Obese Hypertensive Patients Research Articles

Comparative study of outcomes between Laparoscopic single anastomosis sleeve ileum bypass (SASI bypass) Versus Laparoscopic Sleeve Gastrectomy for Management of Type II Diabetes and Hypertension in Obese Patients

Comparative study of outcomes between Laparoscopic single anastomosis sleeve ileum bypass (SASI bypass) Versus Laparoscopic Sleeve Gastrectomy for Management of Type II Diabetes and Hypertension in Obese Patients

Real-world data regarding blood pressure control rates in hypertensive obese patients: a prospective, observational multicentric study performed in Romania

Real-world data regarding blood pressure control rates in hypertensive obese patients: a prospective, observational multicentric study performed in Romania

EPLERENONE VS IRBESARTAN AS FIRST LINE THERAPY IN OBESE HYPERTENSIVE PATIENTS: PRELIMINARY RESULTS OF HEBRO TRIAL IN ECHOCARDIOGRAPHIC DIASTOLIC FUNCTION INDEXES

Objective: Obesity is significantly associated with hypertension and cardiovascular outcomes. However, little is known about the impact of aldosterone blockade using eplerenone on hypertensive obese patients as first line therapy. The aim of this study is to compare the efficacy between eplerenone-based strategy and irbesartan-based strategy in obese hypertensive individuals, regarding blood pressure reduction and change of echocardiographic diastolic function parameters. Design and method: HEBRO (antiHypertensive treatment with Eplerenone vs. irBesartan in hypeRtensive Obese patients) is a prospective, randomized, open-labeled, multicenter trial enrolled 112 obese hypertensive patients aged 30-75 years old, evaluated by office and out-of-office BP measurements. Patients were randomized to either 25 mg eplerenone twice (59) or 150 mg irbesartan (53) once daily. The primary endpoint is the difference in ambulatory BP measurements after 6 months follow-up period and secondary endpoint is difference in diastolic function parameters. Results: We enrolled 112 patients, 54.6 years old, 53% female, mean BMI 34.4 kg/m2 and mean eGFR 82.5 ml/min/1.73m2. Diastolic function was assessed at baseline and 6 months, by calculating left ventricular mass index (LVMI) and left atrial volume index (LAVI). At baseline, mean LVMI was 102.9 g/m2 ± 18.1 in the irbesartan group vs. 110.1 g/m2 ± 30.5 in the eplerenone group, p=0.237. The change of LVMI was – 5.6 ± 17.8 vs. -4.5 ± 22.6, p=0.843. At baseline, mean LAVI was 30.6 ml/m2 ± 16.9 in the irbesartan group vs. 30.7 ml/m2 ± 11.1 in the eplerenone group, p=0.979. The change of LAVI in the two study arms was +0.9 ± 6.7 vs. -3.6 ± 11.5, p=0.063, respectively. Although, the result was not statistically significant, there was a numerical trend towards the eplerenone arm. Conclusions: There were no statistically significant differences at baseline and follow-up evaluation of changes in left ventricular and left atrial geometry, though there is a numerical trend towards eplerenone arm, regarding reduction of LAVI after 6 months follow-up period. Patients are currently still enrolled and data on larger pool are anticipated.

SINGLE-PILL COMBINATION ANTIHYPERTENSIVE THERAPY IN HYPERTENSIVE, OBESE PATIENTS: A PROSPECTIVE, EPIDEMIOLOGICAL STUDY IN ROMANIA

Objective: To assess the blood pressure (BP) management in obese, hypertensive patients under treatment with single-pill combination (SPC) antihypertensive therapy. Design and method: Prospective, observational, multicenter study, involving 192 investigators (85 cardiologists and 107 general practitioners) randomly selected from Romanian healthcare system, which included 1299 obese, hypertensive patients (Body Mass Index (BMI) of 30 kg/m2 or higher); 56.22±11years; 53.89% females) (1-month recruitment). The total study duration was 5 months (May-Aug 2023), while the patient observational period was 12 weeks (including 3 visits: baseline, at one month and at three months after inclusion). At enrolment visit each patient received a SPC antihypertensive therapy as per investigator’s decision, based on his/her own best medical judgement and in line with the current practice guidelines. Demographic data, comorbidities and data regarding hypertension and evolution of BP values in relation to the antihypertensive treatments were collected. Results: The study population had the following characteristics: BMI 34.35±4.21 kg/m2; 20.94% smokers, 56.81% with CV family history, and 52.12% had comorbidities. Among the patients with comorbidities the most frequently identified were diabetes mellitus type 2 (37.37%), valvular heart disease (20.97%), angina (19.35%) and heart failure (16.24%). At study inclusion the investigators’ perception regarding the cardiovascular (CV) risk was that only 27.02% of patients are in “very high” risk category, while according to SCORE2 and SCORE2-OP the actual calculated CV “very high” risk, was identified in 68.82% of patients. The most frequent recommended double SPC at study inclusion were perindopril/indapamide (81.68%) and olmesartan/amlodipine (5%). Hypertension was treated in all patients and systolic and diastolic BP values (SBP and DBP) and heart rate (HR) decreased significantly throughout the study (p<0.001) (Fig. 1). Analyzing the patients treated with different double SPC a significant decrease in BP and HR values was observed (p<0.001) for the perindopril/indapamide SPC, and olmesartan/amlodipine, respectively (Fig. 2). Conclusions: This study showed that single pill antihypertensive combinations are effective in decreasing BP and HR values in hypertensive obese patients, while correct CV risk estimation by clinicians remains challenging in their daily practice, with the tendency of underestimation.

CORRELATION OF BODY MASS INDEX (BMI) WITH SYSTOLIC AND DIASTOLIC BLOOD PRESSURE IN RURAL INDIAN PATIENTS

Objective: Body mass index (BMI) is positively and independently associated with morbidity and mortality from hypertension, cardiovascular disease, type II diabetes mellitus, and other chronic diseases. In Caucasian and Asian populations, a strong association has been depicted between BMI and mortality. Overweight and obesity increase the risks of high BP, coronary heart disease, ischemic stroke, type II diabetes mellitus, and certain cancers. Worldwide, about 58% of diabetes mellitus and 21% of ischemic heart disease are attributable to BMI above 21 kg/m2. The combination of blood pressure and Body Mass Index (BMI) contribute more than 60% cases of cardiovascular disease. The main objective was to determine the correlation between BMI and blood pressure of rural Indian patients. Design and method: This cross sectional study used 310 patients who visited our hospital in rural India from January 15,2021 to February 15,2021. Data were collected directly by measuring the blood pressure, weight and height to determine BMI. BMI was derived from booking weight (kilograms) and height (meters). Using this, the patients were categorized as underweight (<18.5 kg/m2), normal or lean BMI (18.5–22.9 kg/m2), overweight (23.0 –24.9 kg/m2) and obese (> 25 kg/m2) based on the revised consensus guidelines for India. Descriptive analysis and Spearman correlation test were used to analyze the data. Results: The results of the bivariate analysis using Spearman correlation test showed that there was significant relationship between BMI and systolic blood pressure (p < 0.001, r = 0.375) or diastolic blood pressure (p <0.001, r = 0.432). This study shows that higher BMI was associated with increase in systolic as well as diastolic blood pressure. Conclusions: This study shows statistically significant relationship between Body Mass Index (BMI) and systolic and diastolic blood pressure in rural Indian patients. Weight gain seems to be an important risk factor for development of hypertension. Weight loss has been recommended for obese hypertensive patients and has been shown to be most effective non pharmacological treatment approach. Physical activity and caloric restriction should be promoted to control the obesity epidemic which will significantly reduce global cardiovascular disease burden.

The association between lymphocyte-to-monocyte ratio and all-cause mortality in obese hypertensive patients with diabetes and without diabetes: results from the cohort study of NHANES 2001-2018.

Obesity, hypertension and diabetes are high prevalent that are often associated with poor outcomes. They have become major global health concern. Little research has been done on the impact of lymphocyte-to-monocyte ratio (LMR) on outcomes in these patients. Thus, we aimed to explore the association between LMR and all-cause mortality in obese hypertensive patients with diabetes and without diabetes. The researchers analyzed data from the National Health and Nutrition Examination Survey (2001-2018), which included 4,706 participants. Kaplan-Meier analysis was employed to compare survival rate between different groups. Multivariate Cox proportional hazards regression models with trend tests and restricted cubic splines (RCS) analysis and were used to investigate the relationship between the LMR and all-cause mortality. Subgroup analysis was performed to assess whether there was an interaction between the variables. The study included a total of 4706 participants with obese hypertension (48.78% male), of whom 960 cases (20.40%) died during follow-up (median follow-up of 90 months). Kaplan-Meier curves suggested a remarkable decrease in all-cause mortality with increasing LMR value in patients with diabetes and non-diabetes (P for log-rank test < 0.001). Moreover, multivariable Cox models demonstrated that the risk of mortality was considerably higher in the lowest quartile of the LMR and no linear trend was observed (P > 0.05). Furthermore, the RCS analysis indicated a non-linear decline in the risk of death as LMR values increased (P for nonlinearity < 0.001). Increased LMR is independently related with reduced all-cause mortality in patients with obese hypertension, regardless of whether they have combined diabetes.

Unraveling the Underlying Factors of Hypertension in Obese Patients: Beyond the Weighty Culprit

Hypertension, a prevalent cardiovascular concern, has conventionally been associated with obesity. However, recent research reveals a nuanced relationship, extending beyond simplistic associations with excess weight. This comprehensive investigation delves into the intricate interplay of metabolic, inflammatory, and endocrine factors contributing to hypertension in obese patients, aiming to redefine our understanding within internal medicine.

Obesity in Hypertensive Patients Is Characterized by a Dawn Phenomenon in Systolic Blood Pressure Values and Variability.

One of the causes of hypertension is excess weight gain, which can also affect the course of this disease. Both the diagnosis and management of hypertension commonly use ambulatory blood pressure monitoring; the results of which correlate more strongly with cardiovascular diseases and cardiovascular death than office blood pressure monitoring. We evaluated blood pressure values and their variability from hour to hour to see if and when they differed between hypertensive patients with and without obesity. The study included 1345 patients who underwent 24 h ambulatory blood pressure monitoring and then were divided into groups according to body mass index and waist circumference. The obtained data were analyzed according to the subjects' wake-up time, and short-term blood pressure variability parameters were calculated as the mean of the absolute values of the differences between consecutive measurements. The systolic blood pressure in obese subjects was significantly higher between 1 and 5 h before waking than in normal-weighted individuals. In turn, the variability in systolic and diastolic blood pressure was higher with increasing body mass index. The difference in systolic blood pressure values and blood pressure variability was most prominent in the last 5 h of sleep in obese patients.

Clinical profile and comparison of renal insufficiency in obese and non-obese hypertensive patients: A cross-sectional comparative study

Renal failure can stem from various conditions, and detecting biomarkers associated with obesity-related disorders is crucial for early identification of the risk of renal failure and timely intervention in obese individuals. Though different studies have depicted a relationship between obesity, metabolic abnormalities and cardiovascular outcomes but there is scarcity of evidence in the Indian population as there are no published data comparing this condition in hypertensive patients with or without excess BMI. Thus, we designed a prospective study to determine the prevalence of renal insufficiency in a tertiary care hospital by correlating various socio demographic and clinical risk factors. A total of 100 subjects were enrolled in the study as per the inclusion and exclusion criteria. We conducted a clinical and biochemical profiling to evaluate renal insufficiency in subjects.: The mean duration of HTN in obese hypertensive patients were 7.50 ± 3.86 years and in non-obese hypertensive patients it was 7.22 ± 4.09 years. The mean systolic blood pressure recorded in obese and non-obese patients was 136.36 ± 12.17 and 138 ± 14.64 mm Hg respectively. Prevalence of renal insufficiency in obese and non-obese patients was found 30% and 20% respectively. We can conclude on the basis of obtained results, hypertension is one of the major risk factors in the development of renal insufficiencies, and the presence of obesity may further increase its prevalence rate of kidney diseases.

Effects of cardiac rehabilitation on obese hypertensive patients: A controlled trial

IntroductionThe relationship between obesity and hypertension is clearly known and cardiac rehabilitation (CR) is shown as an effective treatment method in both obese and hypertensive patients. The aim of this study is to reveal the effect of CR on obese hypertensive patients by comparing them with non-obese hypertensive patients. MethodsEighty eligible, volunteer participants with hypertension (SBP ≥140mmHg and/or DBP ≥90mmHg) were enrolled in this study. The patients were divided into 2 groups according to their BMI values: obese (BMI ≥30kg/m2) hypertensive patients and non-obese (BMI <30kg/m2) hypertensive patients. The CR program, in which aerobic exercise training was the main part, was performed on the patients. At the end of the 10-week CR program, the resting SBP and DBP values were measured. ResultsA total of 74 patients (37 obese and 37 non-obese) completed the study. After CR significant improvements were achieved in all evaluated parameters compared to pre-CR values. When the amounts of changes before and after CR were compared, the decrease in SBP was found to be significantly higher in obese patients compared to non-obese patients (p=.003). Higher BMI was associated with more reduction in SBP (r=0.287, p=0.013). ConclusionsExercise-based CR effectively reduced SBP in obese and non-obese hypertensive patients. However, it was more effective in obese patients compared to non-obese patients.

Association between Morning Surge and Left Ventricular Hypertrophy in Obese Hypertensive Patients.

Weight gain can trigger mechanisms that increase blood pressure. Nevertheless, obesity causes structural changes in the myocardium, including increased ventricular mass, atrial dilatation, and diastolic and systolic dysfunction. Additionally, blood pressure variations, like morning surge (MS) in obese hypertensive patients may have clinical relevance in cardiovascular events. Although morning blood pressure surge is a physiological phenomenon, excess MS can be considered an independent risk factor for cardiovascular events. To evaluate MS values and their association with left ventricular hypertrophy (LVH) and nocturnal dipping (ND) in obese and non-obese hypertensive patients. A cross-sectional study that evaluated BP measurements by ambulatory blood pressure monitoring (ABPM) and the presence of LVH by echocardiography in 203 hypertensive outpatients, divided into two groups: 109 non-obese and 94 obese hypertensives patients. The significance level was set at 0.05 in two-tailed tests. A MS above 20 mmHg by ABPM was detected in 59.2% of patients in the non-obese group and 40.6% in the obese group. LVH was found in 18.1% and 39.3% of patients in the non-obese and obese groups, respectively, p<0.001. In the "obese group", it was observed that a MS>16 mmHg was associated with LVH, [prevalence ratio: 2.80; 95%CI (1.12-6.98), p=0.03]. For the non-obese group, the cut-off point of MS for this association was >22 mmHg. High MS was positively associated with LVH, with a particular behavior in the hypertensive obese group.

Abstract P381: Impact Of The Obesity Paradox On Outcomes Of Hypertensive Emergencies

Introduction: The "obesity paradox" is a surprising occurrence wherein obesity appears to offer a protective benefit, leading to enhanced survival rates for particular patient populations. This research seeks to explore the presence of this paradox in patients who were admitted due to hypertensive emergencies across the United States in the initial year of the COVID-19 pandemic. Methods: We examined data from the 2020 National Inpatient Sample to identify patients who were primarily admitted due to hypertensive emergency. We used ICD-10 codes to distinguish between those with and without obesity. We employed logistic and linear regression analyses and accounted for potential confounders. We deemed the results as statistically significant when the 2-tailed p-value was less than 0.05. Results: During the calendar year of 2020, there were a total of 1,221,535 admissions primarily for hypertensive emergencies, of which 282,285 (23.1%), involved patients concurrently diagnosed with obesity. After adjusting for confounding variables, patients hospitalized for hypertensive emergencies, with obesity, demonstrated a decreased in-hospital mortality risk (aOR 0.67, 95% CI 0.63 - 0.73), as well as reduced usage of vasopressor therapy (aOR 0.69, 95% CI 0.60 - 0.79), mechanical circulatory support (aOR 0.33, 95% CI 0.24 - 0.47), and hemodialysis (aOR 0.55, 95% CI 0.53 - 0.58). However, they showed increased use of mechanical ventilation (aOR 1.57, 95% CI 1.52 - 1.63). Conclusion: In conclusion, obese hypertensive emergency patients showed reduced in-hospital mortality, vasopressor use, mechanical circulatory support, and hemodialysis initiation, but increased mechanical ventilation use compared to non-obese counterparts. More comprehensive studies are required to comprehend the obesity paradox's impact on such patients, helping to unearth underlying factors, and thereby enhancing patient care strategies.

THE ASSOCIATION OF HYPERTENSION AND OBESITY: WHAT IMPACT ON THE LONGITUDINAL SYSTOLIC FUNCTION OF THE LEFT VENTRICLE

Objective: Hypertension and obesity are well known each result in heart failure with preserved ejection fraction. Indeed, there is ample evidence that the accumulation of adipose tissue in obese subjects negatively affects the left atrial and ventricular structure, as well as diastolic and systolic function. Predisposing factors for heart failure with preserved LVEF are advanced age, hypertension, diabetes, dyslipidemia and obesity. The development of the 2D strain has made it possible to make an early diagnosis of ventricular dysfunction in patients with cardiovascular risk factors. Design and method: This work consists of performing in a series of 128 hypertensive patients divided into two subgroups: 58 obese patients and 70 patients with normal BMI. A complete cardiographic echo study was performed in both subgroups, including LVEF by Simpson biplane method, calculation of indexed left ventricular mass and parietal relative thickness, analysis of diastolic function and finally study of longitudinal LV deformation by speckle tracking technique. Results: We note in this work that dyslipidemia and diabetes were significantly more prevalent in the HTA+obesity arm. The average blood pressure figures were slightly higher in the HTA+obesity arm. LVH was clearly predominant in the HTA+obesity arm with a more consequent decrease in the longitudinal contraction index. In obese hypertensive patients, LVH was most often concentric (53.4%). An increase in filling pressures was found in 11 obese hypertensive patients compared to only 4 non-obese hypertensive patients (p = 0.0001), with a good correlation with the decrease in GLS. These results suggest that increased BMI is closely associated with atrioventricular interaction in patients with hypertension, with a perfect correlation with impairment of longitudinal systolic function and diastolic function compared to the control group. Conclusions: Although the pathophysiological mechanism behind obesity is disputed, several possible explanations have been proposed: obesity has been considered a state of chronic volume overload, increased blood volume, neurohormonal activation, thus increasing oxidative stress. Therefore, obesity is associated with mild ventricular dilation (eccentric remodeling). However, this finding is in contrast to other studies that associate obesity with a concentric rather than eccentric remodeling of the LV.

EPLERENONE VS IRBESARTAN AS FIRST LINE THERAPY IN OBESE HYPERTENSIVE PATIENTS: BASELINE CHARACTERISTICS FROM HEBRO STUDY

Objective: Obesity is significantly associated with adverse cardiovascular outcomes. The relationship between obesity and hypertension is well described. However, little is known about the impact of aldosterone blockade using eplerenone on hypertensive obese patients as first line therapy. The aim of this study is to compare the efficacy between eplerenone-based strategy and irbesartan-based strategy in obese hypertensive individuals. Design and method: A prospective, randomized, open-labeled, multicenter trial enrolled 80 hypertensive patients aged 30 to 75 years old, with obesity [body mass index BMI &gt;or = 30 kg/m2)], evaluated by home BP, office BP and ambulatory BP measurements. Subjects randomly received 25mg eplerenone twice or 150mg irbesartan once daily. The primary endpoint is the difference in ambulatory BP measurements after 6 months follow-up period and the secondary endpoints are the differences in left ventricular hypertrophy and albuminuria after 6 months follow-up period. Results: At baseline, there were no significant differences between the two study arms regarding gender (men 49,3%, p = 0.732), age (53.9± 10.4 in the eplerenone arm vs. 56.1 ± 10 in the irbesartan arm, p = 0.326), BMI (34.2 ± 3.3 vs. 34.9 ± 3.3, p = 0.376, respectively), renal function (mean eGFR 84.6 ± 16.4 vs. 81.3± 13.1, p = 0.358, respectively) and the presence of diabetes mellitus (9.8% vs 10.5%, p = 0.910, respectively). Moreover, there were no significant differences regarding home BP (142.5/88.5 mmHg ± 8.6/7.3 vs. 141.8/89.4 mmHg ± 8.3/6.7, p = 0.716 and p = 0.558 respectively), office BP (146.3/91.3 mmHg ± 8.2/9.4 vs. 145.1/92.3 mmHg ± 9.1/9.1, p = 0.506 and p = 0.547 respectively) and ambulatory BP (140.9/85.5 mmHg ± 8.4/8.8 vs. 140.1/84.7 mmHg ±7.8/7.5, p = 0.662 and p = 0.667 respectively). Regarding left atrial geometry, evaluated by left atrial volume index (LAVI), there was no significant difference (30.7 mL/m2± 11.1 vs. 30.6 mL/m2 ± 16.9, p = 0.979, respectively). Finally, regarding arterial stiffness evaluated by pulse-wave velocity, there was no significant difference (9.5 m/s ± 1.7 vs. 10.1 m/s ± 2.4, p = 0.435, respectively) Conclusions: In conclusion, the two study arms did not differ in most baseline characteristics, suggesting true homogeneity among comparison arms. Soon, we anticipate the results from the primary endpoint completion.

EVALUATION OF LIPID PROFILE AND LIVER FUNCTION PARAMETERS IN OBESE AND NON-OBESE HYPERTENSIVE INDIVIDUALS ATTENDED TERTIARY CARE TEACHING HOSPITAL

Objective: In this study, lipid profile parameters and liver function parameters were measured and correlated in hypertensive obese and non-obese patients who were attended a tertiary care teaching hospital.&#x0D; Methods: This study is a retrospective observational, cross-sectional study over the course of a year in a tertiary care hospital. All adult patients with hypertension, both obese and non-obese, are included in the study population. The study involved 150 participants in total, including obese and non-obese people (71 men and 79 women). Standard techniques were used to assess the serum levels of TG, TC, LDL, HDL, and liver enzymes such SGOT, SGPT, bilirubin, and ALP. Moreover, BMI was calculated for both study groups. The association between elevated lipid profile markers and liver enzyme abnormalities was assessed by correlation analysis.&#x0D; Results: Out of 150 samples size comprises 75 obese and 75 non-obese individuals, 71 males and 79 females were reported in the current study. Our study gives very good association between lipid profiles to almost all LFT and the highest is shown between HDL, LDL and VLDL to all LFT. There was a high significant difference was noticed between the obese and non-obese individuals in relation to bilirubin (D) concentration, SGOT and SGPT between the two groups P&lt;0.0001. The levels of albumin were lowered and the significant variations were noticed between the two groups. The mean values of cholesterol, LDL and triglycerides were very high in obese individuals than non-obese individuals and the HDL was lower in obese individuals.&#x0D; Conclusion: The study found that liver function variables and abnormal lipid profiles were highly prevalent in obese hypertension patients. In participants with dyslipidemia, increased liver enzymes were seen more frequently.

Effects of Obesity on Blood Pressure Among Adult Malesand Females in Tikrit City - Sep-Dec, 2008

Obesity is an independent risk factor for cardiovascular disease. Clinical studies have shown that body weight reduction decreases blood pressure. The aim of this study was to illustrate the relationship between obesity and blood pressure among adult males and females in Tikrit city. A case series study among the population aged over 25, (400 individuals, 200 males and 200 females) in Tikrit city. Sample was collected from September till December 2008. The blood pressure of subjects was measured in three occasions one month apart via mercurial sphygmomanometer by well trained personnel to those patients attending to Medicine outpatient of Tikrit Teaching Hospital. Mean systolic blood pressure (SBP) was significantly lower in all groups (P&lt;0.005) in non-obese compared with obese patients. This positive relation well indicates the higher the BMI, the more elevated SBP. However, reduction of diastolic blood pressure (DBP) mean was significant only in men and women who were under treatment with antihypeftensive drugs (P&lt;0.05). In all hypertensive groups and in healthy subjects, there was an increase in body mass index (BMI). This increase was more notable in hyper-tensive groups, compared with healthy individuals. The prevalence of obesity in hypertensive patients was higher than that of the healthy group.

Obesity-related kidney disease: Beyond hypertension and insulin-resistance.

Chronic kidney disease (CKD) causes considerable morbidity, mortality, and health expenditures worldwide. Obesity is a significant risk factor for CKD development, partially explained by the high prevalence of diabetes mellitus and hypertension in obese patients. However, adipocytes also possess potent endocrine functions, secreting a myriad of cytokines and adipokines that contribute to insulin resistance and induce a chronic low-grade inflammatory state thereby damaging the kidney. CKD development itself is associated with various metabolic alterations that exacerbate adipose tissue dysfunction and insulin resistance. This adipose-renal axis is a major focus of current research, given the rising incidence of CKD and obesity. Cellular senescence is a biologic hallmark of aging, and age is another significant risk factor for obesity and CKD. An elevated senescent cell burden in adipose tissue predicts renal dysfunction in animal models, and senotherapies may alleviate these phenotypes. In this review, we discuss the direct mechanisms by which adipose tissue contributes to CKD development, emphasizing the potential clinical importance of such pathways in augmenting the care of CKD.

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.

PS-C06-11: IRISIN ASSOCIATION WITH NON DIPPER HYPERTENSION DEVELOPMENT IN OBESE PATIENTS WITH CORONARY ARTERY DISEASE

Objective: Recent investigations showed that irisin, as a possible inflammatory marker, can be closely related to heart function, vessels tone regulation and possible development of arterial hypertension HTN. The purpose of the work was to study the relationship between irisin and the development of non dipper hypertension in obese patients with coronary artery disease CAD. Design and method: 97 obese hypertensive patients with CAD were enrolled into the study. CAD was presented as chronic coronary syndrome CCS according to 2019 ESC Guidelines, essential HTN as systolic blood pressure SBP ≧ 140 mmHg and or diastolic blood pressure DBP ≧ 90mmgHg. Obesity was assessed as body mass index BMI ≧ 30 kg per m2 according to WHO criteria. The mean age of participants was 53.61 ± 4.88 years. Patients were divided into 2 groups. The first one was with dipper HTN, n 46, and the second one with non dipper HTN, n 51. Dippers were established by Holter monitoring. Serum irisin levels were measured by ELISA. Results: It was found that irisin levels were significantly lower in non dipper hypertensive subjects compared with dippers 125.72 ± 15.09 vs 141.53 ± 21.84 ng per mL, p &lt; 0.001. Irisin has a negative correlation with SPR r = 0.29, p &lt; 0.01, and after adjusted for age, sex and BMI it remained a significant link between irisin and SBP, r = 0.21, p = 0.044. In multivariate logistic regression analysis of the irisin odds ratio OR 0.859, 95 per cent Confidence Interval 0.471 to 0.993, p &lt; 0.001 was found to be independent predictors for non dipper hypertension in obese patients with CCS. Conclusions: This study shows that decreased irisin levels are significantly associated with the development of non dipper hypertension in obese patients with coronary artery disease.

PS-C09-9: AMBULATORY BLOOD PRESSURE CHARACTERISTICS IN CHINESE OBESE HYPERTENSIVE PATIENTS: A POPULATION-BASED AMBULATORY BLOOD PRESSURE MONITORING COHORT STUDY

Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recommended for clinical practice, but more knowledge about the characteristics of Chinese obese hypertensive patients ABPM remains to further explore. This study aimed to assess the features in Chinese obese and hypertensive patients from multi-regions ambulatory blood pressure database in China. Methods: In this cohort, 35,367 hypertensive patients who were eligible for this study including 19,380 men (54.8%) and 15,987 women (45.2%) aged from 19 to 99 were recruited. ABPM characteristics were defined according to European guidelines. Overweight was defined as BMI 18.5 kg/m2 or greater, and obesity BMI 25 kg/m2 or greater. Hypertension was defined as elevated mean ambulatory BP (135/85 mmHg greater in day-time, 120/70 mmHg greater in night-time, 130/80 mmHg greater over 24-h). There are four kinds of blood pressure circadian rhythm, dippers, non-dippers, reverse dippers and extreme dippers. Results: Based on the ABPM recordings, 70.5% of participants had 24-h hypertension, 26.1% had dippers rhythm. 2.6% of participants had normal weight, 51.0% were overweight, 38.2% were obesity, and 8.2% were in severe obesity state. Considering blood pressure circadian rhythm, 48% non-dippers rhythm, 23.6% reverse dippers rhythm and 2.3% extreme dippers rhythm. Among participants who were obesity and severe obesity, 48% and 45.1% of patients were non-dippers. Severe obesity patients had higher 24-h blood pressures, especially in independent nocturnal hypertension. The prevalence of reverse dippers rhythm hypertension increased with age and the obesity degree. A positive association between blood pressure level and variability was observed, and within-person and between-person SD and CV were of similar magnitude. Conclusions: In Chinese obese hypertensive population, circadian rhythm blood pressure variation is an underappreciated problem on the population level. Therefore, the ambulatory blood pressure monitoring in obese hypertensive population needs to be expanded.