Mean Systolic Blood Pressure Research Articles

Effectiveness and safety of hydrogen inhalation therapy as an additional treatment for hypertension in real-world practice: a retrospective, observational study in China

AimTo evaluate the real-life effectiveness and safety of hydrogen inhalation (HI) therapy as an additional treatment in Chinese adults with hypertension.MethodsThis observational, retrospective clinical study included hypertensive patients receiving routine antihypertensives with or without HI initiation from 2018 to 2023. Participants were assigned to the HI group or non-HI group (control group) after propensity score matching. The changes in mean systolic blood pressure (SBP) level during the 24-week follow-up period in different groups were examined primarily. The secondary outcome was the changes in diastolic blood pressure (DBP) and blood pressure (BP) control rate during the study. Several subgroup and sensitivity analyses were performed to confirm the robustness of our main findings. Adverse event (AE) was also assessed in patients of both groups.ResultsIn total, we selected 2,364 patients into the analysis. Both mean SBP and DBP levels significantly decreased in the HI group compared to control group at each follow-up visit with the between group difference of −4.63 mm Hg (95% CI, −6.51 to −2.74) at week 8, −6.69 mm Hg (95% CI, −8.54 to −4.85) at week 16, −7.81 mm Hg (95% CI, −9.57 to −6.04) at week 24 for SBP, and −1.83 mm Hg (95% CI, −3.21 to −0.45) at week 8, −2.57 mm Hg (95% CI, −3.97 to −1.17) at week 16, −2.89 mm Hg (95% CI, −4.24 to −1.54) at week 24 for DBP. Patients in the HI group were more likely to attain controlled BP at the follow-up period with odds ratio of 1.44 (95% CI, 1.21–1.72) at week 8, 1.90 (95% CI, 1.59–2.27) at week 16, and 2.24 (95% CI, 1.87–2.68) at the end. The trends of subgroup and sensitivity analyses were mostly consistent with the main analysis. The incidences of AEs were similar between the HI group and control group with all p-value >0.05.ConclusionThe HI therapy is related to significant amelioration in BP levels with acceptable safety profile in Chinese hypertensive adults after 24 weeks of treatment, building a clinical ground for further research to evaluate the antihypertensive effect of HI therapy.

Abstract 4124518: Recent Trends in Cardiovascular Risk Factors in Latin America and the Caribbean: The Rising Threat of a Cardiometabolic Epidemics

Introduction: The sociodemographic context of population growth and ageing, social disparities and the high level of urbanisation in Latin America and the Caribbean (LAC) provide a unique entry point to reflect on the impact of cardiovascular diseases (CVD) on populations. Our objective was to evaluate recent trends in cardiovascular risk factors (CVRF) in LAC to inform the development of potential solutions to address CVD in LAC. Methods: Using data from the “NCD Risk Factor Collaboration (NCD-Risc)” available for public consultation, we evaluated trends in the main CVRFs in LAC from 1990 to 2016-2020, namely: systolic blood pressure (SBP) in mmHg, total cholesterol (TC) in mmol/ml, body mass index (BMI) in average kg/m2 and prevalence of diabetes. NCD Risc compiles and harmonises data from studies representative of populations from various countries around the world. Data on the estimated prevalence of smoking in the region come from the “Global Burden of Diseases” study. Data are presented standardised by age to allow comparison of different periods, given that the age distribution of the population varied. Results: The CVRFs that showed favourable trends in LAC in recent decades were: smoking, mean SBP and TC. The prevalence of smoking fell from 69% to 17% for men and 67.6% to 7.6% for women, reducing the CVD risk attributable to tobacco by 34%. Mean SBP fell from 130 mmHg to 129 mmHg for men and 127 mmHg to 122 mmHg for women. The mean CT reduced from 4.7 mmol/L to 4.6 mmol/L for men and 4.8 mmol/L to 4.7 mmol/L for women. Obesity and diabetes showed unfavourable trends. The average BMI increased from 23.0 kg/m2 to 26.8 kg/m2 for men and from 23.0 kg/m2 to 27.5 kg/m2 for women, with the prevalence of obesity increasing from 3% to 11% in men and from 6% to 15% in women. The prevalence of diabetes followed this pattern and increased from 5.4% to 8.8% for men and from 5.8% to 9.6% for women. Conclusion: CVRF trends are heterogeneous and demonstrate success for policies aimed at CVRF, such as high blood pressure and smoking. However, the trends reveal that the problem in the coming decades will be the rise in obesity and its consequences, which may reverse favourable trends in CVD mortality risk in LAC. Population and individual strategies, considering the social determinants of health, need to be planned, such as taxation of ultra-processed foods and campaigns to encourage physical activity.

Abstract 4116298: Once Weekly Utreglutide (GL0034), a Glucagon-like Peptide-1 Receptor Agonist, at 4 × 450 µg Doses Reduces Blood Pressure, Lipids, and Body Weight in Post-menopausal Females: A Phase I Study

Background: Utreglutide (GL0034), a novel, once weekly glucagon-like peptide-1 receptor agonist (GLP-1RA), previously demonstrated significant reductions in body weight (BW) after a single dose ascending study in individuals with obesity . BW reductions after pharmacological treatment of obesity with GLP-1RA is associated with blood pressure (BP) lowering effects. Aim: This phase I study assessed the safety, tolerability, and cardio-metabolic effects of utreglutide after multiple ascending doses in post-menopausal female volunteers with overweight and obesity. Methods: In this randomized, double-blind, placebo-controlled study 12 post-menopausal female volunteers with overweight/obesity, aged 18 to 65 years old with a body mass index (BMI) ≥26 kg/m 2 were randomized (9:3) to subcutaneous utreglutide fixed doses (4 × 450 µg); or placebo once weekly for four weeks. Safety, tolerability, and key cardio-metabolic parameters were assessed. Biomarker measurements included oral glucose tolerance test (OGTT) insulin and glucose area under the curve (AUC), systolic- and diastolic BP, lipid profile (triglycerides (TG), total cholesterol (TC), low density lipoprotein (LDL), and non-high-density lipoprotein (non-HDL), creatinine, potassium, BW and leptin. Results: Utreglutide was generally well tolerated and related adverse effects were mainly gastrointestinal with dose-dependent nausea, vomiting and decreased appetite. Reductions in OGTT AUCs of insulin ( p <0.05) and glucose ( p <0.01) were noted on Day 23 after four weeks treatment with Utreglutide. This was accompanied by a decrease ( p <0.001) in mean systolic and diastolic BP on Day 23 from baseline (BL). On Day 23, significant reductions in TC ( p <0.01), LDL ( p <0.05) and non-HDL ( p <0.05) were observed. BW reduction versus BL ( p <0.001) was 2.0 kg and 1.8 kg respectively on Day 29 and End of Study (EoS). Leptin levels significantly reduced from BL on Day 23 ( p< 0.01) and EoS ( p <0.001). No significant changes were observed for TG, creatinine and potassium (Table). Conclusions: Once weekly utreglutide dosing for four weeks at a dose of 450 µg in post-menopausal females with overweight and obesity, demonstrated clinically relevant reductions of systolic and diastolic BP. This was associated with improved performance of OGTT AUC of insulin and glucose, lipids, BW and leptin with an overall good tolerability and with potential to demonstrate cardio-metabolic benefits.

Abstract 4141472: Birthweight is Associated with Left Ventricular Mass Index in Childhood

Introduction/Background: Increased left ventricular mass (LVM) is a risk factor for adult CV disease and is associated with cardiac development in utero. Associations of birthweight with LVM have been demonstrated in young children and adolescence, however, the association between birth weight and LVM in mid-childhood is not well described. Research Questions/Hypothesis: Utilizing an existing longitudinal data set of healthy children, we aimed to determine the association of birthweight to increased LVM at 6-8 years of age. Methods/Approach: A longitudinal cohort of 372 term-born children was enrolled at age 3 and followed until age 6-8 years. Anthropometrics, echocardiography, and maternal recall of birth weight were collected. LVM from echocardiography was indexed to height 2.7 . Multiple linear regression analysis was performed to assess the association of birthweight with LVM index at 6-8 years of age, adjusting for race, sex, body mass index (BMI) z-score, and systolic blood pressure (SBP) percentile collected at the time of echocardiography. Results: 303 children were included in the analysis (21.5% Black and 88.5% White, mean age 7.4 ± 0.3 years at the time of echocardiography, mean birthweight 3.4 ± 0.6 kg, mean SBP percentile 42.7 ± 21.6 percentile). Greater birthweight significantly contributed to greater LVM index (1.2 ± 0.6, p = 0.03), along with Black race (1.9 ± 0.8, p = 0.02) and greater current BMI z-score (2.1 ± 0.3, p < 0.01). Sex and SBP percentile were included in the model but were not significantly related to LVM index (p = 0.23 and 0.51 respectively) in this analysis. Conclusions: Greater birthweight is significantly associated with greater left ventricular mass in childhood, independent of BMI z-score at the time of echocardiography. This suggests a critical period in fetal cardiac development that affects cardiac structure in mid-childhood.

Patient-specific multifactorial mortality risk assessment using classification and regression tree analysis in the context of ambulatory blood pressure monitoring.

Ambulatory blood pressure monitoring is essential for understanding blood pressure patterns beyond clinical visits, aiding in risk assessment, treatment evaluation, and managing hypertension. This retrospective cohort study aimed to identify risk factors for all-cause mortality and major cardiovascular events in patients who underwent ambulatory blood pressure monitoring. Eligible participants aged 18 or older, with an estimated glomerular filtration rate (eGFR) > 60ml/min/1.73m2, who underwent ambulatory blood pressure monitoring for various reasons, were included in the study. Data were gathered through telephone interviews, electronic health records, and the national health record system. Descriptive analysis and classification and regression tree modeling were used to uncover significant risk factors related to all-cause mortality and cardiovascular events, and to assess the model's performance compared to traditional Cox survival analysis. The study included 1291 patients, primarily male (51.8%) with a mean age of 61.1 ± 15.2years. During a mean follow-up of 46.9months, 76 (5.9%) patients died of any cause, and 195 (15.1%) had a cardiovascular event. The highest survival rates were observed in patients with a diastolic blood pressure (BP) dipping percentage between -2% and 29%, nighttime systolic BP variability below 32mmHg, and age below 72. Conversely, smokers with a diastolic BP dipping percentage below -10% showed the lowest survival rates. The best cardiovascular outcomes were observed in patients with diastolic BP dipping above -11%, nighttime mean systolic BP < 144mmHg, no statin use, normotensive status, and daytime mean heart rate ≥ 60bpm. Conversely, the worst outcomes were seen in patients with diastolic BP dipping below -11% and a morning surge ≥ 14mmHg. In all-cause mortality and cardiovascular event analysis, the combined model demonstrated excellent calibration and predictive power, like the classification and regression tree model and traditional analysis. These findings highlight the potential of a combined model for assessing mortality and cardiovascular event risk in patients who have undergone ambulatory blood pressure monitoring.

Efficacy of Olmesartan/Amlodipine Single-Pill Combination on 24-h Mean Systolic Blood Pressure Measured by Ambulatory Monitoring in Non-Responders to Valsartan or Candesartan Monotherapy.

The aim of this study was to evaluate the efficacy of olmesartan/amlodipine (OLM/AML) single-pill combination (SPC) therapy using ambulatory blood pressure monitoring (ABPM) in non-responders to valsartan or candesartan monotherapy. Isolated systolic hypertension (ISH) is the most prevalent form of hypertension in middle-aged and elderly individuals. Patients aged over 55 years who did not achieve the target systolic blood pressure (SBP < 140mmHg) with valsartan 80mg or candesartan 8mg for at least 4 weeks were included. Doses were escalated from 20/5mg to 40/5mg and finally to 40/10mg of OLM/AML SPC until patients reached the target SBP. Efficacy was assessed via ABPM by comparing baseline values with those in the 12th week. Office blood pressure (OBP) and brachial-ankle pulse wave velocity (baPWV) were assessed at baseline, weeks 4, 8, and 12. Fifty-four patients (average age 64 ± 6 years; 33 males) participated. The 24-h mean BPs decreased significantly from an average of 146.2 ± 12.7/93.3 ± 9.2mmHg to 129.7 ± 14.3/83.4 ± 10.7mmHg (p < 0.001), and pulse pressures (PPs) from ABPM were reduced (p < 0.001). Additionally, significant reductions in night-time SBP standard deviations (SDs) (14.7 ± 4.7vs. 12.5 ± 3.9, p = 0.029) were observed at 12 weeks compared to baseline. OBPs significantly dropped from 151.1 ± 9.7/89.3 ± 8.3mmHg to 125.5 ± 13.8/77.8 ± 8.8mmHg after 12 weeks of SPC therapy (p < 0.001). Reductions in PPs of OBP and baPWVs were also observed. OLM/AML SPC therapy effectively reduced the 24-h mean BP, as measured by ABPM, in hypertensive patients over 55 years old who failed to achieve a target SBP (< 140mmHg) with angiotensin receptor blocker (ARB) monotherapy using valsartan 80mg or candesartan 8mg. Trial Registration: ClinicalTrials.gov identifier: NCT01713920.

Adherence to antihypertensive medications in Omani patients: a comparison of drug biochemical analysis and the Morisky Medication Adherence Scale.

Medication nonadherence is a major risk factor for suboptimal or failed hypertension pharmacologic therapy. To determine the nonadherence rate to antihypertensive medications using high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) and the self-reported Morisky Medication Adherence Scale (MMAS). This study used a prospective cross-sectional cohort design. Patients with hypertension aged ≥18 years and prescribed at least one antihypertensive medication were recruited from an outpatient hypertensive clinic at a tertiary healthcare institution in Oman. Adherence was assessed using LC-MS/MS urine analysis and the MMAS. In total, 162 patients completed the MMAS questionnaire and provided urine samples for LC-MS/MS analysis. The overall mean age of the cohort was 55 ± 13 years, and 57% of the patients were men. The mean systolic and diastolic blood pressures were 146 ± 18 mmHg and 79 ± 10 mmHg, respectively. Using the MMAS method, 65% of the patients reported nonadherence. However, LC-MS/MS analysis revealed that only 27% of the patients were nonadherent. The adherent group by LC-MS/MS had significantly lower systolic (P = 0.026) and diastolic blood pressures (P < 0.001) than the nonadherent group, whereas no differences were observed using the MMAS method. There was weak or no agreement between the MMAS and LC-MS/MS results (P = 0.142). Almost one-fourth of our patients with hypertension were nonadherent to their medications. There was a weak concordance between the MMAS and LC-MS/MS methods in detecting medication nonadherence. Further research into noninvasive convenient adherence scales or methods and their correlations with LC-MS/MS analysis is warranted.

Second-trimester Uterine Artery Doppler Pulsatility Index in Singleton Pregnant Women with and without Risk of Pre-eclampsia

Background: Preeclampsia (PE) is gestational hypertension and one of the most serious disorders in pregnant women. Objective: This study aimed to compare second-trimester uterine artery Doppler pulsatility index (UAPI) in singleton pregnant women with and without risk of PE. Methods: A case-control study was carried out among 200 singleton pregnant women in the second trimester of pregnancy, who were referred to Imam Hospital in Ahvaz (Iran). The data were recorded on their demographic, obstetric, clinical characteristics, and Doppler indices. The average UA-PI value was considered as the mean PI between the right and left arteries. Women who were categorized into Groups 1 and 2 had a moderate-high and low risk of PE, respectively. Results: The mean UA-PI, right UA-PI, left UA-PI, systolic and diastolic blood pressures (BP), age, body mass index (BMI), and abdominal circumference (AC) of women in Group 1 were significantly higher than those in Group 2 (p&lt;0.05). Furthermore, Group 1 had a higher frequency of abortions, comorbidities, abnormal UA Doppler results, and nulliparous women than Group 2 (p&lt;0.05). Based on maternal age (&lt;35, ≥35), BMI (&lt;25, ≥25), comorbidities (yes, no), and nulliparity (yes, no) categories, those who were in Group 1 had a significantly higher mean systolic and diastolic BP, UA-PI, right UA-PI, and left UA-PI than their counterparts in Group 2 (P&lt;0.001). Conclusion: This study declared the second-trimester UA-PI had good potential for timely prediction of PE risk in pregnant women.

Epidemiological Profile and Correlates for Left Ventricular Diastolic Dysfunction among Patients Attending a Tertiary Health Facility in India

Background: There is an increasing recognition that congestive heart failure (CHF), caused by diastolic dysfunction (DD) (diastolic heart failure), is common and causes significant morbidity and mortality. Methods: The institution-based cross-sectional study was conducted among 119 subjects to determine the epidemiological profile, and regression analysis was used to evaluate the association of clinico-social correlates with the likelihood of developing DD. Result: The mean age of subjects was 51.6(±17.7) years. The mean systolic (SBP) and diastolic blood pressures (DBP) were 130(±18.9) mm Hg and 82.1(±11.1) mm Hg, respectively. Thirty-three (27.7%) subjects were hypertensive. Twelve (10%) were diabetic and experienced heart failure. DD was present in 54 (45.4%) subjects. Age, diabetes, ejection fraction (EF), and interventricular septal thickness in diastole (IVSd) were significant (P &lt; 0.05) correlates of DD. Mean values of age, body mass index (BMI), EF, IVSd, and left ventricular posterior wall thickness in diastole (LVPWD) were higher in subjects with DD. Hypertension contributed to 1.63 times greater odds of developing DD. Conclusion: The prevalence of DD increased with age among hypertensive and diabetic participants. Preventive strategies directed toward identifying subclinical signs of early stage and aggressive blood pressure and blood sugar control are likely to offer the greatest promise for reducing the incidence of DD.

Overall and linked blood pressure variabilities in the first 24 hours and mortality after spontaneous intracerebral hemorrhage: a retrospective study of 1,036 patients.

This study aims to establish the individual contributions of blood pressure variability (BPV) indexes, categorized into overall and linked variability, to mortality following intracerebral hemorrhage (ICH) by examining the risk factors. Patients with spontaneous ICH (n = 1,036) were identified with valid blood pressures (BP) from the first 24-h systolic BP records in the Medical Information Mart for Intensive Care IV version 2.2 database (MIMIC IV). Information on the baseline characteristics, including age, sex, initial Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) scores, ICH location, Charlson comorbidity index score, and presence of diabetes with or without complications, were collected. Three indexes of BPV-range, standard deviation (SD), and generalized BPV (GBPV)-were calculated using the first 24-h systolic BPs. An automated stepwise variable-selection procedure was used to develop the final logistic model for predicting in-hospital mortality. Out of 1,036 patients, 802 (77.4%) survived and were discharged after spontaneous ICH. Factors associated with mortality included age; male sex; ICH in the brainstem, ventricle, or multiple locations; low GCS score (< 9); high NIHSS score (> 20); and diabetes with complications. Mean systolic BP, SD, and GBPV were also linked to mortality. Higher GBPV notably increased the risk of in-hospital death, with an odds ratio of 3.21 (95% confidence interval, 2.10 to 4.97) for every + 10 mmHg/h change in GBPV. This study underscores the additional impact of GBPV, herein linked to BPV, on mortality following ICH, providing further insights into the management of blood pressure in the early stages of ICH treatment.

Impact of Haemodialysis: Analysis of Haemoglobin Levels and Blood Pressure Control in Patients with End-Stage Renal Disease

Aims: To analyze the effect of hemodialysis on hemoglobin levels and blood pressure in patients with End Stage Renal Disease (ESRD). Method: The study used a one-group pretest-posttest design with 17 respondents. Data were collected using EDTA tubes, sphygmomanometers, and stethoscopes. A paired t-test and Wilcoxon signed-rank test were applied to analyze the significance of changes between pretest and posttest results Results: The mean hemoglobin level before hemodialysis was 7.92 g/dL and increased to 8.50 g/dL after hemodialysis (p = 0.001). The mean systolic blood pressure decreased from 136.6 mmHg before to 124.0 mmHg after hemodialysis (p = 0.003). However, there was no significant difference in diastolic blood pressure, with an average of 80.6 mmHg before and 78.6 mmHg after hemodialysis (p = 0.180). Conclusion: It can be concluded that hemodialysis significantly increases hemoglobin levels and reduces systolic blood pressure in ESRD patients, while diastolic blood pressure remains unchanged. Regular monitoring of hemoglobin and systolic blood pressure is crucial for managing patient health. Hemodialysis effectively raises hemoglobin levels and reduces systolic blood pressure in ESRD patients. Regular monitoring of both parameters is essential for effective patient management. While the findings highlight the benefits of hemodialysis, the limited sample size may restrict the generalizability of the results. Further studies with larger sample sizes are needed to confirm these findings and explore the long-term implications.

Association between the cumulative excessive systolic blood pressure and left ventricular mass index

Abstract Background Ambulatory blood pressure (ABP) has been increasingly adopted in day-to-day clinical practices. Although clinicians can access an enormous amount of information regarding an individual’s blood pressures (BPs) through the ABP monitoring (ABPM), to date, only the mean BP is utilized as the diagnostic threshold of hypertension and the therapeutic target for BP control and no other indices were widely used to assess the burdens of high BP in the ABPM. Because elevated systolic BPs (SBPs) cumulatively damage the myocardium and induce hypertrophy and fibrosis, we hypothesized that the summated value of BP readings beyond a target level may be the better indicator of the overall BP loads than the mean BP value. Methods The Korean ABP registry is a multicenter prospective longitudinal cohort study performed in outpatients with hypertension. Among 5,965 patients enrolled in the registry, 951 patients with valid ABPM records and appropriate echocardiography measurements included in the study. The left ventricular mass (LVM) was normalized using the height2.7(m) (LVM index [LVMIH2.7] = LVM/Height2.7). The cumulative excessive SBP CE-SBP) was defined as the summation of the products of excessive SBPs (≥135 mmHg during wake, ≥10 mmHg during sleep) and the durations of the excessive SBP (Figure 1). Results The CE-SBP was non-linearly associated with both the office SBP and the mean SBP, but the association strength was much greater with the mean SBP than with the office SBP (R2=0.902 vs. R2=0.430). In linear regression models, the association of the CE-SBP with the LVMIH2.7 (R2=0.112 [0.074-0.149]) was greater than that of the office SBP (R2=0.072 [0.040-0.103]), the mean SBP (R2=0.082 [0.049-0.116]) or the mean SBP during sleep (R2=0.99 [0.063-0.134]). Non-linear regression models using restrictive cubic spline fits also showed that the association strength was greater with the CE-SBP (R2=0.117 [0.078-0.155]) than with the office SBP, mean SBP or mean SBP during sleep (Figure 2). Left ventricular hypertrophy (LVH) defined as the LVMIH27 ≥54 g/m2.7 was better predicted with the CE-SBP than with the other SBPs. The association between the CE-SBP and LVMIH27 was stronger in the patients not taking antihypertensive medications (R2=0.121) and strongest in those with the non-dipper pattern (R2=0.125). Combination with the variability indices (successive variation and average real variability) during sleep or the maximum SBP during sleep significantly improved the association strength of CE-SBP with LMMIH27, whereas the combination with the mean SBP or the variability indices during the entire period did not, in the linear models. Conclusion The CE-SBP was more strongly associated with the LVMIH27 than the office SBP and the mean SBP in the ABPM. This result suggests that the CE-SBP may be the better indicator of overall BP loads than the office SBP or the mean SBP in the ABPM, in patients with hypertension.Figure 1Figure 2

Measurements and medication data are indispensable for population blood pressure monitoring

Abstract Background The National Study on Health of Older People in Germany “Gesundheit 65+” included blood pressure (BP) measurements at home by a study nurse and classification of all current medication. Methods Nationally representative examination survey of the population aged 65 years and older residing in Germany using two-stage population registry sampling from 128 sample points, with a standardized examination at home from June 2022 to April 2023. Three standardized blood pressure measurements at two-minute intervals were taken after 5 minutes rest with an oscillometric device (Mobil-O-Graph) using one of five cuffs according to upper arm circumference. The mean of the second and third measurement was used for analysis. Hypertension was defined as mean systolic BP (SBP) at or above 140 mmHg, or mean diastolic BP (DBP) at or above 90 mmHg, or the use of antihypertensives (antihypertensives, diuretics, beta-blockers, calcium-channel blockers, ACEI and ARB) in participants with self-reported hypertension diagnosis. Provisional weights account for unequal sampling and participation probabilities. Results The “Gesundheit 65+” examination part included 1,493 participants of whom 1,475 (98.8%) had successful BP measurements (763 men and 712 women, aged 66 to 101 years). Based on self-reported diagnoses alone, the prevalence of hypertension would be 58.3% [95% CI 53.2-63.3] in men and 59.5% [53.8-64.9] in women. However, overall hypertension prevalence was estimated at 70.4% [65.8-74.7] in men and 72.3% [66.9-77.1] in women based on the study definition which combines self-reported diagnoses, standardized BP measurements and medication. Conclusions The prevalence of hypertension is greatly underestimated in the absence of examination survey data with standardized measurements and recording of medication use. In addition, measurement and medication data are needed for monitoring the hypertension cascade, i.e. awareness, treatment and control of hypertension. Key messages • Hypertension prevalence is underestimated in the absence of health examination surveys with measurements and medication data. • The hypertension cascade, i.e. assessment of awareness, treatment and control of hypertension needs population surveys with measurements and medication assessment.

The impact of cardiovascular risk factors on longitudinal changes in cardiac structure and function in an older population of hypertensive patients

Abstract Background Hypertension is associated with cardiac structural and functional changes, with left ventricular hypertrophy and diastolic dysfunction as strong predictors of adverse cardiac events. Limited data exist on how cardiovascular (CV) risk factors accelerate left ventricular (LV) mass and diastolic dysfunction over time in older hypertensive patients. Purpose To investigate the association between CV risk factors and accelerated deterioration of LV mass, left atrial volume (LAV), global longitudinal strain (GLS), and tissue Doppler E/e’ ratio in an older population of hypertensive patients. Methods Post-hoc analysis of a randomized clinical trial that investigated whether atrial fibrillation screening, using an implantable loop recorder, and subsequent initiation of anticoagulation, could prevent stroke in high-risk individuals. Only individuals with hypertension who had transthoracic echocardiography performed on two occasions, with a median of 5 years between echocardiograms, were included in this sub-study (n = 570). Multivariable linear regression analysis was performed to investigate the association between risk factors and changes in LV mass, LAV, GLS and E/e’. ß-values were calculated per 1 SD change for all variables. Results Mean age was 74±3 years, and 55% were men. Mean body mass index (BMI) was 27.8±4.3 kg/m2, 26% had diabetes, 58% used statins, 12% had a history of ischemic heart disease, and 4% had heart failure. The median use of antihypertensive drugs was 2 (IQR: 1,2), mean systolic blood pressure was 148.6±18.2 mmHg. During a median follow-up of 5 years, the mean increase in LV mass was 6.5±38.3g. Male sex (ß 0.24, p &amp;lt; 0.001) and increasing BMI (ß 0.29, p &amp;lt;0.001) were significantly associated with an accelerated increase in LV mass (Fig. 1). The mean increase in LAV was 14.6±15.7ml. Diabetes (ß -0.16, p = 0.006) and high sensitivity C-reactive protein (hsCRP) (ß 0.14, p = 0.007) were significantly associated with changes in LAV (Fig. 2). The absolute decline in mean GLS was 0.27%. Increasing age (ß -0.09, p = 0.027), heart failure (ß -0.10, p = 0.020), ischemic heart disease (ß -0.16, p &amp;lt; 0.001), hsCRP (ß -0.12, p = 0.003) and s-creatinine (ß -0.09, p = 0.033) were all significantly associated with an accelerated decline in GLS (Fig. 1). E/e’ declined with an average 0.96±2.89. Increasing age (ß 0.12, p = 0.001), female sex (ß 0.09, p = 0.049), and increasing systolic blood pressure (ß 0.13, p = 0.004) were associated with an increase in E/e’ (Fig. 2). Conclusion Male sex and increasing BMI were independently associated with an accelerated increase in LV mass. Diabetes was independently associated with LAV decline, while hsCRP was significantly associated with increasing LAV. Increasing age, heart failure, ischemic heart disease, hsCRP, and s-creatinine were independently associated with an accelerated decline in GLS. Increasing age, systolic blood pressure and female sex were independently associated with increasing E/e’.

Clinical Implications of NT-proBNP trajectory following Sacubitril/Valsartan initiation

Abstract Introduction Serum N-terminal pro–B-type natriuretic peptide (NT-proBNP) values after initiating Sacubitril/Valsartan is considered as a favorable prognostic factor, and widely used for risk stratification in patients with heart failure (HF). However, the relationship between the trajectory of serially measured NT-proBNP values and cardiovascular events in patients with HF who are treated with Sacubitril/Valsartan remains uncertain. Purpose This study aimed to reveal the prognostic association of an NT-proBNP trajectory after initiating Sacubitril/Valsartan and subsequent cardiovascular outcomes. Methods and Results A Japanese nationwide multicenter study was conducted on HF patients who initiated Sacubitril/Valsartan. Out of the 995 patients enrolled, we excluded 561 patients who were undergoing assessment of BNP or who lacked a complete set of NT-proBNP measurement. Finally, 434 patients included this study, and were divided into three groups based on NT-proBNP trajectory as follows; the ‘sustained-responder’ group (n = 129, 30%) : which exhibited a reduction of NT-proBNP by ≥10% at 1 month and further reduction of ≥10% at 3 months; and the ‘transient-responder’ group (n = 161, 37%), with ≥10% reduction at 1 month but not at 3 months; and the ‘non-responder’ group (n = 144, 33%), which did not achieve ≥10% reduction at 1 month. The mean age was 68 years, with females comprising 29%. In the ‘sustained-responder’ group, the age was significantly younger, and the duration of heart failure was significantly shorter. There were no significant differences in the mean systolic blood pressure, mean Sacubitril/Valsartan dose at each measurement points among the 3 groups. During follow-up of 456 (IQR, 371-549) days, the primary endpoint, which was either cardiovascular death or hospitalization of HF occurred in 78 of 434 patients (18%). The Kaplan-Meier analysis showed that the ‘sustained responder’ group experienced significantly lower event rate among the 3 groups (Log-rank p&amp;lt;.001). Additionally, an analysis that set a landmark time at 3 months post-initiation of Sacubitril/Valsartan showed that the ‘sustained-responder’ group experienced significantly fewer events than the ‘transient-responder’ group (Log-rank p=0.039) (Figure.1). Also, the ‘sustained responder’ was observed to have a better prognosis in a subgroup with LVEF&amp;lt;50%, but not in patients with LVEF ≥50%. (p value for interaction=0.035) (Figure.2). Conclusions This study revealed that sustained reduction of NT-proBNP was associated with a reduced risk of cardiovascular death or hospitalization for HF. The periodic NT-proBNP monitoring and the patterns of NT-proBNP during treatment with Sacubitril/Valsartan may be helpful in optimizing HF therapy and understanding the prognosis of HF.Figure.1Figure.2

Unleashing the potential: early evaluation of blood pressure control with novel measurements in patients with hypertension

Abstract Objective To assess the prognostic value of two novel blood pressure measurements——short-term cumulative systolic blood pressure (SBP) load and Time in Target Rang (TTR) in major adverse cardiovascular outcomes and all-cause mortality. Method This is a post-hoc analysis of the SPIRNT (Systolic Blood Pressure Intervention Trial). Participants with complete record of BP values and no adverse events occurred in the initial 90-days follow-up were enrolled. Short-term cumulative SBP load and TTR were calculated by the 3-month SBP values in the follow-up period (Fig 1). The primary outcome was major adverse cardiovascular events (MACEs), defined as the composite of myocardial infarction, stroke, heart failure and cardiovascular death. Secondary outcomes were the components of the primary outcomes and all-cause mortality. Results The study population included 8639 adults (median [IQR]or mean (%) baseline age, 67 [61,76] years; 2940 women (35.1%); Median follow-up time 3.8[3.3-4.4] years). 559 MACEs were occurred. Participants categorized by tertiles of cumulative SBP Load (T1: [0,0.1572]; T2: (0.1572 ,3.5946]; T3: (3.5946 ,30.2949]) showed a significant increase hierarchical trend (P for trend &amp;lt;0.05) in the incidence of MACEs and stroke. For Participants grouped by SBP TTR (T1: [0,21.2657]; T2: (21.2657 ,71.1462]; T3: (71.1462 ,100]), it indicated a decrease hierarchical trend (P for trend &amp;lt;0.05) in the incidence of MACEs and MI (Fig2 and Fig3). Both short-term cumulative SBP Load (HR: 1.117(1.033-1.208)) and TTR (HR: 0.861(0.785-0.945)) were correlated with MACEs independently(tabal1). According to C-statistics and Net Reclassification Indexes (NRI), short-term cumulative SBP Load and TTR both outperformed mean SBP and SBP standard derivation (SD) on the prognosis value of MACEs. Moreover, our results showed that the coefficient of cumulative SBP Load under penalty decreased to 0 with the largest log(lambda),which indicted a major role across 4 different measures in models. (Fig 4). Conclusions Both short-term cumulative SBP load and TTR had an independent prognosis value for MACEs superior to mean SBP and SBP SD in hypertension patients without diabetes. This study provided the evidence of novel BP measurements for early assessment of BP levels after antihypertensive treatment.

Effect of Propofol and Isoflurane on Hemodynamic changes during Spinal Surgery Under General Anesthesia

Background: Hemodynamic stability are vital requirements of up-to-date anesthesia. Both propofol and isoflurane meet these criteria though the clinical effects like postoperative nausea vomiting after administering propofol and isoflurane have been studied in various surgeries but have not been much evaluated or studied in patients undergoing major surgical procedures like spine surgeries, There’ is definite advantage of one technique over the other. Isoflurane has a low blood gas partition coefficient, which contributes to rapid induction and emergence from anaesthesia than with other volatile anesthetics in current clinical use. Propofol has been established as the intravenous agent that provides faster and smoother recovery &amp; peri operative hemodynamic stability. Objective: To compare the effects of isoflurane and propofol regarding hemodynamic status in spinal surgery under general anaesthesia. Methods: After getting ethical approval, a randomized controlled trial study design was performed where patients were selected in the pre-anesthetic checkup room based on inclusion and exclusion criteria for those who were scheduled for spine surgeries under general anesthesia is admitted in the Department of Neurosurgery in East West Medical College from January 2023 – December 2024. A total number of 40 patients were selected. 20 patients were enrolled each in group A and group B by lottery method in a sealed envelope. They were divided into two groups by randomization; Group A and Group B. A written informed consent was taken from all selected patients. Patients were advised to fast for at least 8 hours before intervention. In Group A, anesthesia is maintained with propofol infusion, nitrous oxide (66%), and oxygen (33%) while in Group B, anesthesia is maintained with Isoflurane, nitrous oxide (66%), and oxygen (33%). All patients were given N2O in oxygen and 1.25% inspired concentration of Isoflurane (MAC -1.15). In Group A propofol infusion at rate of 80 μg/kg/min (fixed from the beginning). All data was collected at –Just after starting, 15 minutes, 30-minute, 1 hour, and &gt;1 hour interval per operatively. Data was compiled, edited and plotted in tabular and figure form. P value was determined as significant when it was &lt;0.05. Results: 40 patients yielded the following results. The mean age of Group A and B were 32.56±12.55 years and 34.6±12.5 years. Mean difference of heart rate was lower in Group A than that of Group B. Other parameters in both groups were confined to good and acceptable categories. But interestingly, there was a statistically significant difference found between Group A and Group B in Systolic Blood Pressure (SBP) &amp; Diastolic Blood Pressure (DBP). The scoring was far better in Group A than Group B. Mean SBP was higher in Group B than Group A (p= &gt;0.05). Similarly, mean DBP was also higher in Group B than Group A (p = &gt;0.05). Conclusion: Propofol is better for maintaining hemodynamic status than Isoflurane for Spine surgery under General anaesthesia. EWMCJ Vol. 12, No. 1&amp;2, January-July 2024: 21-26

Association of different timepoint and threshold of time-in-target-range and MACEs: insight from the SPRINT study

Abstract Objective To evaluate the prognostic value of different timepoint and threshold of systolic blood pressure (SBP) Time in Target Rang (TTR) in Major Adverse Cardiovascular Events (MACEs). Method This is a post-hoc analysis of the SPIRNT (Systolic Blood Pressure Intervention Trial). Participants with complete record of BP values and no adverse events occurred in the initial 2-years follow-up were enrolled. Different SBP TTR indexes was calculated by different timepoint (3 month,12 month,24 month) and threshold (110-130mmHg;110-140mmHg;110-130mmHg for intensive treatment group and 120-140mmHg for standard treatment group) (Fig 1). The primary outcome was major adverse cardiovascular events (MACEs) occurred 2 years later, defined as the composite of myocardial infarction, stroke, heart failure and cardiovascular death. Results A total of 7134 participants in SPIRNT were enrolled in this study. Those SBP TTR indicators with independent predictive value of MACEs were selected by a multivariable COX model adjusted for traditional cardiovascular risk factors (Fig 2). SBP TTR calculated with 110-140mmHg window in 3 months (3month SBP TTR110-140) was considered to be the best predictor of MACEs occurred 2 years later among selected SBP TTR indexes according to c statistics and relative informativeness (Table1). The restricted cubic spline plot was used to evaluate the nonlinear trend of the TTR indicator. In addition, we obtain the cut-off value by looking for the point in the RCS curve with the largest slope change. 0.65 was considered to be the best truncation for 3month SBP TTR110-140(Fig 3). Patients with 3month TTR110-140 greater than 0.65 had 23.9% lower incidence of MACEs than patients with TTR less than or equal to 0.65 (HR 0.761[0.592-0978], P=0.033).(Table 2) In addition, for patients with early SBP control (3month SBP TTR110-140 &amp;gt;0.65), there was no significant difference in mean SBP between 110-130 mmHg and 130-140 mmHg (Fig4 Group1 Vs Group2). Lasso regression also suggests that TTR110-140 has more informatics advantages than TTR110-130 in cox model at different timepoints (Fig5). Conclusions 3month SBP TTR110-140 was considered to be the best predictor of MACEs occurred 2 years later in different SBP TTR indexes, which indicated the importance of early SBP control. This study also proposed 0.65 as the critical value of 3-month SBP TTR110-140 for prevention of the incident of MACEs. In the future, more cohort studies are needed to expend these findings.

Systolic plood pressure response to ASi BI 690517 with and without empagliflozin in CKD

Abstract Background and Aims: BI 690517 is a highly selective aldosterone synthase inhibitor (ASi) in clinical development for CKD treatment. Coadministration of BI 690517 with a sodium-glucose cotransporter-2 inhibitor may provide additive efficacy and also mitigate risk of hyperkalaemia. This multinational, randomised, dose-finding, Phase II trial (NCT05182840) investigated the efficacy and safety of BI 690517, given alone or in combination with empagliflozin (EMPA), for albuminuria reduction in people with CKD and with or without type 2 diabetes.1 Here, we present a secondary analysis for effects on systolic blood pressure (SBP). Method Adults with CKD receiving a maximally tolerated dose of a renin-angiotensin system inhibitor were randomised (R1) 1:1 to receive background EMPA 10 mg or placebo (PBO-EMPA) during an 8-week run-in. They were then re-randomised (R2) 1:1:1:1 to receive BI 690517 (3 mg, 10 mg, or 20 mg) or PBO-ASI for 14 weeks, in addition to their assigned EMPA or PBO-EMPA therapy. Participants had mean baseline SBP ≥110 and ≤160 mmHg. Elevated blood pressure (BP) was defined as SBP ≥140 mmHg or DBP ≥90 mmHg and receiving ≥2 classes of anti-HTN medication. Changes in SBP from R2 baseline to Week 14 were analysed to assess BI 690517 effects with and without EMPA use. Results Of 714 people randomised at R1, 586 were randomised at R2, and the treated set consisted of 583 people. Demographics and clinical characteristics were similar between dose groups.1 At R2 baseline, 169 (29.0%) people had elevated BP. Mean SBP was 142.7 mmHg in the elevated BP group versus 129.2 mmHg in the non-elevated BP group. Treatment with BI 690517 consistently reduced SBP with reductions that were comparable in people with and without elevated BP (p-value for interaction not significant) (Table). Conclusions In people with CKD, BI 690517 reduced SBP in people with and without elevated BP.(Table)

Nationwide trends in blood pressure control among those with and without diabetes in England over last 2 decades: Health Survey of England 2003-2019

Abstract Diabetes and hypertension are both risk factors for cardiovascular disease (CVD), and often co-exist. Over recent decades practice guidance and health policy efforts have been made to improve population wide blood pressure (BP) control, particularly amongst those with diabetes, to reduce CVD. However, the nationwide impact of these ongoing efforts is yet to be documented comprehensively in England. We used data from 11 serial nationally representative health surveys of England between 2003 and 2019 and compared BP control and presence of untreated hypertension amongst those with and without diabetes. These cross-sectional, randomly sampled surveys included 94,100 individuals cumulatively. We applied sample weights, accounting for oversampling and survey nonresponse, and transformations mitigating for survey equipment changes during this period. We used ‘period definitions’ to define those with diabetes and quantify BP control at the time of each coinciding survey, facilitating accurate comparison of trends over the sixteen-year period, while accounting for changes in understanding, variations in definitions, and shifts in medical practices. Python and STATA were used to conduct analyses and Join Point regression software was used to develop and compare trends. In England, from 2003-2019, the prevalence of hypertension amongst those with diabetes and without diabetes decreased from 74.4% to 66.5% and from 32.6% to 27.1% (7.9% vs. 5.5%), respectively. This corresponded to reductions in population-wide mean systolic (S) and diastolic (D) BPs: compared to those without diabetes, those with diabetes had greater reduction in both SBP (7.9mmHg vs. 4.8mmHg) and DBP (2.7mmHg vs. 1.9mmHg) (Figure1). Both groups showed similar temporal improvement in BP-control amongst those with diagnosed hypertension, with those with diabetes showing better improvement in BP control compared to those without diabetes (14% vs. 12%). There was a significant difference in proportions of those with undiagnosed (unaware) hypertension amongst those with and without diabetes (11.4% vs. 30.0% respectively) (Figure2). Notably, there was no change in proportion of those with hypertension unaware about the condition (i.e. detection rate for hypertension in either of the group did not show any improvement over time). These results suggest that we have been able to improve BP control over this period amongst those with and without diabetes, however, those without diabetes (more than 90% of population) have shown significantly poorer improvement. In addition, around one third of hypertensive patients amongst the no-diabetes group are unaware of the condition, and overall, the detection rates for hypertension in both groups have not improved in the last two decades. Lessons learnt from improving BP control amongst those with diabetes should be applied across the entire population, and newer strategies need to develop to improve detection of those with hypertension and are unaware.