Prevalence Of Arterial Hypertension Research Articles

Undiagnosed arterial hypertension in a Latin American country, 2019 to 2021

To determine the factors associated with undiagnosed hypertension. A quantitative, observational, retrospective, cross-sectional and analytical study was carried out in people aged 15 years and over included in the Demographic and Family Health Survey from 2019 to 2021 in Peru. A statistical analysis was carried out using the corrected F test, and crude and adjusted prevalence ratio (aPR), with a 95% confidence interval (95%CI) for inferential analysis, through Poisson regression with robust variance. Likewise, the CSPLAN analysis was carried out for complex samples according to the sample design and taking into account the weighting factor. In the multivariate analysis, a significant association was found between the factors male sex (aPR: 1.22; 95%CI: 1.19-1.26), age from 30 to 49 years (aPR: 0.94; 95%CI: 0.92-0.96), native ethnicity (aPR: 1.07; 95%CI: 1.04-1.10), having health insurance (aPR: 0.91; 95%CI: 0.89-0.93), suffering from some permanent limitation (aPR: 0.83; 95%CI: 0.76-0.91) and diabetes mellitus (aPR: 0.59; 95%CI: 0.55-0.64). No significant association was found with educational level, language, Afro-Peruvian ethnicity, or alcohol or tobacco consumption (p > 0.05). The prevalence of undiagnosed arterial hypertension is high, 69.5%. The associated factors are male sex, native ethnicity, age between 30 and 49 years, having health insurance, suffering from some permanent limitation and having diabetes mellitus.

ARTERIAL HYPERTENSION AS A COMPONENT OF METABOLIC SYNDROME IN MEN IN AN OPEN URBAN POPULATION

Purpose. To determine blood pressure (BP) levels and the prevalence of arterial hypertension (AH), as a component of metabolic syndrome, in men of an open urban population aged 25–64 years. Materials and methods. A one-time epidemiological study was conducted on a representative sample of men 25–64 years old, formed from the electoral lists of citizens of the city of Tyumen in the amount of 1000 people, the response was 85.0%. To analyze the prevalence of AH as a component of the metabolic syndrome, the NCEP ATP III (2004), IDF (2005), All-Russian Scientific Society of Cardiology (2009) assessment criteria were used. Results. The levels of systolic BP in men of the Tyumen population were high due to the average age groups of 35–44 and 45–54 years; in the same groups there was a significant increase in the average values and percentile distribution of the trait. According to the levels of diastolic BP in men of the Tyumen population, a directional age trend of the indicator was formed with a significant increase in its levels in each subsequent age group. In terms of the prevalence of AH, the standardized indicator in the male population of Tyumen 25–64 years old was 59.8%; a positive relationship was established with age in the younger and older age categories. Conclusion. Thus, the study results obtained in an open urban population, which identified the most vulnerable age categories of men with regard to the development of metabolic syndrome, represent a scientific basis for the formation of a preventive program in the region.

Significance of Hypoalbuminemia in the Development of Thromboembolic Complications in Severe Cases of SARS-CoV-2 Coronavirus Infection.

The course of coronavirus disease 2019 (COVID-19) is associated with the progression of a wide range of complications, among which thrombosis and thromboembolism are of particular importance. The significance of hypoalbuminemia in the development of thromboembolic complications (TECs) in patients with a severe course of COVID-19 is currently under active discussion. The objective of our study was to evaluate the significance of hypoalbuminemia in the development of TECs in patients with severe SARS-CoV-2 coronavirus infection. In a single-center observational retrospective study, case histories of 1,634 patients with a verified diagnosis of SARS-CoV-2 coronavirus infection were analyzed. Patients were divided into two groups according to the presence of TECs: 127 patients with venous TECs constituted the main group and 1,507 patients, in whom the course of COVID-19 was not complicated by the development of TECs, constituted the comparison group. The patients with TECs were older, and the prevalence of arterial hypertension, coronary heart disease, chronic heart failure, chronic kidney disease, and diabetes mellitus was higher than that in the comparison group. A single-factor regression analysis showed that a decrease in albumin levels of less than 35 g/L is associated with an eightfold increase in the risk of developing TECs in patients with severe SARS-CoV-2 coronavirus infection (area under the curve (AUC): 0.815, odds ratio (OR): 8.5389, 95% confidence interval (CI): 4.5637 - 15.977, P < 0.001). The sensitivity of the method was 76.34%, and the specificity was 72.58%. The study revealed that hypoalbuminemia is a predictor of development of TECs in severe cases of SARS-CoV-2 coronavirus infection.

Prevalence of risk factors for development of cardiovascular diseases in urban and rural areas of Eastern Croatia: a cross-sectional study.

Cardiovascular diseases are the leading global cause of death. Due to the disparities in cardiovascular risk factors between rural and urban populations, this study aims to assess the differences in the prevalence of risk factors in urban and rural areas of eastern Croatia. The cross-sectional study included 280 participants (140 from urban and 140 from rural areas) registered at studied general practice offices. Methods included e-health records, questionnaire, physical examination methods, and blood sampling for laboratory tests. The most common risk factors among participants were elevated total cholesterol (83.6%), elevated LDL cholesterol (81.8%), increased body mass index (75.0%), increased waist-hip ratio (82.9%), increased waist circumference (63.2%), and arterial hypertension (70.1%). The rural participants had a significantly higher prevalence of arterial hypertension (p = 0.023), increased body mass index (p = 0.004), increased waist circumference (p = 0.004), increased waist-hip ratio (p < 0.001), and increased LDL cholesterol (p = 0.029), while the urban participants had a significantly higher prevalence of insufficient physical activity (p < 0.001). In the examined sample, the prevalence of cardiovascular risk factors is generally high. Participants from rural areas are significantly more susceptible to cardiovascular risk factors than participants from urban areas.

Letter to the editor regarding "Prevalence of arterial hypertension in hospitalized pediatric patients"

Letter to the editor regarding "Prevalence of arterial hypertension in hospitalized pediatric patients"

Prognostic role of mesangial IgM deposition in IgA nephropathy: a long-term cohort study

Background The clinical significance of mesangial immunoglobulin (Ig) M deposition in IgA nephropathy (IgAN) has been less explored and remains a topic of debate. Therefore, our study aimed to investigate the prognostic value of mesangial IgM deposition in a long-term follow-up cohort of IgAN patients. Methods A unicentric retrospective study was conducted on 93 consecutive IgAN patients (median age 41 years, 68% male, eGFR 48.7 mL/min, proteinuria 1.1 g/g) from 2010 to 2015. They were followed until end-stage kidney disease (ESKD), death, or until the end of the study in January 2021, with a median follow-up of 7 years. An independent pathologist evaluated the IgM immunofluorescence pattern, Oxford MEST-C score, and transmission electron microscopy (TEM) lesions following a comprehensive protocol. Results In our cohort, 70% had mesangial IgM-positive deposits, while 30% were IgM-negative. Both groups were similar in age, sex, prevalence of arterial hypertension, Charlson comorbidity scores, kidney function (eGFR and proteinuria), pathology findings (Oxford MEST-C score, IgG and C3 immune deposition), and TEM analysis. Treatment with RASI and immunosuppression, and death rates were also comparable. However, 37% of IgM-positive patients progressed to ESKD, significantly higher than the 11% in the IgM-negative group. Univariate and multivariate Cox proportional hazards regression analyses identified lower eGFR, higher Oxford MEST-C score, and mesangial IgM deposits as independent factors associated with shorter kidney survival. Conclusions Our study highlights mesangial IgM deposition as a potential risk factor for ESKD in patients with advanced IgAN, laying a foundation for further research in this area.

Therapeutical Approach to Arterial Hypertension - Current State of the Art.

Arterial hypertension (AH) is recognized as the most common illness within the group of cardiovascular diseases and the most massive chronic non-infectious disease in the world. The number of hypertensive patients worldwide has reached 1.28 billion, contributing to an increase in cardiovascular diseases and premature death globally. The high prevalence of hypertension emphasizes the importance of effectively treating this condition. Elevated blood pressure often leads to lethal complications (heart failure, stroke, renal disorders, etc.) if left untreated. Considering an increase in AH prevalence in the future, a successful therapeutical approach to this disease and its complications is essential. The goal of AH treatment is to maintain normotensive blood pressure through various approaches, including lifestyle changes, a well-balanced diet, increased physical activity, psychoeducation, and, when necessary, pharmacotherapy. The evolving pharmacotherapeutic landscape reflects the progress made in our understanding of hypertension and emphasizes the need for continuous innovation to meet the challenges posed by this prevalent global health concern. The journey toward more effective and tailored treatments for hypertension is ongoing, and the introduction of new medications plays a pivotal role in shaping the future of antihypertensive pharmacotherapy.

Management and outcomes of spontaneous coronary artery dissection: a systematic review of the literature.

Contemporary management of spontaneous coronary artery dissection (SCAD) is still controversial. This systematic review of the literature aims to explore outcomes in the patients treated with conservative management vs. invasive strategy. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed when we extensively searched three electronic databases: PubMed, ScienceDirect, and Web of Science, for studies that compared conservative vs. invasive revascularization treatment outcomes for patients with SCAD from 2003 to 2023. The outcomes of interest were all-cause death and major adverse cardiovascular events (MACE), including acute coronary syndrome (ACS), heart failure (HF), need for additional revascularization, target vessel revascularization (TVR), SCAD recurrence, and stroke. The systematic review included 13 observational studies evaluating 1,801 patients with SCAD. The overall mean age was 49.12 +/- 3.41, and 88% were females. The overall prevalence of arterial hypertension was 33.2%, hyperlipidemia, 26.9%, smoking, 17.8%, and diabetes, 3.9%. Approximately 48.5% of the patients were diagnosed with non-ST elevated myocardial infarction (NSTEMI), 36.8% with ST elevated myocardial infarction (STEMI), 3.41% with unstable angina, 0.56% with stable angina, and 0.11% were diagnosed with various types of arrhythmias. The left anterior descending artery (LAD) was the most common culprit lesion in 51% of the patients. There were initially 65.2% of conservatively treated patients vs. 33.4% that underwent percutaneous coronary intervention (PCI) or 1.28% that underwent coronary artery bypass graft (CABG). SCAD-PCI revascularization was associated with a variable range of PCI failure. The most common complications were hematoma extension and iatrogenic dissection. SCAD-PCI revascularization frequently required three or more stents and had residual areas of dissection. The overall reported in-hospital and follow-up mortality rates were 1.2% and 1.3%, respectively. The follow-up range across studies was 7.3-75.6 months. The authors reported variable prevalence of MACE, recurrent SCAD up to 31%, ACS up to 27.4%, TVR up to 30%, repeat revascularization up to 14.7%, UA up to 13.3%, HF up to 17.4%, and stroke up to 3%. Our results highlight that conservative treatment should be the preferred method of treatment in patients with SCAD. PCI revascularization is associated with a high prevalence of periprocedural complications. SCAD poses a considerable risk of MACE, mainly associated with TVR, ACS, and recurrent SCAD.

Conn´s syndrome after kidney transplantation.

Conn's syndrome, defined as unilateral aldosterone-producing adenoma, accounts for 35-40% of cases of primary hyperaldosteronism. Primary hyperaldosteronism typically occurs in younger patients with poorly controlled arterial hypertension due to extracellular fluid retention, in whom at least atriple combination of antihypertensives, including adiuretic, is needed to maintain normotension. The clinical picture of arterial hypertension may be complemented by symptoms associated with hypokalaemia, such as weakness, fatigue, palpitations, convulsions, polydipsia, or polyuria. In addition to arterial hypertension and hypokalaemia, the diagnosis of Conn's syndrome relies on examination of serum renin and aldosterone concentrations, plasma renin activity, exercise or furosemide stimulation tests, and imaging studies, preferably computed tomography. The method of treatment of Conn's syndrome is adrenalectomy. In patients with primary hyperaldosteronism with underlying bilateral adrenal cortical hyperplasia or patients contraindicated for surgery, mineralocorticoid receptor antagonists are administered in combination with antihypertensives targeted for optimal blood pressure control.In the group of patients after kidney transplantation, the exact incidence of primary hyperaldosteronism is unknown. Based on across-sectional study performed in 2020, it is estimated to be approximately 15% in the group of patients with unsatisfactorily compensated arterial hypertension; in the cohort of normotensive recipients, the incidence of primary hyperaldosteronism is not documented. Diagnosis of Conn's syndrome in patients in the early period after kidney transplantation is problematic, as the prevalence of arterial hypertension in transplanted patients is high (70-90%) according to the literature. Mineral abnormalities, including hypokalaemia, are also common in the early post-transplant period, mainly due to factors such as duration of cold ischaemia, onset of graft function, donor parameters, post-transplant tubulopathy, and diuretics, the effects of immunosuppressive drugs (especially calcineurin inhibitors and corticosteroids), and possibly potassium-restricted dietary habits that the patient brings from the pre-transplant period, which may mask the effect of hyperaldosteronism on potassium.We present the case of apatient who was diagnosed with Conn's syndrome 7 months after primary kidney transplantation from adeceased donor based on persistent hypokalaemia unresponsive to replacement therapy. At the time of the first manifestation of severe hypokalaemia, the patient was treated with adual combination of antihypertensives (amlodipine at adaily dose of 5 mg and carvedilol at adaily dose of 50 mg), without the need for adiuretics.We consider the case interesting because the spectrum of mineral and acid-base abnormalities in advanced renal failure and in the early post-transplant period, as well as acid-base and mineral imbalances, including hypokalaemia, and the high prevalence of arterial hypertension in the post-transplant period, may mask the picture of Conn's syndrome (Fig. 3, Ref. 19). Text in PDF www.elis.sk Keywords: kidney transplantation, primary hyperaldosteronism, hypokalaemia, metabolic alkalosis, secondary arterial hypertension.

Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Embolism in SARS-CoV-2

Introduction: Chronic thromboembolic pulmonary disease (CTEPD) consists of persistent pulmonary vascular obstruction on imaging and involves long-term functional limitations, with or without chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to evaluate the incidence and risk factors of both persistent pulmonary vascular defects and CTEPH after hospitalization in patients with COVID-19 and PE during a 2-year follow-up. Methods: A prospective observational study was carried out in a tertiary hospital center. Patients were hospitalized between March 2020 and December 2021 with a diagnosis of PE during SARS-CoV-2 infection. Patients received anticoagulant treatment for at least 3 months and were followed up for 2 years. Between the third and fourth months after discharge, all patients were evaluated for the presence of residual thrombotic defects by CTPA and/or perfusion pulmonary scintigraphy. Clinical findings, lung function tests with DLCO, exercise capacity, and echocardiograms were also assessed. Results: Of the 133 patients included, 18% had persistent thrombotic defects on lung imaging at follow-up. The incidence of CTEPD was 0.75% at 2 years of follow-up. Patients with persistent defects were significantly older, had a higher prevalence of systemic arterial hypertension, higher D-dimer and NT-proBNP levels, and more severe PE at diagnosis. Furthermore, there was a higher prevalence of right ventricular dysfunction on echocardiogram at diagnosis of PE (25.0% vs. 2.7%, p = 0.006). This was the only variable independently related to persistent defects in multivariate analyses (OR: 8.13 [95% CI: 1.82–36.32], p = 0.006). Conclusion: The persistence of thrombotic defects after PE is a common finding after SARS-CoV-2 infection, affecting 18% of the population. However, the incidence of CTEPH appears to be lower (0.75%) in COVID-19-related PE compared to that previously observed in PE unrelated to COVID-19.

INVESTIGATING PREVALENCE OF ARTERIAL HYPERTENSION AS HIGH-RISK FACTOR IN PATIENTS WITH CORONARY HEART DISEASE ELIGIBLE FOR OFF-PUMP CORONARY BYPASS

The aim of the study was to analyze the prevalence of arterial hypertension in patients with coronary heart disease eligible for coronary bypass surgery on a working heart.&#x0D; Participants and methods. This study included 991 patients (786 men, 205 women) whose average age was 64.3 ± 1.4, the variation range of age was from 39 to 84 years. All study participants underwent coronary bypass surgery on a working heart. The design of the article is based on the analysis of the frequency of arterial hypertension in different clinical groups: with one-, two- and multi-vessel lesions of the coronary arteries.&#x0D; Results. The prevalence of arterial hypertension as a leading cardiovascular risk factor for ischemic heart disease after surgical treatment by performing coronary bypass surgery on a working heart was studied. We analyzed the prevalence of arterial hypertension in all clinical groups of the study as one of the leading factors that aggravate the course of coronary heart disease. Under a prolonged history of the disease, arterial hypertension has the potential to impact the structure of coronary arteries, leading to the formation of "tortuous vessels" i. e. structural changes in the coronary arteries that rise a number of question for the cardiovascular surgeons, determining the choice of tactics of surgical treatment of coronary heart disease.&#x0D; It was established that the frequency of arterial hypertension as a concomitant pathology in ischemic heart disease, is significantly higher in clinical groups with two- and multi-vessel lesions of the coronary arteries, mainly among male patients. It was also found that myocardial infarction occurred significantly more often in patients with coronary heart disease in the clinical group with multi-vessel lesions compared to its frequency in the clinical groups with one- and two-vessel lesions of the coronary arteries.&#x0D; Conclusion. Arterial hypertension patients with coronary heart disease presented for coronary bypass surgery on a working heart is a quite prevalent comorbidity, the frequency of which is higher among male patients and in clinical groups with multi-vessel lesions of the coronary arteries (lesions ≥ 3).

To estimate prevalence of pulmonary arterial hypertension in HIV patients and its association with CD4 cell count

IntroductionHIV infection is considered as one of the leading infectious cause of pulmonary arterial hypertension (PAH) and it exhibits higher rate of development of this condition than general population. The prevalence of HIV associated PAH has not been established accurately and varies based on factors such as geographical distribution, gender, duration of HIV and ART etc. This study aims to estimate the prevalence of PAH in HIV infected patients who are on first line ART and to study the association of PAH with CD4 count and viral load. MethodsThis cross-sectional study was conducted on 150 HIV positive patients who visited medical OPD and ART centre, JLN medical college and hospital, Ajmer and were above 18 years of age and were on first line ART. PAH was identified through transthoracic doppler echocardiographic screening and systolic pulmonary artery pressure (sPAP) estimation of more than 35 mmHg was used to diagnose PAH. ResultIn this study, out of 150 patients, PAH was diagnosed in 12 patients and hence the prevalence of PAH came out to be 8 % (95 % CI: 3.65; 12.34). Significant association of PAH has been observed with viral load (p value = 0.04). While no significant association has been found between PAH and CD4 count. ConclusionPAH in HIV patients was found to be 8% which is considerably higher than the already established global prevalence. Hence, PAH should be an important consideration for clinicians in differential diagnosis of dyspnea in HIV patients.

Head-to-head comparison of two embolic protection devices in carotid artery stenting

Abstract Introduction Embolic protection devices (EPD) have been developed to reduce the risk of distal embolization and have become ubiquitous in carotid interventions. There are two classes of EPD: distal filter EPD (f-EPD) and proximal EPD (p-EPD). However, the best device for carotid artery stenting (CAS) has yet to be established. Purpose We aimed to assess and compare the early prognosis between the f-EPD and p-EPD groups in patients undergoing CAS. Methods Single-center, retrospective study. Patients who underwent CAS from 2000 to 2022 were included. The composite of transient ischemic attack(TIA)/stroke and death at 24 hours and 30 days were evaluated. Statistical analysis was performed using SPSS 28.0.1.1 software. Results A total of 436 patients were included (380 and 56 patients used f-EPD and p-EPD, respectively). The population's mean age (±SD) was 71,8 (±8,2) years, 74,8% men. There was a significant prevalence of arterial hypertension (88,3%), dyslipidemia (75,9%), diabetes (33,9%), and smoking background (25,9%). Regarding baseline clinical characteristics, arterial hypertension was more prevalent in the f-EPD group, with statistical significance (91,7% vs. 78,8%; p=0,003). Concerning the indications for carotid intervention, 16,1% of patients were asymptomatic but had severe stenosis, and 39,4% had neurological symptoms. In 41,9% of patients, the procedure was accomplished before cardiac surgery (coronary artery bypass graft or valvular surgery). Regarding the first 24 hours after the procedure, the combined endpoint of TIA/stroke or death occurred in 3,4% of patients in the f-EPD group and 3,6% in the p-EPD group, with no statistically significant difference (p=1,000). The incidence of TIA/stroke was also similar in both groups (3,2% and 3,6% in the f-EPD and p-EPD groups, respectively; no statistical difference was found; p=0,694). The early mortality rate was slightly lower in the f-EPD group (0,8%) compared with the p-EPD group (1,8%), though this difference did not reach statistical significance (p=0,424). During the 30-day follow-up, the combined endpoint of TIA/stroke or death occurred in 1,6% of patients in the f-EPD group and 1,8% in the p-EPD group, with no statistically significant difference (p=1,000). The incidence of TIA/stroke was lower in the f-EPD group (1,1%) compared to the p-EPD group (1,8%), however, no statistical difference was found (p=0,499). Regarding mortality rate, the incidence in the f-EPD group was 0,5%, in contrast with no events in the p-EPD group (statistical analysis not possible to compute). Conclusion In this cohort, no significant differences were found between the distal filter and proximal embolic protection devices in the risk of TIA/stroke and death at 24 hours and 30 days after carotid artery stenting. However, conclusions should be carefully drawn since the distal filter EPD was used more often than the proximal EPD, making direct comparisons challenging.

Abstract 12562: DYRK1A/PPARG/EGR1 Pathway Elicits Endothelial Dysfunctions and Predispose to Developing Pulmonary Hypertension in Down Syndrome

Introduction: Patients with Down syndrome (DS) have a higher prevalence of pulmonary arterial hypertension (PAH). Pulmonary vascular endothelial dysfunction has been recognized to be one of the predisposing factors to develop PAH, but pathophysiology of pulmonary endothelial cells in DS specific PAH is still unknown. Hypothesis: Endothelial dysfunctions contribute to developing PAH in DS. Methods: Induced pluripotent stem cell-derived vascular endothelial cells (iPSC-ECs) from DS patients were utilized for analyzing cellular and mitochondrial functions. A Cre-loxP mediated isogenic correction line of disomy 21 was established and used as a control. Results: DS-iPSC-ECs showed increased apoptosis, reduced angiogenesis, increased mitochondrial reactive oxygen species, and decreased ATP production, which were all consistent with features of endothelial dysfunctions previously reported in other types of PAH. RNA-seq revealed increased expression of EGR1 in DS-iPSC-ECs, and its inhibition restored cellular and mitochondrial dysfunctions, demonstrated by si EGR1 and pioglitazone treatment. Moreover, we revealed that increased expression of DYRK1a , one of the major pathogenic genes in DS critical region on chromosome 21, led to elevated EGR1 expression thorough PPARG suppression. These experimental results were reinforced by the observations that pulmonary ECs of a DS patient with severe PAH also exhibited increased EGR1. Conclusions: DYRK1A/PPARG/EGR1 pathway in DS is responsible for endothelial dysfunctions and might be a new therapeutic target for DS specific PAH.

Comparative analysis of methods for evaluating myocardial hypertrophy in children with arterial hypertension

Relevance: over the past decades, the prevalence of arterial hypertension (AH) in the pediatric population has increased significantly, but there are still many open questions related to the diagnosis and course of the disease, the validity of the choice of antihypertensive therapy and the risks of target organ injury. In clinical practice, patients with hypertension are observed by a team of specialists of various profiles, and a unified approach to managing the disease is not always formed between them. Underestimation of risk factors, late detection of target organ injury and untimely start of antihypertensive therapy significantly increase the risks of an unfavorable, progressive course of the disease, aggravating the further prognosis. Strict adherence to the methods of diagnosing the disease and its potential consequences recommended by the professional community of pediatric cardiologists ensures an adequate initiation of drug therapy, which allows not only to control the course of hypertension, but also to prevent the development of long-term complications. Objective: to analyze the indicators obtained using the formula recommended by pediatric cardiologists compared to the routine method for detecting left ventricular myocardial remodeling in children with AH. Materials and methods: a cross-sectional, cohort, non-randomized study, which included 92 patients with newly diagnosed primary arterial hypertension, who were not receiving antihypertensive therapy at the time of the examination. The standard linear dimensions of the walls and cavities of the heart were assessed during echocardiography. The results were evaluated by the standard Fisher’s test, the xi2 test in the Statistica 9 software. The sample excluded children-athletes, patients with secondary hypertension, overweight, congenital heart disease and cardiomyopathy. All children were tested the same according to the current Federal Clinical Guidelines “Diagnosis and treatment of arterial hypertension in children and adolescents”. Results: the usage of the recommended formula is not only significantly more often allowed to identify the early stages of LV myocardial hypertrophy, but has great sensitivity. The routine method for calculating LV remodeling showed the norm much more often even in case of severe violation of the geometry of the heart. Conclusion: untimely detection of LV myocardial hypertrophy leads to late initiation of antihypertensive therapy, underestimation of risk factors, which increases the risk of an unfavorable course of the disease and the occurrence of long-term cardiovascular complications at a young age.

OR06-04 Environmental Pollutants Perfluoroalkyl Acids Potently Stimulated Aldosterone Biosynthesis

Abstract Disclosure: B. Caroccia: None. T.M. Seccia: None. G. Pallafacchina: None. M. Piazza: None. I. Caputo: None. R. Rizzuto: None. G. Rossi: None. A large environmental contamination of drinking water by perfluoroalkyl substances (PFAS) markedly increased by 8-fold the plasma levels of pentadecafluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) in a Northern Italy population with that shows a high prevalence of arterial hypertension and cardiovascular disease. As the link between PFAS and arterial hypertension is unknown, we investigated if they could enhance the biosynthesis of aldosterone, the main mineralocorticoid hormone that has pressor effects. We exposed human adrenocortical carcinoma HAC15 cells to 1 µM or 10 µM concentration of PFOA and PFOS, alone or in combination, for 24, 48 or 72 hours and we measured changes in cell viability, aldosterone synthase (CYP11B2) mRNA, cell and mitochondrial reactive oxygen species (ROS), and aldosterone production in the absence or presence of the superoxide scavenger tempol. Experiments were also performed in the presence of 10 or 100 nM Ang II. We found that PFAS increased CYP11B2 mRNA by 3-fold and aldosterone secretion and mitochondrial ROS production by 2-fold over controls (p &amp;lt; 0.01 for all). PFAS also enhanced the effects of the aldosterone secretagogue Ang II on CYP11B2 mRNA and aldosterone secretion: 10 nM or 100 nM Ang II increased CYP11B2 mRNA by 12- and 52-fold, respectively, compared to vehicle (p &amp;lt; 0.001). Moreover, 1 µM PFAS potentiated the effect of 10 nM or 100 nM Ang II on CYP11B2 gene expression by 30- and 80-fold, respectively (p &amp;lt; 0.001). As the ROS scavenger tempol, which decreased ROS, significantly blunted the CYP11B2 gene expression induced by either PFAS alone, or by concomitant exposure to Ang II and PFAS, the effect of PFAS likely occurs via increased ROS generation. These results indicate that at concentrations mimicking those found in human plasma of exposed individuals, PFAS exert a prooxidant effect and act as potent disruptors of human adrenocortical cell function, thus implicating them as causative factors of human arterial hypertension due to aldosteronism. Presentation: Thursday, June 15, 2023

FRI124 Insights From The Incidence Of Primary Aldosteronism In Patients With Hypokalemia (IPAHK+) - Study

Abstract Disclosure: S. Gruber: None. E. Stasi: None. A. Boan Pion: None. R. Steiner: None. I. Sudano: None. F. Beuschlein: None. Background: Hypokalemia plays an important role in the diagnosis and management of primary aldosteronism (PA). The hypokalemic variant of the disease accounts for about one third of all cases. However, little is known about the incidence of PA in a hypokalemic population. Design: The IPAHK+ study is an epidemiological, monocentric, cross-sectional trial to provide evidence on the incidence of PA in a hypokalemic outpatient population. Methods: Recruitment of outpatients with hypokalemia ≤3 mmol/l is carried out on a continuous referral-basis through an automated data delivery system at the University Hospital Zurich (USZ). Todate, 69 patients underwent the study protocol, which includes guideline-compliant workup for PA. Results: The mean age of the participants was 52.5±1.5 years with a sex ratio of 35:34 women to men, a mean potassium value of 2.77±0.03 mmol/l [1.8; 3.0] and a prevalence of arterial hypertension of71%. PA was diagnosed in 45.9% of all participants, all of whom had a history of hypertension. The incidence of PA increased continuously with decreasing potassium level with proportions of 26.7%,45.8% and 59.1% in the subgroups of 3.0 mmol/l (n=15), 2.8-2.9 (n=24) and ≤2.7 mmol/l (n=22),respectively. In the subgroup of hypertensives the incidence of PA was as high as 65.1%. Prior testing,60.9% of all patients presented at least with one plausible other cause for their hypokalemia with potential drug triggers accounting for the largest portion (33.3%). Among participants on diuretics the incidence of PA was 57.9%. Conclusions: The incidence of PA in the investigated outpatient population was more than 4 out of 10and inversely correlated with baseline potassium levels. Moderate or severe hypokalemia, regardless of its cause, should therefore prompt evaluation for PA in hypertensive individuals. Normotensive PA was not observed in our cohort. The significance of the study is limited by the still low number of enrolled patients with a potential selection bias. Presentation: Friday, June 16, 2023

Prevalence of pulmonary arterial hypertension in post-tuberculosis lung fibrosis patients: A cross-sectional observational study

Introduction: Post-tuberculosis (TB) lung fibrosis is an infrequently reported cause of Pulmonary arterial hypertension (PAH). Pulmonary TB still being an important global health problem, especially in developing countries, PAH developing after pulmonary TB deserves attention. This study was undertaken to know the prevalence of PAH among patients with post-TB lung fibrosis. Methods: A cross-sectional observational study was carried out in two tertiary care hospitals in Kolkata over a period of 1 year. Sixty adult post-TB lung fibrosis patients without any cardiovascular or other pulmonary comorbidities were included in this study. Results: Out of the 60 patients with varying degrees of lung fibrosis confirmed radiologically, eight patients were found to have PAH (13.33% of the study population). Among the eight cases, six were males and two were females. Five of the males were smokers with a mean of 17.6 pack years of smoking. Out of the eight diagnosed PAH cases, three were mild PAH, four were moderate, and one case had severe PAH (grading based on 2D echocardiography findings). Pulmonary function test (PFT) revealed obstructive pattern in three cases, restrictive pattern in three cases, and mixed in two cases. On PFT, smokers with PAH exhibited obstructive pattern and mixed pattern, whereas the nonsmoker PAH cases exhibited restrictive pattern. Conclusion: All post-TB lung fibrosis cases must be followed up at regular intervals and screened to rule out PAH. Early diagnosis and prompt treatment of the cases will help to reduce morbidity and mortality of the disease which otherwise has a poor prognosis.

Prevalence, patient characteristics and treatment patterns among SLE-PAH patients in real-world clinical practice: A retrospective analysis of Medical Data Vision Database in Japan.

Real-world evidence regarding prevalence, patient characteristics and treatment patterns for pulmonary arterial hypertension (PAH) related to systemic lupus erythematosus (SLE) in Japan is limited. We conducted a retrospective study analysing Japan's Medical Data Vision (MDV) database from April-2008 to September-2020. Prevalence, incidence, patient characteristics, treatment patterns and use of vasodilators by treatment line were evaluated. Prevalence of PAH was 0.392% in SLE patients (n=114/29,077). Cumulative incidence was 0.53% (3-years (y)) and 0.77% (5y). Of 114 SLE-PAH patients, 49% developed PAH <1 year from SLE diagnosis. SLE-PAH patients were more female (88% vs. 72%), had lower mean age at SLE diagnosis (53y vs. 56y) and more severe SLE (61% vs 25%), versus non-PAH SLE patients. Glucocorticoids (58%) and vasodilators (27%) were preferred first-line monotherapy for SLE-PAH. Glucocorticoids+immunosuppressants (19%) was predominant first-line combination therapy. Endothelin receptor antagonists (40% and 44%) and nitric oxide analogues (31% and 40%) were dominant first- and second-line vasodilators. SLE-PAH patients were more females, younger at diagnosis, had more severe SLE than non-PAH SLE patients. Most were diagnosed <1 year of SLE diagnosis. In Japan's real-world practice, initial treatment goal is SLE management, while vasodilators are preferred in advanced disease, as per MDV database.

Prevalence of arterial hypertension in pediatric hospitalized patients

Prevalence of arterial hypertension in pediatric hospitalized patients