Optimal Blood Pressure Research Articles

Evaluation of Intensive vs Standard Blood Pressure Reduction and Association With Cognitive Decline and Dementia

Optimal blood pressure (BP) targets for the prevention of cognitive impairment remain uncertain. To explore the association of intensive (ie, lower than usual) BP reduction vs standard BP management with the incidence of cognitive decline and dementia in adults with hypertension. A systematic review and meta-analysis of randomized clinical trials that evaluated the association of intensive systolic BP lowering on cognitive outcomes by searching MEDLINE, Embase, CENTRAL, Web of Science, CINAHL, PsycINFO, the International Clinical Trials Registry Platform, and ClinicalTrials.gov from database inception to October 27, 2020. Data screening and extraction were performed independently by 2 reviewers based on Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The risk of bias was assessed using the Cochrane risk of bias 2 tool. Random-effects models with the inverse variance method were used for pooled analyses. The presence of potential heterogeneity was evaluated with the I2 index. The primary outcome was cognitive decline. Secondary outcomes included the incidence of dementia, mild cognitive impairment (MCI), cerebrovascular events, serious adverse events, and all-cause mortality. From 7755 citations, we identified 16 publications from 5 trials with 17 396 participants (mean age, 65.7 years [range, 63.0-80.5 years]; 10 562 [60.5%] men) and 2 additional ongoing trials. All 5 concluded trials included in quantitative analyses were considered at unclear to high risk of bias. The mean follow-up duration was 3.3 years (range, 2.0 to 4.7 years). Intensive BP reduction was not significantly associated with global cognitive performance (standardized mean difference, 0.01; 95% CI, -0.04 to 0.06; I2 = 0%; 4 trials; 5246 patients), incidence of dementia (risk ratio [RR], 1.09; 95% CI, 0.32 to 3.67; I2 = 27%; 2 trials; 9444 patients) or incidence of MCI (RR, 0.91; 95% CI, 0.73 to 1.14; I2 = 74%; 2 trials; 10 774 patients) when compared with standard treatment. However, a reduction of cerebrovascular events in the intensive group was found (RR, 0.79; 95% CI, 0.67 to 0.93; I2 = 0%; 5 trials; 17 396 patients) without an increased risk of serious adverse events or mortality. In this study, there was no significant association between BP reduction and lower risk of cognitive decline, dementia, or MCI. The certainty of this evidence was rated low because of the limited sample size, the risk of bias of included trials, and the observed statistical heterogeneity. Therefore, current available evidence does not justify the use of lower BP targets for the prevention of cognitive decline and dementia.

The effects of blood pressure on post stroke cognitive impairment: BP and PSCI.

Cognitive function following acute ischemic stroke (AIS) is critical to prognosis and quality of life. Hypertension is a risk factor for stroke and is associated with post stroke cognitive impairment (PSCI). However, the optimal blood pressure parameters after AIS is unknown. This is a sub‐study of the Impairment of CognitiON and Sleep after acute ischemic stroke or transient ischemic attack in Chinese patients (ICONS) study conducted between August 2015 and March 2018. Cognition was assessed at two‐week (2w), three‐month (3 m), and twelve‐month (12 m) by Montreal Cognitive Assessment (MoCA). A total of 682 participants who met the inclusion criteria were enrolled. The primary outcome was cognitive changes after 3 and 12 months post stroke. Among 682 participants, the mean age was 59.35 ± 10.40 years and 72.29% were men. PSCI patients with high systolic blood pressure (SBP ≥140 mm Hg) at 3 m not only had worse cognition as evidenced by MoCA scores at 3 m but also predicted worse scores at 12 m. When participants were stratified into cognitively stable/improved (MoCA score ≥0, 2w vs. 12 m) and cognitively impaired (MoCA score ≤‐2, 2w vs. 12 m), those with high SBP were more likely to be cognitively impaired (OR 2.17, 95%CI 1.12–4.21, p < .05) and less likely to be cognitively stable/improved (OR 0.66, 95%CI 0.44–0.99, p < .05). SBP more than 140 mm Hg is associated with worse cognitive performance after ischemic stroke. Patients with SBP lower than 140 mm Hg have better cognitive outcome at 3‐month and 1 year after stroke.

Abstract 13849: Association of Optimal Blood Pressure and Risk of Atrial Fibrillation in Aged Type 2 Diabetes Mellitus Patients: From the JPAD Cohort Study

Introduction: Even, both type 2 diabetes (T2DM) and hypertension are important risk factors for nonvalvular atrial fibrillation (NVAF), the efficacy of strict blood pressure control for prevention of NVAF have not been established. Hypothesis: We assessed the hypothesis that optimal blood pressure is associated with lower risk of NVAF among T2DM patients in long term cohort of aged Japanese T2DM patients, JPAD cohort study. Methods: The JPAD cohort study was a follow-up cohort study of the JPAD trial, which was a randomized, standard-care controlled trial examining whether low-dose aspirin prevented cardiovascular disease (CVD) events in 2535 Japanese patients with T2DM from 2002. After that trial ended in 2008, we followed up the patients until 2019. Optimal blood pressured was defined as systolic blood pressure &lt; 120 mm Hg at baseline regardless of use of antihypertensive drugs. The association of optimal blood pressure and risk of NVAF was evaluated by Cox proportional hazard model adjusted for conventional risk factors for CVD. We also performed subgroup analysis by use of antihypertensive drugs. Results: Mean age of participants was 65 ± 10 years. During the median follow up of 10.9 years, 132 patients developed NVAF. The adjusted hazard ratio (HR) and its 95% confidence interval (CI) of NVAF of T2DM patients with optimal blood pressure comparing to those with higher blood pressure was 0.89 (0.45-1.75). In subgroup analysis by use of antihypertensive drugs, the results were not altered. The risk of NVAF among patients with optimal blood pressure comparing to those with higher blood pressure among patients using antihypertensive drugs and those not using antihypertensive drugs were 1.08 (0.34-3.45) and 0.78 (0.34-1.79), respectively. Conclusions: Optimal blood pressure was not associated with lower risk of NVAF among aged T2DM patients. However, due to high risk profile of NVAF among aged T2DM patents, careful follow up may be still necessary for prevention of CVD.

Abstract 10095: Beneficial Effects of Intensive Blood Pressure Control on Cardiovascular Outcomes Are Seen in Cohabitating Black Individuals but Not in Those Living Alone

Introduction: Living alone, a key proxy of social isolation, is a risk factor for cardiovascular disease. In addition, Black race is associated with less optimal blood pressure (BP) control than in other racial/ethnic groups. However, it is not clear whether living arrangement modifies the beneficial effects of intensive BP control on reduction in cardiovascular events among Black individuals. We aimed to examine whether the effects of intensive BP control on cardiovascular events differ by living arrangement among Black and non-Black individuals in the Systolic Blood Pressure Intervention Trial (SPRINT). Methods: This secondary analysis of the SPRINT trial included 9,361 participants (30% Black individuals; 29% living alone) who were randomized to a systolic BP target of either &lt;120mmHg (intensive treatment group) or &lt;140mmHg (standard treatment group). Cox proportional hazards model was used to estimate the effect of intensive treatment on the composite cardiovascular outcome according to living arrangement (i.e., living alone or living with others) among Black and non-Black individuals. Results: At a median follow-up of 3.2 years, the intensive treatment group showed a significantly lower rate of the composite cardiovascular outcome than the standard treatment group among cohabitating Black individuals (hazard ratio [HR], 0.53 [95%CI, 0.33-0.85]) but not among those living alone (HR, 1.07 [95%CI, 0.66-1.73]; p-for-interaction, 0.04). A significant reduction of the composite cardiovascular outcome was observed among non-Black individuals regardless of living arrangement status. Conclusion: Intensive BP control was beneficial to reduce cardiovascular events among Black individuals living with others and non-Black individuals but not among Black individuals living alone. Our findings highlight a potentially important role of assessing living arrangements in tailored approaches to improve cardiovascular health among Black individuals.

Focus on blood pressure levels and variability in the early phase of acute ischemic stroke with hypertension and carotid stenosis.

To investigate the optimal blood pressure (BP) levels and relative importance of BP and BP variability in the early phase of acute ischemic stroke (AIS) for hypertensive patients with carotid artery stenosis (CAS). A single‐center cohort study included 750 AIS patients with hypertension and tests were performed for CAS. Participants were categorized to Group 1 (SBP < 140 mm Hg and DBP < 90 mm Hg), Group 2: (SBP: 140–159 mm Hg and or DBP: 90–99 mm Hg), and Group 3: (SBP ≥160 mm Hg and/or DBP ≥100 mm Hg) according to the guidelines. The associations of mean BP levels and variability with outcomes (recurrent stroke, all‐cause death and the composite cardiovascular events) at 6 months were analyzed by Cox proportional hazard models. The associations of BP variability with BP levels and cerebral blood flow (CBF) were analyzed by linear regression and generalized additive models. Both for primary and secondary outcome, more events occurred in Group 1 compared with Group 2, while no significant difference was found in Group 3 with higher BP levels. Lower systolic BP variability showed better prognosis and higher CBF. The associations were more significant in patients with CAS ≥50%. BP variability exhibited a linear negative relationship with BP levels. In the early phase of AIS with hypertension and CAS, maintaining low blood pressure variability may be important to improve outcomes while low BP levels (SBP/DBP < 140/90 mm Hg) were harmful, especially in those patients with CAS ≥ 50%.

Preoperative mineralocorticoid receptor antagonist reduces postoperative hyperkalaemia in patients with Conn syndrome.

The preoperative use of mineralocorticoid receptor antagonists (MRA) in patients with unilateral forms of primary aldosteronism (PA) is not standardized. The current Endocrine Society Guidelines do not specifically recommend MRA treatment before surgery. It is unclear whether preoperative MRA can optimize perioperative blood pressure and potassium control, and reduce the incidence of postoperative hyperkalaemia. This study aimed to investigate the effect of MRA on the incidence of postoperative hyperkalaemia in addition to perioperative blood pressure and potassium concentration in patients undergoing unilateral adrenalectomy for the treatment of PA. Retrospective cohort study. Tertiary referral centres, Victoria, Australia. A total of 96 patients who were diagnosed with unilateral forms of PA: 73 patients ('MRA' group) received preoperative MRA while 23 patients ('No-MRA' group) did not. The prevalence of postoperative hyperkalaemia was significantly higher in the 'No-MRA' group at 2-4 weeks after surgery, compared to the 'MRA' group (35% vs. 11%, p = .014). In a logistic regression, the use of MRA significantly predicted a lower incidence of postoperative hyperkalaemia after adjusting for age, sex, baseline aldosterone-to-renin ratio, potassium and preoperative eGFR. Before surgery, patients in the 'MRA' group had normalized blood pressure and potassium concentration requiring fewer antihypertensive medications and no potassium supplements. Preoperative MRA use was associated with optimal perioperative blood pressure and normalized serum potassium in addition to a lower incidence of postoperative hyperkalaemia. MRA should be considered standard treatment for patients awaiting surgery for PA.

Prevalence, awareness, treatment, and control of hypertension in Northern China: a cross-sectional study

BackgroundHypertension has always been a worldwide health concern. The purpose of this study was to investigate the prevalence, awareness, treatment, and control rates of hypertension among adult residents of northern China, where people usually have a high-fat, high-salt diet and heavy alcohol consumption.MethodsThrough the Early Screening and Comprehensive Intervention Project for High Risk Groups of Cardiovascular Diseases in the Inner Mongolia of northern China, we collected data of 70,380 residents, from September 2015 to June 2017. We assessed the prevalence, awareness, treatment, and control of hypertension in the total population and sub-populations. Multivariable logistic regression analyses were used to identify the factors associated with the prevalence and control of hypertension.ResultsAmong participants, only 13.4% had optimal blood pressure levels. About 55.7% (95% confidence interval (CI) = 55.3–56.1%) of the participants had hypertension. In addition, the awareness, treatment, control and control under-treatment rate of hypertension were 52.8% (95%CI = 52.3–53.3%), 43.3% (95%CI = 42.8–43.8%), 8.6% (95%CI = 8.3–8.9%) and 19.8% (95%CI = 19.2–20.4%), respectively. Multivariable logistic regression showed that older, male, Han, living in rural areas, current drinker, not married, lower educational level, lower annual income, diabetes, obesity, and dyslipidemia were more likely to be suffered from hypertension (P < 0.05). Controlled hypertension was less common in those younger, Mongol, not married, farmer, current drinker, lower educational level, obesity, diabetes, without prior CHD, and without prior CVD (P < 0.05).ConclusionAmong populations aged 35–75 years in Northern China, more than half have hypertension, fewer than one-tenth have successfully controlled hypertension, and fewer than one-fifth of hypertension patients receiving treatment have controlled hypertension.

Compliance of the fish outflow tract is altered by thermal acclimation through connective tissue remodelling.

To protect the gill capillaries from high systolic pulse pressure, the fish heart contains a compliant non-contractile chamber called the bulbus arteriosus which is part of the outflow tract (OFT) which extends from the ventricle to the ventral aorta. Thermal acclimation alters the form and function of the fish atria and ventricle to ensure appropriate cardiac output at different temperatures, but its impact on the OFT is unknown. Here we used ex vivo pressure–volume curves to demonstrate remodelling of passive stiffness in the rainbow trout (Oncorhynchus mykiss) bulbus arteriosus following more than eight weeks of thermal acclimation to 5, 10 and 18°C. We then combined novel, non-biased Fourier transform infrared spectroscopy with classic histological staining to show that changes in compliance were achieved by changes in tissue collagen-to-elastin ratio. In situ gelatin zymography and SDS-PAGE zymography revealed that collagen remodelling was underpinned, at least in part, by changes in activity and abundance of collagen degrading matrix metalloproteinases. Collectively, we provide the first indication of bulbus arteriosus thermal remodelling in a fish and suggest this remodelling ensures optimal blood flow and blood pressure in the OFT during temperature change.

The 10-year incidence of hypertension across blood pressure categories in a population-based cohort in southwestern Sweden

BackgroundTo explore the determinants of incident hypertension, and especially the impact of baseline blood pressure categories, in a representative Swedish population.MethodsA 10-year longitudinal study of residents aged 30–74. Blood pressures were measured and categorized according to ESH guidelines with optimal blood pressure < 120/80 mmHg, normal 120–129/80–84 mmHg, and high normal 130–139/85–89 mmHg. Incident hypertension was defined as ongoing treatment or three consecutive blood pressure readings ≥ 140/ ≥ 90 mmHg (one or both) at follow-up, while those with ≥ 140 and/or ≥ 90 mmHg at only one or two visits were labelled as unstable. After excluding subjects with hypertension, ongoing blood pressure lowering medication or a previous CVD event at baseline, 1099 remained for further analyses.ResultsSixteen (2.6%) subjects with optimal baseline blood pressure had hypertension at follow up. Corresponding numbers for subjects with normal, high normal and unstable blood pressure were 55 (19.4%), 50 (39.1%) and 46 (74.2%), respectively. Compared with subjects in optimal group those in normal, high normal and unstable blood pressure categories had significantly higher risk to develop manifest hypertension with odds ratios OR and (95% CI) of 7.04 (3.89–12.7), 17.1 (8.88–33.0) and 84.2 (37.4–190), respectively, with adjustment for age, BMI and family history for hypertension. The progression to hypertension was also independently predicted by BMI (p < 0.001), however, not by age.ConclusionsSubjects with high normal or unstable blood pressure should be identified in clinical practice, evaluated for global hypertension risk and offered personalized advice on lifestyle modification for early prevention of manifest hypertension and cardiovascular disease.

Optimizing blood pressure control by an Information Communication Technology-supported case management (PIA study): study protocol for a cluster-randomized controlled trial of a delegation model for general practices

BackgroundLongitudinal hypertension control prevents heart attacks, strokes, and other cardiovascular diseases. However, 49% of patients in German family medicine practices do not reach blood pressure (BP) targets (< 140/90 mmHg). Drawing on successful international approaches, the PIA study introduces the PIA information and communication technology system (PIA-ICT) for hypertension management in primary care. The PIA-ICT comprises the PIA-App for patients and the PIA practice management center for practices. Case management includes electronic communication with patients, recall, and stepwise medication adjustments following guidelines. The system supports a physician-supervised delegation model to practice assistants. General practitioners are qualified by eLearning. Patients learn how to obtain reliable BP readings, which they communicate to the practice using the PIA-App.MethodsThe effectiveness of the PIA-Intervention is evaluated in a cluster-randomized study with 60 practices, 120 practice assistants, and 1020 patients. Patients in the intervention group receive the PIA-Intervention; the control group receives usual care. The primary outcome is the BP control rate (BP < 140/90 mmHg) after 12 months. Using a mixed methods approach, secondary outcomes address the acceptance on behalf of physicians, practice assistants, and patients. This includes an evaluation of the delegation model.DiscussionIt is hypothesized that the PIA-Intervention will improve the quality of BP care. Perspectively, it may constitute an important health service model for primary care in Germany.Trial registrationGerman Clinical Trials Register DRKS00012680. Registered on May 10, 2019

How blood pressure predicts frailty transitions in older adults in a population-based cohort study: a multi-state transition model.

BackgroundLow blood pressure (BP) is associated with frailty in older adults. Our aim was to explore how BP predicts transitions between frailty states.MethodsWe used data from the Lausanne cohort Lc65+, a population-based cohort of older adults randomly drawn from a population registry in Switzerland, in 2004, 2009 and 2014. BP was measured using a clinically validated oscillometric automated device and frailty was defined using Fried’s phenotype, every 3 years. We used an illness-death discrete multi-state Markov model to estimate hazard ratios of forward and backward transitions between frailty states (outcome) in relation to BP categories (predictor of interest) with adjustment for sex, age and antihypertensive medication (other predictors).ResultsAmong 4200 participants aged 65–70 years (58% female) at baseline, 70% were non-frail, 27% pre-frail and 2.0% frail. Over an average follow-up of 5.8 years, 2422 transitions were observed, with 1575 (65%) forward and 847 (35%) backward. Compared with systolic BP (SBP) <130 mmHg, the hazard ratio (95% confidence interval) of the transition from non-frail to pre-frail was 0.86 (0.74 to 1.00) for SBP 130–150 mmHg, and 0.89 (0.74 to 1.06) for SBP ≥150 mmHg. Compared with SBP <130 mmHg, the hazard ratio of the transition from pre-frail to frail was 0.71 (0.50 to 1.01) for SBP 130–150 mmHg, and 0.90 (0.62 to 1.32) for SBP ≥150 mmHg. Diastolic BP was a weaker predictor of forward transitions.ConclusionsBP categories had no strong relationship with either forward transitions or backward transitions in frailty states. If our findings are confirmed with greater precision and assuming a causal relationship, they would suggest that there is no well-defined optimal BP level to prevent frailty among older adults.

Blood pressure, frailty status, and all-cause mortality in elderly hypertensives; The Nambu Cohort Study

Antihypertensive therapy is pivotal for reducing cardiovascular events. The 2019 Guidelines for the Management of Hypertension set a target blood pressure (BP) of <140/90 mmHg for persons older than 75 years of age. Optimal BP levels for older persons with frailty, however, are controversial because evidence for the relationship between BP level and prognosis by frailty status is limited. Here, we evaluated the relationship between systolic BP and frailty status with all-cause mortality in ambulatory older hypertensive patients using data from the Nambu Cohort study. A total of 535 patients (age 78 [70–84] years, 51% men, 37% with frailty) were prospectively followed for a mean duration of 41 (34–43) months. During the follow-up period, 49 patients died. Mortality rates stratified by systolic BP and frailty status were lowest in patients with systolic BP < 140 mmHg and non-frailty, followed by those with systolic BP ≥ 140 mmHg and non-frailty. Patients with frailty had the highest mortality regardless of the BP level. The adjusted hazard ratios (95% confidence intervals) of each category for all-cause mortality were as follows: ≥140 mmHg/Non-frailty 3.19 (1.12–11.40), <140 mmHg/Frailty 4.72 (1.67–16.90), and ≥140 mmHg/Frailty 3.56 (1.16–13.40) compared with <140 mmHg/Non-frailty as a reference. These results indicated that frail patients have a poor prognosis regardless of their BP levels. Non-frail patients, however, with systolic BP levels <140 mmHg had a better prognosis. Frailty may be a marker to differentiate patients who are likely to gain benefit from antihypertensive medication among older hypertensives.

Treatment outcomes among adults with HIV/non-communicable disease multimorbidity attending integrated care clubs in Cape Town, South Africa

BackgroundThe growing burden of the HIV and non-communicable disease (NCD) syndemic in Sub- Saharan Africa has necessitated introduction of integrated models of care in order to leverage existing HIV care infrastructure for NCDs. However, there is paucity of literature on treatment outcomes for multimorbid patients attending integrated care. We describe 12-month treatment outcomes among multimorbid patients attending integrated antiretroviral treatment (ART) and NCD clubs in Cape Town, South Africa.MethodsAs part of an integrated clubs (IC) model pilot implemented in 2016 by the local government at two primary health care clinics in Cape Town, we identified all multimorbid patients who were enrolled for IC for at least 12 months by August 2017. Mean adherence percentages (using proxy of medication collection and attendance of club visits) and optimal disease control (defined as the proportion of participants achieving optimal blood pressure, glycosylated haemoglobin control and HIV viral load suppression where appropriate) were calculated at 12 months before, at the point of IC enrolment and 12 months after IC enrolment. Predictors of NCD control 12 months post IC enrolment were investigated using multivariable logistic regression.ResultsAs of 31 August 2017, 247 HIV-infected patients in total had been enrolled into IC for at least 12 months. Of these, 221 (89.5%) had hypertension, 4 (1.6%) had diabetes mellitus and 22 (8.9%) had both diseases. Adherence was maintained before and after IC enrolment with mean adherence percentages of 92.2% and 94.2% respectively. HIV viral suppression rates were 98.6%, 99.5% and 99.4% at the three time points respectively. Retention in care was high with 6.9% lost to follow up at 12 months post IC enrolment. Across the 3 time-points, optimal blood pressure control was achieved in 43.1%, 58.9% and 49.4% of participants while optimal glycaemic control was achieved in 47.4%, 87.5% and 53.3% of participants with diabetes respectively. Multivariable logistic analyses showed no independent variables significantly associated with NCD control.ConclusionMultimorbid adults living with HIV achieved high levels of HIV control in integrated HIV and NCD clubs. However, intensified interventions are needed to maintain NCD control in the long term.

A Systolic Blood Pressure of 100 mm Hg Is Optimal for Optimal Visualization in Arthroscopic Rotator Cuff Repair in the Beach-Chair Position

PurposeTo investigate the relationship between visualization and blood pressure during arthroscopic rotator cuff repair (ARCR) in the beach-chair position and to clarify the optimal blood pressure to maintain good visualization during surgery.MethodsOne senior surgeon evaluated intraoperative visualization at the start of arthroscopy, at acromioplasty, at the refresh of the footprint on the greater tuberosity, at marrow vent creation in the footprint on the greater tuberosity, and at rotator cuff fixation. The evaluation grades were: 5, clear; 4, mild bleeding; 3, bleeding but operable; 2, poor visualization due to bleeding; and 1, inability to continue surgery due to massive bleeding. During ARCR, an arterial line was inserted, and blood pressure was measured continuously. The relationship between visualization and blood pressure was analyzed. Receiver operating characteristic analysis was performed with evaluation grades 5 and 4 as the good visualization group and the other evaluation grades as the poor visualization group.ResultsVisualization assessment and systolic/diastolic blood pressure were associated at the start of arthroscopy (P = .0257/.0057), at acromioplasty (P = .0023/.0399), and at the refresh of the footprint (P = .0201/.0272). The average blood pressure of evaluation grade 5 cases was 91/50 mm Hg. The cut-off values, based on the area under the curve on receiver operating characteristic analysis, were as follows: 104/60 mm Hg (0.91-0.95) at acromioplasty; 116/70 (0.94-0.96) at the refresh of the footprint; 116/70 mm Hg (0.94-0.96) at the refresh of the footprint; and 106/58 mm Hg (0.73-0.70) at marrow vent creation.ConclusionsGood visualization during ARCR in the beach-chair position was significantly associated with blood pressure. An optimal blood pressure resulting in good visualization that would not cause excessive hypotension during ARCR surgery in the beach-chair position might be a systolic blood pressure of 100 mm Hg.Level of EvidenceIII, prospective, nonrandomized, observational study.

Clinical and genetic markers of prehypertension in North-Western Russian population

Abstract Introduction Prehypertension is a medical classification for patients with above normal blood pressure (BP) but insufficient for confirming hypertension diagnosis. Condition is often asymptomatic as it gradually develops over the years, yet recent meta-analyses suggest that prehypertension is a significant risk factor for stroke and other cardiovascular diseases. Methods We analyzed phenotypic data from 879 (age 25–64) individuals without hypertension from a population based-sampling cohort of St. Petersburg region in the North-West of Russia to identify clinical risk factors associated with prehypertension condition. All patients were divided in two groups – optimal BP (systolic BP &amp;lt;120 mmHg and diastolic BP &amp;lt;80; N=426) and prehypertension (systolic BP in range 120–140 mmHg and diastolic BP in range 80–90 and not on antihypertensive therapy; N=453). Results Phenotypic analysis with linear regression was corrected for age, sex, smoking status, BMI and levels of LDL and HDL cholesterol (Figure 1). Interestingly, blood level of insulin was significantly associated with prehypertension status along with insulin resistance index, however, presence of diabetes diagnosis in medical history was not significant. Phenotypes associated with prehypertension suggest that prehypertension is often developing along with hyperinsulinemia. Finally, we estimated polygenic risk scores (PRS) for hypertension using UK biobank GWAS summary statistics and confirmed that prehypertension is more frequent at earlier age in patients with higher genetic susceptibility (Figure 1, Figure 2). Conclusions Hyperinsulinemia and genetic susceptibility to hypertension are strong risk factors for prehypertension. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was financially supported by the Ministry of Science and Higher Education of the Russian Federation (Agreement No. 075-15-2020-901) to Al.K. Figure 1. Clinical markers of prehypertensionFigure 2. Genetic markers of prehypertension

Catestatin in patients with essential hypertension of different cardiovascular risk

Abstract Maximum association of arterial hypertension is found with sympathetic overactivity which is involved in different mechanisms including RAAS, OSA, obesity, etc. It is not overt sympathetic activity but disturbed basal sympathetic tone. However, the factors that indicate the beginning of the regulation system impairment in hypertensive patients haven't been studied enough. Catestatin is considered by some studies as a part of the “catecholamines-catestatin buffer system” because of its inhibitory effect on excess catecholamine release. The purpose of the study was to assess the concentrations of catestatin and to analyze its relationships with cardiovascular continuum in patients with essential hypertension (EH) of different cardiovascular risk (CVR). The methods of the research. The study included 180 men in age from 30 to 50 years old, the patients were divided into groups: group 1 (n=28) – EH of moderate CVR, group 2 (n=76) – EH of high CVR, group 3 (n=31) – EH of very high CVR. The control group (n=45) included almost healthy men with optimal and normal blood pressure (BP). All included in the study were examined, anamnesis and complaints were collected, daily monitoring of BP and ECG, TTE were performed, carotid intima–media thickness (IMT) was measured. Catestatin (ng/ml) was determined by the ELISA method using RayBiotech kits. Results Patients with moderate and very high CVR and a history of inherited EH had statistically significantly higher (p&amp;lt;0,05) catestatin concentrations compared to those in the control group who has a family history of EH. Catestatin correlations with a history of inherited EH were revealed in groups of patients with EH of moderate (r=0,555; p=0,049) and high (r=−0,285; p=0,027) CVR. The participation of catestatin in cardiovascular remodeling mediated by hypertension was proved: in a group of patients with EH of high CVR catestatin correlations with carotid IMT were received (r=−0,246; p=0,040). The relationships between catestatin concentrations and left ventricular posterior wall thickness (r=−0,523; p=0,045) and the interventricular septum (r=−0,523, p=0,045) in group 2 in diastole were discovered. Catestatin concentrations in patients with normal heart geometry were higher (p=0,04) comparing to the patients with cardiac remodeling (9,05±5,12 vs 7,49±3,62 ng/ml respectively). Catestatin concentrations correlated with indicators characterizing the CVR: diastolic BP variability in all included in the study patients with EH (r=0,218; p=0,022), group 2 (r=0,326; p=0,006), and the value of the morning surge (r=−0,745; p=0,002). Conclusion Catestatin concentrations change at all stages of the cardiovascular continuum of arterial hypertension, which is proved by the obtained correlations, so all of the above allows us to consider catestatin as a new factor in the regulation of blood pressure in patients with essential hypertension of different cardiovascular risk. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Samara Region Provincial Grant

The relationship between visceral fat depots and markers of renal dysfunction in patients with borderline arterial hypertension and obesity

Abstract Introduction Obesity is a potent risk factor for the development of kidney disease (CKD). The localization of adipose tissue and its hormonal activity plays an important role in the formation of the cardiorenal relationship. Purpose of work To assess the relationship between visceral fat stores with hormonal activity of adipose tissue, metabolic parameters and markers of renal dysfunction in patients with borderline arterial hypertension (AH) and obesity. Materials and methods The study included 100 people aged 44.8±6.4 years. Group 1 – patients with borderline hypertension – SBP 134.1±4.7 mm Hg; DBP – 84.3±5.9 mm Hg, BMI 36.1±3.2kg/m2. Group 2 was patients with BMI 35.5±3.9 kg/m2, SBP level 120.6±10.1 mm Hg and DBP 70.1±8.4 mm Hg. Albumin/creatinine ratio urine (ACRU), β2 microglobulin, tumor necrosis factor (TNF), interleukin 6 (IL6), monocytechemoattractant protein (MCP-1) was determined in a single portion of morning urine, the level of leptin, resistin and cystatin C was determined by ELISA. Glomerular filtration rate (GFR) was calculated using the CKD-EPI formula and cystatin C (Hoek's formula). The examination of visceral adipose tissue (VAT) was using an ultrasound method of investigation: the epi- and pericardial fat depots were assessed; VAT 1 – measurement at the level of the navel from the inner surface of the rectus abdominis to the posterior wall of the aorta and L4; VAT 2 – measurement at the level of the navel from the inner surface of the rectus abdominis to L4; the thickness of the posterior perirenal VAT on the right and left and the area of perirenal fat on both sides. Result The amount of fat depots in the groups is shown in Table 1. Indicators of hormonal activity of adipose tissue and renal markers are presented in Table 2. In the group with borderline hypertension the relationship between VAT 1 and 2 with ALT levels (r=0.40) and (r=0.42) was established, AST (r=0.52) and (r=0.47); HDL (r=−0.67) and (r=−0.70), TG (r=0.38) and (r=0, 39), HOMA index (r=0.45) and (r=0.39), MCP-1 (r=0.28) and (r=0.36). Perineal fat depot located to the right and left is correlated with LDL (r=0.40) and (r=0.37), glucose (r=0.49) and (r=0.50), ACRU (r=0.43) and (r=0.57), urinary excretion of cystatin C (r=0.28) and (r=0, 39). The connection with the optimal blood pressure level in control group was established between the perineal adipose tissue on the right and the left with the level of TG (r=0.35) and (r=0.29), GFR according to Hoek (r=0.29) and (r=0, 38), MCP-1 (r=0.36) and (r=0.29). Findings The increase of perinephral adipose tissue in obese patients is associated with an increase in cytokine excretion in the urine, an increase in VAT is accompanied by a deterioration in metabolic parameters. Funding Acknowledgement Type of funding sources: None.

Risk of atrial fibrillation in young adults aged 20 to 39 years with isolated diastolic, isolated systolic, and systolic-diastolic hypertension: a nationwide population-based study

Abstract Background There is limited evidence regarding the comparative risks of incident atrial fibrillation (AF) associated with stage 1 isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH), especially amongst young adults aged 20–39 years. Purpose To evaluate the association between early-stage of hypertension and AF in young adults aged 20–39 years. Methods From the Korean nationwide health screening database, 2,958,544 subjects aged 20–39 years who were not prescribed antihypertensive medication at the index examination in 2009 were included. Subjects were categorized into eight groups according to the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines: normal BP, elevated BP, stage 1 IDH, stage 1 ISH, stage 1 SDH, stage 2 IDH, stage 2 ISH, and stage 2 SDH. The primary outcome was new-onset AF during follow-up. Results During a median follow-up of 8.3 years, 7,347 subjects had incident AF (incidence rate, 0.3 per 1,000 person-years). Compared to the normal BP group, stage 1 IDH (adjusted hazard ratio [aHR], 1.160; 95% confidence interval [CI], 1.086–1.240) and stage 1 SDH (1.250; 1.165–1.341) were associated with higher risks of incident AF, but not stage 1 ISH. Stage 2 IDH, ISH, and SDH were associated with higher risks of incident AF by 24%, 37%, and 61%, respectively (Figure). Conclusion Among young adults, stage 1 IDH and SDH were associated with higher risks of incident AF compared to normal BP. The risk of incident AF with stage 2 IDH was similar to that of stage 1 SDH. Optimal BP control including diastolic BP is crucial for preventing new-onset AF, even amongst young adults. Funding Acknowledgement Type of funding sources: None.

659 Four Limb Amputations due to Peripheral Gangrene from Vasopressor Use

Abstract Case Symmetrical peripheral gangrene (SPG) is a relatively rare phenomenon characterized by symmetrical distal ischemic damage that leads to gangrene of 2 or more sites in the absence of large blood vessel obstruction, where vasoconstriction rather than thrombosis is implicated as the underlying pathophysiology. We present 2 cases of symmetrical peripheral gangrene (SPG) associated with the use of vasopressors to elevate blood pressure, resulting in four-limb amputation. Both patients had different backgrounds, and each presented to Accident and Emergency (A&amp;E) with Streptococcal septicemia and subsequently septic shock, warranting ICU admission and the use of vasopressors to optimize blood pressure. Both patients then started to develop symmetrical peripheral gangrene of both the upper and lower limbs leading to staged amputations performed electively. Vasopressors including dopamine and norepinephrine are used frequently in the treatment of septic shock and its effectiveness is firmly established. However, it can result in peripheral gangrene due to the prolonged vasoconstrictive effect on peripheral blood vessels. Therefore, it is crucial that the astute physician consider the possibility of the development of peripheral gangrene and amputation when using vasopressors to treat septic shock.

Associations of changes in late-life blood pressure with cognitive impairment among older population in China

BackgroundThe cognitive impact of changes in late-life blood pressure is less clear. We aimed to investigate the association between late-life blood pressure changing pattern and risk of cognitive impairment.MethodsUsing data from the community-based Chinese Longitudinal Healthy Longevity Survey, change in systolic (SBP) or diastolic (DBP) blood pressure was calculated as the difference between follow-up and baseline, cognitive impairment was defined based on both the Mini-Mental State Examination and education level. The generalized additive model with penalized spline and multivariate logistic regression model were used, respectively, to examine the associations between continuous and categorized blood pressure changes with cognitive impairment at the follow-up wave.ResultsA total of 8493 Chinese elderly without cognitive impairment were included, with mean (standard deviation) age 80.6 (10.7) years. U-shaped associations between late-life blood pressure changes and risk of cognitive impairment were found, with only stable optimal blood pressure related to the lowest risk. For participants with baseline SBP around 130–150 mmHg, the adjusted odds ratio was 1.48 (1.13–1.93) for increasing follow-up SBP (> 150 mmHg), 1.28 (1.02–1.61) for decreasing follow-up SBP (< 130 mmHg), compared to stable follow-up SBP (130–150 mmHg). For participants with relative lower baseline DBP (< 80 mmHg), increasing their DBP to 80–90 mmHg during follow-up was associated with lower cognitive impairment risk (0.73 (0.58–0.93)), compared to steady low follow-up DBP (< 80 mmHg). Sex-specific analysis suggested that men were more vulnerable in term of SBP change.ConclusionsAdhering to a stable optimal level of blood pressure in late-life is related to lower risk of cognitive impairment in Chinese elderly.