Previous Diagnosis Of Hypertension Research Articles

Abstract 4136889: Impact of hypercholesterolemia definitions on prevalence and prognosis of patients without standard modifiable cardiovascular risk factors and ST-segment elevation myocardial infarction.

Background: In patients with acute myocardial infarction (AMI), recent studies have intriguingly reported that up to a quarter of AMI patients have none of the 4 main standard modifiable cardiovascular (CV) risk factors (SMuRFs) (i.e. hypertension (HTN), diabetes mellitus (DM), hypercholesterolemia (HC), and smoking) and have worse mortality. Hypothesis: We tested the hypothesis that the prevalence and prognosis of SMuRF-less patients varies with the definition of risk factors. Aim: Using a French nationwide MI cohort, we aimed to compare SMuRF-less ST-segment elevation MI (STEMI) patients according to 2 HC definitions, given the possibility of using several HC criteria. Methods: The French Cohort of Myocardial Infarction Evaluation (FRENCHIE) is a large ongoing AMI cohort, collecting data from all patients hospitalized for AMI < 48 h of symptom onset in 21 French centers. STEMI patients without prior CAD admitted in 2019 to 2022 were studied. DM was defined as prior DM diagnosis, HbA1c>7% or anti-diabetic medications, ongoing or at discharge, HTN was defined as treated or previous HTN diagnosis and smoking was defined as current smoking within the past month. Restrictive HC (RHC) was defined as either a previous diagnosis of HC or statin therapy. Permissive HC (PHC) was defined as previous diagnosis of HC or lipid-lowering therapy, or LDL-C > 135 mg/dL or total Cholesterol > 213 mg/dL. Results: Among 8008 patients (mean age 61.5± 12.9y, 22.6% women), 41.4% were smokers, 17.4% had diabetes, and 38.5% HTN. According to HC definitions, the prevalence of HC almost doubled, ranging from 30.3% for RHC to 61.0% for PHC. Consequently, the prevalence of SMuRF-less was divided by ≈ two (21.1% vs 11.3%, respectively), depending on the definition of HC used. Age and sex-adjusted logistic regression analysis showed that PHC, but not RHC, was associated with lower odds of in-hospital death ( figure ). Moreover, having multiple SMuRFs was associated with higher risk of mortality than no SMuRF when using RHC, but not with PHC definition. Conclusion: The prevalence and impact on acute mortality of being SMURFless varies largely with the definition of HC. More research is needed, using HC standardized definitions to explore these patients. Frenchie: was supported in part by the RHU iVASC grant ANR-16-RHUS-00010 from the French National Research Agency (ANR) as part of the Investissements d’Avenir program. The FRENCHIE cohort is registered with ClinicalTrials.gov, NCT04050956.

Lipoprotein (a), coronary artery disease risk, and MACE in individuals without standard modifiable risk factors in the UK Biobank

Abstract Background A significant proportion of patients with coronary artery disease (CAD) lack standard modifiable risk factors (SMuRFs; smoking, hypercholesterolaemia, diabetes and hypertension), for example with recent analyses demonstrating that around 25% of patients with ST-elevation myocardial infarction are SMuRF-less(1). With continued focus on primary prevention in cardiovascular disease, the SMuRF-less subset is likely to increase over time. A body of evidence has implicated lipoprotein (a) in CAD, but no such studies have investigated this association in a purely SMuRF-less population. Purpose To investigate the role of lipoprotein (a) in predicting CAD risk and major adverse cardiovascular events (MACE) in a large, SMuRF-less cohort. Methods The UK Biobank is a large prospective multicentre study which recruited over 500,000 participants in the UK aged 37-73 years at entry between 2006-2010. SMuRFs were defined as 1) smoking (current or historical), 2) hypercholesterolaemia – lipid lowering medication on enrolment or total cholesterol >5.5mmol/L or LDL-C >3.5mmol/L, 3) previous diagnosis of diabetes mellitus, or HbA1c >48mmol/mol, 4) previous diagnosis of hypertension. MACE was defined as a composite of coronary artery disease – previous myocardial infarction, percutaneous coronary intervention or coronary artery bypass graft surgery –, stroke, or all-cause mortality. Results Of the total UK Biobank cohort, 46,139 participants were identified as SMuRF-less together with a valid lipoprotein (a) level. Median follow-up duration was 12yrs. In univariate analyses (Table 1), there was no significant difference in lipoprotein (a) concentrations between individuals with and without MACE (16.9 vs. 17.1nmol/L respectively, p = 0.913). The overall event rate was low, with just 3% MACE (1381 events) overall. Older age, male gender, apolipoprotein A, apolipoprotein B, HbA1c level, HDL cholesterol level and body mass index were all associated with MACE. In regard to all-cause mortality alone, there was no association with lipoprotein (a) level, although the other aforementioned parameters were all significantly associated with this outcome. Similarly, lipoprotein (a) was not a significant predictor of stroke. However, there was a large difference in lipoprotein (a) levels between patients with and without CAD (27.2 vs. 17.1nmol/L respectively, p = 0.004). In Kaplan-Meier analysis, lipoprotein (a) level above the 77th percentile (60.3nmol/L) was significantly associated with CAD (p=0.032). In Cox regression models, despite the low event rate, lipoprotein (a) was a significant predictor of CAD (HR 1.00-1.01, p=0.01), and importantly the only potentially modifiable parameter (N = 39,433, 111 events, Table 2). Conclusion Lipoprotein (a) independently predicts CAD in those without SMuRFs, highlighting the importance of checking this parameter in such patients, particularly given the novel antisense technologies in development which may lower lipoprotein (a)(2).Univariate analysesCox regression for CAD

Treatment optimisation for blood pressure with single-pill combinations in India (TOPSPIN) – Protocol design and baseline characteristics

BackgroundThe burden of over 300 million individuals living with hypertension in India is increasing steadily. Most current guidelines recommend initial combination therapy for effective blood pressure (BP) control. However, there is no randomised evidence to inform which combinations to use in the South Asian population, who account for over one-quarter of the world's population. MethodsThis multi-centre, single-blind, randomised, three-arm trial recruited men and women aged 30–79 years with hypertension. The trial compares the efficacy of commonly recommended single pill combinations (SPCs) of three drug classes – calcium channel blocker (amlodipine), ACE inhibitor (perindopril), and a thiazide-like diuretic (indapamide). The primary objective is to determine the most effective two-drug combination, initially at starting doses with forced up-titration at 2 months, in reducing 24-h ambulatory systolic blood pressure (ASBP) at 6 months. The trial has 85 % power to detect a difference of 3 mmHg in 24-h ASBP amongst the groups.Participant recruitment took place from August 2022 to February 2024. Baseline resultsThe 1981 participants (42.0 % women) enrolled had a mean age of 52.1 (SD 11.3) years and a mean body mass index of 26.5 (SD 4.2) kg/m2. 58.1 % of participants had a previous diagnosis of hypertension and 18.6 % of participants were known to diabetes. The mean ASBP was 135.6 (SD 17.0) mmHg, and the mean ambulatory diastolic BP was 84.5 (SD 10.9) mmHg. ConclusionThe TOPSPIN trial is the first randomised evaluation of commonly used BP-lowering combination therapies in a South Asian population. The results have potentially significant implications for choosing first-line antihypertensive agents among Indians and the South Asian diaspora.

P079 HOME BLOOD PRESSURE SCREENING IN MAY MEASUREMENT MONTH 2022 USING THE ZOE HEALTH STUDY APP

Background and Objective: May Measurement Month (MMM) is a global blood pressure (BP) screening campaign with aims to raise awareness of raised BP. In 2022, MMM incorporated home BP measurements from UK users of the ZOE Health Study app. We compare rates of hypertension prevalence, treatment, and control amongst ZOE app users with other European non-ZOE MMM participants. Methods: Adult (≥18 years) UK ZOE app users were invited to participate in MMM in 2022. ZOE participants were advised on taking three home BP measurements and non-ZOE participants had three standardised seated BP measurements in a range of facilities outside the home. All participants completed a questionnaire including demographics and antihypertensive medication use. Hypertension was defined using thresholds for clinic BP (≥140/90 mmHg) for non-ZOE participants and thresholds for home BP (≥135/85 mmHg) for ZOE participants, based on the mean of the second and third measurements, and/or taking antihypertensive medication. Awareness was defined as having a previous diagnosis of hypertension or treatment with antihypertensive medication. Results: A total of 50,200 ZOE participants were screened in MMM22, of whom 94.0% were over 50 years of age and 65.8% were female. 24,967 (49.7%) were hypertensive, of whom 19,356 (77.5%) were aware, and 18,195 (72.9%) were taking antihypertensive medication, and 11,454 (45.9%) were controlled to <135/85 mmHg. Compared to the other 64,256 MMM22 European participants (mean age 53.6 [SD 16.8] years, 58.7% female), ZOE participants had slightly higher rates of hypertension (49.7% vs 48.9%), and greater proportions of ZOE hypertensive participants were aware (77.5% vs 70.8%), treated (72.9% vs 63.3%), and controlled to <135/85 in ZOE participants and <140/90 mmHg in non-ZOE participants (45.9% vs 30.9%) (p<0.001 for all). Conclusions: In this large UK sample of ZOE users with hypertension, a higher proportion were aware, treated and controlled than amongst other European MMM screenees with hypertension. These digitally-enabled ZOE users apparently have greater access or engagement with effective BP management strategies.

Recreational beach tennis training reduces ambulatory blood pressure in adults with hypertension: a randomized clinical trial.

To determine the effect of 12 weeks of beach tennis training on 24-h ambulatory blood pressure in adults with essential hypertension. This was a randomized, single-blinded, two-arm, parallel superiority trial. Forty-two participants aged 35-65 years with a previous diagnosis of hypertension were randomized into 12 weeks of beach tennis training group (two sessions per week lasting 45-60 min) or a nonexercising control group. Ambulatory 24 h (primary outcome) and office blood pressure, heart rate at rest, cardiorespiratory fitness, and muscle strength were assessed at baseline and after the intervention period. Generalized estimating equation analyses were employed to examine the main effects of the interventions. In the beach tennis group, night-time systolic (-9 mmHg, P = 0.023), diastolic (-4 mmHg, P = 0.026), and mean arterial pressure (-7 mmHg, P = 0.023) decreased after 12 weeks of training. The office SBP/DBP (-6 mmHg, P = 0.016/-6 mmHg, P = 0.001) also decreased in the beach tennis group. Heart rate at rest decreased in the beach tennis group (-4 bpm, P = 0.012) but increased in the control group (6 bpm, P = 0.005). The lower and upper limb muscle strength increased in the beach tennis group after training. However, no such changes were observed in the control group. A 12-week recreational beach tennis training significantly reduced office and ambulatory BP among untrained adults with essential hypertension. Additionally, participation in this sport has led to improvements in physical fitness and overall cardiovascular risk profiles.This clinical trial was registered at Clinicaltrials.gov (NCT03909321).

Assessing the Accuracy of Reporting of Hypertension on Death Certificates in Australia.

There is insufficient evidence of how accurately hypertension is reported on death certificates, which are the primary evidence of causes of death. This study assesses the accuracy of reporting of hypertension on death certificates of decedents in Australia who previously had their blood pressure measured. Blood pressure data from the 2014-2015 and 2017-2018 National Health Surveys were linked to death registration data from July 2015 to December 2021 (average 3.3 years from survey to death). The percentage of decedents with hypertension reported on the death certificate was calculated according to blood pressure level and previous diagnosis of hypertension. Hypertension was reported on the death certificate of 20.2% (95% confidence interval 12.1%-28.3%) of decedents who had very high to severe blood pressure (160/100 mm Hg and above), 14.5% (10.3%-18.8%) who had high blood pressure (140 to <160 / 90 to <100 mm Hg), 14.1% (10.8%-17.4%) who had normal to high blood pressure (<140/90 mm Hg) and who took hypertension medication, and 17.8% (13.6%-22.0%) who had been diagnosed with hypertension. Where the decedent had very high to severe blood pressure, hypertension was reported for 27.9% (14.1%-41.8%) of deaths if they had been diagnosed with hypertension, and 21.7% (9.6%-33.7%) where another cardiovascular disease was reported on the death certificate. Hypertension mortality in Australia is only reported for a minority of deaths of people with high or very high to severe blood pressure; this is also found for those with a prior diagnosis of hypertension.

May Measurement Month 2021: an analysis of blood pressure screening results from Venezuela.

Cardiovascular diseases continue to be the main cause of death in Venezuela, and hypertension is the principal risk factor. The May Measurement Month (MMM) campaign is a global initiative aimed to raising awareness of hypertension, which has been conducted in Venezuela since 2017. May Measurement Month 2021 included 46 732 participants with a mean age of 56.4 years (SD 14.4), 57.9% of whom were female. The percentage with hypertension was 60.3% (57.9% of females and 63.7% of males), 82.3% (84.8% of females and 79.2% of males) were aware, and 80.2% were taking antihypertensive medication. Of those on antihypertensive medication, 44.2% (41.2% of females and 48.2% of males) were not controlled [blood pressure (BP) ≥ 140/≥90 mmHg], with 61.3% receiving one drug, 30.0% two drugs, and 8.7% three or more drugs. 87.5% of those on treatment reported taking it regularly. Conditions associated with higher BP levels include fewer years of education, having a previous diagnosis of hypertension, and women who were hypertensive during a previous pregnancy. Physical activity and pregnancy were conditions associated with lower BP levels. A previous positive COVID-19 test was reported in 11.1%, and one or more COVID-19 vaccinations reported in 22.7% of participants. Of those on antihypertensive medication, 78.8% reported their treatment was not affected by COVID-19. Results are consistent with previous MMM campaigns and indicate that the screening campaign is feasible and useful to identify hypertension even in exceptional conditions such as the COVID-19 pandemic.

Heterogeneous effects of blood pressure screening

This is the first study that investigates the heterogeneous effects of blood pressure (BP) screening on subsequent changes in BP in a high-income country. We use data from clinical health assessments carried out in 2010 (baseline) and 2014 (follow-up) as part of a nationally-representative longitudinal study on ageing in Ireland. We focus on individuals who at baseline do not report a previous hypertension diagnosis and employ a Regression Discontinuity Design by comparing outcomes at follow-up on either side of the BP cutoff that separates normal to abnormal BP at baseline. We find that the BP screening reduces BP at follow-up, with larger and more precisely estimated effects for males, middle-age individuals (as opposed to older individuals), and individuals without public health insurance coverage.

Prevalence, risks factors, and control of hypertension in Guinean older adults in 2021: a cross-sectional survey

BackgroundThe incidence of arterial hypertension increases with the aging of the population, but its magnitude remains insufficiently assessed. The aim of this study was to investigate the prevalence of hypertension and associated factors in elderly people in Guinea.MethodsData were obtained from a cross-sectional general population survey, conducted among people aged ≥ 60 years. A stratified enumeration area random sample survey was conducted in the four natural regions of Guinea from February to April 2021. This study included an interview on sociodemographic data, and a clinical examination. Hypertension was defined as systolic blood pressure ≥ 140mmHg and/or diastolic blood pressure ≥ 90mmHg or previous diagnosis of hypertension (with or without antihypertensive medication). Hypertension control was defined as blood pressure below 140/90 mmHg during treatment. Age-standardized prevalence was calculated, and logistic regression was used to examine factors associated with hypertension.ResultsA total of 1698 adults (1079 men, mean age: 71.6 ± 9.4 years) had at least two blood pressure measurements. The standardized prevalence of hypertension was 61.4% [95% CI: 61.3–61.6], ranging from 52% in Middle Guinea to 67% in Upper Guinea, and was higher in women (65.2%: 65.0-65.4) than in men (59.1%:58.9–59.3). Among those with hypertension, 46.7% were unaware of their condition before the survey and 49.6% were on treatment and only 18.5% had controlled hypertension. Whatever the residence (rural or urban), increasing age, being unmarried, working as a trader or functionary, jobless, living in upper Guinea, low monthly income, intake of extra salt, known diabetic, overweight, and obesity increased the risk of hypertension. In urban area, female sex (AOR: 1.14: 1.12–1.17), living in lower Guinea (AOR: 3.08: 2.97–3.20), being Maninka (AOR: 1.26: 1.21–1.31), being Nguerze (AOR: 1.71: 1.63–1.81) increased the risk of hypertension, but living in forest Guinea (AOR: 0.88: 0.83–0.93), being Soussou (AOR: 0.88: 0.85–0.92) decreased the risk. In rural area, living in forest Guinea (AOR: 2.14: 2.03–2.26), being Soussou (AOR: 1.14: 1.12–1.17) increased the risk of hypertension, but female sex (AOR: 0.96: 0.94–0.98), living in lower Guinea (AOR: 0.87: 0.85–0.89), being Maninka (AOR: 0.94: 0.92–0.97), being Nguerze (AOR: 0.50: 0.47–0.52) decreased the risk.ConclusionHypertension is a major problem in the elderly population in Guinea, and the level of treatment and control in elderly with known hypertension is inadequate. The place of hypertension among cardiovascular diseases and the identification of associated factors underlines the need to develop innovative approaches to control this major risk factor.

Group-based Education and monitoring program delivered by community health workers to improve control of high blood pressure in island districts of lake victoria, Uganda

BackgroundIndividuals living in communities with poor access to healthcare may be unaware of their high blood pressure (BP). While the use of community health workers (CHWs) can address gaps in human resources for health, CHWs in Uganda have not been used previously for BP screening and management. We report the results of an initiative to train CHWs to evaluate BP and to administer group-based education in Kalangala and Buvuma Island Districts of Lake Victoria, Uganda.MethodsWe randomly selected 42 of 212 villages. We trained CHWs based in island districts on measuring BP. CHWs visited all households in the selected villages and invited all adults ≥ 18 years to be screened for high BP. We used the World Health Organization’s STEPwise tool to collect data on demographic and behavioral characteristics and BP measurements. High blood pressure was defined as systolic BP (SBP) ≥ 140 mm Hg and/or diastolic BP (DBP) ≥ 90 mm Hg over three readings. CHWs created and led fortnight support groups for individuals identified with high blood pressure at baseline. At each group meeting, CHWs re-measured BP and administered an intervention package, which included self-management and lifestyle education to participants. The paired t-test was used to compare mean values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after the intervention. Generalized estimating equations (GEE) were used to model longitudinal changes in BP.ResultsWe trained 84 CHWs to measure BP and deliver the intervention package. Among 2,016 community members, 570 (28.3%) had high blood pressure; of these, 63 (11.1%) had a previous diagnosis of hypertension. The comparison of SBP and DBP before and after the intervention revealed significant reductions in mean SBP from 158mmHg (SD = 29.8) to 149 mmHg (SD = 29.8) (p < 0.001) and mean DBP from 97mmHg (SD = 14.3) to 92mmHg (p < 0.001). GEE showed decreases of -1.133 (SBP) and − 0.543 mmHg (DBP)/fortnight.ConclusionHigh BP was common but previously undiagnosed. The CHW-led group-based self-management and education for controlling high BP was effective in the island districts in Uganda. Scaling up the intervention in other hard-to-reach districts could improve control of high BP on a large scale.

The Role of Blood Pressure Control in Prevention of Hematoma After Blepharoplasty.

Hematoma formation after blepharoplasty is serious and potentially vision-threatening, with hypertension being the primary risk factor. The aim of this paper is to assess perioperative blood pressure trends and rates of complication in patients undergoing a strict blood pressure protocol designed to keep perioperative systolic blood pressure below 120 mmHg. A retrospective chart review was performed of 32 patients undergoing face lift with conomitant blepharoplasty from January 2015 to July 2018. For each patient blood pressure readings obtained before, during, and after surgery were reviewed. Two-sample one-tail T-tests were performed, and p values less than 0.05 were considered statistically significant. The mean systolic blood pressure (SBP) for all patients was highest intraoperatively. Patients with known hypertension had higher mean SBPs than patients without hypertension across all phases of care, with a statistically significant difference in immediate preoperative SBP (p=0.05). Males had a higher average blood pressure immediately postoperatively (p=0.05). A previous diagnosis of hypertension in females was associated with a higher immediate preoperative SBP (p=0.07) as well as age over 65 (p=0.07). The overall rate of complications was 37.5%. No patients experienced hematoma. This study demonstrated that keeping blood pressure below 120 mmHg after surgery was an effective method of preventing hematoma after blepharoplasty, even in patients concurrently on anti-coagulative medications. Special attention to blood pressure control should be shown to patients with known risk factors such as a previous diagnosis of hypertension, male sex, or age greater than 65. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

MONITORING OF ACUTE TENSION (BLOOD PRESSURE) INCREASES DETECTED IN HOSPITAL EMERGENCIES

Objective: To assess whether, after an acute increase in blood pressure in the hospital emergency department, the control objectives are subsequently achieved in primary care. Design and method: Cross-sectional descriptive study assessing blood pressure figures in the Emergency Department, the days elapsed until the first visit to the Primary Care Center since the incident and until the visit in which minimal control has been obtained (defined as blood pressure &lt;140/90 mmHg). Results: 96 patients were preselected, of which only 85 met the inclusion criteria for the study, 49 women, mean age was 69 years, 72 had a previous diagnosis of Hypertension with a mean of 10 (standard deviation +/- 9) years of evolution, 66 with previous pharmacological treatment, 20 had been referred from Primary Care. The mean systolic blood pressure on arrival at the emergency room was 181 mmHg (standard deviation +/- 20) and at discharge 152 mmHg (standard deviation +/-18.5), the diastolic blood pressure on arrival at the emergency room was 91 mmHg (standard deviation +/- 16) and at discharge 82 mmHg (standard deviation +/-11.7). From the 85 patients included, 84 followed primary care controls (98%) and 60 achieved control of arterial hypertension (70.5%), with a median in days of 12 (interquartile range 3-35) and 90 respectively (interquartile range 26.5-147.5). Conclusions: This study allows us to know that a high percentage of patients consult the Primary Care after an acute increase in blood pressure but interventions could be proposed to further reduce the time of this coordination in some cases. The blood pressure goal was achieved in 70.5% of the patients, so the causes of suboptimal control in the remaining patients would have to be reviewed.

Early screening for metabolic syndrome opens a window of opportunity - learnings from a long-term, population-based study

Abstract Introduction The metabolic syndrome (MetS) represents a cluster of risk factors that predict cardiovascular disease (CVD) and type 2 diabetes. Early detection of MetS opens up for a successful treatment of the cardiovascular (CV) risk factors involved, hopefully leading to later advent of CVD in the general population. Purpose In this long-term, population-based study we aimed to investigate how presence of MetS, in middle-aged men and women, was associated with all-cause mortality and non-fatal CVD later in life. Methods Between 1990 -1999 a screening program was conducted among 40- and 50-year-old inhabitants in the County of Västmanland, Sweden. Data on lifestyle habits and socio-economic status were collected. Total cholesterol, fasting blood glucose, blood pressure, weight, height, waist and hip circumference were measured. Individuals that met three or more of the following risk factors were classified with MetS: waist circumference: ≥102 cm (men) and ≥88 cm (women), total cholesterol: ≥6.1 mmol/ l, blood pressure: ≥130 and/ or ≥85 mm Hg (or previous diagnosis of hypertension) or fasting plasma glucose: ≥5.6 mmol/ l (or previous diagnosis of type 2 diabetes). A control group was identified with individuals from the same population, without MetS diagnosis. Each participant with MetS was matched to two controls regarding sex, age and date for the health examination. The association between midlife MetS and all-cause mortality and non-fatal CV events (stroke and myocardial infarction) was adjusted for age, sex, smoking, physical inactivity, educational level, BMI, hip circumference and living alone or with family members. Multivariable cox regression and Kaplan-Meier analyses were used. Results A total number of 5084 individuals met the criteria for MetS and a control group of 10 168 individuals was identified. The median (Q1, Q3) follow-up time was 27 years (24.6, 30.1), corresponding to 130 820 and 269 696 person-years at risk in the MetS and the control group respectively. During follow up, 1317 MetS and 1904 control subjects died, implying 10 deaths in the MetS group and 7 deaths in the controls per 1000 person-years at risk (fig. 1). Cox analysis showed increased mortality in the MetS group compared to the controls, hazard ratio (HR) 1.30 (95% CI: 1.20-1.40); p&amp;lt;0.001. Non-fatal CV events in the MetS group and in the controls were 32.4% vs 22.8%, respectively (p&amp;lt;0.001); HR 1.35 (CI;1.25–1.46) (fig 2). Median time (Q1, Q3) for first non-fatal CV event was 16.8 years (9.9,22.3) in the MetS group and 19.1 (12.2, 23.6) for the controls. Conclusions Results from this long-term, population-based study underline that the risk of non-fatal CVD and all-cause mortality was significantly higher in individuals with asymptomatic MetS. Present results support previous studies that early identification of MetS with screening programs might open a window of opportunity for prevention of CVD and premature death in the general population.Figure 1.All-cause mortalityFigure 1.Cardiovascular events

Access to Dental Services among Hypertensive Elderly in Peru: Exploring Patterns and Implications

Background: This study was conducted to determine access to dental services in the elderly with hypertension in Peru.&#x0D; Methods: Observational, analytical, and cross-sectional design. Data used for analysis in this research was collected from the Demographic and Family Health Survey of Peru (ENDES) from 2019 to 2021.&#x0D; Results: A Poisson regression analysis was performed a weighted sample for calculating prevalence ratio (PR) with their 95% confidence intervals (95%CI). The multiple regression analysis did not find among the factors associated with the probability of using the dental health service, since neither the time less than two years of hypertension (PR=0.74, 95%CI 0.53 – 1.02); nor from 2 to 4 years (PR = 0.97, CI 95% 0.86 – 1.09); neither a time of hypertension from 5 years or more (PR = 0.94, CI 95% 0.85 – 1.03) were associated.&#x0D; Conclusion: The study concluded that hypertensive patient over 60 years of age, despite a previous diagnosis of hypertension or not, does not attend dental service, reflecting a lack of interest and a greater risk exposure to cardiovascular complications associated with oral health.

Relationship between serum 25-hydroxyvitamin D concentrations and blood pressure among US adults without a previous diagnosis of hypertension: evidence from NHANES 2005-2018.

There are various cross-sectional studies that concluded that vitamin D is associated with blood pressure, but randomized controlled studies have not yielded consistent conclusions. Considering many limitations indeed, our study aimed to examine whether concentrations of 25(OH)D are inversely associated with blood pressure in people without a previous diagnosis of hypertension. We analyzed data from the 2005-2018 National Health and Nutrition Examination Survey. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by applying multivariable logistic regression models. The dose-response relationship was assessed by means of restricted cubic spline regression, and stratification analyses were employed to test the consistency between the subgroups. Of 17,467 participants aged ≥ 20 years without a previous diagnosis of hypertension, 4,769 had higher blood pressure. Compared with individuals whose 25(OH)D levels were in the bottom quartile (<44.3 nnol/L), adjusting for multiple confounders, the ORs for higher blood pressure were 0.90(95%CI 0.78, 1.05), 0.85(95%CI 0.72, 0.99), and 0.86(95%CI 0.72, 1.02), respectively (P for trend = 0.096). Furthermore, as a continuous variable, 25(OH)D concentrations were non-linearly associated with an increased risk of hypertension (P < 0.001). The interaction between the sleeplessness subgroup and higher blood pressure was significant (P = 0.042). In adults without a previous diagnosis of hypertension in the United States, concentrations of 25(OH)D were inversely associated with higher blood pressure when it was <84 nmol/L.

Identifying barriers and utility of obtaining ambulatory blood pressure monitoring in a pediatric chronic kidney disease population

BackgroundHypertension is a prevalent complication of Chronic Kidney Disease (CKD) and Ambulatory Blood Pressure Monitoring (ABPM) is the gold standard for diagnosis. The aim of our study was to assess the usefulness of obtaining ABPM and to identify barriers to ABPM in this pediatric patient population.MethodIn this retrospective analysis of patients with CKD stage 3–5 who were seen in one academic medical center’s outpatient Pediatric Nephrology clinics between 2018 and 2021, we performed logistic regression to evaluate for associations between demographic factors and odds of having an ABPM.ResultAmong 96 patients included in the study, 48 patients carried a diagnosis of hypertension. 31 patients had ABPM performed with usable data. In those who had ABPM done, 21 had normotension and 10 had undertreated hypertension. Our study also showed 1 had masked hypertension and 5 had white coat hypertension or effect. We did not find a statistically significant difference in those who did or did not undergo ABPM evaluation based on gender, previous diagnosis of hypertension, distance from clinic, language preference, or racial or ethnic identity.ConclusionABPM is a useful tool in our CKD population for the diagnosis and management of hypertension. We did not identify specific barriers to ABPM in our CKD population, and there were no differences in patients who obtained ABPM when looking at specific demographic and disease characteristics. Given these findings, we recommend focusing on areas of future improvement in spheres of patient and provider education as well as better quantification using surveys to further illuminate barriers.

Use of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life

The utility of antihypertensives and ideal blood pressure (BP) for dementia prevention in late life remains unclear and highly contested. To assess the associations of hypertension history, antihypertensive use, and baseline measured BP in late life (age >60 years) with dementia and the moderating factors of age, sex, and racial group. Longitudinal, population-based studies of aging participating in the Cohort Studies of Memory in an International Consortium (COSMIC) group were included. Participants were individuals without dementia at baseline aged 60 to 110 years and were based in 15 different countries (US, Brazil, Australia, China, Korea, Singapore, Central African Republic, Republic of Congo, Nigeria, Germany, Spain, Italy, France, Sweden, and Greece). Participants were grouped in 3 categories based on previous diagnosis of hypertension and baseline antihypertensive use: healthy controls, treated hypertension, and untreated hypertension. Baseline systolic BP (SBP) and diastolic BP (DBP) were treated as continuous variables. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-Analyses of Individual Participant Data reporting guidelines. The key outcome was all-cause dementia. Mixed-effects Cox proportional hazards models were used to assess the associations between the exposures and the key outcome variable. The association between dementia and baseline BP was modeled using nonlinear natural splines. The main analysis was a partially adjusted Cox proportional hazards model controlling for age, age squared, sex, education, racial group, and a random effect for study. Sensitivity analyses included a fully adjusted analysis, a restricted analysis of those individuals with more than 5 years of follow-up data, and models examining the moderating factors of age, sex, and racial group. The analysis included 17 studies with 34 519 community dwelling older adults (20 160 [58.4%] female) with a mean (SD) age of 72.5 (7.5) years and a mean (SD) follow-up of 4.3 (4.3) years. In the main, partially adjusted analysis including 14 studies, individuals with untreated hypertension had a 42% increased risk of dementia compared with healthy controls (hazard ratio [HR], 1.42; 95% CI 1.15-1.76; P = .001) and 26% increased risk compared with individuals with treated hypertension (HR, 1.26; 95% CI, 1.03-1.53; P = .02). Individuals with treated hypertension had no significant increased dementia risk compared with healthy controls (HR, 1.13; 95% CI, 0.99-1.28; P = .07). The association of antihypertensive use or hypertension status with dementia did not vary with baseline BP. There was no significant association of baseline SBP or DBP with dementia risk in any of the analyses. There were no significant interactions with age, sex, or racial group for any of the analyses. This individual patient data meta-analysis of longitudinal cohort studies found that antihypertensive use was associated with decreased dementia risk compared with individuals with untreated hypertension through all ages in late life. Individuals with treated hypertension had no increased risk of dementia compared with healthy controls.

MYOCARDIAL MECHANO-ENERGETIC EFFICIENCY AND CLINIC AND 24 HOURS BLOOD PRESSURE VALUES IN PATIENTS ATTENDING THE OUTPATIENT CLINIC AT AN ESH EXCELLENCE CENTRE IN ITALY

Objective: It has been demonstrated that low myocardial mechano-energetic efficiency index (MEEi),estimated as stroke volume/heart rate ratio per g of left ventricular(LV) mass(LVM) is an independent predictor of cardiovascular(CV) events. Out of office blood pressure (BP) is better correlated to hypertension mediated organ damage(HMOD) and to CV events as compared to BP measured in the office. Design and method: Aim of the study was to evaluate the relationship between myocardial mechano-energetic efficiency index and both clinic and 24 hours BP values in 839 consecutive uncomplicated patients attending the outpatient at an ESH Excellence Centre in Italy. Methods BP values were measured by the physician with an automated oscillometric device, after 5 minutes of rest. ABPM was performed in all subjects with a Spacelabs BP monitor. All patients underwent transthoracic echocardiography, and standard indices of systolic function were calculated. Furthermore in all patients myocardial mechanoenergetic efficiency (MEE) was calculated as stroke volume/heart rate and indexed to LV mass (MEEi=MEE/LVM) (de Simone et al, 2016). Results: Mean age was 53 ± 14 yrs, 53% female, BMI 26 ± 5, 34 % were overweight, 18% obese, 8% % diabetics, 64 % with a previous diagnosis of hypertension(71 % treated). MEEi was lower in males (0.41 ± 0.14 vs 0.52 ± 0.15), and in patients with diabetes(0.40 ± 0.11 vs 0.48 ± 0.16). MEEi was inversely -correlated with age(r = -0.146, p &lt; 0.0001) and BMI(r = -0.353, p &lt; 0.0001). MEEI was similarly correlated to 24 hours SBP and clinic SBP(respectively r = -0.267, p &lt; 0.0001 and r = -0.196, p &lt; 0.001, Steiger's Z test for the comparison p ns) and to 24 hours DBP and clinic DBP(r = -0.249, p &lt; 0.0001 and r = -0.248, p &lt; 0.001, Steiger's Z test for the comparison p ns). However, at receiver operating curves(ROC) the area under the curve(AUC) for 24 hours SBP(0.627, 95 % CI 0.593 - 0.659) was superior in predicting low MEEI (defined as &lt; 0.35) as compared to the AUC of clinic SBP(0.582, 95 % CI 0.548 - 0.615)(p for the comparison &lt; 0.05). Conclusions: In a large sample of uncomplicated patients attending the outpatient clinic at an ESH Excellence Centre in Italy 24 hours BP is a better predictor of reduced myocardial myocardial mechanoenergetic efficiency than clinic BP.

INDEPENDENT ASSOCIATION BETWEEN URIC ACID LEVELS AND MYOCARDIAL MECHANO-ENERGETIC EFFICIENCY AS ASSESSED BY ECHOCARDIOGRAPHY

Objective: In the last decades several studies have investigated the relationship between serum uric acid (SUA) levels and cardiovascular disease and heart failure. Low myocardial mechano-energetic efficiency (MEE), estimated as stroke volume/heart rate ratio per g of left ventricular (LV) mass (LVM) is an independent predictor of cardiovascular (CV) events and heart failure. Design and method: Aim of the study was to evaluate the relationship between SUA and myocardial mechano-energetic efficiency index (MEEi) in 694 consecutive uncomplicated patients attending the outpatient at an ESH Excellence Centre in Italy. Methods BP values were measured by the physician with an automated oscillometric device, after 5 minutes of rest. All patients underwent transthoracic echocardiography, and standard indices of systolic function were calculated. In all patients myocardial mechanoenergetic efficiency (MEE) was calculated as stroke volume/heart rate and indexed to LV mass (MEEi = MEE/LVM) (de Simone et al, 2016). Results: Results Mean age was 57±13 yrs, 52% female, 21 % obese, 10 % diabetics, 69 % with a previous diagnosis of hypertension (77 % treated). MEEi was lower in males (0.42±0.14 vs 0.49±0.16, p&lt;0.001), and in patients with diabetes (0.38±0.11 vs 0.47±0.16, p&lt;0.001). At multivariate analysis the variables independently correlated with MEEI were male sex, systolic blood pressure, presence of obesity, plasma glucose levels, and serum uric acid, but not age and eGFR (CKD EPI). At receiver operating curves (ROC) analysis the optimal cutoff of uric acid for the prediction on reduced MEEI was 5.4 mg/dl (AUC 0.611. 95 CI 0.574-0.648). Conclusions: Conclusions In a large sample of uncomplicated patients attending the outpatient clinic at an ESH Excellence Centre in Italy uric acid is an independent predictor of myocardial mechanoenergetic efficiency. In this population the optimal cutoff of uric acid for reduced MEEI is 5.4 mg/dl. These findings may contribute to the explanation of the greater risk of heart failure in patients with increased uric acid levels.

ETHNIC DIFFERENCES IN THE PREVALENCE OF MASKED HYPERTENSION PHENOTYPES: ISOLATED AMBULATORY, ISOLATED HOME, AND DUAL MASKED HYPERTENSION

Objective: Ethnic differences in the prevalence of masked hypertension (MH) are known. However, no studies have examined whether there are ethnic differences in the prevalence of MH phenotypes, assessed by ambulatory blood pressure (ABP) or home blood pressure (HBP), or both. The object was to investigate the ethnic differences in the prevalence of MH phenotype in individuals without a previous diagnosis of hypertension (NHT) and those with a diagnosed hypertension (HT). Design and method: Cross-sectional ABP, HBP, office blood pressure (OBP) and characteristic data were compared in 1,588 participants (mean age 61.8±10.4 years, 49.2% males, 80.1% HT, White British 16.8%, South Asian 9.9%, African Caribbean 10.6%, Japanese 62.7%) from combined database of the UK and Japan in clinical practice. Isolated ambulatory MH was defined as normal OBP (&lt;140/90 mmHg) and HBP (&lt;135/85 mmHg) and elevated daytime ABP (&gt; = 135/85 mmHg), isolated home MH as normal OBP and daytime ABP (&lt;135/85 mmHg) and elevated HBP (&gt; = 135/85 mmHg), and dual MH as normal OBP and elevated daytime ABP and HBP. Results: Among participants with any phenotype of MH in NHT (n = 129) or HT (n = 356), 31.0% and 36.0% had isolated ambulatory MH, 29.5% and 25.3% isolated home MH, and 39.5% and 38.7% dual MH, respectively. For the diagnostic accuracy of HBP against daytime ABP for MH, there were no differences among groups in NHT; low sensitivity (50-73%), but moderate specificity (74-88). In HT, Japanese showed lower sensitivity (38%) than others (72-79%). There were no differences in specificities (78-94%) among groups. In diagnostic agreements of MH between ABP and HBP monitoring, Japanese showed lower reproducibility both in NHT and HT (Kappa statistic, 0.28 and 0.38, respectively) than other groups (0.38-0.52 and 0.51-0.55). In multivariate logistic regression analysis, Japanese in NHT showed higher odds ratio (OR) for isolated ambulatory MH and those in HT showed lower OR for isolated home MH compared with White British: 4.01 (p = 0.016), 0.36 (p = 0.004), respectively. Conclusions: In Japanese population compared with White British, HBP alone might underestimate the prevalence of MH and ABP could behave as a complementary to HBP.