Prehypertension Research Articles

Abstract 11891: Adverse Childhood Experiences are Associated With Elevated Blood Pressure and Disturbed Sleep in the First Trimester of Pregnancy in Apparently Healthy, Young Adult Women

Introduction: Adverse childhood experiences (ACEs) are potentially traumatic psychosocial stressors that occur in early life, such as abuse, neglect, and household dysfunction. We hypothesize that ACEs are an underlying risk factor for disturbed sleep and hypertension in pregnancy, which is a major cause of maternal-fetal morbidity and mortality. Hypothesis: In young adult women, ACE exposure will be positively associated with first trimester systolic (SBP), diastolic blood pressure (DBP), and wakefulness after sleep onset (WASO), and inversely associated with sleep efficiency (SE). Further, ACE exposure will be associated with greater odds of first trimester elevated or stage 1 hypertension (ES1H). Methods: Data were obtained at 10-12 weeks of gestation from 142 pregnant women who were enrolled in an ongoing, clinical cohort study in Iowa City and Pittsburgh. Participants were 18-45 y of age, had a BMI <40 kg/m 2 , and could not be taking medications or receiving treatment for sleep or cardiometabolic disorders such as chronic hypertension or diabetes. BP was assessed in accordance with AHA recommendations. Actigraphy was used to assess WASO and SE over ≥5 nights. ACE scores were log transformed and correlations were used to examine associations between ACE exposure and SBP, DBP, WASO and SE. Logistic regression was used to examine the association of ACE exposure with the probability of ES1H in an unadjusted model (model 1) and a model adjusted for age, race, ethnicity, BMI, and depressive symptoms (model 2). Results: 56% reported exposure to ≥1 ACE, and 28% reported exposure to ≥3. ACE exposure was positively related to SBP (r = 0.17, p = 0.04), DBP (r = 0.21, p = 0.01), and WASO (ρ = 0.21, p = 0.01), and negatively associated with SE (ρ = -0.22, p = 0.009). ACE exposure was associated with greater odds of first trimester ES1H in model 1 (OR = 2.73, 95% CI = 1.36 - 5.50; p = 0.005) and model 2 (OR = 2.44, 95% CI = 1.07 - 5.56; p = 0.03). Conclusions: ACEs represent an important risk factor for elevated BP and disturbed sleep in pregnancy. Large cohort studies are needed to understand the links among ACE exposure, sleep, resilience factors and hypertensive risk in pregnancy to provide information for developing targeted interventions to improve maternal-fetal cardiovascular health.

Inverse Salt Sensitivity of Blood Pressure Is Associated with an Increased Renin-Angiotensin System Activity.

High and low sodium diets are associated with increased blood pressure and cardiovascular morbidity and mortality. The paradoxical response of elevated BP in low salt diets, aka inverse salt sensitivity (ISS), is an understudied vulnerable 11% of the adult population with yet undiscovered etiology. A linear relationship between the number of single nucleotide polymorphisms (SNPs) in the dopamine D2 receptor (DRD2, rs6276 and 6277), and the sodium myo-inositol cotransporter 2 (SLC5A11, rs11074656), as well as decreased expression of these two genes in urine-derived renal proximal tubule cells (uRPTCs) isolated from clinical study participants suggest involvement of these cells in ISS. Insight into this newly discovered paradoxical response to sodium is found by incubating cells in low sodium (LS) conditions that unveil cell physiologic differences that are then reversed by mir-485-5p miRNA blocker transfection and bypassing the genetic defect by DRD2 re-expression. The renin-angiotensin system (RAS) is an important counter-regulatory mechanism to prevent hyponatremia under LS conditions. Oversensitive RAS under LS conditions could partially explain the increased mortality in ISS. Angiotensin-II (AngII, 10 nmol/L) increased sodium transport in uRPTCs to a greater extent in individuals with ISS than SR. Downstream signaling of AngII is verified by identifying lowered expression of nuclear factor erythroid 2-related factor 2 (NRF2), CCCTC-binding factor (CTCF), and manganese-dependent mitochondrial superoxide dismutase (SOD2) only in ISS-derived uRPTCs and not SR-derived uRPTCs when incubated in LS conditions. We conclude that DRD2 and SLC5A11 variants in ISS may cause an increased low sodium sensitivity to AngII and renal sodium reabsorption which can contribute to inverse salt-sensitive hypertension.

Threshold of BMI for the Development of Hypertension among Japanese Adults

The optimal value of BMI for the development of hypertension and the influence of BMI on the development of stage 1 or stage 2 hypertension remain unclear. We sought to identify the BMI threshold for the prevention of hypertension and how changes in BMI would influence the risk of developing hypertension. We analyzed 1,262,356 participants (median age: 43 y; 50.9% men) with normal blood pressure [BP; systolic BP (SBP) <120 mmHg and diastolic BP (DBP) <80 mmHg] or elevated BP (SBP: 120-129 mmHg and DBP <80 mmHg). The primary outcome was stage 1 (SBP 130-139 mmHg or DBP 80-89 mmHg) or stage 2 hypertension (SBP ≥140 mmHg or DBP ≥90 mmHg). We analyzed the relation between baseline BMI, change in BMI, and the risk of developing hypertension using generalized additive models with a smoothing spline. During the median follow-up of 851 d, 341,212 cases of stage 1 hypertension and 70,968 cases of stage 2 hypertension were detected. The risk of developing stage 1 or stage 2 hypertension increased steeply after BMI (kg/m2) exceeded 20. The annual change in BMI was positively correlated with the risk of developing stage 1 or 2 hypertension. Contour mapping using generalized additive models demonstrated an additive increase in the risk of developing hypertension with higher baseline BMI and increases in BMI over 1 y. Body-weight gain increases the risk of developing hypertension even in underweight or normal-weight individuals based on the WHO classification. In Japanese adults with normal or elevated BP, the risk of developing hypertension increased with BMI when baseline BMI was >20. Body-weight gain additively interacted with baseline BMI during hypertension development. Our results underscore the importance of maintaining body weight in preventing the development of hypertension.

Association between Surgical Fibroid Removal and Blood Pressure: A Retrospective Case-Control and Prospective Cohort Study

<h3>Study Objective</h3> Fibroids, monoclonal proliferations of uterine smooth muscle cells, are common in women and have recently been associated with cardiometabolic risk factors including hypertension. The objective of this study is to determine whether fibroids are biomarker of systemic hypertension, and whether they may contribute to elevation in blood pressure. <h3>Design</h3> IRB-approved retrospective case-control study and prospective cohort study. <h3>Setting</h3> Single academic institution. <h3>Patients or Participants</h3> Retrospective chart review of 313 patients undergoing hysterectomy or myomectomy for fibroids and patients undergoing other surgical procedures for benign gynecological indications with similar demographic characteristics (control). Prospective cohort of 9 women undergoing myomectomy or hysterectomy for fibroids. <h3>Interventions</h3> Hysteroscopy, laparoscopy, open myomectomy or hysterectomy for fibroids (or non-fibroid indications as control). <h3>Measurements and Main Results</h3> In our retrospective cohort (n=294; mean age 41.9±10.6, 43.5% Black, 50% with fibroids), we found consistently that compared to patients without fibroids, patients with fibroids had significantly elevated systolic BP (pre-op 128 vs 122mmHg, p=0.0005; post-op 126 vs 122mmHg, p=0.02) but not diastolic BP (pre-op 77.6 vs 75.9mmHg, p=0.17; post-op 76.7 vs 75.0, p=0.19). Among patients with fibroids, surgical fibroid removal was associated with a small but not statistically or clinically significant drop in systolic (Δ=-2.21mmHg, p=0.062) but not diastolic BP (Δ=-0.93mmHg, p=0.39). The direction and magnitude of effect for change in systolic BP remained consistent after adjustment for age, race, and presence of diagnosed hypertension (β=-2.45, p=0.17). In our prospective cohort, there was a significant decrease in SBP of 9.9mmHg (pre- versus post-operatively), but no change in DBP following fibroid removal (p=0.03, p=0.14, respectively). Serum levels of Ang-II and ACE were not significantly altered following surgical fibroid removal (p=0.39, p=0.80, respectively). <h3>Conclusion</h3> Altogether, these findings demonstrate that fibroids are associated with hypertension and suggest that fibroid removal may lead to a clinically significant decrease in systolic blood pressure. These changes may occur by a mechanism independent of the renin-angiotensin-aldosterone system.

Different Associations of Systolic Blood Pressure and Body Mass Index With Cardiac Structure and Function in Young Children.

Both elevated systolic blood pressure (SBP) and excess weight can lead to early cardiovascular organ damage in children. In this study, we investigated whether there is a difference in the associations of SBP and body mass index (BMI) with cardiovascular structure and function in 4-year-old children. In 1474 children (52.3% males) from the Shanghai Birth Cohort, physical examination and echocardiography were performed. Standardized linear regression models were used to evaluate the associations of BMI Z score and SBP Z score with cardiovascular parameters and to compare the strengths of these associations. The incidence of SBP elevation significantly increased in overweight children. SBP was positively related to heart rate, left ventricular (LV) ejection fraction and fraction shortening (β=1.824 [95% CI, 1.014-2.634], 0.579 [0.294-0.864], and 0.480 [0.257-0.704], respectively). BMI Z score was positively associated with LV mass index (β=1.225 [0.863-1.587]) and the risk of LV hypertrophy (odds ratio=1.428 [1.157-1.761]) but negatively related to measures of systolic function, including LV ejection fraction, LV fraction short, and global longitudinal strain (β=-0.417 [-0.735 to -0.099], -0.302 [-0.551 to -0.053], and -0.392 [-0.621 to -0.163], respectively). No noteworthy additive or multiplicative interactions between BMI and SBP were detected. Elevations in both BMI and SBP were related to cardiac structure and function in children as young as 4 years old. Elevated SBP was associated with increased heart rate and LV ejection at the early stage of BP elevation. BMI showed a closer relationship with left heart diameters and geometry than SBP.

Evaluation of the Safety and Efficacy of Dual Therapy Perindopril/Amlodipine in the Management of Hypertension. A Systematic Review and Meta-Analysis.

Hypertension represent the commonest cause of death in 2017. Hypertension is classified into two types which are primary or essential hypertension and secondary hypertension. The perindopril-amlodipine combination showed a significant effect in reduction of the elevated BP and the cardiovascular complications. To evaluate the efficacy and safety of a fixed-dose single-pill combination of perindopril-amlodipine in hypertensive patients. We searched PubMed, Medline, SCOPUS, and Web of Science for relevant clinical trials. Quality appraisal was evaluated according to GRADE and we assessed the risk of bias using Cochrane's risk of bias tool. We included the following outcomes: systolic blood pressure, diastolic blood pressure, pulse pressure, mean blood pressure, heart rate, cough, dizziness, headache, and peripheral edema. We performed the analysis of homogeneous data under the fixed-effects model, while analysis of heterogeneous data was analyzed under the random-effects model. We conducted a meta-regression according to the dose. We included ten clinical trials. The pooled analysis showed that there was a significant reduction of the systolic blood pressure, diastolic blood pressure, pulse plessure, mean blood pressure, and heart rate after the the perindopril-amlodipine combination (MD=18.96 [14.32, 23.60], P<0.0001), (MD=11.90 [8.45, 15.35], P<0.0001), (MD=8.44 [6.91, 9.97], P=0.0001), (MD=13.07 [5.86, 20.29], P=0.0004), and (MD=2.93 [0.89, 4.96], P=0.005), respectively. The results of the meta-regression revealed that the efficacy is increased by increasing the dose (P<0.001) CONCLUSION: The use of the perindopril-amlodipine combination had a significant effect on the reduction of SBP, DBP, mean blood pressure, pulse pressure, and HR.

Association between Berlin questionnaire index and blood pressure, organ damage and metabolic profilein a general population.

We evaluated the relationships between Berlin questionnaire (BQ) scores, hypertension and other metabolic variables in 598 subjects (age: 65.8±10 years, mean±SD) enrolled in the PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) study representative of the general population, treated or untreated with antihypertensive drugs. Two hundred and eleven subjects (35%) had a positive BQ with two or more positive categories of the inquiry. Compared to those without sleep disorders these subjects showed a greater male prevalence (55.9%), worse serum cholesterol, triglycerides and glucose profile, greater body mass index (BMI) (28.9±4.9vs. 24.9±3.4kg/m2 ), higher office (and to a lesser extent 24-h) BP and HR values, higher serum creatinine values and greater rate of echocardiographic left ventricular (LV) hypertrophy (25%vs. 13%). These differences were not detected when the data analysis was restricted to treated hypertensive patients. Thus, BQ scores allow to identify among subjects belonging to a general population those with elevated BP, organ damage and altered metabolic. When antihypertensive drug treatment is present, however, the approach fails to detect differences between groups with low or high BQ index.

ASSOCIATION BETWEEN PERIODONTAL DISEASE AND BLOOD PRESSURE – A SURVEY

Hypertension is the most prevalent cardiovascular disease increasing the risk of stroke, atherosclerosis, endothelial dysfunction. At risk (Pre hypertension) levels are - Systolic -120- 139, Diastolic – 80-89. High Blood Pressure levels are - Systolic – 140 or above, Diastolic – 90 or above. Periodontitis and hypertension share common risk factors: Smoking, Stress, Socio-economic factors. These Confounds the association between hypertension and periodontal disease. Objective was to assess the risk of hypertension in participants with periodontal disease. A randomized sample of 100 patients within the age group of 18-70 years were selected from the Department of Periodontology. Clinical Parameter recorded were missing teeth, bleeding on probing, gingival recession, probing pocket depth, clinical attachment loss, age, BMI, Smoking status. Blood Pressure assessment- using an automated Sphygmomanometer device. In this study, a signicant association between periodontitis and hypertension is seen (45.5%). Association with smoking (41.8%), age and BMI is also found to be prevalent.

Relationship of 24-h ambulatory blood pressure variability with micro and macrovascular parameters and hypertension status.

Increased blood pressure variability (BPV) has been associated with an increased risk of subclinical organ damage and cardiovascular events, independently of elevated average BP values. We aimed to investigate the association of BPV indices with micro- and macrovascular parameters, some of them not previously studied. We evaluated 344 individuals (233 never-treated/newly diagnosed hypertensive and 111 normotensive individuals). BPV was assessed using average real variability (ARV) during 24-h, daytime and night-time ambulatory blood pressure monitoring, and systolic weighted standard deviation (wSD). Retinal microvascular diameter was assessed by nonmydriatic retinal photography. Arterial stiffness was assessed by pulse wave velocity (PWV) and aortic augmentation index (AIx); subendocardial variability ratio (SEVR) was used as an index of myocardial perfusion. Carotid intima-media thickness (cIMT) was measured by ultrasound. Data were analyzed using multiple regression analysis. After adjusting for potential confounders, PWV and cIMT were independently associated with ARV components in the total sample (P < 0.023 and P < 0.014, respectively). Within hypertensives only PWV and cIMT were independently associated with ARV components (P < 0.002 for PWV and P < 0.003 for cIMT). In contrast, within normotensives, only retinal parameters and AIx were associated with ARV components (P < 0.017 and P = 0.013, respectively). None of the univariate correlations between vascular parameters and wSD remained significant after adjustment for potential confounders. Short-term BPV as assessed by ARV is independently associated with macrovascular parameters in untreated hypertensive patients, and with microvascular parameters in normotensive individuals.

Determinants of impaired coupling of right ventricle to hemodynamic load in advanced HFrEF

Abstract Background The mechanisms and consequnces of impaired right ventricular (RV) dysfunction and impaired RV-pulmonary artery (PA) coupling in advanced heart failure (HF) poorely understood. Purpose To compare RV-PA coupling parameters in patients with advanced HFrEF, PAH and in controls to ellucidate determinants and prognostic impact of RV-PA uncoupling in HFrEF. Methods 260 pacients with advanced HF (NYHA 3.0±0.5, 40% CAD, LVEF: 23±10%, 87% males, BMI: 28±4.5 kg/m2, BNP: 1238±982 pg/ml), 39 controls and 21 PAH patients underwent lab tests, ecocardiography, right heart catheterisation and equilibrium gated blood pool SPECT to precisely measure cardiac volumes. RV End-systolic elastance (Ees) and Effective arterial elastance (Ea) were calculated by single beat method. Patients were longitudinally followed for occurrence of adverse outcome (urgent Tx, LVAD or death without Tx/LVAD). Results PAH patients had higher PA pressures and more dilated RV than HFrEF and controls. Despite of that, RV-PA coupling, reflected by Ees/Ea ratio, was more profoundly reduced in HFrEF than in PAH (Figure). While RV contractility (Ees) was augmented by increased afterload in PAH, such augmentation was absent in HFrEF. At follow-up (median 258; 53–763 days), 69% of HFrEF subjects experienced adverse event (17% death, 24% urgent HTx, 28% LVAD). In HFrEF, RV-PA coupling was strongly predictive od adverse outcome, more than RV EF%, RV EDV or RV Ees. The strongest predictors of reduced RV Ees/Ea ratio in HFrEF were in descending order: RV EF, RV EDV, PA systolic/systemic systolic pressure ratio (PAs/SBP), PAWP, heart rate, PA compliance, RA mean pressure, PA mean pressure, BNP level, SBP, PAs, Tri Reg grade, Non-CAD etiology of HF, Mi Reg grade, PVR, RV dyssynchrony, absence of ACEi/ARB/S-V (GLM model, all p&amp;lt;0.001). RV Ees/Ea ratio correlated with PAs/SBP ratio, that reflects systolic ventricular interdependence. Invasive PAs/SBP predicted outcome and closely correlated with non-invasive estimation of PAs/SBP. Conclusion Despite having less PH and smaller RV, RV coupling is more impaired in HFrEF than in PAH due to absence of RV contractility enhancement. Higher RV volume, heart rate, tricuspid regurgitation, lower PA compliance, higher PAWP and systolic ventricular interdependence (PAs/SBP) are main determinants of RV PA decoupling in HFrEF. Elevated PA systolic pressure but low systemic BP (high PAs/SBP ratio) is associated with poor RV-PA coupling and prognosis. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): AZV NU20-02-00052, AZV NU21-02-00402

Hearing Loss and Cardiovascular Disease Risk Profiles: Data from the Hispanic Community Health Study/Study of Latinos.

Individual cardiovascular disease (CVD) risk factors (RFs) have been associated with hearing loss (HL). The relationship to aggregate risk is poorly understood and has not been explored in the Hispanic/Latino population. The aim of this study was to characterize the association between aggregate CVD RF burden and hearing among Hispanics/Latinos. Cross-sectional examination. Participants (18-74 years; n = 12,766) in the Hispanic Community Health Study/Study of Latinos. Thresholds (0.5-8 kHz) were obtained, and HL was defined dichotomously as pure-tone average (PTA0.5,1, 2,4) > 25 dB HL. Optimal CVD risk burden was defined as follows: systolic blood pressure (SBP) < 120 mm Hg and diastolic blood pressure (DBP) < 80 mm Hg; total cholesterol < 180 mg/dL; nonsmoking; and no diabetes. Major CVD RFs were diabetes, currently smoking, SBP >160 or DBP > 100 mm Hg (or antihypertensives), and total cholesterol > 240 mg/dL (or statins). Thresholds were estimated by age (18-44 and ≥45 years) and sex using linear regression. The association between CVD risk burden and HL was assessed using multivariable logistic regression. Models were adjusted for age, sex, Hispanic/Latino background, center, education, income, alcohol use, body mass index, and noise exposure. In the target population, 53.03% were female and 18.81% and 8.52% had all RFs optimal and ≥2 major RFs, respectively. Elevated BP (SBP 120-139 mm Hg or DBP 80-89 mm Hg) was associated with HL in females < 45 years (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.14-4.16). Diabetes (OR, 1.37; 95% CI, 1.01-1.84) and tobacco smoking (OR, 1.44; 95% CI, 1.03-2.01) were associated with HL in females ≥ 45 years. The odds of HL were higher for females ≥ 45 years with ≥2 RFs versus those with all RFs optimal (OR, 1.99; 95% CI, 1.12-3.53). Elevated BP (SBP 140-159 mm Hg or DBP 90-99 mm Hg), but not aggregate risk burden, was associated with HL in males ≥ 45 years (OR, 1.49; 95% CI, 1.02-2.19). No relationships with major CVD RFs were significant in males < 45 years. HL is associated with elevated BP in females < 45 years, with diabetes and hypertension in males ≥ 45 years, and with diabetes, smoking, and having ≥2 major CVD RFs in females ≥ 45 years. Future studies are needed to examine if these factors are associated with incident HL.

Circadian Blood Pressure Profile in Pediatric Patients with Primary Hypertension

Our study aimed to evaluate factors affecting circadian BP profile and its association with hypertension-mediated organ damage (HMOD) in pediatric patients with primary hypertension (PH). The study included 112 children (14.7 ± 2.1 age, 79 boys, 33 girls) with untreated PH. Non-dipping was defined as a nocturnal drop in systolic or diastolic BP (SBP, DBP) < 10%, and a nocturnal drop >20% was defined as extreme dipping. The nocturnal SBP drop was 10.9 ± 5.9 (%), and the DBP drop was 16.2 ± 8.5 (%). Non-dipping was found in 50 (44.6%) children and extreme dipping in 29 (25.9%) patients. The nocturnal SBP decrease correlated with BMI Z-score (r = −0.242, p = 0.010) and left ventricular mass index (LVMI) (r = −0.395, p = 0.006); diastolic DBP decrease correlated with augmentation index (AIx75HR) (r = 0.367, p = 0.003). Patients with a disturbed blood pressure profile had the highest LVMI (p = 0.049), while extreme dippers had the highest augmentation index (AIx75HR) (p = 0.027). Elevated systolic and diastolic BP dipping were risk factors for positive AIx75HR (OR 1.122 95CI (1.009–1.249) and OR 1.095 95CI (1.017–1.177). We concluded that disturbed circadian BP profile was common in children with PH and should not be considered a marker of secondary hypertension. A disturbed circadian BP profile may be associated with higher body weight. In pediatric patients with PH, non-dipping is associated with increased left ventricular mass, and extreme dipping may be a risk factor for increased arterial stiffness.

Abstract 086: Impact Of Ambulatory Blood Pressure Monitoring On Hypertension Diagnosis In Primary Care

Introduction: Hypertension (HTN) screening guidelines recommend using ambulatory blood pressure monitoring (ABPM) to exclude white coat HTN prior to newly diagnosing HTN. Yet, little is known about the impact of ABPM testing on HTN diagnosis decisions in primary care. Unfamiliarity with how to interpret ABPM results could lead to overtreatment or diagnostic inertia, the failure to diagnose a disease despite clinical evidence. Methods: We examined medical records of primary care patients with elevated office BP (≥140/90 mmHg) who were referred to an ABPM testing service. Patients were eligible for analysis if they were ≥18 years old, had elevated office BP without a HTN diagnosis and not prescribed BP medications, were referred by a primary care clinician from clinics affiliated with Columbia University Medical Center, and completed ABPM testing between 2016-2019. Using mean awake BP of 135/85 mmHg as the threshold for elevated ABPM, we compared the BP testing outcome (white coat HTN, in which only office BP was elevated, or sustained HTN, in which both office and ambulatory BP were elevated) to the physician’s action at the subsequent scheduled primary care visit (diagnosed or did not diagnose HTN per manual review of electronic medical records). Results: Overall, 111 patients with newly elevated office BP completed ABPM testing during the analysis period. Patients were referred by 60 physicians (50% trainees) from 6 clinics. Patients had a mean (SD) age of 53 (15) years; 73% were women. Fifty-nine patients (53%) had white coat HTN, and 52 (88%) were not diagnosed with HTN at their next primary care visit. The remaining 52 patients (47%) had sustained HTN, and 44 (85%) were diagnosed with HTN at their next visit. Medication was started for 31 of these 44 (70%). Overall, physicians diagnosed HTN concordantly with ABPM results for 96/111 patients (86%). Conclusions: More than half of primary care patients with elevated office BP referred for ABPM had white coat HTN. There was high concordance between ABPM results and physician HTN diagnoses, suggesting that ABPM reduces but does not eliminate overdiagnosis and diagnostic inertia in HTN. More research is needed to understand the reasons for discordance and how to optimize the implementation of ABPM testing into primary care.

Abstract 051: Exploiting Angiotensin Sensitive Vagal Afferents To Understand And Alleviate Hypertension: A Closed Loop System For Blood Pressure Control

Cardiovascular homeostasis is maintained by neural signals arising from arterial baroreceptors (BRs) that apprise the brain of vascular stretch. Here, we test the overall hypothesis that angiotensin-II (AngII) type 1a receptor expressing neurons within the nodose ganglia (NDG AT1aR ) serve as BR that undergo plasticity during chronic elevations in BP. We found that NDG AT1aR receive input from the aortic arch, project to the caudal nucleus of the solitary tract (cNTS), and synthesize Piezo-1/-2. AT1aR-GCaMP6s mice were used to determine whether NDG AT1aR couple their firing to elevated BP. Two-photon intravital imaging revealed that phenylephrine (PE; i.v.) increased GCaMP6s fluorescence within NDG AT1aR (ΔF/F max = 0.65±0.05*, Time ΔF/Fmax = 92s) and this response was delayed in mice given DOCA-salt (Time ΔF/Fmax = 124s) or chronic AngII (Time ΔF/Fmax = 155s). To determine if optical perturbation of NDG AT1aR affects the baroreflex, expression of excitatory channelrhodpsin2 (ChR2) or inhibitory halorhodopsin (Halo) was directed to AT1aR cells. Optical excitation of NDG AT1aR at their axon terminals in the cNTS elicited frequency-dependent decreases in BP (ΔSBP @ 0.5, 1, 2, 3 Hz = -6.74±3.42 # , -9.75±2.33 # , -23.24±4.39 # , -25.27±4.38 # ) and HR (ΔHR @ 0.5, 1, 2, 3 Hz = -7.81±3.14 # , -14.86±3.22 # , -23.39±5.02 # , -23.66±4.13 # ). Conversely, optical inhibition of NDG AT1aR at axon terminals in the cNTS blunted pressor responses to PE (ΔHR PE(Min) = -36.15±5.31, ΔHR PE+Light(Min) = -23.11±3.33 + ). ChR2-expressing mice were then subjected to DOCA-salt. Optical excitation elicited hypotensive (ΔSBP Min = -21.11±4.05 + ) and bradycardic (ΔHR Min = -235.6±46.69 + ) responses; however, the duration of these effects was altered. We developed a closed loop system to target NDG AT1aR at axon terminals in the cNTS of ChR2-expressing mice to determine if these neurons can be exploited to alleviate hypertension. Mice were subjected to acute and chronic stimuli to elevate BP and stimulated by the system until BP returned below threshold. Collectively, these studies reveal the structure and function of NDG AT1aR and suggest that such neurons may be exploited to discern and relieve hypertension. ( p &lt; 0.05, * time by treatment, # time by frequency, or + time by light interaction)

Abstract P242: Psychological Distress Related To Hypertension Diagnostic Testing And Diagnosis

Background: Little information is available as to whether undergoing hypertension diagnostic testing or receiving a new diagnosis of hypertension leads to psychological distress. Design, Setting, and Participants: BP CHECK was a randomized diagnostic study of 510 adults aged 18-85. Participants had elevated BP in clinic at baseline but no previously diagnosed hypertension. The trial was conducted from 2017 to 2019 in primary care centers of an integrated healthcare system. Participants were randomized to one of three diagnostic regimens: (1) Clinic BP, (2) Home BP, or (3) Kiosk BP. All participants completed 24-hour ambulatory blood pressure monitoring (ABPM) at 3 weeks. ABPM results were sent to participants and their primary care providers and uploaded into the electronic health record. This analysis includes a subset of participants (n=255) who completed psychological distress questionnaires at baseline, and at least one follow-up (after completing their diagnostic regimen and 6 months after randomization) Main Outcomes and Measures: The primary outcomes were within-person change in psychological distress (impact of events and state anxiety scales, BP worry Likert 5-point scale) comparing baseline to 3 weeks and 6 months post-enrollment. Results: Participants were half female (127/255), mostly &gt; age 50 (78%), and White race (83%). Baseline mean BP was 150 mmHg systolic and 80 mmHg diastolic; 63.9% had hypertension on ABPM (daytime average &gt; 135/85 mmHg). There was no significant change in impact of events or state anxiety at either follow-up. BP worry was significantly increased at 3 weeks (mean change 0.22 (0.13-0.30), but not at 6 months. Six month outcomes were not influenced by ABPM test results or receiving a hypertension diagnosis. Conclusion and Relevance: The hypertension diagnostic process increased hypertension worry short term, but not longer-term. It had little impact on other measures of psychologic distress. The risk of psychologic distress after hypertension diagnostic testing and receipt of a hypertension diagnosis appears to be low, reinforcing the importance of timely hypertension diagnoses. Additional studies with more diverse patient populations are needed.

Abstract P351: Prognosis Of Different Forms Of Resistant Hypertension

Resistant hypertension (RH) is related to increased risk for cardiovascular events. We aimed to evaluate the risk of total and cardiovascular mortality associated with RH in comparison to controlled hypertension, as well as in true versus “white-coat” RH. From the mortality data of the Spanish ABPM Registry, including 35119 treated patients, we identified 9408 RH, defined as office BP ≥ 140/90 mmHg while treated with ≥ 3 drugs (8577 patients), or treated and controlled (office BP &lt; 140/90 mmHg) with ≥ 4 drugs (831 patients). They were compared against 8144 patients treated with ≤ 3 drugs and having normal office BP. In addition, among 8577 patients with uncontrolled RH, 5288 (61.7%) had true RH (24-h BP ≥ 130/80 mmHg) and 3289 (38.3%) had “white coat” RH (24-h BP &lt; 130/80 mmHg). Median follow-up was 5 years. Total and cardiovascular mortality were assessed through death certificates. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated through Cox-proportional models, adjusted for age and sex. Table shows the number of patients in each group, number of total and cardiovascular deaths and HR of the 2 comparisons performed. Compared to treated and controlled patients, those with RH had and increased risk of total (19%) and cardiovascular (32%) mortality. Likewise, true RH had an increased risk of total (42%) and cardiovascular (81%) mortality, in comparison with “white-coat” RH. We conclude that RH is associated with and increased total and cardiovascular mortality. In RH patients with elevated office BP, the concomitant elevation of 24-hBP (true RH) is also associated with an increased risk of mortality when compared with those with normal 24-h BP (“white-coat” RH).

Abstract 081: Pulse Wave Velocity And Blood Pressure Variability As Prognostic Indicators In Very Elderly Patients With Advanced Chronic Conditions

The prognostic value of BP elevation in very old patients with other chronic comorbidities is uncertain. We aimed to assess the prognostic impact of 24-hour BP (both brachial and central), BP variability, and pulse wave velocity (PWV) in very elderly patients hospitalized due to a chronic disease decompensation. We included 249 patients older than 80 years, admitted to the hospital due to decompensation of congestive heart failure (149), chronic obstructive pulmonary disease (60), chronic kidney disease with acute kidney injury (26), or other decompensated chronic conditions (14). During hospital stay, 24-h BP monitoring was performed (Mobil-O-Graph PWV). Mean values of brachial and central BP, aortic PWV, and BP variability (24-hour SD) were obtained in all participants. After discharge, patients were followed-up for one year. The primary outcome was total mortality. Hazard ratio (HR) of BP estimates (for 1 SD increase) were obtained through Cox models, adjusted for clinical confounders. During follow-up 72 patients (29%) died. Progression of heart failure (58%) was the most frequent cause of death. No differences were observed in 24-h BP between those who died or remained alive. Systolic BP-SD, and PWV were higher in patients who subsequently died, while 24-hour HR- SD was lower (Table). In fully adjusted models, PWV (HR: 3.54; 95%CI: 2.37-5.28), SD of 24-h brachial systolic BP (1.29; 1.00-1.67) and SD of 24-h heart rate (0.65; 0.46-0.91) were associated with the risk of mortality. We conclude that PWV, SBP and heart rate variabilities, but not the level of BP are associated with mortality in very old patients with advanced chronic conditions

Sex, gender, and subclinical hypertensiveorgan damage-heart.

Hypertension-mediated organ damage (HMOD) at cardiac level include a variety of abnormal phenotypes of recognized adverse prognostic value. Although the risk of cardiac HMOD is related with the severity of BP elevation, the interaction of numerous non-hemodynamic factors plays a relevant role in this unfavorable dynamic process. In particular, sex-related differences in cardiovascular (CV) risk factors and HMOD have been increasingly described. The objective of the present review is to provide comprehensive, updated information on sex-related differences in cardiac HMOD, focusing on the most important manifestations of subclinical hypertensive heart disease such as left ventricular hypertrophy (LVH), LV systolic and diastolic dysfunction, left atrial and aortic dilatation. Current evidence, based on cross-sectional and longitudinal observational studies as well as real-world registries and randomized controlled trials, suggests that women are more at risk of developing (and maintaining) LVH, concentric remodeling and subclinical LV dysfunction, namely the morpho-functional features of heart failure with preserved ejection fraction. It should be pointed out, however, that further studies are needed to fill the gap in defining gender-based optimal therapeutic strategies in order to protect women's hearts.

Polycystic Ovary Syndrome: Insights from Preclinical Research.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, affecting approximately 10%. PCOS is diagnosed by the presence of at least two of these three criteria: hyperandrogenemia, oligo- or anovulation, and polycystic ovaries. The most common type (80%) of PCOS includes hyperandrogenemia. PCOS is also characterized by obesity or overweight (in 80% of US women with PCOS), insulin resistance with elevated plasma insulin but not necessarily hyperglycemia, dyslipidemia, proteinuria, and elevated BP. Although elevated compared with age-matched controls, BP may not reach levels considered treatable according to the current clinical hypertension guidelines. However, it is well known that elevated BP, even modestly so, increases the risk of cardiovascular disease. We have developed a model of hyperandrogenemia in rodents that mimics the characteristics of PCOS in women, with increases in body weight, insulin resistance, dyslipidemia, andproteinuria and elevated BP. This review discusses potential mechanisms responsible for the elevated BP in the adult and aging PCOS rat model that may be extrapolated to women with PCOS.

Hypertensive patients' knowledge and practices on lifestyle modification in Extension 6, Middelburg.

BackgroundHypertension (HTN) is one of the most common chronic diseases affecting the majority of patients worldwide, including in South Africa. The control of HTN and prevention of complications are major challenges for patients and healthcare workers. The proper control of the disease requires a multifactorial approach consisting of medical treatment, as well as lifestyle modification, with the assistance of healthcare workers. Addressing patients’ beliefs, the practice of lifestyle and acceptance of change are some of the ways of aiding control.MethodsThe researchers used a cross-sectional and descriptive survey to establish the knowledge and practices of lifestyle modifications in patients with hypertension. A validated questionnaire was adopted. A total of 250 participants from the Extension 6 Clinic in Middelburg, Mpumalanga, constituted the study population.ResultsMost of the participants had borderline high blood pressure (37.2%) or uncontrolled high blood pressure (46%). The participants’ knowledge of HTN and its complications was not adequate. The study established that increased age and long duration of HTN were associated with high numbers of uncontrolled HTN. Most of the participants (88.8%) had difficulty exercising. Also, most of the participants (90.8%) did not have a place or facility for exercises. Fifty per cent of the participants were unable to maintain a balanced healthy diet which included fruits and vegetables.ConclusionThe study explored the participants’ knowledge and practice of lifestyle modification. The participants lacked knowledge regarding the definition of HTN and the meaning of controlled HTN. To assist the patients and improve on the identified pitfalls, each consultation session should include some methods of education, and motivation for healthy behaviours and lifestyle modification. This should be extended to all the people visiting the health facilities for them to adopt a healthier diet, greater intake of vegetables and availability of fitness facilities for the community.