Mortality In Hypertensive Patients Research Articles

Low Serum Uric Acid Levels Promote Hypertensive Intracerebral Hemorrhage by Disrupting the Smooth Muscle Cell-Elastin Contractile Unit and Upregulating the Erk1/2-MMP Axis.

Intracerebral hemorrhage (ICH) is a catastrophic stroke with high mortality, and the mechanism underlying ICH is largely unknown. Previous studies have shown that high serum uric acid (SUA) levels are an independent risk factor for hypertension, cardiovascular disease (CVD), and ischemic stroke. However, our metabolomics data showed that SUA levels were lower in recurrent intracerebral hemorrhage (R-ICH) patients than in ICH patients, indicating that lower SUA might contribute to ICH. In this study, we confirmed the association between low SUA levels and the risk for recurrence of ICH and for cardiac-cerebral vascular mortality in hypertensive patients. To determine the mechanism by which low SUA effects ICH pathogenesis, we developed the first low SUA mouse model and conducted transcriptome profiling of the cerebrovasculature of ICH mice. When combining these assessments with pathological morphology, we found that low SUA levels led to ICH in mice with angiotensin II (Ang II)-induced hypertension and aggravated the pathological progression of ICH. In vitro, our results showed that p-Erk1/2-MMP axis were involved in the low UA-induce degradation of elastin, and that physiological concentrations of UA and p-Erk1/2-specific inhibitor exerted a protective role. This is the first report describing to the disruption of the smooth muscle cell (SMC)-elastin contractile units in ICH. Most importantly, we revealed that the upregulation of the p-Erk1/2-MMP axis, which promotes the degradation of elastin, plays a vital role in mediating low SUA levels to exacerbate cerebrovascular rupture during the ICH process.

Attributable risk of all-cause mortality in hypertensive adults based on disease risk prediction model: A Chinese cohort study

BackgroundThe aim of this study was to estimate the attributable risk for all-cause mortality in hypertensive adults living in Beijing, China. MethodsWe conducted a prospective cohort study on the basis of the disease risk prediction model, which included 3006 hypertensive patients aged 50 and over who participated in the annual health examination from thirty-eight community health centers were randomly selected from all 53 community health centers in Dongcheng district of Beijing in China. This cohort study was conducted from January 1, 2013 to June 31, 2018 in these community health centers. Data included age, gender, education level, BMI, smoking and drinking status, renal function, diabetes mellitus (DM), coronary heart disease, levels of blood pressure, use of medications, and blood lipid levels. Resultsthe follow-up time was 4.90±0.51 years. There were significant survival differences by gender, renal function (eGFR>90 vs. 60–90 vs. <60mL/min per 1.73m2), smoking (smoking vs. No smoking), hypertension severity (SBP≥140 or DBP≥r vs. SBP/DBP<140/90mmHg), education level (<6 vs. 6–12 vs. >12 years), coronary heart disease (CHD) (CHD vs. NO CHD). In the multivariate Cox proportional hazard analysis, the prognostic factors of all-cause mortality in hypertensive patients were male [HR 1.662, 95% CI 1.110–2.489, p=0.014], educational level<6 years [HR 2.044, 95% CI 1.164–3.591, p 0.013], age ≥65 years [HR 3.092, 95% CI 1.717–5.571, p<0.001], smoking [HR 1.885, 95% CI 1.170–3.309, p=0.009], eGFR<60mL/min per 1.73m2 [HR 3.591, 95% CI 2.023–6.371, p<0.001]. Conclusionswe conclude that decreasing eGFR, increasing age, smoking, low education and gender (male) are significant and independent risk factor for mortality in hypertension for this urban cohort. Recommendations may include protecting renal function, providing patient education, and cessation of smoking. It highlights that early preventive measures are needed to detect kidney impairment and protect renal function. It also suggests that earlier smoking cessation may be important for hypertensive patients.

Impact of antihypertensive agents on clinical course and in-hospital mortality: analysis of 169 hypertensive patients hospitalized for COVID-19.

Coronavirus disease 2019 (COVID-19) is an emerging health threat caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Previous studies have noted hypertension is associated with increased mortality due to COVID-19; however, it is not clear whether the increased risk is due to hypertension itself or antihypertensive agents. We aimed to evaluate the impact of antihypertensive agents on the clinical outcomes of hypertensive patients with COVID-19. Our study included 169 consecutive hypertensive patients hospitalized due to COVID-19 between March 20 and April 10, 2020. The demographic characteristics, clinical data, and type of antihypertensive agents being used were reviewed. The mean age of patients was 65.8±11.7 years.30 patients(17.7%) died during hospitalization. A total of 142 patients(84%) were using angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), 91 (53.8%) were using diuretics, 69 (40.8%) were using calcium channel blockers (CCBs), 66 (39.1%) were using beta-blockers, 12 (7.1%) were using alpha-blockers, and 5 (2.9%) were using mineralocorticoid receptor antagonists (MRAs). There was no significant difference between survivors and non-survivors based on the type of antihypertensive agents being used. Binary logistic regression analysis showed that the type of the antihypertensive agent being used had no effect on mortality [OR=0.527 (0.130-2.138), p=0.370 for ACEIs/ARBs; OR=0.731 (0.296-1.808), p=0.498 for CCBs; OR=0.673 (0.254-1.782), p=0.425 for diuretics; OR=1.846 (0.688-4.950), p=0.223 for beta-blockers; OR=0.389 (0.089-1.695), p=0.208 for alpha-blockers; and OR=1.372 (0.107-17.639), p=0.808 for MRAs]. The type of antihypertensive agent being used had no effect on the clinical course and mortality in hypertensive patients with COVID-19. The use of these agents should be maintained for the treatment of hypertension during hospitalization.

Comparison of Nebivolol and Bisoprolol for Cardiovascular Mortality in Hypertensive Patients.

IntroductionBeta-blockers again are now considered as first-line therapy for various cardiovascular diseases. In this study, we compare the cardiovascular event between two beta-blocker, i.e. Nebivolol and Bisoprolol.Materials and MethodsIt is a two-arm open-label randomized prospective study that was conducted from 1st Jan 2016 to 30th July 2019 in tertiary care hospital, Nawabshah. One thousand and fifty-six (n=1056) hypertensive patients were enrolled after informed consent, which were randomized into two equal groups. Patients were followed up for one year.ResultsComparison between Nebivolol and Bisoprolol showed that all-cause mortality (9.8% vs 11.48%), cardiovascular mortality (5.4% vs 7.0%), all-cause hospitalization (14.4% vs 16.3%), and cardiovascular hospitalization (9.8% vs 12.09%) was numerically lower in nebivolol but the difference was not statistically significant.ConclusionFurther large scale multicentric trials with a longer follow up period are needed to compare various beta-blockers for cardiovascular event.

Hypertensive Cardiomyopathy: Diagnostic Approach and Clinical Differentiation from Hypertrophic Cardiomyopathy

Hypertensive Cardiomyopathy (HTN-CM) is a structural cardiac disorder generally accompanied by concentric or eccentric Left Ventricular Hypertrophy (LVH) associated with diastolic or/and systolic dysfunction in patients with persistent systemic hypertension. It occurs in the absence of other cardiac diseases capable of causing myocardial hypertrophy or cardiac dysfunction. Long standing arterial hypertension (HTN) leads to structural and functional myocardial abnormalities resulting in myocardial ischemia, fibrosis, and hypertrophy. HTN-CM is predominantly a disease of impaired relaxation rather than impaired contractility, although subtle myocardial systolic abnormalities could be detected recently by Global Longitudinal Systolic Strain (GLS) Speckle Tracking Echocardiography (STE). Importantly, the accompanying LVH is itself a risk factor for mortality and morbidity and is considered an independent predictor for Sudden Cardiac Death (SCD). Therefore, early detection of LVH development in patients with Hypertensive Hypertrophic Cardiomyopathy (HTN-CM) is crucial for optimal treatment. In addition to pathological findings, echocardiography and cardiac magnetic resonance imaging are ideal tools for the diagnosis of HTN-CM and can differentiate it from Hypertrophic Cardiomyopathy (HCM). Timely diagnosis of this condition and utilization of appropriate treatment are required to improve morbidity and mortality in hypertensive patients. This review presents an overview of utilization of multidisciplinary imaging modalities approach for proper diagnosis of HTN-CM and its differentiation from HCM. Relevant article highlighted key points in differentiation of HTN-CM from HCM and the effects of hypertension on cardiac hypertrophy and heart failure development are discussed in clinical case study.

Hyperuricemia Associated with Thiazide Diuretics in Hypertensive Adults.

IntroductionThiazide diuretics are essential first-line anti-hypertensive drugs which not only maintain blood pressure but also reduce stroke and congestive heart failure associated with morbidity and mortality in hypertensive patients. However, thiazide diuretics are associated with elevated serum uric acid (SUA) levels. This study aimed to evaluate the impact of thiazide diuretic use on their SUA levels among hypertensive individuals of Pakistan.MethodsIn this cross-sectional, prospective study, adult hypertensive patients were recruited. They were divided into two groups - thiazide diuretic group and non-thiazide group. Demographic characteristics, hypertension-related characteristics, and SUA levels were included. Data were then entered and analysed using SPSS for Windows version 22.0 (IBM Corp., Armonk, NY, USA).ResultsIn the thiazide group, 24.5% were hyperuricemic as compared to 15.3% in the non-thiazide group (p=0.03). The overall mean SUA levels in the thiazide group were significantly higher than those in the non-thiazide group (5.9 ± 2.1 vs. 5.3 ± 2.7 mg/dL; p=0.02). Males in the thiazide group also showed a similar pattern (5.9 ± 2.3 vs. 5.1 ± 2.1 mg/dL; p=0.02); however, the differences were insignificant in females. Patients using thiazide diuretics for one to three years were more non-hyperuricemic than hyperuricemic (p=0.000). Among hyperuricemic patients, 36.5% were taking thiazides for three to four years and 46% were taking them for more than four years (p<0.05).ConclusionHyperuricemia is a more common occurrence in thiazide diuretic users as compared to non-users. The overall sample, and men using thiazide diuretics, reported a higher mean SUA as compared to non-users. As the years of thiazide usage advanced, the number of hyperuricemic participants also significantly increased.

Correlation between Diastolic Function and left ventricular global longitudinal stress (GLS) decline in Hypertensive Patients

Heart failure with preserved LVEF is a major cause of morbidity and mortality in hypertensive patients. The close correlation between the impairment of diastolic function and the longitudinal systolic dysfunction has several possible explanations. First the diastole is an energy-dependent process, especially during its first phase, it also includes active systolic components during the isovolumetric relaxation phase; in addition, the achievement of intrinsic myocyte function is part of hypertensive pathology as evidenced by recent studies. Echocardiography was performed in a series of 200 hypertensive patients (25 to 75 years-old). The left ventricular ejection fraction was calculated by biplane method, the indexed left ventricular mass and the relative wall thickness were measured or calculated. In order to differentiate eccentric and concentric LVH, diastolic function analysis and finally study of the LV longitudinal deformation by the speckle tracking technique (GLS calculation) were performed. Patients with secondary hypertension, valve insufficiency or stenosis, arrhythmia, history of coronary insufficiency were excluded from this study. One hundred and seventy-eight patients (89%) of the 200 hypertensive patients had diastolic function impairment, of which 37 patients (18.5%) had high filling pressures. Mean arterial blood pressure was statistically higher in hypertensive patients with high filling pressures than in hypertensives with normal filling diastolic LV pressure. 30 of 37 patients with high filling pressure had low GLS. We reported a significant relationship between the decrease in GLS and the increase in the left ventricular filling pressure. These results suggest that the increase in filling pressures is closely associated with the atrioventricular interaction in hypertensive patients, with a significant correlation with the impairment of longitudinal systolic function and diastolic function. When myocardial fibrosis develops, collagen accumulation increases myocardial rigidity and induces diastolic dysfunction; it also deprives cardiomyocytes of the skeleton necessary for myocardial contraction. Therefore, the degree of myocardial fibrosis can be associated with the defects of systolic and diastolic properties. LVEF is a poorly sensitive indicator of myocardial contractility and subclinical alterations in LV systolic function are already evident in heart failure with preserved LVEF. The decline in the longitudinal function index, despite a preserved LVEF, is well correlated with the increase in filling pressures in hypertensive patients with LVH. The association between HT with LVH and the deterioration of asymptomatic diastolic function is well recognized. A linear relationship is thus established between the increase in left ventricular mass, diastolic dysfunction and LV systolic dysfunction. Finally, the detection of longitudinal systolic dysfunction in an hypertensive patient should impose a therapeutic prevention strategy with the objective of delaying the onset of symptomatic heart failure.

AMBULATORY ARTERIAL STIFFNESS INDEX AS PREDICTOR OF IN-HOSPITAL RENAL DYSFUNCTION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective: The ambulatory arterial stiffness index (AASI) is a marker of arterial stiffness, predicts cardiovascular morbidity and mortality in hypertensive patients and is associated with indices of target organ damage. However, data is scarce regarding the prognostic role of AASI for renal dysfunction in patients with myocardial infarction (MI).We therefore evaluated the relationship between AASI and worsening of renal function (WRF)in patients suffering a MI. Design and method: We studied 197 patients [78.7% male; mean age 62.44 years; 68.5% hypertensives; 27.9% with diabetes mellitus (DM)] who were hospitalized because of ST-elevation myocardial infarction (STEMI, 50.3%) and NonST–elevation myocardial infarction (NSTEMI). All patients underwent baseline estimation of clinical and laboratory parameters during their hospitalization. Moreover, patients underwent 24-h ambulatory BP monitoring during the third day of hospital stay. AASI was measured according to established methodology. WRF was defined as a reduction of GFR > or = 25% according to the RIFLE criteria using MDRD formula. Results: AASI demonstrated a prognostic role for WRF in the entire population (HR, 0.094; CI, 0.026–0.161; p = 0.007). After separate analysis for STEMI and NSTEMI groups, AASI was a significant predictor for WRF in the STEMI group(HR, 0.087; CI, 0.004–0.170; p = 0.04) with a tendency in the NSTEMI one (p = 0.08). Therefore, a model of multivariate regression analysis was conducted for the entire population and STEMI group, where AASI retained its significant role as a predictor of WRF (OR, 0.097; CI, 0.034–0.157; p = 0.003 and OR, 0.104; CI, 0.020–0.187; p = 0.016 respectively), independently of age, gender, history of hypertension, history of DM and low density lipoprotein (LDL-C). Conclusions: According to our study AASI is an independent predictor of in-hospital renal dysfunction in patients with MI. More data and research are required to determine the usefulness of this non-invasive tool in clinical practice in general population and in patients with MI.

DIFFERENCES IN THE PROGNOSTIC VALUE OF TOTAL CHOLESTEROL ACCORDING TO GRADES OF HYPERTENSION IN THE OLD-HTA LYONʼS COHORT

Objective: Patients with grade 3 hypertension are categorized at high risk patients and a LDL target below 1.0 g/L has been recommended by the European Guidelines. However, the level of evidence for this subgroup is scarce and their risk is not assessed by SCORE. The aim of the present study was to test the prognostic value of total cholesterol in our historic cohort of hypertensive patients including an important part of patients with grade 3 hypertension. Design and method: A total of 1909 individuals from the OLD-HTA Lyon's cohort of hypertensives were categorized in grade 1–2 hypertension (47.3%) and in grade 3 hypertension (52.7%) according to recent European guidelines. Systolic (SBP) and diastolic blood pressure (DBP) were recorded as the average of six measurements in supine position. An overnight fasting blood sample was drawn for total cholesterol. Patients were classified according to tertiles of baseline cholesterol (<2.0 g/L, 2.0–2.4 g/L and >2.4 g/L) Results: Baseline characteristics of the cohort were as follow: 45.1+/−13.4 years, 60.8% of men, 48.1% of smokers, 13.2% of diabetics, 22.7% of secondary prevention, SBP/DBP 180+/−32 mmHg/104+/−20 mmHg. During a 30 years follow-up, we observed 1127 death and 598 from cardiovascular causes. Kaplan-Meier curves demonstrated a gradual increased risk of all-cause and cardiovascular death according to tertiles of cholesterol (Figure, p < 0.001). Then, we performed a multivariate Cox regression analysis adjusted for all confounders. In grade 1 or 2 hypertension, we observed an independent increased risk of cardiovascular (tertile 2 vs. 1 HR 1.31 [0.86–2.01], tertile 3 vs. 1 HR 1.66 [1.05–2.62]) and all-cause death (tertile 2 vs. 1 HR 1.26 [0.94–1.69], tertile 3 vs. 1 HR 1.49 [1.09–2.04]) for total cholesterol. In grade 3 hypertension, total cholesterol was not independently associated with cardiovascular (tertile 2 vs. 1 HR 1.11 [0.83–1.50], tertile 3 vs. 1 HR 1.08 [0.79–1.48]) and all-cause death (tertile 2 vs. 1 HR 1.09 [0.88–1.35], tertile 3 vs. 1 HR 0.99 [0.79–1.25]).Conclusions: Our results confirmed the prognostic value of total cholesterol on long-term mortality in hypertensive patients. However, its independent impact on severe forms of hypertension needs to be clarified.

Abstract #447 The Impact of Gender on Inpatient Mortality of Hypertensive Patients Across CKD Stage 3 To ESRD and Races in the United States

Abstract #447 The Impact of Gender on Inpatient Mortality of Hypertensive Patients Across CKD Stage 3 To ESRD and Races in the United States

Low-Grade Albuminuria Is Associated with Left Ventricular Hypertrophy and Diastolic Dysfunction in Patients with Hypertension

Introduction: Microalbuminuria is a risk factor for cardiovascular morbidity and mortality in hypertensive patients. However, the relationship between low-grade albuminuria, a higher level of albuminuria below microalbuminuria threshold, and hypertension-related organ damage is unclear. Left ventricular (LV) hypertrophy (LVH) is well recognized to be a subclinical organ damage of hypertension, and LV diastolic dysfunction is also reported to be an early functional cardiac change of hypertension that predicts heart failure. The present study aimed to investigate the association of low-grade albuminuria with LVH and LV diastolic dysfunction in hypertensive patients. Methods: This cross-sectional observational clinical study was retrospectively performed in 870 hypertensive patients admitted to our hospital. Urinary albumin to creatinine ratio (UACR) was calculated to assess the levels of albuminuria: macroalbuminuria (≥300 mg/g), microalbuminuria (≥30 mg/g, but <300 mg/g), and normal albuminuria (<30 mg/g). Low-grade albuminuria was defined as sex-specific highest tertile within normal albuminuria (8.1–29.6 mg/g in males and 11.8–28.9 mg/g in females). LVH and LV diastolic dysfunction were identified as recommended by American Society of Echocardiography. Results: Of the 870 patients, 765 (87.9%) had normal albuminuria, 77 (8.9%) had microalbuminuria, and 28 (3.2%) had macroalbuminuria. Percentage of LVH and LV diastolic dysfunction was increased with ascending UACR. UACR was independently associated with LVH and LV diastolic dysfunction, even in patients with normal albuminuria. Multivariable logistic regression showed that the patients with the highest tertile within normal albuminuria had nearly 80% increase in LVH and nearly 60% increase in LV diastolic dysfunction (adjusted OR for LVH 1.788, 95% CI 1.181–2.708, p = 0.006; adjusted OR for LV diastolic dysfunction 1.567, 95% CI 1.036–2.397, p = 0.034). After further stratification analyses in patients with normal albuminuria, it was shown that this independent association persisted in female patients, those who were younger than 70 years old, and those with duration of hypertension <15 years. Conclusion: Low-grade albuminuria was associated with LVH and LV diastolic dysfunction in hypertensive patients, especially in patients younger than 70 years old, and those with duration of hypertension <15 years.

A15570 Micro-albuminuria in Stage 2 Hypertensive patients with Left Ventricular Hypertrophy

Objectives: Microalbuminuria (MA, albuminuria: 20–200 μg min-1) is associated with several cardiovascular risk factors including left ventricular hypertrophy (LVH). The relationship, usually assumed to reflect an increased blood pressure (BP) load on the heart and the kidney. To evaluate this relation between MA and LVH, left ventricular mass index (LVMI) was deter-mined in stage 2 hypertensive patients with LVH. Methods: Hundred cases of non diabetic patients with stage 2 hypertension and left ventricular hypertrophy visiting outdoor and indoor patients of Mayo Hospital Lahore were registered. Microalbuminuria was detected using standardized dipstick technique (MICRAL, Roche, USA) and recorded in mg/dL. Left ventricular hypertrophy was deter-mined by measuring LVMI in gram/m2 using GE Logic pro 500 echocardiography with color Doppler. All this information was collected through a specially designed proforma Results: Microalbuminuria was present in 65% of the hypertensive individuals with LVH. When the occurrence of microalbuminuria was analyzed according to the different clinical parameters like age and gender and duration of hypertension, a significant correlation was found with age and duration of hypertension, but no significant relation was found with either gender Conclusion: There is high frequency of microalbuminuria in hypertensive individuals with left ventricular hypertrophy. This is associated with advanced age, duration of hypertension and degree of left ventricular hypertrophy. So microalbuminuria is an important predictor of cardiovascular morbidity and mortality in hypertensive patients with left ventricular hypertrophy and should be checked routinely in all hypertensive patients, regardless of the presence of diabetes.

A15574 Micro-albuminuria in Stage 2 Hypertensive patients with Left Ventricular Hypertrophy

Objectives: Microalbuminuria (MA, albuminuria: 20–200 μg min-1) is associated with several cardiovascular risk factors including left ventricular hypertrophy (LVH). The relationship, usually assumed to reflect an increased blood pressure (BP) load on the heart and the kidney. To evaluate this relation between MA and LVH, left ventricular mass index (LVMI) was deter-mined in stage 2 hypertensive patients with LVH. Methods: Hundred cases of non diabetic patients with stage 2 hypertension and left ventricular hypertrophy visiting outdoor and indoor patients of Mayo Hospital Lahore were registered. Microalbuminuria was detected using standardized dipstick technique (MICRAL, Roche, USA) and recorded in mg/dL. Left ventricular hypertrophy was deter-mined by measuring LVMI in gram/m2 using GE Logic pro 500 echocardiography with color Doppler. All this information was collected through a specially designed proforma Results: Microalbuminuria was present in 65% of the hypertensive individuals with LVH. When the occurrence of microalbuminuria was analyzed according to the different clinical parameters like age and gender and duration of hypertension, a significant correlation was found with age and duration of hypertension, but no significant relation was found with either gender Conclusion: There is high frequency of microalbuminuria in hypertensive individuals with left ventricular hypertrophy. This is associated with advanced age, duration of hypertension and degree of left ventricular hypertrophy. So microalbuminuria is an important predictor of cardiovascular morbidity and mortality in hypertensive patients with left ventricular hypertrophy and should be checked routinely in all hypertensive patients, regardless of the presence of diabetes.

A9360 Major Outcomes of Simvastatin in High-risk Hypertensive Patients with a High–normal Level of Total Cholesterol

Objectives:To investigate the effects of simvastatin compared with standard treatment on cardiovascular outcomes and all-cause mortality in hypertensive patients with a high–normal level of total cholesterol (TC) and at least 1 additional cardiovascular risk factor.Methods:In a randomized, open-labe

Comparison Between Valsartan and Amlodipine Regarding Cardiovascular Morbidity and Mortality in Hypertensive Patients With Glucose Intolerance: NAGOYA HEART Study.

Comparison Between Valsartan and Amlodipine Regarding Cardiovascular Morbidity and Mortality in Hypertensive Patients With Glucose Intolerance: NAGOYA HEART Study.

NT-PROBNP COMBINED WITH R WAVE IN AVL LEAD PREDICTS MORTALITY BETTER THAN ECHOCARDIOGRAPHIC LEFT VENTRICULAR MASS IN HYPERTENSION

Objective: Plasma NT-proBNP and R wave in aVL lead (RaVL) have been associated with mortality in hypertensive patients. The aim of the present study was to test the prognostic value of their combination, in comparison to left ventricular mass index assessed by echocardiography (LVMI). Design and method: 1104 hypertensive patients having at baseline an assessment of plasma NT-proBNP, a resting 12-lead ECG and an echocardiography were included. LVMI was assessable in 921 patients. After a median follow-up of 8.5 [5.4–13.3] years, 110 deaths occurred, 62 of which were from cardiovascular cause. Results: Optimal thresholds of RaVL and plasma NT-proBNP to predict mortality were 0.7 mV and 150 pg.mL-1, respectively. A 3-modality variable based on RaVL and NT-proBNP, was built: 0 when none were above the threshold, 1 or 2 when only one or both were above the threshold, respectively. After adjustment for cardiovascular risk factors, previous cardiovascular event and LVMI in Cox regression analysis, we observed a gradual increase risk for patients having 1 marker above the threshold (hazard ratio (HR) 1.76; 95% confidence interval (CI) (1.08–2.86) for all-cause mortality, HR 2.18; 95 %CI (1.06–4.46) for cardiovascular mortality) or 2 markers above the threshold (HR 2.76; 95 %CI (1.51–5.03) for all-cause mortality, HR 3.90; 95 %CI (1.69–9.00) for cardiovascular mortality); the prognostic value of the combination of RaVL and NT-proBNP was greater than that of LVMI, which did not reach statistical significance while included in the same model. Similarly, the combination demonstrated the best accuracy to predict outcome in comparison to LVMI (C-index, ROC curves and likelihood ratio test). Conclusions: Risk stratification in hypertension with the combination of NT-proBNP and RaVL is a simple method that appears more powerful and accurate than LVMI. This approach should be considered as a game changer in hypertension.

NT-proBNP combined with R wave in aVL lead predicts mortality better than echocardiographic left ventricular mass in hypertension

Plasma NT-proBNP and R wave in aVL lead (RaVL) have been associated with mortality in hypertensive patients. The aim of the present study was to test the prognostic value of their combination, in comparison to left ventricular mass index assessed by echocardiography (LVMI). A total of 1104 hypertensive patients having at baseline, an assessment of plasma NT-proBNP, a resting 12-lead ECG, and an echocardiography, were included. LVMI was assessable in 921 patients. After a median follow-up of 8.5 [5.4–13.3] years, 110 deaths occurred, 62 of which were from cardiovascular cause. Optimal thresholds of RaVL and plasma NT-proBNP to predict mortality were 0.7 mV and 150 pg.mL −1 , respectively. A 3-categorical variable based on RaVL and NT-proBNP, was built: 0, when none were above the threshold, 1 or 2 when only one or both were above the threshold. After adjustment for cardiovascular risk factors, previous cardiovascular event and LVMI in Cox regression analysis, we observed a gradual increase risk for patients having 1 marker above the threshold (hazard ratio (HR) 1.76; 95% confidence interval (CI) (1.08–2.86) for all-cause mortality, HR 2.18; 95%CI (1.06–4.46) for cardiovascular mortality) or 2 markers above the threshold (HR 2.76; 95%CI (1.51–5.03) for all-cause mortality, HR 3.90; 95%CI (1.69–9.00) for cardiovascular mortality); the prognostic value of the combination of RaVL and NT-proBNP was greater than that of LVMI, which did not reach statistical significance while included in the same model. Similarly, the combination demonstrated the best accuracy to predict outcome in comparison to LVMI (C-index, ROC curves and likelihood ratio test). Risk stratification in hypertension with the combination of NT-proBNP and RaVL is a simple method that appears more powerful and accurate than LVMI. This approach should be considered as a game changer in hypertension.

A Systematic Review On Lifestyle Change Interventions Performed By Health Care Professionals Targeting Blood Pressure In Hypertensive Patients

About 0.9 billion people in the world have hypertension. The annual death rate due to hypertension increased by 51% from 1990 to 2015. The challenge is to provide an effective pharmacological and nonpharmacological intervention.Objectives: As modifications of lifestyle are essential in decreasing blood pressure and lowering cardiovascular disease risk, the aim of this study was to determine if health care professional-led interventions/recommendations on life style are effective in lowering blood pressure in patients with hypertension. Methods: A systematic literature review following PRISMA guidelines was carried out. We searched PubMed, EMBASE and CINAHL for RCT of life style interventions performed by health care professionals (physician, nurse, pharmacist) targeting blood pressure in hypertensive patients. Papers were reviewed by two reviewers and analyzed using Cochrane software Revman 5.2. Outcomes for the meta-analysis were Systolic blood pressure (SBP), Diastolic blood pressure (DBP) and number of patients under blood pressure (BP) control. Results: A total of 32 clinical trials with the recommendation on life style change like diet, smoking cessation, physical activity etc. were included. In the included studies 22,226 patients were randomized (age M= 58,2), 49% of them were woman, 69,7% were already using antihypertensive medications. SBP decreased by 4.42 [95% CI -5.56, -3.28] comparing intervention group vs usual care group, DBP by 1.63 [95% CI -2.44, -0.83]. Overall, 56% of patients achieved BP control in intervention group vs 44% in usual care group, OR= 1.87 [95% CI 1.51, 2.31]. Data on intervention direct costs was provided in two studies. Third study estimated differences in inpatient utilization, outpatient expenditures and total expenditures between intervention and usual care group. Conclusions: Overall, interventions were effective and achieved almost 5 mmHg decrease of SBP. This may have an impact on preventing cardiovascular disease, morbidity and mortality in hypertensive patients. Yet there is a lack of pharmacoeconomic evaluation on life style change interventions.

PP.16.18] REPRODUCIBILITY OF DIPPING PATTERN AND NOCTURNAL HYPERTENSION IN NORMOTENSIVE AND ESSENTIAL HYPERTENSIVE SUBJECTS

Objective: It is well known that non-dipping pattern, nocturnal hypertension and isolated nocturnal hypertension are associated with target organ damage development and cardiovascular morbidity and mortality in hypertensive patients. Aim of our study was to evaluate the reproducibility of dipping pattern, nocturnal hypertension and isolated nocturnal hypertension in normotensive and essential hypertensive subjects. Design and method: A total of 68 consecutive never treated individuals referred for evaluation at the Hypertension Unit of our department, underwent 24-h ambulatory blood pressure (BP) monitoring at baseline and 1 month. Subjects with 24-h BP values > = 130/80mmHg were defined as hypertensives, whereas those with 24-h BP <130/80mmHg as normotensives. The degree of nocturnal BP dipping (%) was calculated as 100[1 – nighttime BP/daytime BP] for both systolic and diastolic BP. Dippers were defined as subjects with nocturnal BP fall >10% and non-dippers as patients with nocturnal BP fall <10%. Nocturnal hypertension was defined as nighttime SBP > = 120 mmHg and/or DBP > = 70 mmHg. Isolated nocturnal hypertension Statistical analysis was performed by means of reliability analysis (intraclass correlation coefficient (ICC)) for continuous variables and kappa agreement coefficient for categorical variables. Results: Our study population consisted of 22 normotensives (32%) and 46 hypertensive (68%) subjects. In normotensive subjects the ICC for systolic dipping was 0.172 (p = 0.332) and for diastolic dipping was 0.647 (p = 0.009). The kappa agreement coefficient for systolic non-dippers was 0.273 (p = 0.170), for diastolic non-dippers was 0.507 (p = 0.006), for nocturnal hypertension was 0.560 (p = 0.003) and for isolated nocturnal hypertension was 0.389 (p = 0.068). In hypertensive patients the ICCs for systolic and diastolic dipping were 0.671 (p < 0.001) and 0.557 (p = 0.003), respectively. The kappa agreement coefficient for systolic non-dippers was 0.521 (p < 0.001), for diastolic non-dippers was 0.322 (p = 0.029), for nocturnal hypertension was 0.254 (p = 0.030) and for isolated nocturnal hypertension was 0.237 (p = 0.102). Conclusions: In hypertensive patients, non-dipping pattern is more reproducible than nocturnal hypertension. In contrast, systolic non-dipping pattern is less reproducible than diastolic non-dipping pattern and nocturnal hypertension in normotensive subjects. The reproducibility of isolated nocturnal hypertension is limited.

5958The relation between systolic blood pressure and mortality in hypertensive patients with different blood pressure targets: the J-curve revisited

5958The relation between systolic blood pressure and mortality in hypertensive patients with different blood pressure targets: the J-curve revisited