mmHg Blood Pressure Research Articles

Effect of Antihypertensive Therapy Compliance Using Medication Possession Ratio Method on Blood Pressure in Patients with Hypertension

Hypertension is a circulatory system disorder that causes an increase in blood pressure, specifically systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. Hypertension can cause serious medical conditions such as damage to various organs. The complications caused by hypertension can be prevented with treatment regularly to achieve controlled blood pressure. This study determines the relationship between antihypertensive therapy compliance to blood pressure in hypertensive patients. This type of research is analytical observational with retrospective cohort design and purposive sampling techniques. The data were obtained from patients’ medical records, including demographic data, blood pressure, and prescribed drugs. The subject's compliance was measured using the Medication Possession Ratio (MPR). A total of 124 subjects met the inclusion criteria. The data were analyzed using a chi-square test with Yates correction. Most patients had uncontrolled blood pressure as much as 101 patients. The statistical analyses show that antihypertensive therapy compliance affects controlled blood pressure in patients with hypertension (p= 0.00). More efforts to support adherence to hypertensive treatment should be initiated to have greater effect on therapy compliance.

The Effectivity of Flavonoid Content Which Contained in “Dark Chocolate” with Decreased Blood Pressure in Hypertension Without Complication Patients at Tresna Werdha Public Center in 2017

As the times progressed, lifestyle and food pattern alterations have taken place in society these days. Such things cause the health issues, such as hypertension. Research recently declared “Dark Chocolate” could be one of the blood pressure-lowering food alternatives. This research aims to find out if “Dark Chocolate" could lower blood pressure in hypertension without complications in patients. The research method is a descriptive quantitative study, and the research has been done on 30 women 80-97 years old elderly at Tresna Werdha Public Center, Cibubur. The blood pressure was measured by calculating the systolic and diastolic blood pressure in mmHg before and after consuming “Dark Chocolate”. Data analysis was using the SPSS statistic test. The result of the research is that the blood pressure in 15 respondents who consumed “Dark Chocolate” began to decrease on the third day (p<0,05). Finally, it is concluded that "Dark Chocolate” could lower blood pressure.
 Keywords: “Dark Chocolate”, blood pressure

Prevalence, Awareness, Treatment, and Control of Hypertension among Adult Residents of Tehran: The Tehran Cohort Study.

Background:High levels of blood pressure (BP) remain undetected and poorly controlled in large segments of the population leading to an enormous burden in terms of disease and mortality.Objective:We aimed to assess the prevalence, awareness, treatment, and control of hypertension in Tehran.Methods:We used the data of 8,296 adults aged ≥35 years from the Tehran Cohort Study who were enrolled between May 2016 and February 2019. Hypertension was defined as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, self-report, and/or current antihypertensive medication use. The age- and sex-weighted prevalence of hypertension and high normal BP was calculated using the 2016 national census. Furthermore, awareness, treatment, and control of hypertension were analyzed.Results:The mean age of the participants was 53.8 ±12.75 years, and 54.0% were women. The weighted prevalence of hypertension and high normal BP were 36.5% and 12.2%, respectively. Among hypertensive individuals, 68.2% were aware of hypertension, 53.3% were receiving medication, and 40.4% had adequate BP control. The awareness, treatment, and control of hypertension were significantly higher in women (72.2% vs. 63.4% [P < 0.001], 55.1% vs 51.1% [P = 0.020], and 42.7% vs. 37.7% [P = 0.004], respectively) and this gap considerably increased with advancing age. Hypertension was more prevalent in northern Tehran but with a better treatment rate and control in the same regions.Conclusion:Despite the high prevalence of hypertension in the adult population of Tehran, the rates of awareness, treatment, and control of hypertension are unsatisfactory and demand comprehensive strategies to improve this situation, especially in younger men.

Parameters indicating development of hypertension in three-year follow-up study of subjects with high normal blood pressure

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction The clinical importance of a hypertensive response to exercise (HRE) in subjects with high normal blood pressure (BP) is not fully elucidated, while sympathetic overactivity followed by arterial stiffening are linked with development of hypertension (HTN). Purpose The aim of this study was to assess the relation of HRE with sympathetic drive as assessed by muscle sympathetic nerve activity (MSNA) and arterial stiffness in subjects with high normal BP who developed hypertension in a 3 year follow up. Methods 100 subjects with high normal office BP [systolic BP=130-139 mmHg and diastolic BP=85-89 mmHg] underwent a treadmill exercise stress test. Arterial stiffness was evaluated based on carotid to femoral pulse wave velocity (PWV). Sympathetic drive was assessed by MSNA levels. Follow up was every 6 months for 3 years, where BP was measured at both office (OffBP) and ambulatory blood pressure monitoring (ABPM). All participants offered lifestyle advises. Endpoint was development of HTN diagnosed either from OffBP or from ABPM. Then they were divided into Group I: those developed HTN and Group II: those remained normotensive. Results Mean age 54±8 years, 42 males, baseline offBP: 132/82 mmHg, ABPM: 122/76 mmHg). Out of them, 50 subjects developed HRE (BP ³210mmHg in men and ³190 mmHg in women) and 40 HTN. Group I developed higher HRE (75% vs. 13%, p=0.026), higher levels of PWV (8.35 vs 7.5 m/sec, p=0.043) and MSNA levels (37 vs. 31 bursts, p=0.04), while did not differ at their metabolic profile. Echocardiographically left ventricular mass index did not differ statistically as E/A ratio of mitral valve inflow (0.92 vs 1.05, p=0.034). Those who developed HTN was related to night systolic BP from ABPM (116 vs 112 mmHg, p&amp;lt;0.04), as also to intermediate stage intervals of 3 min (160 vs 147 mmHg, p=0.068) and 6 min (181 vs 164, p=0.035) of Bruce protocol. A novel metric, the SBP/MET-slope [(peak SBP—resting SBP)/(peak MET-1)] found to add crucial information. Regarding those who developed HTN, SBP/MET-slope was higher in all stages till peak exercise (stage 1: 6.25 vs 4.25, stage 2: 7.6 vs 5.3, peak: 7.22 vs 5.1, p=0.035). It was noticed that they performed a higher exercise capacity (10 vs 11.5 METs) and additionally differ significantly in their maximal heart rate (HR) at peak exercise (154 vs 164, p=0.001). Conclusion In subjects with high normal BP, a HRE, the intermediate BP intervals along with the SBP/MET-slope, identifies a state of systemic vascular resistance, arterial stiffening and sympathetic overdrive, as reflected by increased PWV and MSNA levels respectively. Additionally, exercise capacity demonstrates cardiovascular functional tolerance. These findings suggest that exercise testing provides determining clinical information regarding the overall cardiovascular status, proving its superior prognostic value as a hypertension screening tool, that alarms the physician to warn the patient to take action.

17 EFFECTS OF WHOLE-BODY VIBRATION TRAINING ON BLOOD PRESSURE IN POSTMENOPAUSAL WOMEN WITH HYPERTENSION: A SYSTEMATIC REVIEW

Background: Menopause is considered an important determinant of hypertension in women, with 41% of postmenopausal women are hypertensive. Increased blood pressure (BP) in postmenopausal women can be caused by arterial stiffness, renin-angiotensin system activation, endothelial dysfunction, lack of estrogens, sympathetic activation, anxiety, and depression. Hence, they should be given special treatment, such as exercise therapy, to improve the quality of their hypertensive therapy. Whole-body vibration training (WBVT) is a resistance training known for its ability to improve arterial stiffness. However, its ability to decrease BP is still controversial. Objective: This study aims to identify the effects of WBVT on blood pressure in postmenopausal women with hypertension. Method: A systematic literature search was performed using particular keywords with medical subheading (MeSH) terms on three journal databases, including Pubmed, Proquest, and Cochrane. The search results were screened and assessed using inclusion and exclusion criteria, double article, and full text availability by three independent authors. The quality of the randomized control trial (RCT) was evaluated using the Jadad scale. Result: Four Randomized controlled trials (RCTs) consisting of 114 total patients were eligible to fulfil the criteria. All studies showed that WBVT significantly decreased systolic (10-12 mmHg) and diastolic (5-6 mmHg) BP compared with the control group. One study also showed a reduction of mean arterial pressure (9 mmHg). Conclusion: WBVT might be beneficial as an adjuvant therapy to reduce blood pressure in postmenopausal women with hypertension, but further research that includes more subjects is needed to confirm this result.

A new deep learning framework based on blood pressure range constraint for continuous cuffless BP estimation

Blood pressure (BP) is known as an indicator of human health status, and regular measurement is helpful for early detection of cardiovascular diseases. Traditional techniques for measuring BP are either invasive or cuff-based and thus are not suitable for continuous measurement. Aiming at the deficiencies in existing studies, a novel cuffless BP estimation framework of Receptive Field Parallel Attention Shrinkage Network (RFPASN) and BP range constraint is proposed. Firstly, RFPASN uses the multi-scale large receptive field convolution module to capture the long-term dynamics in the photoplethysmography (PPG) signal without using long short-term memory (LSTM). On this basis, the features acquired by the parallel mixed domain attention module are used as thresholds, and the soft threshold function is used to screen the input features to enhance the discriminability and robustness of features, which can significantly improve the prediction accuracy of diastolic blood pressure (DBP) and systolic blood pressure (SBP). Finally, in order to prevent large fluctuations in the prediction results of RFPASN, RFPASN based on BP range constraint is proposed to make the prediction results of RFPASN more accurate and reasonable. The performance of the proposed method is demonstrated on a publically available MIMIC-II database. The database contains normal, hypertensive and hypotensive people. We have achieved MAE of 1.63/1.59 (DBP) and 2.26/2.15 (SBP) mmHg for BP on total population of 1562 subjects. A comparative study shows that the proposed algorithm is more promising than the state-of-the-art.

Associations of serum PFOA and PFOS levels with incident hypertension risk and change of blood pressure levels

Evidence on the associations of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with hypertension or blood pressure (BP) levels was limited and inconsistent. The present prospective study aims to evaluate the longitudinal associations of serum levels of PFOA and PFOS with incident hypertension risk and change of blood pressure levels. At baseline 1080 participants (mean age 62 years, 58.9% females) free of hypertension, cardiovascular disease, diabetes, and cancer were followed up for nearly 5 years. Baseline serum levels of PFOA and PFOS were measured with ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS). Hypertension was defined as any of (1) self-reported physician-diagnosed hypertension (2) use of hypotension drugs (3) measured systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. Change of BP was evaluated as a difference between twice measurements (BP at follow-up visit－BP at baseline). After adjustment for multiple covariates, serum PFOS levels were negatively correlated with risk of hypertension [RR per lg-unit = 0.94 (95% CI: 0.88, 0.99)] and change of systolic BP [β = −1.48 (95% CI: −2.56, −0.41)]. The highest vs lowest quartiles of PFOS concentration was negatively associated with hypertension risk. Compared with Q1, the RRs (95% CIs) for Q2, Q3, and Q4 were 0.83 (0.67–0.98), 0.81 (0.67–0.97), and 0.81(0.67–0.97), respectively (p for trend = 0.016). The negative associations remained in females but not in males (p for interaction = 0.44). No significant association of PFOA with hypertension risk was observed. Further studies are needed to validate our findings.

Insulin resistance is more severe in patients with primary hyperparathyroidism

BackgroundPrimary hyperparathyroidism is associated with an increased cardiovascular mortality, and its underlying mechanisms remain unclear. Insulin resistance has been suggested with low level of evidence. The goal of this study was to evaluate glucose metabolism and insulin resistance in primary hyperparathyroidism patients, to compare with control subjects, and to identify risk factors for insulin resistance in patients with primary hyperparathyroidism. MethodsCross-sectional study of consecutive primary hyperparathyroidism patients without history of diabetes or severe chronic kidney disease (glomerular filtration rate ≤30 mL/min/1.73 m2). Fasting glucose and insulin were evaluated before parathyroidectomy. Glucose metabolism was compared with population-based control subjects (n = 171). ResultsOne hundred and seventy-four patients with primary hyperparathyroidism (140 females) were included. Mean fasting glucose was 0.983 ± 0.129 g/L, and 63 patients (36%) had prediabetes (>1.0 g/L). Mean Homeostatic model assessment of insulin resistance (HOMA-IR) was 3.386 ± 3.111 mUI/L, and 78 patients (45%) had insulin resistance (HOMA-IR >2.6). Blood calcium levels (0.171; P = .023) and body mass index (0.450; P < .001) were correlated positively with HOMA-IR. Insulin secretion (HOMA-B%) was correlated positively with preoperative systolic blood pressure in mm Hg (0.187; P = .013). In multivariate analysis, classic hypercalcemic primary hyperparathyroidism (18.47, 6.84–49.87; <.001), mild hypercalcemic primary hyperparathyroidism (5.35, 2.40–11.95; <.001), and body mass index (1.27, 1.17–1.38; <.001) remained independent predictors for insulin resistance (HOMA-IR >2.6). When compared with control subjects, mean HOMA-IR was significantly higher in primary hyperparathyroidism patients (3.386 ± 3.111 vs 1.919 ± 1.158; P < .001). ConclusionInsulin resistance was significantly higher in primary hyperparathyroidism patients than in control subjects. The impact of parathyroidectomy on insulin resistance should be evaluated in patients with higher calcium levels.

Lack of Effects of Renin-Angiotensin-Aldosterone System Activity and Beta-Adrenoceptor Pathway Polymorphisms on the Response to Bisoprolol in Hypertension.

PurposeThis study examined the effects of plasma renin activity (PRA), angiotensin II (Ang II) and aldosterone (PAC) concentrations as well as common polymorphisms in the β1-Adrenoceptor gene (ADRB1) and the G-protein α-Subunit (Gαs) protein gene the G protein α-Subunit 1 gene (GNAS) on the blood pressure (BP) and heart rate (HR) response to bisoprolol in Chinese patients with hypertension.MethodsPatients with sitting clinic systolic BP (SBP) 140–169 mmHg and/or diastolic BP (DBP) 90–109 mmHg after placebo run-in were treated with open-label bisoprolol 2.5 mg daily for 6 weeks. Patients diagnosed as having primary aldosteronism or renal artery stenosis were excluded. PRA, Ang II and PAC concentrations were measured after the placebo run-in and after 6 weeks of treatment. The Ser49Gly and Arg389Gly polymorphisms in ADRB1 and the c.393C > T polymorphism in GNAS were genotyped by the TaqMan® assay.ResultsIn 99 patients who completed the study, baseline PAC levels were significantly associated with baseline DBP and plasma potassium on univariate but not on multivariate linear regression analysis. PRA, Ang II, and PAC concentrations at baseline were not associated with changes in BP with bisoprolol treatment, but the values were all significantly reduced (PRA −0.141 ± 0.595 ng/mL/h, Ang II −2.390 ± 5.171 pmol/L and aldosterone −51.86 ± 119.1 pg/mL; all P < 0.05) following 6 weeks of bisoprolol treatment. There were no significant differences in BP or HR responses in patients with baseline PRA above or below the PRA cut-point of 0.65 ng/mL/h or the median value of 0.9 ng/ml/hour. There were no significant associations of the ADRB1 and GNAS polymorphisms with the clinic and ambulatory BP and HR responses to bisoprolol.ConclusionBaseline PRA, PAC and Ang II concentrations showed no significant association with the BP response to bisoprolol treatment, but all these parameters were reduced after 6 weeks of treatment with bisoprolol. The two common polymorphisms in ADRB1 and the c.393C > T polymorphism in GNAS had no significant association with the BP and HR response to bisoprolol in these patients.

IDF21-0145 Prevalence, awareness, treatment and control of hypertension among non-diabetics, prediabetics and diabetics in India

Background: Hypertension is the most common co-morbidity among people with diabetes. Prehypertension, hypertension, prediabetes and diabetes increase the risk of cardiovascular disease (CVD) which is the number one cause of death among adult Indians. Aim: To estimate the prevalence, awareness, treatment and control of hypertension among adults with no diabetes, prediabetes and diabetes in India. Method: We conducted a cross-sectional study in 2018 among 12284 participants aged ≥30 years residing in epidemiologically transitioning representative population in rural and urban north (Sonipat) and south (Vizag) India. Participants were selected using a multistage cluster random sampling technique. Trained data collectors administered the questionnaire and trained phlebotomists collected blood samples to estimate fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c). Blood pressure (BP) was measured following standard guidelines. Prediabetes was defined as FPG between 100 and 125 mg/dl or HbA1C between 5.7% and 6.4%. Diabetes was defined as FPG ≥ 126 mg/dl or HbA1C ≥ 6.5% or self-reported diagnosis. Hypertension was defined as Systolic BP ≥140 mmHg or Diastolic BP ≥90 mmHg or self-reported diagnosis. Awareness was defined as self-reported physician diagnosed hypertension among prevalent cases. Treatment was defined as currently taking anti-hypertensive medication. Control was defined as participants with SBP<140 mmHg and DBP<90mmHg and on anti-hypertensive medication. Bivariate logistic regression was used to measure associations. Results: The mean (±SD) age was 49.2 (±12.6) years. Nearly half of them were residing in rural areas and were women. The age standardized prevalence of hypertension was 26.0% (95% CI: 25.1–26.8), 35.8% (34.9–36.7) and 48.6% (47.7–49.6) in participants with no diabetes, prediabetes and diabetes respectively. The prevalence of hypertension was higher in males compared to females and also increased with increase in wealth index in all the three groups. Percentage aware, treated and controlled is given in Table 1. People with diabetes were more likely to be aware of their hypertension status if they were females [OR: 1.4 (1.1–1.6)], urban residents [1.6 (1.3–2)], from Vizag site [2.2 (1.8–2.6)], belonged to highest quintile of wealth index [1.5 (1.1 - 2.1)] compared to lowest, never consumed tobacco [1.6 (1.3–2.1)] or alcohol [1.4 (1.1–1.7)], had a family history of hypertension [2.3 (1.8–2.9)], diabetes [1.5 (1.2–1.8)] or heart disease [2.2 (1.4–3.4)].Table 1Proportion (with 95% CI) of participants aware of hypertension diagnosis, treated and controlledNo diabetesPrediabetesDiabetesAwareness38.5 (35.8–41.2)42.7 (40.1–45.3)63.8 (61.0–66.5)Treatment74.8 (71.0–78.7)82.3 (79.2–85.4)90.3 (88.2–92.4)Control45.0 (39.8–50.2)43.9 (39.5–48.4)44.2 (40.4–48.0) Open table in a new tab Discussion: Hypertension is very high in people with prediabetes and diabetes and its awareness, treatment and control is sub-optimal. Tailored and culturally relevant interventions to improve hypertention awareness and management among people with diabetes is urgently needed along with screening for prediabetes among those with hypertension.

Sex differences in autonomic recovery following repeated sinusoidal resistance exercise.

A simple bodyweight squat is sufficient to cause substantial stress on the autonomic nervous system (ANS) via ~30–50 mmHg blood pressure (BP) oscillations. However, it is unknown to the extent of the ANS is impacted during and immediately following bodyweight and resistance squat‐stand maneuvers (SSM) while considering chromosomal sex. Thirteen females and twelve males performed four, 5‐minute bouts of squat‐stand maneuvers (SSM); two at 0.05 Hz (10‐second squat/10‐second stand) and two at 0.10 Hz (5‐s squat/5‐s stand). The SSM were performed using bodyweight resistance and additional external resistance (~20% of bodyweight). Five‐minutes of quiet‐sitting and quiet‐standing were completed immediately following both bodyweight and resistance squats. Heart rate variability (HRV) and baroreceptor sensitivity metrics were extracted from beat‐to‐beat electrocardiography and systemic BP recordings. Repeated measure Analysis of Variance with generalized eta‐squared effect sizes assessed differences between SSM task type and chromosomal sex on ANS metrics. Despite added resistance eliciting greater elevations in blood pressure, no differences in ANS function were noted during competition and recovery between SSM tasks (all p > 0.050; negligible/small effect sizes). During recovery, females had an elevated heart rate (p = 0.017; small effect size), greater time‐domain HRV measures (p < 0.047; small effect size), greater high‐frequency domain HRV measures (p = 0.002; moderate effect size), and reduced low‐frequency domain HRV measures (p = 0.002; moderate effect size). A healthy ANS can modulate repetitive cardiovascular stressors via squat‐stand maneuvers in a harmonious manner irrespective of added low‐level resistance. Females were more parasympathetically driven following low‐level resistance exercise/stress, which may be a cardioprotective trait.

Abstract EP50: Implementation Of A Cloud-Connected Remote Blood Pressure Monitoring Program During The Postpartum Period Improves Ascertainment

Introduction: Postpartum hypertension is a leading cause of postpartum hospital readmissions and severe maternal morbidity. Monitoring postpartum blood pressure (BP) through office visits is challenging due to barriers in accessing care, which disproportionately affect people of color. Remote BP monitoring programs are promising but many require cellular data plans or smartphones. The aim of this study is to examine the impact of a cloud-connected remote BP monitoring program in BP ascertainment during the six weeks postpartum in a diverse, safety-net hospital population. Methods: Eligible patients were those delivering between April 2020 through September 2021 at Boston Medical Center and at high-risk of postpartum hypertension, including those with hypertensive disorders of pregnancy, chronic hypertension, or hypertension during hospitalization for delivery. Patients were given a cell-enabled cuff and provided instructions in either English, Spanish, or Haitian Creole to take their BP daily for six weeks. BP measurements are transmitted to a web-based portal via the local cellular network. Data collected through the portal were merged with clinical information from the medical record. Metrics of compliance included frequency, defined as number of daily measurements ascertained, and duration, or day of last measurement, within the six-week period were examined using means and standard deviations (SD). We examined compliance by self-reported race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic). We calculated the prevalence of postpartum hypertension, defined as ≥ 2 BP measures with systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg. Severe hypertension was defined as SBP ≥160 and/or DPB ≥110. Results: Among the 3,525 deliveries during the study period, 1,008 (28.6%) were eligible for the program. Of the eligible participants, 40.5% identified as Black (n=409), 36.3% as Hispanic (n=366), and 14.4% as White (n=145). Participation was high; only 15 patients (1.5%) did not take any BP measures. Among the 993 participants, the average number of daily BP measures was 17.1 (SD: 10.4), which was similar across racial/ethnic groups (Black: 17.3, Hispanic: 16.5, White: 17.1). Furthermore, the mean duration of participation was 31.7 days (SD: 12.2), which was also similar by race/ethnicity. In this high-risk cohort, the prevalence of postpartum hypertension was 64.3% (n=638), with 9.6% (n=61) meeting severe criteria. Conclusion: In conclusion, implementation of a cloud-connected BP monitoring program among a diverse, safety-net population was successful at ascertaining multiple BP measures in the postpartum period. Furthermore, similar patterns of use across racial and ethnic groups suggest that this program could reduce disparities with respect to postpartum BP ascertainment.

Abstract P012: Orthostatic Hypo- And Hyper-tension Are Associated With Cognitive Decline: The S.ages Cohort

Introduction: The association between orthostatic hypotension (OHYPO) and cognition has reported conflicting results. Although orthostatic hypertension (OHYPER) is an emerging cardiovascular risk factor, only very few studies investigated its association with cognition. We aimed to assess the impact of OHYPO and OHYPER on cognitive performances in non-institutionalized subjects aged ≥ 65 years. Method: The S.AGES (Sujets Ågés) cohort followed for three years non-institutionalized subjects aged ≥ 65 years without major neurocognitive impairment at inclusion. OHYPO was defined as a decrease in systolic blood pressure (SBP) of at least 20 mmHg and/or diastolic blood pressure (DBP) of at least 10 mmHg from a sitting to a standing position. In contrast, OHYPER was defined as an increase in SBP of at least 20 mmHg and/or DBP of at least 10 mmHg under the same measurement conditions. Cognition was assessed using the Mini-Mental State Examination (MMSE). Linear mixed models were used for the analyses. Results: We included 3,170 subjects (mean age 78 years, 56% women). 209 (6.5%) had OHYPO at inclusion and 226 (7.1%) had OHYPER. Over time, MMSE was on average 0.5 points lower in patients with OHYPO compared to those without OHYPO or OHYPER (adjusted β [IC95%] = -0.52 [-0.97 ; -0.08], p=0.021) after adjustment for age, sex, education, baseline body mass index, smoking, alcohol intake, atrial fibrillation, congestive heart failure, transient ischemic attack or stroke, coronary artery disease, type 2 diabetes, dyslipidemia, seated SBP/DBP and antihypertensive treatment. Similarly, patients with OHYPER had, on average, poorer cognitive performances over time compared to those without pathological blood pressure (BP) postural changes (adjusted β [IC95%] = -0.54 [-0.98; -0.09], p = 0.017). Conclusion: Both OHYPO and OHYPER were associated with cognitive decline. Considering that BP postural changes are common in the elderly and easy to detect, orthostatic BP measurements could help identify patients with greater risk of cognitive impairment.

Incidence of hypertension in people with HIV who are treated with integrase inhibitors versus other antiretroviral regimens in the RESPOND cohort consortium.

ObjectiveTo compare the incidence of hypertension in people living with HIV receiving integrase strand transfer inhibitor (INSTI)‐based antiretroviral therapy (ART) versus non‐nucleoside reverse transcriptase inhibitors (NNRTIs) or boosted protease inhibitors (PIs) in the RESPOND consortium of HIV cohorts.MethodsEligible people with HIV were aged ≥18 years who initiated a new three‐drug ART regimen for the first time (baseline), did not have hypertension, and had at least two follow‐up blood pressure (BP) measurements. Hypertension was defined as two consecutive systolic BP measurements ≥140 mmHg and/or diastolic BP ≥90 mmHg or initiation of antihypertensives. Multivariable Poisson regression was used to determine adjusted incidence rate ratios (aIRRs) of hypertension, overall and in those who were ART naïve or experienced at baseline.ResultsOverall, 4606 people living with HIV were eligible (INSTIs 3164, NNRTIs 807, PIs 635). The median baseline systolic BP, diastolic BP, and age were 120 (interquartile range [IQR] 113–130) mmHg, 78 (70–82) mmHg, and 43 (34–50) years, respectively. Over 8380.4 person‐years (median follow‐up 1.5 [IQR 1.0–2.7] years), 1058 (23.0%) participants developed hypertension (incidence rate 126.2/1000 person‐years, 95% confidence interval [CI] 118.9–134.1). Participants receiving INSTIs had a higher incidence of hypertension than those receiving NNRTIs (aIRR 1.76; 95% CI 1.47–2.11), whereas the incidence was no different in those receiving PIs (aIRR 1.07; 95% CI 0.89–1.29). The results were similar when the analysis was stratified by ART status at baseline.ConclusionAlthough unmeasured confounding and channelling bias cannot be excluded, INSTIs were associated with a higher incidence of hypertension than were NNRTIs, but rates were similar to those of PIs overall, in ART‐naïve and ART‐experienced participants within RESPOND.

Abstract P035: Seasonal Variations In Blood Pressure Control Among U.S. Adults With Hypertension, 2011-2018

Introduction: Blood pressure (BP) varies seasonally, typically manifesting as increased BP during the winter and reduced BP during the summer, that may contribute to difficulty in maintaining BP control among individuals with hypertension. We investigated seasonal differences in population-level BP control among U.S. adults with hypertension and whether such associations were modified by demographic and socioeconomic characteristics. Methods: We used cross-sectional 2011-2018 National Health and Nutrition Examination Survey (NHANES) data to identify participants aged ≥20 years with hypertension (defined as self-report, systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or antihypertensive medication use). Participants were categorized into two seasonal periods - winter-spring (November to April) and summer-fall (May to October) - based on their NHANES examination month. Survey-weighted logistic regression modeling was performed to analyze the association of BP control (&lt;140/90 mmHg) with six-month seasonal period, adjusted for age, sex, race and ethnicity, income level, education level, and insurance status. Subgroup analyses were also performed, stratifying by demographic and socioeconomic characteristics. Results: Across all panel years, 4,350 participants had examinations in the winter-spring and 4,521 in the summer-fall season. Mean (SEM) systolic BP was significantly higher in the winter-spring season compared to the summer-fall season (136.2 [0.48] mmHg vs 134.7 [0.61] mmHg; p=0.02). A significantly lower proportion of participants had controlled BP during the winter-spring season compared to participants during the summer-fall season (50.7% vs 55.2%; unadjusted odds ratio [OR]: 0.84 [95% CI: 0.72—0.98]), though the association was modestly attenuated after adjusting for covariates (adjusted OR [aOR]: 0.88 [95% CI: 0.75—1.05]). Similar observations were seen among those taking antihypertensive medication (62.5% vs 67.7%; aOR: 0.83 [95% CI: 0.69—0.99]). Subgroup analyses in the overall hypertensive population did not reveal evidence of heterogeneity of effect across age, sex, race and ethnicity, income level, education level, or insurance status. Conclusions: Seasonal variations in population-level BP control were observed among U.S. adults with hypertension, with a lower prevalence of BP control seen among those on antihypertensive treatment during the winter-spring season than the summer-fall season. No demographic or socioeconomic characteristics appeared to be more susceptible to these seasonal variations.

Isolated diastolic hypertension is not associated with endothelial dysfunction.

Hypertension is associated with an impairment of endothelial function. However, it is unclear whether isolated diastolic hypertension is associated with endothelial dysfunction. The purpose of this study was to investigate the association of endothelial function with isolated diastolic hypertension diagnosed by using two major hypertension guidelines: systolic blood pressure (BP) < 130 mmHg and diastolic BP ≥ 80 mmHg according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline and systolic BP < 140 mmHg and diastolic BP ≥ 90 mmHg according to the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) hypertension guideline. We measured the flow-mediated vasodilation (FMD) of the brachial artery in subjects without systolic hypertension who were not treated with antihypertensive drugs. Of 3727 subjects (2813 men; mean age: 41.3 ± 10.9 years), 749 (20.1%) had isolated diastolic hypertension according to the 2017 ACC/AHA definition. Multiple logistic regression analysis revealed that isolated diastolic hypertension was not associated with endothelial dysfunction, defined as FMD < 7.0% (OR, 1.15; 95% CI, 0.98-1.35; P = 0.09). Of 4747 subjects (3727 men; mean age: 45.1 ± 10.8 years), 314 subjects (6.6%) had isolated diastolic hypertension according to the ESC/ESH definition. Multiple logistic regression analysis revealed that isolated diastolic hypertension was not associated with endothelial dysfunction after adjusting for age and sex (OR, 1.04; 95% CI, 0.82-1.32; P = 0.76). Isolated diastolic hypertension was not associated with endothelial dysfunction in individuals who were not treated with antihypertensive drugs regardless of the major hypertension guideline definition used.

Clinical implications of cardiac troponin-I in patients with hypertensive crisis visiting the emergency department

Objectives Cardiac troponin-I (cTnI) is a representative marker of myocardial injury. Elevation of cTnI is frequently observed in patients with hypertensive crisis, but few studies have examined its prognostic significance in hypertensive crisis. We aimed to determine whether cTnI could predict all-cause mortality in patients with hypertensive crisis visiting the emergency department (ED). Methods This observational study included patients aged ≥18 years who visited an ED between 2016 and 2019 for hypertensive crisis, defined as systolic blood pressure (BP) ≥180 mmHg and/or diastolic BP ≥110 mmHg. Among 6467 patients, 3938 who underwent a cTnI assay were analysed. Results Among the 3938 patients, 596 (15.1%) had cTnI levels above the 99th percentile upper reference limit (elevated cTnI >40 ng/L) and 600 (15.2%) had cTnI levels between the detection limit (≥10 ng/L) and the 99th percentile upper reference limit (detectable cTnI). The 3-year all-cause mortality in the elevated, detectable and undetectable cTnI groups were 41.6%, 36.5% and 12.8%, respectively. After adjusting for confounding variables, elevated cTnI patients (adjusted hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.61–2.52) and detectable cTnI patients (adjusted HR, 1.64; 95% CI, 1.32–2.04) showed a significantly higher risk of 3-year all-cause mortality than did patients with undetectable cTnI. Conclusions In patients with hypertensive crisis, elevated cTnI levels provide useful prognostic information and permit the early identification of patients with an increased risk of death. Moreover, putatively normal but detectable cTnI levels also significantly correlated with a higher risk of all-cause mortality. Intensive treatment and follow-up strategies are needed for patients with hypertensive crisis with elevated and detectable cTnI levels. Key messages Cardiac troponin-I level was an independent prognostic factor for all-cause mortality in patients with hypertensive crisis. Detectable but normal range cardiac troponin-I, which was considered clinically insignificant, also had a prognostic impact on all-cause mortality comparable to elevated cardiac troponin-I levels.

Severe Pre-Eclampsia with Partial Hellp Syndrome in Multigravida Preterm Pregnancy

Preeclampsia is the second highest cause of maternal death in Indonesia. The incidence of preeclampsia in Indonesia is very high at 24%. West Java is a province in Indonesia with a high preeclampsia rate of 25%.Pre-eclampsia is a vascular endothelial dysfunction and vasospasm that occurs at gestational age above 20 months and is characterized by hypertension and proteinuria, with or without pathological edema. Severe preeclampsia (PEB) is characterized by a minimum of systolic blood pressure 160 mmHg or diastolic blood pressure 110, impaired liver function, progressive renal insufficiency, pulmonary edema, brain and visual disturbances, or thrombocytopenia. This research is descriptive observational with a case report approach. The aim of this research is to discuss updates on the occurrence, concept, pathophysiology, and management of preeclampsia. In the case reported, a female patient, aged 29 years G3P2A0, 36 weeks gestational age with severe pre-eclampsia, partial hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome in a multigravida preterm pregnancy with grade I obesity and a history of cesarean section 5 years ago. After evaluation, the patient complained of headache and heartburn. After confirmation, the fetus has IUGR, then active management with Transperitoneal Sectio Caesarea is chosen.

Hypertension and Socioeconomic Status in South Central Uganda: A Population-Based Cohort Study.

Background:Limited studies exploring the impact of socioeconomic status (SES) on hypertension in Africa suggest a positive association between higher SES and hypertension. The economic development in sub-Saharan African countries has led to changes in SES and associated changes in lifestyle, diet, and physical activity, which may affect the relationship between hypertension and SES differently compared with higher income countries. This cross-sectional study from a large population-based cohort, the Rakai Community Cohort Study (RCCS), examines SES, hypertension prevalence, and associated risk factors in the rural Rakai Region in south-central Uganda.Methods:Adults aged 30–49 years residing in 41 RCCS fishing, trading, and agrarian communities, were surveyed with biometric data obtained between 2016 and 2018. The primary outcome was hypertension (systolic blood pressure (BP) ≥ 130 mmHg or diastolic BP ≥ 80 mmHg). Modified Poisson regression assessed the adjusted prevalence ratios (PR) of hypertension associated with SES; body mass index (BMI) was explored as a potential mediator.Results:Among 9,654 adults, 20.8% had hypertension (males 21.2%; females 20.4 %). Participants with hypertension were older (39.0 ± 6.0 vs. 37.8 ± 5.0; p < 0.001). Higher SES was associated with overweight or obese BMI categories (p < 0.001). In the multivariable model, hypertension was associated with the highest SES category (aPR 1.23; confidence interval 1.09–1.38; p = 0.001), older age, male sex, alcohol use, and living in fishing communities and inversely associated with smoking and positive HIV serostatus. When BMI was included in the model, there was no association between SES and hypertension (aPR 1.02; CI 0.90–1.15, p = 0.76).Conclusion:Hypertension is common in rural Uganda among individuals with higher SES and appears to be mediated by BMI. Targeted interventions could focus on lifestyle modification among highest-risk groups to optimize public health impact.Key Messages What is already known about this subject? Hypertension is an important modifiable risk factor for cardiovascular disease.There are few large epidemiological studies that investigate the relationship between hypertension and socioeconomic status in low-income countries. What are the new findings? Hypertension is common among adults in rural South–Central Uganda, particularly among those with higher socioeconomic status.BMI is a mediator of the relationship between hypertension and socioeconomic status. How might it impact on clinical practice in the foreseeable future? These findings suggest that public health interventions and community efforts to prevent chronic cardiovascular disease and hypertension should focus on lifestyle modification by elucidating obesity risk perception and health risk awareness, particularly among those of higher socioeconomic status.

BLOOD PRESSURE LEVEL IN NURSES WHO WORK IN SHIFTS AND FACTORS AFFECTING IT

The aim is to assess the level of blood pressure in nurses of therapeutic and surgical departments who work in shifts and to establish the factors affecting it. Methods. 20 nurses from therapeutic departments and 20 from surgical departments who worked in shifts were included in the study. Systolic blood pressure and diastolic blood pressure (in mm Hg) were measured according to a standard protocol. Results. Arterial hypertension is found in 65% of nurses in therapeutic departments and in 45% of surgical departments, while the level of systolic blood pressure is probably higher in nurses of a therapeutic profile (p&lt;0.05). Factors affecting the blood pressure increasing in nurses of therapeutic and surgical departments include: duration of shift work, frequency of night shifts during the month, marital status (married, divorced) and presence of children. At the same time, the blood pressure of married and those who have 2 children nurses of therapeutic departments is probably higher than such data of employees of surgical departments. Conclusions. Nurses who work in shifts are more vulnerable to cardiovascular disorders.