Normotensive Subjects Research Articles

Omega-3 Fatty Acids in Arterial Hypertension: Is There Any Good News?

Omega-3 polyunsaturated fatty acids (ω-3 PUFAs), including alpha-linolenic acid (ALA) and its derivatives eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are "essential" fatty acids mainly obtained from diet sources comprising plant oils, marine blue fish, and commercially available fish oil supplements. Many epidemiological and retrospective studies suggested that ω-3 PUFA consumption decreases the risk of cardiovascular disease, but results of early intervention trials have not consistently confirmed this effect. In recent years, some large-scale randomized controlled trials have shed new light on the potential role of ω-3 PUFAs, particularly high-dose EPA-only formulations, in cardiovascular prevention, making them an attractive tool for the treatment of "residual" cardiovascular risk. ω-3 PUFAs' beneficial effects on cardiovascular outcomes go far beyond the reduction in triglyceride levels and are thought to be mediated by their broadly documented "pleiotropic" actions, most of which are directed to vascular protection. A considerable number of clinical studies and meta-analyses suggest the beneficial effects of ω-3 PUFAs in the regulation of blood pressure in hypertensive and normotensive subjects. These effects occur mostly through regulation of the vascular tone that could be mediated by both endothelium-dependent and independent mechanisms. In this narrative review, we summarize the results of both experimental and clinical studies that evaluated the effect of ω-3 PUFAs on blood pressure, highlighting the mechanisms of their action on the vascular system and their possible impact on hypertension, hypertension-related vascular damage, and, ultimately, cardiovascular outcomes.

<i>NOS2</i>, <i>NOS3</i>, <i>SONE</i> gene transcripts levels in peripheral blood leukocytes and their relationship with markers of endothelial dysfunction in hypertension

Objective. The aim of the study was to evaluate the level of expression of the NOS2, NOS3, SONE genes in peripheral blood leukocytes (PBL) of patients with hypertension (HTN) and to study the relationship between the level of transcripts of these genes and the content of nitric oxide metabolites and markers of endothelial dysfunction.Design and methods. The study included healthy people (25 people) and patients with HTN (stages I–II) before prescribing antihypertensive drugs (15 people) and taking cardioselective β-adrenergic receptor blockers for more than a year (metoprolol (25 mg per day) or bisoprolol (5–10 mg per day)) (20 people). The level of gene transcripts was assessed by real-time polymerase chain reaction (PCR). The level of nitric oxide metabolites was determined by the colorimetric method using the Griess reagent. The content of asymmetric dimethylarginine (ADMA), soluble forms of vascular cell adhesion molecule (sVCAM), and intercellular adhesion molecule (sICAM) in blood plasma was determined by ELISA. The content of malondialdehyde (MDA) in blood plasma was determined spectrophotometrically by color reaction with thiobarbituric acid. Statistical processing of the results was carried out using the Statgraphics Centurion XVI software package (version 16.1.11).Results. The level of nitric oxide metabolites in the blood plasma of HTN patients without antihypertensive therapy was 2,1 times higher than in healthy individuals (p = 0,001) and 1,7 times higher than in patients with HTN taking metoprolol or bisoprolol (p = 0,002). The relative content of mRNA of the NOS3 gene in PBL of individuals included in the study did not differ (p > 0,05). The level of NOS2 gene transcripts in PBL of HTN patients before the prescription of antihypertensive drugs exceeded that in healthy individuals (p = 0,0009) and in HTN patients taking metoprolol or bisoprolol (p = 0,0002). The number of SONE transcripts in the PBL of HTN patients was higher than in people with normal blood pressure (p < 0,00001 when comparing patients before the prescription of antihypertensive therapy and individuals from the control group; p = 0,04 when comparing patients with HTN taking antihypertensive drugs and normotensive subjects). The content of MDA, ADMA, sVCAM was higher in the plasma of HTN patients without antihypertensive therapy compared with people from the control group (p = 0,005, 0,003, 0,039, respectively) and patients taking metoprolol or bisoprolol (p = 0,0006, 0,019, 0,016, respectively). The content of nitric oxide metabolites positively correlated with NOS2, SONE, VCAM1 mRNA level in PBL, the content of MDA and ADMA in blood plasma (p < 0,05). A positive correlation was found between the concentration of MDA and ADMA in plasma (p = 0,03).Conclusions. An increase in the level of nitric oxide metabolites in HTN is associated with an increase in the transcriptional activity of the NOS2 gene, a disturbance of the redox balance of the body, and the development of endothelial dysfunction. The SONE gene is probably involved in the modulation of nitric oxide levels in HTN not only as an antisense transcript that destabilizes the mRNA of the NOS3 gene in vascular endothelial cells, but also indirectly, namely, through the regulation of homeostasis of immune system cells through autophagy.

Exercise systolic blood pressure indexed to work rate predicts future risk of incident stroke

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): 1) The CircM network, Linköping University 2) The Swedish Stroke Association. Background Hypertension is a major risk factor for stroke. Exaggerated peak systolic blood pressure (SBP) during exercise is associated with increased risk of hypertension in normotensive subjects, whereas low, rather than high, peak exercise SBP predicts cardiovascular and all-cause mortality. Purpose We aimed to study the risk of incident fatal and non-fatal stroke in relation to absolute and work rate indexed exercise SBP, in patients referred for exercise testing. Methods We cross-linked clinical data from 14,428 bicycle ergometer exercise tests with data from the National Patient Registry and the Registry of Prescribed Medications up until December 2019. Subjects with a history of cerebrovascular disease were excluded, as well as subjects with submaximal tests, a drop in SBP during exercise, or with missing SBP data at the end of exercise. Baseline comorbidity was defined as diagnosis of, or treatment for, hypertension, diabetes, hyperlipidemia, and coronary artery disease (CAD). Work rate indexed SBP response (SBP/Watt-slope) was calculated as the increase in SBP during exercise divided by the increase in work rate. We applied Cox regression to calculate hazard ratios (HR) with 95% confidence intervals (95% CI) for the risk of incident stroke in association to peak SBP and the SBP/Watt-slope. We used absolute values as well the upper limit of normal (≥2 Z scores) of a recently published reference population, with reference equation including age, sex, SBP at rest, Wmax (for SBP peak only) and height (for SBP/W-slope only). Analyses were adjusted for age, sex, and baseline comorbidity. Results In total, 7,946 subjects (54% male, age 55±13 years) were included, with baseline comorbidity of hypertension (28%), diabetes (7%), hyperlipidemia (16%), and CAD (13%). During a median follow-up of 8.4 years (inter quartile range 5.8-11.5), 3.1% developed ischemic (2.2%) or hemorrhagic (1.0%) stroke. There were positive associations to future stroke with absolute peak exercise SBP (HR: 1.08 [1.03 – 1.13] per 10 mmHg increase) and with SBP/Watt-slope (HR: 1.09 [1.05 – 1.14] per 1 mmHg/10 Watt increase), but not after adjustment for sex, age and baseline comorbidity. However, having a SBP/Watt-slope ≥2 Z scores was associated with an increased risk for stroke (HR: 1.56 [1.08 – 2.25)] after adjustment for baseline comorbidity, whereas an adjusted SBP peak ≥2 Z scores was not (HR: 0.62 [0.32 – 1.21]). Conclusion A workload-indexed SBP response (SBP/Watt-slope) above the upper limit of normal may help to identify subjects with no history of cerebrovascular disease at risk of future stroke. In contrast, the absolute exercise SBP response to exercise does not add substantial information to the risk estimation above age, sex, and baseline comorbidity.

Vascular endothelial growth factor receptor 1 gene (FLT1) longevity variant increases lifespan by reducing mortality risk posed by hypertension.

Longevity is written into the genes. While many so-called "longevity genes" have been identified, the reason why particular genetic variants are associated with longer lifespan has proven to be elusive. The aim of the present study was to test the hypothesis that the strongest of 3 adjacent longevity-associated single nucleotide polymorphisms - rs3794396 - of the vascular endothelial growth factor receptor 1 gene, FLT1, may confer greater lifespan by protecting against mortality risk from one or more adverse medical conditions of aging - namely, hypertension, coronary heart disease (CHD), stroke, and diabetes. In a prospective population-based longitudinal study we followed 3,471 American men of Japanese ancestry living on Oahu, Hawaii, from 1965 until death or to the end of December 2019 by which time 99% had died. Cox proportional hazards models were used to assess the association of FLT1 genotype with longevity for 4 genetic models and the medical conditions. We found that, in major allele recessive and heterozygote disadvantage models, genotype GG ameliorated the risk of mortality posed by hypertension, but not that posed by having CHD, stroke or diabetes. Normotensive subjects lived longest and there was no significant effect of FLT1 genotype on their lifespan. In conclusion, the longevity-associated genotype of FLT1 may confer increased lifespan by protecting against mortality risk posed by hypertension. We suggest that FLT1 expression in individuals with longevity genotype boosts vascular endothelial resilience mechanisms to counteract hypertension-related stress in vital organs and tissues.

Body fat percentage utility over lipid profile as marker of dyslipidemia in type 2 diabetes mellitus

Obesity, Metabolic syndrome and dyslipidaemia are gaining prevalence as noncommunicable causes of health hazards like CVD, IHD. National surveys under the leadership of ICMR were in progress to detect causes of high fat content in the body and means to detect the same early are underway. We made an attempt to know the importance of body fat percentage in Type 2 Diabetes Mellitus as marker of dyslipidaemia. : To study relationship of BMI, body fat percent (BFP) and lipid profile in type 2 Diabetes Mellitus.: 35 Type2DM (normotensive) subjects in the age group of 30-55yrs in both sexes and 35 age & sex matched healthy controls were selected for the study after obtaining informed consent. Anthropometric data was recorded. Their fasting venous blood samples were analysed for sugar & Lipid profile ERBA Chem 5 semiautoanalyser. BMI and BFP were calculated.: BFP was well above normal levels in both cases and controls (38.03±12.13 &44.9±7.66 respectively) for the age group of 30-55yrs normal limits being 19,3% -26.3% according to Jackson & Pollard. The mean BMI of cases was 33.22±8.59 compared to 37.07±4.1 of controls, indicating both groups were class II obese individuals. BMI & BFP showed statistically significant correlation between cases and controls by Student’s ‘t’ test (p <0.009 & <0.003 respectively) and also within the groups (P <0.00001) by way of ANOVA. Analysis was done to detect gender difference. In males and females there was strongly positive correlation of BMI as detected by Pearson’s Correlation coefficient (r = 0.914 & 0.976). TC, TG & HDL showed weak positive correlation with BMI & BFP in diabetic subjects, whereas LDL correlated negatively with BMI & BFP.: We could not conclude superiority of BFP over BMI in assessing dyslipidaemia. Nevertheless, the study can be done using other methods of evaluation of BFP in T2DM like ultrasound, computerised tomography.

Assessment of serum concentrations of matrix metalloproteinases-2, -3 and -9, and tissue inhibitor of metalloproteinases-1 in children with primary hypertension

Introduction: Primary hypertension is regarded to be a growing health concern in children. The pathogenesis of primary hypertension is multifactorial. The role of altered levels of matrix metalloproteinases has been proposed. In hypertension, metalloproteinases are engaged not only in vascular remodelling but also in activation of vasoconstrictive agents. Aim of the study: We aimed at comparing the serum concentrations of matrix metalloproteinases-2, -3 and -9, and tissue inhibitor of metalloproteinases-1 in children with primary hypertension and normotensive peers. Materials and methods: We surveyed 23 children with primary hypertension, aged 14.75 years (median; interquartile range, IQR 3.66) and 23 normotensive subjects, aged 14.66 years (median; IQR 6.25). Serum concentrations of matrix metalloproteinases-2, -3 and -9, and tissue inhibitor of metalloproteinases-1 were measured using enzyme-linked immunosorbent method, and the scores were compared with Mann–Whitney U test, with the level of significance at p ≤ 0.05. Results: In children with primary hypertension, serum concentration of matrix metalloproteinase-2 [178.1 (IQR: 35.84) vs. 99.9 (IQR: 20.1) ng/mL], -3 [6.47 (IQR: 1.75) vs. 2.67 (IQR: 1.08) ng/mL], -9 [191.1 (IQR: 52.75) vs. 58.34 (IQR: 18.99) ng/mL] and tissue inhibitor of metalloproteinases-1 [863.9 (IQR: 192.9) vs. 335.41 (IQR: 109.99) ng/mL] were significantly higher than in the normotensive controls (p < 0.00001). Matrix metalloproteinase-9/tissue inhibitor of metalloproteinases-1 ratio [0.22 (IQR: 0.1) vs. 0.18 (IQR: 0.05)] was also significantly elevated in the hypertensive participants (p = 0.008). Conclusions: Elevated serum concentrations of matrix metalloproteinases-2, -3 and -9, and tissue inhibitor of metalloproteinases-1 in children with primary hypertension may indicate their role in the development of hypertension and/or on the presence of vascular remodelling at an early stage of the disease.

The characteristics of elevated blood pressure in abdominal obesity correspond to primary hypertension: a cross-sectional study

BackgroundObesity-related hypertension and the associated metabolic abnormalities are considered as a distinct hypertensive phenotype. Here we examined how abdominal fat content, as judged by waist:height ratio, influenced blood pressure and hemodynamic profile in normotensive subjects and never-treated hypertensive patients.MethodsThe 541 participants (20–72 years) underwent physical examination and laboratory analyses and were divided into age and sex-adjusted quartiles of waist:height ratio. Supine hemodynamics were recorded using whole-body impedance cardiography, combined with analyses of radial tonometric pulse wave form and heart rate variability.ResultsMean waist:height ratios in the quartiles were 0.46, 0.51, 0.55 and 0.62. Radial and aortic blood pressure, systemic vascular resistance, pulse wave velocity, markers of glucose and lipid metabolism, leptin levels and C-reactive protein were higher in quartile 4 when compared with quartiles 1 and 2 (p < 0.05 for all). Cardiac index was lower in quartile 4 versus quartile 1, while no differences were seen in heart rate variability, augmentation index, plasma renin activity, and aldosterone concentration between the quartiles. Linear regression analyses showed independent associations of abdominal obesity with higher aortic systolic and diastolic blood pressure, systemic vascular resistance, and pulse wave velocity (p < 0.05 for waist:height ratio in all regression models).ConclusionHigher waist:height ratio was associated with elevated blood pressure, systemic vascular resistance, and arterial stiffness, but not with alterations in cardiac sympathovagal modulation or activation of the circulating renin-angiotensin-aldosterone system. Although obesity-related elevation of blood pressure has distinct phenotypic features, these results suggest that its main characteristics correspond those of primary hypertension.Trial registrationClinicalTrails.gov NCT01742702 (date of registration 5th December 2012).

Distinct cytokine profiles in patients with preeclampsia

Preeclampsia (PE) is a common but serious pregnancy complication that adversely affects both maternal and fetal health. However, the mechanisms of its pathogenesis remain unclear, and effective biomarkers for early diagnosis are still lacking. In this retrospective study, comprehensive bioinformatic analysis and logistic regression analysis were used to compare profiles of 48 serum cytokines in 27 PE patients with those in 41 normotensive pregnant subjects. The results revealed that serum cytokine profiles accumulated to different levels between the two groups, which had significant correlations with the clinical features of PE. Nine cytokines with high discriminatory capacity for diagnosising PE (AUC ≥ 0.7) were selected for inclusion in a multivariate logistic regression model for PE and calculated as a probability diagnostic formula. This model constructed from the panel of nine cytokines had better diagnostic performance than any individual cytokine (AUC = 0.97, 95% CI 0.94-1.00, P < 0.0001), with a sensitivity of 96.30% and a specificity of 90.24%. The set of cytokine profiles and risk assessment model described here can serve as a basis for developing early clinical diagnostic and therapeutic strategies for PE.

SAGE Score in Normotensive and Pre-Hypertensive Patients: A Proof of Concept.

The SAGE score was developed to detect individuals at risk for increased pulse wave velocity (PWV). So far, studies have been focused on hypertensive patients. To assess the ability of the score to detect non-hypertensive and pre-hypertensive patients at risk for increased PWV. Retrospective cross-sectional study of analysis of central blood pressure data and calculation of the SAGE score of non-hypertensive and pre-hypertensive patients. Each score point was analyzed for sensitivity, specificity, positive and negative predictive values, using the cut-off point for positive diagnosis a PVW ≥ 10m/s, ≥9.08 m/s (75thpercentile) and ≥7.30 m/s (50thpercentile). A p<0.05 was considered statistically significant. The sample was composed of 100 normotensive and pre-hypertensive individuals, with mean age of 52.64 ± 14.94 years and median PWV of 7.30 m/s (6.03 - 9.08). The SAGE score was correlated with age (r=0.938, p<0.001), glycemia (r=0.366, p<0.001) and glomerular filtration rate (r=-0.658, p<0.001). The area under the ROC curve was 0.968 (p<0.001) for PWV ≥ 10 m/s, 0.977 (p<0.001) for PWV ≥ 9.08 m/s and 0.967 (p<0.001) for PWV ≥ 7.30 m/s. The score 7 showed a specificity of 95.40% and sensitivity of 100% for PWV≥10 m/s. The cut-off point would be of five for a PWV≥9.08 m/s (sensitivity =96.00%, specificity = 94.70%), and two for a PWV ≥ 7.30 m/s. The SAGE score could identify individuals at higher risk of arterial stiffness, using different PWV cutoff points. However, the development of a specific score for normotensive and pre-hypertensive subjects is needed.

Plasma brain derived neurotrophic factor level as a modifying factor for trans fat intake and hypertension

Long-term consumption of trans-fat has been linked with its incorporation in brain neural membrane that could lead into alteration of signalling pathways, including Brain Derived Neurotrophic Factor (BDNF). As an ubiquitous neurotrophin, BDNF is believed to play a role in the regulation of blood pressure yet prior studies shown conflicting results to its effect. Moreover, direct effect of trans fat intake to hypertension has not yet been elucidated. This study aimed to investigate the role of BDNF and its association between trans-fat intake and hypertension. We conducted a population study in Natuna Regency which once reportedly has the highest prevalence of hypertension from Indonesian National Health Survey. Subjects with hypertension and those without hypertension were recruited for the study. Demographic data, physical examination, and food recall were collected. The level of BDNF from all subjects were obtained through analysis of blood samples. A total of 181 participants were included in this study, comprising 134 (74%) hypertensive subjects and 47 (26%) normotensive subjects. Median of daily trans-fat intake of hypertensive subjects was higher compared to normotensive subjects (0,013 [0,0003-0,07] vs 0,010 [0,0006-0,06] % of total energy/day, p=0,021). Interaction analysis showed significant results for plasma BDNF level in relationship of trans-fat intake and hypertension (p=0,011). Trans-fat intake association to hypertension in overall subjects showed odds ratio (OR) of 1,85 95%CI 1,05-3,26 (p=0,034), while in those with low-middle tercile BDNF level the OR was 3,35 95%CI 1,46-7,68 (p=0,004). Plasma BDNF level has a modifying effect in the association between trans-fat intake and hypertension. Subjects with high trans-fat intake, while having low BDNF level, have the highest probability for hypertension.

Blood pressure response to dynamic resistance exercise with different times under blood flow restriction on normotensive subjects: a randomized crossover trial

Introduction: Recommendations for time under blood flow restriction (BFR) during resistance training (RT) vary between 5 to 10 minutes, and beneficial effects on muscle mass and strength have already been reported. However, there exists the potential for longer times under restriction to produce greater acute activation of the exercise pressor reflex and subsequent sympathetic pathways leading to a greater hemodynamic response. Objective: To verify blood pressure responses to dynamic resistance exercise with different times (5 vs. 10 minutes) under blood flow restriction in normotensive subjects. Methods: In a randomized crossover trial design, twelve healthy and physically active male participants completed a training with BFR under the following protocols: control, BFR-5 minutes, BFR-10 minutes. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) measurements were taken by an experienced researcher immediately after each exercise set. Results: Both BFR-5 minutes and BFR-10 minutes induced acute elevations in SBP, DBP and heart rate (HR) as the sets progressed, without statistical differences between them. However, BFR-10 displayed a superior effect size for SBP and DBP compared to BFR-5 minutes. Conclusion: Based on the present study results, the time under BFR during resistance exercise does not affect blood pressure response in normotensive subjects.

Urine sodium excretion is related to extracellular water volume but not to blood pressure in 510 normotensive and never-treated hypertensive subjects

Purpose High sodium intake is an accepted risk factor for hypertension, while low Na+ intake has also been associated with increased risk of cardiovascular events. In this cross-sectional study, we examined the association of 24-h urinary Na+ excretion with haemodynamics and volume status. Materials and methods Haemodynamics were recorded in 510 normotensive and never-treated hypertensive subjects using whole-body impedance cardiography and tonometric radial artery pulse wave analysis. The results were examined in sex-specific tertiles of 24-h Na+ excretion, and comparisons between normotensive and hypertensive participants were also performed. Regression analysis was used to investigate factors associated with volume status. The findings were additionally compared to 28 patients with primary aldosteronism. Results The mean values of 24-h urinary Na+ excretion in tertiles of the 510 participants were 94, 148 and 218 mmol, respectively. Average tertile age (43.4–44.7 years), office blood pressure and pulse wave velocity were corresponding in the tertiles. Plasma electrolytes, lipids, vitamin D metabolites, parathyroid hormone, renin activity, aldosterone, creatinine and insulin sensitivity did not differ in the tertiles. In supine laboratory recordings, there were no differences in aortic systolic and diastolic blood pressure, heart rate, cardiac output and systemic vascular resistance. Extracellular water volume was higher in the highest versus lowest tertile of Na+ excretion. In regression analysis, body surface area and 24-h Na+ excretion were independent explanatory variables for extracellular water volume. No differences in urine Na+ excretion and extracellular water volume were found between normotensive and hypertensive participants. When compared with the 510 participants, patients with primary aldosteronism had 6.0% excess in extracellular water (p = .003), and 24-h Na+ excretion was not related with extracellular water volume. Conclusion In the absence of mineralocorticoid excess, Na+ intake, as evaluated from 24-h Na+ excretion, predominantly influences extracellular water volume without a clear effect on blood pressure.

Hypertension in a cohort of obese Caucasian children and adolescents and its association with glycometabolic indices: A proposed screening tool

Background and aimHypertension (HTN) is common among obese children and adolescents and increases their cardiovascular risk later in adulthood. The aim of the study was to evaluate the prevalence of HTN identified by office blood pressure (BP) measurement and ambulatory BP monitoring (ABPM) in a cohort of obese children and adolescents and its association with anthropometric and glycometabolic indices. Methods and resultsSeventy consecutive obese Caucasian children and adolescents aged 7–16 years were enrolled. Patients underwent ABPM, echocardiogram and carotid ultrasonography. Sex- and age-adjusted logistic multivariable analysis models were used to assess the association between HOMA-IR, HOMA-β, QUICKI with HTN at ABPM. Receiver Operation Curve (ROC) analysis with Youden J statistics was used to identify the optimal HOMA-IR, HOMA-β and QUICKI cut-off to predict HTN at ABPM. Hypertensive office BP was found in 25.7% of obese patients. ABPM diagnosed HTN in 34.9% of patients: 20.6% of obese patients had masked HTN (MHTN), and 12.7% had white coat HTN (WCH). Hypertensive obese patients (according to ABPM) had higher HOMA-IR and HOMA-β, and a lower QUICKI than normotensive subjects. HOMA-IR, HOMA-β and QUICKI predicted HTN at ABPM in obese patients in age- and sex-adjusted logistic multivariable models. Optimal cut-offs to predict HTN at ABPM in obese patients were: HOMA-IR ≥ 3.30, HOMA-β ≥ 226.7 and QUICKI <0.33, with high sensitivity. ConclusionsA sequential testing strategy applying office BP and glycometabolic indices can identify hypertensive obese pediatric patients with high diagnostic accuracy and potentially reducing costs. This strategy needs validation in an external and larger cohort.

Prevalence and prognostic implications of hypertensive response to exercise in patients with hypertrophic cardiomyopathy

ObjectiveHypertensive response to exercise (HRE) is observed in patients with hypertrophic cardiomyopathy (HCM) with normal resting blood pressure (BP). However, the prevalence or prognostic implications of HRE in HCM remain unclear. MethodsIn this study, normotensive HCM subjects were enrolled. HRE was defined as systolic BP > 210 mmHg in men or >190 mmHg in women, or diastolic BP > 90 mmHg, or an increase in diastolic BP > 10 mmHg during treadmill exercise. All participants were followed for subsequent development of hypertension, atrial fibrillation (AF), heart failure (HF), sustained ventricular tachycardia/fibrillation (VT/VF), and all-cause death. Six hundred and eighty HCM patients were screened. Results347 patients had baseline hypertension, and 333 patients were baseline normotensive. 132 (40%) of the 333 patients had HRE. HRE was associated with female sex, lower body mass index and milder left ventricular outflow tract obstruction. Exercise duration and metabolic equivalents were similar between patients with or without HRE, but the HRE group had higher peak heart rate (HR), better chronotropic response and more rapid HR recovery. Conversely, non-HRE patients were more likely to exhibit chronotropic incompetence and hypotensive response to exercise. After a mean follow-up of 3.4 years, patients with and without HRE had similar risks of progression to hypertension, AF, HF, sustained VT/VF or death. ConclusionHRE is common in normotensive HCM patients during exercise. HRE did not carry higher risks of future hypertension or cardiovascular adverse outcomes. Conversely, the absence of HRE was associated with chronotropic incompetence and hypotensive response to exercise.

Association and Risk Factors for Hypertension and Dyslipidemia in Young Adults from Poland.

Hypertension and dyslipidemia are major risk factors for cardiovascular disease. Studies on the association between abnormal levels of lipids and hypertension have yielded inconsistent results. The aim of this study was to examine the prevalence of hypertension and dyslipidemia and its risk factors in young Polish adults. Furthermore, the association between plasma lipid levels and the risk of hypertension was determined. A cross-sectional study was conducted among 115 volunteer participants. Blood pressure was measured using an automated oscillometric sphygmomanometer. Blood lipids were analyzed from a fasting blood sample received by finger prick. Body fat percentage was assessed using a bioelectrical impedance analysis device. Socioeconomic and lifestyle factors (age, date of birth, place of residence, screen time, and tobacco use) were self-reported by the participant. The prevalence of hypertension was higher in men than in women (61.5 vs. 21.3%). The prevalence of elevated TC, TG, high LDL, and low HDL was 22.6%, 7.8%, 38.3%, and 13.9%, respectively. Spending more than 2 h daily in front of a computer was identified as a significant predictor of hypertension and elevated TG levels (p < 0.05). A high number of cigarettes smoked daily was a significant risk factor for hypertension (p = 0.047). Hypertension contributed to a higher risk of abnormal values of TC (OR = 5.89), LDL (OR = 5.38), and TG (OR = 9.75). Participants with hypertension were more likely than normotensive subjects to have elevated levels of TC, LDL, and TG. The prevalence of hypertension was significantly higher in young men than in women. BMI was associated with the prevalence of hypertension and elevated TC levels. Spending more than 2 h per day in front of a computer contributed to the prevalence of hypertension and elevated TG levels. Participants with hypertension smoked a higher number of cigarettes daily compared to those with normotension.

PS-C05-12: OMENTIN-1 PREDICTS MEMBRANE FLUIDITY OF RED BLOOD CELLS AND MICROCIRCULATORY FUNCTION IN HYPERTENSIVE SUBJECTS BY THE NITRIC OXIDE-DEPENDENT MECHANISM

Objective: It has been shown that abnormalities in physical properties of the cell membranes may strongly be linked to hypertension. Recent evidence indicates that omentin-1, an adipokine with anti-inflammatory properties, may actively participate in the pathophysiology of hypertension, atherosclerosis and other cardiovascular diseases. However, few studies have evaluated the association between omentin-1 and membrane function in hypertension. The present study was performed to investigate possible relationships among omentin-1, endothelial function and membrane fluidity (a reciprocal value of membrane microviscosity) of red blood cells (RBCs) in patients with essential hypertension and normotensive subjects. Design and method: We measured the membrane fluidity of RBCs with an electron spin resonance (ESR) and spin labeling method. In each ESR spectrum, we calculated the order parameter (S) for the spin-label agent (5-nitroxide stearate). The greater the value of the order parameter (S) was, the lower the membrane fluidity of RBC was. Results: (1) The order parameter (S) obtained from the ESR spectra of RBC membranes was significantly greater in hypertensive subjects (0.727 ± 0.001, n = 64) than in normotensive subjects (0.719 ± 0.001, n = 49, P &lt; 0.0001), indicating that membrane fluidity of RBCs might be reduced in hypertensive subjects compared with normotensive subjects. (2) Plasma omentin-1 levels were lower in hypertensive subjects than in normotensive subjects (HT 0.486 ± 0.014 ng/mL, n = 64, NT 0.537 ± 0.019 ng/mL, n = 49, P &lt; 0.05). Plamsa omentin-1 significantly correlated with plasma nitric oxide (NO)-metabolite levels (an index of endothelial function) (r = 0.392, n = 113, P &lt; 0.0001). (3) Furthermore, the order parameter (S) of RBCs inversely correlated with both plasma omentin-1 (r = -0.347, n = 113, P &lt; 0.001) and plasma NO-metabolites, suggesting that reduced membrane fluidity of RBCs might be associated with decreased levels of plasma omentin-1 and endothelial dysfunction. (4) Multivariate regression analysis showed that, after adjusting for confounding factors, plasma omentin-1 might be an independent predictor of membrane fluidity of RBCs. Conclusions: The ESR study demonstrated that lower plasma omentin-1 levels might have a close correlation with reduced membrane fluidity of RBCs and impaired hemorheologic behavior in hypertensive subjects by the NO-dependent mechanism. It is strongly suggested that plasma omentin-1 could be a putative biomarker for the microcirculatory function in hypertension.

PS-C03-8: NOVEL STUDY TO SEE ARTERIAL STIFFNESS CHANGES WITH POSTURE IN HYPERTENSIVE SUBJECTS IN ASIAN POPULATION

Aim: To see the effect of postural variation on parameters of arterial stiffness, in Asian population especially in Singapore. Methods: Postural variations and their effects on measures of arterial stiffness were analysed in 2 groups of patients consisting of hypertensive subjects (57 patients) and normotensive subjects (54 patients). Operator index (OI), central pressures such as aortic systolic pressure (ASP), aortic pulse pressure (APP), Aortic Pulse Augmentation (APA), Augmentation Index (AI) and brachial blood pressures (BP) such as brachial systolic pressure (SP) and brachial diastolic pressure (DP) were measured in supine and sitting positions. Differences between BP characteristics in supine and sitting were compared using non parametric paired test of Wilcoxon Signed-rank test. A p-value of p &lt; 0.05 was accepted as statistically significant Results: A statistically significant increase in APP (45(35–54) vs 42(31–48) = 0.0058 and a significant decrease in DP (75(69–83) vs 78(69–87), p = 0.023) was seen in the supine position as compared to in the sitting position. A similar trend of significant increase in APP and decrease in DP (33(28.3–36) vs 30(23.3–33.8), p = 0.00158 and 62(55–67) vs 65(59–71), p = 0.0006 respectively was seen in normotensive subjects. Conclusion: Postural changes has an effect on arterial stiffness. Normotensive subjects and hypertensive patients on treatment behave similarly on postural changes. On the other hand, hypertensive subjects who are not on medications, behave differently with posture. Central aortic pulse pressure is a sensitive marker for postural variation response of arterial stiffness.

PS-BPP02-3: FACTORS FOR NEW-ONSET ISOLATED DIASTOLIC HYPERTENSION AND PROGRESSION TO SYSTOLIC HYPERTENSION IN JAPAN

Objective: Factors for New-Onset of isolated diastolic hypertension (IDH: systolic blood pressure ≧ 140 mmHg and diastolic blood pressure ≧ 90 mmHg) have been identified as increasing body mass index (BMI), young age at baseline, male, and BMI by analysis of the Framingham Study in middle-class Caucasians. However, in Japanese, there are few reports of predictors of IDH or the progression from IDH to systolic and diastolic hypertension (SDH: systolic blood pressure ≧ 140 mmHg and diastolic blood pressure ≧ 90 mmHg). Method: The present study analyzed 42,591 subjects aged 35 to 65 years who underwent a health checkup between 2007 and 2013 and re-examined 5 years later. A logistic regression analysis was performed for three patterns of blood pressure change (normal to IDH, normal to SDH, and IDH to SDH) after 5 years from the time of the first health checkup. Systolic and diastolic blood pressure, age, gender, smoking habit, exercise habit, fasting blood glucose level, total cholesterol level, heart rate, and BMI were used as factors for adjustment. Results: At the time of the first checkup, 29,965 subjects were normotensive, 1,169 had IDH, and 11,457 had SDH. Of the 29,965 normotensive subjects, 566 developed IDH after 5 years. Multivariate logistic regression analysis adjusted for blood pressure showed a 1-unit increase in age (OR 0.96, CI[0.95–0.97], p &lt; 0.0001), men (OR 1.44, CI[1.14–1.82], p = 0.002), BMI (OR 1.03, CI[1.00–1.06], p = 0.002), and a 1-unit increase in heart rate (OR 1.02, CI[1.01–1.03], p &lt; 0.0001) were independently significant predictors of developing IDH. Of the 29,965 normotensive subjects, 4,631 developed SDH after 5 years, and all factors except heart rate were independently significant predictors. On the other hand, 612 (52%) of the 1,169 subjects with IDH at the initial visit developed SDH 5 years later. The first checkup systolic blood pressure was significantly (p &lt; 0.0001, 132.3 ± 5.5 mmHg vs. 129.5 ± 6.5 mmHg) higher, but no factors were found to be associated with the development of SDH. Conclusions: In Japanese subjects, IDH predominantly occurs in young, male, obese, and high heart rate individuals. However, the progression from IDH to SDH is difficult to predict, and it is important to prevent obesity from developing IDH.

PS-BPP02-2: BLOOD PRESSURE VARIABILITY PREDICTS THE DEVELOPMENT OF HYPERTENSION IN NORMOTENSIVE INDIVIDUALS

Objective: Hypertension is one of the important risk factors for atherosclerosis leading to cardiovascular diseases. Although several factors have been reported as predictors of new onset of hypertension, the association of blood pressure (BP) variability in normotensive subjects with future development of hypertension is not intensively discussed. We tested the hypothesis that the yearly variability of BP in normotensive subjects predicts new onset of hypertension. Design and Methods: Subjects who participated in our annual physical check-up program for 5 years in a row during 2008 and 2013 were screened (screening period) and those under antihypertensive medication or with the average BP for the 5 visits ≧ 140/90 mmHg were excluded. The rest of 2006 participants (male = 1287) were eligible in the present study. Standard deviation (SD) and coefficient of variation (CV) of their systolic BP (SBP) during the 5 consecutive visits were calculated (screening period) and, then, they were followed up for the next 5 years (follow-up period). The onset of hypertension was defined as average BP during the follow-up period ≧ 140/90 mmHg or the use of antihypertensive medications. Results: The average, SD, and CV of SBP were 118.7 ± 10.0 mmHg, 7.44 ± 2.98 mmHg, and 6.30 ± 2.54%, respectively. During the follow-up, hypertension developed in 259 subjects, with the incidence being more frequent in male (n = 180, 14.0%) than female subjects (n = 79, 11.0%). In retrospective analysis, the average (128.7 ± 7.7 vs. 117.2 ± 9.5 mmHg, p &lt; 0.001) and SD (8.05 ± 3.48 vs. 7.34 ± 2.89 mmHg, p &lt; 0.001) were higher in subjects with than without future hypertension, whereas CV was not different in the both groups (6.28 ± 2.73 vs. 6.30 ± 2.51%). Non-adjusted odds ratio (OR) (95% confidence interval [CI]) of average, SD and CV for the incident hypertension were 1.169 (1.146–1.193), 1.078 (1.034–1.124) and 0.997 (0.947–1.050), respectively. Multivariate logistic regression analysis adjusted for age, gender, family history of hypertension, frequent alcohol consumption (six or seven times per week), current smoking, body mass index, heart rate, serum creatinine, fasting plasma glucose, LDL-cholesterol, and triglyceride at baseline demonstrated that average (OR [95%CI] = 1.193 [1.138–1.187]) and SD (1.058 [1.014–1.105]), but not CV (0.992 [0.941–1.046]), were associated with new onset hypertension. Similar results were obtained using diastolic BP (data not shown). Conclusions: In normotensive subjects, an increase in year-to-year variability as well as average of SBP may be a predictor of the new onset of hypertension. Careful interpretation of year-to-year BP variability is necessary for evaluation of future cardiovascular risk in normotensive individuals.

Some Haematological Parameters in Primary Hypertensive Subjects Attending a Tertiary Hospital in Nigeria

Background: Hypertension is a persistent elevation of blood pressure in the arteries which if not properly managed can lead to stroke, heart failure, atrial fibrillation, peripheral vascular disease and other life threatening outcomes. This study investigated some haematological parameters of Primary hypertensive subjects. Objectives: To compare some haematological parameters (haematocrit, haemoglobin concentration, Platelets count, White Blood Cells count, red blood cell count and Red Cells Indices between hypertensive and normotensive subjects. Materials and methods: Blood samples were collected from 76 known hypertensive subjects between 30 - 70 years attending the Cardiology clinic of the University of Abuja Teaching Hospital Gwagwalada. Another 37 normotensive subjects between 30 - 65 years served as the control. All subjects gave their consents. Platelets count, Haemoglobin estimation, Packed Cell Volume, Red Blood Cell Count, Mean Cell Volume, Mean Cell Haemoglobin, Mean Cell Haemoglobin Concentration and White Blood Cell count were determined using Mythic 22 five parts haematology analyzer. Results: Results for Hypertensive and Control subjects were, White Blood Cell, 5.76 ± 1.45 × 109/l and 4.76 ± 1.03 × 109/l, Platelet count, 248.7552.45 × 109/l and 284.95 ± 27.66 × 109/l, Mean Cell Volume, 91.81 ± 3.05 fl and 85.68 ± 6.48 fl, Mean Cell Haemoglobin, 30.59 ± 1.04 pg and 27.922 ± 2.74 pg, Mean Cell Haemoglobin Concentration, 33.34 ± 0.61 g/dl and 32.32 ± 0.93 g/dl, Red Blood Cell, 4.33 ± 0.39 × 109/l and 4.50 ± 0.52 × 109/l, Packed Cell Volume, 39% ± 3.15% and 40% ± 4.41% and Haemoglobin, 13.21 ± 1.10 g/dl and 13.50 ± 1.63 g/dl respectively. Mean Cell Volume, Mean Cell Haemoglobin, Mean Cell Haemoglobin Concentration (Red cells indices) were significantly higher in hypertensive compared to normotensive subjects (P 0.05), total White Blood Cell count was also higher in hypertensive than normotensive but not statistically significant (P > 0.05). However, Platelet counts, Red Blood Cell, Packed Cell Volume and Haemoglobin were significantly lower in hypertensive compared to normotensive (P 0.05). All the parameters were within established reference ranges for the age and sex of the subjects. Our findings show that hypertension may lead to haematological derangement, if not properly managed. Conclusively, haematological parameters can be used to monitor the prognosis of the disease and manage hypertensive related complications. It is important to assess haematological parameters for hypertensive individuals which may help to prevent complications associated with haematological disorders.