Population Of Hypertensive Patients Research Articles

Does body mass index or waist-hip ratio correlate with arterial stiffness based on brachial-ankle pulse wave velocity in Chinese rural adults with hypertension?

BackgroundThe relationship between obesity indices and arterial stiffness (AS) has not been fully discovered nor has it been studied in depth in large hypertensive patient populations. The aim of this study was to explore the association between body mass index (BMI) and waist-hip ratio (WHR) levels and AS based on brachial-ankle pulse wave velocity (baPWV) in Chinese rural adults with hypertension.MethodsThis cross-sectional study analyzed 5049 Chinese rural adults with essential hypertension. BMI was calculated as the body weight in kilograms divided by the square of the height in meters (kg/m2). Central obesity was defined as WHR ≥ 0.9 for males and ≥ 0.85 for females. Measurement of arterial stiffness was carried out via brachial-ankle pulse wave velocity (baPWV).ResultsThe prevalence of overweight, general obesity, central obesity and increased AS were 26.88%, 3.39%, 63.85% and 44.01%, respectively. Multivariate logistic regression analysis indicated that BMI levels were negatively associated with the prevalence of increased AS (adjusted-OR per SD increase: 0.74, 95% CI 0.67–0.81, P < 0.001). When BMI was instead treated as a categorical variable divided into tertiles, the same relationship was observed (P for trend < 0.001). Inversely, WHR levels were positively associated with the prevalence of increased AS (adjusted-OR per SD increase: 1.25, 95% CI 1.14–1.36, P < 0.001). Compared to subjects without central obesity, those with central obesity had a higher prevalence of increased AS (adjusted-OR: 1.52, 95% CI 1.28–1.81, P < 0.001). Linear regression models indicated similar results in the correlation between BMI or WHR levels and baPWV levels (adjusted-β per SD increase: − 0.57, 95% CI − 0.68 to − 0.46, P < 0.001; adjusted-β per SD increase: 4.46, 95% CI 3.04–5.88, P < 0.001). There were no interactions in terms of age and blood pressure on the relationship between BMI or WHR levels and the prevalence of increased AS or baPWV levels.ConclusionThere was an inverse relationship between BMI levels and increased AS or baPWV levels, whereas WHR levels and central obesity were positively associated with increased AS or baPWV levels in Chinese rural adults with hypertension.

Abstract 13055: Endotrophin is Significantly Associated With Risk of Mortality in HFpEF Patients Irrespective of Underlying Atrial Fibrillation

Introduction: The global burden of heart failure with preserved ejection fraction (HFpEF) is increasing. HFpEF is projected to become the dominant type of HF, and atrial fibrillation (AF) is known to contribute to pathogenesis by aggravating fibrosis. Endotrophin is a bioactive molecule released from collagen type VI during its maturation, and it is a marker of fibroblast activity. The aim of this post-hoc analysis was to confirm the previously observed prognostic potential of endotrophin (measured by PRO-C6) for adverse outcome in HFpEF and to investigate the potential influence in risk stratification by AF. Methods: 166 patients with hypertensive HFpEF were included for analysis. 48.2% were NYHA Class II, 49.4% NYHA Class III and 1.2% NYHA Class IV. 50.6% of patients had a previous history of AF. Cardiac function was assessed by echocardiography and standard clinical measures. Circulating endotrophin was quantified at baseline in serum by means of an enzyme-linked immunosorbent assay, PRO-C6. Results: PRO-C6 levels increased significantly with disease severity in HFpEF patients (NYHA Class III vs II, p=0.0003), and in HFpEF patients with AF (p=0.023). PRO-C6 was able to discriminate between patients at risk of all-cause mortality (AUC=0.73, p&lt;0.001), but no improvement in this association was observed when factoring in AF (AUC=0.72, p=0.001). When looking at patients stratified in PRO-C6 tertiles, patients in the upper tertile had a significantly higher risk of mortality (p&lt;0.0001, hazard ratios 3 vs 1=4.1, 3 vs 2=3.5, respectively) and HF hospitalization (p&lt;0.0001, hazard ratio 3 vs 1=4.4, 3 vs 2=1.6, respectively) compared to tertiles 1 and 2. Conclusions: In this population of hypertensive HFpEF patients, circulating endotrophin, measured by PRO-C6, was increased with increasing disease severity, and associated with a higher risk of adverse outcome in HFpEF, regardless of underlying AF. The data presented here suggest a potential role of endotrophin in HFpEF pathophysiology, associated to disease progression in HFpEF patients with or without AF. These data confirm previous observations, and strengthen the usefulness of endotrophin, measured by the PRO-C6 biomarker, as a prognostic tool aiding in assessment of HFpEF patients.

Endotrophin is significantly associated with disease severity and increased risk of adverse outcome in HFpEF but not in HFrEF patients

Abstract Introduction The global burden of heart failure (HF), with either reduced (HFrEF) or preserved (HFpEF) ejection fraction, has increased dramatically over the past years, and HFpEF is projected to become the dominant type of HF. Fibrogenesis, promoted by fibroblast activity, plays an important role in the pathology of HF regardless of subtype, causing impaired cardiac function. Endotrophin is a bioactive molecule released from collagen type VI during its maturation, and it is a marker of fibroblast activity. The aim of this post-hoc analysis was to confirm the previously observed prognostic potential of endotrophin (measured by PRO-C6) for adverse outcome in HFpEF and to test its prognostic abilities in HFrEF. Methods 234 patients with hypertension and either HFrEF (30.3%) or HFpEF (69.7%) were included for analysis. 43.2% were NYHA Class II, 52.5% NYHA Class III and 2.5% NYHA Class IV. 53.4% of patients had a previous history of atrial fibrillation. The cohort did not include diabetic patients. Cardiac function was assessed by echocardiography and standard clinical measures, including left ventricle ejection fraction (EF), blood pressure (BP) and measurement of N-terminal natriuretic brain-peptide (NT-proBNP). Circulating endotrophin was quantified at baseline in serum by means of an enzyme-linked immunosorbent assay, PRO-C6. Results PRO-C6 levels increased significantly with disease severity in HFpEF patients (NYHA Class III vs II, p=0.0003), but not in HFrEF patients (NYHA Class III vs II, p=0.33). In HFpEF patients, PRO-C6 was able to discriminate between patients that were hospitalized for HF (AUC=0.69, p&amp;lt;0.001), died from cardiovascular (CV) causes (AUC=0.74, p&amp;lt;0.001), or by any other cause (AUC=0.73, p&amp;lt;0.001). PRO-C6 was not associated with none of these outcomes in HFrEF patients (AUC=0.56, p=0.42; AUC=0.53, p=0.73; AUC=0.56, p=0.53, respectively). Adding PRO-C6 to a risk prediction model containing age, sex, body mass index and systolic BP significantly increased the discriminatory power of the model for mortality (deltaAUC=0.037, p=0.04). When looking at patients stratified in PRO-C6 tertiles, patients in the upper tertile had a significantly higher risk of mortality (p&amp;lt;0.0001, hazard ratios 3 vs 1=4.1, 3 vs 2=3.5, respectively) and HF hospitalization (p&amp;lt;0.0001, hazard ratio 3 vs 1=4.4, 3 vs 2=1.6, respectively) compared to tertiles 1 and 2. Conclusion In this population of hypertensive HF patients, circulating endotrophin, measured by PRO-C6, was increased with increasing disease severity, and associated with a higher risk of adverse outcome in HFpEF, but not in HFrEF patients. The data presented here suggest a potential role of endotrophin in HFpEF pathophysiology and further underline the differences between HFpEF and HFrEF. These data confirm previous observations, and strengthen the usefulness of endotrophin, measured by the PRO-C6 biomarker, as a prognostic tool aiding in assessment of HFpEF patients. Funding Acknowledgement Type of funding sources: None.

UNSUSPECTED CAUSES OF HYPERTENSION

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Pheochromocytomas (PC) are catecholamine-secreting tumors that arise from the chromaffin cells of the adrenal medulla and other extra-adrenal sources. The annual incidence of PC is approximately 0.8 per 100,000 person-years, however this is thought to be an underestimation as a substantial portion of PC's were diagnosed at autopsy (Beard et al). With the relative rarity of this disease coupled with its often-complicated presentation, it is not uncommon to see this disease misdiagnosed. CASE PRESENTATION: We present a 68-year-old Caucasian female with a past medical history significant for chronic tobacco use, hypertension, hypothyroidism secondary to partial thyroidectomy, coronary artery disease, paroxysmal atrial fibrillation, periodic headaches, backpain and dizziness who presented after a fall at home. An elevated troponin with normal EKG led to treatment for NSTEMI. CT head returned within normal limits and a cardiac catheterization revealed LVEF of 35-40% with 60% mid-LAD stenosis and Coreg and Ramipril were started. A few weeks later, she presented to the ED again with chest pain radiating between her shoulder blades. A CTA chest was significant for a 1.7cm soft tissue density in the right lower lung lobe and a 1.6cm right adrenal nodule. A follow-up PET/CT showed a peak SUV (standardized uptake value) of 1.6 in the lung nodule and a peak SUV of 2 in the adrenal gland nodule. Biopsy of the lung nodule via bronchoscopy was unattainable due to its small size and anatomic location. The decision to proceed to a CT-guided needle biopsy of the right adrenal mass was made with pathology returning consistent with a PC. Further evaluation included measurement of urine metanephrines, which returned elevated. Due to continued suspicion of the right lower lobe nodule likely representing an unrelated, early-stage bronchogenic carcinoma, cardiothoracic surgery consultation was obtained. Pathology of the right lower lobectomy with lymph node biopsies returned consistent with adenocarcinoma of likely lung primary origin. DISCUSSION: It is estimated that approximately 0.2-0.6% of patients with hypertension have a concurrent PC (Omura et al). In fact, approximately 15-30% of the population of hypertensive patients have secondary hypertension and resistant hypertension was noted in approximately 34% of hypertensive patients in the ALLHAT trial (Koch et al). This patient's presentation attests to the semi-cryptic nature of PC. CONCLUSIONS: This case also demonstrates that, despite a suspected cardiac etiology and incidental pulmonary malignant process, searching for the overall causation of the patients presenting symptoms may be more difficult than it first appears. After completing a secondary hypertension workup (as well as dietary and lifestyle changes) with unremarkable results it is important to consider endocrinopathies as an underlying cause, despite their rarity. REFERENCE #1: Beard CM, Sheps SG, Kurland LT, Carney JA, Lie JT. Occurrence of pheochromocytoma in Rochester, Minnesota, 1950 through 1979. Mayo Clin Proc. 1983 Dec;58(12):802-4. PMID: 6645626. REFERENCE #2: Omura M, Saito J, Yamaguchi K, et al. Prospective Study on the Prevalence of Secondary Hypertension among Hypertensive Patients Visiting a General Outpatient Clinic in Japan. Hypertens Res. 2004;27(3):193–202. REFERENCE #3: Koch C, Papadopoulou-Marketou N, Chrousos GP. Overview of Endocrine Hypertension. 2020 Feb 4. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dungan K, Grossman A, Hershman JM, Hofland J, Kaltsas G, Koch C, Kopp P, Korbonits M, McLachlan R, Morley JE, New M, Purnell J, Singer F, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 25905214. DISCLOSURES: No relevant relationships by David Heintze, source=Web Response no disclosure on file for Billy Rosson

The relationship between the atherogenic index of plasma and arterial stiffness in essential hypertensive patients from China: a cross-sectional study

BackgroundThe atherogenic index of plasma (AIP) always remains in a potential association with arterial stiffness, however, this association has not been fully discovered and needs to be studied in depth in large hypertensive patient populations. The present analysis thus sought to further explore the association that exists between AIP and arterial stiffness in Chinese patients diagnosed with arterial hypertension.MethodsThis cross-sectional study analyzed 4744 Chinese individuals with essential hypertension. AIP was defined as the base 10 logarithm of the ratio of plasma of triglycerides to high-density lipoprotein cholesterol levels indicated in molar concentrations. Measurement of arterial stiffness was carried out via brachial-ankle pulse wave velocity (baPWV).ResultsData were adjusted for potential confounding variables, and multivariate linear regression analysis revealed AIP to be positively correlated with baPWV (β = 1.34, 95% CI: 0.96 to 1.72, P < 0.001). When AIP was instead treated as a categorical variable divided into quartiles, the same relationship was observed (P for trend < 0.001). We additionally found AIP and baPWV had a stronger positive association in individuals with a body mass index (BMI) < 24 kg/m2 (P for interaction < 0.05).ConclusionAIP and arterial stiffness were positively correlated in essential hypertension patients in China, especially in those with a BMI < 24 kg/m2.Clinical trial registration ChiCTR1800017274.

THE ROLE OF ANGIOTENSIN II RECEPTOR BLOCKERS IN THE FUNCTION AND MORPHOLOGY OF PLATELETS IN HYPERTENSIVE PATIENTS

Objective: Activation of platelet angiotensin receptors could potentially contribute to further progression of thrombotic events in hypertension. The aim of our study was to investigate the effect of antihypertensive therapy with ARBs on platelet function and morphology in a population of untreated hypertensive patients. Design and method: 120 untreated hypertensive patients(mean age 51 years; office blood pressure: 153/87 ± 7.3 mmHg, 55% males; 56% smokers)were divided into groups based on ARBs treatment (group 1) or no (group 2) and were prospectively followed up. Group 1 was further classified into 2 subgroups with subgroup 1 (n = 50) receiving Olmesartan and subgroup 2(n = 50)receiving Candesartan. Platelet function was assessed at baseline and at 40 days by means of a PFA-100 analyzer using epinephrine (EPI) and ADP. Time to aperture occlusion, closure time (CT),was recorded in seconds. Additionally, clotting times, mean platelet volume (MPV), vWf:Ag and fibrinogen levels were assessed. Results: At baseline, platelet activity was determined(PFA CTEPI, PFA CTADP)with no statistically significant differences between groups. At reassessment, changes in both CT- PFAEPI and CT-PFAADP were found between groups(group 1: CT-PFAEPI = 138.9 ± 22.3 sec, group 2: CT-PFAEPI = 104.9 ± 22.9 sec, group 1: CT-PFAADP = 85.5 ± 18.6 sec and group 2: CT-PFAADP = 81.5 ± 11.9 sec). However, after checking the significance of these changes (δ)it was found that only CT-PFAEPI change (δ) difference between treatment groups reached statistical significance(group 2 vs subgroup 1: δCT-PFAEPI21.8 [95% CI (2.17 – 41.4)],p = 0,025, group 2 vs subgroup 2: δCT-PFAEPI20.7 [95% CI (1.09 – 40.3)], p = 0.035, subgroup 1 vs subgroup 2: δCT-PFAEPI 1.08[95% CI (-15.3 – 17.4)], p = NS). During follow-up, treatment with ARBs was associated with significant lowering of fibrinogen (from 341.7 ± 62.2 to 316.3 ± 61.8 mg/dl, p &lt; 0.001),MPV levels (from 10.4 ± 0.91 to 8.8 ± 0.9fL, p &lt; 0.001) and vWf:Ag (from 103.2 ± 6.7 to 93.8 ± 7.1)with no corresponding reductions in group 2. After multivariate analysis,CT-PFAEPI changes(δ)were significantly correlated only with ARBs(p &lt; 0.001),irrespectively of specific drug. Conclusions: The present study indicates that treatment with ARBs contributes to downregulation of platelet activity in hypertension, suggesting that it could offer additional cardiovascular benefit in hypertensive patients.

Impact of Beliefs about Medicines on the Level of Intentional Non-Adherence to the Recommendations of Elderly Patients with Hypertension.

Background: Non-adherence to pharmaceutical treatment is one of the most common causes of uncontrolled hypertension. Non-adherence may be intentional or unintentional. In the case of intentional non-adherence, it is crucial to understand the reasons behind it. The literature increasingly addresses the issue of beliefs and concerns about medication, but studies on this subject performed in a Polish population of hypertensive patients are still lacking. The aim of the study was to assess the level of intentional non-adherence among patients with hypertension, and to determine the relationship between beliefs about medication and the level of intentional non-adherence to treatment in elderly patients with hypertension. Material and methods: The study included 300 patients (106 of whom were male, mean age (SD) 71.71 (8.12) years) with hypertension, treated at a hypertension clinic. The following instruments were used: the Intentional Non-Adherence Scale (INAS) for evaluating intentional non-adherence, and the Beliefs about Medicines Questionnaire (BMQ) for evaluating patients’ beliefs and opinions regarding medication. Socio-demographic and clinical data were obtained from patients’ medical records. Results: The mean (SD) INAS score in the study was 47.28 (19.12). Patients were most concerned about the harm caused by medication, and least concerned about the necessity to take medication (mean score per item 3.49 vs. 2.14). Correlation analysis demonstrated weak correlations between BMQ and INAS: higher scores for necessity were associated with more intentional non-adherence (r = 0.174, p = 0.003), while higher scores for overuse, harm, and concerns were associated with less intentional non-adherence (respectively: r = −0.253, p < 0.001 vs. r = −0.336, p < 0.001 vs. r = −0.351, p < 0.001). In multiple-factor analysis, factors increasing the level of intentional non-adherence were elderly age (β = −0.352, p = 0.009), multimorbidity (β = −2.374, p = 0.035), and a higher BMQ concerns score (β = −1.376, p < 0.001), while being single was an independent predictor decreasing intentional non-adherence (β = 5.646, p = 0.013). Conclusions: The overall level of intentional non-adherence among patients with hypertension is moderate, but approximately one third of patients with hypertension demonstrate a high level of non-adherence. Independent determinants of intentional non-adherence include concerns, elderly age, multimorbidity, and being single.

DESCRIPTION OF PHYSICAL ACTIVITY IN HYPERTENSION CLIENTS

Hypertension is a non-communicable disease and has a risk of heart disease. Hypertension can be managed by doing physical activity. Physical activity can control blood pressure in hypertensive clients. The purpose of this research was to identify the overview of the biological activities of hypertensive clients at the Guntur Community Health Centre in Garut Regency.The research type was a quantitative descriptive with the study population of hypertensive patients who were registered at Guntur Community Health Centre. The sampling method in this research was a total sampling method, and the total number of this study was 118 hypertensive patients. This research instrument used the long form of the International Physical Activity Questionnaire with a number of 25 questions and consisted of 4 activity domains. The data were processed using the analysis of distribution frequency and percentage. The results showed as many as 100 respondents (84.7%) did a mild physical activity, and none did moderate physical activity, and as many as 18 respondents (15.3%) did a strenuous physical activity. From the research results, it can be concluded that most of the respondents did a mild physical activity. The implication of this research is to provide health education about appropriate physical activity for hypertensive clients at Guntur Health Center.

Abstract 16717: Features of the Candidate Genes Polymorphisms Accumulation in Population of Hypertensive Patients of Different Age Groups

Introduction: Nowdays the analysis of gene candidates polymorphisms and formation of genetic risk scores are actively being used in diagnostic and preventive management in arterial hypertension (AH). Hypothesis: The purpose of the research was to analyze and compare the proportion of modified candidate genes (CG) of AH in different age groups by calculating the gene modification index (GMI) for confirmation of the hypothesis of modified genes accumulation through generations. Methods: 182 patients with AH were examined, mean age 44,3 [18-75], m/f=95/87, (ESC/ISH 2018). Patients were divided into 3 groups depending on age: 1st group - from 18 to 30 y.o. (n=48, m/f=27/21); 2nd group - from 31 to 55 y.o. (n=74, m/f=34/40); 3rd group - from 56 to 75 y.o. (n=60, m/f=28/32). Patients were analysed on the the following CG by PCR: ADD1: 1378, AGT: 704, AGT: 521, AGTR1: 1166, AGTR2: 1675, CYP11B2: - 344, GNB3: 825, NOS3: -786 , NOS3: 894. The GMI which represents the percentage of "pathological" genotypes. The GMI from 0 to 20% was considered as low genetic risk (GR), from 21 to 40 % - moderate GR, from 41 to 70% - high GR, from 71 to 100% - very high GR. Results: In 1 group the average GMI was 64,7% [CI 95%, 29-74], with low GR in 2 (4,2%), moderate GR - in 10 (20,8%), high GR - in 22 (45,8%), very high GR - in 14 (29,2%) patients. In 2 group the average GMI was 56,2% [CI 95%, 18-72], 12 (16,2%) patients had low GR, moderate GR was in 20 (27,1%), high GR - in 26 (35,1%), very high GR - in 16 (21,6%) patients. In 3 group the average GMI was 42,4% [CI 95%, 16-71], low GR was in 16 (26,7%), moderate GR - in 22 (36,7%), high GR - in 14 (23,3%), very high GR - in 8 (13,3%) patients. Analyzing data between the groups, a strong significant difference in GMI was between 1 and 3 groups (64,7% vs 42,4%, p=0,002), high significant differences were also between the 1 and 3 groups, especially in the proportion of patients with high GR (45,8% vs 23,3%, p=0,001) and very high GR (29,2% vs 13,3%, p=0,008) in the group of young patients. Conclusions: It was revealed in the research the accumulation of pathological genetic polymorphisms in the population of hypertensive patients through generations. It was found the strong significant difference in the proportion of "pathological" GP between young and older patients.

Impact of diastolic blood pressure on speckle tracking derived myocardial work components in a population of normotensive and untreated hypertensive patients

Abstract Background Arterial hypertension deeply influences left ventricular (LV) mechanics and global longitudinal strain (GLS). The effect of blood pressure (BP), in particular systolic BP burden, on speckle tracking derived myocardial work (MW) was demonstrated in both hypertensive and healthy subjects. Purpose Aim of our study was to evaluate the impact of diastolic BP (DBP) on MW components in a population of newly-diagnosed, never treated hypertensive patients and healthy subjects. Methods The study population included 105 newly-diagnosed, never treated hypertensive patients (M/F= 62/43; age=46.1±13.0 years, BP=145.1±10/89.8±7.4 mmHg), and 105 healthy normotensive subjects (BP=121.6±9.8/73.7±7.4mmHg), matched for age and sex. All participants underwent standard echo exam, including GLS evaluation (in absolute value). Cuff BP was employed as a surrogate of LV peak pressure for the assessment of global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). Exclusion criteria were diabetes mellitus, coronary artery disease, overt heart failure, valve heart disease, primary cardiomyopathies, atrial fibrillation and inadequate echo imaging. The study population was divided into two groups according to DBP threshold of normalcy defined by 2018 ESH/ESC guidelines: the first group including individuals with normal DBP (n=135, DBP&amp;lt;90mmHg) and the second group including patients with abnormal DBP (n=75, DBP ≥90 mmHg). Results The two groups were comparable for sex prevalence, age and heart rate. Body mass index (BMI), systolic and mean BP were higher in the group with abnormal DBP (all p&amp;lt;0.0001). Among echo data, no significant intergroup difference was found in LV mass index, relative wall thickness, ejection fraction and diastolic parameters. GLS was lower in patients with abnormal DBP (20.4±1.9 vs. 22.1±2.1%, p&amp;lt;0.0001). GWI (2443.0±403.1 vs. 2277.3±359.6 mmHg%, p&amp;lt;0.002), GCW (2733.5±406.0 vs. 2556.9±405.6 mmHg%, p=0.003) and GWW (112.8±84.4 vs. 76.8±45.1 mmHg%, p&amp;lt;0.0001) were significantly higher in patients with abnormal DBP, whereas GWE (95.3±2.8 vs. 96.2±1.7%, p&amp;lt;0.002) was lower in this group. In the pooled population, DBP was positively related to GWI, GCW (both r=0.30, p&amp;lt;0.0001) and GWW (r=0.26, p&amp;lt;0.0001), while negatively correlated with GLS (r=−0.37, p&amp;lt;0.0001) and GWE (r=−0.21, p&amp;lt;0.002). By separate multiple linear regression analyses, GWI (β=0.45, p&amp;lt;0.0001), GCW (β=0.47, p&amp;lt;0.0001), GWW (β=0.20, p=0.007) and GWE (β=−0.15, p&amp;lt;0.05) were all independently associated with DBP, after adjusting for male sex, age, BMI, heart rate, GLS and E/e' ratio. Conclusions In a population of untreated hypertensive patients and healthy subjects, increased DBP affects longitudinal function and MW. In particular, elevated diastolic BP induces an increase of wasted work which is only partially balanced by the increased constructive work, thus provoking a clear reduced efficiency of myocardial mechanics. Figure 1 Funding Acknowledgement Type of funding source: None

Increased carotid cross-sectional area is a marker of organ damage in young hypertensive patients

Abstract Background Common Carotid artery (CA) cross sectional area (CCSA) is strictly related to vessel remodelling stimulated by mechanical stress due to arterial hypertension. Accordingly, increased CCSA might represent an early marker of vascular target organ damage independently of presence of atherosclerotic plaque. Purpose To assess early correlates and prognostic impact of CCSA in a large population of young treated HTN patients. Methods We selected 970 hypertensive patients, 18 to 40 years old (mean age 34±5 yrs; 30% women) of the Campania Salute Network registry with available CA ultrasound and follow-up data, free of overt cardiovascular (CV) disease. CCSA was computed as: CCSA = π [(CAd/2 + IMT)2 – (CAd/2)2] where CAd = CA diameter and IMT = mean intima media thickness. Participants were compared by CCSA tertiles. Results Compared to the lowest and intermediate tertiles, patients in the highest tertile were more often male, smokers, older, and had higher body mass index (BMI), diastolic blood pressure (BP), higher fasting glucose, triglycerides, LDL cholesterol and uric acid, with lower level of HDL cholesterol. They also exhibited higher left ventricular mass index and IMT and had more often carotid atherosclerotic plaque (all p&amp;lt;0.05). During a median follow-up of 45 months, 22 incident composite CV events occurred. In Cox-Regression analyses, adjusting for the above covariates, presence of carotid plaque and classes of antihypertensive medications, increased CCSA was significantly associated with increased CV risk (HR 1.08/mm2; 95% CI 1.02–1.13; p&amp;lt;0.01). Conclusions In a population of young hypertensive patients, increased CCSA is related to metabolic and atherosclerotic disease and is associated with increased CV risk, also independently of overt carotid plaque. Funding Acknowledgement Type of funding source: None

Hypertension in cardiac transplant recipients: tackling a new face of an old foe.

Systemic hypertension (HTN) is a common complication arising in the heart transplant recipient. This article aims to review the most current literature and update readers on the epidemiology, pathophysiology and management of HTN in heart transplant patients. In contrast to the general nontransplant hypertensive patient population, traditional risk factors, including family history of HTN, obesity and diabetes, play a minor role in the genesis of posttransplant HTN. Dysregulation in sodium and water balance, vascular stiffness, endothelial dysfunction, abnormal cardiorenal neural reflexes resulting from immunosuppression and cardiac denervation seem to be the predominant factors leading to postheart transplant HTN. Calcineurin inhibitors induced nephrotoxicity and steroid use further contributes to posttransplant HTN. Owing to the paucity of data, particularly randomized controlled trials to guide the evaluation and management of HTN in the cardiac transplant patients, much of the available data come from the renal transplant population. The choice of antihypertensive should be based on timing related to transplantation and patient's comorbidities. Although calcium channel blockers and loop diuretics are the preferred agents in the early postheart transplant period, angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers may be beneficial in the late postheart transplant period especially in the setting of diabetes and in the presence of proteinuria.

P658 Impact of hyperuricemia on left ventricular longitudinal systolic function in uncomplicated hypertensive patients

Abstract Background Hyperuricemia has been reported to accelerate the occurrence and worsening of cardiovascular disease, being a risk factor for coronary heart disease and cardiac mortality. Elevated uric acid (UA) is also associated with left ventricular (LV) hypertrophy and with LV diastolic dysfunction. The effect of hyperuricemia (HU) on LV systolic function is still unclear. Purpose Aim of our study was to evaluate the impact of elevated UA serum levels on LV systolic function, also evaluating longitudinal deformation, in a population of hypertensive patients. Methods We enrolled 160 treated hypertensive patients (M/F = 104/56, age 58.2 ± 13.3 years, blood pressure = 136.7 ± 16.8/81.3 ± 10.9 mmHg), who underwent standard echo-Doppler exam, including speckle tracking quantification of global longitudinal strain (GLS, considered in absolute value). HU was defined as UA≥7 mg/dL and the study population was divided in two groups: patients with (n = 63) and without (n = 97) HU. Exclusion criteria were coronary artery disease, overt heart failure, hemodynamically significant valve heart disease, primary cardiomyopathies, permanent atrial fibrillation and inadequate echo imaging. Results The two groups were comparable for sex prevalence, blood pressure and heart rate. Patients with HU were older and had higher body mass index (BMI) (both p &amp;lt; 0.0001). Prevalence of diabetes mellitus was higher in the group of patients with HU than in patients with normal UA (69% vs. 12% p &amp;lt; 0.0001). Fasting glycaemia was higher (p &amp;lt; 0.0001) and glomerular filtration rate (GFR) lower in HU hypertensives (both p &amp;lt; 0.0001). LV mass index (LVMi) was higher in patients with HU (p &amp;lt; 0.0001). Among diastolic parameters, transmitral E/A ratio (p &amp;lt; 0.0001) was lower, whereas E/e’ ratio (p &amp;lt; 0.0001), E velocity deceleration time and left atrial volume index (both p &amp;lt; 0.001) were higher in HU hypertensives. GLS resulted to be lower in patients with HU (20.8 ± 1.5 vs. 22.3 ± 2.2%, p &amp;lt; 0.0001). LV ejection fraction, despite still in normal range values, was also slightly lower in comparison with controls (60.6 ± 4.0 vs. 62.2 ± 3.9%, p &amp;lt; 0.01). Serum UA levels resulted to be negatively correlated with GLS (r=-0.28, p &amp;lt; 0.0001) (Figure), but not with ejection fraction. By a multiple linear regression analysis performed in the pooled hypertensive population, after adjusting for age, BMI, GFR, fasting glycaemia and LVMi, the association between UA levels and GLS remained significant (standardized beta coefficient =-0.25, p &amp;lt; 0.01), besides the significant impact of age (beta=-0.19 , p &amp;lt; 0.05). Conclusions In hypertensive patients with multiple cardiovascular risk factors, the presence of HU is associated with LV diastolic and systolic dysfunction. Serum UA levels and GLS resulted independently associated even after adjusting for several clinical and echo confounders. Acid uric might be considered as an independent marker of early LV dysfunction, able to identify hypertensive patients at increased risk for heart failure. Abstract P658 Figure. Relation between uric acid and GLS

Distância percorrida em indivíduos hipertensos: estudo de corte transversal

INTRODUÇÃO: A hipertensão arterial sistêmica é uma condição clínica ocasionada por diversos fatores que acarretam na elevação dos níveis de pressão arterial de forma sustentada, sendo importante avaliar a capacidade funcional desses indivíduos, visando ter-se um diagnóstico precoce, além de ser um meio de prevenção das repercussões da hipertensão. Um dos instrumentos utilizados é o teste de caminhada de seis minutos (TC6) que é executado em nível submáximo, possibilitando a análise das respostas dos sistemas envolvidos durante as atividades. OBJETIVOS: Verificar a distância percorrida dos indivíduos hipertensos. MATERIAIS E MÉTODOS: Estudo de corte transversal, com população de hipertensos, entre 30 e 60 anos. O TC6 foi realizado de acordo com protocolo padronizado pela ATS e calculada a distância prevista através da equação preditiva de Enright e Sherrill. Foi utilizado o teste T de Student para comparação das médias de distância e calculado o percentual da diferença entre os valores percorridos e previstos. RESULTADOS: 44 sujeitos de ambos os sexosforam avaliados e observou-se média de idade de 48,80±7,08 anos, 56,8% dos indivíduos apresentaram pressão controlada, 81,8% estavam em uso regular da medicação anti-hipertensiva. A média da distância obtida nos indivíduos que alcançaram os valores previstos foi de 503±38,6 metros. Sendo que a maioria dos indivíduos percorreram em média 86,3±7,2% da distância prevista. CONCLUSÃO: Indivíduos com hipertensão arterial apresentam diminuição da distância percorrida, independente da pressão arterial estar controlada ou não.

Long-Term Outcomes of a Cohort of Hypertensive Subjects in Rural Ecuador

BackgroundIn contrast with the abundance of global epidemiological descriptive data on cardiovascular diseases and their risk factors, information on the outcomes of real populations prospectively followed up in their life and care settings is much rarer, especially in low-income countries. ObjectivesThis study sought to evaluate the feasibility and the overall results of a hypertension control program, based mainly on a network of community nonprofessional health promoters, in the poor rural region of Borbon (Ecuador). MethodsThis is a prospective cohort study describing the results of a program of hypertension diagnosis, treatment and follow-up from 2004 to 2015 in the area, carried out mainly by the health promoters. ResultsThe number of hypertensive patients identified and followed over the years increased from 1,024 in 2004 to 1,733 in 2015. The percentage of patients with no visits during a year was reduced to <10%, whereas the proportion of hypertensive subjects attending all 4 scheduled annual checks approached and, in some years, exceeded 50%. From 2004 to 2015, the proportion of patients at high or very high cardiovascular risk progressively decreased from 26.6% in 2004 to 17.5% in 2015 (p for trend <0.01), whereas the proportion of hypertensive patients at low or very low risk increased from 30.4% in 2004 to 45.0% in 2015 (p for trend <0.01). ConclusionsIn a poor, disadvantaged area, a strategy of control mainly based on the involvement and responsibility of community health promoters (with health professionals as supporters more than direct actors) can achieve adequate follow-up of the population of hypertensive patients and improve their global cardiovascular risk level.

Resistant/Refractory Hypertension and Sleep Apnoea: Current Knowledge and Future Challenges.

Hypertension is one of the most frequent cardiovascular risk factors. The population of hypertensive patients includes some phenotypes whose blood pressure levels are particularly difficult to control, thus putting them at greater cardiovascular risk. This is especially true of so-called resistant hypertension (RH) and refractory hypertension (RfH). Recent findings suggest that the former may be due to an alteration in the renin–angiotensin–aldosterone axis, while the latter seems to be more closely related to sympathetic hyper-activation. Both these pathophysiological mechanisms are also activated in patients with obstructive sleep apnoea (OSA). It is not surprising, therefore, that the prevalence of OSA in RH and RfH patients is very high (as reflected in several studies) and that treatment with continuous positive airway pressure (CPAP) manages to reduce blood pressure levels in a clinically significant way in both these groups of hypertensive patients. It is therefore necessary to incorporate into the multidimensional treatment of patients with RH and RfH (changes in lifestyle, control of obesity and drug treatment) a study of the possible existence of OSA, as this is a potentially treatable disease. There are many questions that remain to be answered, especially regarding the ideal combination of treatment in patients with RH/RfH and OSA (drugs, renal denervation, CPAP treatment) and patients’ varying response to CPAP treatment.

P3563The influence of circadian patterand obstructive sleep apnean of blood pressure in nocturnal arrhythmias in hypertensive patients

Abstract Introduction There is growing evidence suggesting hypertension is related to the occurrence of arrhythmias. When occurring predominantly during the night, two potential entities commonly present in hypertensive patients could be related with increased arrhythmogenesis: (1) the lack of normal nocturnal dipping of blood pressure (BP) (non-dipping pattern of hypertension) or (2) obstructive sleep apnea (OSA). Thus, nocturnal arrhythmias (NAs) can identify hypertensive patients with OSA and/or non-dipping pattern, both related with adverse outcomes. Aims To determine if NAs are related with non-dipping hypertension, OSA or both. Methods We studied hypertensive patients who performed ambulatory blood pressure monitoring (ABPM) and also polysomnography and 24-hour Holter monitoring. Non-dipping pattern was considered when nocturnal BP reduction was inferior to 10%. Based on Holter monitoring, NAs were present when atrial fibrillation, frequent premature atrial contractions (PACs) (&gt;30 PACs/hour), runs of &gt;4 consecutive PACs, frequent premature ventricular contractions (PVCs) (&gt;30PVCs/hour) or runs of &gt;4 consecutive PVCs were present predominantly during sleeping hours. During polyssonography, apnoea/hypopnoea index (AHI) and oxygen saturation (SaO2) were analysed. Moderate to severe OSA was considered when AHI &gt;15. Results We studied 104 patients [median age 62 (54–70) years, 65% male): 42 (40%) had moderate to severe OSA (median AHI=11 (6–26), mean SaO2=94% (92–95)] and 64 (61%) were non-dippers. NAs occurred in 18 patients (17%) and they were independently associated with AHI (Odds Ratio (OR) for a one unit increase 1.04, 95% confidence interval (CI) 1.01–1.07, p=0.03) but not with SaO2 (OR 0.96, CI 0.78–1.19, p=0.73) nor non-dipping pattern (OR 1.23, CI 0.38–3.98, p=0.72). No interaction was found between OSA and non-dipping hypertension (p=0.35). In patients with dipping pattern (n=40), AHI was higher in NAs patients comparing with no NAs patients (median AHI 29 versus 10, p=0.04), while in those with non-dipping pattern (n=64), AHI was not statistically different between patients with and without NAs (21 versus 11, p=0.12) (figure). Figure 1 Conclusion In this population of hypertensive patients, the presence of NAs was associated with OSA severity (i.e AHI), but not with the non-dipping pattern of hypertension. The importance of obstructive events in arrhythmogenesis seemed to be more pronounced in dipping patients, suggesting the abnormal high blood pressure during the night may also have some impact on NAs in non-dipping patients. Overall, our results suggest that OSA screening should be considered when nocturnal arrhythmias are detected in hypertensive patients, but ABPM should not be forgotten since multiple mechanisms can be involved in nocturnal arrhythmogenesis.

P6378Characteristics of hypertensive iron ore miners with oral glucocorticoid induced diabetes mellitus and compromised lung function

Abstract Introduction Oral glucocorticoids are efficacious agents for treating respiratory diseases, with high risk to induce metabolic diseases including diabetes and hypertension Purpose To analyse the hypertensive patient population from the rural setting on ongoing glucocorticoid treatment and diagnosed as diabetic due to the extensive chronic methylprednisolone equivalent glucocorticoid dose of more than 4 mg/day for at least 3 months for treatment of respiratory ailments due to occupational hazard Methods We diagnosed the identified and analysed a subset of patients from the Redi iron ore miners (n=25,500), who were newly diagnosed diabetics (n=1100) and with associated systemic hypertension (systolic BP &gt;140 mmHg, diastolic BP &gt; than 90 mmHg). Patients diagnosed as Oral Glucocorticoid Induced Diabetes Mellitus (GIDM) and hypertensives (n=847; 572 males and 275 females) were characterised on metabolic parameters. t-test was utilised for statistical analysis Results We observed a high incidence of GIDM (4.31%) with a high rate of hypertension (77%, 847/1100). Mean SBP was 150 mmHg (SD ± 9.9, 95% CI 147–152), mean DBP was 90 mmHg (SD ± 8.9, 95% CI 88–92). BMI in GIDM with hypertension (GIDM-H) group was similar to GIDM group (26 kg/m2) (Table), with relatively older age in GIDM–H (53 vs 51 years). The glycemic parameters were relatively more deranged in GIDM-H group. There was significant correlation for a high propensity of relatively younger &lt;50 years (n=506) and near normal weight people with BMI &lt;26 kg/m2 (n=594) to develop GIDM (p=0.006) Metabolic Parameters GIDM Vs GIDM-H Mean ±SD, min, max, 95% CI GIDM (n=1100) GIDM with Hypertension (n=847) Age (yrs) 51 (SD ±14, 95% CI 48–54) 53 (SD ±13, 95% CI 50–56) HbA1c (%) 7.1 (SD ±0.62, 95% CI 7–7.3), 7.2 (SD ±0.60, 95% CI 7.1–7.3) BMI (kg/m2) 26 (SD ±3.6, 95% CI 25–27) 26 (SD ±3.4, 95% CI 25–27) Fasting Plasma Glucose (mg/dl) 146 (SD ±49, 95% CI 136–155) 149 (SD ±48, 95% CI 138–160) Post Prandial Glucose (mg/dl) 207 (SD ±74, 95% CI 192 - 221) 212 (SD ±74, 95% CI 195–228) Conclusions The high rates of hypertension in patients with GIDM is an alarmingly problem which has pronounced harmful comorbid implications, especially in younger, economically productive population in limited resource setting. The health care professionals need to be educated to limit use of glucocorticoids to inhalational therapy with minimal systemic effects. Specific pathophysiological approach to address the steroid induced insulin resistance, strategies to reduce cardiovascular risk and damage, makes treatment of hypertension and GIDM difficult, which calls for action to limit the mining activities and mitigate risk of chronic complications

Deprescribing of hypotensive therapy in hypertensive patients over 60 years (results of the program “GRANAT”)

Objective. To conduct a comprehensive study of comorbidity, medications and to assess the possibilities of deprescribing in hypertensive patients older than 60 years. Design and methods . The study was registered as an observational program “Arterial hypertension: the main clinical and pharmacological determinants in patients over 60 years” and was conducted within the period from June to August 2018. In total, 460 patients (201/43,7 % — men, the age — 76,72 ± 8,1 years) with hypertension (HTN) were included sequentially. Results. The main complaints were: headaches (n = 393/85,4 %), decreased memory, attention (305/66,3 %), dizziness (286/62,2 %), back pain (215/46,7 %), joint pain (206/44,8 %), sleep disorders (183/39,8 %), heartburn (179/38,9 %), epigastric pain (154/33,5 %), constipation (147/31,9 %). The main diagnosed pathologies included: ischemic heart disease (332/72,2 %), chronic brain ischemia/dyscirculatory encephalopathy (305/66,3 %), spinal osteoarthrosis (293/63,7 %), chronic gastritis (198/43 %), varicose veins of the lower limbs (136/29,6 %), diabetes mellitus (121/26,3 %), cataract (96/20,9 %). The following medications were taken by the patients: antihypoxants/nootropics/neuroprotectors (302/65,7 %), diuretics (251/54,6 %), angiotensinconverting enzyme (ACE) inhibitors (273/59,4 %), β -blockers (203/44,1 %), non-steroidal anti-inflammatory drugs (NSAIDs) (179/38,9 %), sartans (147/32 %), calcium antagonists (120/26,1 %), proton pump inhibitors (117/25,4 %), statins (111/24,1 %). Among patients, 176 (38,3 %) subjects stopped taking the antihypertensive drugs on their own, they were not informed by the doctor about the possibilities of reducing the dose of antihypertensive drugs and deprescribing technology. Conclusion s. Our data demonstrate the multimorbidity of the population of hypertensive patients over 60 years of age, receiving a wide range of drugs and the need for a comprehensive discussion of the deprescribing approach.

Ambulatory blood pressure monitoring after one major cardiovascular event to predict a second one

To compare ambulatory blood pressure (ABP) values after a first major cardiovascular event, between patients with and without a second event, and to evaluate if ABP measurements could have a role in the prediction of a second event occurrence. We included 368 hypertensive patients who had ABP measurements after a first major cardiovascular event (acute coronary syndrome or stroke), with a mean age of 69.9 ± 11.8 years, 62.5% of men. One hundred and three patients had a second event during a mean follow-up of 2.8 ± 1.6 years. Twenty-four-hours systolic blood pressure (SBP) values were 135 ± 15 mm Hg in patients with a second event versus 126 ± 13 mm Hg in those with one event ( P = 0.002). Daytime SBP was 139 ± 14 mm Hg and 129 ± 13 mm Hg respectively ( P = 0.002). Night-time SBP was 129 ± 17 mm Hg and 118 ± 16 mm Hg respectively ( P = 0.003). Using Cox model with adjustments for age, sex and systolic office blood pressure, all the three measures: 24 hours SBP (HR: 1.032; CI 95%: 1.005–1.060), Daytime SBP (HR: 1.026; CI 95%: 1.00–1.052) and Night-time SBP (HR: 1.031; CI 95%: 1.007–1.055) significantly associated with a recurrence of a second event. In the 24-hours systolic blood pressure ROC curve analysis, a value of 125 mm Hg was the best cutoff for prediction of a second event, with a sensitivity of 83%. In our population of hypertensive patients with a previous cardiovascular event, higher values of 24 hours, daytime and night-time SBP were predictive of a second event occurrence.