BP Levels Research Articles

P804The significance of 24h blood pressure variability improvement regarding target organ damage indices three years after medical treatment initiation in essential hypertension

Abstract Background Blood pressure variability (BPV) has been associated with development, progression and severity of cardiac and vascular organ damage and with an increased risk of cardiovascular events and mortality, independently adding to cardiovascular risk, over and above the contribution of elevated mean BP levels. We aimed to explore any correlation between differences in BPV and target organ damage indices (TOD) in hypertensive patients three years after medical treatment initiation. Methods At baseline and before medical treatment initiation, we measured 24h average SBP and DBP as well as 24h systolic BPV after 24h ambulatory blood pressure monitoring (ABPM) in newly diagnosed and never treated hypertensive patients (n=171, mean age=52+12 years, 110 males, 24h average SBP/DBP=138+10/87+9 mmHg, 24h systolic BPV=15+3) who were also subjected to arterial stiffness by carotid-femoral pulse wave velocity (PWV), left ventricular hypertrophy by left ventricular mass index (LVMI) and coronary flow reserve (CFR) estimations. All the above tests were repeated approximately three years later after treatment initiation. Results Patients were characterized as controlled (n=113, mean age=54+12 years, 62 males, 24h average SBP/DBP=118+6/71+6 mmHg) or non-controlled hyperensives (n=58, mean age=48+11 years, 48 males, 24h average SBP/DBP=133+8/83+7 mmHg) based on ABPM results three years later (controlled BP=24h average BP<130/80 mmHg). In the whole population, 24h average SBP/DBP, systolic BPV (p<0.001) and LVMI (p=0.01) were decreased while systolic BPV difference was related with LVMI difference (r=0.27, p<0.001). In controlled hypertensives, 24h average SBP/DBP, systolic BPV (p<0.001) and LVMI (p=0.02) were decreased while systolic BPV difference was related with LVMI difference (r=0.35, p<0.001). In non-controlled hypertensives, 24h average SBP (p=0.001), DBP p<0.001) and systolic BPV (p=0.04) were decreased while PWV was increased (p=0.03) and no correlations were found between systolic BPV and TOD. Correlation between BPV and LVMI Conclusions It seems that antihypertensive-induced systolic BPV improvement relate with cardiovascular risk decrease occur only in the setting of blood pressure treated within normal limits and confirmed by ABPM. Our study confirms that left ventricular mass between other TOD primarily improves due to successful antihypertensive treatment.

P6368Blood pressure control in a registry of clinical practice, PINNACLE-BRAZIL REGISTRY

Abstract Introduction The prevalence of hypertension is estimated to be nearly 50% among Brazilian adults. Achieving an adequate control of this CVD risk factor is challenging but truly relevant on a public health perspective, as this is the top-ranking cause of all deaths globally. Purpose We aimed to describe crude and simple metrics of blood pressure management (including its control), as based on current guideline-derived recommendations, after one year of the clinical practice registry Methods Patients with documented Hypertension were included by using electronic case report form based on the ACC PINNACLE Registry. The registry has been enrolling patients from general practitioners and specialists. The main goal of the PINNACLE program is to improve the quality of care in “real world” clinical practice. Patients data were evaluated after 01 year of follow-up on regular clinical appointments and the differences on clinical practice were evaluated Results Currently, PINNACLE-Brazil has enrolled 7598 patients, with 87% of diagnosed hypertension. Percentage of patients with a diagnosis of hypertension who had a blood pressure measurement <140/90 mmHg was 47.9% (baseline) and 57.3% (follow-up). Percentage of patients who had a blood pressure <140/90 mm Hg, or who had a blood pressure ≥140/90 mm Hg and were prescribed ≥2 antihypertensive medications were 67.1% on baseline and 71.2% after 1 year. Conclusion The preliminary data of PINNACLE Registry in Brazil shows that a significant proportion of hypertensive patients (nearly half) have not presented with adequate control of blood pressure levels and, moreover, a large proportion have not been treated with recommended combination of 02 or more antihypertensive medications to reach targeted BP levels the quality of care was improving after 01 year of registry. Acknowledgement/Funding ACC Foundation

Alcohol and Hypertension-New Insights and Lingering Controversies.

To examine outstanding issues in the relationship of alcohol to hypertension. These include whether the increase in BP with alcohol is causally related, the nature of the relationship in women, the contribution of alcohol-related increases in BP to cardiovascular disease and the aetiology of alcohol-related hypertension. Intervention studies and Mendelian randomisation analyses confirm the alcohol-BP relationship is causal. The concept that low-level alcohol intake reduces BP in women is increasingly unsustainable. Alcohol-related hypertension is in the causal pathway between alcohol use and increased risk for several cardiovascular outcomes. The aetiology of alcohol-related hypertension is multifactorial with recent data highlighting the effects of alcohol on the vasoconstrictor 20-HETE and oxidative stress. The high prevalence of both alcohol use and hypertension mandates a careful alcohol history in every patient with elevated BP. Early intervention for excessive alcohol use offers the promise of lower levels of BP and reduced risk of adverse cardiovascular outcomes.

Abstract P2055: Incremental Impact of Stressful Situations in Stage 1 vs. Stage 2 Hypertensives: Insights From a Large Digital BP Management Service and Registry

Stressful conditions induce an increase in BP levels. It is often difficult to systematically record BP levels under those conditions. The current availability of digital data collection platforms may provide new insights on the changes of BP level under multiple conditions on a large scale. This study leverages the 298,621 BP values of 8992 subjects (2702 females, 48.8 ±13.4 y) consecutively accrued on a digital platform. This is a software-as-a-service (SAAS) platform for BP management leveraging innovative proprietary AI expert systems algorithms providing to patients progressive interpretation of the evolution of their BP and delivering highly personalized lifestyle interventions. Users access the service via App (iOS and Android). This service fosters the Class IA indication for HBPM of the 2017 AHA Hypertension Guidelines. Upon BP data entry (through connected devices, the smartphone health app, or manual entry after extensive validation) users are required to indicate any additional condition at the time of BP measurement including work, after exercising, during intense stress, during headache. Overall, in all subjects, we observed a significantly higher systolic +10.3±0.4mmHg and diastolic +5.1±0.3mmHg BP vs rest (Mean±SEM;95% C.I.) [9.4-11.25, p< 0,0001 and 5.1-11.25, p< 0,001; respectively]. Out of 8992 subjects, 1986 subscribed the lifestyle intervention program after self-declaring their usual BP range. Thus, according to the AHA Hypertension Guidelines, 325 subjects declared normal BP (Group N) values, while 1641 were normotensives (Group H). We analyzed the BP changes during stress in both normotensive and hypertensives, and we observed significant increase of both systolic (N: +6.7±0.7; [2.99-10.4] p=0.0004; H: +10.2±1.4 [7.49-12.9] p<0.0001) and diastolic BPs (N: +2.2±0.3; [2.99-10.4] p=0.0004; H: +6.0±0.3 [7.49-12.9] p<0.0001). These data support the notion of a more intense response to stress in hypertensives. These insights are useful for an appropriate and personalized treatment strategy in hypertensives. A digital SAAS platform is a strong adjunctive tool for a better management of hypertension.

Abstract P2061: Cardiovascular Risk Profile of a Young Adult Population Assisted by a Family Healthcare Unit in Rio De Janeiro With High Risk for Obstructive Sleep Apnea Screened By Stop-Bang Questionnaire and Epworth Sleepiness Scale

Objective: To establish the relationship between cardiovascular (CV) risk profile and detected risk of Obstructive Sleep Apnea (OSA) in two questionnaires - STOP-BANG (SB) and Epworth Sleepiness Scale (ESS), in a young population of adults registered in a Family Health Unit (USF) located in Rio de Janeiro, Brazil - LapARC cohort study. Methods: This cross-sectional population study enrolled adults between 20-50 years old, registered in a primary healthcare unit in Rio de Janeiro. A database is being developed including sociodemographic and anthropometric data, and CV risk factors. Office blood pressure (OBP) and Home Blood Pressure Monitoring (HBPM) (7-day protocol) were obtained with Omron-705CP. Furthermore, OSA was investigated by SB and ESS. Patients with a high risk for OSA in either of these two questionnaires were subsequently assigned for polysomnography (PSG). Results: A total of 391 subjects were evaluated [40% males, 38 ± 8 years], where 96 (25%) were identified as high risk for OSA by the SB questionnaire and 143 (37%) by ESS. The most common CV risk factor was physical inactivity (45%), followed by dyslipidemia (34%) and obesity (24%). By OBP, the prevalence of hypertension was 24% while by HBPM was 18%, with a low concordance between them (kappa=0.385). Subjects with a high risk by SB are older, with a higher prevalence of obesity (50% vs 16%), hypertension (29% vs 9%), and higher office BP and HBPM. On the other hand, individuals with high-risk by ESS were more obese (34% vs 19%), with increased waist circumference (48% vs 32%), higher prevalence of dyslipidemia (43% vs 41%) and metabolic syndrome (13% vs 7%). However, there was no difference in BP levels. Among the subjects assigned to PSG, 46% had a diagnosis of OSA (AHI ≥ 5/hour) and 23% of moderate/severe OSA (AHI>15/hour). The best predictor of OSA was SB, positive in 100% of subjects with moderate/severe OSA, while ESS was positive in only 20% of them. Conclusion: This young and apparently healthy population presented a high prevalence and risk for OSA. The SB had a higher association with higher BP levels, while ESS was associated with a worse metabolic profile. Therefore, SB questionnaire seems to be the best predictor for moderate/severe OSA in this population.

Abstract P105: Sex Hormonal Changes of Calcium-Sensing Receptor and Renin-Angiotensin-Aldosterone System in Salt-Sensitive Rats via Exposure of High Salt Diets

The CaSR regulates Ca 2+ -mediated release of parathyroid hormone (PTH) from parathyroid cells by sensing small changes in serum Ca 2+ concentration. The receptor is also involved in the regulation of cell Ca 2+ levels independent of PTH secretion. The renin-angiotensin-aldosterone system (RAAS) plays vital roles in the development of hypertension, which is associated with vascular and renal dysfunction, and treatment is difficult because the mechanisms are not fully understood. Studies show that adequate Ca 2+ intake (1.0 to 1.5 g/day) is critical for optimal BP regulation and randomized controlled trials have revealed significant reductions in hypertension risk and BP levels in humans. In the kidney, the CaSR is expressed along the nephron and plays an important role, with the Na + /Ca 2+ exchanger (NCX), in the regulation of tubular Ca 2+ , Na + and water reabsorption. In the present study, we analyzed the effects of mutation, sex hormones and high salt diets on the expression of the CaSR, its downstream signaling complements and proteins in the RAAS in both female and male salt-sensitive (SS) rats. Our data indicate that CaSR gene mutation and high salt diets modulate the expression of the CaSR, GRK2, PKCα, NCX1 and RAAS proteins in the kidney of SS female rats than male rats. And also showed statistically significant difference in electrolytes as shown in the data below. Thus, CaSR signaling is linked to RAAS to control hypertension.

Abstract 005: Intensity of Hypertensive Exposure in Young Adulthood and Subclinical Atherosclerosis in Middle Age

Background and aims: To measure the association between intensity of hypertensive exposure and coronary artery calcification (CAC) during a 25-year period in young adulthood. Methods: The Coronary Artery Risk Development in Young Adults (CARDIA) Study enrolled 5,115 healthy black and white American aged 18-30 years at baseline (March 1985-June 1986 to June 2010-May 2011). Durations of hypertension was estimated based on their identification at examinations 7, 10, 15, 20, and 25 years later, and cumulative BP exposure (millimeters of mercury х year) were used to represent long-term exposure to BP levels. CAC was identified by computed tomography (CT) at years 15, 20, and 25. Results: Among 2057 participants at year 0, 30.8% (634 of 2057) developed stage 1 hypertension and 13.8% (284 of 2057) developed stage 2 hypertension. After adjustment, the hazard ratio for the presence CAC was 1.07 (95% CI 0.99, 1.17) and 1.14 (95% CI 1.02, 1.29) times higher for each follow-up years longer duration of stage 1 and stage 2 hypertension respectively. For cumulative BP exposure at year 25, the odds ratio (ORs) for CAC were 1.58 (95% CI 1.39, 1.80) in cumulative SBP, 1.45 (95% CI 1.28, 1.64) in cumulative DBP, 1.26 (95% CI 1.13, 1.41) in cumulative PP, and 1.55 (95% CI 1.36, 1.76) in cumulative MAP for each SD increment. Conclusions: In early adulthood, more severe intensity of hypertensive exposure, durations of hypertension or exposure to BP, is associated with subclinical atherosclerosis in middle age. Key Words: coronary artery calcification, hypertension, young adult

Association of Multifaceted Mobile Technology–Enabled Primary Care Intervention With Cardiovascular Disease Risk Management in Rural Indonesia

Cardiovascular diseases (CVDs) are the leading cause of disease burden in Indonesia. Implementation of effective interventions for CVD prevention is limited. To evaluate whether a mobile technology-supported primary health care intervention, compared with usual care, would improve the use of preventive drug treatment among people in rural Indonesia with a high risk of CVD. A quasi-experimental study involving 6579 high-risk individuals in 4 intervention and 4 control villages in Malang district, Indonesia, was conducted between August 16, 2016, and March 31, 2018. Median duration of follow-up was 12.2 months. Residents 40 years or older were invited to participate. Those with high estimated 10-year risk of CVD risk (previously diagnosed CVD, systolic blood pressure [BP] >160 mm Hg or diastolic BP >100 mm Hg, 10-year estimated CVD risk of 30% or more, or 10-year estimated CVD risk of 20%-29% and a systolic BP >140 mm Hg) were followed up. A multifaceted mobile technology-supported intervention facilitating community-based CVD risk screening with referral, tailored clinical decision support for drug prescription, and patient follow-up. The primary outcome was the proportion of individuals taking appropriate preventive CVD medications, defined as at least 1 BP-lowering drug and a statin for all high-risk individuals, and an antiplatelet drug for those with prior diagnosed CVD. Secondary outcomes included mean change in BP from baseline. Among 22 635 adults, 3494 of 11 647 in the intervention villages (30.0%; 2166 women and 1328 men; mean [SD] age, 58.3 [10.9] years) and 3085 of 10 988 in the control villages (28.1%; 1838 women and 1247 men; mean [SD] age, 59.0 [11.5] years) had high estimated risk of CVD. Of these, follow-up was completed in 2632 individuals (75.3%) from intervention villages and 2429 individuals (78.7%) from control villages. At follow-up, 409 high-risk individuals in intervention villages (15.5%) were taking appropriate preventive CVD medications, compared with 25 (1.0%) in control villages (adjusted risk difference, 14.1%; 95% CI, 12.7%-15.6%). This difference was driven by higher use of BP-lowering medication in those in the intervention villages (1495 [56.8%] vs 382 [15.7%]; adjusted risk difference, 39.4%; 95% CI, 37.0%-41.7%). The adjusted mean difference in change in systolic BP from baseline was -8.3 mm Hg (95% CI, -10.1 to -6.6 mm Hg). This study found that a multifaceted mobile technology-supported primary health care intervention was associated with greater use of preventive CVD medication and lower BP levels among high-risk individuals in a rural Indonesian population.

The Effects of a New Generation of Nutraceutical Compounds on Lipid Profile and Glycaemia in Subjects with Pre-hypertension.

Treatment strategies for patients with pre-hypertension and low-moderate cardiovascular (CV) risk may include nutraceutical compounds (NCs). To investigate the efficacy and safety of a new-generation of NC in lowering BP values and improving metabolic profile, in a group of hyper-cholesterolemic subjects with pre-hypertension. 131 subjects with pre-hypertension (systolic BP 130-139mmHg and/or diastolic BP 85-89mmHg) without organ damage and history of CV diseases were enrolled. 66 subjects were treated with a once-daily oral formulation of a NC (red yeast rice, Berberine, Coenzyme Q10, folic acid and chrome) added to diet for 3months, while 65 patients followed a diet only. Differences in serum total cholesterol (TC), low- and high-density lipoprotein cholesterol (LDLC and HDLC), triglycerides (TG), glycemia, creatine phosphokinase (CPK), aspartate aminotransferase (AST) alanine aminotransferase (ALT) and body mass index (BMI) were evaluated. At the end of treatment, significant reductions of TC, LDLC, TG glucose levels were observed in both treatment groups, while HDLC values increased in the active treatment group only. A greater reduction of TC, LDLC and glycemia was observed in the treatment group. TG levels were not different within the two groups. BP and BMI levels remained unchanged, as well AST, ALT; CPK slightly increased in both groups, but it remained in the normal range. In patients with pre-hypertension, NC supplementation was safe, well tolerated and effective in improving lipid pattern and glucose levels and in preventing the progression to overt hypertension.

Characteristics and pregnancy outcomes across gestational diabetes mellitus subtypes based on insulin resistance.

This study aimed to determine the characteristics and pregnancy outcomes across different subtypes of gestational diabetes mellitus (GDM) based on insulin resistance. GDM subtypes were defined in 1813 pregnant women from a multicentre prospective cohort study, stratified according to insulin resistance, based on Matsuda index below the 50th percentile of women with normal glucose tolerance (NGT), during a 75g OGTT at 24-28weeks' gestation. GDM was diagnosed in 12.4% (n = 228) of all participants based on the 2013 WHO criteria. Compared with women with NGT (1113 [61.4%] of the total cohort) and insulin-sensitive women with GDM (39 [17.1%] women with GDM), women with GDM and high insulin resistance (189 [82.9%] women with GDM) had a significantly higher BMI, systolic BP, fasting plasma glucose (FPG), fasting total cholesterol, LDL-cholesterol and triacylglycerol levels in early pregnancy. Compared with women with NGT, insulin-sensitive women with GDM had a significantly lower BMI but similar BP, FPG and fasting lipid levels in early pregnancy. Compared with women with NGT, women with GDM and high insulin resistance had higher rates of preterm delivery (8.5% vs 4.7%, p = 0.030), labour induction (42.7% vs 28.1%, p< 0.001), Caesarean section (total Caesarean sections: 28.7% vs 19.4%, p = 0.004; emergency Caesarean sections: 16.0% vs 9.7%, p = 0.010), neonatal hypoglycaemia (15.4% vs 3.5%, p< 0.001) and neonatal intensive care unit admissions (16.0% vs 8.9%, p = 0.003). In multivariable logistic regression analyses using different models to adjust for demographics, BMI, FPG, HbA1c, lipid levels and gestational weight gain in early pregnancy, preterm delivery (OR 2.41 [95% CI 1.08, 5.38]) and neonatal hypoglycaemia (OR 4.86 [95% CI 2.04, 11.53]) remained significantly higher in women with GDM and high insulin resistance compared with women with NGT. Insulin-sensitive women with GDM had similar pregnancy outcomes as women with NGT. The need for insulin treatment during pregnancy and the rate of glucose intolerance in the early postpartum period were not significantly different among the GDM subtypes. GDM with high insulin resistance represents a more adverse metabolic profile with a greater risk of adverse pregnancy outcomes.

Efficacy Study of Folic Acid Supplementation on Homocysteine Levels in Adolescent Epileptics Taking Antiepileptic Drugs: A Single Blind Randomized Controlled Clinical Trial.

Background: Epilepsy is a chronic medical condition that requires long-term therapy with antiepileptic drugs (AEDs). However, long-term employment of AEDs may lead to the onset of hyperhomocysteinemia, which has been found to modulate imperative metabolic mechanisms and induce cardiovascular disorders (CVDs). Therefore, adolescent population that have been diagnosed with epilepsy and utilize AEDs are among the most vulnerable, exhibiting higher risks of developing CVDs.Purpose: The present study was designed to explore the effects of folic acid (FA) supplementation on AED-induced hyperhomocysteinemia and CVD risk factors in adolescent epileptics.Methods: The randomized clinical trial included adolescent epileptics (i.e., 10–19 years of age) of either sex, on antiepileptic therapy for > 6 months with high homocysteine levels (i.e., >10.9 µmol/L). At the time of enrolment, their baseline BP, lipid and homocysteine levels were recorded. Participants were randomly assigned to either treatment or placebo groups and received the respective treatments. At the end of the first month, BP, lipid and homocysteine levels were recorded and compared to determine the effect of FA on these parameters.Results and conclusion: A significant fall in homocysteine levels was observed with FA supplementation (P < 0.05). However, this fall was significantly high in valproic acid treated epileptic patients. In addition, we observed an improvement in high-density lipoprotein levels, a risk factor for CVDs, but the change was statistically insignificant (P > 0.05). The study results suggest that FA supplementation in epileptic patients receiving AED therapy may minimize AED-induced hyperhomocysteinemia and other CVD risk factors.

SAT-061 THE COMPARATIVE IMPACT OF DIALYTIC MODALITIES ON ELECTRIC MYOCARDIAL REPOLARIZATION INHOMOGENEITIES

Patients with end stage renal disease (ESRD) on dialysis have increased all cause and CV mortality, a significant proportion of this being represented by sudden unexplained (cardiac) death, most probably secondary to malignant ventricular arrhythmias. QT dispersion (QTd), defined as the difference in duration between the longest and the shortest QT interval on electrocardiogram (ECG), may be considered as a direct measure of the regional heterogeneity of myocardial repolarization and also an approximation for repolarization abnormalities. The aim of our study was to investigate the effect of the dialytic modalities on ECG abnormalities (QT interval, QT dispersion) and to find its important modulators, as markers of arrhythmia and sudden death in a large population of dialysis patients. We compared 68 HD patients (4 h/HD session, F100 dialysers); mean age 41.5 ±11.2 years; mean dialysis vintage 55.2 ± 38.3 months, with 63 PD patients (4 exchanges of 2000 ml/day, glucose/Na/Ca/K/Mg = 1.5/134/1.75/2/0.5 mmol/l), mean age 50.9 ± 15.2 years; mean dialysis vintage 34.7 ± 20 months. The QT interval was calculated as an average of three consecutive complexes, and corrected for heart rate using the Bazett's formula (QTc=QT/(R–R)1/2). Echocardiography was performed in all patients; Na+, K+, Ca2+, PO4, pH and BP levels were also determined. Follow-up was performed to analyze the overall survival and to determine the potential impact of inhomogeneities in myocardial repolarization and dialytic method on patient survival. The mean values for QTc and QTdc were 428.8 ± 34.1 ms and 39.3 ± 32.1 ms. Overall, QTc significantly correlated (univariate analysis) with the LVM and QTdc with serum ionized Ca and LVM (p < 0.05 for all). Stepwise multiple linear regressions showed Ca2+ to be the only independent predictor for QTdc. In CAPD patients, the mean value for QTc was 426.8 ± 40.7 ms (27% patients with abnormal QTc interval) and for QTdc = 43.2 ± 42.7 ms. In the HD subgroup, the mean value for QTc was 430.3 ± 27.2 ms (33.8 % abnormal QTc interval), p = NS vs CAPD; QTdc valuewas 35.7 ± 16.9 ms. In both dialysis groups (univariate analysis) QTc significantly correlated with LVM; QTd and QTdc only correlated with serum ionized Ca (p < 0.05). In Cox analysis model significant predictors for survival were gender (p=0.009), serum potassium (p = 0.007) and QTc (p = 0.005). The difference in QTc between HD and PD, unadjusted for confounders, was 14.9 % greater in PD vs HD patients (p = NS). QTc significantly correlated with LVM (r = 0.223, p = 0.039), QTd and QTdc correlated with serum ionized Ca2+ (r = 0.335, p = 0.000; r = 0.375, p = 0.000 respectively) and LVM (r = 0.240, p = 0.026; r = 0.23, p = 0.032 respectively). Stepwise multiple linear regression showed Ca2+ to be the only independent predictor for both QTd (adjusted R2 = 0.18; beta = 0.44) and QTdc (adjusted R2 = 0.19; beta = 0.45). Our study, the largest to date and with follow-up survival analysis, thoroughly describes the characteristics of CAPD and HD patients, supporting the lack of a significant different impact between these two dialytic modalities on ECG abnormalities. We also confirm the paramount influence of subjacent structural cardiac abnormalities on arrhythmia risk. Calcium represents probably the most relevant electrolyte for this pathology, in ESRD subjects on renal replacement therapy.

ARTERIAL WALL REMODELING AND A RISK OF LEFT VENTRICLE HYPERTROPHY IN HIGH COMPLIANCE PATIENTS WITH ARTERIAL HYPERTENSION

Objective: to estimate the contribution of arterial wall remodeling into a risk of left ventricle hypertrophy (LVH) in high compliance patients with arterial hypertension Design and method: 139 high compliance patients with arterial hypertension were examined (average age 52.59 ± 6.04 years). Patients were divided into 2 groups depending on LVH presence. The 1st group included 62 patients with LVH, the 2nd one – 77 patients without LVH. All patients were examined using echocardiography to estimate LVH. Increase in LVMMI > 115 g/sq.m in male and >95 g/sq.m. according to European Guidelines. All patients underwent volume sphygmopletismography by VaSera VS-1000 (Japan) to evaluate the following parameters: CAVI1, R-PWV, L-PWV, PWVao, PWVcf. Results: patients in the groups were equal in sex, age, comorbidities, BP level, lipid panel parameters, and antihypertensive therapy. CAVI1 was significantly higher in the 1st group, than in the 2nd: (p < 0,001 and p = 0,046 respectively). Also, in patients with LVH such parameters as R-PWV and L-PWV were reliably higher (p = 0,001 and p = 0,006 respectively). There was no difference in PWVao between the groups. Correlation analysis showed moderate direct interconnection of LVH and CAVI1(r = 0,43; p = 0,025), PWVcf (r = 0,39; p = 0,016), R-PWV and L-PWV (r = 0,45; p = 0,034 and r = 0,37; p = 0,011). There was no interconnection between LVH and PWVao. Conclusions: in high compliance patients with arterial hypertension the LVH is associated with arterial remodeling which is evaluated using CAVI1, R-PWV, L-PWV, PWVcf

SUN-228 ACC/AHA BLOOD PRESSURE THRESHOLD AND BURDEN OF HYPERTENSION, AND PREVENTING CHRONIC KIDNEY DISEASE

The diagnosis and treatment of hypertension with the appropriate agents to the desirable BP goal is arguably one of the most cost effective interventions in modern medicine. What constitutes the appropriate BP treatment goal is based on the available evidence that the attainment of such BP levels should limit or altogether prevent the complications such as CKD due to hypertensive nephrosclerosis. Recently the AHA/ACA recommended a downward review of the BP threshold compared to the JNC 7 recommendations for diagnosis of hypertension. In this cross sectional survey of the general population in the Northeast, Nigeria, we recruited all the adults who responded to our invitation for medical check in clusters of residential areas in the Maiduguri and its environs. Besides the documentation of the demographic characteristics, we recorded three consecutive blood pressure measurements of all adults aged 18 and above and determined the average of both the systolic (SBP) and diastolic (DBP) blood pressures. We further categorized the study population into BPs groups according to the JNC7 cut off value of SBP >/=140 and or DBP of >/=90mmHg for stage 1 hypertension and by the 2017 ACC/AHA threshold of >/=130 and/or >/=80 mmHg. Nigeria in 2017 had a median age of 18.4 years and an estimated population of 197.7 million people. 1010 adults aged 18 to 79 (mean 36.7) years made up of 544 males and 466 females (M:F = 1.2:1) were studied. The prevalence of hypertension by the JNC 7 threshold was 344/1010 (34%) plus an additional 138 (13.6%) individuals classified as having hypertension by the AHA/ACA threshold. Therefore 47.6% of the adult population are at risk of developing complications of hypertension in Nigeria. The mean eGFR for the general study population was 100.5ml/min/1.73M2. The SBP categories 130-139mmHg and the >/= 140mmHg had eGFRs of 98.6 and 98.5 ml/min/1.73M2 respectively. On the other hand SBP categories less than 120mmHg and the 120-9 mmHg had eGFRs of 103 and 102.0ml/min/1.73M2 respectively. Those eGFR values were higher than eGFRs of the study population as a whole and those of the individuals with higher SBPs than 130mmHg. The individuals with DBP categories < 80 and 80 - 89mmHg had eGFRs of 101.5 and 101.6 which were higher than the 97.4ml/mi/1.74M2 for the individuals with DBP greater than 90mmHg. Based on the ACC/AHA guideline on hypertension, close to half of the adults in the general population amounting to about 50 million Nigerians are at the risk of developing the consequences of hypertension. Moreover the blood pressure categories of SBP less than 130mmHg and/or DBP less than 90mmHg had kidney functions which were better than the average for the study population and those of individuals with higher BP measurements. Our study lends support to the ACC/AHA report that some health risk including the possible loss of kidney function maybe associated with SBP greater than 130mmHg in the general population.

HYPERTENSIVE PATIENTS WITH RHEUMATOID ARTHRITIS ARE CHARACTERIZED BY HIGHER LEVELS OF THE OFFICE BLOOD PRESSURE AND WORSE CONTROL OF CENTRAL BLOOD PRESSURE COMPARED TO THE CONTROLS

Objective: Rheumatoid arthritis (RA) is associated with a high cardiovascular disease (CVD) risk. Arterial hypertension (HTN) is an important modifiable CVD risk factor. Its prevalence and significance in RA is still a matter of investigation. The aim of the study was to evaluate the office peripheral and central BP levels in patients with RA compared to the control group. Design and method: The study group included 85 patients without known CVD (77.6% females, age 59.7 ± 14.3 (M ± SD) years, 65% with HTN, median duration of HTN 6.6 years. Median duration of RA was 7 years, seropositive RA was diagnosed in 65%. Median hsCRP was 10 mg/dl, median rheumatoid factor – 51.3 IU/ml, mean DAS-28(CRP)-3.7 ± 1.1. All received disease-modifying anti-rheumatic drugs. The control group included 40 patients matched by basic parameters (77.5% females, age 58.9 ± 15.5 years, 60% with HTN, median duration of HTN 5 years). All patients with HTN received antihypertensive therapy. Office peripheral BP was measured with a validated oscillometric device, office central BP (CBP)–with applanation tonometry. CBP elevation was assessed according to individual reference values by gender and age. p < 0.05 was considered significant. Results: The rate of BP control in hypertensive patients was 58% in RA and 67% in the control group (χ2 = 0.5, p = 0.48). In patients without HTN mean office peripheral and central BP levels were similar in the RA and the control groups: 117 ± 13/73 ± 9 vs 117 ± 7/68 ± 8 mmHg and 108 ± 13/74 ± 10 mmHg vs 106 ± 10/71 ± 8 mmHg respectively (p > 0.05 for the trend). In patients with HTN corresponding BP levels were the following: 138 ± 17/82 ± 10 vs 130 ± 16/74 ± 11 mmHg (p = 0.04 for SBP; p = 0.0003 for DBP) and 132 ± 20/82 ± 10 vs 120 ± 17/74 ± 12 mmHg (p = 0.01 for SBP; p = 0.001 for DBP). The elevation of CBP was observed in 42.4% of RA patients and 17.5% of the controls (χ2 = 14.9, p = 0.0001): 16.7% vs 0% in the group without HTN (χ2 = 6.0, p = 0.01) and 56.4% vs 29.2% in the HTN group (χ2 = 9.9, p = 0.002), respectively. Conclusions: Despite similar BP control patients with RA are characterized by higher levels of office peripheral and central BP compared to the control group. RA is associated with worse control of central BP.

30-YEAR TRENDS IN BLOOD PRESSURE, PREVALENCE, AWARENESS, TREATMENT AND CONTROL OF HYPERTENSION IN THE CZECH REPUBLIC. THE CZECH MONICA AND CZECH POST-MONICA STUDIES

Objective: Unlike most former East Bloc countries, the Czech Republic has seen a decrease in total, and cardiovascular (CV) mortality; the decrease, since 1985, was most pronounced in cerebrovascular mortality (77%). Objective: To assess trends in BP levels, prevalence, awareness, treatment and control of hypertension in the Czech population from 1985 to 2016/17. Design and method: A total of seven independent cross-sectional population surveys of major CV risk factors were performed in 1985, 1988, 1992, 1997/98, 2000/01, 2007/08 and 2016/17 in a 1% random population sample aged 25–64 years (7,606 males; 8,050 females) in six districts of the Czech Republic. Hypertension was defined as a mean of 2 BP readings =>140/90 mmHg taken at one visit or being on antihypertensive medication. Results: Over a period of 31/32 years, there was a significant reduction in both systolic BP (males: from 135.8 ± 19.2 to 131.1 ± 14.9 mmHg; females: from 131.6 ± 20.9 to 124.7 ± 16.9 mmHg; p < 0.001) and diastolic BP (males: from 85.9 ± 11.0 to 84.7 ± 9.0 mmHg; females: from 82.5 ± 11.3 to 80.0 ± 9.4 mmHg; p < 0.001) in both genders, while the prevalence of hypertension decreased only in females (from 42.5% to 33.5%; p < 0.001; males: from 51.9% to 50.8%; n.s.). Within the same period, BMI increased in males (from 27.0 ± 4.0 to 29.2 ± 5.1 kg/m2; p < 0.001) while not changing in females (27.3 ± 5.4 vs 27.3 ± 6.0 kg/m2; n.s.). There was also an increase in the awareness of hypertension (males: from 41.4% to 74.6%; p < 0.001; females: from 58.9% to 77.7%; p < 0.001) and the proportion of individuals treated by antihypertensive drugs (males: from 21.1% to 60.4%; p < 0.001; females: from 38.9% to 64.3%; p < 0.001). Hypertension control improved in both genders (males: from 2.8% to 29.8%; p < 0.001; females: from 5.2% to 37.0%; p < 0.001). Conclusions: A favorable trend in population mean BP and improved hypertension control were found in a representative sample of the Czech population over the years 1985–2016/17, most likely contributing to the remarkable decrease in CV mortality. However, a substantial proportion of the hypertensive population remains uncontrolled.

CONTRIBUTION OF GENES POLYMORPHISM TO LEFT VENTRICLE HYPERTROPHY IN HIGH COMPLIANCE PATIENTS WITH ARTERIAL HYPERTENSION

Objective: to evaluate the contribution of genes polymorphism to left ventricle hypertrophy (LVH) in high compliance patients with arterial hypertension Design and method: 144 patients with arterial hypertension. The average age was 51,72 ± 5,94 years. Patients were divided into 2 groups depending on presence of LVH been estimated using echocardiography. LVH criterion was LVMMI>115 g/sq.m in male and >95 g/sq.m in female. The 1st group consisted of 65 patients with LVH. The 2nd group included 79 patients without LVH. All the patients were examined for genotypes of the following genes: AGT Thr174Met, GNB3 C825T, MTHFR C677T, MTRR Ile22Met, ApoE Cys130Arg, PPAR G/C. α Results: Patients in the groups were equal in sex, age, comorbidities, BP level, and lipid panel parameters. In the 1st group, the rate of AGT and MTRR heterozygous polymorphism was reliably higher, than in the 2nd one: (p < 0,001 and p = 0,004 respectively). Also, in patients with LVH, both heterozygous and homozygous polymorphism of GNB3 were found more frequently (p = 0,007 and p < 0,001 respectively). There was no significant difference between the groups in MTHFR polymorphism. Correlation analysis showed direct moderate interconnection between LVH and the polymorphism of the following genes: AGT (r = 0,47; p = 0,005), GNB3 (r = 0,48; p = 0,004), MTRR (r = 0,39; p = 0,021). There was no correlation between MTHFR polymorphism and LVH. Conclusions: In high-compliance patients with arterial hypertension appearance of LVH is linearly associated with heterozygous polymorphism of AGT and MTRR genes, and with both heterozygous and homozygous polymorphism of GNB3 gene.

Is self-reported insomnia a risk factor for subclinical carotid atherosclerosis?

Background. Insomnia is considered an additional cardiovascular (CV) risk factor (RF). However, the data on its association with vascular damage is controversial. We analyzed the relation between self-reported insomnia and carotid atherosclerosis in the population-based sample. Material and methods. We selected 985 (males — 38%; mean age 45.2 ± 11.6 years) participants of the St Petersburg population-based sample (the ESSE-RF study) who did not have previously known CV events. All subjects underwent a structured interview (lifestyle, medical history). Insomnia was diagnosed when complaints occurred ≥ 3 times/week (the questions: “How often did you have difficulties in falling asleep for > 30 min after going to bed in the last month?”, “How often did you have difficulties in falling asleep after midnight awakening in the last month?”). Subclinical atherosclerosis was assessed by carotid intima-media thickness (IMT): normal ≤ 0.9 mm, increased IMT 0.9–13 mm, IMT > 13 mm indicated an atherosclerotic plaque. Results. In total, 209 subjects reported at least one insomnia complaint; 79 participants (8%) reported both sleeponset and sleep-maintenance problems. IMT thickening was found in 142 subjects (14.4%). IMT values were higher in those with frequent nocturnal awakenings vs. non-insomniacs (0.75 ± 0.18 vs. 0.71 ± 0.17 mm, p = 0.006). They also showed greater prevalence of thickened IMT (χ 2 = 4.6, p = 0.026). Mean IMT weakly correlated with insomnia complaints (ρ = 0.10, p = 0.002), but the association was no longer significant after adjustment for age, BP and total cholesterol level. Conclusion. We demonstrated an association between insomnia complaints and subclinical carotid atherosclerosis, although we assume it to be weak compared to the common CV RF.

UNATTENDED VERSUS ATTENDED AUTOMATED OFFICE BLOOD PRESSURE USING THE SAME DEVICE AND PROTOCOL

Objective: Office blood pressure measurements taken using automated devices (AOBP) are being increasingly used in clinical practice. This study compared unattended versus attended AOBP when the same device and measurement protocol is used. Design and method: Untreated or treated subjects attending an outpatient hypertension clinic were subjected to unattended and attended AOBP measurements (randomized order; 2 separate visits on 2 consecutive days; triplicate sitting measurements after 5-min rest; Microlife WatchBP Office professional oscillometric device) and 24-hour ambulatory blood pressure (ABP) monitoring (Microlife WatchBP O3). Results: 113 subjects were analyzed (mean age 60.9 ± 13.4 years, 54% males, 60% treated hypertensives; 25% smokers; 11% diabetics; 7% with cardiovascular disease). Unattended systolic AOBP was slightly lower than attended AOBP, with no difference in diastolic AOBP (unattended AOBP 128 ± 16.2/78.4 ± 11.8 mmHg, systolic/diastolic, mean difference −2.2 ± 10.8/−0.5 ± 8.3 mmHg, p = 0.04/NS). The attended-unattended systolic AOBP difference was correlated with attended systolic AOBP (r = 0.41, p < 0.01) but not with age. Subjects with attended systolic AOBP > = 140 mmHg had higher attended minus unattended systolic AOBP difference compared to those with lower systolic AOBP (7.4 ± 10.8 vs. −0.1 ± 10.1 mmHg respectively, p < 0.01). The attended-unattended AOBP was similar in treated hypertensives and untreated subjects (3.2 ± 11.7 vs. 1.2 ± 9.2 mmHg, p = NS), or in men and women (3.2 ± 11.4 vs. 0.8 ± 10.1 mmHg, p = NS). Daytime ABP did not differ from unattended and attended AOBP (difference 0.5 ± 12.3/−0.6 ± 9.1 mmHg, systolic/diastolic vs. unattended and −1.7 ± 14.2/−1.1 ± 8.9 mmHg vs attended AOBP, p = NS for all). Conclusions: These data suggest that when standardized triplicate AOBP measurements are obtained, there is no difference between unattended and attended measurements provided that the same device and measurement protocol is used. However, at office BP levels >140/90 mmHg attended AOBP may be higher than unattended measurements.

THE DELAYED INEFFICIENCY OF ANTIHYPERTENSIVE THERAPY AND INCREASED ARTERIAL STIFFNESS

Objective: To detect predictors of the delayed inefficiency of antihypertensive therapy (AHT) among arterial stiffness parameters. Design and method: The AHT (2–3 drugs from various groups) was assigned to 102 hypertensive patients (52 men, 54.2 ± 9.8 years). Antihypertensive agents and their dosages were selected during 2–3 weeks of ambulatory management, with a possible single correction of the initially prescribed AHT. In all participants were achieved the target BP levels at the inclusion stage, which were confirmed by office blood pressure measurement (<130/80 mm Hg, oscillometric method, OMRON, Japan), and by 24-hour ambulatory blood pressure monitoring (mean 24-hour BP < 130/80 mm Hg, oscillometric method, BpLab, Russia). In addition, the applanation tonometry was carried out with carotid-femoral pulse wave velocity (cf-PWV) assessment (SphygmoCor, AtCor Medical, Australia). 1 and 3 months after inclusion stage the evaluation of the efficacy of AHT was carried out by OBPM and ABPM. Results: During the first three months of taking recently prescribed AHT, 34 patients (33.3%) demonstrated the escape phenomenon in according to the data of at least one of the measurement methods. There weren’t differences between two groups (with and without the escape phenomenon) by the classical cardiovascular risk factors. In one-factorial logistic regression models, the next predictors of the escape phenomenon were detected: cf-PWV > 10,8 m/c (OR 2,9, 95% CI 1,24 – 7,17, p = 0,01), 24ASI > 137 (OR 4,9, 95% CI 1,72 – 13,43, p = 0,002), 24PBP > 46 mm Hg (OR 6,3, 95% CI 2,27 – 17,6, p = 0,0003). The maximum sensitivity and specificity for the 24PBP was revealed (81,8% and 58,5% resp., pic. 1).Conclusions: After the AHT administration, in addition to the control BP measurements, it is important to provide the arterial stiffness assessment – to determine the odds ratio of the escape phenomenon.