Longer Duration Of Hypertension Research Articles

The influence of cortisol co-secretion on clinical characteristics and postoperative outcomes in unilateral primary aldosteronism.

The prevalence of unilateral primary aldosteronism (UPA) with cortisol co-secretion varies geographically. To investigate the prevalence and clinical characteristics of UPA with cortisol co-secretion in a Chinese population. Retrospective cohort study. We recruited 580 patients with UPA who underwent cosyntropin stimulation test (CST) after the 1-mg dexamethasone suppression test (DST) and retrospectively analyzed the clinical characteristics and postoperative outcomes of UPA with and without cortisol co-secretion. UPA with cortisol co-secretion (1 mg DST>1.8 ug/dL) was identified in 65 of 580 (11.2%) patients. These patients were characterized by older age, longer duration of hypertension, higher concentration of plasma aldosterone and midnight cortisol, lower adrenocorticotropic hormone (ACTH) and dehydroepiandrosterone sulfate (DHEAS), larger tumor diameter, and more history of diabetes mellitus. Cortisol and aldosterone levels were higher and DHEAS level was lower in UPA with cortisol co-secretion at 0-120 min after CST. Among 342 UPA patients with KCNJ5 gene sequencing and follow-up results, the complete clinical success rate was lower in UPA with cortisol co-secretion (33.3% vs. 56.4%, P<0.05); the complete biochemical success rate and KCNJ5 mutation did not differ between the two groups. Age, tumor size, and ACTH were independent predictors of UPA with cortisol co-secretion. Sex, BMI, duration of hypertension, KCNJ5 mutation, and cortisol co-secretion were independent predictors for complete clinical success in UPA after surgery. UPA with cortisol co-secretion is not uncommon in China, but the clinical features were distinctly different from those without co-secretion. Cortisol co-secretion is an independent risk factor for incomplete clinical success after surgery in UPA.

Prevalence and associated risk factors of resistant hypertension among Chinese hypertensive patients in primary care setting

IntroductionHypertension (HT) is a major public health problem globally, and it is the commonest chronic disease with a prevalence of 27% among people aged 15 years or above in Hong Kong. There is emerging literature confirmed that patients with resistant hypertension (RHT) give its increased risk for adverse clinical outcomes and higher rate of documented target organ damage. This study aims to identify the prevalence of RHT among Chinese hypertensive patients managed in public primary care setting of Hong Kong and exploring its associated risk factors.MethodologyThis is a cross-sectional descriptive study. Chinese hypertensive patients aged 30 or above with regular follow-up between 1st July 2019 and 30th June 2020 in 10 public primary care clinics under the Hospital Authority of Hong Kong were included. Demographic data, clinical parameters and drug profile of patients were retrieved from its computerized record system. The prevalence of RHT was identified and the associated risk factors of RHT were explored by multivariate logistic regression analysis.ResultsAmong the 538 sampled Chinese hypertensive patients, the mean age was 67.4 ± 11.5 years old, and 51.9% were female. The mean duration of hypertension was 10.1 ± 6.4 years, with a mean systolic and diastolic blood pressure of 128.8 ± 12.3 and 72.9 ± 10.8 mmHg respectively. 40 out of 538 patients were found to have RHT, giving an overall prevalence of 7.43%. Four factors were found to be associated with increased risk of RHT, in ascending order of odds ratio: duration of hypertension (OR 1.08), male gender (OR 2.72), comorbid with type 2 diabetes mellitus (T2DM, OR 2.99), and congestive heart failure (CHF, OR 5.39).ConclusionThe prevalence of RHT among Chinese hypertensive patients in primary care setting of Hong Kong is 7.43%. RHT is more common in male patients, patients with longer duration of hypertension, concomitant T2DM and CHF. Clinicians should be vigilant when managing these groups of patients and provide aggressive treatment and close monitoring.

Dry eye rate and its relationship with disease stage in patients with primary hypertension: a cross-sectional study in Vietnam.

To determine the dry eye (DE) rate and its relationship with disease stage in patients with primary hypertension. A cross-sectional study included 432 patients with primary hypertension (with an equal number of patients in each group: 144 in stage I, II, and III hypertension) and 144 healthy subjects as a control group. The Ocular Surface Disease Index (OSDI) and Schirmer I test without anesthetics were conducted on all 576 subjects. Subjects with OSDI scores <13 and Schirmer I values equal to or under 10 mm were diagnosed with DE. The ratio of DE in hypertension patients was higher than in the control group (41.7% versus 18.8%; P<0.001). The proportion of patients with DE increased gradually according to the hypertension stage: 27.1% in stage I, 40.3% in stage II, and 57.6% in stage III, P<0.001. Age, duration of hypertension, plasma urea, creatinine, and high-sensitivity C-reactive protein (CRP-hs) levels in hypertension patients with DE were higher than those without DE, P<0.001. Advanced age, a long duration of hypertension, diabetes mellitus, elevated plasma creatinine, and CRP-hs levels were independent factors associated with DE in primary hypertension patients, P<0.001. DE is a common disorder associated with advanced age, a long duration of hypertension, diabetes mellitus, elevated plasma CRP-hs, and creatinine levels in patients with primary hypertension.

Clinical characteristics and prognosis of primary aldosteronism associated with subclinical Cushing syndrome

Objective: To analyze the clinical characteristics and prognosis of patients with primary aldosteronism (PA) associated with subclinical Cushing syndrome (SCS). Methods: This retrospective cohort study was conducted at the First Affiliated Hospital of Chongqing Medical University in China. Patients with PA were included between January 2014 and December 2022. According to the results of 1-mg overnight dexamethasone suppression test, the patients were divided into the PA group and PA associated with SCS (PA/SCS) group. The demographic information, hormone levels, and follow-up results were analyzed. Independent sample t-test, chi-square test and Mann-Whitney U test were used for data comparison. Results: A total of 489 PA patients were enrolled in this study, of which 109 had PA/SCS (22.3%). Patients with SCS were on average older (54.4±10.7 vs. 47.4±11.0, P<0.001); had a larger proportion of women (69.7%, 76/109 vs. 57.4%, 218/380; P=0.020); and a longer duration of hypertension [96 (36, 180) vs. 60 (12, 120) months, P=0.001] than patients without SCS. There were 215 and 51 patients in the PA group and PA/SCS group, who completed adrenalectomy and follow-up, respectively. The remission rate of autonomous cortisol secretion in the PA/SCS group was 85.3% (29/34). There was no significant difference in the remission rate of autonomous aldosterone secretion among patients between the PA/SCS and PA group (94.1%, 48/51 vs. 94.4%, 203/215; P=1.000), while the clinical remission rate in the PA/SCS group was lower than that in the PA group (39.2%, 20/51 vs. 61.9%, 133/215; P=0.003). Conclusions: SCS is common in PA patients (22.3%), and the clinical remission rate is low. Screening using the 1-mg overnight dexamethasone suppression test is recommended for all patients with PA.

(141) Can a Nocturnal Penile Tumescence and Rigidity Test Detect Organic Aetiology of Erectile Dysfunction? A Peripheral and Penile Vascular Study

Abstract Introduction In the diagnostic workup of erectile dysfunction (ED) the Nocturnal Penile Tumescence and Rigidity test (NPTR) is being used less and less because of its inconvenience but also in part because of the intrinsic limits of this test. In particular, the NPTR has been considered very useful to diagnose psychogenic ED when it is positive (normal) but less informative when it is negative (pathological) because of the high incidence of false negatives. Other tests have been suggested to better diagnose an organic ED, especially the dynamic Penile Colour-Doppler Ultrasound (PCDU) to study the penile vascular response and detect a vasculogenic ED. Objective The purpose of the study was to explore the value of a pathological NPTR by investigating relationship between the NPTR result and the peripheral vascular health at the carotid, brachial and cavernous arteries. Methods We conducted an observational study involving patients with ED who had undergone a NPTR as part of their ED diagnostic workup. We assessed their peripheral vascular health through (1) the measurement of the intima-media thickness at the carotid arteries (cIMT), (2) the measurement of the flow-mediated dilation at the brachial artery (FMD), and (3) performing a PCDU. Results Globally, our patients presented with a normal cIMT, FMD and Peak Systolic Value (PSV) in the PCDU. The group with pathological NPTR were significantly older than patients with normal NPTR (55.6 vs 44.1 years, p=0.002), had a higher prevalence of hypertension (50.0 vs 6.8%, p=0.001), longer hypertension duration (8.0 vs 1.3 years, p=0.035), a higher prevalence of diabetes mellitus (42.9 vs 6.8%, p= 0.004), higher blood glucose (111 vs 92 mg/dl, p=0.004) and higher blood triglycerides levels (188 vs 96 mg/dl, p=0.002). Furthermore, they showed lower PSV (46.2 vs 71.0 cm/s, p=0.002) while we did not find significant differences as regards cIMT and FMD between the two groups. Interestingly, the prevalence of patients with pathological PSV (&amp;lt;35 cm/s) was higher among patients with a pathological NPTR but without reaching the statistical significance. However, when adopted an age-dependant cut-off described in the literature (PSV &amp;lt; age x 0.7 + 6.73) the difference between the two groups became significant (50.0 vs 11.4%, p=0.005). Finally, the correlation analysis showed a significant correlation between PSV and the cIMT (-0.352, ρ=0.009), the maximum number of events in the RPTR record (+0.344, ρ=0.012), and the mean tip tumescence (+0.303, ρ=0.036). When corrected for age, these associations lost their statistical significance. Conclusions This study demonstrates the diagnostic value of a pathological NPTR which suggests an organic aetiology of the ED and associates with pathological findings in the PCDU. Age appears to be one of the most important risk factors for ED, even when other risk factors are present. Finally, when using a PCDU to diagnose vasculogenic ED, a cut-off of 35 cm/s might be less sensitive than an age-dependent cut-off to detect early impairments of penile endothelial function. Disclosure No.

Prolonged Hypokalemia and Delayed Diagnosis of Primary Aldosteronism: Clinical Course and Risk Factors.

Primary Aldosteronism (PA) is a common cause of hypertension. However, diagnosis is often delayed, leading to poorer clinical outcomes. Hypokalemia with hypertension is characteristic of PA, and is an indication for screening. We evaluated if patients with PA had prolonged hypokalemia before diagnosis, the subsequent biochemical/clinical control, and factors associated with delayed diagnosis. Our study included all PA patients with hypokalemia diagnosed between 2001 to 2022. Delayed diagnosis was defined as duration of hypokalemia of >1 year from first occurrence, to first evaluation by a PA specialist. Patients were reassessed post-adrenalectomy using the Primary Aldosteronism Surgery Outcomes criteria. We performed multivariable analysis to assess for factors associated with delayed diagnosis. Among 240 patients with PA who presented with hypokalemia, 122 (51%) patients had delayed diagnosis, with prolonged hypokalemia of median duration 4.5 (2.4-7.5) years. Patients with delayed diagnosis were older, had longer duration of hypertension, higher pill burden, lower renal function and more prevalent cardiovascular disease. Factors associated with delayed diagnosis included older age, presence of hyperlipidaemia, and less severe hypokalemia (serum potassium >3.0mmol/L). Compared to patients with early diagnosis, a lower proportion of those with delayed diagnosis underwent adrenal vein sampling (73% vs 58%), P<0.05. Sixty of 118 (50.8%) non-delayed, and 39 of 122 (32.0%) patients with delayed diagnosis underwent surgery. Despite manifestation of hypokalemia, many patients with PA fail to be promptly screened. Greater emphasis in hypertension guidelines, and efforts to improve awareness of PA amongst primary care physicians are urgently needed.

Kidney damage in hypertension disease

Essential hypertension (EH) is the most common cardiovascular disease and the leading cause of chronic kidney disease (CKD) worldwide. The aim of the study was to investigate the frequency and nature of kidney damage in hypertension. 189 patients (69 men and 120 women) with hypertension (stages I, II, and III) aged 43 years and older were examined. The average age of the patients was 61.2 ± 8.7 years. Clinical and biochemical tests were conducted on all patients, including red blood cell indices, C-reactive protein (CRP), lipid profile, fibrinogen, electrolytes, glucose, uric acid, creatinine, and cystatin C. The duration of hypertension was also recorded for each patient. Kidney function was assessed using serum creatinine (CKD-EPI) and cystatin C (F. Houcke). Patients were categorized according to the degree of decrease in glomerular filtration rate (GFR) based on the recommendations of the Russian Nephrology Society. Patients with kidney damage were divided into two groups: Group 1 consisted of patients with hypertension without signs of CKD (GFR calculated by cystatin C ≥ 60 ml/min), while Group 2 consisted of patients with hypertension complicated by CKD. The results showed that hypertension was accompanied by target organ damage in 70.8% of cases. The prevalence of CKD among patients with hypertension was 28.5%. Proteinuria was mainly detected in patients with renal insufficiency. The frequency of GFR categories according to CKD-EPI and F. Houcke formulas was as follows: G1 — 54.4% and 13.7% (p &lt; 0.05); G2 — 35.9% and 57.6% (p &lt; 0.05); G3a — 5.2% and 19.5% (p &lt; 0.05); G3b — 3.1% and 5.2% (p &lt; 0.05); G4 — 0.5% and 3.1% (p &lt; 0.05) and G5 — 0.5% and 0.5%, respectively. There was a strong correlation between GFR and serum creatinine (r = –0.439; p &lt; 0.05) and cystatin C (r = –0.866; p &lt; 0.0001). Patients in Group 2 (hypertension with kidney damage) had significantly higher levels of CRP, low-density lipoprotein cholesterol, cystatin C, and longer duration of hypertension, but lower levels of total calcium than patients in Group 1. In conclusion, CKD was present in 28.5% of patients with hypertension, and proteinuria was mainly detected in patients with renal insufficiency. Serum cystatin C levels most accurately reflect kidney filtration function.

Hypertension Trends and White Matter Brain Injury in the Offspring Framingham Heart Study Cohort.

Hypertension is the most potent stroke risk factor and is also related to cerebral small vessel disease. We studied the relation between mid-to-late-life hypertension trends and cerebral white matter injury in community-dwelling individuals from the FHS (Framingham Heart Study). FHS Offspring cohort participants with available mid-life and late-life blood pressure measurements and brain magnetic resonance imaging were included. Multiple regression analyses were used to relate hypertension trends (normotension-normotension [reference], normotension-hypertension, and hypertension-hypertension) to white matter injury metrics on diffusion tensor imaging (free water, fractional anisotropy, and peak skeletonized mean diffusivity) and Fluid Attenuated Inversion Recovery (white matter hyperintensity volume) by different blood pressure cutoffs (130/80, 140/90, and 150/90 mm Hg). We included 1018 participants (mean age 47.3±7.4 years at mid-life and 73.2±7.3 at late-life). At the 140/90 mm Hg cutoff, the hypertension-hypertension trend was associated with higher free water (β, 0.16 [95% CI, 0.03-0.30]; P=0.021) and peak skeletonized mean diffusivity (β, 0.15 [95% CI, 0.01-0.29]; P=0.033). At a 130/80 mm Hg cutoff, the hypertension-hypertension trend had significantly higher free water (β, 0.16 [95% CI, 0.01-0.30]; P=0.035); and the normotension-hypertension (β, 0.24 [95% CI, 0.03-0.44]; P=0.027) and hypertension-hypertension (β, 0.22 [95% CI, 0.04-0.41]; P=0.022) trends had significantly increased white matter hyperintensity volume. Exploratory stratified analysis showed effect modifications by APOE ɛ4 allele and age. Mid-to-late-life hypertension exposure is significantly associated with microstructural and to a lesser extent, visible white matter injury; the effects are observed at both conventional and lower blood pressure cutoffs and are associated with longer duration of hypertension.

Hypertension Self-Care Behavior and Its Associated Factors among Patients with Hypertension

Background: Hypertension is a chronic medical condition that affects millions of people worldwide and can lead to severe health complications. Hypertension self-care behavior is important in managing their condition and reducing their risk of complication. This study aimed to to determine factors that associated with self-care behavior among patients with hypertension. Subjects and Method: This was cross-sectional study, conducted at Boyolali Regency, Central Java. A total of 122 participant are included in this study. The Independent variables were including age, sex, education level, income, and duration of hypertension. The dependent variable was Hypertension self-care behavior. The data of Hypertension self-care behavior were collected by Hypertension self-care behavior questionnaire (HSCBQ). Knowledge about hypertension was measured using a modified questionnaire of hypertension evaluation of lifestyle and management (HELM). The data were analyzed by multiple logistic regression. Results: Age ≥ 50 years (aOR=3.76; 95%CI=1.30 to 10.50; p=0.014), higher level of education (aOR=6.06; 95%CI=1.91 to 22.85; p=0.003) higher income (aOR=2.89; 95%CI=1.07 to 7.80; p=0.035), longer duration of hypertension (aOR=3.35; 95%CI=1.13 to 9.93; p=0.029) and good knowledge of hypertension (aOR=10.56; 95%CI=3.51 to 31.71; p&lt;0.001) were associated and statistically significant with Hypertension self-care behavior. Conclusion: Older age, higher level of education, higher income, longer duration of hypertension and good knowledge had statistically significant association with good Hypertension self-care behavior. Keywords: age, duration of hypertension, hypertension self-care behavior, income, knowledge, level of education. Correspondence: Akhmad Azmiardi. School of Health Science Mamba’ul ‘Ulum Surakarta. Jln. Ringroad, Mojosongo, Jebres, Surakarta, Central Java, Indonesia. Email: aazmiardi@gmail.com. Mobile: +6285245412021.

DELAYED DIAGNOSIS OF PRIMARY ALDOSTERONISM IN PATIENTS WITH HYPOKALEMIA: CLINICAL COURSE AND ASSOCIATED FACTORS

Objective: PA is a common and curable cause of hypertension. However, diagnosis is often delayed, leading to poorer clinical outcomes. Presence of hypokalemia, with hypertension, is characteristic of PA, and is an indication for screening. We evaluated if patients with PA had prolonged hypokalaemia before PA screening, the subsequent clinical course, and factors associated with delayed diagnosis. Design and method: Our retrospective study included all PA patients with hypokalemia diagnosed between 2001 to 2022. Delayed diagnosis was defined as duration of hypokalemia of &gt;1 year from first occurrence, to first evaluation by a PA specialist. Patients who underwent unilateral adrenalectomy were assessed using the Primary Aldosteronism Surgery Outcomes criteria. We performed multivariable analysis to assess for factors associated with delayed diagnosis. Results: Of 240 newly diagnosed PA patients with hypokalemia, 122 (51%) patients had prolonged hypokalemia, with a median duration 4.5 (2.3 – 7.5) years. Patients with delayed diagnosis were older, had longer duration of hypertension, poorer renal function and more frequent cardiovascular disease. A lower proportion of patients with delayed diagnosis underwent adrenal vein sampling (58% vs 73%), P&lt;0.05, adrenalectomy (32% vs 51%), P&lt;0.05, and eventually achieved partial/complete clinical success post-adrenalectomy (21% vs 37%), P&lt;0.05, compared to those with early diagnosis. Factors associated with delayed diagnosis included older age, presence of hyperlipidemia, and less severe hypokalemia (serum potassium &gt;3mmol/L). Conclusions: Despite manifestation of hypokalaemia, many patients with PA fail to be promptly screened. Greater emphasis in hypertension guidelines, and efforts to improve awareness amongst primary care physicians are urgently needed.

COMPARISON BETWEEN CENTRAL AND AUTOMATED PERIPHERAL BLOOD PRESSURE MEASUREMENT FOR EARLY DETECTION OF KIDNEY DYSFUNCTION IN HYPERTENSIVE PATIENTS

Objective: To assess the difference of blood pressure measurements using central and automated peripheral blood pressure measurement (oscillometric) devices among patients with primary hypertension for early detection of kidney dysfunction and the validity of automated BP measurement device compared with non-invasive central BP measurement device for diagnosis of hypertension. Also, to link between parameters such as augmentation index and pulse wave velocity index and early kidney dysfunction markers. Design and method: The study is a case-comparative study that included 201 patients with primary hypertension (108 patients with chronic kidney disease and 93 patients without kidney disease). Exclusion criteria were patients presenting with secondary hypertension, diabetes mellitus (DM), end stage renal disease (ESRD) on regular dialysis, young patients below 40 and above 70 years old and patients with collagen diseases. All patients underwent blood pressure measurement by OMRON M2 and Mobil-O-Graph devices, kidney function assessment and abdominal ultrasonography. Results: Patients with chronic kidney disease were significantly older (60.02±9.1 vs. 55.33±8.5; P &lt; 0.001), with longer duration of hypertension (7.56±5.9 vs. 6.05±5.8; P = 0.020) in comparison to those without chronic kidney disease. Automated peripheral measurement of systolic blood pressure, diastolic blood pressure and pulse pressure were significantly higher in comparison to central blood pressure. Patients with chronic kidney disease had significantly higher augmentation index (24.06±12.6 vs. 19.02±10.8; P &lt; 0.001) and pulsed wave velocity (8.66±1.5 vs. 8.69±6.8; P = 0.004) in comparison to those without chronic kidney disease. Augmentation index had positive correlation with pulse wave velocity (r = 0.183, P = 0.005). There was negative correlation between both pulse wave velocity and augmentation index and estimated glomerular filtration rate (r = -0.318, P &lt; 0.001), and (r = -0.236, P &lt; 0.001), respectively. Hence, arterial stiffness parameters are good positive test for prediction of chronic kidney disease. Conclusions: There is a strong agreement between non-invasive centrally and automated peripherally measured blood pressure in diagnosis of hypertension. But non-invasive central measurements are preferred over automated measurements for early prediction and detection of renal impairment.

Comparison between central and automated peripheral blood pressure measurement for early detection of kidney dysfunction in hypertensive patients

BackgroundThere is a close relationship between blood pressure levels and the risk of cardiovascular events, strokes, and kidney disease. For many years, the gold standard instrument for blood pressure measurement was a mercury sphygmomanometer and a stethoscope, but this century-old technique of Riva-Rocci/Korotkov is being progressively removed from clinical practice. Central blood pressure is considered better than peripheral blood pressure in predicting cardiovascular events, as it assesses wave reflections and viscoelastic properties of the arterial wall which make systolic and pulse pressures vary from central to peripheral arteries, but mean blood pressure is constant in the conduit arteries.MethodsThe study included 201 patients with primary hypertension (108 patients with chronic kidney disease and 93 patients without kidney disease). All patients underwent blood pressure measurement by OMRON M2 and Mobil-O-Graph devices, kidney function assessment and abdominal ultrasonography.ResultsPatients with chronic kidney disease were significantly older (60.02 ± 9.1 vs. 55.33 ± 8.5; P < 0.001), with longer duration of hypertension (7.56 ± 5.9 vs. 6.05 ± 5.8; P = 0.020) in comparison to those without chronic kidney disease. Automated peripheral measurement of systolic blood pressure, diastolic blood pressure and pulse pressure were significantly higher in comparison to central blood pressure. Patients with chronic kidney disease had significantly higher augmentation index (24.06 ± 12.6 vs. 19.02 ± 10.8; P < 0.001) and pulsed wave velocity (8.66 ± 1.5 vs. 8.69 ± 6.8; P = 0.004) in comparison to those without chronic kidney disease. Augmentation index had positive correlation with pulse wave velocity (r = 0.183, P = 0.005). There was negative correlation between both pulse wave velocity and augmentation index and estimated glomerular filtration rate (r = -0.318, P < 0.001), and (r = -0.236, P < 0.001), respectively. Hence, arterial stiffness parameters are good positive test for prediction of chronic kidney disease.ConclusionThere is a strong agreement between non-invasive centrally and automated peripherally measured blood pressure in diagnosis of hypertension. But non-invasive central measurements are preferred over automated measurements for early prediction and detection of renal impairment.

Association of Hyperuricemia with Hypertension in Patients Presenting in the Outpatient Department for Regular Follow–Up

Objective: To determine the association of hyperuricemia with hypertension in patients presenting in the Outpatient Department for regular follow-up.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of General Medicine, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jun 2019 to 2020.&#x0D; Methodology: Three-hundred patients suffering from hypertension for more than years were recruited in this study. They were evaluated for hyperuricemia during a routine follow-up visit by performing serum uric acid levels. &#x0D; Results: Out of 300 hypertension patients included in the study, 187(62.3%) had no hyperuricemia, while 113(37.7%) showed the presence of hyperuricemia on routine analysis. The mean age of the study participants was 41.72±6.98 years. The mean duration of hypertension in our patients was 6.61±2.75 years. Polypharmacy and long duration of illness had a significant association with the presence of hyperuricemia among the study participants (p-value&lt;0.001).&#x0D; Conclusion: Patients with hypertension showed a high frequency of hyperuricemia in our study. The long duration of hypertension and the use of multiple pharmacological agents to achieve adequate control of hypertension predicted raised levels of uric acid among hypertensive attending the routine outpatient clinic in our study.

Associated factors and hemodynamic characteristics of resistant hypertension in the elderly.

The purpose of this study was to explore the associated factors and hemodynamic characteristics of resistant hypertension (RHTN) in the elderly. A total of 283 patients aged ≥60 years with hypertension were evaluated by the CNAP™ monitor. Among them, 240 patients were non-RHTN (controlled hypertension with use of three or fewer antihypertensive medications) and 43 patients were RHTN (uncontrolled hypertension despite the concurrent use of ≥3 antihypertensive drugs at optimized doses, including a diuretic, or achieving target blood pressure with the use of ≥4 antihypertensive medications). RHTN was associated with higher body mass index (BMI), longer hypertension duration, and coronary heart disease (p=.004, p<.001, and p=.042, respectively). The mean number of antihypertensive medications was greater in patients with RHTN (p<.001). Hemodynamic analysis revealed higher cardiac output in the RHTN group than in the non-RHTN group, while no difference was observed in systemic vascular resistance. Screening for secondary etiology showed that, among the 43 patients with RHTN, 8 (18.6%) had chronic kidney disease, 8 (18.6%) had obstructive sleep apnea, 4 (9.3%) had primary aldosteronism, 2 (4.7%) had renovascular disease. No significant differences were observed in the cardiac output and systemic vascular resistance values between different causes of RHTN. These findings suggest that higher body mass index, longer hypertension duration, and coronary heart disease emerged as the associated factors of RHTN in the elderly. RHTN is characterized by higher cardiac output. Screening for the possible secondary etiology of RHTN in the elderly patients is necessary and important.

Development and Validation of a Nomogram for Predicting Blood Pressure Change Failure in Patients with Pheochromocytoma and Concomitant Hypertension after Adrenalectomy.

(1) Background: Pheochromocytoma is a common cause of secondary hypertension, which is considered curable; nevertheless, some patients still suffer from hypertension after adrenalectomy. Therefore, we developed and validated a nomogram for predicting blood pressure change failure in patients with pheochromocytoma and concomitant hypertension after adrenalectomy. (2) Methods: The development cohort of this study consisted of 259 patients with pheochromocytoma who underwent adrenalectomy at our center between 1 January 2007 and 31 December 2018. Each patient's clinicopathologic data were recorded. LASSO (the least absolute shrinkage and selection operator) regression was used to reduce and select the features of the data. Furthermore, we used multivariate logistic regression analysis to develop the prediction model. An independent cohort of 110 consecutive patients from 1 January 2019 to 31 December 2021 was used for validation. The performance of this nomogram was assessed with regard to discrimination, calibration, and clinical usefulness. (3) Results: 40.9% and 46.4% of patients experienced blood pressure change failure in the development and validation cohorts of this study, respectively. We found that older patients with a longer duration of hypertension and concomitant cardiovascular events were more likely to suffer from blood pressure change failure. In the validation cohort, the model manifested great discrimination with an AUROC (area under the receiver operating characteristic) of 0.996 (p < 0.001) and good calibration (unreliability test, p = 0.359). Decision curve analysis demonstrated that the model was clinically useful. (4) Conclusions: This study presented a reliable nomogram that facilitated individualized preoperative prediction of blood pressure change failure after adrenalectomy in patients with pheochromocytoma, which may help decision-making in perioperative treatment and follow-up strategies.

PS-BPC01-2: PREDICTORS AND EFFECTS OF COMORBID ATRIAL FIBRILLATION IN HYPERTENSIVE PATIENTS DUE TO PRIMARY ALDOSTERONISM

Objective: The incidence of atrial fibrillation (AF) and risk of cardiovascular events are reportedly higher in patients with primary aldosteronism (PA) than those with essential hypertension. This study sought to determine independent predictors of comorbid AF and cardiovascular events in PA patients after PA treatment. Design and method: This nationwide registration study included PA patients more than 20 years old. Incident cardiovascular events were observed with a mean follow-up of approximately 3 years. A total of 3,654 patients with PA were included at the time of analysis. Results: Prevalence of AF was 2.4%. PA patients with AF were older, more frequently male and had longer duration of hypertension than those without AF. No significant difference in basal plasma and adrenal venous aldosterone concentration, renin activity, potassium concentration, confirmatory tests of PA, laterality or surgery rate were seen between groups. Logistic regression analysis showed age, male sex, cardiothoracic ratio, past history of coronary artery disease and heart failure were independent determinants for AF. PA patients with AF showed a higher frequency of cardiovascular events than those without AF (P &lt; 0.001). Multivariate Cox analyses demonstrated AF in addition to duration of hypertension, older age, male sex, hypokalemia and surgery as independent prognostic factors for cardiovascular events (hazard ratio [HR] 1.866, 95% confidence interval [CI] 1.024–3.401, P &lt; 0.05; HR 1.022, 95%CI 1.006–1.039, P &lt; 0.01; HR 1.424, 95%CI 1.043–1.943, P &lt; 0.05; HR 1.027, 95%CI 1.012–1.042, P = 3.2 × 10–4; HR 1.726, 95%CI 1.226–2.430, P &lt; 0.005; HR 1.458, 95%CI 1.041–2.041, P &lt; 0.05, respectively). After PA treatment, incidence of cardiovascular events did not differ significantly between PA patients with AF and essential hypertension patients with AF from the Fushimi registry during follow up after adjusting age, sex and prevalence of hypertension. Conclusion: Early diagnosis of PA may prevent AF and other cardiovascular events in PA patients by shortening the duration of hypertension.

The relationship of fibroblast growth factor 23 with calcification of the thoracic aorta according to the results of multislice computed tomography in patients with resistant arterial hypertension

Objective: to evaluate the incidence and severity of thoracic aortic calcification, the relationship with endothelial dysfunction and fibroblast growth factor in patients with resistant arterial hypertension.Materials and methods: the study involved 92 patients with resistant hypertension. Daily monitoring of blood pressure (ABPM) was performed, the functional state of the endothelium was assessed in a sample with reactive hyperemia, the calcium index (CI) of the thoracic aorta was determined using MSCT, and the serum level of FGF-23 was determined using enzyme immunoassay.Results: based on ABPM, patients were divided into groups 1st-controlled (n=44) and 2nd-uncontrolled (n=48) resistant AH. In the 2nd group, a more pronounced dysfunction of the endothelium was revealed in the sample with reactive hyperemia and changes in the velocity parameters of blood flow. FGF23 levels and CI were higher in individuals with uncontrolled resistant hypertension. According to the results of correlation-regression analysis, CI was associated with the value of pulse pressure (r=0.49, p=0.007), the duration of hypertension (r=0.68, p=0.04) and the duration of regular antihypertensive therapy (r = −0 .33, p=0.02). FGF- 23 was found to be associated with PA hemodynamic parameters: with Ved (r=0.42, p=0.003), PI (r=0.43, p=0.041) and RI (r=0.46, p=0.025), as well as with CI (r=0.76, p=0.006).Conclusion: patients with uncontrolled resistant hypertension showed a more pronounced decrease in brachial artery EVR and an increase in vascular resistance indices in the test with reactive hyperemia, which was statistically significantly associated with the level of FGF23. In patients with resistant hypertension, excessive calcification of the thoracic aorta was found according to the results of MSCT. Calcium index values are higher in patients with high pulse BP, longer duration of hypertension and high levels of FGF23.

A comparative cross-sectional study investigating prevalence and patterns of sexual dysfunction among hypertensive and non-hypertensive men

Background and Aims: Erectile dysfunction is prevalent among men with hypertension, but there is paucity of data on prevalence of other domains of sexual dysfunction (SD) in hypertensives and the general population. The study compared the prevalence and patterns of SD among treated hypertensive male patients with normotensive men. The effect of antihypertensive drugs on different domains of sexual function was also investigated in our study. Methods: A total of 195 participants (95 hypertensive and 100 non-hypertensive men) were recruited from the medical out-patient department of a secondary health care facility in Lagos, Nigeria. Sexual function was assessed using International Index of Erectile Function (IIEF) which measures erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. Results: Sexual dysfunction affecting at least one domain was present in 82.1% of the hypertensive subjects and 52% of non-hypertensive controls (P&lt;0.001). The hypertensive patient had more severe dysfunction in the multiple domains (p&lt; 0.001). The use of methyldopa, furosemide and ß-blockers were associated with significantly lower scores while there was no significant difference in scores with the use calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, thiazide and potassium sparing diuretics. SD was higher in the older age group and with longer duration of hypertension and treatment. Conclusion: SD is common in the adult male population with hypertension significantly increasing the risk. Hypertension is associated with involvement of multiple domains for sexual dysfunction. Use of methyldopa, furosemide and ß-blockers were associated with higher rates of SD in the hypertensive population.

Recovery from diabetes mellitus in primary aldosteronism patients after adrenalectomy

BackgroundThe prevalence of diabetes mellitus (DM) was higher in primary aldosteronism (PA) patients. We aimed to evaluate the outcome of DM after adrenalectomy and determine the factors associated with that in PA patients.MethodsPA patients with DM (PA + DM patients) who received adrenalectomy were recruited into the study. The patients were classified into 3 groups based on their DM conditions after treatment, including “remission”, “improved” and “unchanged” groups. Univariate and multivariate logistic regression analysis was conducted to uncover the preoperative factors affecting the outcome of DM after adrenalectomy.ResultsA total of 54 PA + DM patients received adrenalectomy. After adrenalectomy, 16.7%, 33.3% and 50.0% of patients were classified into the “remission”, “improved” and “unchanged” groups, respectively. The factors negatively associated with remission or improvement from DM after adrenalectomy were longer duration of hypertension (P = 0.029). Higher concentration of urinary magnesium (P = 0.031) and higher 24 h urinary potassium (P = 0.049) were factors negatively associated with the “remission” from DM after adrenalectomy.ConclusionsAdrenalectomy was beneficial for the remission and improvement from DM in the half of PA patients with DM. Longer duration of hypertension, higher concentration of urinary magnesium and higher 24 h urinary potassium may prevent the remission and improvement from DM after adrenalectomy in PA patients. Examination of urinary electrolyte could be considered in PA patients with DM for predicting the outcome of DM after adrenalectomy.

New-onset diabetes mellitus risk associated with concurrent autonomous cortisol secretion in patients with primary aldosteronism.

Concurrent autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA patients) is not uncommon. This work aimed to determine the effect of cortisol levels on incident new-onset type 2 diabetes mellitus (NODM) in PA patients. Using the prospectively designed observational TAIPAI cohort, the PA patients were grouped by cortisol level after an overnight low-dose dexamethasone suppression test (1-mg DST). Of the 476 PA patients, 387 (43.7% men; mean age 52.8 years) did not have baseline DM. After a mean follow-up of 4.3 ± 2.9 years, 32 patients (8.3%) developed NODM. The cutoff value obtained via a generalized additive model showed that a serum cortisol level ≥ 2.65 µg/dL after 1-mg DST was a risk factor for developing NODM (HR, 3.5, p = 0.031) by Cox proportional- hazards model.. In PA patients with a higher body mass index (>25 kg/m2; HR, 3.16), lower estimated glomerular filtration rate (<90 ml/min/1.73 m2; HR, 3.18), longer hypertension duration (>7 years; HR, 3.34), and higher waist-to-hip ratio (>0.9; HR, 3.07), a concomitant cortisol level ≥ 2.65 μg/dL after 1-mg DST were more likely to develop NODM. The high-cortisol group of patients with aldosterone-producing adenoma (APA) using mineralocorticoid receptor antagonist (MRA) was associated with an increased risk of NODM (HR, 5.72). Our results showed that PA patients with a concomitant cortisol level ≥ 2.65 µg/dL after 1-mg DST, independent of the aldosterone level, had a higher incidence of NODM. Such PA patients should be carefully evaluated and managed to achieve better glucose control and prevent metabolic syndrome.