Obesity Hypertension Research Articles

Трансформуючий фактор росту- β1 в формуванні патологічного ремоделювання серця при артеріальній гіпертензії з цукровим діабетом 2 типу та ожирінням

The purpose of the study was to investigate the role of transforming growth factor-β1 in the formation of pathological remodeling of the left ventricle of the heart in patients with arterial hypertension with and without type 2 diabetes mellitus against the background of abdominal obesity. Materials and methods. 58 patients with arterial hypertension of the II stage, 2-3 degree with abdominal obesity of the I-III degree were involved in the examination, of which 32 had type 2 diabetes. The control group consisted of 14 healthy people. Structural indicators of the heart were studied using an echocardiographic study. Determination of the level of transforming growth factor-β1 in blood serum was carried out by the immunoenzymatic method. Results and discussion. It was established that in the groups of patients with arterial hypertension with type 2 diabetes mellitus and abdominal obesity and arterial hypertension with abdominal obesity, probable differences in transforming growth factor-β1 between types of cardiac remodeling were not detected. Probable differences in the levels of transforming growth factor-β1 in CGLS and EGLS were established only between the groups of the examined and probably differed from the control group, which indicates a significant influence of abdominal obesity on the development of adverse remodeling, both in arterial hypertension with type 2 diabetes mellitus and with arterial hypertension without it. However, the most pronounced changes in transforming growth factor-β1 were observed in subjects with impaired carbohydrate metabolism (type 2 diabetes mellitus), which allows us to consider hyperglycemia as an additional factor in the formation of pathological geometry of the heart. Conclusion. The data obtained as a result of the study may indicate that in the formation of pathological types of cardiac remodeling in patients with arterial hypertension with abdominal obesity, from the point of view of the development of interstitial fibrosis, a significant contribution belongs to the transforming growth factor-β1, which is a key factor in the formation of hypertrophy of the myocardium of the left ventricle. Along with this, additional factors of the formation of cardiac remodeling should be noted in case of violation of carbohydrate metabolism in arterial hypertension with type 2 diabetes mellitus on the background of abdominal obesity. The association of a probable increase in the levels of transforming growth factor-β1 in concentric hypertrophy of the left ventricle and eccentric hypertrophy of the left ventricle and the consequences of hyperglycemia significantly increases the cardiovascular risk, which determines the expediency of earlier therapeutic intervention

The relationship of smoking with gestational diabetes: a large population-based study and a matched comparison

Research questionIs smoking associated with an increased risk for gestational diabetes (GDM)? DesignA retrospective population-based study using data from the United States Healthcare Cost and Utilization Project–Nationwide Inpatient Sample. A dataset of all deliveries that took place between 2004 and 2014 (inclusive) was created. The population was divided into two groups according to smoking status and matched 1:1 for age, obesity, race, insurance type, thyroid disease, drug use and chronic hypertension. Delivery outcomes were compared between the two matched groups and the control group of non-smokers as a whole. A multivariate logistic analysis was performed adjusting for any statistically significant confounding baseline effects not matched for. ResultsThe study identified 9,096,788 births between 2004 and 2014, of which 443,590 (4.9%) were maternal smokers. When compared with the entire group of non-smokers as controls, there was an increased risk of GDM, adjusted odd ratio (aOR) 1.10 (95% confidence interval [CI] 1.07–1.14, P < 0.001). This relationship was of a mild nature and there were many confounding variables that differed between the groups. As such a matched control group was developed to compare the risk of GDM in the smokers and non-smokers. An increased risk for GDM among smokers remained, with an aOR of 1.07 (95% CI 1.05–1.10, P < 0.001). ConclusionsThe current data suggest that smoking is a small but significant risk factor for GDM with an aOR of 1.07.

Abstract 14204: Impact of Concomitant Tobacco Use on Major Adverse Cardiovascular Events in Young Adults Hospitalized With Known Cannabis Use Disorder

Introduction: Cannabis use disorder (CUD) and tobacco use disorder (TUD) are both independent CVD risk factors. However, with the increasing use of recreational cannabis use, the impact of concomitant TUD on major adverse cardiovascular/cerebrovascular events (MACCE) remains unexplored. Hypothesis: Evaluating the impact of concomitant CUD &amp; TUD on MACCE. Methods: We queried 2019's National Inpatient Sample to identify young adults hospitalized with CUD, with vs. without TUD. Baseline demographics, comorbidities, major adverse cardiac events, and the need for revascularization were compared. Multivariable regression analysis was performed, adjusting for confounders to assess the odds of MACCE. Results: Of 539125 patients with CUD, 288260 (53.5%) were TUD+ [median age 31 (25-37)]. TUD+ cohort often had males (60% vs 51.6%), white (58.1% vs 46.8%) patients than TUD- cohort (all p&lt;0.001). The TUD+ cohort showed higher rates of uncomplicated hypertension (15.0% vs 11.6%), alcohol abuse (21.0% vs 12.9%) but lower rates of obesity (9.2% vs. 11.6%), diabetes with chronic complications (4.5% vs. 5.4%), complicated hypertension (3.7% vs 4.4%) and metastatic cancer (0.2% vs. 0.5%) (all p&lt;0.001). After adjusting for covariates, the TUD+ arm had significantly higher odds of acute MI (OR:1.37), Acute PE (OR:1.46), Type 1-DM (OR:1.66), PCI (OR:1.78), CABG (OR:2.62) but lower odds of all-cause mortality (OR:0.55), cardiac arrest including VF (OR:0.59), AF (OR:0.67) and dysrhythmia (OR:0.75) (all p&lt;0.001) [Fig. 1]. The TUD+ cohort incurred lower hospital charges than TUD- cohort (p&lt;0.001). No statistical significance was observed in the odds of stroke and MACCE. Conclusions: Concomitant tobacco &amp; cannabis use had higher odds of Acute MI, PE, PCI and CABG but, interestingly, lower odds of all-cause mortality, dysrhythmia, AF and cardiac arrest including VF. The association between cannabis use and concomitant tobacco use on MACCE needs to be further studied.

Abstract 13174: Cardio-Metabolic Traits of a Heart Failure With Preserved Ejection Fraction Mouse Model

Introduction: Heart failure with preserved ejection fraction (HFpEF, EF&gt;50%) syndrome is often associated with hypertension, hyperlipidemia, obesity, and diabetes. Morbidity and mortality in patients with HFpEF are similar to those with heart failure with reduced ejection fraction, however therapies are scarce. Mouse models used to understand sarcomere dysfunction in HFpEF and to identify new targets are needed. In this study we challenged young mice with volume overload and metabolic perturbations induced by high fat diet (HFD) to harbor the conditions of HFpEF. Methods: C57BL/6N 16-weeks old female and male mice were treated with subcutaneous pellets of controlled released DOCA (Deoxycorticosterone Acetate, 0.71 mg/d), drinking water with 1% saline and HFD for a period of 3 weeks to induce obesity and mild hypertension. Cardiac function was evaluated at baseline (before treatment) and 2 and 3 weeks after treatment. Body weight, % fat mass, %lean mass, glucose tolerance test, and lipid profile were also evaluated at baseline and 3 weeks after treatment. Results (Table): Treatment induced diastolic dysfunction measurable by echocardiography at 3 weeks with slower peak myocardial relaxation velocity (e’), increased peak blood inflow velocity at early diastolic filling E/e’ ratio, increased E/A ratio, and increased isovolumetric relaxation time (IVRT). Meanwhile ejection fraction is preserved. As expected HFD feeding elicited body weight increase with increased fat mass accumulation associated with decreased lean mass, glucose intolerance and hypercholesterolemia. Conclusions: This study describes a mouse model of HFpEF that only requires 3 weeks of treatment with DOCA, 1% saline drinking water and HFD. This model reproduces the most common comorbidities of HFpEF such as diastolic dysfunction, obesity, glucose intolerance, and hypercholesterolemia, and may be used to understand the molecular pathophysiology of HFpEF.

Diabetes mellitus tipo 2 en pueblos indígenas

La diabetes mellitus tipo 2 (DM2) representa un grave problema de salud por las complicaciones que conlleva y por su elevada tasa de mortalidad. En efecto, se considera la más prevalente y se caracteriza por la resistencia a la insulina. El objetivo de la presente revisión bibliográfica fue analizar la evidencia científica que describe los factores asociados a DM2 en población indígena. Se consideraron artículos publicados en bases de datos como: Scopus, Scielo y Pubmed. Así como también información publicada por los Centros para el Control y la Prevención de Enfermedades que monitorean la salud pública. Entre los factores asociados a DM2 en población indígena destacan mayor edad, el sexo femenino obesidad e hipertensión arterial. Se suma a la problemática que en el territorio indígena un alto porcentaje de población es analfabeta y coexisten desigualdades consecuencia de patrones sociales, culturales En efecto considerar los factores de riesgo asociados a la DM2 resulta indispensable para generar estrategias de prevención según el contexto de cada etnia, para reducir la morbimortalidad ocasionada por la diabetes en grupos indígenas.

PMON312 A De Novo Heterozygous Nonsense Variant In The SEC31A Gene Associated With Pituitary Hormone Deficiency And Disorders Of Sex Development.

Abstract Introduction XYdisorders of sex development (DSD) result from variants in many different human genes but frequently have no detectable molecular cause. In approximately 25% of cases of XY DSD, the index case may have associated malformations. Genetic disorders of endoplasmic reticulum (ER) function are increasingly being recognised but have not been associated with DSD or pituitary disorders. Clinical case Three siblings (with unaffected non-consanguineous parents) were reviewed at the tertiary endocrine clinic. Child I was noted at birth to have cliteromegaly. Imaging and examination under anaesthetic revealed a normal vagina and uterus but gonads of indeterminate origin. She was 46,XY and basal endocrine investigations at the age of 4 years showed a low AMH for male but otherwise normal gonadal and thyroid function and normal IGF-1. She had a laparoscopic bilateral gonadectomy aged 5 years. Pathology demonstrated bilateral testicular tissue, with substantial fibrotic atrophic change and occasional placental alkaline phosphatase (PLAP) positive cells, suggestive of germ cell tumours. Aged 8 years she developed obesity and later hypertension. Child II was reviewed due to short stature and diagnosed with GH deficiency aged 2 years. She has normal adrenal and thyroid function and gonadotrophins. MRI demonstrated an ectopic posterior pituitary. Child III presented with perineal hypospadias, a small phallus, bilateral undescended testes and craniofacial abnormalities. Endocrine investigations revealed hypogonadotrophic hypogonadism, with no testosterone response to hCG stimulation, a low normal AMH and no response of LH or FSH on LHRH stimulation. He has panhypopituitarism with an ectopic posterior pituitary gland on MRI and is currently on treatment with GH, hydrocortisone and levothyroxine. His BP is on the 98th centile for age and height. Child I and Child III have mild developmental delay but are in mainstream school with additional educational support. High-throughput DNA sequencing revealed, in all three siblings, a heterozygous truncating variant in the SEC31A gene that encodes a component of the COPII-complex that coats the vesicles mediating ER to Golgi transport. CRISPR-Cas9 targeted knockout of the corresponding Sec31a region resulted in embryonic lethality in homozygous mice. mRNA phenotyping of ER-related genes demonstrated increased mRNA expression of ATF4 and CHOP in the affected children, genes encoding key ER stress-related proteins, associated with defective protein transport. Conclusions Dysregulation ofanterograde and retrograde COPII-coated-vesicle ER-Golgi transport is increasingly recognised to underlie human developmental disorders, including Craniolenticulosutural dysplasia (OMIM 607812) and Saul-Wilson syndrome (OMIM 618150). The de novo SEC31A nonsense variant in all three affected siblings, the ER stress response, plus reported developmental syndromes with dysfunction of this transport mechanism and evidence from the preclinical mouse model suggest that SEC31A might underlie a previously unrecognised clinical syndrome comprising DSD, endocrine abnormalities, dysmorphic features and developmental delay. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

PO09: Treatment of Facial Folliculotropic Mycosis Fungoides with High Dose Rate Brachytherapy in Two Fractions

<h3>Purpose</h3> To describe the treatment and outcomes for the treatment of folliculotropic mycosis fungoides (FMF) with high dose rate (HDR) brachytherapy in the facial area with complex topography. <h3>Materials and Methods</h3> A 68-year-old male with past medical history of morbid obesity status post gastric bypass, diabetes mellitus, hypertension, and atrial fibrillation was diagnosed with FMF of the face, scalp, trunk and extremities. Patient was referred to radiation therapy due to severe burning pain and pruritus of facial lesions on the nose, upper lip, and left temple after no response with UVA therapy. Electron beam therapy was initially chosen with a prescription of 3600 cGy in 20 fractions, but the resulting treatment plans were highly non-conformal with large dose heterogeneity and poor target coverage. HDR brachytherapy was pursued as an alternate treatment option with a prescription dose of 800 cGy in 2 fractions. Patient setup for simulation included a custom Freiburg flap applicator on an Aquaplast mask using 18 catheters to cover all lesions. Patient was scanned with pink bolus in the nostrils, a lead shield under the lip, and a bite block. Treatment planning was performed using Oncentra (Elekta, Stockholm, Sweden). HDR treatment was delivered using an Elekta Flexitron remote afterloader unit. Bilateral internal tungsten eye shields (Civco, Orange City, IA) were placed prior to treatment to reduce ocular dose. <h3>Results</h3> The drawn target was 25.2cc along the upper lip, bilateral nose, right medial canthus, and left temple. Achieved target coverage was V90% = 98.6%, D90% = 100.5%, and D95% = 95.9%. Skin V150% was 0.12cc. Without eye shield placement, right and left eye D0.01cc were 117.9% and 78.2%, respectively. Right and left lens doses were 99.1% and 69.4%, respectively. Average fractional delivery time was 603.5 seconds with an air kerma strength of 39.0 mGy*m²/s (apparent activity 9.7 Ci). Patient tolerated treatment without complications. At two week follow up, patient showed grade 1 dermatitis of the treatment area with erythema and mild desquamation. Patient has been asymptomatic six months post treatment. <h3>Conclusions</h3> Low dose HDR brachytherapy can be an effective treatment for facial FMF lesions with complex topography. It allows for suitable target coverage and normal tissue sparing, a shorter treatment course when compared to electron beam radiotherapy, and is associated with minimal adverse effects and rapid clinical response. It also allows sparing total skin electron therapy for the future in case of disease progression as the volume of tissue receiving radiation is very small. Figure 1a: Oncentra treatment plan in axial, sagittal, and coronal planes, with 3D rendering show in bottom right. Target volume in light blue, right eye in green, and left eye in blue. 1b shows wires outlining the target volume (top); pre-mask setup with pink bolus, bite block, gauze in the nostrils, and bilateral eye shields (middle); and final treatment setup with mask (bottom). 1c shows the pre-treatment lesions, and 1d shows the same area four months post treatment.

A COMPARATIVE STUDY OF THE EFFECT OF BODY MASS INDEX ON SYMPATHOVAGAL ACTIVITIES IN HYPERTENSIVE INDIVIDUALS

The rising rates of obesity and hypertension can be traced to a combination of factors including decreased physical activity, increased psychological stress, and increased work-related stress. Sympathetic overactivity is the primary pathophysiologic process in the development of obesity and hypertension, regardless of origin. Many clinical diseases can be traced back to a sympathovagal imbalance, or disruption of autonomic functioning due to sympathetic excess activity and vagal withdrawal. Autonomic dysfunction has been linked to obesity, hypertension, and diabetes mellitus separately. The measurement of heart rate variability (HRV) has become a popular, non-invasive method for studying cardiac autonomic dysfunction quantitatively. The current research sought to answer the question of whether obesity contributes to the worsening of autonomic dysfunction, especially in hypertensive individuals. Adult males and females in their forties and fifties who were patients at the OPD in UPUMS, Saifai, Etawah, India, were enlisted for the study.HRV was measured using the one-minute method while the subjects were in a relaxed state and deep breathing was encouraged. A total of 105 participants were divided into Groups I (obese hypertensive), II (non-obesity hypertension), and III (non-obese normotensive, control). The mean heart rate variability (HRV) of obese hypertension patients was considerably lower than that of non-obese hypertensive patients (p&lt;0.005 at α 0.05 HRV, data provided as Mean± SD inferential statistics by One Way ANOVA and Tukeys Post Hoc test). Our findings suggest that obesity and hypertension may have an additive effect in inducing autonomic dysfunction.

Endometrioid Carcinoma of the Fallopian Tube Associated with Obesity, Diabetes Mellitus and Arterial Hypertension. A Case Report and Review of the Literature

Endometrioid Carcinoma of the Fallopian Tube Associated with Obesity, Diabetes Mellitus and Arterial Hypertension. A Case Report and Review of the Literature

S899 Sex and Racial Disparities in Cardiovascular Disease Risk and Major Adverse Cardiac and Cerebrovascular Events in NAFLD: A National Inpatient Sample Analysis (2019)

Introduction: Non Alcoholic Fatty Liver Disease (NAFLD) increases the risk of CVD independently of the conventional cardiovascular risk factors. However, related sex and racial disparities in cardiovascular outcomes remain poorly understood on the large scale. This prompted us to attempt an investigation between the association of NAFLD and major cardiovascular and cerebrovascular events [MACCE] using a nationally representative sample in the US. Methods: We curated National Inpatient Sample (2019) for NAFLD hospitalizations stratified by age, sex and race using ICD-10 codes. Baseline characteristics, comorbidities, and MACCE:all-cause mortality, acute myocardial infarction (AMI), cardiac arrest and stroke were compared between groups stratified by sex and race. Multivariate regression analyses were performed adjusting for sociodemographics, hospitalization characteristics and comorbidities. Results: Our study included 409,130 NAFLD hospitalizations [median 55 (IQR 43-66) years. The prevalence of NAFLD was higher in females vs males (1.2%), Hispanic (2%), Native Americans (1.9%) vs white. Median age of females was 55 years (IQR 42-67), were often from lowest income quartile, Medicare enrollees, and had non-elective admissions. Females demonstrated lower rates of hypertension, hyperlipidemia, complicated diabetes but higher rates of obesity and uncomplicated diabetes vs. males. Median age of Hispanics was 48 years (IQR 37-60), majority of them belonged to the lowest income quartile, Medicaid enrollees, and underwent non elective admissions. Hispanics exhibited lower frequency of hypertension, hyperlipidemia but higher rates of diabetes and obesity vs. whites. Geriatric patients had higher risk of MACCE (aOR 3.01), all-cause mortality (aOR 4.13), Acute MI (aOR 2.81), Cardiac arrest (aOR 2.24) and Stroke (aOR 2.58) (p< 0.001). Males had greater risk of MACCE (aOR 1.22), AMI (aOR 1.35) and Cardiac arrest (aOR 1.54) (p< 0.001). By race, Native Americans (aOR 1.64) followed by Asian Pacific Islanders(API) (aOR 1.18) had significantly higher odds of all-cause mortality vs whites (Table). Conclusion: NAFLD is associated with adverse MACCE especially with increasing age and male sex. Native Americans followed by API race was associated with higher odds of all-cause mortality. This study reiterates the interplay between NAFLD and cardiovascular/cerebrovascular diseases and highlights prevailing sex/racial disparities in outcomes warranting tailored care. Table 1. - Multivariable Odds of Major Adverse Cardiac and Cerebrovascular Events in NAFLD patients by Age, Sex, and Race, 2019 Categories MACCE All cause mortality Acute MI Cardiac arrest Stroke 18-44 ref ref ref ref ref 45-64 2.31 (2.06-2.59) 3.00 (2.42-3.72) 2.23 (1.87-2.66) 2.08 (1.55-2.80) 1.90 (1.52 – 2.38) >=65 3.01 (2.61-3.47) 4.13 (3.11-5.48) 2.81 (2.29-3.45) 2.24 (1.52-3.31) 2.58 (1.96-3.39) p< 0.001 p< 0.001 p< 0.001 p< 0.001 p< 0.001 Male vs Female 1.22 (1.14-1.30) 1.04 (0.92-1.18) 1.35 (1.24-1.48) 1.54 (1.26-1.88) 1.04 (0.91-1.19) P-values < 0.001 0.539 < 0.001 < 0.001 0.579 White ref ref ref ref ref Black 1.00 (0.90-1.11) 0.89 (0.72-1.10) 0.95 (0.81-1.11) 1.16 (0.86-1.57) 1.25 (1.03-1.53) Hispanic 0.88 (0.79-0.98) 0.69 (0.56-0.85) 0.93 (0.81-1.08) 0.75 (0.55-1.02) 1.07 (0.87-1.31) API 1.06 (0.86-1.30) 1.18 (0.82 – 1.89) 1.06 (0.81-1.38) 0.77 (0.42-1.43) 0.99 (0.69-1.42) NA 1.14 (0.81-1.61) 1.64 (1.04-2.60) 0.91 (0.53-1.56) 0.74 (0.25-2.15) 0.84 (0.41-1.81) Others 1.11 (0.92 -1.34) 0.91 (0.62-1.33) 1.33 (1.06-1.67) 1.05 (0.62-1.78) 0.99 (0.68-1.45) P-values 0.125 0.001 0.121 0.272 0.377 MACCE - Major Adverse Cardiovascular and Cerebrovascular Events API - Asian Pacific Islanders NA - Native Americans.Multivariate regression models were adjusted for Age, sex, race, household income quartile, payer status, type of admission, hospital bed size, location/teaching status, region, comorbidities including HTN DM HLD obesity, smoking, PVD, PriorMI PriorPCI PriorCABG, drug abuse, prior stroke/TIA, prior VTE.

Abstract 047: PPARg Deacetylation Mitigates Aortic Stiffness And Aortic Perivascular Adipose Tissue (aPVAT) Remodeling In Obese Male Mice

Clinical findings show that stiffening of large arteries can precede hypertension in obesity. The causality between arterial stiffness and blood pressure is complex and the underlying mechanism remains unclear. Thoracic aPVAT, a brown-like adipose tissue (AT), undergoes phenotypic changes in obesity resulting in the loss of its protective vascular effect. Our recent findings demonstrated that peroxisome proliferator-activated receptor gamma (PPARγ) deacetylation, a post-translational modification, enhances endothelium-dependent vasodilation. Based on this evidence and PPARγ’s role in regulating AT, we hypothesize that PPARγ deacetylation alleviates aortic stiffness and aPVAT remodeling in obesity . Male eight-week-old C57Bl/6 mice and genetically engineered deacetylation-mimetic mice with a double lysine to arginine mutation (K268R, K293R; 2KR mice) were randomized into two groups: Control groups of C57Bl/6 (n=8) and 2KR mice (n=5) received a regular chow diet (5% fat, 48.7% carbohydrates [3.2% sucrose]) and WD groups of C57Bl/6 (n=11) and 2KR mice (n=9) received a western diet (40% fat, 43% carbohydrates [34% sucrose]) for 20 weeks. Obesity was confirmed by markedly increased body weight in the C57Bl/6 (40.47 ± 1.71 g vs. 29.89 ± 0.76 g controls, p&lt;0.05) and 2KR mice (34.48 ± 1.68 g vs. 24.76 ± 0.59 g controls, p&lt;0.05) at 16 weeks on WD. Pulse wave velocity data, the gold standard measurement for arterial stiffness, revealed increased aortic stiffness in the 16 weeks (5.70 ± 0.61 m/s vs. 3.82 ± 0.24 m/s controls) and 20 weeks (4.89 ± 0.21 m/s vs. 4.02 ± 0.17 m/s controls) on WD in the C57Bl/6 group. Strikingly, WD 2KR mice did not show aortic stiffness after 16 weeks (4.36 ± 0.37 m/s vs. 4.34 ± 0.54 m/s controls, p=0.75) or 20 weeks (5.00 ± 0.65 m/s vs. 5.84 ± 0.96 m/s controls, p=0.49) of WD. aPVAT from WD C57Bl/6 group exhibited profound phenotypic changes, switching from brown- to white-like AT with larger Oil Red O stained lipid droplets, while aPVAT from WD 2KR showed reduced phenotypic modifications. Whether aPVAT contributes to aortic stiffness in obesity remains poorly understood and warrants further investigation. In conclusion, our results support a protective role of PPARγ deacetylation in obesity-related vascular complications.

Abstract P118: Metabolic And Hemodynamic Disorders In Obese Patients With True And Pseudo-resistant Hypertension

Objective: to conduct a comparative assessment between pseudo-resistant and true resistant hypertension (RH) in obesity. Methods: The study included 302 patients with uncontrolled hypertension and obesity. Initial treatment efficacy was assessed 3 months after dual therapy was administered. Those patients who did not reach target blood pressure (BP) in dual therapy were transferred to triple therapy. Among patients who received triple therapy, 69 people did not reach target BP (they received the fourth drug spironolactone). All patients were additionally examined 6 months after the initiation of antihypertensive therapy. Results: In the absence of a difference in BP levels, patients who subsequently become resistant, already at the stage of inclusion, significantly more often had circadian rhythm (CR) violations with a predominance of the non-dipper CR. Despite the target BP achievement after 6 months, in the majority (91.42%) of non-RH patients, the CR normalized, while in RH a normal CR was only in 60.87%. At the stage of enrolling patients into the study and 3 months after the start of therapy there was no significant difference in BP levels between true and pseudo-RH, then after 6 months of therapy, patients with true RH had significantly higher office SBP levels (p&amp;lt;0.01) and 24 h average SBP according to ABPM data (p&lt;0.05) compared with pseudo-RH. Already at the stage of inclusion in the study, the normal CR in true RH was significantly less common than in pseudo-RH, and during the prescribed therapy, a similar trend persisted: after 6 months of therapy, 71.05% of pseudo-RH had a normal CR, while with true RH - only about half of the patients. Obese patients with true RH had also significantly lower BMI and LDL-cholesterol (p&lt;0.05) as well as higher levels of aldosterone and SBP (p&amp;lt;0.05) compared with pseudo-RH. Conclusions: Even when target BP levels in antihypertensive therapy are achieved, obese patients with RH are characterized by more pronounced CR disturbances and higher levels of office and out-of-office BP, compared with non-RH. Compared with pseudo-RH, the presence of true RH in obesity is associated with higher SBP and aldosteron levels, as well as lower BMI and LDL-cholesterol.

Abstract P256: Higher Angiotensin Converting Enzymes Activities Are Observed In Covid-19 Positive Volunteers.

The high transmissibility and the broad spectrum of clinical manifestations of COVID-19 are in part due to the high affinity of SARS-CoV-2 for its receptor, Angiotensin Converting Enzyme 2 (ACE2). The depletion of the biological functions of ACE2, due to the internalization of the receptor along with SARS-CoV-2, leads to impairment of Renin Angiotensin System (RAS), which can contribute to COVID-19 pathogenesis. In addition, genetic differences in RAS may be associated with more severe symptoms and complications observed in COVID-19 patients. This study aims to perform a comparative analysis between COVID-19 positive patients and uninfected individuals, to correlate such disease profiles with ACE I/D (Insertion/Deletion) and ACE2 G8790A polymorphisms, and their enzymatic activities. The anthropometric, demographic, clinical and cardiovascular parameters of 764 individuals from Ipaussu/SP (Brazil) were evaluated. ACE and ACE2 activities were measured by fluorometric assays, and assessment of both enzymes polymorphisms was performed by PCR. In this cohort, 35,2% (269 of 764) the volunteers were positive for COVID-19. The prevalence of COVID-19 was higher among women (67%) and individuals aged between 18 and 49 years. Also, comorbidities as obesity and arterial hypertension were more frequent in the positive group, when considered individuals under 60 years old. Higher ACE and ACE2 enzymatic activities were observed in positive group (46.4 vs 41.6 and 11.3 vs 8.5, respectively). Individuals with ID genotype in the positive group presented higher ACE activity compared to individuals with same genotype in control group (46.9 vs 41.7). In the positive group, ACE activity was increased in the DD (54.5) when compared to ID (46.9) and II (37.9) genotypes. No significant differences related to ACE2 activity and polymorphism were observed. ACE/ACE2 activity ratio was higher in the COVID-19 negative group (4.7 vs 3.7). The increased ACE activity for the DD genotype was in line with the literature data for hypertension and cardiovascular diseases. We can suggest a synergic effect between ACE DD genotype and COVID-19 infection enhancing ACE activity, what may contribute to pro-inflammatory phenotype and more severe symptoms of COVID-19.

Early coronavirus disease 2019 restrictive measures and changes in maternal characteristics, use of assisted reproductive technology, and stillbirth.

BackgroundThe initial COVID‐19 pandemic response−related effects on conceptions following the use of assisted reproductive technologies (ART), and on changes in the maternal characteristics of women who conceived during the early vs. pre‐pandemic period, have been understudied.ObjectivesTo examine the effects of ART clinic closures in the United States (US) in March 2020 on the frequency of ART‐conceived live births, multiple births and stillbirths; and to describe changes in the characteristics of women who conceived in the early pandemic period.MethodsPopulation‐based cohort study including all births in the US from January 2015 to December 2020 (22,907,688 live births; 134,537 stillbirths). Interrupted time series (ITS) methodology was used to estimate rate ratios (RR) of expected versus observed rates in December 2020 (i.e., among births conceived mainly in March 2020). Demographic and clinical characteristics were compared between mothers who conceived in March 2020 versus March 2015–2019.ResultsOverall, 1.1% of live births and 1.7% of stillbirths were conceived by ART. ART‐conceived live births decreased by 57.0% in December 2020 (observed vs. expected RR 0.43, 95% confidence interval [CI] 0.40, 0.45), and these declines occurred in all subgroups of women. Multiple births also declined in December 2020. Stillbirth rates increased in December 2020 in ART‐conceived births (RR 2.55, 95% CI 1.63, 3.92) but remained unchanged in the non‐ART group. Maternal characteristics of women who conceived in the early pandemic versus pre‐pandemic period differed and included an increased prevalence of pre‐pregnancy obesity class 3 and chronic hypertension.ConclusionsThe early pandemic closure of ART clinics resulted in a substantial decline in ART‐conceived live births and multiple births in December 2020 and an increase in the proportion of stillbirths among ART‐conceived births. Women who conceived in the early pandemic period also had an increased prevalence of obesity and chronic hypertension.

Assessing 48 SNPs in Hypertensive Paediatric Patients and Young Adults with Review of Genetic Background of Essential Hypertension.

Essential hypertension in paediatric patients and young adults is rising, mostly on account of obesity-related hypertension. Clinically, the difference between obese hypertensive and non-obese hypertensive individuals is evident; yet, the pathophysiology of essential and obesity-related hypertension is multifactorial, complex and not fully understood. The aim of our study was to obtain a comprehensive view of the clinical differences between obesity-related hypertension and hypertension in non-obese paediatric patients and young adults and to do genetic tests to possibly highlight some of the pathophysiological differences with a review of their genetic backgrounds. Four hundred and thirty-six hypertensive paediatric patients and young adults were included in the study, and a study of 48 single-nucleotide polymorphisms, using Kompetitive allele specific PCR, was conducted. The subjects were divided into 243 non-obese participants with hypertension and 193 obese participants with hypertension. The data for the clinical comparison of both groups were collected as well. The differences in some clinical and biochemical parameters were confirmed. Genetic tests showed a significant difference in one allele frequency between both groups in five SNPs: rs6232, rs6235, rs12145833, rs59744560 and rs9568856. In rs6235 and rs59744560, a direct effect of different allele states could be implied. Obesity-related hypertension at a young age differs from essential hypertension in those non-obese. The reported genetic differences could be important in understanding the complex pathophysiology of early-onset obesity-related hypertension and should be further evaluated.

Comment on Alghnam et al. The Association between Obesity and Chronic Conditions: Results from a Large Electronic Health Records System in Saudi Arabia. Int. J. Environ. Res. Public Health 2021, 18, 12361.

I have read the interesting and informative paper recently published by Alghnam and colleagues that examined associations between obesity and diabetes (DM) and hypertension (HTN) [...].

Assessing the Impact of Demographic Factors on Presenting Conditions or Complaints Among Internal Medicine Patients in an Underserved Population in Central Florida.

Background and objectivePatients’ demographics (race, age, gender, and ethnicity) have been determined to affect patients’ health status. It has been established that chronic disease prevalence varies by race, age, gender, and ethnicity; however, not much is known about how these demographic factors influence presenting conditions or complaints within a student-run clinic (SRC). This study aimed to investigate how demographic factors in the Apopka community in Florida determine what internal medicine (IM) conditions or complaints patients present with at a student-run free clinic.MethodsElectronic medical record (EMR) data for adult patients seen at the clinic from February 2019 to February 2020 were reviewed to collect information on patient demographics, IM presenting conditions or complaints, and body mass index (BMI). Binary logistic regressions were employed to investigate the relationship between demographic factors and presenting conditions or complaints.ResultsThe majority of the patients were female (62.2%), with an almost equal representation of Hispanic (50.3%) and non-Hispanic individuals. About half of the patients visiting the clinic were either overweight or obese. Of the 167 patients, the average age was 44.17 and 44.32 years for males and females respectively. The most common presenting conditions or complaints included cardiac conditions (25.07%), diabetes (9.64%), gastric pain (9.21%), and upper respiratory infection (URI)/allergies (6.15%). Cardiac conditions were further broken down into hypertension (18.94%), dyslipidemia (3.94%), and palpitations (2.19%). Patient age was a contributing factor to the incidence of diabetes (p=0.002), hypertension (p<0.0001), and cardiovascular conditions excluding hypertension (p=0.021). There was a significant relationship between obesity and diabetes (p=0.036) and hypertension (p=<0.001).ConclusionSRCs can make use of the information obtained from this study to advocate for coverage of medications to treat diabetes and hypertension in this undocumented population to prevent morbidity rates. We believe our findings can also provide guidance in terms of instituting screening programs for these illnesses among the broader population and SRCs with different patient makeups.

Nutrition and the state of the intestinal microflora in the formation of the metabolic syndrome

The literature review presents the results of modern studies of the relationship between diet and intestinal microbiota in the regulation of metabolic disorders. Metabolic syndrome, which is a symptom complex that combines abdominal obesity, insulin resistance, hyperglycemia, dyslipidemia and arterial hypertension, remains an important problem, being a risk factor for cardiovascular, neurodegenerative, oncological diseases and the development of type 2 diabetes mellitus. Although the pathogenesis of the metabolic syndrome has not yet been fully elucidated, it is known that visceral obesity and its associated complications, such as dyslipidemia and increased levels of pro-inflammatory cytokines, play a central role. The article presents data on the impact of the consumption of certain food products, the inclusion of plant biologically active substances (flavonoids, polyphenols, etc.) in the diet, as well as the use of elimination diets with the exclusion of carbohydrates or fats from the diet, on reducing the risk of cardiovascular accidents, levels of fasting glucose, total cholesterol, LDL, triglycerides, C-reactive protein, leptin, insulin, reduction in body weight and waist circumference, reduction in the level of circulating endotoxins and changes in the activity of immunocompetent cells. Data are presented on the possible influence of the intestinal microbiota in maintaining inflammation and the formation of degenerative changes in the body. The role of changes in the ratio of the levels of pathogenic microflora, bifidobacteria and lactobacilli in the formation of a pathological condition is shown.

Absence of Association of Tinnitus With Pre-existing Hypertension: A Population-based Study.

Whether tinnitus is associated with pre-existing hypertension remains uncertain. This study explored the association between tinnitus and pre-existing hypertension. We obtained data on a retrospective cohort of 542 884 cases ≥18 years old with a first-time tinnitus diagnosis from Taiwan's National Health Insurance Research Database. We used propensity-score matching to select 542 884 matched controls and performed multiple logistic regression analyses to estimate the adjusted odds of prior hypertension among patients with tinnitus versus controls. Bivariate analysis showed no significant difference in the prevalence of prior hypertension between the tinnitus and no-tinnitus groups (35.58% vs 35.5%, P = .617). Univariable logistic regression analysis confirmed the bivariate analysis finding, unadjusted odds of prior hypertension among the tinnitus group relative to controls, 1.002, 95% CI: 0.994-1.010, P = .617). After adjusting for age, sex, monthly income, geographic location and urbanization level, hyperlipidemia, diabetes, hearing loss, obesity, anemia, rheumatoid arthritis, alcohol abuse, nicotine dependence, anxiety disorder, depressive disorder and idiopathic intracranial hypertension, the odds of prior hypertension were similar among the tinnitus and no-tinnitus groups (OR = 1.006, 95% CI: 0.997-1.016, P = .178). Our population-based study found no evidence for an association between tinnitus and pre-existing hypertension.

Tetrahydroxystilbene glycoside attenuates endothelial dysfunction and obesity-associated hypertension in obese rats: The role of omentin-1

Background and Aims : Hypertension in obesity has become a major threat for public health. Omentin-1, a novel adipokine, is down-regulated in obesity. Tetrahydroxystilbene glycoside (TSG) is the main ingredient extracted from Polygonum multiflorum Thunb (PMT), a traditional Chinese medicinal herb safely used for protecting cardiovascular systems over bimillennium. This study aims to examine (i) the impact of omentin-1 downregulation on obesity-related hypertension in murine models and the underlying mechanisms; (ii) whether tetrahydroxystilbene glycoside (TSG) improved endothelial dysfunction and obesity-associated hypertension via the increase of omentin-1.