Importance Of Blood Pressure Control Research Articles

Higher systolic and diastolic blood pressures in recently postmenopausal women are associated with greater WMH more than a decade later in the KEEPS Continuation

AbstractBackgroundHigher blood pressure (BP) is associated with greater white matter hyperintensity (WMH) volume, but research is limited in recently menopausal and postmenopausal women. Postmenopausal women have a greater burden of WMH than men and premenopausal women, but whether hormone therapy (HT) modifies the association between systolic and diastolic BP (SBP, DBP) and WMH is unknown. We investigated the association of SBP and DBP in recently postmenopausal women who participated in an HT trial with WMH volumes measured 14 years later and explored whether HT modified the results.MethodWomen with good cardiovascular (CV) health, who were previously enrolled in a randomized placebo‐controlled HT trial, the Kronos Early Estrogen Prevention Study (KEEPS), participated in the current observational KEEPS continuation (n = 212; median age = 67; range 58‐72). SBP and DBP were measured at KEEPS baseline (median age = 54 years; range 44‐59) and continuation. Antihypertensive users were excluded (baseline, n = 34; continuation, n = 61). Approximately 10 years after the end of KEEPS HT versus placebo 4‐year interventions, automated WMH volumes were measured from 3D‐FLAIR MRI. Associations of KEEPS baseline and continuation SBP and DBP with log WMH volume at KEEPS continuation were tested using linear regression analyses adjusting for covariates in model 1 (age, total intracranial volume, study site) and model 2 (model 1 plus cardiovascular risk factors (CVRF)).ResultHigher KEEPS baseline SBP and DBP were associated with greater WMH volume measured 14 years later, and after adjusting for CVRF (p = 0.01). Similarly, in KEEPS continuation, higher SBP and DBP were associated with greater WMH volume measured concurrently and after adjusting for CVRF (p<0.001). We did not find statistically significant evidence that HT versus placebo modified these associations. Topographically, higher SBP and DBP were associated with greater periventricular WMH in the frontal and parietal lobes after adjusting for age (Figure).ConclusionHigher SBP and DBP in recently menopausal women with good CV health were associated with greater WMH volumes more than a decade later after adjusting for CVRF, independent of randomization to HT. Our results show the importance of blood pressure control in recently menopausal women, that may reduce the white matter injury later in life.

Association between blood pressure and Alzheimer’s disease biomarkers in cognitively unimpaired adults

AbstractBackgroundHigh blood pressure is an established risk factor for dementia. However, the underlying mechanisms are not completely understood. We aimed to evaluate the association between blood pressure and Alzheimer’s disease (AD) biomarkers in cognitively unimpaired adults from the ALFA+ study.MethodWe analyzed data from 301 participants with available cross‐sectional blood pressure measures (acquired by trained staff with an oscillometric device after 5 minutes of rest) and cerebrospinal fluid (CSF) AD core biomarkers data (CSF p‐tau and t‐tau were measured with Elecsys® immunoassays and CSF Aβ42 and Aβ40 with the Roche NeuroToolKit, a panel of robust prototype assays, both from Roche Diagnostics International Ltd), and a subset of 278 participants with amyloid PET data, of whom 110 had a second follow‐up PET acquisition (3.4 years after in average). We used separate linear regression models to analyze the association of systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP = SBP‐DBP) with CSF and PET biomarkers at a cross‐sectional level, and their association with the annualized rate of change in amyloid PET [(follow‐up centiloids – baseline centiloids) / years between PET scan acquisition]. We adjusted all models by age, sex, APOE status, waist‐to‐hip ratio, dyslipidemia, diabetes, tobacco and alcohol consumption, physical activity, and antihypertensive treatment.ResultHigher baseline SBP (but not DBP or PP) was significantly associated with increased amyloid PET uptake over time (p = 0.043). In cross‐sectional analyses, DBP was negatively associated with Aβ42 (p = 0.013), Aβ40 (p = 0.026), and t‐tau (p = 0.045), and marginally associated with p‐tau (p = 0.069), but not with the Aβ42/40 ratio nor baseline amyloid PET uptake. Associations with Aβ42 and t‐tau were no longer significant after further adjustment by CSF Aβ40 levels. SBP and PP were not associated with CSF biomarkers or baseline amyloid PET uptake.ConclusionHigher SBP is associated with longitudinal brain amyloid accumulation, which reinforces the importance of blood pressure control in AD prevention. DBP is also associated at a cross‐sectional level with AD biomarker concentration in CSF, but the attenuation of this association after adjusting by Aβ40 suggests a non‐specific.

Higher systolic and diastolic blood pressures in recently postmenopausal women are associated with greater WMH more than a decade later in the KEEPS Continuation

AbstractBackgroundHigher blood pressure (BP) is associated with greater white matter hyperintensity (WMH) volume, but research is limited in recently menopausal and postmenopausal women. Postmenopausal women have a greater burden of WMH than men and premenopausal women, but whether hormone therapy (HT) modifies the association between systolic and diastolic BP (SBP, DBP) and WMH is unknown. We investigated the association of SBP and DBP in recently postmenopausal women who participated in an HT trial with WMH volumes measured 14 years later and explored whether HT modified the results.MethodWomen with good cardiovascular (CV) health, who were previously enrolled in a randomized placebo‐controlled HT trial, the Kronos Early Estrogen Prevention Study (KEEPS), participated in the current observational KEEPS continuation (n = 212; median age = 67; range 58‐72). SBP and DBP were measured at KEEPS baseline (median age = 54 years; range 44‐59) and continuation. Antihypertensive users were excluded (baseline, n = 34; continuation, n = 61). Approximately 10 years after the end of KEEPS HT versus placebo 4‐year interventions, automated WMH volumes were measured from 3D‐FLAIR MRI. Associations of KEEPS baseline and continuation SBP and DBP with log WMH volume at KEEPS continuation were tested using linear regression analyses adjusting for covariates in model 1 (age, total intracranial volume, study site) and model 2 (model 1 plus cardiovascular risk factors (CVRF)).ResultHigher KEEPS baseline SBP and DBP were associated with greater WMH volume measured 14 years later, and after adjusting for CVRF (p≤0.01). Similarly, in KEEPS continuation, higher SBP and DBP were associated with greater WMH volume measured concurrently and after adjusting for CVRF (p<0.001). We did not find statistically significant evidence that HT versus placebo modified these associations. Topographically, higher SBP and DBP were associated with greater periventricular WMH in the frontal and parietal lobes after adjusting for age (Figure).ConclusionHigher SBP and DBP in recently menopausal women with good CV health were associated with greater WMH volumes more than a decade later after adjusting for CVRF, independent of randomization to HT. Our results show the importance of blood pressure control in recently menopausal women, that may reduce the white matter injury later in life.

The importance of blood pressure control in patients with ischaemic stroke in the acute period

The importance of blood pressure control in patients with ischaemic stroke in the acute period

Abstract 12638: The Independent and Joint Associations of Obesity and Hypertension on Incident Heart Failure: A Pooled Cohort Analysis

Introduction: Obesity and hypertension (HTN) are major risk factors for incident heart failure (HF). Obesity is a major cause of HTN; thus, it is difficult to disentangle the impact of each risk factor on HF incidence. Further, it is not established what factors modify these relationships. Aims: To assess the associations of obesity and HTN as well as their potential synergistic effect on incident HF in large, diverse populations. Methods: We studied participants of 3 major epidemiologic cohorts: Atherosclerosis Risk in Communities Study, Multi-Ethnic Study of Atherosclerosis, and Jackson Heart Study. Participants were stratified into 4 groups: neither obesity nor HTN (reference), only obesity, only HTN, or both obesity and HTN. HTN was defined as ≥140 mmHg systolic or ≥90 mmHg diastolic blood pressure or use of antihypertensive medications. Obesity was defined as body mass index ≥30 Kg/m2. Cox proportional hazards models adjusted for age, sex, race, smoking, alcohol use, diabetes, coronary heart disease, and estimated glomerular filtration rate were used to assess the association of 4 groups with incident HF. Results: 18,351 participants (55.1% women and 31.4% black adults) followed over a mean 14 years were included in our analysis. Participants with only obesity (adjusted HR= 1.60; 95% CI 1.36 to 1.88) and only HTN (aHR 2.1; 95% CI 1.87, 2.37) demonstrated an increased risk of incident HF compared with participants with neither obesity nor HTN after adjustment for covariates. The greatest risk of incident HF was in participants with both obesity and HTN (aHR 2.97; 95% CI 2.63 to 3.36; Figure). HTN did not modify the effects of obesity or vice versa (p=0.193). Conclusions: Obesity and HTN are associated with incident HF and individuals with both have the highest risk of HF. This is an additive effect. These data emphasize the importance of blood pressure control and weight management in the prevention of HF.

PS-BPC11-10: BLOOD PRESSURE IN PATIENTS WITH FABRY DISEASE

Background: Fabry disease is a lysosomal storage disorder caused by a deficiency of α-galactosidase A (α-gal A) activity, one of the lysosomal hydrolases. A defect in α-gal A activity leads to the systemic accumulation of glycosphingolipids resulting in multiple organ involvement such as acroparesthesia, hypohidrosis, angiokeratoma, and corneal opacities. In many patients with Fabry disease, cardiac and/or cerebrovascular disease is the primary cause of death. Control of hypertension, which is a risk factor for cardiac and cerebrovascular disease, is therefore important. The prevalence of uncontrolled hypertension in patients with Fabry disease is unknown. Method: We st udied uncontrolled hypertension (systolic blood pressure(SBP)< 130 mmHg or diastolic blood pressure(DBP) < 80 mmHg) at the first visit of 31 patients who were diagnosed with Fabry disease in our department from April 2015 to December 2021. Of these, two children and four whose blood pressure had not been measured were excluded. Results: We examined 7 males(28%) and 18 females(72%). Uncontrolled hypertension was present in 76% of the patients with Fabry disease (males; 57,1%, females; 83.3%). Median SBP was 125 mmHg and median DBP was 83mmHg. Conclusion: In our study, we found a very high prevalence of uncontrolled hypertension in patients with Fabry disease, especially in women. Given that the leading causes of death in Fabry disease are cardiac and cerebrovascular disease, our data suggest the importance of blood pressure control in patients with Fabry disease. Our study was limited by the single-center data and the limited number of cases.

Cerebral perfusion in untreated, controlled, and uncontrolled hypertension

This study evaluated the association between systemic arterial blood pressure and cerebral perfusion in 740 participants of the UK's largest tri-ethnic study with measurements of cerebral blood flow (CBF) performed using arterial spin labelling MRI. A significant negative correlation between blood pressure, age and CBF was observed across the patient cohort. The lowest CBF values were recorded in the group of patients with hypertension that were prescribed with anti-hypertensive drugs, but uncontrolled on medication. These findings confirm that hypertension is associated with reduced cerebral perfusion and highlight the importance of blood pressure control for the benefit of maintaining brain blood flow.

ARTERIAL HAEMODYNAMIC PARAMETERS LINKED TO ARTERIAL PULSATILITY, EXCESS WAVE PROPAGATION AND COGNITIVE FUNCTION

Objective: Hypertension is associated with the development of cognitive impairment and dementia in an ageing population. Aortic stiffness and alterations in central artery haemodynamics could intensify the penetration of excess wave energy into the cerebral circulation, damaging the microvasculature in addition to age-associated vascular changes. We aimed to determine whether haemodynamic parameters linked to arterial pulsatility and excess wave propagation was associated with cognitive function in a sample of normotensive and hypertensive individuals. Design and method: We studied 35 treatment-naïve patients with stage II/III hypertension (HT: 63.8 ± 7.4yrs, 19F, SBP 175.6 ± 16.8 mmHg) and 35 age-, sex- and body mass index-matched normotensive individuals (NT: SBP 127.2 ± 8.2 mmHg). Indices of excess pressure including excess pressure integral (INTXSP) and peak excess pressure (MAXXSP) were obtained by radial artery tonometry. Aortic forward compression wave intensity (FCWI) and aortic pulse wave velocity (aPWV) were estimated as proposed by Hughes et al (Front Physiol. 2020). A battery of cognitive examination tests was administered including Addenbrooke’s Cognitive Examination-III (ACE), Mini-Mental State Examination (MMSE), Trail making test part A (TMT-A) and B (TMT-B). Results: Both INTXSP (9.2 ± 2.7 vs 5.4 ± 1.2 mmHg s) and MAXXSP (54.1 ± 12.8 vs 33.4 ± 5.9 mmHg) were significantly higher in HT compared to NT (p < 0.001). Additionally, FCWI [14.9 (12.0–20.0) vs 8.0 (6.8–9.3) x105 W/m2] and aPWV (7.2 ± 1.7 vs 4.5 ± 0.8 m/s) were significantly greater in HT compared with NT (p < 0.001). Higher INTXSP was associated with poorer ACE (rs = -0.310, p = 0.009), longer TMT-A (r = 0.409, p < 0.001) and TMT-B (r = 0.380, p = 0.001). Similarly, higher MAXXSP was associated with poorer ACE (rs = -0.343, p = 0.004), longer TMT-A (r = 0.397, p = 0.001) and TMT-B (r = 0.330, p = 0.006), and greater aPWV was associated with poorer ACE (rs = -0.331, p = 0.005), longer TMT-A (r = 0.397, p = 0.001) and TMT-B (r = 0.324, p = 0.007). Higher FCWI was associated with longer TMT-A (rs = 0.378, p = 0.002) and TMT-B (rs = 0.260, p = 0.038), and showed a trend to be associated with poorer ACE (rs = -0.238, p = 0.054). None of the haemodynamic indices was associated with MMSE. Conclusions: Haemodynamic parameters linked to excess arterial wave propagation are associated with poorer cognitive function. These observations reveal a potential mechanism linking hypertension and cognitive impairment, and reinforce the importance of blood pressure control to reduce cognitive impairment risk.

Abstract #1185203: Regular blood pressure screening to decrease stroke risk in Hypertension and Brachydactyly syndrome

We report a case of a young women with hypertension and brachydactyly syndrome, highlighting the importance of blood pressure control in these patients, as there is an increased risk of stroke at age less than 50 years form severe hypertension starting at a very young age.

Risk factors associated with uncontrolled blood pressure among patients with non-dialysis chronic kidney disease in Vietnam.

Uncontrolled blood pressure rates are high in patients with non-dialysis chronic kidney disease, worsening the disease progression and leading to end-stage renal disease. However, studies on uncontrolled blood pressure in patients with non-dialysis chronic kidney disease and its associated factors in Vietnam are scarce.Objectives: This study aimed at identifying uncontrolled blood pressure rates and risk factors associated with uncontrolled blood pressure among Vietnamese patients with non-dialysis chronic kidney disease. A cross-sectional, correlational study design was employed among 182 participants coming to follow up at two tertiary hospitals in Vietnam. The participants were selected by a convenience sampling technique. Data were collected using Participant Demographic Information Form, Clinical Characteristics Form, Alcohol Use Disorders Identification Test, Pittsburgh Sleep Quality Index, Charlson Comorbidity Index, and an automated office oscillometric upper arm device. Descriptive statistics, Chi-square, Fisher's Exact Test, and binary logistic regression were used to analyze the data. 63.2% of the participants could not control their BP less than 130/80 mmHg. Poor sleep quality (OR 2.076, 95%CI 1.059-4.073, p=.034) and severe comorbidities (OR 2.926, 95%CI 1.248-6.858, p=.013) were risk factors associated with uncontrolled blood pressure among Vietnamese patients with non-dialysis chronic kidney disease. Interestingly, the study found a high rate of awareness toward the importance of blood pressure control but a low rate of known blood pressure targets. Uncontrolled blood pressure rates among Vietnamese patients with non-dialysis chronic kidney disease were high. Sleep quality and comorbidity severity were significantly associated with uncontrolled blood pressure in this population. To achieve blood pressure targets, nurses and other healthcare providers should pay more attention to the patients with poor sleep quality and severe comorbidities.

Hypertension control and end-stage renal disease in atrial fibrillation: a nationwide population-based cohort study.

The impact of hypertension control on the risk of end-stage renal disease (ESRD) in patients newly diagnosed with atrial fibrillation (AF) is unknown. This study aimed to investigate the impact of hypertension control on incident ESRD among AF patients. From the National Health Information database of Korea, we identified ESRD-free patients who were newly diagnosed with AF during 2010 and 2016. The patients were divided into four groups (NN, NH, HN, and HH) according to combinations of dichotomous blood pressure status [normotensive (N) or hypertensive (H)] of two consecutive check-ups. The primary outcome was incident ESRD. Coxproportional hazard regression analysis evaluated ESRD risks across the groups. The association between ESRD risks and changes in blood pressures was also evaluated. During the mean follow-up duration of 3.2 ± 1.9years, 130,259 ESRD-free patients with AF (mean age 63.1 ± 12.1years, male 61.2%) were evaluated. Compared to NN, other patient groups showed higher ESRD risks [hazard ratio (95% confidence interval) = 1.43 (1.08-1.89), 1.39 (1.08-1.79), and 2.03 (1.55-2.65) for NH, HN, and HH, respectively]. There was a significant trend of decreasing risks of ESRD in patients with greater reductions in systolic blood pressure after AF diagnosis (p for-trend < 0.001). The association between hypertension control and the ESRD risk was more accentuated in patients with chronic kidney disease. Uncontrolled hypertension was associated with an increased risk of incident ESRD in patients with newly diagnosed AF. This study emphasizes the importance of blood pressure control once patients are diagnosed with AF to prevent ESRD.

Carotid approach to anterior circulation thromboembolectomy in an adult with failing fontan physiology: a case report

BackgroundAnesthetic management of an adult with failing Fontan physiology is complicated given inherent anatomical and physiological alterations. Neurosurgical interventions including thromboembolectomy may be particularly challenging given importance of blood pressure control and cerebral perfusion. Case PresentationWe describe a 29 year old patient born with double outlet right ventricle (DORV) with mitral valve atresia who after multi-staged surgeries earlier in life, presented with failing Fontan physiology. She was admitted to the hospital almost 29 years after her initial surgeries to undergo workup for a dual heart and liver transplant in the context of a failing Fontan with elevated end diastolic pressures, NYHA III heart failure symptoms, and liver cirrhosis from congestive hepatopathy. During the workup in the context of holding anticoagulation for invasive procedures, she developed a middle cerebral artery (MCA) stroke requiring a thromboembolectomy via left carotid artery approach.Discussion and ConclusionsThis case posed many challenges to the anesthesiologist including airway control, hemodynamic and cardiopulmonary monitoring, evaluation of perfusion, vascular access, and management of anticoagulation in an adult patient in heart and liver failure with Fontan physiology undergoing thromboembolectomy for MCA embolic stroke.

FIXED-DOSE COMBINATIONS IN THE TREATMENT OF HYPERTENSION IN THE RUSSIAN FEDERATION

Objective: To estimate the frequency of fixed-dose combinations (FDC) of antihypertensive medications (AHM) in the hypertension treatment in the population of the Russian Federation (RF). Design and method: A cross-sectional study ‘Epidemiology of Cardiovascular Diseases in the RF (ESSE-RF)’ was performed in 13 regions (2012–2013). Randomly selected males (N = 8304) and females (N = 13464) aged 25–64 were included (response rate&gt;80%). Standard epidemiology methods and criteria were used. Hypertension defined as a measured blood pressure (BP) of 140/90 mm Hg or greater and/or treatment with AHM. The structure of FDC in AHM was investigated. AHM have been analyzed by the following classes: diuretics (D), betablockers (BB), calcium antagonists (CA), angiotensin converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), and «other». In addition, FDC of AHM have been studied. Statistical data was processed using R 3.6.1 (R Foundation for Statistical Computing, Vienna, Austria). Results: Results The prevalence of hypertension and treatment in the RF was 45,7% and 51.8%. Among hypertensive patients who were receiving treatment, 65.6% were taking 1 AHM, 2 – 23.1%, 3 and more – 6.7%, whereas 4,6% were taking non-AHM. The most commonly taken medications were ACEi (58.4%), BB (34.9%), and D (32.4%) The frequency of taking an FDC of AHM was 15.6%. Among those taking FDC the most frequently employed were D+ACEi (49.3%), D+ARBs (24.8%), and D+BB (17.2%) fig 1. Conclusions: Despite the importance of BP control in preventing cardiovascular and cerebrovascular events, only 1/3 of hypertensive patients in the RF have their BP under control. Prescription frequency of an FDC of AHM remains low – only every sixth patient with hypertension taking medications applied the FDC.

Midlife vascular risk factors and risk of incident dementia: Longitudinal cohort and Mendelian randomization analyses in the UK Biobank.

Midlife clustering of vascular risk factors has been associated with late-life dementia, but causal effects of individual biological and lifestyle factors remain largely unknown. Among 229,976 individuals (mean follow-up 9 years), we explored whether midlife cardiovascular health measured by Life's Simple 7 (LS7) is associated with incident all-cause dementia and whether the individual components of the score are causally associated with dementia. Adherence to the biological metrics of LS7 (blood pressure, cholesterol, glycemic status) was associated with lower incident dementia risk (hazard ratio=0.93 per 1-point increase, 95% confidence interval [CI; 0.89-0.96]). In contrast, there was no association between the composite LS7 score and the lifestyle subscore (smoking, body mass index, diet, physical activity) and incident dementia. In Mendelian randomization analyses, genetically elevated blood pressure was associated with higher risk of dementia (odds ratio=1.31 per one-standard deviation increase, 95% CI [1.05-1.60]). These findings underscore the importance of blood pressure control in midlife to mitigate dementia risk.

Blood pressure levels and risk of haemorrhagic stroke in patients with atrial fibrillation and anticoagulants: results from a primary care cohort with hypertension

Abstract Background Haemorrhagic stroke (HS) is a serious condition that kills and debilitates many of those afflicted by it. Hypertension and oral anticoagulation (OAC) are independent risk factors for HS. Many patients with atrial fibrillation (AF) have hypertension and OAC. The concomitance of hypertension and OAC confers an even higher risk of haemorrhagic stroke, but less is known about the association between specific blood pressure levels and the risk of HS in patients with AF and OAC. Purpose To assess the risk of haemorrhagic stroke at different systolic blood pressure (SBP) levels in a primary care population with hypertension, AF and OAC. Methods We identified 3972 patients with hypertension, AF and OAC in a primary care database in southern Sweden. We followed patients from Jan 1, 2006 until a first event of HS, death, cessation of OAC or Dec 31, 2016. HS was defined as ICD-10 diagnosis codes: I60, I61, and I62. We analysed the association between SBP levels and HS by dividing SBP into five categories: &amp;lt;130, 130–139, 140–159, 160–179 and ≥180 mmHg. We also fitted a spline curve to visualise the relationship between SBP and HS. Hazard ratios (HR) were calculated for the SBP categories with a Cox proportional hazards model. The 130–139 group was used as a reference in the model. We identified age, sex, previous stroke, platelet inhibitor treatment, alcohol abuse and smoking as possible confounders with a directed acyclic graph and included them as co-variates in the model. Results We identified 51 cases of HS during follow-up. In the categorical analysis of SBP, point estimates of HRs for HS increased gradually from the lowest SBP category to the 160–179 category. Only the 160–179 category had a significantly different HR (3.76, CI 1.56–9.04) than the reference 130–139 category, however. See Table 1. No other co-variates were significantly associated with HS. The spline curve, Figure 1, illustrates a significantly increased HR for HS in the 140–175 SBP range. Conclusions In this real-world primary care cohort with hypertension, AF and OAC, we found that SBP in the 160–179 mmHg range was significantly associated with an increased risk of haemorrhagic stroke. Our findings emphasise the importance of blood pressure control in this patient category. Figure 1. Continuous and categorical SBP &amp; HS risk Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The study was financed by grants from the Swedish state under the agreement between the Swedish government and the country councils, the ALF-agreement.

Abstract WP24: Impact of Blood Pressure Control in First 24 Hrs Post-Thrombectomy

Introduction: The importance of blood pressure control after IV tPA is well known. Current practice is to use these same parameters for patients undergoing Endovascular Thrombectomy (ET). However, optimal blood pressure control following ET is not well defined, the DAWN trial used a target of &lt;140mmHg in their study population and there is retrospective evidence that a target of &lt;160mmHg is associated with good outcomes. Herein, we provide retrospective evidence in regards to likelihood of good outcomes based on relative SBP control after successful ET. Methods: A retrospective analysis of patients who underwent ET was conducted from January 2017 to April 2018 yielding 92 patients; those with unsuccessful recanalization or incomplete data were excluded leaving 51 for final analysis. Patients were dichotomized in two groups based on good (mRS ≤ 2) and bad (mRS ≥3) outcomes. We performed an ROC analysis to determine the percentage of time that SBP exceeded 140mmHg in order to be associated with a poor outcome at 90 days. Results: ROC analysis found that when 45% of SBP readings exceeded 140mmHg, there was a poor outcome at 90 days with sensitivity and specificity of 61 and 82%, respectively. The AUC of this analysis was 0.71 with a p-value of &lt;0.05. The PPV and NPV for this cutoff were 80% and 66%, respectively. Conclusion: The percentage of time that SBP exceeds the target of 140mmHg in the first 24 hours appears to have an independent correlation with outcome in patients after successful ET. Those patients with uncontrolled SBP, defined as SBP &gt;140mmHg 45% of the time or more experienced a poor outcome in 80% of cases. Those patients with controlled SBP, defined as &lt;140mmHg 55% of the time or more experienced a good outcome in 82% of cases. Our study has obvious limitations due to the retrospective nature of the study and small sample size. While the values we studied for SBP control do not represent the continuously variable nature of this parameter, they do represent a general trend and are compatible with the standard of care seen amongst facilities providing ET. A randomized controlled trial to study these findings could have great implications to current practice.

A Rare Case of Isolated Idiopathic Inferior Mesenteric Artery Dissection

Patient: Male, 43Final Diagnosis: Isolated idiopathic inferior mesenteric artery dissectionSymptoms: Lower abdominal painMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Rare diseaseBackground:Isolated dissection of a mesenteric artery is very rare and usually presents with acute gastrointestinal symptoms. There have been previously published reports on the isolated dissection of the superior mesenteric artery. However, isolated dissection of the inferior mesenteric artery is rare.Case Report:A 43-year-old man presented with sudden onset of lower abdominal pain. Abdominal computed tomography (CT) imaging confirmed isolated dissection of the inferior mesenteric artery. To prevent exacerbation of the dissection, his systolic blood pressure was controlled to <140 mmHg, and his progress was observed for ten days while in hospital during which time the dissection stabilized. There was no extension of the dissection. After three years, the dissection had healed and did not recur.Conclusions:To our knowledge, this is the first case report of isolated dissection of the inferior mesenteric artery that resolved spontaneously. This case shows the importance of blood pressure control in the management of arterial dissection.

Cardiovascular Structure and Function in Children With Middle Aortic Syndrome and Renal Artery Stenosis.

Middle aortic syndrome (MAS) is a narrowing of the abdominal aorta, often in conjunction with renal artery stenosis (RAS). Structure and function of the cardiovascular system are not well understood. In a prospective cross-sectional study, 35 children with MAS or RAS or both (MAS/RAS) were compared with 140 age-, sex-, and body surface area-matched healthy children. Vascular assessment included carotid intima-media thickness and carotid distensibility using B-mode ultrasound and central and peripheral pulse wave velocities using applanation tonometry. Left ventricular structure and function were assessed by 2-dimensional and speckle-tracking echocardiography. Children with MAS or RAS were 12.5±3.0 years old at enrollment, and 50% were men. Carotid intima-media thickness (0.54±0.10 versus 0.44±0.05 mm; P<0.001) and central pulse wave velocities (5.58±1.83 versus 5.00±0.90 m/s; P=0.01) were significantly higher in children with disease compared with healthy children; however, after adjustment for systolic blood pressure z score, only carotid intima-media thickness remained significantly higher in the MAS/RAS group compared with the controls (β=0.07 [0.03, 0.10]). Peripheral pulse wave velocities and carotid distensibility were normal. Children with disease had significantly increased left ventricular mass and changes in diastolic function (lower E/a ratio and lower e' velocities). Systolic parameters, including ejection fraction, global longitudinal and circumferential strain, were similar to controls. Our findings demonstrate that children with MAS or RAS have evidence of carotid and left ventricular remodeling, without peripheral arterial involvement, which suggests a localized disease process. Left ventricular systolic function is preserved; however, subtle changes in diastolic function are observed. Carotid vessel changes are consistent with a 5- to 10-year aging, which underscores the importance of blood pressure control.

Locally Invasive Fungal Lung Disease and Exercise-Induced Pulmonary Hemorrhage: A Deadly Interplay of Cavitary Aspergilloma Kinetics and Capillary Hemodynamics

SESSION TITLE: Chest Infections II: Student Resident Case Report Posters SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM INTRODUCTION: Aspergilloma is an opportunistic fungal disease which typically forms in cavitary lung. We report the case of an enlarging aspergilloma in an immunocompromised patient with pulmonary hemorrhage precipitated by strenuous cardiopulmonary exercise. CASE PRESENTATION: A 58-year old female presented to our emergency department in February 2015 with hemoptysis. She underwent a multi-stage treadmill cardiac stress test seven days earlier to evaluate exertional dyspnea, achieving a heart rate of 143 and a peak blood pressure of 175/100. She subsequently coughed several teaspoons of blood streaked sputum for the next week. Prior to admission she ran vigorously at her gym triggering large-volume hemoptysis (130-150ml), prompting hospital admission. Her past medical history included fully treated pulmonary tuberculosis with residual localized cystic bronchiectasis in right upper lobe with a suspected aspergilloma and Crohn's disease in remission on azathioprine and mesalamine. On arrival her blood pressure was 162/86, pulse 72, afebrile with a resting SpO2 of 100% on air. Examination was significant for coarse breath sounds in the right upper chest. Labs revealed a hemoglobin of 14.5g/dl, WBC 6,600/nL, platelets 223,000/nL, INR 0.9 and PTT 20secs. Initial CT imaging demonstrated an enlarged lobulated right apical cavity containing a soft tissue mass, which had increased in size from 19.6mm to 22.4mm over 4 months. The patient was treated with piperacillin-tazobactam for an infectious exacerbation of bronchiectasis and her blood pressure was tightly controlled with beta-blockade. Her hemoptysis ceased by hospital day 4 without need for blood transfusion or endovascular intervention. Azathioprine was discontinued and voriconazole was initiated to minimize the risk of local fungal invasion. She was counselled on the importance of blood pressure control and advised to change her exercise routine from running to a low impact activity such as cycling to minimize aspergilloma movement and prevent shearing forces within the cavity. DISCUSSION: Aspergillomas confer significant morbidity to predisposed individuals with potential for life-threatening hemoptysis. Immunosuppression may facilitate local invasion of hyphae into the adjacent lung parenchyma. The delicate granulation tissue lining the cavity is probably susceptible to pendulous forces of the aspergilloma during high impact exercise such as running and jumping resulting in capillary rupture and bleeding1. CONCLUSIONS: There is little guidance on what lifestyle modification is appropriate for patients with aspergillomas. Providers should consider the exercise tolerance of each patient, their immune status and size of the aspergilloma before recommending a type and intensity of exercise that can safely be undertaken. Reference #1: Corrin, B. (2011). Pathology of the Lungs. Churchill Livingstone/Elsevier DISCLOSURE: The following authors have nothing to disclose: Haider Ali, Erika Diaz-Narvaez, Armando Cuesta, Schantal Polanco, Chang Shim, Virginia Chung No Product/Research Disclosure Information

Management of hypertension in chronic kidney disease.

Hypertension is a common comorbidity in patients with impaired kidney function. The kidney exerts a marked degree of control over blood pressure through various mechanisms, such as by regulating sodium balance and hormone secretion through the activity of the renin-angiotensin system. The kidney is susceptible to injury, and if already damaged can be at risk of further loss of function as a consequence of elevated blood pressure. Once elevated blood pressure is identified, a combination of sensible lifestyle measures, such as sodium restriction and weight loss, with pharmacological intervention to reduce blood pressure will usually achieve blood pressure goals. In this Review, we outline the importance of blood pressure control for patients with chronic kidney disease (CKD), the mechanisms that affect blood pressure control, and the basis for non-drug and drug therapies. We further discuss the rationale for <140 mmHg systolic and <90 mmHg diastolic targets for blood pressure in patients with CKD, with consideration for tighter targets in the setting of proteinuria.