mmHg For DBP Research Articles

Validation of the Rossmax AC1000f upper-arm blood pressure monitor in adults according to the British Hypertension Society Protocol.

To evaluate the accuracy of the Rossmax AC1000f oscillometric upper-arm blood pressure monitor in adults according to the British Hypertension Society Protocol. Eighty-five subjects (male 42 and female 43) with a mean age of 48.1 years were recruited to fulfill the blood pressure distribution criteria of the British Hypertension Society Protocol in general population using the same arm sequential blood pressure measurement method. For each subject, we sequentially measured blood pressure using a mercury sphygmomanometer (two observers) and the AC1000f device (one supervisor). Data analysis was carried out according to the British Hypertension Society Protocol. A total of 255 comparison pairs were obtained for analysis. The device achieved grade A. The percentage of blood pressure differences within 5, 10 and 15 mmHg was 66.7, 92.2 and 98.0%, respectively, for SBP, and 64.7, 90.2 and 98.4%, respectively, for DBP. The average (±SD) of the device-observer differences was -0.5 ± 6.0 mmHg for SBP and -1.4 ± 5.9 mmHg for DBP, respectively. The automated upper-arm blood pressure monitor Rossmax AC1000f has passed the requirements of the British Hypertension Society Protocol, and hence can be recommended for blood pressure measurement in adults.

The association of outdoor temperature with blood pressure, and its influence on future cardio-cerebrovascular disease risk in cold areas.

To explore whether lower outdoor temperature increases cardio-cerebrovascular disease risk through regulating blood pressure and whether indoor heating in winter is beneficial to prevent cardio-cerebrovascular disease in cold areas. We analyzed the data of 38 589 participants in Harbin from the China Kadoorie Biobank (CKB) during 2004-2008, with an average of 7.14-year follow-up. Linear regression analysis was performed to estimate the relationship between outdoor temperature and blood pressure. Cox regression analysis and logistic regression analysis were used to analyze the association of blood pressure with cardio-cerebrovascular event risk. Mediation analysis was performed to explore the role of blood pressure in the association between outdoor temperature and cardio-cerebrovascular events risk. There was an increase of 6.7 mmHg in SBP and 2.1 mmHg in DBP for each 10 °C decrease in outdoor temperature when outdoor temperature was higher than 5 °C. There was an inverse association between outdoor temperature and cardio-cerebrovascular event morbidity. The increases in blood pressure and cardio-cerebrovascular event morbidity were attenuated in months when central heating was fully provided. Participants with hypertension have higher risks of cardio-cerebrovascular disease (hazard ratio 1.347; 95% CI 1.281--1.415), CVD (hazard ratio 1.347; 95% CI 1.282--1.416), MACE (hazard ratio 1.670; 95% CI 1.560--1.788) and stroke (hazard ratio 1.683; 95% CI 1.571--1.803). Mediation analysis demonstrated that the association between outdoor temperature and cardio-cerebrovascular events risk was potentially mediated by blood pressure. Temperature-driven blood pressure potentially mediates the association between outdoor temperature and cardio-cerebrovascular events risk. Indoor heating in winter is probably beneficial to cardio-cerebrovascular disease prevention by inhibition of blood pressure increase.

A comparison of first trimester blood pressures obtained at the time of first trimester pre-eclampsia screening and those obtained during prenatal care visits

ObjectiveTo determine if enrollment blood pressures in a study on first trimester preeclampsia prediction significantly differed from those obtained during routine prenatal care visits in the first trimester. Study DesignWomen carrying a singleton gestation were prospectively enrolled in a first trimester study on preeclampsia prediction, and had systolic and diastolic blood pressure (SBP, DBP) measured at the time of enrollment. Blood pressure was also measured with the same technique by clinic nurses during the routine prenatal visits throughout the first trimester of pregnancy (9–14 weeks). The enrollment-BP (E-BP) and average first trimester-BP (aFT-BP) were compared using a paired samples t-test or Wilcoxon test, as appropriate. Smokers and patients on antihypertensive medications were excluded from the analysis. test. Results644 women had prenatal care in the primary study center and met study criteria. The mean gestational age at study enrollment was 12.5 weeks. No significant difference was found between E-SBP and aFT-SBP (p = 0.10). Enrollment DBP and mean arterial pressure (MAP) were significantly lower than the aFT- DBP and -MAP (median DPB 67 vs 70 mm Hg and median MAP 83.7 vs 85 mmHg, respectively, p < 0.001). However, the difference was not clinically relevant (3 mmHg for DBP, and 1.3 mmHg for MAP). ConclusionsBlood pressures obtained in a setting of preeclampsia screening are not higher than those obtained during regular prenatal care in the first trimester. This suggests that the setting in which pre-eclampsia screening is performed is unlikely to be a confounder for blood pressure measurements and the risk assessment.

P1513 Myocardial work analysis is a potential novel tool to diagnose subclinical cardiac dysfunction in cirrhotic cardiomyopathy

Abstract Funding Acknowledgements This work was supported by a grant of Ministery of Research and Innovation, CNCS-UEFISCDI, project number PN-III-P1-1-TE-2016-0669, within PNCDI III Background Cirrhotic cardiomyopathy (CCM) is defined as systolic and/or diastolic cardiac dysfunction, associated with high preload and low afterload. Thus, assessment of cardiac dysfunction in these circumstances is still debatable. Left ventricular (LV) deformation is still load-dependent, and does not reflect directly myocardial energy consumption. Since myocardial work (MW)incorporates both deformation and afterload, it might be a better alternative for the assessment of LV function in CCM. Methods 80 subjects were assessed by 2D conventional and speckle tracking echocardiography (STE): 40 patients with liver cirrhosis (LC) (58 ± 8 years, 23 males), free of any cardiovascular disease or diabetes, and 40 age and gender matched normal, control subjects. Left ventricular ejection fraction (LVEF) and systolic/diastolic blood pressure (SBP/DBP) were measured. A new approach was used to evaluate myocardial work by 2DSTE: global constructive work (GCW), as the "positive" work of the heart; global wasted work (GWW), as the "negative" work of the heart; global work efficiency (GWE), as the GCW/(GCW + GWW) in %; and global work index (GWI), as the GCW added to GWW. E/E’ ratio, left atrial volume index (LAVi), and systolic pulmonary arterial pressure (sPAP) were also assessed. Results Patients with LC had significantly lower SBP/DBP than controls, with similar LVEF (Table). GCW and GWI were decreased in patients with LC, probably due to decrease in afterload, which shifts LV work to a lower level of energy. GWE and GWW were similar to controls. By segmental analysis (18 segments model), apical and mid antero-lateral segments were the first affected in terms of myocardial work, with higher WW, low WE, but without a compensatory increase in CW in other segments, suggesting a regional myocardial dysfunction. All patients with LC presented significantly elevated E/E’ ratio, LAVi, and sPAP, compared to controls (Table). Conclusion Myocardial global constructive work and global work index decrease in LC patients, compared to normal individuals, probably due to augmented peripheral vasodilatation. Apical and mid antero-lateral segments are the first affected. Assessment of global and regional MW might be a potential new tool to assess CCM, and to understand the relationship between LV remodeling and increased filling pressure under different loading conditions. Comparative myocardial work indices group SBP (mmHg) DBP LVEF (%) E/E’ LAVI sPAP GWI GWE (% ) GCW (mmHg % ) GWW (mmHg %) LC (40) 111 ±14 69 ± 12 59 ± 7 8.5 ± 2.5 45.9 ± 14.5 26 ± 9 1927 ± 379 95 ± 2 2068 ± 386 90.1 ± 49 Controls (40) 126 ± 14 76 ± 8 61 ± 7 7.5 ± 2.2 31.8 ± 6.8 21 ± 8 2123 ± 353 95± 2 2302 ± 335 94.4 ± 49 P value 0.001 0.004 0.3 0.05 0.001 0.009 0.01 0.9 0.005 0.7 Abstract P1513 Figure. Myocardial Work Cirrhotic Cardiomyopathy

P6362Impact of the 2017 AHA/ACC hypertension guideline on hypertension prevalence and cardiovascular risk factors in a healthy older cohort

Abstract Background The 2017 American Heart Association (AHA)/American College of Cardiology (ACC) hypertension guideline recommends a target blood pressure (BP) of &lt;130/80 mmHg regardless of age, which is lower than previously recommended BP goals. Purpose We aimed to determine how much the updated classification for high BP would increase the overall prevalence of “hypertension” in an otherwise healthy elderly population. Additionally, we explored the cardiovascular disease (CVD) risk factor distribution in those newly classified “hypertensives” to determine whether the increased prevalence of hypertension was accompanied by an increase in other modifiable CVD risk factors. Methods We used baseline data from 19,114 participants (16,703 in Australia and 2,411 in the USA) aged ≥65 years who were enrolled in the ASPirin in Reducing Events in the Elderly (ASPREE) study between 2010 and 2014. Participants were classified as having hypertension using either: (a) pre-2017 thresholds (SBP ≥140 mmHg or mean DBP ≥90 mmHg and/or on anti-hypertensive) or (b) 2017 AHA/ACC guidelines (SBP ≥130 mmHg or DBP ≥80 mmHg and/or on anti-hypertensive). We assessed the presence of cardiovascular disease risk factors such as diabetes, hypercholesterolemia, smoking, obesity, reduced renal function among these hypertensive participants and also estimated their predicted risk over 10 years. Results Based on pre-2017 thresholds, 74% of the participants met the criteria for hypertension. Hypertension prevalence increased to 87% when the more stringent 2017 guideline was applied. 29% of this subset of newly classified hypertensive participants did not have any other identifiable traditional CVD risk factors. Further, a significantly lower 10-year predicted cardiovascular risk (22% versus 26%, p&lt;0.001) among those newly classified hypertensive participants was observed in relation to those having hypertension based on pre-2017 guideline (Figure 1). Figure 1. 10-year predicted CVD risk among hyoertensive and newly classified hypertensive ASPREE participants by presence of CVD risk factor Conclusion As expected, the prevalence of hypertension increased among the healthy elderly when applying the new AHA-2017 guideline; however, the increased prevalence occurs despite lack of an accompanying increase in additional CVD risk factors or predicted 10-year risk. Our findings suggest an individualized approach is needed in evaluating high BP among the healthy elderly. Acknowledgement/Funding National Institute on Aging and the National Cancer Institute at NIH; NHMRC Australia, Monash University, Victorian Cancer Agency (Australia)

Reproducibility of the European Society of Hypertension - International Protocol for validation of blood pressure measuring devices in obese patients.

Electronic devices for blood pressure (BP) measurements need to go through independent clinical validation as recommended by different authorities, both in general and special populations. Reproducibility of such validation protocols is unknown. The aim of this study was to assess the inter-centre reproducibility of the European Society of Hypertension-International protocol (ESH-IP) in patients with large arm circumference at least 32 cm or obesity. Two independent validation studies were performed in parallel according to the ESH-IP protocol in two centres (Serbia and Armenia). The two studies were performed blindly and independently. The ESH-IP criteria were applied for the analysis. The OMRON RS7 wrist oscillometric devices were used in both studies. The distribution of the mean differences values of 5 or less, 10 or less and 15 mmHg or less between the observers and the device were for the Serbia team: 74, 95 and 98 for SBP and 78, 95 and 99 for DBP; and for the Armenia team: 86, 95 and 99 for SBP and 90, 99 and 99 for DBP. The mean differences (SD) of BP values between the observers and the device were for the Serbia team of 1.7 ± 4.8 mmHg for SBP and 1.2 ± 4.6 mmHg for DBP and for the Armenia team of -1.1 ± 4.2 mmHg for SBP and -0.3 ± 3.5 mmHg for DBP. This study showed that the ESH-IP validation protocol presents a good inter-centre reproducibility. The OMRON RS7 device showed similar results, fulfilling the validation criteria in two independent studies in patients with arm circumference at least 32 cm.

Abstract 036: Genetics and Epigenetics on Circadian Blood Pressure and Variability in Rats Compared With Ambulatory Blood Pressure Variability in Human

Hypertension is associated with high morbidity and mortality. Blood pressure (BP) levels vary widely due to predictable biological rhythms and unpredictable environmental factors. Daily (circadian) rhythm characteristics are considered essential parameters for recognizing and treating increased risks in BP. Franz Halberg spent most of his academic career in cardiovascular research, focused on ambulatory monitoring and developing chronobiological methods for clinical application. To compare BP Variability (BPV), automatically monitored ambulatory BP around the clock at 30-60 min intervals in 20 human subjects was compared with telemetered circadian BP in rats after one-cell homozygous embryo-transfer into spontaneously hypertensive (SHR, pup:shr) or normotensive (WKY, pup:wky) rats' oviducts (embryos: s,w; oviduct-uterus: S,W) and cross-suckled at birth (nurses S,W). The circadian response peaked in the late afternoon hours in most human subjects and early morning hours in rats. Human circadian double amplitudes (2A) varied from 8 to 26 mm Hg with higher 2A in elder adults, and 3-8 mm Hg in rats with significantly higher fluctuations in SHR groups (7.5±0.7 for sSS, 8.3±0.6 for sSW vs. 4.7±0.3 mm Hg for wWW). The circaseptan 2A in the adolescents were 10±1 for SBP and 12±3 mm Hg for DBP, and sharp increased winter 2A (SBP 54; HR 48, both P&lt;0.0001) were observed. In rats, mostly clustered peaks around the light-on hours, while sWS and wSS groups showed peak-hour variations (19:18 to 08:06 and 02:58 to 09:10 hrs, respectively). The peak-hour in shr strains was shifted to earlier or delayed in the WKY uterus (sWW and sWS groups) with large deviations as compared to the wWW group. Hypertensive-prone shr strains showed significantly lowered BPs in WKY uterine and/or WKY nursing environments indicating that environment can strongly modify genetic influence, yet the lowered shr MESORs by the WKY environments remained above the MESORs encountered in wky donors. Thus, the maternal environment may be a major factor that affects the offspring’s BP and BPV later in life. Chronomes broader than circadian BPs are considered as a gauge of vascular disease status. Abnormal BP/BPV modifications may lead to novel implications in preventive and therapeutic strategies in CVD.

The accuracy of blood pressure measurement by a smartwatch and a portable health device

ABSTRACTObjectives: Handheld medical devices and smartwatches that measure BP without a cuff have recently become available. Since these measurements are relatively more user-friendly than conventional cuff-based measurements they may aid in more frequent BP monitoring. We investigated the accuracy and precision of two popular cuff-less devices: the Everlast smartwatch and the BodiMetrics Performance Monitor.Methods: We enrolled 127 patients from the Thomas Jefferson University Hospital Preadmission Testing Center. Research staff were trained to measure BP according to manufacturer guidelines for the investigational devices. The Everlast smartwatch provides measurements of systolic (SBP) and diastolic (DBP) BP, whereas the Bodimetrics only provides SBP. Reference BP measurements were obtained using a hospital-grade automated sphygmomanometer. After 5 minutes of quiet sitting, four standard and three investigational BP measurements were taken with sixty seconds in between each measurement. The reference BP value was calculated by determining the average of the 2 standard BP measurements that bounded the investigational measurements. We thus determined 3 comparison pairs for each investigational device in each subject. We calculated the mean (SD) of the absolute difference between the respective investigational devices and the reference for SBP and DBP.Results: Data from 42 individuals was excluded because of variation in standard BP measurements per prespecified rules. Of 85 participants used for analysis, 36 (42%) were women, the mean (SD) age was 53 (21) years, 32 (38%) self-reported hypertension, and 97% of these (n = 31) reported taking antihypertensive medications. The average differences between the Everlast watch and reference were 16.9 (13.5) mm Hg for SBP and 8.3 (6.1) mm Hg for DBP. The average difference between the Bodimetrics performance monitor and the reference was 5.3 (4.7) mm Hg for SBP.Conclusions: The Everlast smartwatch and the BodiMetrics Performance Monitor we tested are not accurate enough to be used as BP measurement devices.

M-HEALTH IN PATIENTS WITH UNCONTROLLED HYPERTENSION

Objective: Hypertension (HTN) has multiple combinations of stages and risk profiles affecting treatment efficacy. Handy m-Health tools are to be a valuable adjunct to conventional care. The aim was to determine the effect of m-Health intervention in patients with essential uncontrolled HTN with response to its stage and related cardiovascular (CVD) risk profile. Design and method: Study enlisted 64 patients (44 males, mean age 50 ± 16 y.o.) with essential HTN, office and home blood pressure (BP) above target for 3 previous months. A non-blind design was expected and all patients consecutively underwent teleBP monitoring and distant counseling using safe and simple m-Health app integrated into local medical information system. Follow-up for 6 months with treatment effect calculation respectively to HTN stage and CVD risk profile according to the latest practice Guidelines (Group 1: stage 1 HTN and low-to-moderate risk; Group 2: stages 2–3 HTN and high-to-very high risk). Results: Total of 60 patients has completed follow-up (42 males, 48 ± 14 y.o., 5 with Grade 3, 22 - Grade 2 and 33 - Grade 1 HTN; mean office BP 156 ± 15.4 mmHg). Of all individuals 8 were with stage 3 HTN (mostly due to HFpEF and AFib, very-high risk), 22 patients with stage 2 HTN (mostly due to hypertensive LVH, high risk) and 30 - uncomplicated stage 1 HTN (low-to-moderate risk), therefore Group 1 and 2 consisted of 30 patients each. Patients in Group 2 were older (56 ± 15.6 vs 42.2 ± 12.7 y.o., p < 0.001), with longer history of HTN (10.3 ± 5.1 vs 3.5 ± 1.4 years, p < 0.0001). The overall effect of m-Health was –22 ± 12,4 mmHg for SBP and –13,6 ± 10,8 mmHg for DBP) and 63% (n = 38) of patients were in target range at 6 months. Patients in Group 1 were more likely to have their BP controlled at the end of the study (n = 24 in Group 1 and n = 14 in Group 2, OR 4.57, [95%CI, 1.45 - 14.4]). Conclusions: m-Health intervention is associated with remarkable improvement in blood pressure at 6 months. The effect is more pronounced in younger patients with uncomplicated short-term HTN and of low-to-moderate CVD risk.

PERCUTANEOUS CUTTING BALLOON ANGIOPLASTY FOR TREATMENT OF RESISTANT RENAL ARTERY STENOSIS IN PEDIATRIC PATIENTS

Objective: Percutaneous transluminal renal angioplasty (PTRA) without stenting is the recommended treatment for hypertensive children with renal artery stenosis (RAS). However not infrequently RAS is resistant to PTRA or recurs after the procedure. To circumvent PTRA limitations percutaneous cutting balloon angioplasty (PCBA) has been used occasionally but caution is warranted because of the risk of rupture or dissection of renal artery. However the technical improvements in PCBA prompted us to exploit this procedure in children with severe hypertension and RAS resistant to PTRA. Design and method: Thirteen children (10 males, mean age 7.9 ± 3.3 y at operation) with resistant RAS (bilateral in 5) underwent PCBA. In 10 patients (pts) RAS was due to fibromuscular dysplasia, in 2 due to NF1 and in 1 to William's Syndrome. In 3 pts in addition to PCBA stenting of the aorta (1pt) and of RAS (3 pts) was also applied. Office blood pressure (BP), 24 hours ambulatory pressure monitoring (ABPM) (4/13pts), renal function and ultrasound (US) of renal arteries were evaluated before and after PCBA after a mean follow up of 21 ± 17.4 months. Results: PCBA achieved dilation of RAS in all cases. In one single case partial renal artery dissection occurred that did not require stent application. At follow-up no restenosis was found at US investigation in the 15 lesions who didn’t need stenting of RAS and in 1/3 stented RAS. Hypertension was cured in 7 pts and improved in the remaining 6 pts. After PCBA mean office systolic and diastolic BP (SBP and DBP mmHg) were reduced respectively from 141 ± 19 to 122 ± 12 and from 87 ± 10.to 69 ± 11 (p < 0.05 for both). With ABPM, SBP and DBP decreased respectively from 145 ± 3 to 130 ± 3 and from 88 ± 14 to 79 ± 16 (p < 0.05 for both). The antihypertensive agents assumed by pts with improved BP decreased from a mean of 2.7 to 0.6 per day. No significant changes were found in renal function after PCBA. Conclusions: In our experience PCBA appears a safe and effective treatment of RAS resistant to PTRA.

A novel deep learning based automatic auscultatory method to measure blood pressure

BackgroundIt is clinically important to develop innovative techniques that can accurately measure blood pressures (BP) automatically. ObjectivesThis study aimed to present and evaluate a novel automatic BP measurement method based on deep learning method, and to confirm the effects on measured BPs of the position and contact pressure of stethoscope. Methods30 healthy subjects were recruited. 9 BP measurements (from three different stethoscope contact pressures and three repeats) were performed on each subject. The convolutional neural network (CNN) was designed and trained to identify the Korotkoff sounds at a beat-by-beat level. Next, a mapping algorithm was developed to relate the identified Korotkoff beats to the corresponding cuff pressures for systolic and diastolic BP (SBP and DBP) determinations. Its performance was evaluated by investigating the effects of the position and contact pressure of stethoscope on measured BPs in comparison with reference manual auscultatory method. ResultsThe overall measurement errors of the proposed method were 1.4 ± 2.4 mmHg for SBP and 3.3 ± 2.9 mmHg for DBP from all the measurements. In addition, the method demonstrated that there were small SBP differences between the 2 stethoscope positions, respectively at the 3 stethoscope contact pressures, and that DBP from the stethoscope under the cuff was significantly lower than that from outside the cuff by 2.0 mmHg (P < 0.01). ConclusionOur findings suggested that the deep learning based method was an effective technique to measure BP, and could be developed further to replace the current oscillometric based automatic blood pressure measurement method.

La hipertensión arterial y el score de Framingham de riesgo vascular en la obstrucción venosa retiniana

ObjectivesTo determine the prevalence of arterial hypertension (AHT), systolic blood pressure (SBP), the diastolic blood pressure (DPB), and the Framingham vascular risk score (FRS), in subjects with retinal vein occlusion (RVO), as well as in a control group. Patients and methodA prospective, cross-sectional case and control study was conducted on all patients with a diagnosis of RVO referred to the General Medicine Clinic, and comparing them with a control group. An analysis was performed on the clinical and laboratory variables. ResultsA total of 253 patients with RVO were studied (132 males and 121 females) and 244 controls (112 males and 132 females) of similar age (67.9±12.3 vs. 68.1±9.2 años). The prevalence of AHT, and the SBP and DPB values in the clinic after the RVO were significantly higher in patients with RVO than in the controls (71.5% vs. 51.2%), SBP mmHg (148±22 vs. 138±18mmHg), DBP mmHg (83±10 vs. 77±10mmHg). The de novo diagnosis of AHT was made from the RVO in 23.8% of the cases. Significant differences were found in the FRS between the patients with RVO and the controls (11±8.3 vs. 8.25±6.3. There were no differences in any of the parameters studied between patients with peripheral or central RVO. ConclusionsHypertension is very prevalent as significantly more common in patients with RVO than in controls. Its diagnosis and treatment is often established from the RVO. The FRS is greater in patients with RVO. There were no differences in any of the parameters studied between patients with peripheral or central RVO. It is suggested that RVO should be considered a vascular event when defining therapeutic objectives.

The prevalence, awareness, treatment, and control of hypertension among adults: the first cross-sectional national population-based survey in Laos.

AimThe aim of this study was to determine the national prevalence of hypertension and its awareness, treatment, and control in Laos.MethodsA national cross-sectional study was conducted in 2013. Using stratified cluster random sampling, 2,543 individuals aged 18–64 years were included from Laos. According to WHO STEPS methodology, questionnaire interview, anthropometric and blood pressure measurements, and biochemistry tests were conducted. Logistic regressions were used to estimate the determinants of hypertension (SBP [and/or DBP] ≥140 [90] mmHg or use of antihypertensive medications).ResultsOverall, 20.0% of the population had hypertension, 18.5% among men and 21.1% among women. Among hypertensives, 29.4% were aware, 18.2% were currently using antihypertensive medication, and 16.7% had controlled their blood pressure (<140 mmHg SBP and DBP <90 mmHg). In fully adjusted models in both men and women, older age and general obesity were positively associated with hypertension. In addition, among men having raised cholesterol and completed primary education, and among women central obesity and hazardous or harmful alcohol users were positively associated with hypertension.ConclusionThe study found a significant prevalence of hypertension and low awareness, treatment, and control rates of hypertension among adults in Laos.

Total, insoluble, and soluble dietary fiber intake and insulin resistance and blood pressure in adolescents.

Background/Objectives:To evaluate sex and race differences in fiber intakes, which are understudied in adolescents, and to investigate whether low insoluble and soluble fiber intakes would be associated with higher risk for insulin resistance and blood pressure (BP).Subjects/Methods:A total of 754 black and white adolescents, 14 to 18 years old (49.2% blacks; 50.3% female) were previously recruited in Augusta, Georgia, the US between 2001 to 2005. Diet was assessed with four to seven independent 24-hour dietary recalls.Results:The average daily consumption of total, insoluble, and soluble fiber were 10.9, 6.7, and 4.0g, respectively. Only two adolescents met their daily fiber intake recommendation. Adjusted multiple linear regressions revealed that increasing dietary fiber intake from current averages to recommendation levels (12g to 38g in the male and 9.9g to 25g in the female), were associated with predicted decreases of 5.4 and 3.0 mg/dL fasting glucose, 7.0 and 5.0 mg/dL fasting insulin, 1.6 and 1.1 HOMA-IR, 6.3 and 3.7 mmHg SBP, and 5.2 and 3.0 mmHg DBP in the males and females, respectively (all p < 0.05). Furthermore, both insoluble and soluble fiber intakes were inversely associated with fasting insulin and HOMA-IR (p <0.05); whereas only soluble fiber intake was found to be associated with BP (p <0.05).Conclusions:Fiber consumption in adolescents is far below daily-recommended levels across all sex and race groups. Lower fiber intake of all types is associated with higher insulin level. Fiber Intake at recommendation levels may be associated with significant cardiometabolic benefits.

Lifestyle characteristics as moderators of the effectiveness of weight control interventions among semiconductor workers

BackgroundWorkers in high technology industry are experiencing stressful environment and have been ranked as a high risk group for adverse health effects. The effectiveness of worksite health promotion is important for occupational health. This study is to investigate the effect of health interventions on body measurement changes while examining the role of their lifestyle factors. MethodsA total of 904 participants aged over 30 years were recruited from 14 semiconductor worksites in Taiwan from 2011 to 2015. A multi-settings, quasi-experimental study was conducted that assigned participants into two intervention programs, including exercise program and diet-plus-exercise program. The outcomes include the changes of body weight, waist circumference, body mass index (BMI), and biophysiological indicators. Lifestyle variables include alcohol consumption, cigarette smoking, and regular exercise. Multiple linear regression analyses were performed to test the association. ResultsThe findings have demonstrated that one kilogram body weight reduction is associated with a decrease of 0.58 mmHg SBP (p < 0.001), 0.29 mmHg DBP (p < 0.001), 3.33 mg/dL triglyceride (p < 0.001), 0.96 mg/dL total cholesterol (p < 0.001), and 0.68 mg/dL LDL (p < 0.001). The diet-plus-exercise group had more significant effect on both weight changes and biophysiological changes than exercise-only group (p < 0.001). Lifestyle factors, including cigarette smoking, alcohol consumption, and regular exercise, were significant moderators of the effectiveness of health interventions. ConclusionsBoth exercise and diet interventions are important to the effectiveness of health promotion in occupational sectors. Lifestyle modifications are vital for weight control programs in improving body shape changes and biophysiological indicators.

Combined impact of risk factors on the subsequent development of hypertension.

This study aimed to develop a cumulative score composed of seven risk factors: age, resting heart rate, overweight or obesity, dyslipidemia, hyperuricemia, impaired glucose regulation, and impaired estimated glomerular filtration rate (eGFR), to evaluate the risk of new-onset hypertension. We retrospectively conducted a cohort study in 23 665 participants free from hypertension at baseline, who attended at least two annual health examinations between 2011 and 2016. We defined hypertension as SBP of 140 mmHg or less and/or DBP of at least 90 mmHg, according to the 2010 Chinese guidelines for the management of hypertension. We computed a composite, individual-level cumulative score incorporating all seven risk factors (no = 0 point; yes = 1 point; total range 0-7 points). Cox regression was used to analyze the association between cumulative score and risk of hypertension. A total of 2305 participants developed hypertension during a median follow-up period of 3.6 years. Compared with participants with 0 points, the adjusted hazard ratios (95% confidence intervals) for the development of hypertension for those with 2, 3, and at least 4 points were 1.61 (1.29-2.02), 2.05 (1.64-2.57) and 2.77 (2.22-3.46), respectively (P trend < 0.001). This association was present after adjustment for sex and baseline blood pressure. Age, resting heart rate, overweight or obesity, dyslipidemia, hyperuricemia, impaired glucose regulation, and impaired eGFR were associated with significant risk of new-onset hypertension and when combined there was an accumulation of risk.

Disparities in the impact of overweight on hypertension among Asians: a Japanese and Thai population-based study

The divergence in cardiovascular disease risk among Asian countries may be related to differences in economics, lifestyles, and cultural backgrounds. We examined the differential association of overweight and hypertension between the high- and middle-income Asian countries, namely Japan and Thailand and extended to compare other cardiovascular risk factors between these two countries, using the data sets from the annual health examinations conducted in 127,152 Japanese (mean age, 41.5 ± 11.1 years; mean body mass index [BMI], 22.4 ± 3.4 kg/m2) and 4243 Thai (mean age, 47.9 ± 10.7 years: mean BMI, 24.0 ± 3.7 kg/m2) aged over 18 years with no history of hypertension treatment. Hypertension was diagnosed as office SBP ≥ 130 mmHg and/or office DBP ≥ 80 mmHg. Overweight was defined as BMI ≥ 25 kg/m2. The analysis using the direct standardization method showed a lower prevalence of hypertension in the Japanese than in the Thai population (31.8% vs. 57.3%, P < 0.001). The Japanese population had higher estimated glomerular filtration rate and lower cholesterol level and BMI than in the Thai population (all P < 0.001). The association between overweight and hypertension was observed in both populations regardless of age and sex (all P < 0.05). In the analysis stratified by age and sex, the association between overweight and the presence of hypertension was more prominent in the Japanese population aged <50 years in both sexes compared with the Thai population (all P for interaction < 0.001). These results confirmed the differential impact of overweight on hypertension between the high- and middle-income countries even in the similar regions of Asia.

A13979 Efficacy and safety of compound-reserpine-triamterene tabletsin treatment to non-dipper hypertension in elderly

Objectives: To observe the Efficacy and safety of compound-reserpine-triamterene tablets in treatment to non-dipper hypertension in elderly. Methods: This is a multi-center, open, random and controlled study. Patients older than 60 years old with mild to moderate hypertension were enrolled in. All of patients were divided into two groups, one group taken Compound-reserpine-triamterene tablet in the morning (morning group) and the other at night (night group). Results: Total 155 patients were enrolled in, their mean age were (68.2 ± 6.0) years. Baseline BP was (158.7 ± 11.3)/(90.0 ± 9.8)mmHg. Eighty-one patients were in morning group and the other 74 patients were in night group. Clinic blood pressure decreased significantly in both groups after treatment. The mean decrease were (33.1 ± 14.0) /(31.9 ± 11.4)mmHg in SBP and (11.3 ± 11.2) /(11.8 ± 9.9)mmHg in DBP in the two groups respectively, the difference haven’t statistical significance (P = 0.583 and P = 0.760). The results of ABPM showed that after six months treatment, the mean decrease of blood pressure was 24.7/14.8mmHg in the whole day, 23.6/12.1mmHg mmHg in daytime and 28.5/15.mmHg in nighttime respectively, the difference between the two groups haven’t reach the statistical significance. The blood pressure curve of total 37 patients changed into dipper type, 23 (28.4%) in the morning group and the other 14 (18.9%) in night group, the difference hasn’t statistical significance (P = 0.168).The changes of laboratory examination didn’t reach the statistical significance also. There haven’t serious side effects. Conclusion: It is effective and safe of Compound reserpine-triamterene tablets in the treatment of hypertension in aged patients. Patients with non-dipper hypertension can take Compound reserpine-triamterene tablets either in the morning or at night.

A11591 Ambulatory Blood Pressure Monitoring (ABPM) and Holter Monitoring Simultaneously as a Standard Care Approach to Evaluate the Risk Correlates in Hypertensives

Objectives: We evaluated 3230 (Males = 2228, Females = 1002) hypertensives, hospitalised for 24 hours to analyse association of hypertension and arrhythmia simultaneously for three years Methods: We used holter recorder and ABPM. ST depression was defined as an ST segment depression (1 mm limb or chest recordings V1 to V6) Results: Mean age was 51.2 ± 7.9 years (range 41 - 82 yrs). The tertile in triad of age > 60 years, duration of diabetes > 20 years and HbA1c > 11% had highest incidence of arrhythmias, statistically significant as compared with the other tertiles (p < 0.0001). Socioeconomic status were high, middle income and low income in 43% (n = 1388), 36 % (n = 1163) and 21 % (n = 679), respectively. Awake and asleep BP mean were 147 ± 11 mmHg and 137 ± 13.7 mmHg for SBP, 89.5 ± 10.2 and 83.1 ± 8.9 mmHg for DBP, respectively. Arterial pressure variability and bradyarrhythmia were significantly associated with sleep apnea (p < 0.0001). Patients with ST-T wave depression > 1 mm (26%) and tachycardia (31%) were significantly associated with both the reverse dippers and non-dippers. (p < 0.0001) Conclusion: The combined-simultaneous approach of holter and ABPM is a suitable approach for optimising the standard care in hypertensives. Association of various arrhythmia and BP patterns are important to triage high-risk patients and customise therapeutic approach. We could not draw out association between white coat hypertension and BP variability as ABPM was done under controlled environment in hospital setting only. Chronotherapy in concurrence with circadian rhythm to reduce side effects, optimise the dosage, reduce pill burden would be a suitable option to achieve a better BP control. Nocturnal anti-hypertensive dosing to target nocturnal hypertension would be an appropriate management approach

A17293 Relationship between amount of salt intake and long-term blood pressure variability

Objectives: Existing data indicate that blood pressure (BP) variability is a strong predictor of cardiovascular events in patients with arterial hypertension (AH). In spite of known influence of salt intake amount on BP level, relationship between amount of salt intake and BP variability (BPV) still needs investigation. Methods: 50 men with AH (mean age 55.94 ± 9.8 years) underwent to three different 10 day salt intake diets: regular (9–12 g/day), low (2.5–4 g/day) and high (>20 g/day). Home BP measurement three times a day (9am; 3pm; 9pm) according to the standard protocol during the whole study period was used. Standard deviation (SD) of measured BPs was used to calculate BPV. Coefficient of variation was calculated in all the groups according to the salt intake amount. Results: Average SBPs, DBPs and SDs during regular, low and high salt intake were as follows: 152.4 mmHg vs 148.2 mmHg and 154.8 mmHg for SBP, 91.4 mmHg, 90.2 mmHg and 93.8 mmHg for DBP, respectively; SDs of SBP were 12.2 ± 4.2 vs 9.4 ± 3.8 vs 13.2 ± 3.5 for systolic and 6.4 ± 3.7 vs 6.3 ± 3 and 6.8 ± 3.3 for diastolic, respectively. Coefficient of variation of SBP for regular, low and high salt diets were 8 ± 2.7%, 6.3 ± 2.5% and 8.6 ± 2.3% and for DBP - 6.9 ± 4%, 7 ± 3.3% and 7.3 ± 3.5%, respectively. High salt diet significantly increased average SBP, DBP and SDs. Conclusion: Study data show, that high sodium diet leads to the higher average BP and BPV. Differences of SBP and DBP between the groups were higher than 2 mmHg. Framingham Heart Study showed that population wide reduction of DBP in 2 mmHg is associated with a 6% reduction in CHD risk and Lewington et al, in 2002 showed that SBP reduction in only 2 mmHg would lead to 7% reduction in the incidence of death secondary to stroke and 10% reduction in IHD. High BPV is considered as a strong indicator for CV events per