Prevalence Of Hypertension In Patients Research Articles

Prevalence of Hypertension in Patients with Type-2 Diabetes Mellitus

Background: Hypertension contributes enormously to the global disease burden and mortality. The prevalence of hypertension among type 2 diabetes mellitus (DM) patients is higher than that of age- and sex-matched patients without diabetes, ranging from 32% to 82%. Diabetes mellitus is a global health issue, about 9% of adults have diabetes, and an estimated 1.5 million people die due to diabetes worldwide each year. Increasing age, trend of obesity and worsening renal function increasing the prevalence of hypertension in people with type-2 diabetes mellitus. Objective: To assess the prevalence of hypertension in patients with type-2 diabetes mellitus. Methods: This was a cross-sectional study which was conducted in the Department of Medicine, 250 Beded Mohammad Ali Hospital, Bogura, Bangladesh during the period from January to December 2023. In total 100 patients with type-2 diabetes mellitus attended to the mentioned hospital with proper documents were finalized as the study people. Besides data regarding type 2 diabetes mellitus, data of blood pressure and macro-vascular as well as micro-vascular complications were collected. A predesigned questioner was applied to collect patient data. All data were processed, analyzed and disseminated by MS Office and SPSS version 20. Results: In this study, a total of 100 type-2 diabetic patients (56 male, 44 female) were observed. The mean age of the patients was 53.86 years with Standard deviation (SD) of ±11.54 years. The mean duration of diabetes mellitus was 7.08 SD ± 5.95 years. In analyzing the duration of type 2 diabetes among participant we observed 46%, 25%, 18% and 11 % participants suffered from T2DM for 1-5, 6-10, 11-15 and >15 years respectively. Finally, among total participants in analyzing the prevalence of hypertension we observed out of 100patients with T2DM only 32 were with hypertension which was 32%. On the other hand, in analyzing the stages of hypertension among total participants we found, 32% were with normal and pre-hypertension (in total 68%) respectively. On the other hand, among 32% hypertensive participants, 20% (n=20) were with stage I HTN whereas 12% (n=12) were with stage II HTN. Conclusion: In this study, the prevalence of hypertension among type 2 diabetes patients was found some higher than that in normal. But if we consider the number of pre-hypertensive patients as a potential concern, then it is alarming. The findings of this study may be helpful in the treatment arena of diabetes and in similar further studies.

Predicting the risk of hypertension using machine learning algorithms: A cross sectional study in Ethiopia.

Hypertension (HTN), a major global health concern, is a leading cause of cardiovascular disease, premature death and disability, worldwide. It is important to develop an automated system to diagnose HTN at an early stage. Therefore, this study devised a machine learning (ML) system for predicting patients with the risk of developing HTN in Ethiopia. The HTN data was taken from Ethiopia, which included 612 respondents with 27 factors. We employed Boruta-based feature selection method to identify the important risk factors of HTN. The four well-known models [logistics regression, artificial neural network, random forest, and extreme gradient boosting (XGB)] were developed to predict HTN patients on the training set using the selected risk factors. The performances of the models were evaluated by accuracy, precision, recall, F1-score, and area under the curve (AUC) on the testing set. Additionally, the SHapley Additive exPlanations (SHAP) method is one of the explainable artificial intelligences (XAI) methods, was used to investigate the associated predictive risk factors of HTN. The overall prevalence of HTN patients is 21.2%. This study showed that XGB-based model was the most appropriate model for predicting patients with the risk of HTN and achieved the accuracy of 88.81%, precision of 89.62%, recall of 97.04%, F1-score of 93.18%, and AUC of 0. 894. The XBG with SHAP analysis reveal that age, weight, fat, income, body mass index, diabetes mulitas, salt, history of HTN, drinking, and smoking were the associated risk factors of developing HTN. The proposed framework provides an effective tool for accurately predicting individuals in Ethiopia who are at risk for developing HTN at an early stage and may help with early prevention and individualized treatment.

Cardiovascular characterisation of a novel mouse model that combines hypertension and diabetes co-morbidities

Epidemiologic data suggest that the prevalence of hypertension in patients with diabetes mellitus is ∼1.5–2.0 times greater than in matched non-diabetic patients. This co-existent disease burden exacerbates cardiac and vascular injury, leading to structural and functional changes to the myocardium, impaired cardiac function and heart failure. Oxidative stress and persistent low-grade inflammation underlie both conditions, and are identified as major contributors to pathological cardiac remodelling. There is an urgent need for effective therapies that specifically target oxidative stress and inflammation to protect against cardiac remodelling. Animal models are a valuable tool for testing emerging therapeutics, however, there is a notable lack of appropriate animal models of co-morbid diabetes and hypertension. In this study, we describe a novel preclinical mouse model combining diabetes and hypertension to investigate cardiac and vascular pathology of co-morbid disease. Type 1 diabetes was induced in spontaneously hypertensive, 8-week old, male Schlager (BPH/2) mice via 5 consecutive, daily injections of streptozotocin (55 mg/kg in citrate buffer; i.p.). Non-diabetic mice received citrate buffer only. After 10 weeks of diabetes induction, cardiac function was assessed by echocardiography prior to post-mortem evaluation of cardiomyocyte hypertrophy, interstitial fibrosis and inflammation by histology, RT-PCR and flow cytometry. We focussed on the oxidative and inflammatory stress pathways that contribute to cardiovascular remodelling. In particular, we demonstrate that markers of inflammation (monocyte chemoattractant protein; MCP-1), oxidative stress (urinary 8-isoprostanes) and fibrosis (connective tissue growth factor; CTGF) are significantly increased, whilst diastolic dysfunction, as indicated by prolonged isovolumic relaxation time (IVRT), is elevated in this diabetic and hypertensive mouse model. In summary, this pre-clinical mouse model provides researchers with a tool to test therapeutic strategies unique to co-morbid diabetes and hypertension, thereby facilitating the emergence of novel therapeutics to combat the cardiovascular consequences of these debilitating co-morbidities.

Association of ApoE gene polymorphisms with serum lipid levels and the risk of type 2 diabetes mellitus in the Chinese Han population of central China.

Apolipoprotein E (ApoE) is involved in lipid transformation and metabolism. Although some studies have examined the association between ApoE polymorphisms and the risk of type 2 diabetes mellitus (T2DM), the findings differ depending on the location and population. A total of 1,738 participants, including 743 patients with T2DM and 995 controls without T2DM, were enrolled from central China, and ApoE polymorphisms, 388T > C (rs429358) and 526C > T (rs7412), were genotyped. The association between ApoE alleles and T2DM and blood lipid levels was analyzed. Logistic regression analysis was performed to evaluate the interactions between ApoE polymorphisms and various factors, such as age, sex, and prevalence of hypertension in patients with T2DM. The genotype ɛ3/ɛ4 and ɛ4 alleles of ApoE were associated with T2DM risk in the Chinese Han population in central China. Moreover, in patients with T2DM, participants in the E4 (ɛ3/ɛ4, ɛ4/ɛ4) group had significantly higher lipid profiles than those in the E3 (ɛ3/ɛ3) group, whereas participants in the E2 group (ɛ2/ɛ2, ɛ2/ɛ3) showed lower total cholesterol, low-density lipoprotein cholesterol, and ApoE-A1 levels than those in the E3 (ɛ3/ɛ3) group. The results from the current study may help in understanding ApoE polymorphisms and lipid profiles in the Chinese Han population.

The importance of blood pressure measurements at the emergency department in detection of arterial hypertension.

Arterial hypertension (AH) is the most important modifiable risk factor for cardiovascular diseases in Poland and around the world. Unfortunately, despite its potentially catastrophic consequences, more than 30% of hypertensive patients in Poland remain undiagnosed. Therefore, emergency department (ED) triage may play a role in screening of a significant proportion of the population. The present study aimed to assess the prevalence of hypertension in patients reporting to the ED by verifying ad hoc measurements with ambulatory blood pressure monitoring (ABPM). The study included 78,274 patients admitted to the ED of the University Clinical Center in Gdansk from 01.01.2019 to 31.12.2020, with elevated blood pressure values (systolic blood pressure [SBP] > 140 mmHg and/or diastolic blood pressure [DBP] > 90 mmHg) during triage according to the inclusion and exclusion criteria. Out of 34,597 patients with SBP > 140 mmHg and/or DBP > 90 mmHg, 27,896 patients (80.6% of patients) had previously been diagnosed with AH. Finally, a group of 6701 patients with elevated values of arterial blood pressure in triage, who had not yet been diagnosed with AH, was identified. This accounted for 8.6% of patients admitted to the ED. Ultimately, 58 patients (26 women and 36 men) agreed to undergo ABPM. Based on the analysis, AH 32 patients were diagnosed with AH (55.2%). The ED plays an essential role in diagnosing hypertension among people reporting to the ED for various reasons. There is a high probability of a diagnosis of AH in a group of patients who have elevated blood pressure values during triage and have not yet been diagnosed with hypertension.

Association between DIO2 Thr92Ala polymorphism and hypertension in patients with hypothyroidism: Korean Genome and Epidemiology Study.

Recent evidence has identified the significance of type 2 iodothyronine deiodinase (DIO2) in various diseases. However, the role of DIO2 polymorphism in metabolic parameters in patients with hypothyroidism is not fully understood. We assessed the polymorphism of the DIO2 gene and various clinical parameters in 118 patients who were diagnosed with hypothyroidism from the Ansan-Anseong cohort of the Korean Genome and Epidemiology Study. Furthermore, we systematically analyzed Genotype-Tissue Expression (GTEx) data. A total of 118 participants with hypothyroidism were recruited; 32 (27.1%) were homozygous for the Thr allele, 86 (73.9%) were homozygous for the Ala allele or heterozygous. Patients with hypothyroidism with DIO2 polymorphism without hypertension at baseline had higher incidence of hypertension compared to patients without DIO2 polymorphism. Analysis of the GTEx database revealed that elevation of DIO2 expression is associated with enhancement of genes involved in blood vessel regulation and angiogenesis. Commonly inherited variation in the DIO2 gene is associated with high blood pressure and prevalence of hypertension in patients with hypothyroidism. Our results suggest that genetic variation in the hypothalamic-pituitary-thyroid pathway in influencing susceptibility to hypertension.

Prevalence and Associated Predictors of Hypertension in Adult Patients with Thyroid Nodules at the Royal Commission Hospital, Kingdom of Saudi Arabia.

Hypertension and thyroid nodules (TNs) are common medical problems that are increasing in prevalence globally. Hence, we conducted this study to assess the prevalence and associated predictors of hypertension in adult patients with TNs at the Royal Commission Hospital, Kingdom of Saudi Arabia (KSA). A retrospective study was conducted between 1 January 2015 and 31 December 2021. Patients with documented TNs based on the Thyroid Imaging Reporting and Data System (TI-RADS) were recruited to assess the prevalence and associated risk factors for hypertension. Three hundred ninety-one patients with TNs were recruited for this study. The median (interquartile range, IQR) age was 46.00 (20.0) years, and 332 (84.9%) of the patients were females. The median (IQR) body mass index (BMI) was 30.26 (7.71) kg/m2. There was a high prevalence of hypertension (22.5%) in adult patients with TNs. In the univariate analysis, there were significant associations between diagnosed hypertension in patients with TNs and age, sex, diabetes mellitus (DM), bronchial asthma, triiodothyronine (FT3), total cholesterol and high-density lipoprotein (HDL). In the multivariate analysis, age (OR = 1.076 [95% CI 1.048 - 1.105]), sex (OR = 2.28 [95% CI 1.132 - 4.591]), DM (OR = 0.316 [95% CI 0.175 - 0.573]) and total cholesterol levels (OR = 0.820 [95% CI 0.694 - 0.969]) were significantly associated with hypertension. There is a high prevalence of hypertension in patients with TNs. Age, female sex, DM and elevated total cholesterol are significant predictors of hypertension in adult patients with TNs.

Management of Hypertension in Fabry Disease.

Fabry disease (FD), a rare X-linked lysosomal storage disorder that depletes alpha-galactosidase A (α-GalA), is caused by mutations in the GLA gene. Diminished α-GalA enzyme activity results in the accumulation of Gb3 and lyso-Gb3. The pathophysiology of hypertension in FD is complex and unclear. The storage of Gb3 in arterial endothelial cells and smooth muscle cells is known to produce vascular injury by increasing oxidative stress and inflammatory cytokines as a primary pathophysiological mechanism. In addition, Fabry nephropathy developed, resulting in a decrease in kidney function and contributing to hypertension. The prevalence of hypertension in patients with FD was between 28.4% and 56%, whereas hypertension in patients with chronic kidney disease ranged between 33% and 79%. A study using 24-hour ambulatory blood pressure monitoring (ABPM) to measure blood pressure (BP) indicated a high prevalence of uncontrolled hypertension in FD. Thus, 24-hour ABPM ought to be considered for FD hypertension assessments. Appropriate treatment of hypertension is believed to reduce mortality in patients with FD caused by kidney disease, cardiovascular disease, and cerebrovascular disease because hypertension significantly impacts organ damage. Up to 70% of FD patients have been reported to have kidney involvement, and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prescribed for proteinuria are recommended as first-line therapy with antihypertensive drugs. In conclusion, hypertension should be controlled appropriately, given the different morbidity and mortality caused by significant organ involvement in FD patients.

Russian medical society expert consensus on arterial hypertension: arterial hypertension and Post-COVID syndrome

The COVID-19 pandemic triggered a second pandemic, "post-COVID", in people with persistent symptoms after an acute period of coronavirus infection. Most coronavirus patients fully recovered on average within two weeks, but about one in ten people feel long-term symptoms, such as respiratory, cardiovascular, nervous and psychological. Post-COVID symptoms are disparate, various and difficult to interpret. There are no standardized diagnostic methods and generally accepted criteria for verifying post-COVID syndrome now. WHO presented a universal definition of post-COVID syndrome or post-COVID conditions in October 2021. Blood pressure should be observed in post-COVID syndrome due to high prevalence of hypertension in patients with COVID-19. Epidemiology, risk factors and pathophysiology of post-COVID syndrome presents in expert’s consensus of Russian Society of Hypertension. The mechanisms of impairment to the cardiovascular system were analyzed. Particular attention is paid to the clinical features and manifestations of hypertension in post-COVID syndrome, to pathophysiological mechanisms of blood pressure destabilization and further treatment strategy.

Prevalence of Hypertension in patients with chronic Coronary Artery Disease in Cyprus

Coronary Artery Disease (CAD) is the most common type of heart disease and a major cause of mortality worldwide. This study highlights the significance of hypertension as a risk factor in patients with CAD and compares its prevalence to those of EUROASPIRE IV (EUS-IV), ESC Atlas of Cardiology (Atlas) and Cyprus Survey of Coronary Heart Disease of 2006 (CY-2006). A retrospective, observational study was conducted, by the Registry of Cyprus Heart Survey, where 375 individuals with chronic CAD were examined in Nicosia General Hospital Cardiology Clinics, between the years 2011 and 2014. Their medical history regarding hypertension was noted and the data was analyzed using Microsoft Excel software. The total prevalence of hypertension, based on the past medical history of the patients was 59%. Out of these, 52% were found to have elevated blood pressure on their visit to the Cardiology Clinic. The total mean systolic blood pressure amongst the study group was 136 mmHg, with no significant differences between males and females (136 mmHg and 134 mmHg respectively). The findings of the present study are the same compared to those of the CY-2006 (52% both), but slightly higher than the findings of EUS-IV (52% vs. 42.7%) and significantly higher than those recorded in the Atlas (52% vs. 24.8%). The results show that there is still much potential to improve hypertension management in patients with established CAD.

Study of risk factors and prevalence of hypertension among type 2 diabetes patients

According to the World Health Organization, hypertension is responsible for 13% of all deaths worldwide, making it a critical public health problem in developing and developed countries. Economic development, affluence, urbanization, and dietary westernization have contributed to a rise in the prevalence of type 2 diabetes mellitus (DM) and hypertension in South Asian countries. To study the prevalence of hypertension among adult type 2 diabetic patients and identify risk factors that may affect the development of hypertension in those patients. A cross-sectional study was conducted from May 2009 to May 2010 at the Department of Diabetology and Medicine Vinayaka Mission's Medical College & Hospital, Karaikal. 100 patients with Type 2 Diabetes of age 35 and above were screened and included in the study. Out of 100 patients with Diabetes Mellitus, 54 patients were hypertensive, and 46 were non-hypertensive. Hypertension was found to be more common in people aged 45 to 64.Our study reported that hypertension was present in 29% of males and 25% of females. Complications like neuropathy (9.3%) non-proliferative diabetic retinopathy (46.51%); proliferative diabetic retinopathy (4.65%); hypertensive retinopathy (2.33%); nephropathy (2.33%); ulcer foot (4.65%); coronary artery disease (27.9%) and stroke (2.33%) were observed in Diabetic patients and were identified as an independent risk factor for hypertension. It was also found that 31.94% of study populations were in the pre-hypertensive stage and 22.22% were in the second stage of hypertension. The prevalence of hypertension in patients with DM is high. Duration of diabetes was also one of the contributing factors for hypertension in Type 2 diabetes mellitus. It also concluded that the prevalence of hypertension increases with age advancement in DM.

The association between cardiac magnetic resonance-derived aortic stiffness parameters and aortic dilation in young adults with bicuspid aortic valve: With and without coarctation of aorta

BackgroundBicuspid aortic valve (BAV) is associated with progressive aortic dilation. Studies in aortopathies have shown a correlation between increased aortic stiffness and aortic dilation. We aimed to evaluate aortic stiffness measures as predictors of progressive aortic dilation by cardiac magnetic resonance (CMR) in BAV patients. MethodsThis is a retrospective study of 49 patients with BAV (median age 21.1 years at first CMR visit) with ≥2 CMR at the Wisconsin Adult Congenital Heart Disease Program (WAtCH). Circumferential aortic strain, distensibility, and β-stiffness index were obtained from CMR-derived aortic root cine imaging, and aortic dimensions were measured at aortic root and ascending aorta. A linear mixed-model and logistic regression were used to identify important predictors of progressive aortic dilation. ResultsOver a median of 3.8 years follow-up, the annual growth rates of aortic root and ascending aorta dimensions were 0.25 and 0.16 mm/year, respectively. Aortic strain and distensibility decreased while β-stiffness index increased with age. Aortic root strain and distensibility were associated with progressive dilation of the ascending aorta. Baseline aortic root diameter was an independent predictor of >1 mm/year growth rate of the aortic root (adjusted OR 1.34, 95 % CI 1.03–1.74, p = 0.028). Most patients (61 %) had coexisting coarctation of aorta. Despite the higher prevalence of hypertension in patients with aortic coarctation, hypertension or coarctation had no effect on baseline aorta dimensions, stiffness, or progressive aortic dilation. ConclusionSome CMR-derived aortic stiffness parameters correlated with progressive aortic dilation in BAV and should be further investigated in larger and older BAV cohorts.

Prevalence of arterial hypertension in liver cirrhosis and correlation with the severity of liver disease

Background and aim: Metabolic diseases and hypertension have increased dramatically in recent years, so the prevalence of hypertension in patients with cirrhosis is expected to increase. The aim of the study was to estimate the prevalence of hypertension in patients with liver cirrhosis and to determine its association with the severity of the liver disease. Patients and methods: This was a descriptive, cross-sectional, analytical study conducted at the Tropical Medicine and Infectious Diseases Department, Tanta University Hospital, Egypt. A total of 2051 patients with liver cirrhosis of various etiology were screened for participation in this study. 2014 patients were enrolled. They underwent blood pressure evaluation, blood tests and abdominal ultrasonography. Patients were classified into hypertensive and non-hypertensive groups. Results: The prevalence of arterial hypertension in patients with liver cirrhosis was 30.8%. As regards Child-Pugh class, hypertensive patients in class A were significantly increased (72.9 versus 48.7% respectively) while patients in class B and C were significantly decreased when compared with non- hypertensive patients (25.5,1.6 versus 33.29,17.93% respectively) (P <0.001). Conclusions: The prevalence of arterial hypertension in Egyptian cirrhotic patients is 30.7%, lower than that of the general population. Arterial hypertension is inversely associated with the severity of liver disease.

The Deadly Duo of Hypertension and Diabetes in India: Further Affirmation from a New Epidemiological Study.

Hypertension is highly prevalent in patients with type II diabetes mellitus. India has some of the highest rates of diabetes and hypertension worldwide, but there is a lack of local data on the coexistence of these two risk factors. This study determined the prevalence of hypertension in patients with, or at high risk of, type II diabetes mellitus from across India. Data came from a nationwide trial evaluating the effects of yoga-based lifestyle modification for the prevention/management of type II diabetes. Participants were recruited based on randomized house-to-house screening in urban and rural areas from 65 districts of 29 states/union territories. Eligible individuals were aged 20-80 years and had diabetes or were at high risk of diabetes (IDRS ≥ 60). Anthropometric and demographic data were obtained, and resting blood pressure and blood glucose levels were recorded. This analysis included data from 14,135 individuals. Of these, 25% had self-reported diabetes, 19% were diagnosed with diabetes during the trial, and 26.8% were at high risk for type II diabetes. In these three patient groups, hypertension prevalence rates were 58%, 41.0%, and 35.8%, respectively. The prevalence of hypertension was highest in the North East region and lowest in the North West. The high prevalence of hypertension in patients with, or at risk of diabetes, highlights the urgent need for policies to manage this population, who are at high risk of cardiovascular disease and death.

Possible relations between arterial hypertension and cervical spine fibromyalgias (literature review)

The literature review analyses and systematises currently available information on fi-bromyalgia etiology and pathogenesis, hypertension classification and causes, and considers pos-sible relationships between cervical fibromyalgia and hypertension. Statistical data on mortality in
 Ukraine related to cardiovascular diseases, including hypertension, are highlighted. A concise clas-sification of arterial hypertension according to the International Classification of Diseases-10 (ICD-10) and the International Classification of Diseases-11 (ICD-11) is provided, and its pathogenesis
 (emission hypertension, resistance hypertension and hypervolemia) is outlined. Physiological rela-tions between cervical spine and cardiovascular system are considered. The main diagnostic criteria
 for fibromyalgia classification and its development stages are described. Prevalence of fibromyalgiais identified and its forms are classified in accordance with ICD-11. The available data on the likelycauses of fibromyalgia pain and any established mechanisms of fibromyalgia pathogenesis, including,but not limited to peripheral and central sensitisation, neurogenic inflammatory processes occurringin the disease-associated peripheral tissues, spinal cord and brain, as well as potential involvementof genetic, endocrine, psychopathological factors and sleep disorders in fibromyalgia development
 are discussed. The current formal criteria for fibromyalgia classification (revised in 2016), togeth-er with assessment of the main pharmacological and non-pharmacological fibromyalgia treatment
 methods and approaches based upon available published clinical trials outcomes are described. The
 main directions of fibromyalgia research are identified, and further prospective studies covering dif-ferent relationship aspects between hypertension and cervical fibromyalgia are evaluated. Among
 the available literature sources, the only study of patients with comorbid fibromyalgia (fibromyalgiawas diagnosed using 1990 American College of Rheumatology criteria and evaluated by Revisedfibromyalgia impact questionnaire (FIQR)) and hypertension (blood pressure levels were assessedusing the WHO protocol) has been reported. However, this group has only studied the dynamics ofchanges in cortisol, melatonin and serotonin blood levels, which accompany these pathologies, andthese authors have found that fibromyalgia tender points’ quantity and FIQR scores are much higher
 in hypertensive patients with fibromyalgia in comparison with the rest, which has led them to the con-clusion that hypertension prevalence in patients with fibromyalgia could be related to fibromyalgia severity. Thus, this thorough literature review demonstrates that clinical studies examining possiblerelationships between hypertension and cervical spine fibromyalgia are at lack and require furtherconsiderations.

Trends in Antihypertensive Medicine Utilization in the Republic of Srpska, Bosnia and Herzegovina: An Eleven-Year Follow-Up.

Background: In last 2 decades, there have been substantial changes in the utilization patterns of antihypertensive medicines following new clinical trials and the introduction of new treatment guidelines. The aim of this study was to analyze utilization and prescribing patterns regarding antihypertensive medicines in the Republic of Srpska, Bosnia and Herzegovina during an 11-years follow-up according to national and European treatment guidelines. Methods: In this retrospective, observational study, medicine utilization data were analyzed between 2009–2019 period using the ATC/DDD methodology and expressed as the number of DDD/1,000 inhabitants/day (DID/TID). The medicine utilization 90% (DU90%) method was used for determine the quality of prescribing. Results: During the observed period, the use of antihypertensive medicines increased more than 3-times (125.97 DDD/TID in 2009 vs 414.95 DDD/TID in 2019), corresponding to a rise in the prevalence of hypertensive patients from 91.7/1,000 to 186.3/1,000 in the same period. This was mainly driven by increased use of angiotensin converting enzyme inhibitors with 241.69%, beta blockers with 146.87%, calcium channel blockers with 251.55%, and diuretics with 178.95%. Angiotensin receptor blockers were the fastest growing group of antihypertensive medicines in this period and their utilization increased nearly 40 times. Conclusions: The overall antihypertensive medicines utilization was largely influenced by national and ESH/ESC guidelines and strongly corresponded to the positive medicine list of the national health insurance fund. Antihypertensive medicines utilization is comparable with medicine utilization trends in other countries.

SYNERGISTIC EFFECT OF HIGH HOMOCYSTEINE AND LOW VITAMIN B12 LEVELS ON THE PREVALENCE OF ATRIAL FIBRILLATION IN HYPERTENSIVE PATIENTS

Objective: Atrial fibrillation (AF) is common arrhythmia in hypertensive patients. Besides hypertension, several other conditions are deemed to be associated with AF. High blood homocysteine levels (hyperhomocysteinemia) is a known risk factor for cardiovascular disease and are associated with vitamin B12 deficiency that possibly increase cardiovascular risk, as well. The present study assessed the possible effect of high homocysteine and low B12 levels on AF prevalence in hypertensive patients. Design and method: This retrospective study comprised all hypertensives referred to our institutions and had a blood sample measurement of homocysteine and B12 (n = 32800). The presence of sustained AF (SAF; Long-standing/Persistent or Permanent AF) was recorded with a resting electrocardiogram (ECG). Paroxysms of AF (PAF) were confirmed with previous relevant ECGs provided by the patient. The population was divided in quartiles according to homocysteine levels (groups 1, 2, 3 and 4 for increasing levels) and B12 levels (groups 1, 2, 3 and 4 for decreasing levels). The prevalence of AF (SAF and PAF) was calculated for each homocysteine and B12 quartile group as well as for each of the 16 homocysteine/B12 combination quartile subgroups. Results: The mean values for homocysteine were 13.3 ± 7.2 ?mol/l and for B12 525 ± 196 pg/ml. The prevalence of SAF, PAF and all-type AF (SAF and PAF) was 5.0%, 6.1% and 11.1%, respectively. For homocysteine quartiles 1, 2, 3, 4, SAF prevalence was 2.9%, 5.3%, 11.7%, 24.3% (pfor trend 0.049), PAF prevalence was 0.6%, 0.9%, 4.6%, 14.0% (pfor trend 0.090) and all-type AF prevalence was 3.2%, 5.4%, 11.5%, 22.2% (pfor trend 0.051), respectively. For B12 quartiles 1, 2, 3, 4, SAF prevalence was 2.9%, 6.4%, 11.0%, 20.2% (pfor trend 0.030), PAF prevalence was 2.5%, 5.1%, 7.7%, 9.0% (pfor trend 0.009) and all type-AF prevalence was 2.4%, 7.1%, 16.8% 21.0% (pfor trend 0.019), respectively. The synergistic effect of increasing homocysteine and decreasing B12 values on SAF, PAF and all-type AF prevalence is presented in Figure. Conclusions: High homocysteine levels and low vitamin B12 levels are individually and synergistically associated with the prevalence of AF in hypertensive individuals. Underlying mechanisms merit further examination.

Assessing the prevalence of hypertension in patients with chronic coronary artery disease in Cyprus

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Coronary Heart Disease (CHD) is the most common type of heart disease and a major cause of mortality worldwide, since according to CDC and WHO, it accounts for 18.2 million cases and 17.9 million deaths annually, respectively. Hypertension can precipitate the condition significantly, thus controlling it plays an important role in the secondary prevention of the disease. Aim The aim of this study is to highlight the significance of hypertension as a risk factor in patients with CAD, as well as, to compare its prevalence to those of the EUROASPIRE IV and the statistics published from the ESC Atlas of Cardiology in 2019. Methods A retrospective, observational study was created, from the Registry of Cyprus Heart Survey, where 375 individuals (88% Males, 66 years old on average) were examined in Nicosia General Hospital Cardiology Clinics with CAD, between the years 2011 and 2014. Their past medical history in regards to hypertension was noted and the data was analyzed by using Microsoft Excel software. Results The total prevalence of hypertension, based on the past medical history of the patients was 59% (females 61% and males 68%). Out of these, 44% still had abnormally elevated blood pressure on their visit to the Cardiology Clinic (females 36% and males 45%). Additionally, the EUROASPIRE IV study showed a prevalence of hypertension of 42.7% and ESC Atlas 24.8%, with median rates 22.3% for females and 27.0% for males. The total mean systolic blood pressure amongst all patients in our study was 136 mmHg, with no significant differences between males and females (136 mmHg and 137 mmHg respectively), while in ESC Atlas, the median SBP levels were noted to be 123.0mmHg in females and 130.0 in males. Conclusion Comparing the results from this group of consecutive patients from the Cyprus Heart Survey to the results of EUROASPIRE IV and ESC, it is made clear that all three studies point to the same conclusion. Firstly, it is important to acknowledge the difference between the two genders, with males recording a higher prevalence of hypertension. Moreover, despite the improvement observed in the management of hypertension that has been noted in our study, the secondary prevention guidelines are still not appropriately met. Managing appropriately hypertension, is of utmost importance in lowering the risk of recurrence of CAD in the context of secondary prevention measures.

MO705: Factors Associated with Uncontrolled Ambulatory Hypertension in Peritoneal Dialysis Patients

Abstract BACKGROUND AND AIMS Hypertension among patients on long-term peritoneal dialysis (PD) is common and remains often inadequately control (Cocchi et al. Prevalence of hypertension in patients on peritoneal dialysis: results of an Italian multicentre study. Nephrol Dial Transplant. 1999; 14(6): 1536–40; Vaios et al.. Assessment and management of hypertension among patients on peritoneal dialysis. Clin J Am Soc Nephrol. 2019; 14(2): 297–305). The aim of the present study was to describe the epidemiology of hypertension using the ‘gold-standard’ method of ambulatory blood pressure monitoring (ABPM) and to identify determinants of inadequate ambulatory blood pressure (BP) control in this high-risk population. METHOD In 140 stable patients receiving PD in four centers of Northern Greece, we performed 24-h ABPM using the oscillometric Mobil-O-Graph device (IEM, Stolberg Germany) (Franssen and Imholz. Evaluation of the Mobil-O-Graph new generation ABPM device using the ESH criteria. Blood Press Monit. 2010; 15(4): 229–31). Hypertension was defined as 24-h ambulatory BP ≥ 130/80 mmHg or current use of at least 1 BP-lowering medication (Williams et al. 2018 ESC/ESH guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018; 36(10): 1953–2041). The volume status of study participants was assessed with the method of bioimpedance spectroscopy (Fresenius Medical Care, Bad Homburg, Germany). Univariate and multivariate binary logistic regression analysis was performed to identify factors that were independently associated with uncontrolled ambulatory hypertension. RESULTS Ambulatory hypertension was diagnosed in 95% of the patients enrolled in the study. Despite the fact that 96.9% of hypertensives were being treated with an average of 2.4 BP-lowering medications daily, adequate control of 24-h ambulatory BP was achieved in only 38.3% of them. In univariate regression analysis, there was a significant interaction of uncontrolled ambulatory hypertension with the mode of PD, history of cardiovascular disease and smoking status. In multivariate analysis, among variables inserted in the model, the higher overhydration index in bioimpedance spectroscopy [odds ratio (OR): 1.308; 95% confidence interval (CI): 1.023–1.673/L higher overhydration] and the history of cardiovascular disease (OR: 3.069; 95% CI: 1.157–8.140) were the two factors that were associated with higher odds of uncontrolled ambulatory hypertension. In contrast, the presence of residual diuresis ≥ 0.5 L/24 h (OR: 0.304; 95% CI: 0.105–0.881) was the only parameter associated with lower odds of inadequate ambulatory BP control. CONCLUSION Among patients on PD, ambulatory hypertension is highly prevalent and remains often poorly controlled, despite the extensive use of antihypertensive drug therapy. Achievement of adequate volume control and long-term preservation of residual kidney function appear to be two attractive non-pharmacological strategies for optimization of the management of hypertension in this high-risk population.

Hypertension in connective tissue disease.

It is well documented that connective tissue disease (CTD) is a type of autoimmune disease characterized by chronic inflammation, which can occur across various organ systems throughout the whole body. Although the clinical manifestations of CTD are different, studies have shown that different CTD diseases have similar pathogenesis, implying that different CTD diseases may have similar clinical outcomes. Recent population-based studies have demonstrated an increased risk of cardiovascular disease (CVD) in patients with CTD compared with the control group, which is partially attributed to traditional cardiovascular risk factors, such as hypertension (HT), and that controlling the patients' blood pressure (BP) still constitutes one of the most effective means to prevent CVD. Although many studies have shown that the prevalence of HT in patients with CTD is higher than that in the general population, there is a lack of adequate data on the possible pathogenesis of HT. Also, the factors that promote the rise of BP, especially the relationship between connective tissue disease- hypertension (CTD-HT) and traditional cardiovascular risk factors (aging, sex, race, dyslipidemia, diabetes mellitus, smoking, obesity, etc.), have not been fully confirmed. In this review, we explore the mechanisms that might lead to elevated BP in patients with CTD and the factors that contribute to elevated BP and the management of CTD-HT, and we focus on whether traditional cardiovascular risk factors, the disease, and the presence of related therapeutic drugs are associated with an increased risk of HT in patients with CTD.