Prevalence Of Systemic Hypertension Research Articles

Study of nycthemeral variations in blood pressure in patients with non-arteritic anterior ischemic optic neuropathy.

The objective of this study was to analyze the nycthemeral variations in blood pressure (BP) in individuals who presented with non-arteritic anterior ischemic optic neuropathy (NAION). BP was recorded for 24 h (ambulatory blood pressure monitoring, ABPM) in 65 patients with acute NAION. Three definitions of nighttime periods were used: definition 1, 1 a.m.-6 a.m.; definition 2, 10 p.m.-7 a.m.; and definition 3, 10 p.m.-8 a.m. For each of these definitions, patients were classified according to the value of nocturnal reduction in BP into dippers (10-20%), mild dippers (0-10%), reverse dippers (< 0%), and extreme dippers (> 20%). The proportions of dippers, mild dippers, reverse dippers, and extreme dippers varied significantly depending on the definition chosen. We found the highest number of patients with extreme dipping (23%) when using the strictest definition of nighttime period (definition 1, 1 a.m.-6 a.m.), as compared with 6.2% and 1.5% for the other definitions, respectively. Overall, 13 of 33 patients without known systemic hypertension (39%) were diagnosed with hypertension after ABPM. No risk factor for NAION was associated with the extreme-dipping profile. Finally, the prevalence of systemic hypertension was high (69%). In our population of patients who had an episode of NAION, the proportion of extreme dippers was higher than that usually found in the literature. However, extreme dipping is not a frequent feature of patients with NAION as compared to patients with systemic hypertension. ABPM is recommended for all patients with NAION and unknown history of systemic hypertension.

Prevalence of Systemic Hypertension and Control of Systolic Blood Pressure in a Cohort of 14 Dogs with Adrenal-Dependent Hypercortisolism during the First Year of Trilostane Treatment or after Adrenalectomy

Hypercortisolism in dogs is frequently associated with systemic hypertension (SH). However, there are no studies evaluating the changes in systolic blood pressure (SBP) in dogs with adrenal-dependent hypercortisolism (ADH) during trilostane treatment or after adrenalectomy and their response to antihypertensive treatments. For this reason, the objectives of this study were to evaluate the changes in SBP in dogs with ADH during the first year of trilostane treatment or after adrenalectomy, the relation with clinical control of hypercortisolism and certain laboratory parameters, and the response to antihypertensive drugs. Fourteen dogs newly diagnosed with ADH were prospectively included and evaluated at diagnosis (T0) and 1, 3, 6, and 12 months after (T1, T3, T6, and T12, respectively). Dogs were classified as hypertensive (HT; SBP ≥ 160 mmHg) and non-hypertensive. In HT dogs, benazepril was considered as the first-line drug, and, if necessary, amlodipine was prescribed. The prevalence of SH at T0 was 79%, and it was reduced to 25% at T12. Blood pressure (BP) was not associated with disease control or selected laboratory parameters at any endpoint. Only 22% of dogs with SH needed more than one drug to normalize their SBP. In all dogs surgically treated that were HT at T0, BP normalized at T3.

Prevalence and predictors of resistant hypertension among out-patients in Ilorin, Nigeria

Introduction: Systemic hypertension (SH) contributes the highest number of deaths from cardiovascular diseases worldwide. Patients with resistant hypertension (RH) are more prone to hypertension-mediated organ damage. RH has not been well-studied in Africa, despite the fact that the prevalence of SH is highest in Africa. The aim of the study was to establish the prevalence and predictors of RH among out-patients managed in the cardiology unit of the University of Ilorin Teaching Hospital, Ilorin, Nigeria.&#x0D; Method: A cross-sectional study of 201 patients selected via systematic random sampling between April and September 2019.&#x0D; Results: Mean age of the participants was 59.6 (SD 13.8) years, females 58.7%, 32.3% were non-obese, 17 (8.5%) consumed alcohol and three (1.5%) smoked tobacco. 30 participants (14.9%) had co-morbid diabetes mellitus. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly higher among patients with RH 152.5 (SD 18) mmHg vs 131.9 (SD 18.4) mmHg (p&lt;0.001) and 89.43 (SD 13.8) mmHg vs 79.46 (SD 10.5) mmHg (p=0.008). Eighteen patients (8.96%, 95% CI: 5.5-14%) had RH. The predictors of RH were obesity (OR= 3.754; p=0.009), SBP at patients’ first clinic visit, (OR=1.029, p=0.032), DBP at patients’ first clinic visit, (OR=1.048, p=0.014), and serum phosphorus, (OR=1.047, p=0.047).&#x0D; Conclusion: The prevalence of RH among our patients is low and is similar to that in studies with similar blood pressure cut-off values and case definition.

Prospective analysis of serum albumin level as prognostic indicator in acute ischemic stroke

Background and Aim: Effect of albumin is primarily in the early reperfusion phase of acute ischemic stroke where it has an inhibitory effect on thrombosis, stagnation and adhesion of leucocytes in microcirculation. Aim of the study is to understand the association between serum albumin on admission and the functional status at 90 days. It also aims to find the other indicators that influence the outcome after ischemic stroke. Material and Methods: The study population consisted of total 200 patients who were admitted in the hospital wards with the instance of ischameic stroke within the first 2 hours of onset of symptoms. A detailed history was elicited from the attendees, followed by general examination. Serum albumin was measured using Bromocresol Green. Patients were followed up, and after 120 days following the onset of stroke, were evaluated either in person or over the phone using the Modified Ranking scale to assess their functional status. Results: Maximum numbers of patients were in severe disability score group. The prevalence of systemic hypertension was present tin 114 patients and absent in 86 patients. The association between GCS and albumin was found to be significant (p value<0.05) using the ANOVA test. The mean albumin in those with GCS>13 was 5.34 mg/dl while those for GCS< 9 was 4.26 mg/dl. There was a negative correlation between serum albumin at admission with the MRS score at 120 days. The higher the serum albumin levels, the lower the MRS score, hence better the outcome at 120 days. Conclusion: Serum albumin has a significant association with the severity as well as the prognosis of stroke.

Relationship between blood pressure and intraocular pressure in the JPHC-NEXT eye study

Although a positive link between hypertension and intraocular pressure (IOP) has been suggested, the individual effects of systolic and diastolic blood pressure (SBP and DBP, respectively) on IOP remain unclear, particularly among Japanese populations. Here, we conducted a large-scale, cross-sectional study to determine individual and combined effects of SBP/DBP and hypertension on IOP. In total, 6783 Japanese people aged over 40 years underwent systemic and ophthalmological examinations, including measurements of blood pressure and IOP, conducted using non-contact tonometers. After adjusting for a priori known confounding factors, SBP and DBP levels were found to be positively correlated with IOP levels. The multivariable-adjusted odds ratio when comparing the hypertensive and normotensive groups for the prevalence of ocular hypertension was 1.88 (95% confidence interval, 1.14–3.08). When analysing the combined effects of SBP and DBP on ocular hypertension, SBP elevation had a greater effect on ocular hypertension than DBP increase. In conclusion, SBP and DBP levels and the prevalence of systemic hypertension were found to be positively associated with IOP levels and the prevalence of ocular hypertension in an ophthalmologically healthy Japanese population. Our findings suggest that systemic blood pressure control may be key for controlling IOP.

STUDY OF NYCTHEMERAL VARIATIONS IN BLOOD PRESSURE IN PATIENTS WITH NON-ARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY

Objective: Non-arteritic anterior ischemic optic neuropathy (NAAION) is the most common acute pathology of the optic nerve in patients over 50 years of age and loss of vision is irreversible in the vast majority of cases. The role of nocturnal arterial hypotension in the occurrence of NAAION remains a topic of debate. Indeed, studies on this subject are rare and the results contradictory. In this study, we ubject the nychthemeral variations in blood pressure (BP) in a large cohort of patients with acute NAAION to determine the presence and extent of nocturnal arterial hypotension in this population, and thus determine whether nocturnal arterial hypotension could be involved in the pathophysiology of NAAION Design and method: BP was recorded for 24 h (ambulatory blood pressure monitoring, ABPM) in 65 patients with acute NAAION. Three definitions of nighttime periods were used: definition 1, 1 a.m.–6 a.m.; definition 2, 10 p.m.–7 a.m.; and definition 3, 10 p.m.–8 a.m. For each of these definitions, patients were classified according to the value of nocturnal reduction in BP into dippers (10–20%), mild dippers (0–10%), reverse dippers (&lt; 0%), and extreme dippers (&gt; 20%). Results: The proportions of dippers, mild dippers, reverse dippers, and extreme dippers varied significantly depending on the definition chosen. We found the highest number of patients with extreme dipping (23%) when using the strictest definition of nighttime period (definition 1, 1 a.m.–6 a.m.), as compared with 6.2% and 1.5% for the other definitions, respectively. Overall, 13 of 33 patients without known systemic hypertension (39%) were diagnosed with hypertension (systolic and/or diastolic hypertension) after ABPM. No risk factor for NAAION was associated with the extreme-dipping profile. Finally, the prevalence of systemic hypertension was high (69%). Conclusions: In our population of patients who had an episode of NAAION, the proportion of extreme dippers was higher than that usually found in the literature. The definition of the nighttime period used in this study had an impact on the proportion of extreme dippers and might probably explain the contradictory results from the few studies on this ubject.

Alcohol Consumption and Systemic Hypertension (from the Third National Health and Nutrition Examination Survey)

Epidemiological studies have established the association between excessive alcohol consumption and systemic hypertension (SH). However, there are conflicting reports of the association of low to moderate alcohol consumption with SH. The objective of the study was to examine the associations of alcohol consumption and blood pressure categories using the 2017 American College of Cardiology/American Heart Association high blood pressure guidelines. This analysis included 17,059 participants from the Third National Health and Nutrition Examination Survey. Alcohol consumption was ascertained by way of a questionnaire. Blood pressure (mm Hg) was measured during the in-home interview and the participant's visit to the mobile examination center. We used multivariable logistic regression models to examine cross-sectional associations of alcohol consumption and blood pressure categories based on new American College of Cardiology/American Heart Association High Blood Pressure guidelines. Models were adjusted for age, gender, income, and cardiovascular risk factors. Compared with never drinkers, moderate drinkers (7 to 13 drinks/week) had increased odds of prevalent stage 1 and stage 2 SH (odds ratio [95% confidence interval] 1.51 [1.22 to 1.87] and 1.55 [1.20 to 2.00]). Similarly, there were significantly higher odds of prevalent stage 1 and stage 2 SH among heavy drinkers (≥14 drinks/week) (odds ratio [95% confidence interval] 1.65 [1.33 to 2.05] and 2.46 [1.93 to 3.14]). We did not find any association between alcohol consumption and elevated blood pressure category. Response bias must be considered because alcohol consumption was self-reported. Our study indicates the need for further research to understand the potential mechanisms by which alcohol consumption increases the risk of SH. In conclusion, this analysis from a population-based survey showed an association between moderate and heavy alcohol consumption and a higher prevalence of SH.

The impact of atrial fibrillation on hospitalization outcomes for patients with chronic lymphocytic leukemia: A large database analysis.

e19508 Background: With the increased use of novel agents like Bruton tyrosine kinase inhibitors (BTKi) for the treatment of chronic lymphocytic leukemia (CLL), the incidence of atrial fibrillation (AF) is on the rise in these patients. However, the excess burden added by AF to the morbidity and mortality of CLL patients is unclear. Methods: Using the appropriate ICD-9 and ICD-10 codes, the National Inpatient Sample (NIS) database was accessed to gather data of hospitalized CLL patients with AF from 2008 to 2019. Propensity-score matching (PSM) and logistic regression model were performed to control for baseline patient factors like age, sex, income, and the relevant co-morbidities to match 7265 CLL patient admissions with AF and 7265 CLL patient admissions without AF. The primary outcome was all-cause mortality (ACM), while secondary outcomes included stroke, acute heart failure (AHF), and total cost of hospital stay. Results: The mean age of the cohorts was 82 years. Females made up 44% of both groups. The AF group had similar prevalence of systemic hypertension (62.38% vs 62.10%; p= 0.73), diabetes mellitus (5.09% vs 5.43%; p= 0.35), congestive heart failure (5.57% vs 5.36%; p= 0.58), valvular heart disease (1.17% vs 1.44%; p= 0.14), and pulmonary hypertension (0.21% vs 0.14%; p= 0.31) compared to the group without AF. PSM revealed CLL patients with AF had a higher rate of ACM (6.06% vs 4.47%; p= &lt;0.0001), AHF (7.50% vs 3.85%; p= &lt;0.001), and stroke (3.09% vs 1.65%; p= &lt;0.0001). Admission in the AF group also had a higher median total cost of hospital stay ($9097 vs $7646). A logistic regression model was done to adjust for confounders which revealed similar results for the AF group with increased adjusted odd’s ratio (aOR) of ACM (aOR:1.39, 95% confidence interval (CI): 1.19-1.61; p= &lt;0.001), AHF (aOR: 2.16, 95% CI: 1.85-2.52; p= &lt;0.001), and stroke (aOR:1.94, 95% CI: 1.54-2.44; P= &lt;0.001) (Table). Conclusions: Our data suggest that hospitalized CLL patients with AF are at a significantly increased risk of all-cause mortality, AHF, and stroke. Several limitations like the inability to establish the temporal relationship between CLL and AF and the lack of data regarding medications of individual patients are important to keep in mind while interpreting the results.[Table: see text]

Body mass index is associated with low postoperative cardiac output in patients undergoing aortic valve replacement

Background Overweight and obesity (O/O) generate lipotoxicity of the cardiac fiber and increase the incidence and progression of aortic valve stenosis. The low cardiac output syndrome (LCOS) is a timing complication after to aortic valve replacement (AVR) surgery. Objective The objective of the study was to investigate if body mass index (BMI) kg/m2 is a risk factor associated with LCOS and mortality in the post-operative period of AVR. Methods A historic cohort study was designed, including patients with severe aortic stenosis (SAS), who were subjected to AVR. Results 152 patients were included, 45 (29.6%), with normal weight (NW), 60 were overweight (39.5%), and 47 obese (30.9%). The prevalence of systemic hypertension (HT) was higher in O/O (p < 0.0001). Incidence of LCOS was 44.7%, being more frequent in the O/O groups compared to the NW group, 43.3%, 68.1%, and 22.2%, respectively, (p < 0.05 in overweight and p < 0.0001 in the obese). Assessing the presence or absence of LCOS associated with BMI as a numerical variable, we found that women, HT, BMI, left ventricular mass, and valve size, were associated with LCOS (p < 0.02, p < 0.02, p < 0.001, p < 0.032, and p < 0.045, respectively). Mortality was higher in patients who had LCOS (p < 0.02). Multivariate model showed that BMI was an independent risk factor for LCOS (odds ratio [OR] 1.21 [95% CI 1.08-1.35], p < 0.001). Conclusion BMI is a risk factor associated to LCOS in the post-operative period of AVR in patients with SAS.

Abstract 13170: Bicuspid Aortic Valve Exacerbates the Ascending Aorta Aortopathy but Not Hypertension in Repaired Coarctation of the Aorta

Introduction: Coarctation of the aorta (COA) is a generalized vascular disease, associated with reduced aortic distensibility and a higher prevalence of systemic hypertension. 60-85% of COA patients have a bicuspid aortic valve (BAV). BAV is independently associated with lower aortic distensibility, but not hypertension (HTN). It is not known if the presence of a BAV accentuates the aortopathy and hypertension in CoA patients. Hypothesis: COA patients with a BAV have a stiffer aorta than those with a tricuspid aortic valve (TAV). Methods: We retrospectively identified COA patients with and without BAV in whom the cardiac MRI (CMR) data was available from 2005-2019 and calculated aortic distensibility at the ascending (AAO) and descending aorta (DAO). Patients with residual COA were excluded. Results: Among 215 COA patients (median age 25.3 years, 56% male), 67% of patients had a BAV. BAV and TAV groups were similar to the current age, gender, and modality of COA treatment. As expected, BAV patients had larger AAO size (median diameter z -score 1.4 versus 0.1, p&lt;0.001). Median AAO distensibility z-score was significantly lower in the BAV group (-1.2 versus -0.7; p=0.014) but DAO distensibility was similar in BAV and TAV patients. The prevalence of HTN was not different between BAV (32%) and TAV groups (36%, p = 0.56). On multivariable analysis, HTN was not associated with BAV or AAO distensibility but was associated with lower DAO distensibility (p=0.01). Conclusions: In young adults with adequately treated COA, the BAV group had lower AAO distensibility and a larger AAO compared with the TAV group. However, DAO distensibility and the prevalence of hypertension were similar in BAV and TAV patients. These results suggest that although the presence of a BAV in COA exacerbates the AAO aortopathy in a localized fashion, it does not exacerbate the more generalized vascular dysfunction and associated HTN.

Body mass index is associated with low postoperative cardiac output in patients undergoing aortic valve replacement.

Overweight and obesity (O/O) generate lipotoxicity of the cardiac fiber and increase the incidence and progression of aortic valve stenosis. The low cardiac output syndrome (LCOS) is a timing complication after to aortic valve replacement (AVR) surgery. The objective of the study was to investigate if body mass index (BMI) kg/m2 is a risk factor associated with LCOS and mortality in the post-operative period of AVR. A historic cohort study was designed, including patients with severe aortic stenosis (SAS), who were subjected to AVR. 152 patients were included, 45 (29.6%), with normal weight (NW), 60 were overweight (39.5%), and 47 obese (30.9%). The prevalence of systemic hypertension (HT) was higher in O/O (p < 0.0001). Incidence of LCOS was 44.7%, being more frequent in the O/O groups compared to the NW group, 43.3%, 68.1%, and 22.2%, respectively, (p < 0.05 in overweight and p < 0.0001 in the obese). Assessing the presence or absence of LCOS associated with BMI as a numerical variable, we found that women, HT, BMI, left ventricular mass, and valve size, were associated with LCOS (p < 0.02, p < 0.02, p < 0.001, p < 0.032, and p < 0.045, respectively). Mortality was higher in patients who had LCOS (p < 0.02). Multivariate model showed that BMI was an independent risk factor for LCOS (odds ratio [OR] 1.21 [95% CI 1.08-1.35], p < 0.001). BMI is a risk factor associated to LCOS in the post-operative period of AVR in patients with SAS.

Abstract P162: Drug Adherence In Hypertensive Patients And Variables Associated With Nonadherence.

Introduction: The prevalence of systemic hypertension has increased considerably in India over the past few decades from 5 percent to between 20-40 percent in urban population and 12-17 percent in rural population. Although there is availability of numerous affordable antihypertensive drugs, hypertension is still poorly controlled, leading to an epidemic of non-communicable diseases. Drug nonadherence is implicated as a major factor responsible for poorly controlled hypertension. Aim: This study was undertaken to gather data regarding drug adherence among hypertensive cohort and factors responsible for poor adherence. Methods: We prospectively studied 1468 hypertensive patients at a tertiary care hospital. Assessment of antihypertensive medication adherence was determined using the instrument validated by Morisky et al. Poor medication adherence was defined as answering yes to three or more of eight questions. Office reading and 24-hr ABPM were used to assess the level of hypertension control. Result: The mean age of the included patients was 61.2 ± 10.6 years and 63.5 % were male. Among the studied cohort, 55.8 % (819 out of 1468) patients were highly adherent to antihypertensive medication and adequate BP control was achieved in only 39.10 % (574 out of 1468) patients. Independent predictors of drug non-adherence in a multivariate analysis model were illiteracy (hazard ratio [HR] 3.06; 95% confidence interval [CI], 1.31-7.16), low socioeconomic status (HR 2.6; 95% CI, 1.28-4.89), presence of drug side effect (HR 1.7; 95% CI, 1.54-1.95), number of drugs (HR 1.8; 95% CI, 1.4-2.2), number of years on treatment (HR 1.4; 95% CI, 1.1-1.8), incognizant of long term risk of uncontrolled hypertension (HR 1.5; 95% CI, 1.31-1.74), irregular BP monitoring (HR 1.3; 95% CI, 1.1-1.6), and associated CKD and/or DM (HR 2.74; 95% CI, 1.065-7.05) Conclusion: Antihypertensive drug non adherence is a prevalent behavior among patients and since many of the attributed factors are modifiable, they signal opportunities to improve adherence, and thus, BP control in clinical practice

Prevalence and risk factors associated with systemic hypertension in dogs with spontaneous hyperadrenocorticism.

BackgroundSystemic hypertension (SH) is common in dogs with hyperadrenocorticism (HAC) however there are not many studies assessing its prevalence and risk factors.ObjectivesTo determine the prevalence and severity of SH in dogs with HAC and its association with clinical and laboratory findings to identify potential risk factors.AnimalsSixty‐six client owned dogs with spontaneous HAC.MethodsRetrospective cross‐sectional study. Medical records of dogs with HAC were reviewed. Systolic blood pressure (SBP) was measured using Doppler ultrasonography. Clinical signs, physical examination findings and clinicopathologic data (CBC, serum biochemistry and electrolytes, urinalysis and urinary culture, and adrenal function tests) were reviewed for analysis.ResultsPrevalence of SH (≥150 mm Hg) was 82% (54/66) and prevalence of severe SH (≥180 mm Hg) was 46% (30/66). All dogs with thrombocytosis had SH (P = .002), and a platelet count ≥438 × 103/μL was 100% specific and 61.1% sensitive to predict SH (AUC = .802, P = .001). Median potassium levels were lower in hypertensive dogs (4.1 mEq/L, range 3.1‐5.4 mEq/L) than in normotensive ones (4.5 mEq/L, range 4.0‐5.0 mEq/L) (P = .007). Dogs with UPC ≥ 0.5 had higher median SBP than those without proteinuria (P = .03). Dogs with concurrent diabetes mellitus seemed to have a reduced risk of SH (OR = .118, 95%CI = .022‐.626, P = .02).Conclusions and Clinical ImportanceSystemic hypertension is common in dogs with HAC and is frequently severe. Blood pressure should be routinely assessed in these dogs, especially if thrombocytosis, proteinuria or low potassium concentrations are present.

Pet Ownership and Cardiovascular Health in the US General Population

The 2013 American Heart Association Scientific Statement on pet ownership and cardiovascular risk suggested that dog ownership is probably associated with decreased cardiovascular risk. Several studies have been shown that pet ownership, particularly of dogs, is associated with increased physical activity levels, social support, and improved outcomes after a major cardiovascular event. We hypothesized that pet ownership is associated with a lower risk of cardiovascular disease in the US general population. Using the National Health and Nutrition Examination Survey, we identified all patients with heart failure, coronary artery disease, systemic hypertension (SH), diabetes mellitus, and stroke between 1999 and 2016. Multivariable analyses were performed to adjust for demographic factors such as age, gender, marital status, education, co-morbidities, cigarette smoking, family income, working hours, sleeping duration, depression, and lipid profiles. Of 42,038 National Health and Nutrition Examination Survey participants, 10,905 (31%) were inquired about pet ownership. Pet owners were older, less likely to be women or widowed, and more likely to be white, more educated, tobacco users, and work more than 35 hours per week than non-owners (all p values <0.05). Pet owners had higher hemoglobin, lower low-density lipoprotein cholesterol, and a lower prevalence of DM, SH, and stroke (all p values <0.05). After adjusting for potential confounders, pet ownership (either cat or dog ownership) was independently associated with a lower prevalence of SH (odds ratio 0.67; 95% confidence interval 0.49 to 0.89; p = 0.01), but not heart failure, coronary artery disease, DM, or stroke, compared with non-owners. In conclusions, using a large national database, we found that pet ownership is associated with a decreased prevalence of SH. Further longitudinal studies are needed to draw a conclusion on the protective effect of pet ownership in patients with cardiovascular disease.

Prevalence of Systemic Hypertension Among HIV-Infected and HIV-Uninfected Young Adults in Baltimore, Maryland.

Adults with perinatally acquired human immunodeficiency virus (PHIV) infection may be at increased risk for nonacquired immunodeficiency syndrome (AIDS) diseases, including systemic hypertension (HTN). The purpose of this study was to examine the prevalence of HTN among young adults with PHIV compared with recently infected and uninfected young adults. We conducted a cross-sectional study of young adults with PHIV, frequency matched on race and sex to a stratified random sample of young adults with nonperinatally acquired HIV (NPHIV) and HIV-uninfected young adults. All of the subjects were aged 18 to 29 years. HTN was defined as two systolic blood pressure measurements ≥140 mm Hg or diastolic ≥90 mm Hg at least 3 months apart and/or prescription for an antihypertensive medication. Logistic regression was used to estimate adjusted prevalence odds ratios and 95% confidence intervals (CIs) for the association between HIV infection and HTN. A total of 324 patients were included-108 per exposure group. The prevalence of HTN was 23% among individuals with PHIV, 10% among individuals with NPHIV, and 8% among HIV-uninfected patients. PHIV patients had 3.4 (95% CI 1.48-7.66) times the base odds of having HTN compared with HIV-uninfected patients, and 2.7 (95% CI 1.23-5.71) times the odds compared with NPHIV patients. By multivariable analysis, PHIV patients had 4.7 and 2.9 times the odds of having HTN compared with HIV-uninfected patients and NPHIV patients, respectively, after controlling for sex, race, and family history of hypertension. Our findings suggest that HTN prevalence among PHIV young adults is significantly higher than sex- and race-matched NPHIV and HIV-uninfected patients of similar age.

Impact of Treatment Modality on Vascular Function in Coarctation of the Aorta: The LOVE - COARCT Study.

BackgroundOptimally treated patients with coarctation of the aorta remain at risk for late vascular dysfunction. The effect of treatment modality on vascular function is unknown. The LOVE‐COARCT (Long‐term Outcomes and Vascular Evaluation After Successful Coarctation of the Aorta Treatment) study was done to compare vascular function in patients with coarctation of the aorta treated with surgery, balloon dilation (BD), or stent implantation.Methods and ResultsIn treated coarctation of the aorta patients without residual coarctation, we prospectively compared aortic stiffness by applanation tonometry and cardiac magnetic resonance; endothelial function by endothelial pulse amplitude testing; blood pressure (BP) phenotype by office BP, ambulatory BP monitoring, and BP response to exercise; left ventricular mass by cardiac magnetic resonance; and blood biomarkers of endothelial function, inflammation, vascular wall function, and extracellular matrix. Participants included 75 patients treated with surgery (n=28), BD (n=23), or stent (n=24). Groups had similar age at enrollment, coarctation of the aorta severity, residual gradient, and metabolic profile, but differed by age at treatment. Prevalence of systemic hypertension, aortic stiffness, endothelial function, and left ventricular mass were similar among treatment groups. However, BD patients had more‐distensible ascending aortas, lower peak systolic BP during exercise, less impairment in diurnal BP variation, and lower inflammatory biomarkers. Results were unchanged after adjustment for potential confounders, including age at treatment.ConclusionsIn our cohort of patients without residual coarctation, treatment modality was not associated with major vascular outcomes, even though there were some favorable vascular characteristics in the BD patients. Although this suggests that choice of treatment modality should continue to be driven by likelihood of achieving a good anatomical result, more long‐term studies are required to assess the clinical significance of the more‐optimal results of secondary markers of vascular function in BD patients.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03262753.

Telmisartan u pacjentów po 75. roku życia – fakty mówią same za siebie

The worldwide increase in the elderly population is associated with concurrent increases in prevalence of systemic hypertension and morbidity and mortality from vascular complications of hypertensive disease. The elderly population with hypertension is at especially high risk for vascular complications. Telmisartan is highly effective antihypertensive agent and is widely regarded as having tolerability profile similar to that of placebo. The combination therapy with telmisartan plus amlodipine may exert beneficial cardiometabolic effect in elderly patients.

Influence of environmental conditions on the prevalence of systemic hypertension in two riverine communities in the Amazon, Brazil.

This article discusses the influence of environmental conditions on the prevalence of systemic hypertension in two riverine communities in the Sustainable Development Reserve of Tupé, Manaus, Amazonas, Brazil, through an ecological study of multiple groups and contextual analysis carried out with the local inhabitants. To identify the environmental etiology describing the risk of disease development, the study compares demographics, incidence rates and common daily practices in these communities, using data collected in the field, between 2012 and 2014, as well as values provided by IBGE, originally from National Health Survey, 2013. The results suggest that social and environmental determinants, such as general living conditions, occupation and access to protective health care, in the investigated communities, are relevant factors in explaining the observed variability in systemic arterial hypertension (SAH) incidence rates. The study concludes by pointing out the importance and need to consider socio-environmental vulnerability in the elaboration of public health policies and in the management of environmentally protected areas.

Relationship between indirect blood pressure and various stages of chronic kidney disease in cats.

Chronic kidney disease (CKD) is a common cause of secondary systemic hypertension in cats. We investigated the relationship between indirect blood pressure and the prevalence of systemic hypertension in various CKD stages in cats. Client-owned cats (24 control cats and 77 cats with CKD) were included. Biochemical examinations of plasma were conducted by a commercial laboratory. Diseased cats were divided into two groups based on the International Renal Interest Society (IRIS) guidelines (II and III–IV). Indirect blood pressure was measured using an oscillometric technique. Severe hypertension was diagnosed if systolic blood pressure (SBP) was ≥180 mmHg. Indirect blood pressures were significantly higher in IRIS stage III–IV than in the control cats. Of 77 cats with CKD, 25 (32.5%) had severe hypertension. The frequency of severe hypertension increased with an increase in IRIS stage; 0% in the controls, 27.6% in the IRIS stage II, and 47.4% in the IRIS stage III–IV, respectively. The indirect SBP was weakly correlated with urea nitrogen (r=0.27) and creatinine (r=0.23) concentrations in plasma. Binary logistic regression analysis showed that if plasma creatinine concentration is >3.7 mg/dl, cats with CKD had an increased risk for developing severe hypertension (P<0.001). Our results suggest that indirect blood pressure was correlated with the severity of CKD, and the prevalence of severe hypertension increased in cats with severe CKD. The risk of severe hypertension may be high in cats with severe CKD.

Factors associated with the occurrence of a fall in subjects with primary open-angle glaucoma

BackgroundThe aim of the study is to investigate risk factors for future falls in subject with primary open angle glaucoma (POAG).MethodsAll participants answered the following question at their baseline ophthalmic examination: Have you had any falls in the last year? (Yes/No). All study participants answered the same question every 12 months for 3 years. The means of total deviation values in the whole, superior peripheral, superior central, inferior central, and inferior peripheral visual fields (VF) were calculated. The relationship between these mean VF measurements, and various clinical factors against patients’ future falls was analyzed using multiple linear regression.ResultsTwo-hundred ninety four POAG patients answered the baseline and follow-up fall questionnaires over a period of three years. Among 294 subjects, 69 patients experienced a fall during the three-year follow-up. History of falls at baseline (coefficient = 1.22), history of fear of falling at baseline (0.53), best corrected visual acuity in the worse eye (7.37), prevalence of diabetes mellitus (0.60), prevalence of systemic hypertension (0.53) were selected in the optimal model.ConclusionsVisual acuity in the worse eye, history of falls, fear of falling, diabetes mellitus, and systemic hypertension are risk factors for falling in subjects with POAG.