Lower Baseline Blood Pressure Research Articles

Physical activity and cause-specific mortality among 150,000 participants in the Mexico city prospective study

Abstract Background Previous studies of high-income populations have found that physical activity is associated with reduced mortality risk. We investigated the association of recreational physical activity intensity with cause-specific mortality at ages 35-74 in a Mexican population with high levels of adiposity and diabetes. Methods Between 1998 and 2004, 150,000 adults (age ≥35 years) were recruited into the Mexico City Prospective Study, and followed for median 19 years. Cox regression was used to assess the association of baseline-reported intensity of recreational physical activity (none, <30 minutes, ≥30 to <60 minutes, or ≥60 minutes per activity session) with death before age 75 years. Analyses were adjusted for age at risk, sex, residential district, education, smoking and alcohol consumption. They excluded those who at recruitment were aged ≥75 years, had incomplete data, or had vascular disease or any other chronic condition (except diabetes) recorded. Results Among the 45,291 men and 93,627 women aged 35-74 years, 70% of men and 81% of women reported taking no regular recreational physical activity, mean (SD) body mass index was 29.1 (4.9) kg/m2 and 13% had previously-diagnosed diabetes. There were 12,605 deaths from any cause at ages 35-74 years, including 3368 from vascular causes. Physical activity at recruitment was associated with lower all-cause mortality risk in a dose-dependent manner. Compared with those reporting no regular physical activity, those exercising ≥60 minutes per activity session had 28% lower all-cause mortality at ages 35-74 years (HR=0.72; 95% CI 0.67-0.78), including 22% lower vascular mortality (RR 0.78, 0.68-0.90). Associations were similar for the different types of vascular mortality and were similar in those with and without diabetes, so the absolute benefits of physical activity were larger in those with diabetes. Those who exercised for the longest durations per activity session had lower baseline blood pressure and a more favourable lipid profile than those who reported doing no regular recreational physical activity. Conclusions In this Mexican cohort, higher recreational physical activity was associated with a lower risk of premature death, with particularly high absolute benefits in those with diabetes.

Speckle Tracking Echocardiography for the Diagnosis and Prognosis of Light Chain Cardiac Amyloidosis

Background Cardiac amyloidosis was thought to be a rare disease, but the data shows that its prevalence rate is increasing, and the light chain (AL) cardiac amyloidosis are the most common and worst [1]. Because of the lack of symptoms specificity in the preliminary stages of AL cardiac amyloidosis, resulting in underdiagnosis or severe delays in diagnosis, patients are often delayed in the optimal timing of treatment. A considerable proportion of patients are diagnosed after the onset of symptoms of heart failure which progresses rapidly and results in poor prognosis and high mortality. Patients have a mortality rate of up to 50% within 4-6 months after diagnosis of congestive heart failure and the median survival of these patients were less than 12 months [2]. Therefore, early diagnosis and treatment are particularly important for them. Speckle tracking echocardiography has a good imaging analysis of cardiac amyloidosis, which remains the most often used imaging tool. This study aimed to explore the use of speckle tracking echocardiographic parameters to build models which improve the diagnostic rate of patients with suspected AL cardiac amyloidosis and assess the prognosis of patients with AL cardiac amyloidosis. Methods We studied twenty-four patients of pathologically confirmed amyloidosis from March 2017 to February 2023 at the First Affiliated Hospital of Soochow University. According to the criteria for organ involvement, patients were divided into two groups based on whether the heart was involved or not and SPSS 26.0 was used to analyze data. The differences of characteristics and various parameters of Speckle tracking echocardiography between two groups were compared and the indicators with statistical difference were selected for single factor analysis and multivariate analysis. Statistically significant factors were used to establish diagnosis and prognosis assessment models as below. Result In this study, the rate of cardiac involvement was 62.5%. Until June 30 th, 2023, median follow-up time of twenty-four patients was 31 months, and the 5-year survival rate was 74% in CA group and 85.7% in non-CA group. Characteristics The results showed that CA group has lower baseline blood pressure, and the levels of NT-pro BNP and dFLC were significantly higher in the CA group compared to the non-CA group. In speckle tracking echocardiography parameters, CA group has significantly increased IVSd, LVPWd, RWT, E/e and decreased EF, interventricular septum e', lateral wall e' and left ventricular global strain. Diagnosis The results showed that CA group is more likely to be involved in the heart when monoclonal proteins are formed in the peripheral blood （OR=0.031, 95%CI 0.003-0.365, P=0.002）. In univariate analysis, E/e>10.85, interventricular septum e‘<5.25 cm/s, lateral wall e‘<6.05 cm/s, |left ventricular global strain|<16.3% and left ventricular diastolic function ≥Class II have the effect on CA group with statistically significant. Incorporating them into variables to construct a multivariate logistic regression model showed that: the model was built successfully (Omnibus test: P<0.001) and the goodness of fit model is well (Hosmer-Leme show test: P=1). 88.9% of the study subjects who were CA patients were predicted by the model to be CA patients, while 92.9% of the study subjects who were not CA patients were predicted by the model to be not CA patients, but the 5 factors had no significant effect on cardiac amyloidosis (P > 0.05). Prognosis assessment The result of the study shows that IVPWd>13.5mm, RWT> 0.51, NT pro-BNP>6614pg/mL and dFLC>142.35mg/L are elevated risk factors for prognosis with statistically significant. (Figure1). They were included in the variables to construct a multi-factor Cox proportional hazards model and it turns out: the model was built successfully (Omnibus test: P<0.05), but these 4 factors had no significant effect on cardiac amyloidosis (P > 0.05). Conclusion Speckle tracking echocardiography is of great value in the diagnosis and prognosis of patients with cardiac amyloidosis. The combined analysis of echocardiography parameters and serological abnormalities can help in the diagnosis and prognostic assessment of the disease, it also helps to identify patients with poor prognosis early and increasing the possibility of future treatment strategies based on risk stratification.

JS-HR-2: HYPERTENSION MANAGEMENT IN CKD: UPDATE FOR BETTER CARDIO-RENAL OUTCOMES

Hypertension in CKD patients is a risk factor for end-stage renal disease, cardiovascular events, and mortality. Thus, the prevention and appropriate management of hypertension in these patients are essential strategies for better cardio-renal outcomes. Recently, novel risk factors for hypertension have been reported. Circulating fibroblast growth factor 21, an endocrine hormone mainly secreted by the liver, is associated with elevated blood pressure (BP) and/or aortic stiffness with renal dysfunction. Furthermore, several promising prognostic markers for cardio-renal outcomes have been suggested. A higher urinary sodium-to-potassium ratio was independently associated with poor renal outcomes in CKD patients. Higher albumin-to-creatinine ratios significantly increased the risk of first stroke or first ischemic stroke. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) and mineralocorticoid receptor (MR) blockers are promising treatment options for better cardio-renal outcomes. The clinical use of SGLT2is has recently expanded to non-diabetic patients with CKD and heart failure as well as diabetic patients. SGLT2is have an antihypertensive effect, and the degree of BP change in patients undergoing SGLT2i therapy depends on the baseline BP; a larger reduction is observed in patients with higher baseline BP, and a minor reduction or slight increase is observed in patients with lower baseline BP. These BP regulation mechanisms may partially depend on body fluid homeostasis by SGLT2is. SGLT2is ameliorate fluid retention through osmotic diuresis and natriuresis, but are also associated with a low rate of hypovolemia, which is evident by the compensatory upregulation of renin and vasopressin levels. These fluid homeostatic mechanisms exerted by SGLT2is may contribute to the stabilization of BP and better cardio-renal outcomes. MR blockers are used in the treatment of essential hypertension and hyperaldosteronism. Recently, a new MR antagonist, finerenone, has been launched as a treatment for CKD with type 2 diabetes. In the FIDELIO-DKD study, finerenone significantly reduced the risk of kidney and cardiovascular events in CKD and type 2 diabetes.

Trends and Comparisons of Blood Pressure and Fasting Plasma Glucose in Patients with Hypertension, Diabetes, and Comorbidity: 4-Year Follow-Up Data.

Patients with both diabetes and hypertension could face more health risks than those with either condition alone, and less attention has been paid to their management outcomes, so this study may be the first to specifically address this problem. We aimed to examine the management outcomes of blood pressure (BP) in hypertensive patients with/without diabetes and fasting plasma glucose (FPG) in diabetic patients with/without hypertension. Follow-up data were obtained from the National Basic Public Health Service Project in Sanming (2017-2021). A total of 25,795 adults with hypertension only, 4111 adults with diabetes only, and 5729 comorbid adults (namely, hypertensive patients with diabetes) were included. Generalized estimating equations were applied. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with hypertension only both dropped significantly (Coef. = -0.00088, P < 0.001; Coef. = -0.00081, P < 0.001). DBP in comorbid patients decreased considerably (Coef. = -0.00033, P < 0.001). Pulse pressure in comorbid patients grew rapidly (Coef. = 0.00044, P < 0.001). BP control rate in patients with hypertension only increased significantly (OR = 1.00039, P < 0.001). FPG control rates in diabetic patients with/without hypertension grew markedly (OR = 1.00013, P < 0.001; OR = 1.00020, P < 0.001). Comorbid patients had lower baseline SBP and DBP but higher latest SBP than patients with hypertension only (Coef. = -1.18872, P < 0.001; Coef. = -1.16049, P < 0.001; Coef. = 1.0634, P < 0.001). Comorbid patients had lower baseline BP and FPG control rates than those with either condition alone, and differences were greater at the latest follow-up (OR = 0.28086, P < 0.001; OR = 0.91012, P = 0.049; OR = 0.04020, P < 0.001; OR = 0.69465, P < 0.001). BP and FPG management outcomes have achieved progress. Comorbid patients have poorer performance than patients with either disease alone in BP levels especially the SBP level and control rates of SBP, DBP, and FPG. Future studies should be conducted using national data and include more confounding factors.

Association of nutritional status with clinical outcomes of stroke patients with acute anterior circulation large vessel occlusion after emergency endovascular treatment

To explore the influence of nutritional status on 90-day functional outcomes of stroke patients with acute large vessel occlusion in the anterior circulation after endovascular treatment (EVT). We retrospectively analyzed the baseline, laboratory, surgical and 90-day follow-up data of patients with stroke resulting from acute large vessel occlusion in the anterior circulation, who underwent emergency endovascular treatment in our hospital from July, 2015 to December, 2020. A favorable outcome was defined as a modified Rankin scale score ≤2 at 90 days. Univariate and multivariate regression analyses were performed to explore the relationship between nutritional status and 90-day functional outcomes of the patients. A total of 459 patients (mean age of 68.29±11.21 years, including 260 males) were enrolled in this study. According to their prognostic nutritional index (PNI), the patients were divided into normal nutrition group (392 cases, 85.4%), moderate malnutrition group (44 cases, 9.6%), and severe malnutrition group (23 cases, 5.0%). Univariate analysis showed that the patients with good clinical outcomes had a lower proportion of malnutrition with a younger age, a lower rate of diabetes, lower baseline blood pressure, lower baseline NIHSS score, higher baseline ASPECT score, and higher rates of good collateral circulation and complete vascular recanalization. Multivariate analysis showed that in addition to age, diabetes, baseline systolic blood pressure, successful recanalization, baseline ASPECT score, baseline NIHSS score and collateral circulation, a greater PNI was a protective factor for a good 90-day outcome of patients after EVT (moderate vs severe: OR=0.245, 95% CI: 0.066-0.908, P=0.035; normal vs severe: OR=0.185, 95% CI: 0.059-0.581, P=0.004). Nutritional status an important factor affecting the 90-day outcomes after EVT of stroke patients with acute large vessel occlusion in the anterior circulation.

Intraoperative Hypotension and 30-D Mortality After Liver Transplantation.

Background.Intraoperative hypotension (IOH) is common and associated with mortality in major surgery. Although patients undergoing liver transplantation (LT) have low baseline blood pressure, the relation between blood pressure and mortality in LT is not well studied. We aimed to determine mean arterial pressure (MAP) that was associated with 30-d mortality in LT.Methods.We performed a retrospective cohort study. The data included patient demographics, pertinent preoperative and intraoperative variables, and MAP using various metrics and thresholds. The endpoint was 30-d mortality after LT.Results.One thousand one hundred seventy-eight patients from 2013 to 2020 were included. A majority of patients were exposed to IOH and many for a long period. Eighty-nine patients (7.6%) died within 30 d after LT. The unadjusted analysis showed that predicted mortality was associated with MAP <45 to 60 mm Hg but not MAP <65 mm Hg. The association between MAP and mortality was further tested using adjustment and various duration cutoffs. After adjustment, the shortest durations for MAPs <45, 50, and 55 mm Hg associated with 30-d mortality were 6, 10, and 25 min (odds ratio, 1.911, 1.812, and 1.772; 95% confidence interval, 1.100-3.320, 1.039-3.158, and 1.008-3.114; P = 0.002, 0.036, and 0.047), respectively. Exposure to MAP <60 mm Hg up to 120 min was not associated with increased mortality.Conclusion.In this large retrospective study, we found IOH was common during LT. Intraoperative MAP <55 mm Hg was associated with increased 30-d mortality after LT, and the duration associated with postoperative mortality was shorter with lower MAP than with higher MAP.

Natriuresis During an Acute Intravenous Sodium Chloride Infusion in Conscious Sprague Dawley Rats Is Mediated by a Blood Pressure-Independent α1-Adrenoceptor-Mediated Mechanism.

The mechanisms that sense alterations in total body sodium content to facilitate sodium homeostasis in response to an acute sodium challenge that does not increase blood pressure have not been fully elucidated. We hypothesized that the renal sympathetic nerves are critical to mediate natriuresis via α1- or β-adrenoceptors signal transduction pathways to maintain sodium balance in the face of acute increases in total body sodium content that do not activate the pressure-natriuresis mechanism. To address this hypothesis, we used acute bilateral renal denervation (RDNX), an anteroventral third ventricle (AV3V) lesion and α1- or β-antagonism during an acute 1M NaCl sodium challenge in conscious male Sprague Dawley rats. An acute 1M NaCl infusion did not alter blood pressure and evoked profound natriuresis and sympathoinhibition. Acute bilateral RDNX attenuated the natriuretic and sympathoinhibitory responses evoked by a 1M NaCl infusion [peak natriuresis (μeq/min) sham 14.5 ± 1.3 vs. acute RDNX: 9.2 ± 1.4, p < 0.05; plasma NE (nmol/L) sham control: 44 ± 4 vs. sham 1M NaCl infusion 11 ± 2, p < 0.05; acute RDNX control: 42 ± 6 vs. acute RDNX 1M NaCl infusion 25 ± 3, p < 0.05]. In contrast, an AV3V lesion did not impact the cardiovascular, renal excretory or sympathoinhibitory responses to an acute 1M NaCl infusion. Acute i.v. α1-adrenoceptor antagonism with terazosin evoked a significant drop in baseline blood pressure and significantly attenuated the natriuretic response to a 1M NaCl load [peak natriuresis (μeq/min) saline 17.2 ± 1.4 vs. i.v. terazosin 7.8 ± 2.5, p < 0.05]. In contrast, acute β-adrenoceptor antagonism with i.v. propranolol infusion did not impact the cardiovascular or renal excretory responses to an acute 1M NaCl infusion. Critically, the natriuretic response to an acute 1M NaCl infusion was significantly blunted in rats receiving a s.c. infusion of the α1-adrenoceptor antagonist terazosin at a dose that did not lower baseline blood pressure [peak natriuresis (μeq/min) sc saline: 18 ± 1 vs. sc terazosin 7 ± 2, p < 0.05]. Additionally, a s.c. infusion of the α1-adrenoceptor antagonist terazosin further attenuated the natriuretic response to a 1M NaCl infusion in acutely RDNX animals. Collectively these data indicate a specific role of a blood pressure-independent renal sympathetic nerve-dependent α1-adrenoceptor-mediated pathway in the natriuretic and sympathoinhibitory responses evoked by acute increases in total body sodium.

Effectiveness and Safety of Intravenous Nicorandil Application in Patients With Acute Heart Failure With Low Baseline Blood Pressure

To evaluate the effectiveness and safety of intravenous nicorandil application in patients with acute heart failure (AHF) with low baseline blood pressure (systolic blood pressure <110 mmHg). This prospective, controlled, single-centre study randomised 147 patients with AHF with low baseline blood pressure (including both emergent admission and newly developed low blood pressure while in hospital) to one of the following two groups: (1) control group (conventional diuretics, positive inotropic agents, and related therapy according to the guidelines); and (2) intervention group (intravenous [IV] nicorandil application plus routine care). Dyspnoea severity, the ratio of E to e' (E/e'), the incidence of side effects and adverse events, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, left ventricular ejection fraction (LVEF; left ventricular systolic function) before discharge, average length of hospitalisation, LVEF and soluble suppression of tumorigenicity-2 (sST2) at 3 months after discharge, incidence of major adverse cardiac and cerebrovascular events (MACCE) and readmission rate within 3 months were recorded and compared between the two groups. Compared to the control group, nicorandil relieved dyspnoea effectively and improved E/e' significantly; the level of NT-proBNP was lower, LVEF was higher before discharge, and average length of hospital stay was shorter in the intervention group. After 3 months, the LVEF was higher, sST2 was lower, and the readmission rate was lower in the intervention group; there was no statistically significant difference in MACCE. Patients with AHF with low baseline blood pressure could benefit from IV nicorandil application in the urgent phase, but the long-term profits remained to be confirmed.

989-P: Influence of Baseline Blood Pressure on Associations of Visit-to-Visit Blood Pressure Variability and Cardiovascular Risk: Results from the ACCORD Trial

The extent to which baseline blood pressure (BP) level modifies associations between BP variability and cardiovascular disease (CVD) is underexplored. Thus, we used data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, which consists of individuals with type 2 diabetes (T2D) undergoing glucose and other risk factor management, to assess the relationship of visit-to-visit BP variability (estimated by coefficient of variation - CV) with the primary composite cardiovascular outcome (MACE), major coronary heart disease (CHD), and total stroke. Using time-dependent Cox proportional hazards models (adjusted for randomization arm and other relevant risk factors, including mean systolic or diastolic BP - SBP and DBP), CV-SBP and CV-DBP were associated with MACE and CHD, but not stroke in the whole group (Figure). When stratifying the cohort by baseline BP level, an overall U-shaped pattern of risk with SBP and DBP variability was observed for both MACE and CHD (Figure). Our findings suggest that BP variability is an independent risk factor for CVD, particularly for those with either elevated or low BP. It is possible that BP variability induces CVD via different mechanisms depending on the mean pressure level. Our data further support the importance of individualized BP management in those with T2D.View largeDownload slideView largeDownload slide DisclosureD. S. Nuyujukian: None. J. Zhou: None. J. Koska: None. P. Reaven: Research Support; Self; AstraZeneca, Dexcom, Inc.FundingNational Institutes of Health (R01067690, R01094775)

Effects of the Dietary Approaches to Stop Hypertension Diet and Sodium Reduction on Blood Pressure in Persons With Diabetes.

Elevated blood pressure and blood pressure-related morbidity are extraordinarily common in persons with diabetes. The Dietary Approaches to Stop Hypertension dietary pattern and dietary sodium reduction are recommended as lifestyle interventions in individuals with diabetes. However, these recommendations have largely been based on studies conducted in persons without diabetes. In this review, we summarize available evidence from trials that tested the effects of these 2 dietary interventions on blood pressure in people with diabetes. Overall, of the 3 trials (total n=151) that tested the effects of the Dietary Approaches to Stop Hypertension dietary pattern in persons with diabetes, 2 trials documented that the Dietary Approaches to Stop Hypertension dietary pattern lowered blood pressure. While 16 trials (total n=445) tested the effects of sodium reduction in persons with diabetes, results were inconsistent, likely because of design limitations, for example, brief duration, small sample size, and low baseline blood pressure levels, as well as differences in the mode of intervention delivery (behavioral interventions, feeding studies, and sodium supplements). In conclusion, there is a substantial need for additional research on the blood pressure lowering effects of the Dietary Approaches to Stop Hypertension diet and sodium reduction in people with diabetes and hypertension, given the high prevalence of hypertension and the dearth of high-quality trials in this population.

Increasing prescription of renin-angiotensin-aldosterone system blockers associated with improved kidney prognosis in Korean IgA nephropathy patients.

BackgroundWe aimed to describe the characteristics of immunoglobulin A nephropathy (IgAN) in Korea with assessment for time trends.MethodsWe performed a multicenter retrospective observational cohort study including biopsy-confirmed native IgAN cases from four tertiary hospitals in Korea. Time eras of diagnosis were stratified into 1979–2003, 2004–9 and 2010–17. The prognostic variable was progression to end-stage kidney disease (ESKD) analyzed by multivariable Cox regression analysis.ResultsWe included 1366 (from 1979 to 2003), 1636 (from 2004 to 2009) and 1442 (from 2010 to 2017) IgAN patients in this study. In the recent periods, IgAN had relatively better clinical characteristics, as patients had higher estimated glomerular filtration rates and lower baseline blood pressures than before. The use of renin–angiotensin–aldosterone system (RAAS) blockers increased from 57.7% in 1979–2003 to 80.0% in 2010–17. During a median follow-up duration of 11.3 years, 722 patients progressed to ESKD with an incidence rate of 12.5 per 1000 person-years. The 10-year risk of progression to ESKD was lower in 2010–17 compared with that of 1979–2003 [adjusted hazard ratio 0.692 (95% confidence interval 0.523–0.915)], even after adjustment for multiple clinicopathologic characteristics. The use of RAAS blockers was a significant mediator (P < 0.001) for the association between time trends and lower 10-year ESKD risk.ConclusionsClinicopathologic characteristics of IgAN in Korea have changed over time. Although the limitation of a retrospective observational study remains, the result showed that the prognosis of IgAN has improved over the study period, possibly related to increased prescription of RAAS blockers.

1416-P: Blood Pressure Variability and Risk of Heart Failure Events in ACCORD and the VADT

We examined the relationship between blood pressure variability and risk of heart failure (HF) in two cohorts of type 2 diabetes (T2D) participating in trials of glucose and/or other risk factor management. Data were drawn from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and the Veterans Affairs Diabetes Trial (VADT). Coefficient of variation (CV) and average real variability (ARV) were calculated for systolic (SBP) and diastolic blood pressure (DBP) along with maximum and cumulative mean SBP and DBP during both trials. In ACCORD (Table), CV and ARV of SBP and DBP were associated with increased risk of HF, even after adjusting for other risk factors and mean blood pressure (e.g., CV-SBP: HR=1.15, p = 0.01; CV-DBP: HR=1.18, p = 0.003). In the VADT, DBP variability was associated with increased risk of HF (ARV-DBP: HR=1.16, p = 0.001; CV-DBP: HR=1.09, p = 0.04). Further, in ACCORD, those with progressively lower baseline blood pressure demonstrated a stepwise increase in risk of HF with higher CV-SBP, ARV-SBP, and CV-DBP (e.g., for CV-SBP: those with baseline SBP ≥ 140, &amp;lt; 140, &amp;lt; 130 and &amp;lt; 120 mmHg, respectively had the following HRs; 1.03, 1.21, 1.50, and 1.69). Blood pressure variability is independently associated with HF risk and this relationship is most robust at low blood pressure in individuals with T2D. These results may have implications for optimizing blood pressure treatment strategies in those with T2D. Disclosure D.S. Nuyujukian: None. J. Koska: None. P. Reaven: Consultant; Self; Boston Heart Diagnostics, Intercept Pharmaceuticals, Inc. Research Support; Self; Bristol-Myers Squibb, Lysulin. J. Zhou: None. Funding National Institutes of Health (R01067690, R01094775)

1198Women and non-diabetic patients react more strongly to radiofrequency renal sympathetic denervation

Abstract Background/Introduction Three recently published sham-controlled studies proved the efficacy of renal denervation (RDN) in hypertensive patients. However, there it is still unclear which patients should be selected for RDN. Purpose This study seeks to clarify which patient subgroups benefit most from radiofrequency RDN by analysing a nationwide multicentre registry database. Methods This is a post-hoc analysis from the multicentre Austrian Transcatheter Renal Denervation Registry hosted by the Austrian Society of Hypertension. We correlated change of systolic blood pressure (BP) after RDN to gender and presence/absence of comorbidities. Bivariate correlation and multiple linear regression analyses were performed. Results 291 patients (43% female, median age 64 years) undergoing RDN between April 2011 and September 2014 were included in this analysis. Mean baseline ambulatory 24-hour BP (systolic/diastolic) was 150±18/89±14 mmHg and mean baseline office BP was 170±16/94±14 mmHg. After RDN, mean ambulatory 24-hour BP reduction was 9±19/6±16 mmHg. The following features were associated with a good response to RDN: high baseline systolic ambulatory BP (ρ=0.53, p&lt;0.001), high baseline diastolic office BP (ρ=0.40, p&lt;0.001), female gender (ρ=0.10, p=0.049), absence of diabetes mellitus (DM, ρ=0.11, p=0.033), and absence of peripheral arterial disease (ρ=0.17, p=0.002). Multivariate analysis identified high baseline systolic ambulatory BP, female gender and absence of DM as independent predictors for systolic ambulatory BP reduction (systolic ambulatory BP: HR 5.83 [95% CI 4.83–6.83], p&lt;0.001; absence of DM: HR 5.82 [2.04–9.60], p=0.003; female gender: HR 5.07 [1.46–8.68], p=0.006), although women and patients without DM had lowest baseline ambulatory BP. Furthermore, both women and patients without DM used significantly less antihypertensives after RDN (female vs male: 4.0±1.3 vs 4.4±1.3, p=0.002; no DM vs DM: 4.0±1.3 vs 4.6±1.3, p&lt;0.001). Figure 1 Discussion Ambulatory BP reductions after RDN were substantially more pronounced in female and in non-diabetic patients despite lower baseline BP. It is concluded that in terms of efficacy female patients and non-diabetics might be more suitable for RDN. Acknowledgement/Funding The Austrian Renal Denervation Registry was funded by the Austrian Society of Hypertension.

Device-guided slow breathing reduces blood pressure and sympathetic activity in young normotensive individuals of both sexes.

Slow breathing (SLOWB) is recommended for use as an adjuvant treatment for hypertension. However, the extent to which blood pressure (BP) responses to SLOWB differ between men and women are not well-established. Therefore, we tested the hypothesis that an acute bout of SLOWB would induce larger decreases in BP in males than in females, given that males typically have higher resting BP. We also examined autonomic contributors to reduced BP during SLOWB; that is, muscle sympathetic nerve activity and spontaneous cardiovagal (sequence method) and vascular sympathetic baroreflex sensitivity. We tested normotensive females (n = 10, age: 22 ± 2 y, body mass index: 22 ± 2 kg/m2) and males (n = 12, age: 23 ± 3 y, body mass index: 26 ± 4 kg/m2). Subjects were tested at baseline and during the last 5 min of a 15-min RESPeRATE-guided SLOWB session. Overall, SLOWB reduced systolic BP by 3.2 ± 0.8 mmHg (main effect, P < 0.01). Females had lower systolic BP (main effect, P = 0.02); we observed no interaction between sex and SLOWB. SLOWB also reduced muscle sympathetic nerve activity burst incidence by -5.0 ± 1.4 bursts/100 heartbeats (main effect, P < 0.01). Although females tended to have lower burst incidence (main effect, P = 0.1), there was no interaction between sex and SLOWB. Cardiovagal baroreflex sensitivity improved during SLOWB (21.0 vs. 36.0 ms/mmHg, P = 0.03) with no effect of sex. Despite lower overall BP in females, our data support a lack of basement effect on SLOWB-induced reductions in BP, as SLOWB was equally effective in reducing BP in males and females. Our findings support the efficacy of the RESPeRATE device for reducing BP in both sexes, even in young, normotensive individuals.NEW & NOTEWORTHY We provide support for the effectiveness of device-guided slow breathing for blood pressure reduction in young normotensive women and men. Despite having lower baseline blood pressure and sympathetic nerve activity, women experienced equivalent reductions in both measures in response to RESPeRATE-guided slow breathing as men. Thus, slow breathing appears to be effective in young healthy normotensive individuals of both sexes and may be an ideal preventative therapy against future hypertension.

Is resistant hypertension an independent predictor of all-cause mortality in individuals with type 2 diabetes? A prospective cohort study

BackgroundResistant hypertension is independently associated with an increased risk of death in the general hypertensive population. We assessed whether resistant hypertension is an independent predictor of all-cause mortality in individuals with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicentre Study.MethodsOn 31 October 2015, vital status information was retrieved for 15,656 of the 15,773 participants enrolled in 2006–2008. Based on baseline blood pressure (BP) values and treatment, participants were categorized as normotensive, untreated hypertensive, controlled hypertensive (i.e., on-target with < 3 drugs), uncontrolled hypertensive (i.e., not on-target with 1–2 drugs), or resistant hypertensive (i.e., uncontrolled with > 3 drugs or controlled with > 4 drugs). Kaplan–Meier and Cox proportional hazards regression analyses were used to assess the association with all-cause mortality.ResultsUsing the 130/80 mmHg targets for categorization, crude mortality rates and Kaplan–Meier estimates were highest among resistant hypertension participants, especially those with controlled resistant hypertension. As compared with resistant hypertension, risk for all-cause mortality was significantly lower for all the other groups, including individuals with controlled hypertension (hazard ratio 0.81 [95% confidence interval 0.74–0.89], P < 0.0001), but became progressively similar between resistant and controlled hypertension after adjustment for cardiovascular risk factors and complications/comorbidities. Also when compared with controlled resistant hypertension, mortality risk was significantly lower for all the other groups, including controlled hypertension, even after adjusting for cardiovascular risk factors (0.77 [0.63–0.95], P = 0.012), but not for complications/comorbidities (0.88 [0.72–1.08], P = 0.216). BP was well below target in the controlled hypertensive groups (resistant and non-resistant) and values < 120/70 mmHg were associated with an increased mortality risk. Results changed only partly when using the 140/90 mmHg targets for categorization.ConclusionsIn the RIACE cohort, at variance with the general hypertensive population, resistant hypertension did not predict death beyond target organ damage. Our findings may be explained by the high mortality risk conferred by type 2 diabetes and the low BP values observed in controlled hypertensive patients, which may mask risk associated with resistant hypertension. Less stringent BP goals may be preferable in high-risk patients with type 2 diabetes.Trial registrationClinicalTrials.gov, NCT00715481, retrospectively registered 15 July, 2008.

Use of levosimendan in acute heart failure.

As a calcium sensitizer and inodilator that augments cardiac contractility without increasing myocardial oxygen demand or exacerbating ischaemia, levosimendan may be well configured to deliver inotropic support in cases of acute heart failure (AHF). Other factors favouring levosimendan in this setting include its extended duration of action due to the formation of an active metabolite and the lack of any attenuation of effect in patients treated with beta-blockers. Effects of levosimendan on systemic haemodynamics include its significant, dose-dependent increases in cardiac output, stroke volume and heart rate, and decreases in right and left ventricular filling and total peripheral resistance. Rapid and sustained reduction in levels of natriuretic peptides is a consistent effect of levosimendan use and potentially favourable effects on other neurohormonal indicators of cardiac distress are also observed. Levosimendan has repeatedly been shown to be effective in relief of symptoms of AHF, notably dyspnoea and fatigue, while mortality data from clinical trials and registries suggest that levosimendan is markedly less likely than catecholaminergic inotropes to worsen prognosis. The vasodilator pharmacology of levosimendan is also pertinent to the drug’s use in AHF, in which setting organ under-perfusion is often a key pathology. These considerations suggest that levosimendan may have a more favourable impact on the circumstances of the majority of AHF patients than adrenergic agents that act only or primarily as cardiac stimulants. They also suggest that levosimendan may advantageously be integrated into a comprehensive strategy of early intervention designed and intended to prevent cardiac destabilization worsening to the point where hospitalization is necessary. Levosimendan should be used with caution and with tightened haemodynamic monitoring in patients who have low baseline blood pressure (systolic blood pressure <100 mmHg; diastolic blood pressure <60 mmHg), or who are at risk of a hypotensive episode.

Percentage of free fat mass is associated with elevated blood pressure in healthy Chinese children.

Previous studies have reported that a high free fat mass (FFM) was associated with elevated blood pressure in children. However, the observed relationship could be confounded by body weight. Thus, we performed cross-sectional analyses to understand the differences between the percentage of free fat mass (FFM%) and FFM in relation to blood pressure in healthy Chinese children. A total number of 2671 (1264 girls; aged 6-14 years) healthy Chinese children was recruited in 2014 (baseline). We further prospectively examined whether these indices predicted hypertension risk during the 2 years of follow-up (2014-2016) among 2094 participants who were free of hypertension at the baseline. Blood pressure was repeatedly measured in 2014, 2015 and 2016. Hypertension was defined as either high systolic blood pressure and/or high diastolic blood pressure (≥age- and sex-specific 95th percentile for Chinese children). The baseline FFM was assessed by bio-impedance analysis, and FFM% was calculated as FFM divided by the body weight. A high FFM was associated with a high baseline blood pressure and high hypertension risk after adjustment for potential confounders (all p < 0.001). By contrast, a high FFM% was associated with a low baseline blood pressure and low hypertension risk in the fully adjusted model (all p < 0.001). Each one-percent increment of FFM% was associated with a 9% lower risk of developing hypertension (adjusted hazard ratio = 0.91; 95% confidence interval: 0.89, 0.94). A high FFM% was associated with a low blood pressure and low hypertension risk in healthy Chinese children.

Abstract P350: Early Signs of Stress Induced Arterial Hypertension During Cardiopulmonary Testing and Advantages in Cardiac Risk Lowering

Goal: to study early signs and hypertension reaction features during cardiopulmonary exercise testing (CPET) in intellectually working men with rare episodes of stress induced blood pressure (BP) increase. Methods: 47 patients (pats) with periodic episodes of high BP due to high level of stress were included (all men, 42 ± 4.6 years old). Risk factors: smoking had 83% of pats, high cholesterol level 87%, glucose intolerance 39%, family history of high BP 14%. All pats had normal BMI and no signs of visceral fat and target organ damage, 54% used hypotensive therapy non-systemically, 98% complained for sleep disorders. CPET was done for optimal training regime appointment. Baseline BP was 134± 2,8 mm Hg. Most of the pats demonstrated low physical tolerance level (6,7±0.4 MET). All patients demonstrated hypertensive reaction during test, and that was the reason for test stop. 68% of pats demonstrated systolic BP 220 mm Hg at respiratory compensation point (RCP) and RER 1,17 ± 0.01, 32% of pats demonstrated it earlier than RCP and at RER 0.85± 0.06. All pats got recommendations with optimal physical and pulse regime for training. All the patients had 3 ± 1 moderate intensive aerobic training per week for 34 ± 10.7 min. Results: in 6 months all the patients demonstrated increase in physical tolerance (ΔVO2 5,3 ±1,3 ml/kg/min). Patients with hypertension reaction at RCP showed significantly lower baseline BP (124.6± 3.5mm Hg vs 131.2 ± 4.1 mm Hg in other patients, p &lt;0.05), only 14% demonstrated hypertensive reaction during CPET vs 89% in other patients, p &lt;0.05 and mentioned less hypertension episodes during 6 months (7 ± 3 episodes vs 24 ± 2, p &lt;0.05). 96% pats of this group demonstrated higher level of physical tolerance (load 9,8 ± 0.3 MET vs 7.6± 1.1 MET, p &lt;0,05). Also, they didn't show abnormalities in glucose intolerance test. Conclusion: hypertension reaction at RCP during CPET in intellectually working man with episodic stress induced increase of blood pressure can be a predictor of great benefit in life style modification, cardiac risk lowering and arterial hypertension control

Celiac Autoimmunity Is Associated With Lower Blood Pressure and Renal Risk in Type 1 Diabetes.

Though the long-term consequences of celiac disease (CD) in type 1 diabetes are unclear, CD has been associated with increased prevalence of end-stage renal disease (ESRD) independent of type 1 diabetes. We evaluated whether celiac autoimmunity is related to the cumulative incidence of microalbuminuria [albumin excretion rate (AER) 20 to 200 µg/min], macroalbuminuria (AER >200 µg/min), and ESRD. In the prospective follow-up of the Pittsburgh Epidemiology of Diabetes Complications study of childhood-onset type 1 diabetes, 618 participants were screened for tissue transglutaminase (tTG) antibodies with a clinical assay. Nephropathy outcomes were determined at 25 years of diabetes duration. Overall, the 33 subjects (5.3%) with strongly positive tTG levels (≥3 times the upper limit of normal) or a reported clinical history of CD had lower baseline blood pressure and lipid values. At 25 years of diabetes duration, a lower cumulative incidence of macroalbuminuria in strongly positive subjects compared with those with negative serology (3.6% vs 30.0%; P = 0.003) remained significant after adjustment for age, HbA1c, lipid measures, and blood pressure (adjusted P = 0.004). No considerable differences between these subjects and tTG-negative groups were found for microalbuminuria (40.0% vs 57.1%) or ESRD (0 vs 4.1%). These findings show that strongly positive celiac autoimmunity status in individuals with childhood-onset type 1 diabetes is associated with lower baseline blood pressure and cholesterol measurements as well as lower macroalbuminuria risk after 25 years of type 1 diabetes duration with no increase in the risk of microalbuminuria or ESRD.

Acute visual loss in a patient with spinal cord injury.

Patients with spinal cord injury (SCI), especially those with injury at and above T6, are prone to transient episodes of hypertension induced by noxious triggers below the level of SCI, known as autonomic dysreflexia (AD). An uncommonly reported presentation of AD is posterior reversible encephalopathy syndrome (PRES). A 50-year-old male with the history of paraplegia from SCI presented with sepsis secondary to baclofen pump and urinary tract infections. On hospital day 4, he developed acute bilateral vision loss. The next morning he had a generalized-tonic-clonic seizure followed by cardiac arrest, with return of spontaneous circulation following resuscitation. Magnetic resonance imaging brain demonstrated multifocal areas of hyperintensity on T2 fluid-attenuated inversion recovery sequence, most pronounced in the occipital lobes. Systolic blood pressures (SBP) were under 180 mmHg throughout hospital stay but above his baseline (SBP 90 mmHg). PRES was diagnosed on the basis of clinical and radiologic evidence. With strict blood pressure (BP) control, there was resolution of visual abnormalities, headaches, encephalopathy, and seizures. Although PRES has been most commonly described in malignant hypertension, it can be seen in patients with normotension or moderate hypertension who have low baseline BPs, such as patients with SCI. These patients are prone to AD due to imbalanced sympathetic outflow to vasculature below the level of injury caused by noxious stimulus. This results in massive regional vasoconstriction leading to an uncontrolled rise in BP above baseline. This episode of PRES could have been prevented by identifying patient's risk, recognizing early signs and potential triggers of AD, and implementing aggressive treatment of the underlying noxious stimuli.