p&lt;0.0001), less likely to have a history of sleep apnea (12.5 vs 25.0% p&lt;0.0001), cardiac disease (45.2 vs 50.3%; p&lt;0.0012) and smoking (19.1 vs 41.3%; p&lt;0.0001). Body mass index, rates of diabetes and chronic kidney disease, number of anti-HTN drugs (5.1±1.5 in both sexes; p=0.88) and 24-hr SBP were similar by sex. Baseline OSBP was higher in females (174±23 vs 169±19mmHg; p&lt;0.0001). After 3yrs, OSBP significantly decreased in both sexes from baseline (female: -21.5mmHg vs male: -20.4mmHg; ANCOVA adjusted difference: 3.2mmHg [95% CI: 0.5 to 6.0; p=0.021]). There was no difference in 24-hr SBP change (Figure 1A) or number of anti-HTN drugs by sex. CV death rate was significantly higher in females (4.1% vs 2.1% vs p=0.024), but MI rate was significantly lower in females (1.3% vs 3.5%; p=0.007). Stroke rate was similar by sex (Figure 1). Conclusion: Females with resistant hypertension referred for RF RDN were older, had higher OSBP with fewer comorbidities compared to males. Despite similar BP reductions up to 3yrs after RF RDN, CV death rate in females was greater than males. These results suggest the need for sex specific analyses and control of HTN in females.

Abstract 18742: Matrilysin (MMP7) as a Robust Predictor of Hypertension Incidence and Complications: Findings From a Proteomic Analysis in the Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Proteomic techniques can be applied for the discovery of common pathways underlying both incident hypertension and hypertension-related cardiovascular outcomes. Research Questions: To identify and validate proteins associated with incident hypertension and to examine the association of these validated proteins with hypertension-related cardiovascular events. Methods: We quantified the association of 4,955 plasma proteins (measured by SomaScan® Version 4 Assay) with incident hypertension (defined as systolic blood pressure (BP) ≥140, diastolic BP ≥ 90 mmHg, or hypertension medication use) in participants free of hypertension at ARIC visit 3 (1993-95) using Cox regression models adjusted for demographics, clinical characteristics and baseline BP. Significant associations were validated using proteomic measurements at ARIC visit 2 (1990-92). We then examined the association of validated proteins with incident coronary heart disease (CHD), stroke, and heart failure (HF) among participants with hypertension at visit 3 using Cox regression models additionally adjusted for hypertension duration and treatment. Results: There were 5,080 participants in the discovery cohort (mean age 59y, 13% Black, 54% women, median follow up 11 y) and 6,810 in the validation cohort (median follow up 3.1y). Four proteins were significantly associated with incident hypertension in the discovery cohort. One protein, Matrilysin (MMP7), remained significantly associated in the validation cohort (HR 1.22 [1.11-1.34]) (Figure1A). MMP7 was also significantly associated with all hypertension-related complications (Figure 1B-D). Conclusions: MMP7, a protein involved in extracellular matrix degradation, was robustly associated with incident hypertension and cardiovascular events. Future research examining the pathophysiologic mechanism of MMP7 could potentially yield drug targets for the prevention and treatment of hypertension.

Abstract 17986: Impact of Race and Socioeconomic Factors on Hypertensive Emergency

Background: Hypertensive emergency, defined as a blood pressure ≥ 180/110mmHg with target organ damage, is a major cause of cardiovascular morbidity and mortality. There is a lack of data on the impact of race and socioeconomic factors on hypertensive emergency incidence and outcomes. Thus, we investigated these associations in a diverse population at a large tertiary-care academic medical center. Methods: Utilizing the Patient Cohort Explorer Epic electronic health records system at the University of Mississippi Medical Center from 1/1/2013 to 7/31/2021, we identified patients diagnosed with hypertensive emergency. Sociodemographic factors related to hypertension and patient status (alive/deceased) were also examined. Descriptive statistics were used to examine differences in means across groups. Results: 2,483 patients diagnosed with hypertensive emergency were included in this analysis. Among these patients, the mean (SD) age was 52 (17) years, 49% were women, and 82.2% were Black. Nearly half (44.4%) of those diagnosed with hypertensive emergency were uninsured, 46.7% had Medicaid or Medicare, and 7.9% had private insurance. Black patients with hypertensive emergency were significantly younger compared with White patients (51 vs 57 years, p&lt;0.001). There was no significant correlation between race and insurance status in this population. Over the 8-year period, 14.1% were deceased at the time of analysis. Conclusions: Among patients admitted to a large academic medical center with hypertensive emergency, most were Black individuals with Medicaid or lacking health insurance. Black individuals present at significantly younger ages compared to White patients. Our findings are much different than data published from the Nationwide Readmissions Database reporting a mean age of 66 years and nearly 90% insured rate in patients with hypertensive emergency. Further, race was not reported in that analysis. Our findings suggest that hypertensive emergency disproportionately affects minority and underserved populations. Further work is needed to characterize risk factors and improve outcomes for this high-risk population.

GeogRaphic and socioecoNomic Distribution of real-world Indian data of home blood pressure monitoring (GRAND Study): Study protocol for an observational study in 18 medical centers across India.

One-fourth of death in India is attributed to cardiovascular disease (CVD) and more than 80% is related to ischemic heart disease and stroke. The main risk factor for CVD is hypertension. Every third person in India suffers from hypertension and the prevalence increased drastically in the past 20 years, especially among the youngest age group of 20 and 44 years. Regardless of being under anti-hypertension medication, the blood pressure (BP) control rate in the country is still low ranging between 6% and 28% only. Assessing the "true BP control rate" should be performed using both clinic BP measurement and out-of-office BP measurement as the latter shows better prognosis for patients' hypertension and CVD outcomes. Home blood pressure monitoring (HBPM) shows superiority over ambulatory BP measurement as multiple measurements can be collected at the patient's convenience. Only limited evidence on HBPM in India is available and it's either lacking in hypertension participants or of a small sample size. This study will investigate the real BP control status among 2000 hypertensive patients from 18 centers in 12 states across Pan-India. The outcome of this study will emphasize the value of establishing BP control management practice guidelines suitable for physicians and help policymakers in building proper strategies for hypertension management to reduce the CVD burden on the health situation in India.

Factors Affecting Mortality in Elderly Hypertensive Hospitalized Patients with COVID-19: A Retrospective Study.

Corona Virus Disease 2019 (COVID-19) endangers the health and survival of the elderly. We tried to explore factors especially kidney function which affected mortality in elderly hypertensive patients with COVID-19. We conducted a retrospective research of 748 COVID-19 elderly patients (≥65 years old) at Zhejiang Hospital. This study compared demographic data, laboratory values, comorbidities, treatments, and clinical outcomes of hypertension and non-hypertension participants, and subgroup analysis of age and frailty was conducted in the hypertension population. Survival analysis was used to determine risk factors for death in elderly patients with COVID-19. Our study revealed that the elderly hypertensive patients with COVID-19 had higher blood urea nitrogen (BUN), serum uric acid (UA), serum creatinine (Scr), lower estimated glomerular filtration rate (eGFR), higher incidence of severity, admission to intensive care unit (ICU) and death, and longer in-hospital stay than non-hypertensive patients, which also occurred in the very elderly hypertensive patients compared with younger hypertensive patients and frail hypertensive patients compared with no-frail hypertensive patients. In addition, the prevalence of acute kidney injury (AKI) was higher in the oldest old hypertensive patients and frail hypertensive patients. Multivariate survival analysis indicated that the independent risk factors for death from COVID-19 were age ≥80 years, heart failure, antiviral therapy, calcium channel blocker (CCB) therapy, mechanical ventilation, AKI, and eGFR<60 mL/min per 1.73 m2. The results of the present study suggested that the elderly hypertensive patients with COVID-19 would have more serious kidney injury, more serious disease progression and higher mortality, which also occurred in very elderly and frailty subgroup. Kidney dysfunction was closely related to mortality in elderly patients with COVID-19.

Association of Elevated Serum Aldosterone Concentrations in Pregnancy with Hypertension.

Emerging evidence indicates a previously unrecognized, clinically relevant spectrum of abnormal aldosterone secretion associated with hypertension severity. It is not known whether excess aldosterone secretion contributes to hypertension during pregnancy. We quantified aldosterone concentrations and angiotensin peptides in serum (using liquid chromatography with tandem mass spectrometry) in a cohort of 128 pregnant women recruited from a high-risk obstetrics clinic and followed prospectively for the development of gestational hypertension, pre-eclampsia, superimposed pre-eclampsia, chronic hypertension, or remaining normotensive. The cohort was grouped by quartile of aldosterone concentration in serum measured in the first trimester, and blood pressure, angiotensin peptides, and hypertension outcomes compared across the four quartiles. Blood pressures and body mass index were greatest in the top and bottom quartiles, with the top quartile having the highest blood pressure throughout pregnancy. Further stratification of the top quartile based on increasing (13 patients) or decreasing (19 patients) renin activity over gestation revealed that the latter group was characterized by the highest prevalence of chronic hypertension, use of anti-hypertensive agents, pre-term birth, and intrauterine growth restriction. Serum aldosterone concentrations greater than 704 pmol/L, the 75th percentile defined within the cohort, were evident across all categories of hypertension in pregnancy, including normotensive. These findings suggest that aldosterone excess may underlie the development of hypertension in pregnancy in a significant subpopulation of individuals.

Effectiveness of Valsartan's Single-Pill Combination Therapies on Blood Pressure Control in Hypertensive Patients: Malaysian Single-Centre Real-World Experience.

Uncontrolled hypertension can cause cardiovascular disease and is an important public health issue. Single-pill combination (SPC) therapies possess combined blood pressure (BP)-lowering effect and may improve compliance to treatment. This study assessed the effectiveness of valsartan (Val)-based SPC therapies in achieving BP control in hypertensive patients. This was a retrospective study. Data were extracted from the hybrid medical records of patients from the Institut Jantung Negara (IJN), Malaysia. Adults with established diagnosis of hypertension and on prescription of Val-based SPC therapies as part of routine medical care from 1 January 2013 to 31 December 2018, with ≥ 1 year of follow-up were included. Primary endpoint was proportion of patients achieving therapeutic BP control (BP < 140/90 mmHg). Secondary outcomes included change from baseline (CFB) in systolic BP (SBP) and diastolic BP (DBP), and subgroup analysis was based on baseline SBP categories and presence of diabetes. Study included 409 hypertensive patients. The mean (standard deviation [SD]) age of the population was 65.1 (10.6) years old, with male predominance (61.6%). Proportion of patients achieving target BP between baseline and follow-up were 57.0% (P < 0.001). Mean CFB in SBP and DBP were recorded as 19.52 mmHg and 7.47 mmHg, respectively. Over half of the patients achieved the target BP in all subgroups categorised by SBP at baseline, except the subgroup of SBP 160 mmHg-179 mmHg. SPC therapies were continued in 97.3% of patients at 1-year follow-up. Patients using Val-based SPC therapies had significant reduction in BP with good tolerability, with 57% of patients achieving target BP over a prolonged 1-year follow-up period. Uptake of SPC therapy is warranted to improve patient care and outcomes in hypertension.