mmHg In Males Research Articles

P177 MICROBIAL TRYPTOPHAN-INDOLE PATHWAY REGULATES BLOOD PRESSURE (BP) IN A SEX SPECIFIC MANNER

Introduction: Aberrant tryptophan absorption promotes hypertension as gut microbiota converts tryptophan to pro-hypertensive indole. Intestinal Ace2 regulates tryptophan homeostasis, but its role in salt-sensitive hypertension is unknown. Ace2 functions differently in males and females. Therefore, we hypothesized that sex-specific intestinal ACE2 dependent transport of tryptophan contributes to salt-sensitive hypertension via microbiota-indole axis. Methods: 10-week-old Dahl salt-sensitive (S) rats and novel Ace2 KO S rats of both sexes were maintained on either a low (LS) or high (HS) salt diet for 21 days. BP was measured by radiotelemetry. Gut microbiota and indole were analyzed. Results: Mean arterial BP of S Ace2 KO rats on LS was elevated in females by 38 mmHg (SAce2KO 170 ± 10 vs. S 132 ± 3; P=0.0028) and in males by 18 mmHg (SAce2KO 140 ± 6 vs. S 122 ± 1.5; P=0.01), and further elevated on HS by 68 mmHg in females (SAce2KO 211 ± 14 vs. S 143 ± 4.5; P=0.0003) and by 40 mmHg in males (SAce2KO 182 ± 9 vs. S 142 ± 3; P=0.0009). These were associated with elevated serum indole mainly in male SAce2KO rats, compared to S rats on both LS (1.2 ± 0.2 vs. 0.3 ± 0.2 μM; P=0.02) and HS (1.5 ± 0.25 vs. 0.2 ± 0.03 μM; P=0.0001). Microbiota analysis revealed significant shifts in β-diversity in Ace2 KO rats of both sexes with more changes in HS males; and Ace2 KO induced more tryptophan-utilizing, indole-producing bacteria Escherichia-Shigella in males on both LS (P<0.05) and HS (P<0.0001). Strikingly, none of these differences were found in females. Conclusions: Lack of Ace2 increased BP regardless of sex and salt. In males, Ace2 KO increased indole levels and abundance of Escherichia-Shigella. Microbial changes by salt and ACE2 KO were found mainly in males, suggesting a more resilient microbiota in females. Thus, the microbiota-indole axis may be a therapeutic target for BP control in males with altered tryptophan metabolism.

Abstract MP31: The effect of dual SGLT1/2 inhibition on the progression of salt-sensitive hypertension

The dual inhibition of sodium-glucose co-transporter 1 and 2 (SGLT1/SGLT2) presents a novel therapeutic approach to cardiovascular diseases. The FDA recently approved the dual SGLT1/2 inhibitor sotagliflozin (Sota) for treating heart failure regardless of ejection fraction. However, our understanding of the effects and mechanisms of SGLT2 and dual SGLT1/2 inhibitors in salt-sensitive hypertension (SS HTN) remains limited. Thus, additional studies are needed to reveal the role and mechanism(s) of SGLTi in SS hypertension. In our previous studies, we demonstrated the beneficial effect of SGLT2i dapagliflozin (Dapa) on SS HTN in male and female Dahl SS rats on blood pressure (MAP after 3 weeks on high salt diet were: Dapa vs. vehicle: 136 ± 3 vs. 156 ± 6 mmHg in males and 140 ± 5 vs. 160±9 mmHg in females). This study aims to define the effects and potential mechanisms of dual SGLT1/2 inhibition in managing SS HTN. Dual SGLT1/2 inhibition with Sota (30 mg/kg/day) prevented the development of SS HTN in Dahl SS in both sexes without changes in heart rate. By the 21 st day of the high-salt challenge, MAP was lower more than 30 mmHg in treated groups (Sota vs. vehicle: male rats 126 ± 2 vs 157 ± 5 mmHg (N=7, p=0.0002); female rats 126 ± 3 vs 167 ± 10 mmHg (N=6, p=0.0095). Under Sota treatment, rats had significantly increased diuresis (Sota vs. vehicle: males 69 ± 3 vs 35 ± 2 ml and females 48 ± 5 vs 31 ± 2 ml on day 21), glucose and sodium excretion. In both sexes, Sota treatment resulted in a lower heart-to-body weight ratio, and kidney weight was not changed. Also, Sota attenuated kidney fibrosis and protein cast formation (Sota vs. vehicle: cortex fibrosis in males 2.3 ± 0.4 vs 4.6 ± 0.5 % and females 2.0 ± 0.2 vs 4.0 ± 0.7 %, outer medullary protein casts in males 2.5 ± 0.2 vs 16.0 ± 2.6 % and 1.9 ± 0.3 vs 7.5 ± 0.9 % in females) without changes in albuminuria in both sexes. However, no changes in glomerular filtration rate or creatine clearance were detected. Based on our data, it can be inferred that dual SGLT1/2 inhibition prevents the development of SS HTN and kidney damage. Potential mechanisms underlying those beneficial effects of SGLT1/2 inhibition will be further explored.

Blood pressure response to graded bicycle exercise in males and females across the age and fitness spectrum.

Blood pressure (BP) responses to exercise are frequently measured, with the concern that greater increases are a marker of disease. We sought to characterize the normal exercise BP response in healthy adults and its relationships with age, sex, and fitness. 589 participants (median age 46 [IQR 24-56] years, 81% male) underwent cardiopulmonary exercise testing with repeated, automated BP measures. An exaggerated maximal systolic BP (SBPmax) was defined from current guidelines as ≥210 mmHg in males and ≥190 mmHg in females. Individual linear regression analyses defined the relationship between BP and workload (SBP/W-slope and DBP/W-slope). Participants with or without an exaggerated SBPmax and above or below median SBP/W-slope were compared. An exaggerated SBPmax was found in 51% of males and 64% of females and was more prevalent in endurance-trained athletes (males 58%, females 72%, p<0.001). The mean SBP/W-slope was lower in males (0.24±0.10 mmHg/W) than females (0.27±0.12 mmHg/W), p=0.031. In both sexes, peak oxygen uptake (VO2peak) was inversely correlated with SBP/W-slope (p<0.01). Those with an exaggerated SBPmax and below-median SBP/W-slope were 10 years younger and had a 20% higher VO2peak, on average (p<0.001). A non-exaggerated SBPmax and above-median SBP/W-slope was observed in older individuals with the lowest VO2peak. In a large cohort of healthy individuals, an exaggerated SBPmax was common and associated with higher fitness. In contrast, higher SBP indexed to workload was associated with older age, lower fitness, and female sex. Thus, sex, age and fitness should be considered when evaluating BP response to exercise.

Effect of Nonionic Iodinated Contrast Media on Blood Pressure during Contrast-enhanced Computed Tomography of Abdomen Examination: A Cross-sectional Study

ABSTRACT Introduction: Computed tomography (CT) scan has high sensitivity and specificity for numerous conditions. The images produced by a CT scanner can be enhanced using iodinated contrast media. Significant hemodynamic changes are seen with rapid intravenous contrast media injection. The average acceptable blood pressure (BP) value is 120/80 mmHg. Many studies have related hypertensive crises with high-osmolar contrast media, whereas its relation with low-osmolar contrast media is still unclear. This study aims to evaluate the effect of nonionic iodinated contrast media on BP during contrast-enhanced CT (CECT) of the abdomen. Materials and Methods: A cross-sectional study was conducted from April 2022 to August 2023. A total of 146 subjects (73 males and 73 females were included in the study). Statistical analysis of data was done using SPSS 23.0. A comparison of systolic BP and diastolic BP across the three periods was done using repeated measures of ANOVA. A between-group comparison was performed by unpaired t-test. The level of significance was set as 5%. All subjects underwent a CECT abdomen, including a plain, arterial, and venous phase. A bolus of 80 mL of Ultravist was administered. BP was measured before the contrast injection (baseline value), between the arterial and venous phases, and 3 min after the contrast injection. Results: Injection of nonionic contrast media caused a decrease in BP among subjects. The mean systolic BP readings before contrast injection in males and females were 127.5 ± 8 mmHg and 122.8 ± 8.4 mmHg, respectively. The mean diastolic BP before contrast injection was 79.2 ± 6.4 and 76 ± 6.4 mmHg among males and females, respectively. For systolic, these values decreased to 123 ± 10.3 mmHg in males and in females to 115 ± 14.6 mmHg when measured between arterial and venous phases. Similarly, for diastolic BP, the mean values recorded between the arterial-venous phase reduced to 76.7 ± 9.3 mmHg and 72.3 ± 10 mmHg, respectively. The BP readings, however, increased near baseline value when measured 3 min after the injection. The mean systolic BP measured 126.1 ± 8.5 mmHg and 124.9 ± 11.8 mmHg for males and females at 3 min after injection. Similarly, the mean diastolic BP values taken after 3 min of contrast injection were 78.3 ± 6.5 mmHg and 76.2 ± 7 mmHg in males and females, respectively, P &lt; 0.001. BP in both male and female groups was affected similarly. Conclusion: Bolus administration of 80 mL of Ultravist reduced BP. This reduction was short-term and got back to normal within a few minutes. The contrast media similarly affected both genders. The BP changes had no clinical significance.

CAVI (Cardio-Ankle Vascular Index) as an independent predictor of hypertensive response to exercise

ObjectivesHypertensive response to exercise (HRE) is related to the development of future hypertension, cardiovascular morbidity, and mortality, independent of resting blood pressure. We hypothesized that arterial stiffness as measured by cardio-ankle vascular index (CAVI) could be an independent predictor of HRE.Materials and methodsRetrospective chart review of patients participated in the preventive health program at the Bangkok Heart Hospital who underwent both CAVI and treadmill stress testing on the same day between June and December 2018 were performed. Variables for the prediction of HRE were analyzed using univariate analysis, and significant variables were entered into multiple logistic regression. An ROC curve was created to test the sensitivity and specificity of CAVI as a predictor of HRE.ResultsA total of 285 participants (55.1% female) were enrolled in this study. There were 58 patients (20.4%) who met the HRE definition (SBP > 210 mmHg in males, SBP > 190 mmHg in females, or DBP > 110 mmHg in both males and females), with a mean age of 46.4 12.8 years. In univariate analysis, age, systolic blood pressure at rest, diastolic blood pressure at rest, pulse pressure at rest, diabetes mellitus, hypertension, dyslipidemia, history of beta-blocker, and CAVI results were statistically significant. Multiple logistic regression revealed that CAVI and systolic blood pressure were statistically significant predictors of HRE with OR of 5.8, 95%CI: 2.9–11.7, P < 0.001 and OR 1.07, 95%CI: 1.03–1.10, P = 0.001 respectively. ROC curve analysis of the CAVI revealed an AUC of 0.827 (95%CI: 0.76–0.89, p < 0.001), and the sensitivity and specificity of cut-point CAVI > 8 were 53% and 92%, respectively.ConclusionThis study demonstrated that CAVI is an independent predictor of hypertensive response to exercise. Additionally, the findings suggest that CAVI > 8 can be a valuable tool in identifying individuals at risk for hypertensive responses during exercise.

Prevalence, sex differences, and implications of pulmonary hypertension in patients with apical hypertrophic cardiomyopathy.

Apical hypertrophic cardiomyopathy (ApHCM) is a subtype of hypertrophic cardiomyopathy (HCM) that affects up to 25% of Asian patients and is not as well understood in non-Asian patients. Although ApHCM has been considered a more "benign" variant, it is associated with increased risk of atrial and ventricular arrhythmias, apical thrombi, stroke, and progressive heart failure. The occurrence of pulmonary hypertension (PH) in ApHCM, due to elevated pressures on the left side of the heart, has been documented. However, the exact prevalence of PH in ApHCM and sex differences remain uncertain. We sought to evaluate the prevalence, risk associations, and sex differences in elevated pulmonary pressures in the largest cohort of patients with ApHCM at a single tertiary center. A total of 542 patients diagnosed with ApHCM were identified using ICD codes and clinical notes searches, confirmed by cross-referencing with cardiac MRI reports extracted through Natural Language Processing and through manual evaluation of patient charts and imaging records. In 414 patients, echocardiogram measurements of pulmonary artery systolic pressure (PASP) were obtained at the time of diagnosis. The mean age was 59.4 ± 16.6 years, with 181 (44%) being females. The mean PASP was 38 ± 12 mmHg in females vs. 33 ± 9 mmHg in males (p < 0.0001). PH as defined by a PASP value of > 36 mmHg was present in 140/414 (34%) patients, with a predominance in females [79/181 (44%)] vs. males [61/233 (26%), p < 0.0001]. Female sex, atrial fibrillation, diagnosis of congestive heart failure, and elevated filling pressures on echocardiogram remained significantly associated with PH (PASP > 36 mmHg) in multivariable modeling. PH, when present, was independently associated with mortality [hazard ratio 1.63, 95% CI (1.05-2.53), p = 0.028] and symptoms [odds ratio 2.28 (1.40, 3.71), p < 0.001]. PH was present in 34% of patients with ApHCM at diagnosis, with female sex predominance. PH in ApHCM was associated with symptoms and increased mortality.

Abnormal workload-indexed blood pressure response to exercise in patients at risk of or with overt heart failure

Abstract Background Conflicting evidence exists regarding the functional and prognostic significance of hypertensive response to exercise (HRE), commonly defined as peak systolic blood pressure (SBP) &amp;gt;210 mmHg in males and &amp;gt;190 mmHg in females. No study yet has explored the impact of sex-specific, workload-indexed HRE in patients at different stages of the heart failure (HF) spectrum, as defined by the American College of Cardiology/American Heart Association HF staging system. Purpose We evaluated the SBP/Workload slope during exercise across the HF spectrum and investigated the hemodynamic, functional and prognostic correlates of HRE. Methods Fifty-eight healthy controls, 201 subjects at risk of developing HF (HF Stages A-B), and 369 patients with a definite diagnosis of HF (Stage C) were enrolled; among the latter, 143 had preserved (HFpEF) and 226 reduced (HFrEF) left ventricular ejection fraction. All patients underwent a combined cardiopulmonary-exercise stress echocardiography test. For each patient, we recorded at least two BP measurements during exercise: the first within the first minute of exercise and the last at peak effort. The SBP/Workload slope was calculated as the difference in SBP over the corresponding increment in watts (W): (SBPpeak – SBPfirst)/(Wpeak – Wfirst). In each ACC/AHA HF Stage, we divided patients according to SBP/Workload slope tertiles; HRE was defined as the highest sex-specific SBP/Workload slope tertile. A composite of all-cause mortality and hospitalization for cardiovascular reasons was chosen as the primary outcome. Results The median SBP/Workload slope was 0.53 (interquartile range 0.36-0.72) mmHg/W and was steeper in women than in men in all subgroups (p&amp;lt;0.0001). After adjusting for age and sex, SBP/Workload slope was significantly higher in Stages A-B (0.61, 0.47-0.75 mmHg/W) and HFpEF (0.63, 0.42-0.86 mmHg/W) compared to controls (0.43, 0.35-0.57 mmHg/W) and HFrEF (0.47, 0.30-0.63 mmHg/W, Figure 1). In all subgroups, patients with HRE showed significantly lower peak oxygen consumption and peripheral oxygen extraction (Table). After a median follow-up of 16 months, HRE was an independent predictor of adverse outcomes (Hazard Ratio 2.05, 95% confidence interval 1.81-5.18), while rest and peak absolute SBP values did not. Kaplan-Meier analysis confirmed a worse survival probability for patients with HRE in Stages A-B and HFpEF but not in HFrEF. After adjusting for confounding factors, the patients with the highest SBP/Workload slope had a 47% higher risk of the primary outcome than subjects in the lowest tertile (Figure 2). Conclusions Across the HF spectrum, patients with HRE, as evaluated by the SBP/Workload slope, present with peculiar pathophysiological features and impaired functional capacity. This is especially true for those in Stages A-B and patients with HFpEF. In these subgroups, HRE may portend an increased risk of adverse cardiovascular outcomes.SBP/workload slopesKaplan-Meier curves and Hazard Ratios

Transcutaneous Spinal Cord Stimulation to Stabilize Seated Systolic Blood Pressure in Persons With Chronic Spinal Cord Injury: Protocol Development.

Transcutaneous spinal cord stimulation (tSCS) is an emerging therapeutic strategy to target spinal autonomic circuitry to normalize and stabilize blood pressure (BP) in hypotensive persons living with chronic spinal cord injury (SCI). Our aim is to describe our current methodological approach to identify individual tSCS parameters that result in the maintenance of seated systolic blood pressure (SBP) within a pre-defined target range. The parent study is a prospective, randomized clinical trial in which eligible participants will undergo multiple mapping sessions to optimize tSCS parameter settings to promote stable SBP within a target range of 110-120 mm Hg for males and 100-120 mm Hg for females. Parameter mapping includes cathode electrode placement site (T7/8, T9/10, T11/12, and L1/2), stimulation frequency (30, 60 Hz), current amplitudes (0-120 mA), waveform (mono- and biphasic), pulse width (1000 μs), and use of carrier frequency (0, 10 kHz). Each participant will undergo up to 10 mapping sessions involving different electrode placement sites and parameter settings. BP will be continuously monitored throughout each mapping session. Stimulation amplitude (mA) will be increased at intervals of between 2 and 10 mA until one of the following occurs: 1) seated SBP reaches the target range; 2) tSCS intensity reaches 120 mA; or 3) the participant requests to stop. Secondary outcomes recorded include 1) symptoms related to autonomic dysreflexia and orthostatic hypotension, 2) Likert pain scale, and 3) skin appearance after removal of the tSCS electrode. Clinical Trials Registration: NCT05180227.

Abstract 082: Dysregulated Microbiota-indole Axis In Male, Not Female Ace2 Deficient Salt-sensitive Hypertension

Introduction: Aberrant tryptophan (Trp) absorption may promote hypertension (HTN) due to gut microbiota converting Trp to pro-hypertensive indoles. Intestinal Ace2 regulates Trp homeostasis, but its role in salt-sensitive HTN is unknown. Further, lack of Ace2 can affect males and females differently because Ace2 is transcribed from the X-chromosome in a genomic region which escapes X-inactivation. Therefore, we hypothesized that sex-specific intestinal ACE2 dependent transport of Trp contributes to salt-sensitive HTN via the microbiota-indole axis. Methodology: 8-10-week-old Dahl salt-sensitive (S) rats and newly generated CRISPR/Cas9 Ace2 deficient S rats of both sexes (N= 7 rats/group) were maintained on either a low (0.3 % NaCl, LS) or high (2 % NaCl, HS) salt diet for 21 days. BP was measured by radiotelemetry for 24 hours on day 21. Serum and cecal content were collected for indole measurement and microbiota analysis. Results: Mean arterial BP of S Ace2 deficient rats on LS was elevated in females by 38 mmHg (S Ace2 -/- 170 ± 10 vs. S 132 ± 3; P =0.0028) and in males by 18 mmHg (S Ace2 -/Y 140 ± 6 vs. S 122 ± 1.5; P =0.01), and further elevated on HS by 68 mmHg in females (S Ace2-/- 211 ± 14 vs. S 143 ± 4.5; P =0.0003) and by 40 mmHg in males (S Ace2-/Y 182 ± 9 vs. S 142 ± 3; P =0.0009). These were associated with elevated serum indole levels mainly in male S Ace2 -/Y rats, compared to S rats on both LS (1.2 ± 0.2 vs. 0.3 ± 0.2 μM; P =0.02) and HS (1.5 ± 0.25 vs. 0.2 ± 0.03 μM; P =0.0001). Microbiota analysis revealed (1) significant shifts in β-diversity in Ace2 deficient rats of both sexes with a higher R value and a lower P value in HS males; (2) Ace2 deficiency resulted in higher abundance of Trp-utilizing, indole-producing bacteria Escherichia - Shigella in males on both LS ( P &lt;0.05) and HS ( P &lt;0.0001). Strikingly, none of these differences were found in females. Conclusion: Lack of Ace2 led to increased mean BP regardless of sex and salt intake. In males, Ace2 deficiency led to increased indole levels with higher abundance of Escherichia - Shigella . Overall microbial changes by salt and ACE2 deficiency were found mainly in males, suggesting a more resilient microbiota in females. Thus, the microbiota-indole axis may be a potential therapeutic target for BP control in males with altered Trp metabolism.

Distribution and reference intervals of daytime intraocular pressure in the eye health screening population of Handan

Objective: To describe the distribution and establish reference intervals (RI) of daytime intraocular pressure (IOP) in the eye health screening population of Handan. Methods: This cross-sectional study included subjects who participated in eye health screening at the Physical Examination Center of Handan First Hospital from May 2021 to June 2022. A complete general and ocular examination was performed, including measurements of visual acuity and IOP (using Goldmann tonometry), slit lamp microscopy, fundus photography, and anterior and posterior segment optical coherence tomography. Subjects with factors that could cause significant changes in IOP or affect the accuracy of IOP measurement, or with an inability to measure IOP were excluded. Simple random sampling was used to select participants, who were grouped by gender and age (18 to <30, 30 to <40, 40 to <50, 50 to <60, 60 to <70, and ≥70 years). Central corneal thickness and IOP at 8 to 11 o'clock in one eye of each participant were recorded. The independent sample t test and ANOVA were used for statistical analysis, and the RI of IOP values was calculated by x¯±1.96s. Results: A total of 9 310 subjects had their IOP measured, and 3 491 participants (3 491 eyes) were randomly selected from 7 886 healthy subjects. The age of the participants was (47.74±14.47) years old, ranging from 18 to 90 years old. There were 1 694 males and 1 797 females. The central corneal thickness of all participants was (525.56±49.39) μm. The daytime IOP of all participants was (15.40±2.54) mmHg (1 mmHg=0.133 kPa), and the RI was 10.42 to 20.39 mmHg. The IOP was (15.49±2.58) mmHg for males and (15.29±2.49) mmHg for females, and the gender difference was statistically significant (P<0.05). The RI of daytime IOP values was 10.43 to 20.54 mmHg for males and 10.41 to 20.18 mmHg for females. There were significant differences in daytime IOP [(15.13±2.58), (15.33±2.53), (15.49±2.50), (15.53±2.55), (15.39±2.62), and (15.28±2.52) mmHg] among 6 age groups (P<0.05). Conclusions: The distribution of daytime IOP in different gender and age groups in the eye health screening population of Handan and the RIs derived from the distribution were roughly the same as the international normal IOP RI (10 to 21 mmHg). It is recommended to refer to the RI of daytime IOP values of different genders and ages for clinical decision.

Difference of Systolic Blood Pressure Between Arms and Its Influencing Factors Among People Over 35 Years Old in China

Abstract Background To investigate the detection of the increase of interarm systolic pressure difference (IASBPD) in people aged ≥35 years in our country and its related factors. Methods Stratified multistage sampling method was used to randomly select 262 urban and rural residents from 31 provinces from 2012 to 2015. Further, simple random sampling method was used to select 16 cities and 17 rural residents from eastern, central, and western regions. A total of 34,121 subjects aged ≥35 years were analyzed after removing the missing information. Data were collected by questionnaire, and blood pressure in both arms was measured by ankle–brachial index meter. All data were analyzed by SPSS 23.0 software. Continuous data were expressed as mean ± SD. Comparison between groups was performed using t-test if it was normal distribution, and rank-sum test if it was not. Categorical data were expressed as frequency sum rate or constituent ratio, χ2 test was used for comparison of various rates and constituent ratio, and rank-sum test was used for rank data. Multivariate logistic regression was used to analyze the influencing factors of IASBPD increase. Results The detection rates of IASBPD ≥10 and ≥15 mm Hg were 16.31% and 7.55%, respectively. The detection rate of IASBPD ≥10 mm Hg in males was higher than that in females (P &amp;lt; 0.05). Multivariate logistic regression showed that age, family history of hypertension, low HDL-C, hypertension, and abdominal obesity were risk factors for IASBPD ≥10 and 15 mm Hg (all P &amp;lt; 0.05). Conclusions The detection rates of IASBPD ≥10 and 15 mm Hg are 16.31% and 7.55%, respectively, in Chinese ≥35 years old people, and age, low HDL-C emia, family history of hypertension, hypertension, and abdominal obesity are the influencing factors of large differences in interarm blood pressure.

Abstract P3124: Chronic Infusion Of Angiotensin II Promotes Ventricular Fibrosis And Diastolic Dysfunction In Aging Male But Not Female Mouse Hearts

Heart failure prevalence increases with age and affects men and women differently. Chronic activation of the renin-angiotensin system (RAS) in heart failure increases circulating angiotensin II (AII) levels, which elevates blood pressure (BP), promotes fibrosis and leads to adverse remodelling of the heart. Whether maladaptive responses to AII differ between the sexes at older ages is unclear, as most studies use young male animal models. We investigated whether adverse cardiac remodeling induced by chronic exposure to AII differed between the sexes in older C57BL/6 mice. Osmotic minipumps with pressor doses of AII (3 mg/kg/day) or saline were implanted into older mice (≈16 mos) of both sexes for 6 weeks. BP (tail cuff) and ventricular structure/function (echocardiography) were measured at baseline, midpoint, and endpoint. Ventricular fibrosis markers (transforming growth factor-ß (TGF-ß), fibronectin collagen I, collagen III) were quantified with qPCR. Mean arterial pressure increased similarly in both sexes (76.3±4.2 vs. 136.1±4.6 mmHg in males and 73.9±2.9 vs. 116.1±8.7 mmHg in females; p&lt;0.05; n=6-8/group). AII infusion also increased LV mass and reduced ejection fraction in males and females. By contrast, AII increased signs of diastolic dysfunction in males but had little impact on diastolic function in females. For example, isovolumic relaxation time increased over 6 weeks of AII infusion in males (11.7±1.0 vs. 19.0±1.4 ms; p&lt;0.05) but not in females (14.6±0.9 vs. 16.4±1.2 ms). Similar results were seen for E/A ratios. Molecular studies showed a marked increase in mRNA abundance for TGF-ß in male ventricles (1.02±0.13 vs. 1.50±0.16; p&lt;0.05) but not in females (1.01±0.08 vs. 1.25±0.10). Similar male-female differences were seen for collagens I and III (fibronectin was similar in both sexes, and not affected by AII). As TGF-ß signalling increases the production of profibrotic mediators like collagens I and III, these findings suggest that chronic RAS activation increases fibrosis and disrupts diastolic function in aging male hearts. By contrast, older female hearts are resistant to these deleterious effects of RAS activation. These sex-specific differences may modify heart failure expression and responses to treatment in older men and women.

Waist circumference and blood pressure in Brazilian children.

We aimed to examine the association between waist circumference and blood pressure (BP) in children at 9 years of age. This was a cross-sectional study of 142 children enrolled in a cohort study conducted at the participants' homes in southern Brazil. SBP and DBP were measured using the auscultatory method. Waist circumference was measured with a 150-cm flexible tape. Logistic regression adjusted for important covariates was used to examine the association between waist circumference and BP. The prevalence of high BP in children was 20.4%. High BP was more prevalent in males (69.0%). The average SBP/DBP on the right arm was 98/60 mmHg in females and 101/62 mmHg in males. An important proportion of children was classified as having high BP and BMI (44.8%) and waist circumference (50.0%) > 85th percentile (P < 0.01). Logistic regression analysis showed that children with high BMI and waist circumference were 3.91 (95% confidence interval, 1.31-11.71, P = 0.015) times more likely to have high BP than those ≤85th percentile, even after adjusting for other covariates. This study revealed that waist circumference was associated with both SBP and DBP in 9-year-old children and increased waist circumference was the determining factor of cardiovascular risk.

PS-P11-6: ESTABLISHING A RELATINSHIP BETWEEN BMI AND HYPERTENSION IN UNIVERSITY STUDENTS

Introduction: The Body Mass Index (BMI) has been identified as a key predictor of Blood Pressure (B.P). Objective The goal of the study is to discover the pattern of relationship between BMI and blood pressure in 1000 university students. Materials and methods: Blood pressure, weight, and height were all taken into account. The BMI was computed by dividing the weight in kilogrammes by the height in metres squared (kg/m). Results: Females were underweight in greater numbers than males (8.4% versus 4.7%). Males were more overweight than females (9% versus 5%). Males were more likely than females to be obese (7% versus 0.9%). Blood pressure parameters increased significantly with BMI (p0.0001), with higher values in males than females; (the mean systolic blood pressure 125.8 ± 8.3mmHg in males versus 117 ± 5.8mmhg in females and the mean diastolic blood pressure 94.6 ± 6.8mmhg in males versus 71 ± 7.7 in females) (p &lt; 0.05). Conclusion: Among university students, a strong link between BMI and blood pressure was observed. Higher blood pressures were observed with higher BMI.

Adjusting For Exercise Intensity Attenuates Sex Differences In Blood Pressure During Exercise In Healthy Adults

PURPOSE: The exercise pressor reflex, composed of the muscle mechano- and metaboreflex, increases blood pressure (BP). Compared to males, healthy female adults typically exhibit blunted BP responses to exercise. However, recent work suggests that sex differences in BP during isometric handgrip (HG) exercise and post-exercise ischemia (PEI; metaboreflex isolation) are attenuated after adjusting for differences in maximal voluntary contraction (MVC). Therefore, the purpose of this study was to determine whether sex differences in BP responses during HG and PEI would be attenuated after adjustment for submaximal HG squeezing force. METHODS: We analyzed data from 95 participants including 34 females (age: 24±4 years, BMI: 24±4 kg/m2, screening BP: 106±13/64±9 mmHg, Mean ± SD) and 61 males (age: 25±5 years, BMI: 2±3 kg/m2, screening BP: 113±11/66±9 mmHg). All females were tested during days 1-5 of their menstrual cycle. Maximal HG force for each participant was defined as the average of three MVCs. Following a 10-minute baseline period, participants performed static static HG exercise at 40% of their average MVC for two minutes followed by three minutes of PEI via brachial occlusion. We obtained beat-to-beat BP readings via finger photoplethysmography (Finometer). Statistical analyses included t-tests, 2-way ANOVAs (sex x time), and ANCOVAs (average HG force as a covariate). RESULTS: Females exhibited a lower absolute 40% HG force than males (105±30 N v. 169±45 N, p<0.001). There was a significant sex x time interaction for ∆ systolic BP during HG (e.g., minute 2, females: 20±12 mmHg v. 28±18 mmHg in males, p=0.014), but not ∆ diastolic (p=0.106) or ∆ mean BP (p=0.058). After adjusting for absolute HG force, the sex difference for peak ∆ systolic BP during HG was attenuated (p=0.072). During PEI there were sex x time interactions for ∆ systolic, ∆ diastolic, and ∆ mean BP (p<0.05 for all) and adjustment for HG force did not attenuate these differences. Additionally, in a small strength-matched cohort (N=48, 29 females, female HG force mean = 107±23 N, male HG force mean = 118 ± 24 N, p=0.092) there was not a significant sex difference for peak ∆ systolic BP during HG (p=0.667) or PEI (p=0.828). CONCLUSIONS: Our data indicate that the sex difference in BP reactivity is attenuated after adjusting for absolute HG force during exercise.

Delimitation of blood pressure in healthy newborns

Blood pressure (BP) is one of the four vital signs that best reflect cardiovascular status during the physical examination of newborns. Adequate monitoring of vital signs is essential to optimize the management of neonates; therefore, BP measurements should be obtained and recorded throughout their ongoing care. A prospective observational study was carried out, selecting 836 healthy full-term newborns in a maternity hospital in the Federal District. Blood pressures were measured in the delivery room within the first two hours of life using an MX-600 GE automatic oscillometric device, following the hospital's standard care protocol. Maternal and neonatal data were measured to correlate systolic, diastolic, and mean blood pressure percentiles. The measurements obtained were systolic BP 64.89 ± 10.7 mmHg and diastolic BP 37.60 ± 11.7 mmHg in males and systolic BP 66.46 ± 10.9 mmHg and diastolic BP 39.52 ± 12.3 mmHg in females. This article strengthens neonatal care by establishing normative blood pressure values.

The Incidence of Metabolic Syndrome and the Valid Blood Pressure Cutoff Value for Predicting Metabolic Syndrome Within the Normal Blood Pressure Range in the Population Over 40 Years Old in Guiyang, China.

PurposeThe study was conducted to investigate metabolic syndrome (MS) incidence within the normal blood pressure (BP) range in a population over 40 years old in an urban area of Guiyang, Guizhou Province, China, and to identify a valid BP cutoff value for predicting MS.Materials and MethodsData from this study are based on the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. In total, 2935 subjects in the normal BP range and without MS (795 males, 2140 females) aged 40–80 years were included in this study. Follow-up subjects were classified by baseline BP and grouped by age. After the 3-year follow-up, the MS incidence and valid BP cutoff value for predicting MS were calculated for subjects within the normal BP range.ResultsAfter the 3-year follow-up study, the crude and standardized MS incidences in the cohort were 19.83% and 16.89% for follow-up subjects, respectively, with incidences of 10.94% and 10.50% for males and 23.13% and 20.66% for females. The incidence of MS in normotensive subjects (15.53%) was lower than that in subjects with high-normal BP (29.08%). After adjusting for age, sex, BMI, smoking, and drinking, the risk of having MS in the high-normal BP group was 1.823-fold [HR 1.823 95% CI (1.538–2.162)] higher than that in the normotensive group. The ROC curve showed that the BP cutoff values were more than 117/74 mmHg in males and 112/74 mmHg in females.ConclusionWhen BP was within the normal range, the incidence of MS in participants was very high. The MS incidence was higher among high-normal BP subjects than among normotensive subjects, as was the risk of having MS. The valid BP cutoff value for predicting MS in the population was 117/74 mmHg in males and 112/74 mmHg in females. Currently, epidemiological investigations are needed to determine whether a lower BP cutoff value is needed in diagnosing MS.

Lower peak systolic blood pressure during exercise testing predicts higher risk of all-cause mortality even when accounting for exercise capacity and other confounders

Abstract Background The risk associated with an exaggerated systolic blood pressure (SBP) response during exercise testing is controversial. In part, this may be due to the confounding effect of exercise capacity, as achieving a high workload is related to both better survival and higher peak SBP. Purpose We aimed to determine the prognostic value of the SBP response at clinical exercise testing, with and without accounting for exercise capacity and other important confounders, for predicting all-cause mortality. Methods We analysed data from 10,245 subjects aged 18–85 years (54% male), referred for bicycle ergometer exercise testing at a single hospital between 2005 and 2015. Resting SBP, peak SBP, peak Watt as well as the first and last SBP and corresponding Watt during exercise were retrieved. The slope of the increase in SBP per increment in Watt between the first and last measurement during exercise (the SBP/Watt-slope) was calculated. Survival status was determined from the National Cause of Death register up until April 2019. Cox proportional hazard ratios for all-cause mortality were calculated in males and females for peak SBP and the SBP/Watt-slope, and natural cubic spline models (with three knots) were computed to explore the risk of death based on a continuum of each SBP measure. The models were adjusted for age, SBP at rest, a diagnosis of diabetes, hypertension, baseline cardiovascular disease (ICD10 Chapter IX) and the use of cardiac and/or antihypertensive medications. In additional analyses, peak SBP and the SBP/Watt-slope were adjusted for peak Watt or exercise capacity (% predicted), respectively. Results Over a median follow-up of 7.9 (IQR 5.7) years, 890 (8.7%) subjects died. Compared to survivors, subjects who died were older (69±10 vs 57±14 years, p&amp;lt;0.001), had lower age-adjusted exercise capacity (82±15 vs 92±17% pred. Watt, p&amp;lt;0.001), and had lower peak SBP (193±28 vs 196±26 mmHg, p=0.002). The SBP/Watt-slope was on average 21% higher in those who died (0.64±0.36 vs 0.53±0.27 mmHg/Watt, p&amp;lt;0.001). An exercise peak SBP &amp;lt;190 mmHg in females and &amp;lt;210 mmHg in males was associated with increased risk of all-cause death, after adjusting for age, prevalent comorbidities, cardiac medication and exercise capacity at baseline (Figure 1). After adjusting for maximal workload, higher peak SBP was associated with increased risk of dying in females, but not in males. An SBP/Watt-slope &amp;gt;0.5 mmHg/Watt was associated with higher risk of death in both sexes, although not when adjusting for exercise capacity. Conclusion Achieving a lower peak SBP was associated with increased risk of all-cause mortality in both sexes. This persisted after accounting for exercise capacity and other important confounders. In females, but not in males, there was also an increased risk of death associated with higher peak SBP. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): County Council of Ostergotland

Impact of Mineralocorticoid Receptor and Angiotensin II Type 1 Receptor Antagonism on Blood Pressure Regulation in Obese Zucker Rats: Role of Sex Differences.

Previous studies suggest that obesity-induced hypertension in females, but not males, is due to leptin-mediated stimulation of aldosterone secretion and subsequent activation of the mineralocorticoid receptor (MR). Although angiotensin II type 1 receptor (AT1R) antagonism lowers blood pressure (BP) in male obese Zucker rats (OZR), which have defective leptin signaling, the potential role of sex differences in BP responses to renin-angiotensin-aldosterone system blockade, including MR antagonism, in obesity is still unclear. We tested the cardiovascular effects of MR antagonism, alone or in combination with AT1R blockade in male and female OZR (n = 5/sex) and lean Zucker rats (n = 7/sex). BP and heart rate (HR) were measured by telemetry 24 hour/day. After a 6-day control period, spironolactone (40 mg/kg/day) was given for 10 days followed by a 7-day combined treatment with losartan (20 mg/kg/day), and followed by 6-day post-treatment recovery period. Compared with lean rats, OZR were hypertensive (mean arterial pressure: 115 ± 4 vs. 104 ± 2 and 111 ± 1 vs. 100 ± 3 mm Hg for males and females) and had lower HR (355 ± 9 vs. 393 ± 7 and 367 ± 10 vs. 412 ± 13 bpm). MR blockade alone did not alter BP or HR in lean or obese male and female Zucker rats, whereas combined treatment reduced BP in obese and lean rats by 31 ± 3 vs. 21 ± 1 and 8 ± 1 vs. 5 ± 1 mm Hg in males and females, respectively. No changes were observed in HR. These results suggest that there are important sex differences in BP responses to chronic AT1R blockade but no major involvement of MR activation in BP regulation in OZR.

Study of Anorectal Manometry changes in Anal Fissure

Nowadays, wide range of population experience proctologic pathologies at least once in their lives. 10- 15% of proctologic pathologies patients suffer from anal fissure that impair their usual life. So it is mandatory to know how to achieve effective treatment for anal fissure. Aim of Study: The aim of this study is to establish any predictive value of anorectal manometry in assessing the effectiveness of anal fissure treatment.Patients and Methods: This is a prospective study done on 30 patients recruited from outpatient clinic in Benha University divided into two groups whereas group (A) included 15 patients with acute anal fissure (less than six weeks from onset of disease), and group (B) included 15 patients with chronic anal fissure (more than six weeks from onset of disease). Anomanometry was done for all patients and the results were compared.Results: patients with acute anal fissure showed normotensive anal resting pressure (Mean±SD 50.8 ± 5.76 mmHg in males and 64.4 ± 5.81 mmHg in females), while those with chronic anal fissure showed high resting pressure (Mean±SD 88.3 ± 6.18 mmHg in females and 88.65±1.05 mmHg in males).Conclusion: we can conclude that acute anal fissure disease is not usually associated with elevated resting anal pressure but chronic anal fissure is usually associated with hypertensive anal resting pressure in majority of patients. These manometric findings may explain why most cases of acute case anal fissure can be treated medically while cases with chronic anal fissure usually need surgical intervention that liberates anal pressure from hypertensive state to normotensive state. We also can predict that patients with chronic anal fissure associated with normotensive resting anal pressure may be treated either medically or surgically without doing internal sphincterotomy.