Normal Systolic Blood Pressure Research Articles

Systolic blood pressure status modifies the associations between the triglyceride-glucose index and incident cardiovascular disease: a national cohort study in China

BackgroundThe triglyceride-glucose (TyG) index and blood pressure (BP) are correlated and serve as risk factors for cardiovascular disease (CVD). The potential impact of BP status on the association between the TyG index and CVD risk remains uncertain. This study aims to investigate the relationships between the TyG index and incident CVD in Chinese middle-aged and elderly adults, considering variations in BP status among participants.Methods6558 participants (mean age: 58.3 (± 8.7) years; 46.0% were men) without prevalent CVD were recruited from the China Health and Retirement Longitudinal Study. Participants were divided into three groups according to their systolic blood pressure (SBP) levels (< 120mmHg, 120 ∼ 129mmHg, ≥ 130mmHg). The TyG index was computed as ln[triglyceride (mg/dl) * fasting blood glucose (mg/dl)/2]. The primary outcome was CVD (heart disease and stroke), and the secondary outcomes were individual CVD components. Cox regression models and restricted cubic splines were performed to investigate the associations between continuous and categorical TyG with CVD.Results1599 cases of CVD were captured during 58,333 person-years of follow-up. Per 1-SD higher TyG index was associated with a 19% (HR: 1.19; 95% CI: 1.12, 1.27) higher risk for incident CVD, and the participants with the highest quartile of TyG index had a 54% (HR: 1.54; 95% CI: 1.29, 1.84) higher risk of CVD compared to those in the lowest quartile. SBP significantly modifies the association between the TyG index and CVD, with higher HRs for CVD observed in those with optimal and normal SBP. SBP partially mediated the associations between the TyG index with CVD. The results were generally consistent among participants with varying pulse pressure statuses rather than diastolic BP statuses.ConclusionsThe associations between the TyG index and CVD were modified by BP status, with greater HRs for CVD observed among those who had SBP < 130mmHg. SBP can partially mediate the association between the TyG index with CVD, highlighting the importance of early screening for the TyG index to identify at risk of hypertension and CVD.

Evaluation of Cardiovascular Autonomic Nervous System in Essential Tremor and Tremor Dominant Parkinson's Disease.

(1) Background: The differential diagnosis of essential tremor (ET) and tremor-dominant Parkinson's disease (TDPD) can be challenging. Only a few studies have investigated the autonomic nervous system (ANS) in ET. However, some of these suggested that heart rate variability (HRV) might be useful in the differential diagnosis. (2) Methods: Demographic and clinical data, including medications and comorbidities, were collected from 15 TDPD patients, 19 ET patients, and 20 healthy controls. Assessment with the SCOPA-AUT questionnaire, 5 min HRV analysis in time and frequency domains, and evaluation of orthostatic hypotension (OH) with tilt test were performed. (3) Results: There were no significant differences between all groups on the SCOPA-AUT questionnaire. PD patients had OH more frequently and a larger drop in systolic blood pressure (SBP) during the tilt test than ET patients and controls. HRV was affected in PD, but not in ET and controls. Power in the low frequency band, the standard deviation of all normal RR intervals and SBP drop were potentially useful in differential diagnosis with AUCs of 0.83, 0.78, and 0.83, respectively. (4) Conclusions: Cardiovascular ANS dysfunction was present in TDPD, but not in ET and controls. HRV analysis and assessment of SBP drop may be potentially useful in the differential diagnosis of ET and TDPD.

Body Mass Index and Blood Pressure Profile of Newly Enrolled Health Sciences Students in a Medical University of Karachi, Pakistan

Objectives: To measure the Body Mass Index (BMI) and Blood pressure (BP) of newly enrolled undergraduate students in a medical university in Karachi, Pakistan, and to assess any association between BMI and BP levels among them. Methods: A cross-sectional study was conducted on pre-existing three-year data of 1403 students. The age, gender, BMI, and BP were recorded. The BMI of students was classified according to the Asian cutoff and BP was categorized using the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) classification. Data was analyzed using SPSS version 24. Descriptive statistics were used to present quantitative and qualitative variables. The association was measured using the Chi-square test of significance. A p-value of &lt; 0.05 was taken as significant. Results: Total n= 1403 students with a mean age of 19 + 1.4 years students were enrolled including 397 (28.3%) males and 1006 (71.7%) females. A total of 667 (47.5%) students had a normal weight while 216 (15.4%) students were underweight, and 512 (36.5%) were either overweight or obese. Mean systolic BP was 111.42 + 10.7 mmHg and mean diastolic BP was 73.45 + 7.96 mmHg. Most students had normal systolic BP 901 (64.2%) while 501 (35.7%) had prehypertension or stage- I or II hypertension (HTN). The majority of the students had normal diastolic BP 1357 (96.7%) and 45 (3.3%) had stage- I or II HTN. There was a significant association between BMI and BP (0.0001). Conclusion: A significant number of the students are either under or overweight. There is a significant relationship between BMI and BP levels.

Cumulative Diastolic Blood Pressure Burden in Normal Systolic Blood Pressure and Cardiovascular Disease.

The clinical significance of isolated diastolic hypertension defined by the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines remains inconsistent. We examined whether long-term diastolic burden predicts the first major adverse cardiovascular event in participants with sustained and untreated normal systolic BP. The Mass General Brigham Biobank is a New England health care-based cohort recruited between 2010 and 2021. A total of 15 979 participants aged 18 to 64 years and without prior cardiovascular disease, antihypertensives, or high systolic BP were studied. The cumulative diastolic burden was determined as the area under the curve for diastolic BP (DBP) ≥80 mm Hg over 5 years before enrollment. Major adverse cardiovascular event was defined as a composite of first incident ischemic heart disease, stroke, heart failure, or all-cause death. Of the 15 979 participants, mean (SD) age at enrollment was 47.6 (14.3) years, 11 950 (74.8%) were women, and the mean (SD) systolic BP and DBP were 118.0 (12.9) and 72.2 (9.3) mm Hg, respectively. Over a median (interquartile range) follow-up of 3.5 (1.8-5.4) years, 2467 (15.4%) major adverse cardiovascular events occurred. Using Cox proportional hazards regression, each SD increase in cumulative DBP was independently associated with a hazard ratio (95% CI) of 1.06 (1.02-1.10) without effect modification by sex (P=0.65), age (P=0.46), or race/ethnicity (P=0.24). In addition to traditional risk factors, cumulative DBP modestly improved the discrimination C index (95% CI) from 0.74 (0.72-0.75) to 0.75 (0.74-0.76; likelihood ratio test, P=0.037). Among individuals with normal systolic BP, cumulative DBP may augment cardiovascular disease risk stratification beyond a single DBP measure and traditional risk factors.

Non-dipping circadian pattern as a predictor of incipient nephropathy in normotensive normoalbuminuric type 1 diabetics

ABSTRACT The objective of this study was to assess the value of the abnormal circadian blood pressure pattern by ambulatory blood pressure monitoring (ABPM) to predict the onset of abnormal albuminuria in normotensive and normoalbuminuric DM1 patients. The participators were submitted to ABPM and followed prospectively until the onset of albuminuria or the end of follow-up. The patients with normal circadian blood pressure pattern were compared with the non-dippers in regard of the time interval free of albuminuria. The survival curves were evaluated by the Kaplan–Meier method. Of 34 patients screened, 10 patients matched the exclusion criteria. Therefore, 24 patients were submitted to ABPM, aged 24 ± 8.3 y, 18 men, and all Caucasian. Elevated levels of albuminuria did not occurin any individual with normal systolic blood pressure dip (>10%) at 54 months of follow-up. Only 22% of patients among non-dippers were free of albuminuria (<30 mg/g maintained for 3 months) at the same time (p = 0.049). Patients that reached the outcome were homogeneous in regard to other clinical and ABPM data evaluated. Abnormal systolic blood pressure circadian pattern predicts the evolution to incipient nephropathy in normotensive normoalbuminuric DM1 patients.

High-normal systolic blood pressure in early midlife is a stronger risk factor for incident hypertension later in life for women than men

Abstract Background We have previously found that having high-normal blood pressure (BP) in early midlife is a stronger risk factor for incident hypertension later in life for women than for men. Whether this risk is related both to high-normal systolic and diastolic BP is not known. Purpose To explore whether there is a sex difference in risk of incident hypertension related to high-normal systolic and diastolic BP in early midlife. Methods In the community-based Hordaland Health Study, 1025 women and 703 men were examined at age 42 years (baseline) and re-examined after 26 years. Patients with hypertension at baseline were excluded. Attended BP was measured in triplets, and clinic BP taken as the average of the two last measurements. High-normal systolic BP was identified as systolic BP of 130-139 mmHg and high normal diastolic BP as diastolic BP 85-89 mmHg. Incident hypertension was identified as BP ≥140/90 mmHg or patient reported use of antihypertensive drugs on the follow-up visit. The associations of systolic and diastolic BP at baseline with incident hypertension at follow-up were explored in sex specific multivariable logistic regression analyses. Multivariable analysis looking at high-normal diastolic BP was adjusted for baseline BMI, systolic BP, high-normal diastolic BP , heart rate, physical activity, daily smoker, cholesterol, triglycerides. Multivariable analysis looking at high-normal systolic BP was adjusted for baseline BMI, diastolic BP, high normal systolic BP , heart rate, physical activity, daily smoker, cholesterol, triglyceride. Results are presented as odds ratios (OR), 95% confidence intervals (CI) and p-values. Results At baseline, average BP was 119/73 mmHg in women and 126/76 mmHg in men (p&amp;lt;0.001). A high-normal systolic BP was found in 16% of women and 35% of men (p&amp;lt; 0.001). A high-normal diastolic BP was found in 7% of women and 11% of men(p=0.008). After 26 years of follow-up, 39% of women and 45% of men had developed hypertension (p&amp;lt;0.05). In multivariable logistic regression analyses, high-normal systolic and diastolic BP at baseline predicted incident hypertension at follow up in both sexes (Table 1). High-normal systolic BP was a significantly stronger predictor for incident hypertension in women (OR 2.32, CI 1.5-3.5) with p&amp;lt;0.01 for sex interaction (Table 1). In men, high-normal diastolic BP at baseline, was the strongest predictor of incident hypertension (OR 2.1, 95% CI 1.2-3.7), but no sex-interaction was found for high-normal diastolic BP, possibly due to low numbers. Conclusions Having a high-normal systolic BP in early midlife is a greater risk for developing hypertension later in life for women than men.Table 1

Hypertension and poor control of systolic blood pressure after a myocardial infarction with non-obstructive coronary arteries are associated with incident heart failure

Abstract Introduction Myocardial infarction with non-obstructive coronary arteries (MINOCA) occurs in up to 10% of all acute myocardial infarctions. Although previously believed to be a benign condition, recent studies have observed an increased risk for long-term adverse cardiovascular events in this group. However, data on risk markers for specific outcomes following MINOCA are limited. Hypertension is an important risk factor for heart failure (HF), but it is yet unknown whether blood pressure control after MINOCA is associated with incident HF. Aims To investigate whether history of hypertension and control of systolic blood pressure at two-month follow-up visit after MINOCA were associated with hospitalization for HF during long-term follow-up. Material and Methods This was a nationwide cohort study using data from SWEDEHEART and the National Patient Registry. Patients with first-time MINOCA between 2005-2020 were included and divided into grades of hypertension based on systolic blood pressure (SBP) in mmHg at a two-month follow-up visit. The grades were low normal (&amp;lt;120), normal (120-129), high normal (130-139), grade 1 hypertension (140-159), grade 2 hypertension (160-179) and grade 3 hypertension (&amp;gt;180). MINOCA was defined as a discharge diagnosis of AMI combined with a coronary angiography showing less than 50% stenosis in all coronary arteries. Patients with a diagnosis of heart failure or cardiomyopathy one month or earlier before index hospitalization with MINOCA were excluded. After the two-month visit all patients were followed in the registries regarding hospitalization for HF, until December 2020. The association between SBP and time to first HF hospitalization was studied with univariate and multivariate Cox regression models, using high normal SBP as the reference group. Results Among the 5018 included patients (57.8% women, mean age 62.6 years), 197 (3.9%) were hospitalized for HF during a median follow-up of 6.5 years (IQR 3.2-9.9). A diagnosis of hypertension at index hospitalization for MINOCA was associated with hospitalization for HF, both in univariate analysis (HR 1.97 95% CI 1.49-2.62) and after age and sex adjustments (HR 1.45 95% CI 1.09-1.93). The highest hospitalization rate of 7.6% was seen among patients with grade 2-3 hypertension at the two-month follow-up visit. In univariate analysis a SBP &amp;gt;160 mmHg was associated with hospitalization for HF (HR 2.17 CI 1.36-3.45). After exclusion of patients with 30-49% stenosis, these findings remained after age and sex adjustments (HR 1.71 CI 1.04-2.83). Conclusions Both history of hypertension and a poor blood pressure control two-months after MINOCA were associated with hospitalization for HF during long-term follow-up. These findings highlight the importance of adequate blood pressure control following MINOCA. To better detect and treat high SBP should be seen as an opportunity to reduce HF hospitalizations in this group of patients.

Effect of electroacupuncture on myocardial fibrosis in spontaneously hypertensive rats based on cholinergic anti-inflammatory pathway

To observe the effect of electroacupuncture (EA) at "Neiguan" (PC 6) on myocardial fibrosis in spontaneously hypertensive rats (SHR), and explore preliminarily the mediating role of cholinergic anti-inflammatory pathway (CAP) and its downstream nuclear factor κB (NF-κB) signaling pathway. Six 12-week-old WKY male rats were employed as the normal group. Eighteen 12-week-old SHR were randomly divided into 3 groups, i.e. a model group, an EA group and a blocking group (EA after blocking α7 nicotinic acetylcholine receptor [α7nAchR]), with 6 rats in each one. In the EA group, EA was delivered at "Neiguan"(PC 6) and the site 0.5 cm from its left side, with disperse-dense wave, 2 Hz/15 Hz in frequency and 1 mA in current intensity. One intervention took 30 min and was given once every 2 days, lasting 8 weeks. In the blocking group, prior to each EA, the α7nAchR specific blocker, α-bungartoxin was injected intravenously in the tails of the rats. After EA intervention, the systolic blood pressure (SBP), the diastolic blood pressure (DBP) and the mean arterial pressure (MAP) were measured with non-invasive blood pressure monitor. Using echocardiogram, the left ventricular (LV) anterior wall end-diastolic thickness (LVAWd) , LV posterior wall end-diastolic thickness (LVPWd) and the LV end-diastolic internal diameter (LVIDd) were measured. The level of hydroxyproline (Hyp) in the myocardial tissue was determined by using alkaline hydrolysis, and that of acetylcholine (Ach) was detected by ELISA. With the real-time PCR adopted, the mRNA expression of NF-κB p65, tumor necrosis factor α (TNF-α), interleukin (IL)-1β and IL-6 were determined. Compared with the normal group, SBP, DBP, MAP, LVAWd and LVPWd were increased (P<0.01), and LVIDd was decreased (P<0.01) in the rats of the model group. SBP, DBP, MAP and LVAWd were dropped (P<0.01, P<0.05), and LVIDd rose (P<0.01) in the EA group when compared with those in the model group. The differences in the above indexes were not statistically significant between the blocking group and the model group (P>0.05). Compared with the normal group, Hyp level and the mRNA expression of NF-κB p65, TNF-α, IL-1β and IL-6 in the myocardial tissue increased (P<0.01, P<0.05) and Ach level decreased (P<0.01) in the model group. Hyp level, the mRNA expression of NF-κB p65, TNF-α, IL-1β and IL-6 in the myocardial tissue were reduced (P<0.05, P<0.01) and Ach level rose (P<0.01) in the EA group when compared with those in the model group. These indexes were not different statistically between the blocking group and the model group (P>0.05). CAP may be involved in ameliorating the pathological damage of myocardial fibrosis during EA at "Neiguan"(PC 6). The underlying effect mechanism is associated with up-regulating the neurotransmitter, Ach and down-regulating mRNA expression of NF-κB p65 and pro-inflammatory factors such as TNF-α, IL-1β and IL-6 in myocardial tissue.

Angioembolization for Isolated Severe Blunt Splenic Injuries with Hemodynamic Instability: A Propensity Score Matched Analysis.

This study aimed to compare patient outcomes after splenic angioembolization (SAE) or splenectomy for isolated severe blunt splenic injury (BSI) with hemodynamic instability, and to identify potential candidates for SAE. Adult patients with isolated severe BSI (Abbreviated Injury Scale [AIS] 3-5) and hemodynamic instability between 2013 and 2019 were identified from the American College of Surgeons Trauma Quality Improvement (ACS TQIP) database. Hemodynamic instability was defined as an initial systolic blood pressure (SBP) <90mmHg, heart rate (HR) >120bpm, or lowest SBP <90mmHg within 1h after admission, with ≥1 unit of blood transfused within 4h after admission. In-hospital mortality was compared between splenectomy and SAE groups using 2:1 propensity-score matching. The characteristics of unmatched and matched splenectomy patients were also compared. A total of 478 patients met our inclusion criteria (332 splenectomy, 146 SAE). After propensity-score matching, 166 splenectomy and 83 SAE patients were compared. Approximately 85% of propensity-score matched patients sustained AIS 3/4 injuries, and 50% presented with normal SBP and HR before becoming hemodynamically unstable. The median time to intervention (splenectomy or SAE) was 137min (interquartile range 94-183). In-hospital mortality between splenectomy and SAE groups was not significantly different (5.4% vs. 4.8%, p = 1.000). More than half of unmatched patients in the splenectomy group sustained AIS 5 injuries and presented with initially unstable hemodynamics. The median time to splenectomy in such patients was significantly shorter than in matched splenectomy patients (67 vs. 132min, p < 0.001). Splenectomy remains the mainstay of treatment for patients with AIS 5 BSI who present to hospital with hemodynamic instability. However, SAE might be a feasible alternative for patients with AIS 3/4 injuries.

Abstract P147: Cumulative Diastolic Blood Pressure Burden In Normal Systolic Blood Pressure And Cardiovascular Disease

Introduction: The clinical significance of isolated diastolic hypertension defined by the 2017 American College of Cardiology/American Heart Association Blood Pressure (BP) Guideline remains controversial. We examined whether long-term diastolic burden independently predicts the first major adverse cardiovascular event (MACE) in participants with sustained untreated normal systolic BP. Methods: We identified 18,181 Mass General Brigham Biobank participants aged 18 to 64 years with untreated systolic BP &lt;130 mmHg. Cumulative diastolic burden was determined as the area under curve for diastolic BP (DBP) ≥80 mmHg over a 5-year period prior to enrollment. Hazard ratio (HR) between cumulative diastolic burden and MACE was estimated using Cox proportional hazards regression. Prognostic value of enrollment and cumulative DBP was compared. Results: Of the 18,181 participants, mean [SD] age at enrollment was 47.6 [14.3] years, 13,574 [74.7%] were female, and 2853 (15.7%) MACE occurred over a median [IQR] follow-up of 3.5 [1.9-5.3] years. Each SD increase in cumulative DBP was associated with HR (95% CI) of 1.07 (1.03-1.11), adjusting for age, sex, race, body mass index, systolic BP, lipids, diabetes, smoking, statin, and antihypertensives initiation during follow-up. In addition to traditional risk factors, cumulative DBP improved the discrimination C index (95% CI) from 0.732 (0.724-0.742) to 0.739 (0.732-0.748) (Likelihood ratio test P =0.021), whereas inclusion of enrollment DBP did not improve prognosis. Conclusions: Among individuals with normal systolic BP, cumulative DBP may augment risk stratification beyond a single DBP measure and other traditional risk factors.

Associations among Food Systems, Food Environments, Food Choices, Food Security, and Nutrition Transition in Limpopo Province, South Africa: A Cross-Sectional Study.

A cross-sectional study was applied to investigate the influence of food systems and food environments on food choices and nutrition transition of households in Limpopo province, South Africa. A sample of 429 households was systematically selected using a paper selection draw from three districts. This paper determines the association among food systems, food environments, food choices, and nutritional measurements of the respondents. A validated questionnaire was used. Most of the respondents responsible for food procurement were females (80.4%). There was a significant association (p < 0.001) between proximity to food stores and dietary diversity of the households. Staple foods such as bread, maize, rice, samp, and mealie rice were available in almost all surveyed households (95.6%). More than half of the households (59.8%) had home gardens in their yards. Almost half of the households (48.4%) had a low Dietary Diversity Score. The study further revealed that 46.0% of households were food secure. Over a third (36.2%) of the respondents were obese, and 32.5% were diabetic. The mean total blood cholesterol was 3.69 ± 0.74 mmol/L. A high percentage of both females (89.6%) and males (91.5%) had normal hemoglobin levels. Almost half of the respondents had normal systolic blood pressure levels (45.6%), and nearly a quarter had high diastolic levels (21.4%). The 25 coping strategies were applied during food shortage periods. Even though the food environments provided both obesogenic and protective foods, the consumption of unhealthy foods was high.

Association between blood pressure, body mass index, and age: A data analytic approach

Objectives: Increase in body mass index (BMI) increases the risk of developing high blood pressure (BP). Several studies also indicate that high BP is associated with age. Controversies have been found regarding the association of BMI with high BP and age. Hence, this study was conducted to investigate the association between BP, BMI, and age. Material and Methods: Using the Inter-university Consortium for Political and Social Research (ICPSR 131103) Study on the Effects of Mindfulness on Lifestyle Behavior and BP, prospectively gathered data were retrospectively analyzed. A randomized controlled study was conducted. Using the statistical MedCalc program, the patient demographic data – including their age, BMI, and BP – were statistically examined. Statistical significance was determined using a 0.05 P-value. Results: Of the 37 participants, 43.3% had a normal BMI. One-fourth (40.5%) of the people were obese. 13.5% and 32.4% of the people had normal systolic (SBP) and diastolic (DBP) BP, respectively. Age, SBP, or DBP did not significantly correlate with BMI. Nevertheless, there was a positive and substantial correlation between BMI, age, SBP, DBP, weight, and height. Conclusion: According to the study’s findings, there are no appreciable positive connections between BMI and either SBP or DBP, or age. However, the weakly positive relationships between SBP and DBP and age suggest that regular BP monitoring is necessary.

Factors influencing blood pressure fluctuation in pediatric patients with sickle cell disease in Saudi Arabia: A retrospective single-center cohort study.

To investigate changes in blood pressure (BP) among pediatric patients with sickle cell disease (SCD) and determine the variables that might influence these changes. A total of 100 pediatric patients with SCD who followed up in the pediatric outpatient clinic were recruited for this retrospective cohort study. Clinical data included anthropometric measures, average systolic and diastolic BP recorded during multiple follow-up visits, hemoglobin (Hb) level, serum creatinine, and hemoglobin S percentage. Blood pressure measurements were categorized according to the guidelines of the American Academy of Pediatrics (AAP, 2017). In this cohort, 68% of the patients had normal systolic BP, 13% had elevated systolic BP, 17% had stage 1 hypertension (HTN), while only 2% reported stage 2 HTN. Patients who were overweight had relatively high systolic BP compared to patients who were underweight (p=0.034) or had normal weight (p=0.023). The average systolic BP significantly correlates with body mass index (r= 0.377, p<0.001) and serum creatinine (r=0.369, p<0.001). Pediatric overweight SCD patients exhibited higher average systolic BP than those underweight or normal weight. Body mass index and serum creatinine significantly influenced the average systolic BP more than the Hb level or Hb S percentage.

Upregulation of Interleukin-2 Among Hypertensive Subjects in Bayelsa State, Nigeria

Hypertension is a killer disease that increases with age. Several inflammatory biomarkers have been associated with hypertension. However conflicting reports exist on the relationship of interleukin-2 with hypertension. The objective of the present study was to determine the association of hypertension with interleukin-2 (IL-2) as well as the distribution of blood pressure among adults in Bayelsa State, Nigeria. Randomly selected 270 adults were screened for hypertension using Andon blood pressure monitor and real time PCR was used to quantify IL-2 gene expression. A structured questionnaire was used to collect sociodemographic information. A normal systolic and diastolic blood pressure distribution was found. Mean systolic and diastolic blood pressure were 123.69±22.65 and 77.60±13.53 mmHg respectively. The prevalence of hypertension was 47.4% (isolated systolic hypertension, 10.4%; isolated diastolic hypertension, 4.4%; co-occurring systolic and diastolic hypertension, 32.6%). Exactly 71.09% of hypertensive subjects were unaware that they were hypertensive. Age related increase in hypertension was found. Compared with normal control, a significant upregulation in IL-2 gene expression was found among hypertensive subjects (p &lt; 0.05). In conclusion, the present study showed that a high prevalence of hypertension and low hypertensive status awareness exist in rural areas in Bayelsa State, Nigeria. It also showed that hypertension is associated with a significant upregulation in IL-2 gene expression. Hypertension interventions to rural areas and the use of IL-2 as a target biomarker for novel antihypertensive drug design is implicated in the present study. Keywords: [Hypertension, interleukin-2, rural areas, Bayelsa State, Nigeria]

#5978 SUBCAPSULAR INJECTION OF EXTRACELLULAR VESICLES FROM MESENCHYMAL STEM CELLS, PROMOTED ADDITIONAL RENOPROTECTION IN AN EXPERIMENTAL MODEL OF CKD

Abstract Background and Aims Chronic kidney disease (CKD) is considered a public health concern worldwide, both due to its insidious and highly debilitating feature and to its high global prevalence. Clinical management of CKD is often achieved by the blockade of the renin-angiotensin-aldosterone system (RAAS). However, this treatment alone is not efficient to prevent CKD progression completely, motivating the scientific community to search for alternative treatments to control CKD progression and to detain its evolution to the end-stage renal failure. In this context, we have recently shown that the association of a single renal subcapsular injection of 2 × 106 adipose-derived mesenchymal stem cells (ASC) to RAAS blockade with the AT1RB Losartan (LOS) promoted greater renoprotection when compared to LOS monotherapy, leading to the normalization of urinary protein excretion (UPE) and to the regression of established glomerulosclerosis (GS), in experimental CKD. Since there are methodological limits for the number of ASC that can be injected under the renal capsule, and based on the current literature, which suggests the main beneficial effects of ASC are not due to direct in situ cell differentiation, but to paracrine factors produced and released by the ASC; in the present study we aimed to investigate if the association of a renal subcapsular injection of extracellular vesicles (EV) derived from ASC, to the oral treatment with LOS would promote additional renoprotective effects in a model of experimental CKD. Method The present experimental protocol was approved by the Ethics Committee for the Use of Experimental Animals of the University of São Paulo Medical School (CEUA-FMUSP No 1761/2022). EV were obtained from ASC isolated from gonadal adipose tissue of 5 male Wistar rats. Cells were cultured until P4, characterized by flow cytometry and in vitro differentiation, and kept under serum deprivation for 24 h. The conditioned culture media, containing the EV released by these cells, was ultracentrifuged and the resulting EV pellets were diluted in 100 μL of sterile PBS and used for the renal subcapsular injections. Experimental CKD was induced in 25 male Wistar rats through the surgical ligation of 2 from the 3 branches of the left renal artery, followed by the total nephrectomy of the right kidney, resulting in a 5/6 renal ablation. Additional 10 Sham-operated rats were used as control. After 15 days from surgery, the animals submitted to renal ablation were stratified into 3 groups, with closely similar mean values of body weight (BW), systolic blood pressure (SBP), UPE and urinary albumin excretion (UAE), before the start of the different treatments. Animals from CKD group were kept untreated, LOS and LOS+EV animals received diary 50 mg/Kg/d of Losartan, diluted in drinking water and LOS+EV rats underwent a second surgery for the renal subcapsular application of EV. All animals were followed until 30 days after CKD induction, when BW, SBP, UPE and UAE were analyzed again. Animals where then euthanized for the assessment of serum creatinine (SCr) and blood urea nitrogen (BUN) concentration, as well as for histological studies to determine the percentage of GS and the renal interstitial infiltration by macrophages (CD68). Results The association of a single subcapsular injection of EV derived from ASC, to the oral treatment with the AT1RB LOS, significantly improved the effects of this antihypertensive drug. CKD+LOS+EV animals exhibited normal SBP, in spite of having only 1/6 of functioning renal mass. Moreover, the combined treatment significantly reduced UAE and numerically diminished de percentage of glomerulosclerosis, compared to LOS alone. Detailed obtained results are presented in Table 1. Data are presented as Mean ± SE. Differences among groups were analyzed by one-way ANOVA: p&amp;lt;0.05 vs.*CONT, #CKD, †LOS. as Mean ± SE. Conclusion Despite the small number of animals in the association group, our preliminary results suggest EV from ASC to exert additional renoprotective effects when associated to LOS, especially regarding the control of SBP and the protection of the glomerular filtration barrier integrity.

Interplay Between Fitness, Systolic Blood Pressure and Sudden Cardiac Death (from a Cohort Study)

Modifiable risk factors, such as blood pressure and cardiorespiratory fitness (CRF) play a role in the genesis of sudden cardiac death (SCD). However, data on their joint contributions to SCD risk are scarce. We aimed to evaluate the interplay between systolic blood pressure (SBP), CRF, and SCD risk in a cohort of men. Resting SBP was measured using a random-zero sphygmomanometer and CRF was assessed using a respiratory gas exchange analyzer during clinical exercise testing at baseline in 2,291 men aged 42 to 61years. SBP was classified as normal and high (<140 and ≥140mm Hg, respectively) and CRF as low, medium, and high. Cox regression analysis was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for SCD. A total of 262 SCDs occurred during a median follow-up of 28.2years. Comparing high versus normal SBP, the multivariable-adjusted HR (95% CI) for SCD was 1.35 (1.03 to 1.76). Comparing low versus high CRF levels, the corresponding adjusted HR (95% CI) for SCD was 1.81 (1.23 to 2.65). The HRs remained similar when SBP was further adjusted for CRF and CRF was further adjusted for SBP. Men with high SBP and low CRF compared with normal SBP and medium-high CRF, had an increased risk of SCD (HR 2.67, 95% CI 1.76 to 4.05), with no significant evidence of an association between men with high SBP and medium-high CRF and SCD risk (HR 1.38, 95% CI 0.84 to 2.26). There was modest evidence of an additive interaction between SBP and CRF in relation to SCD. In conclusion, there exists an interplay between SBP, CRF, and SCD risk in middle-aged and older men. Medium to high CRF levels may mitigate the increased risk of SCD in subjects with high SBP.

Assessment of Normal Systolic Blood Pressure Maintenance with the Risk of Coronary Artery Calcification Progression in Asymptomatic Metabolically Healthy Korean Adults with Normal Weight, Overweight, and Obesity.

Metabolically healthy obesity (MHO) is known to have a close association with subclinical coronary atherosclerosis. Despite recent data on the benefit of intensive systolic blood pressure (SBP) control in diverse clinical conditions, little is known regarding the association of normal SBP maintenance (SBPmaintain) with coronary artery calcification (CAC) progression in MHO. This study included 2724 asymptomatic adults (48.8 ± 7.8 years; 77.9% men) who had no metabolic abnormalities except overweight and obesity. Participants with normal weight (44.2%), overweight (31.6%), and obesity (24.2%) were divided into two groups: normal SBPmaintain (follow-up SBP < 120 mm Hg) and ≥elevated SBPmaintain (follow-up SBP ≥ 120 mm Hg). CAC progression was defined using the SQRT method, a difference of ≥2.5 between the square root (√) of the baseline and follow-up coronary artery calcium score. During a mean follow-up of 3.4 years, the proportion of normal SBPmaintain (76.2%, 65.2%, and 59.1%) and the incidence of CAC progression (15.0%, 21.3%, and 23.5%) was different in participants with normal weight, overweight, and obesity (all p < 0.05, respectively). The incidence of CAC progression was lower in the normal SBPmaintain group than in the ≥elevated SBPmaintain group in only participants with obesity (20.8% vs. 27.4%, p = 0.048). In multiple logistic models, compared to participants with normal weight, those with obesity had a higher risk of CAC progression. Normal SBPmaintain was independently associated with the decreased risk of CAC progression in participants with obesity. MHO had a significant association with CAC progression. Normal SBPmaintain reduced the risk of CAC progression in asymptomatic adults with MHO.

The Interplay between Systolic Blood Pressure, Sauna Bathing, and Cardiovascular Mortality in Middle-Aged and Older Finnish Men: A Cohort Study

ObjectivesElevated systolic blood pressure (SBP) is associated with an increased risk of cardiovascular disease (CVD) mortality, whereas frequent sauna bathing reduces the risk. Whether frequent sauna bathing mitigates CVD mortality among adults with elevated SBP has not been previously investigated.Design and SettingWe examined the interactions between SBP and frequency of sauna bathing (FSB) with the risk of CVD mortality in a cohort of Caucasian men.ParticipantsThe Kuopio Ischaemic Heart Disease Study cohort comprising of 2,575 men aged 42–61 years at baseline was employed for this prospective study analysis.MeasurementsResting blood pressure was measured using a standardized protocol and sauna bathing habits were assessed by a self-administered questionnaire. Systolic blood pressure was categorized as normal and high (<140 and ≥140 mmHg, respectively) and FSB as low and high (defined as ≤ 2 and 3–7 sessions/week, respectively).ResultsA total of 744 CVD deaths were recorded during a median follow-up of 27.8 yr. Comparing high vs normal SBP, the multivariable-adjusted HR (95% CI) for CVD mortality was 1.44 (1.23–1.68). Comparing low vs high FSB, the multivariable-adjusted HR (95% CI) for CVD mortality was 1.24 (1.03–1.51). The associations persisted following mutual adjustment for each exposure. Compared with men with normal SBP-high FSB, high SBP-low FSB was associated with an increased risk of CVD mortality 1.81 (1.39–2.36), with attenuated but persisting evidence of an association for men with high SBP and high FSB 1.52 (1.06–2.16). When SBP was categorized as normal and high (<130 and ≥130 mmHg, respectively), there was no evidence of an association for men with high SBP and high FSB 1.11 (0.77–1.61).ConclusionThere might be an interaction between SBP, sauna bathing and CVD mortality risk in middle-aged and older Caucasian males. Frequent sauna baths may offset the increased risk of CVD mortality in men with high-normal SBP but not elevated SBP.

Validation of the Pediatric Resuscitation and Trauma Outcome (PRESTO) model in injury patients in Tanzania

IntroductionSub-Saharan Africa has the highest rate of unintentional paediatric injury deaths. The Pediatric Resuscitation and Trauma Outcome (PRESTO) model predicts mortality using patient variables available in low-resource settings: age, systolic...

Evaluating emergency department tube thoracostomy: A single-center use of trauma video review to assess efficiency and technique.

Emergency department tube thoracostomy is a common procedure; however, assessing procedural skills is difficult. We sought to describe procedural variability and technical complications of emergency department tube thoracostomy using trauma video review. We hypothesized that factors such as hemodynamic abnormality lead to increased technical difficulty and malpositioning. Using trauma video review, we reviewed all emergency department tube thoracostomy from 2020 to 2022. Patients were stratified into hemodynamically abnormal (systolic blood pressure <90 or heart rate >120) and hemodynamically normal (systolic blood pressure ≥90 or heart rate ≤120). Emergency department tube thoracostomies outside of video-capable rooms, with incomplete visualization, or in patients undergoing cardiopulmonary resuscitation or resuscitative thoracotomy were excluded. The primary outcome was a procedure score modified from the validated tool ranging from 0 to 11 (higher score indicating better performance). Also measured were procedural times to (1) decision to place, (2) pleural entry, and (3) procedure completion. Postprocedure x-ray and chart review were used to determine accuracy. In total, 51 videos met the inclusion criteria. The median age was 34 [interquartile range 24-40] years, body mass index 25.8 [interquartile range 21.8-30.7], predominately male (75%), blunt injury (57%), with Injury Severity Score of 22 [14.5-41]. The median procedure score was 9 [7-10]. Emergency department tube thoracostomies in patients with abnormal hemodynamics had significantly lower procedure scores (8 vs 10, P < .05). Hemodynamically abnormal patients had significantly shorter times from decision to proceed to pleural entry (4.05 vs 8.25 minutes, P < .001), and to completion (6.31 vs 14.23 minutes, P < .001). The most common complication was malpositioning (35.1%), with no significant difference noted when comparing hemodynamically normal and abnormal patients (P= .41). Using trauma video review we identified significant procedural variability in emergency department tube thoracostomy, mainly that hemodynamic abnormality led to lower proficiency scores and increased malpositioning. Efforts are needed to define procedural benchmarks and evaluation in the context of patient outcomes. Using this technology and methodology can help establish procedural norms.