mmHg Reduction In Systolic Blood Pressure Research Articles

Cost-Savings Associated with Multi-Disciplinary Team Approach for Reducing Macrovascular and Microvascular Complications in Patients with Type 2 Diabetes: A Predictive Model.

This study aims to predict the expected cost savings associated with implementing a multidisciplinary team (MDT) approach to reduce macrovascular and microvascular complications among patients with type 2 diabetes mellitus (T2DM). This economic evaluation study was conducted in Riyadh First Health Cluster, Saudi Arabia as a predictive model conceptualized by the authors based on models used in previous studies, particularly the CORE Diabetes Model. Our model was designed based on 1) the level of glycemic control among 24,755 T2DM patients served by MDTs; 2) the expected incidence of diabetes-related complications without intervention; 3) the predicted risk reduction of developing diabetes-related complications with MDTs. Costs of complications and cost savings were then calculated and expressed as mean incremental annual cost savings adjusted for a 1% reduction in HbA1c, and a 10 mmHg reduction in systolic blood pressure (SBP). Along with the expected reduction in all diabetes-related complications, the average incremental cost savings per diabetic patient is predicted to be ($38,878) with approximately ($11,108) in the year of complication onset and ($27,770) over the subsequent post-index 10-years. On adjustment of cost savings, the average incremental cost savings are predicted to be ($22,869) for each 1% reduction in HbA1c per diabetic patient and ($27,770) for every 10 mmHg reduction in SBP per diabetic patient. MDT as a model of care is effective in glycemic control among T2DM patients with a predicted significant reduction of all diabetes-related complications and in turn, a predicted significant cost savings.

The effects of blood pressure and antihypertensive drugs on heart failure: A Mendelian randomization study

Background and aimsHeart failure (HF) is often triggered by hypertension and can benefit from antihypertensive treatment. We aimed to investigate whether pulse pressure (PP) could independently raise the risk of HF beyond systolic blood pressure (SBP) and diastolic blood pressure (DBP), as well as explore the potential mechanisms of antihypertensives in HF prevention. Methods and resultsWe generated genetic proxies for SBP, DBP, PP, and five drug classes based on a massive genome-wide association study. We applied two-sample Mendelian randomization (MR) using summary statistics derived from European individuals and conducted summary data-based MR (SMR) with gene expression data. In univariate analysis, PP showed an obvious association with HF risk (OR, 1.24 per 10 mm Hg increment; 95% CI, 1.16 to 1.32), which was largely attenuated in multivariable analysis when adjusted for SBP (0.89; 0.77 to 1.04). A significant decrease in HF risk was obtained with genetically proxied β-blockers (equivalent to a 10 mm Hg reduction in SBP, 0.71; 0.62 to 0.82) and calcium channel blockers (0.71; 0.65 to 0.78), but not with genetically proxied angiotensin-converting enzyme inhibitors (0.69; 0.40 to 1.19) and thiazide diuretics (0.80; 0.47 to 1.37). Additionally, the enrichment of expression for the KCNH2 gene, a target gene of β-blockers, in blood vessels and nerves was significantly associated with HF risk. ConclusionOur findings suggest that PP may not be an independent risk factor for HF. β-blockers and calcium channel blockers have a protective effect against HF, which at least partly depends on their blood pressure-lowering effect.

Association between antihypertensive drugs and hepatocellular carcinoma: A trans-ancestry and drug-target Mendelian randomization study.

Antihypertensive drugs were recently reported to have an oncogenic role in common cancer, however, whether these drugs would affect the risk of hepatocellular carcinoma (HCC) remains unclear. A drug-target Mendelian randomization method was adopted to examine the long-term effect of 12 antihypertensive drugs classes on the risk of HCC in Europeans and East Asians. To proxy antihypertensive drugs, we leveraged genetic variants located near or within drug target genes that were associated with systolic blood pressure (SBP). Genetically proxied drugs associated with reduced risk of coronary artery disease were included in primary analysis. Genetic summary statistics of SBP and HCC were derived from publicly available large-scale genome-wide association studies in Europeans and East Asians respectively. Expression quantitative trait loci (eQTLs) of drugs target genes were used to proxy drugs in a sensitivity analysis. Genetically proxied thiazides and related diuretics were associated with decreased risk of HCC in both Europeans (OR [95% CI]: 0.79 [0.73, 0.86] per 1 mmHg reduction in SBP; p < 0.001) and East Asians (0.60 [0.45, 0.82]; p = 0.001). Genetically proxied beta-adrenoceptor blockers (BBs) were strongly associated with increased risk of HCC in Europeans (1.46 [1.12, 1.91]; p = 0.004). These findings were replicated in deCODE genetics study and remained consistent when using eQTLs to proxy antihypertensive drugs. Our findings suggested that thiazides diuretics may lower the risk of HCC in both Europeans and East Asians, while BBs may increase the risk of HCC specifically in Europeans. Further studies are warranted to explore the potential of repurposing or retargeting antihypertensive drugs for HCC prevention.

Effects of Cuisine-Based Chinese Heart-Healthy Diet in Lowering Blood Pressure Among Adults in China: Multicenter, Single-Blind, Randomized, Parallel Controlled Feeding Trial.

Background:More than one-fifth of the world’s population consumes Chinese cuisines regularly, but no evidence-based healthy diets fitting the Chinese food culture are available for implementation.Methods:A multicenter, patient- and outcome assessor–blind, randomized feeding trial was conducted among 265 participants with 130 to 159 mm Hg baseline systolic blood pressure (SBP) for 4 major Chinese cuisines (Shangdong, Huaiyang, Cantonese, Szechuan). After a 7-day run-in period on a control diet matching the usual local diets, participants were randomized to continue with the control diet or the cuisine-based Chinese heart-healthy diet for another 28 days. The primary outcome was SBP, and secondary outcomes included diastolic blood pressure and food preference score. Linear regression models were used to estimate the intervention effects and adjustments for the center. The incremental cost per 1 mm Hg reduction in SBP was also calculated.Results:A total of 265 participants were randomized (135 on the Chinese heart-healthy diet and 130 on the control diet), with 52% women, mean age of 56.5±9.8 years, and mean SBP and diastolic blood pressure of 139.4±8.3 and 88.1±8.0 mm Hg, respectively, at baseline. The change in SBP and diastolic blood pressure from baseline to the end of the study in the control group was –5.0 (95% CI, –6.5 to –3.5) mm Hg and –2.8 (95% CI, –3.7 to –1.9) mm Hg, respectively. The net difference of change between the 2 groups in SBP and diastolic blood pressure were –10.0 (95% CI, –12.1 to –7.9) mm Hg and –3.8 (95% CI, –5.0 to –2.5) mm Hg, respectively. The effect size did not differ among cuisines (P for interaction=0.173). The mean food preference score was 9.5 (with 10 the best preferred) at baseline, and the net change during intervention was 0.1 (95% CI, –0.1 to 0.2; P=0.558). The incremental cost-effectiveness ratio per 1 mm Hg SBP reduction was CNY 0.4 (USD 0.06) per day. No difference in the number of adverse events was found between the 2 groups (P=0.259), and none of the adverse events was associated with the intervention.Conclusions:The Chinese heart-healthy diet is effective, palatable, and cost-effective in reducing blood pressure in Chinese adults with high blood pressure, with a clinically significant effect applicable across major Chinese cuisine cultures.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT03882645.

Effect of weight loss on cardiometabolic risk: observational analysis of two randomised controlled trials of community weight-loss programmes.

BackgroundGuidelines recommend that clinicians identify individuals at high cardiometabolic risk and support weight loss in those with overweight or obesity. However, we lack individual level data quantifying the benefits of weight change for individuals to guide consultations in primary care.AimTo examine how weight change affects cardiometabolic risk factors, and to facilitate shared decision making between patients and clinicians regarding weight loss.Design and settingObservational analysis using data from two trials of referral of individuals with overweight or obesity in primary care to community weight-loss groups.MethodLinear mixed effects regression modelling examining the association between weight change and change in systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose, glycated haemoglobin (HbA1c), and lipid profile across multiple timepoints (baseline to 24 months). Subgroup analyses examined changes in individuals with hypertension, diabetes, and hyperlipidaemia.ResultsIn total, 2041 participants had a mean (standard deviation) age of 50 (SD 13.5) years, mean baseline weight of 90.6 (14.8) kg and mean body mass index (BMI) of 32.7 (SD 4.1) kg/m2. Mean (SD) weight change was −4.3 (SD 6.0) kg. All outcome measures showed statistically significant improvements. Each 1 kg weight loss was associated with 0.4 mmHg reduction in SBP and 0.3 mmHg reduction in DBP, or 0.5 mmHg and 0.4 mmHg/kg respectively in people with hypertension. Each 1 kg weight loss was associated with 0.2 mmol/mol reduction in HbA1c, or 0.6 mmol/mol in people with diabetes. Effects on plasma lipids were negligible.ConclusionWeight loss achieved through referral to community weight-loss programmes, which are commonly accessible in primary care, can lead to clinically relevant reductions in BP and glucose regulation, especially in those at highest risk.

An evidence-based analysis of managing hypertension with isometric resistance exercise-are the guidelines current?

Exercise guidelines for managing hypertension maintain aerobic exercise as the cornerstone prescription, but emerging evidence of the antihypertensive effects of isometric resistance training (IRT) may necessitate a policy update. We conducted individual patient data (IPD) meta-analyses of the antihypertensive effects of IRT. We utilized a one-step fitted mixed effects model and a two-step model with each analyzed trial using a random effects analysis. We classified participants as responders if they lowered their systolic blood pressure (SBP) by ≥5 mmHg, diastolic (DBP) or mean arterial blood pressure (MAP) by ≥3 mmHg. Twelve studies provided data on 326 participants. IRT produced significant reductions in SBP, DBP, and MAP. The SBP responder rates for both groups, or the absolute risk reduction (ARR) between groups, was 28.1% in favor of the IRT group. The number needed to treat (NNT) to achieve one 5 mmHg reduction in SBP was 3.56, 95% CI [2.56, 5.83], or four people. The ARR for DBP was 20.0% in favor of IRT. Therefore, the NNT to achieve one 3 mmHg decrease in DBP was five people, 95% CI [3.22, 11.10]. The ARR for MAP was 28.2% in favor of IRT. Therefore, the NNT to achieve one 3 mmHg reduction in MAP was four people, 95% CI [2.80, 7.42]. Our analyses demonstrated that IRT (three times per week for a total of 8 min of squeezing activity) is able to reduce the participants' SBP by 6-7 mmHg, equating to a 13% reduction in the risk for myocardial infarction and 22% for stroke.

MON-250 THE MANAGEMENT OF NEPHROTOXIC MEDICATIONS IN COLONOSCOPY

The optimal management of potentially nephrotoxic drugs prior to colonoscopy is unclear. This study – part of a broader study assessing acute kidney injury (AKI) following colonoscopy – aimed to assess the current practices of medication management in patients undergoing colonoscopy, with a particular focus on whether nephrotoxic medications were withheld before the procedure. Nephrotoxic medications were defined as Renin Angiotensin Aldosterone System (RAAS) blockers [encompassing Angiotensin Receptor Blockers (ARBs), Angiotensin Converting Enzyme inhibitors (ACEI) and aldosterone antagonists], diuretics and non-steroidal anti-inflammatory drugs (NSAIDs). Adults who underwent inpatient colonoscopy at Blacktown Hospital between April 2017 and April 2018 were included in this retrospective study. Patients who were on renal replacement therapy or did not have at least one serum creatinine value in the 72 hours before and after colonoscopy were excluded. The electronic medication management (eMEDs) system provided an accurate record of medications administered, withheld or discontinued throughout the admission period. Demographic data, comorbidities, pathology results and procedural data were collected from electronic medical records. Statistical analysis was performed using SPSS v22. A total of 140 patients were included (mean age 58.5 + 1.7 years; females 53.6%). The majority of patients (n=74, 52.9%) demonstrated regular use of nephrotoxic medications, including RAAS blocking agents, diuretics or NSAIDs. Of the patients prescribed RAAS blockers (n=57, 40.7%), the likelihood of having the medication continued (n=32, 56.1%) was higher than having it withheld (n=25, 43.9%) before colonoscopy. In the patients prescribed diuretics (n=34, 24.3%), there was a similar proportion of patients continued (n=18, 52.9%) on the medication compared to withheld (n=16, 47.1%). This is also applicable to patients on NSAIDs (n=10, 4%), in which the proportions of each was equal (n=5, 50%). Multivariate analysis of the risk factors associated with AKI post-colonoscopy identified that greater reduction in systolic blood pressure (SBP) during colonoscopy was significantly associated with the incidence of AKI following colonoscopy (odds ratio per 10 mmHg reduction in SBP, 2.22; 95% CI, 1.09 to 4.52, p=0.03). Despite this, there was no statistically significant association between the withholding of RAAS blocking agents or diuretics and the incidence of AKI following colonoscopy. There is substantial variability in the prescribing patterns of RAAS blockers, diuretics and NSAID medications in colonoscopy. There is a need for data to inform standardised protocols in the management of nephrotoxic medications in the peri-procedural period, to prevent the risk of possible acute kidney impairment.

Abstract 021: Interleukin-21 Plays a Critical Role in Hypertension and Vascular Dysfunction

T cell derived cytokines, interleukin 17A (IL17A) and interferon gamma (IFNg), promote angiotensin II (Ang II)-induced hypertension and end-organ damage. Interleukin 21 (IL21), produced primarily by T follicular helper (Tfh) cells, has been shown to induce IL17A and IFNγ production from T effector cells. IL21 is also a potent activator of germinal center (GC) B cells and immunoglobulin (Ig) class switching. We hypothesized that IL21 plays a fundamental role in hypertension and hypertensive end-organ damage through its effects on pro-inflammatory T cell polarization, vascular dysfunction, and enhanced Ig secretion. CD4+ T cells from Ang II infused WT mice exhibit 1.5-fold increased IL21 mRNA expression and 2-fold increased IL-21 production compared to vehicle. We found IL21 -/- mice exhibit a 30mmHg reduction in systolic blood pressure (SBP) in response to 4 weeks of Ang II infusion compared to age-matched wild type (WT) mice. Further, IFNg and IL17A production from CD8+ or CD4+ T cells, respectively, was abrogated in IL21 -/- mice vs. WT mice infused with Ang II. We also found Tfh cells and GC B cells significantly increased in the aortas and mesenteric vessels of Ang II WT mice but not IL21 -/- mice. Ang II induced an increase in percent of lymph node GC B cells and IgG/IgM ratio, consistent with Ig class switching. Ang II-induced increase in renal injury was also blunted in IL21 -/- mice vs. WT mice. Mesenteric vessels from IL21 -/- mice were protected from Ang II-induced endothelial dysfunction. IL21 -/- mice also developed blunted aortic fibrosis and reduced smooth muscle cell hypertrophy after 4 weeks of Ang II vs. WT mice. IL-21 neutralization beginning 2 weeks after Ang II resulted in a 15 mmHg reduction in SBP and reversal of aortic inflammation and vascular endothelial dysfunction compared to isotype control treated animals. Lastly, CD4+ T cell production of IL21 positively correlated with SBP in human volunteers, and in fact, IL-21 production was significantly higher in hypertensive compared to normotensive subjects. Taken together, these studies provide compelling evidence that IL21 may function as a master cytokine in the pathogenesis of hypertension and suggest that therapies targeting IL21 may reduce hypertension and the associated end-organ damage.

Implications of Recent Clinical Trials and Hypertension Guidelines on Stroke and Future Cerebrovascular Research.

The decline in stroke mortality observed over the past 50 years has been attributed, in part, to improved implementation of high blood pressure (BP) treatment and control strategies based on the most current evidence from clinical research studies and randomized controlled trials (RCTs).1 The reduction in stroke risks coincides with the shift to lower systolic BP (SBP) distributions in the US adult population for all age groups.1 However, critical clinical questions remain about the treatment, control, and prevention of high BP. New evidence from RCTs and meta-analyses2–6 is expected to have an important positive impact on hypertension guidelines, clinical practice, and future research. Because stroke risk is substantially associated with BP levels and hypertension treatment and control, raised BP and stroke reduction is so heavily tied to BP control, stroke prevention is a key driving force for clinical practice decisions. As a component of the 2017 International Stroke Conference, the American Heart Association, American Stroke Association, and World Hypertension League cosponsored session focused on impact of recent hypertension studies, meta-analyses and new clinical guidelines on stroke risk reduction, and implications for future research. The Prospective Studies Collaboration7 showed a log-linear relationship between BP and stroke declining with lower BP values right down to <120 mm Hg systolic and <70 mm Hg diastolic. Further, a meta-analysis of 147 RCTs of antihypertensive therapy the percentage reduction in stroke with BP reduction down to a mean of 110/70 mm Hg regardless of their BP before treatment.8 Another systematic review in patients with diabetes mellitus reported a decrease of 13% in the risk of stroke for each 5 mm Hg reduction in SBP, and by 11.5% for each 2 mm Hg reduction in diastolic BP.9 In another meta-analysis of 123 studies, Ettehad et al4 provided support for lowering SBP to …

Abstract P195: Digital Health Tool Use and Outcomes in People With Uncontrolled Hypertension

Background: Digital health applications are increasingly ubiquitous, however the effectiveness remains mixed. Using a large working age cohort we sought to evaluate use of a digital health intervention (DHI) in people with uncontrolled hypertension and their changes in blood pressure control. Methods: We analyzed usage of DHI and change in blood pressure control and other CVD risk factors over one year in 9,724 participants of a work health program across 81 organizations in 42 states. Patients were selected from a larger cohort based on a previous ICD-9 diagnosis of hypertension. Patients with uncontrolled hypertension, systolic blood pressure (SBP) greater than 140 mmHg, at the initial visit were included. Application users, defined as at least one login, were compared to non-users. Changes in blood pressure, weight, and lipids were compared at one year. Results: Users and non-users were similar in age, weight, blood pressure and lipids at baseline, though users were more likely to be female. At one year users had 16.44 mmHg reduction in SBP and 7.16 mmHg reduction in diastolic blood pressure (DBP), both statistically significantly more than non-users (Table 1). Both users and non-users had an improvement in LDL from baseline, while non-users also had an improvement in BMI and TG from baseline. Discussion: These results show that the use of a DHI is associated with improved systolic and diastolic blood pressure control compared to a workplace health program alone.

Birth weight and maternal socioeconomic circumstances were inversely related to systolic blood pressure among Afro-Caribbean young adults

ObjectivesIn this study, we examined the effects of birth weight (BWT) and early life socioeconomic circumstances (SEC) on systolic blood pressure (SBP) and diastolic blood pressure (DBP) among Jamaican young adults. Study Design and SettingLongitudinal study of 364 men and 430 women from the Jamaica 1986 Birth Cohort Study. Information on BWT and maternal SEC at child's birth was linked to information collected at 18–20 years old. Sex-specific multilevel linear regression models were used to examine whether adult SBP/DBP was associated with BWT and maternal SEC. ResultsIn unadjusted models, SBP was inversely related to BWT z-score in both men (β, −0.82 mm Hg) and women (β, −1.18 mm Hg) but achieved statistical significance for women only. In the fully adjusted model, one standard deviation increase in BWT was associated with 1.16 mm Hg reduction in SBP among men [95% confidence interval (CI): 2.15, 0.17; P = 0.021] and 1.34 mm Hg reduction in SBP among women (95% CI: 2.21, 0.47; P = 0.003). Participants whose mothers had lower SEC had higher SBP compared with those with mothers of high SEC (β, 3.4–4.8 mm Hg for men, P < 0.05 for all SEC categories and 1.8–2.1 for women, P > 0.05). ConclusionSBP was inversely related to maternal SEC and BWT among Jamaican young adults.

104-POS

Objectives Blood pressure (BP) elevation after experimental reduction in uteroplacental blood flow in primates is associated with proteinuria and has been a surrogate for studying placental dysfunction manifesting as preeclampsia in humans. Controlling BP is the mainstay of treatment but the effect of antihypertensive treatment on the acute BP response is poorly understood in this animal model. We examined the effect of three oral antihypertensive agents in the treatment of BP in an experimental setting to determine the BP response. Methods Papio hamadryas (baboon) BP was recorded continuously via intra-arterial telemetry in late pregnancy after induction of placental ischaemia by surgical ligation of a uterine branch artery. Proteinuria, haematology, biochemistry and fetal growth were assessed. Antihypertensives hydralazine 15 mg bid, methyldopa 10 mg/kg bid and labetalol 40 mg bid were administered orally for four days followed by a three-day washout phase. The average BP change for each drug from day 1 and 2 of treatment compared to day 3 and day 4 of treatment was evaluated. Results The antihypertensives resulted in a reduction in BP (average 1.4 mmHg, n = 2). Hydralazine and methyldopa showed a 0.4 mmHg and 2.4 mmHg reduction in systolic BP respectively, whereas labetalol showed no decrease; hydralazine and methyldopa showed a 0.5 mmHg and 1.8 mmHg reduction in diastolic BP respectively, and labetalol showed a 0.6 mmHg decrease in diastolic BP. Conclusions Preliminary data shows that hydralazine and methyldopa cause an acute decrease in systolic BP and diastolic BP in an experimental model of preeclampsia in non-human primates. The lack of BP reduction with labetalol may reflect altered drug efficacy or metabolism in this species or inadequate dosing. Disclosures S.J. Pears: None. A. Hennessy: None. S. Lim: None. K. Chau: None. K. Yeung: None. S. Heffernan: None. A. Makris: None.

Impact of a pill box clinic to improve systolic blood pressure in veterans with uncontrolled hypertension taking 3 or more antihypertensive medications.

Two-thirds of Americans who are prescribed antihypertensive medications are not at a blood pressure (BP) goal of <140/90 mmHg, and low adherence is identified as a primary cause of inadequate control. Improved adherence to antihypertensive medications has been shown to enhance BP control and reduce the risk of cardiovascular complications. This study investigated the effectiveness of a pill box clinic to improve BP in veterans with uncontrolled hypertension taking 3 or more antihypertensive medications. To (a) investigate the reduction of systolic BP by 10 mmHg from pre-intervention to post-intervention (primary outcome) and (b) investigate the percentage of patients meeting goal blood pressure--as defined by The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7)--and percentage of patient adherence to antihypertensive medications (secondary outcomes). Patients with uncontrolled hypertension currently taking at least 3 antihypertensive medications were enrolled in this prospective pre/post study. Under the supervision of a pharmacist, each patient was provided two 7-day pill boxes to organize all antihypertensive medications. In addition, baseline BP and previous history of nonadherence were documented. Following the initial encounter, patients attended 2 follow-up appointments, at 2 and 4 weeks, for refill of pill boxes, BP measurement, and adherence assessment. A chi-square test was used for categorical outcomes and logistic regression for nominal outcomes as well as descriptive statistics, as appropriate. Sixty patients were enrolled, with 50 completing appointments 1 and 2, and 45 completing all 3 appointments. Of those, 24% and 31% achieved at least a 10 mmHg reduction in systolic BP from baseline to appointments 2 and 3, respectively (P = 0.438). Systolic BP readings for appointments 1, 2, and 3 were not statistically significant (mean [SD]: 134.1 [11.8], 131.9 [9.4], and 130.6 [11.4], respectively). Goal BP per JNC7 was achieved by 44% and 51% of patients at appointments 2 and 3, respectively, compared with baseline (P = 0.201). All patients had ≥ 80% adherence to antihypertensive medications, assessed via pill counts at the second and third appointments. Although results were not statistically significant, the pill box clinic resulted in clinically significant reductions in systolic BP by 10 mmHg, as well as an increased number of patients meeting prescribed BP goals.

Altering plasma sodium concentration rapidly changes blood pressure during haemodialysis

Plasma sodium is increased following each meal containing salt. There is an increasing interest in the effects of plasma sodium concentration, and it has been suggested that it may have direct effects on blood pressure (BP) and possibly influences endothelial function. Experimental increases of plasma sodium concentration rapidly raise BP even when extracellular volume falls. Ten patients with end-stage renal failure established on haemodialysis were studied during the first 2 h of dialysis without fluid removal during this period. They were randomized to receive haemodialysis with (i) dialysate sodium concentration prescribed to 135 mmol/L and (ii) 145 mmol/L in random order in a prospective, single-blinded crossover study. BP measurements and blood samples were taken every 30 min. Pre-dialysis sitting BP was 137/76 ± 7/3 mmHg. Lower dialysate sodium concentration (135 mmol/L) reduced plasma sodium concentration [139.49 ± 0.67 to 135.94 ± 0.52 mmol/L (P < 0.001)], whereas plasma sodium concentration was not altered by higher dialysate sodium (145 mmol/L) (140.17 ± 0.66 mmol/L at baseline to 140.72 ± 0.43 mmol/L at 120 min). Systolic BP was lower with dialysate sodium concentration 135 mmol/L [area under the curve (AUC) 15823.50 ± 777.15 (mmHg)min] compared with 145 mmol/L [AUC 17018.20 ± 1102.17 (mmHg)min], mean difference 1194.70 ± 488.41 (mmHg)min, P < 0.05. There was a significant positive relationship between change in plasma sodium concentration and change in systolic BP. This direct relationship suggests that a fall of 1 mmol/L in plasma sodium concentration would be associated with a 1.7 mmHg reduction in systolic BP (P < 0.05). The potential mechanism for the increase in BP seen with salt intake may be through small but significant changes in plasma sodium concentration.

Abstract 204: Blood Pressure Reduction And Stroke Recurrence: The Progress Trial

Background: A recent observational analysis of a large-scale randomized controlled trial identified a “J-curve” phenomenon such that low and high blood pressure (BP) levels are associated with increased risks of recurrent stroke among patients with recent ischemic stroke. The objective of the present analysis was to determine whether larger reduction in BP associated with treatment increases the risks of recurrent stroke among patients with cerebrovascular disease. Methods: This is a subsidiary analysis of the PROGRESS trial, a randomized, placebo-controlled trial that established the beneficial effects of BP lowering in secondary prevention of stroke. A total of 6105 patients with prior stroke or transient ischemic attack were randomly assigned to either active treatment (perindopril ± indapamide) or matching placebo(s). There were no BP criteria for entry. BP was measured at every visit and groups of participants defined by reduction in systolic BP (SBP) from baseline (&lt;0, 0-9, 10-19 and ≧20 mm Hg) were used for these analyses. Outcomes of the present analyses were recurrent hemorrhagic and ischemic stroke. Results: During a mean follow-up of 3.9 years, 111 hemorrhagic stroke and 565 ischemic stroke events were observed. There were clear inverse associations between SBP reduction and the risk of hemorrhagic stroke even after adjustment for age, sex, region, baseline SBP, diabetes, current smoking and randomized treatment: adjusted annual incidence rates were 0.08%, 0.06%, 0.05% and 0.03% for participant groups defined by reduction in SBP levels of &lt;0, 0-9, 10-19 and ≧20 mm Hg, respectively. The lowest risks of hemorrhagic stroke were observed among patients who achieved ≧20 mm Hg reduction in SBP associated with treatment. Annual incidence of ischemic stroke was 2.19%, 1.74%, 1.73% and 1.72% for the same participant groups. Compared with patients who did not achieve any SBP reduction, the decreases in the risk of ischemic stroke were similar in the groups achieving SBP reductions of 0-9, 10-19 and ≧20 mm Hg. Conclusions: The present analysis provided no evidence of increase in recurrent stroke associated with larger reduction in SBP produced by BP lowering treatment among patients with cerebrovascular disease.

Resistance exercise training reduces arterial reservoir pressure in older adults with prehypertension and hypertension

We examined changes in central blood pressure (BP) following resistance exercise training (RET) in men and women with prehypertension and never-treated hypertension. Both Windkessel theory and wave theory were used to provide a comprehensive examination of hemodynamic modulation with RET. Twenty-one participants (age 61±1 years, n=6 male; average systolic blood pressure (SBP)/diastolic blood pressure (DBP)=138/84 mm Hg) were randomized to either 12 weeks of RET (n=11) or an inactive control group. Central BP and augmentation index (AIx) were derived from radial pressure waveforms using tonometry and a generalized transfer function. A novel reservoir-wave separation technique was used to derive excess wave pressure (related to forward and backward traveling waves) and reservoir pressure (related to the capacitance/Windkessel properties of the arterial tree). Wave separation using traditional impedance analysis and aortic flow triangulation was also applied to derive forward wave pressure (Pf) and backward wave pressure (Pb). There was a group-by-time interaction (P<0.05) for central BP as there was a significant ~6 mm Hg reduction in SBP and ~7 mm Hg reduction in DBP following RET with no change in the control condition. There were also group-by-time interactions (P<0.05) for Pf, excess wave pressure and reservoir pressure attributable to reductions in these parameters in the RET group concomitant with slight increases in the control group. There was no change in AIx or Pb (P>0.05). RET may reduce central BP in older adults with hypertension and prehypertension by lowering Pf and reservoir pressure without affecting pressure from wave reflections.

PS07 Trends in Blood Pressure in England: Good Treatment or Good Luck?

BackgroundFor 30 years, adult blood pressure (BP) has declined in many developed countries. This is likely to have contributed to declining cardiovascular disease mortality. However, the reasons for this, particularly...

Is a blood pressure rise the only deleterious off-target effect of cholesterol ester transfer protein inhibitors?

Is a blood pressure rise the only deleterious off-target effect of cholesterol ester transfer protein inhibitors?

Dietary patterns and blood pressure among middle-aged and elderly Chinese men in Shanghai.

The prevalence of hypertension has increased over the past decade in many developed and developing countries, including China. This increase may be associated with changes in lifestyle, including dietary patterns. We evaluated the association of dietary patterns with blood pressure (BP) by using data from a large, population-based cohort study of middle-aged and elderly Chinese men, the Shanghai Men's Health Study. The present cross-sectional analysis includes 39 252 men who reported no prior history of hypertension, diabetes, CHD, or stroke nor use of antihypertensive drugs at study enrolment. Three dietary patterns, 'vegetable', 'fruit and milk' and 'meat', were derived using factor analysis. The fruit and milk diet was inversely associated with both systolic and diastolic BP (Ptrend < 0.001). The adjusted mean systolic BP was 2.9 mmHg lower (95 % CI - 3.4, - 2.4), and diastolic BP was 1.7 mmHg lower (95 % CI - 2.0, - 1.4) for men in the highest quintile of the 'fruit and milk' pattern compared with men in the lowest quintile. This inverse association was more evident among heavy drinkers; the highest quintile of the 'fruit and milk' pattern was associated with a 4.1 mmHg reduction in systolic BP v. a 2.0 mmHg reduction among non-drinkers (Pinteraction = 0.003) compared to the lowest quintile. The corresponding reductions in diastolic BP were 2.0 v. 1.3 mmHg (Pinteraction = 0.011). The 'fruit and milk' pattern was associated with a lower prevalence of both pre-hypertension and hypertension, and the associations appeared to be stronger among drinkers. Results of the present study suggest an important role for diet in the prevention of hypertension.

Decreased exercise blood pressure in older adults after exercise training: contributions of increased fitness and decreased fatness

Objective:To describe the contribution of changes in fitness and fatness resulting from exercise training on changes in submaximal exercise blood pressure (BP) during treadmill testing.Design and setting:Prospective, randomised, controlled trial.Participants:Sedentary...