Previous Diagnosis Of Hypertension Research Articles

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.

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 .

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.

IMPACT OF PREVIOUS DIAGNOSIS OF HYPERTENSION ON RENAL FUNCTION IN HEART FAILURE PATIENTS

Objective: The aim of this study is to evaluate the impact of previous diagnosis of HTN in the reduction of the estimated glomerular filtration rate (eGFR) and the development of chronic kidney disease (CKD) in heart failure (HF) patients by using real world data. Design and method: The study population was selected from a database with electronic health records information from 2012 to 2016 of patients older than 24 years of age. Patients with an active diagnosis of HF at some point during this period were selected, and then stratified according to the presence of previous diagnosis of hypertension. eGFR and Kidney Disease Global Outcomes (KDIGO) risk scale during the observational period were analyzed. Two events were studied using survival and Cox proportional hazards regression models: i) reduction of 20% compared to basal eGFR value and ii) increased risk in the KDIGO scale. Other clinically relevant factors were selected as adjustment variables: age, sex, comorbidities (atrial fibrillation, diabetes, dyslipidaemia and coronary heart disease) and drugs used for HF treatment or anticoagulation. Results: The study population included 80631 HF patients, 37426 of them classified with the KDIGO scale. The proportion of patients with hypertension was 87% and the mean baseline eGFR was 64.2 ml/min/1.73m2. The average age was 75.63 years and 54.7% women. Significant increments in risk were found in patients diagnosed of hypertension for the two events, being 1.28 (CI95% 1.21–1.36) for the eGFR reduction and 1.36 (CI95% 1.25–1.48) for the KDIGO increased risk (Figures). This effect increased as the baseline CKD risk was higher, with 1.45 (CI95% 1.37–1.53) times the risk in the case of base high-risk group (eGFR at baseline &lt;60ml/min/1.73m2; N = 5980) compared to the low risk one (N = 15460). Conclusions: Hypertension is a very prevalent comorbidity of patients with HF, and has a negative impact on kidney function, increasing the risk of reduction of eGFR and development of CKD. The prognosis is significantly worse as the baseline risk is higher.

Impacts of Anxiety and Depression on Clinical Hypertension in Low-Income US Adults.

Depression and anxiety are common leading causes of disability and are associated with systemic effects including cardiovascular comorbidities. Low-income populations may experience higher frequencies of depressive or anxiety-related symptoms, and be at greater risk for developing hypertension. We performed a cross-sectional study of low-income participants who completed hypertension and disability questionnaires as part of the 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES) to identify associations between depressive/anxiety-related symptoms and hypertension status. Multivariable logistic regressions were performed to identify whether (1) frequency of depressive symptoms, (2) frequency of anxiety-related symptoms, (3) self-reported depression medication use, or (4) self-reported anxiety medication use predicted previous hypertension diagnosis. A total of 74,285,160 individuals were represented in our cohort. Participants that reported taking depression (OR 2.72; 95% CI 1.41-5.24; P = 0.009) and anxiety (OR 2.50; 95% CI 1.42-4.41; P = 0.006) medications had greater odds of hypertension. Individuals with depressive feelings daily, monthly, and few times per year were more likely to have hypertension. Respondents with daily (OR 2.28; 95% CI 1.22-4.24; P = 0.021) and weekly (OR 1.88; 95% CI 1.05-3.38; P = 0.040) anxiety symptoms were more likely to have hypertension. Low-income adults in the United States with symptoms of anxiety or depression have higher likelihood of hypertension than those with no symptoms. Respondents who indicated taking medication for anxiety disorders or depression were more likely to have been diagnosed with hypertension.

Insulin resistance drives cognitive impairment in hypertensive pre-diabetic frail elders: the CENTENNIAL study.

Pre-diabetes is a condition that confers an increased cardiovascular risk. Frailty is very common in hypertensive patients, and insulin resistance has been linked to frailty in older adults with diabetes. On these grounds, our aim was to evaluate the association between insulin resistance and cognitive impairment in hypertensive and pre-diabetic and frail older adults. We studied consecutive pre-diabetic and hypertensive elders with frailty presenting at the Avellino local health authority of the Italian Ministry of Health (ASL AV) from March 2021 to March 2022. All of them fulfilled the following inclusion criteria: a previous diagnosis of hypertension with no clinical or laboratory evidence of secondary causes, a confirmed diagnosis of pre-diabetes, age >65 years, Montreal Cognitive Assessment (MoCA) Score <26, and frailty. We enrolled 178 frail patients, of which 141 successfully completed the study. We observed a strong inverse correlation (r = -0.807; P < 0.001) between MoCA Score and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). The results were confirmed by a linear regression analysis using MoCA Score as dependent variable, after adjusting for several potential confounders. Taken together, our data highlight for the first time the association between insulin resistance and global cognitive function in frail elders with hypertension and pre-diabetes.

Ups and downs of conducting a national representative survey on hypertension during pandemic time: main results of SEPHAR IV.

This national representative survey sought to assess hypertension's prevalence, awareness, treatment and control in Romania. A representative sample (by age, sex and residence) of 1477 Romanian adults (51.19 ± 16.61 years, range 18-80 years, 59.9% women) was multimodally evaluated during two study visits. Hypertension was defined as SBP at least 140 mmHg and/or DBP at least 90 mmHg or previously diagnosed hypertension, regardless of BP. Awareness was defined by knowledge of previous hypertension diagnosis or of current use of antihypertensive treatment. Treatment was defined by antihypertensive medication taken at least 2 weeks prior to enrolment. Control was defined as SBP less than 140 mmHg and DBP less than 90 mmHg at both visits in treated hypertensive patients. Hypertension prevalence was 46% ( n = 680) consisting of 81.02% ( n = 551) known hypertensive patients and 18.98% ( n = 129) newly diagnosed hypertensive patients. Awareness, treatment and control of hypertension were: 81% ( n = 551), 83.8% ( n = 462) and 39.2% ( n = 181). Despite numerous pandemic-related obstacles in conducting a national survey, SEPHAR IV updates hypertension epidemiological data of a high-cardiovascular-risk Eastern-European population. This study confirms previous predictions of hypertension prevalence, treatment and control, which remain unfavourable because of unsatisfactory control of promoting factors.

Hypertensive Disorders of Pregnancy and the Risk of Developing Hypertension Outside of Pregnancy Based on Updated Hypertension Guidelines [ID: 1377015

INTRODUCTION: The purpose of this study is to determine whether hypertensive disorders of pregnancy (HDP) affect the development of chronic hypertension (HTN) within 5 years postdelivery based on updated guidelines by the American Heart Association (AHA). METHODS: This IRB-approved study evaluated women who delivered at one hospital from 2014 to 2016. Participants were determined to be normotensive or with HDP. Inclusion criteria for the HDP group was diagnosis of gestational HTN or preeclampsia at 20 weeks of gestation or greater. Exclusion criteria were previous diagnosis of HTN and age over 40. Women were followed up to 5 years postdelivery to assess development of chronic HTN, defined by the 2017 AHA guidelines as systolic greater than 130 mm Hg or diastolic greater than 80 mm Hg. RESULTS: Sixty-four participants (30.9%) developed chronic HTN within 5 years of delivery. Of these participants, 6.25% were from the normotensive pregnancy group, while 84.4% were from the preeclampsia with severe features group, with adjusted odds ratio of 11.38 (CI 4.67–22.46). Compared to the 5-year normotensive group, the 5-year chronic HTN group was associated with higher maternal body mass index (BMI) (P=.0146), preterm delivery (P=.0231), and neonatal intensive care unit (NICU) admission (P=.04). CONCLUSION: The rate of chronic HTN development 5 years postdelivery was significantly higher in participants with HDP, notably preeclampsia with severe features. Participants with development of chronic HTN had increased BMI during pregnancy, preterm delivery, and NICU admission rates as compared to participants with 5-year normotensive pressures. Awareness of the prevalence and risk factors for development of chronic hypertension provides areas of focus for future investigations.

MIDO GDM: an innovative artificial intelligence-based prediction model for the development of gestational diabetes in Mexican women

Given the barriers to early detection of gestational diabetes mellitus (GDM), this study aimed to develop an artificial intelligence (AI)-based prediction model for GDM in pregnant Mexican women. Data were retrieved from 1709 pregnant women who participated in the multicenter prospective cohort study ‘Cuido mi embarazo’. A machine-learning-driven method was used to select the best predictive variables for GDM risk: age, family history of type 2 diabetes, previous diagnosis of hypertension, pregestational body mass index, gestational week, parity, birth weight of last child, and random capillary glucose. An artificial neural network approach was then used to build the model, which achieved a high level of accuracy (70.3%) and sensitivity (83.3%) for identifying women at high risk of developing GDM. This AI-based model will be applied throughout Mexico to improve the timing and quality of GDM interventions. Given the ease of obtaining the model variables, this model is expected to be clinically strategic, allowing prioritization of preventative treatment and promising a paradigm shift in prevention and primary healthcare during pregnancy. This AI model uses variables that are easily collected to identify pregnant women at risk of developing GDM with a high level of accuracy and precision.

The effect of urgent blood pressure reduction on left atrial strain in patients with hypertensive attack : Blood pressure lowering affects LA strain.

Left atrial (LA) strain is a robust measure of LA function and is a useful parameter to assess left ventricular filling pressure. While initially considered as a "load-independent" parameter of LA function, later studies have found that acute changes in LA preload may affect LA reservoir and contractile strains. Acute alterations in blood pressure (BP) induces a change in left ventricular (LV) filling pressure without imposing a volume load, thus providing an opportunity to assess the effects of the change in LA afterload on LA mechanics. This study aims to understand the effect of acute BP changes on LA strain. A total of 40 patients admitted to the emergency department with hypertensive urgency were included. All patients underwent a comprehensive echocardiographic examination including measurement of LA reservoir, conduit and contractile strains. A repeat set of measurements were obtained after BP lowering. Average drop in mean BP following intervention was 18.1 ± 5.4%. LV end-systolic and end-diastolic volumes, as well as maximum and minimum LA volumes were decreased significantly after BP reduction. The absolute increases in reservoir and contractile strains were 2.3 ± 4.7% (7.9% ± 13.8% relative to baseline) and 2.5 ± 3.3% (13.5 ± 19.0% relative to baseline), respectively, with both changes being statistically significant (p = 0.003 for reservoir and p < 0.001 for contractile strains). There were no significant changes in conduit strain after BP intervention (p = 0.79). The change in both LA reservoir and contractile strains were more evident in those with a previous diagnosis of hypertension and those with a smaller degree of change in mean BP after intervention. In patients with an acute hypertension, lowering BP leads to an acute improvement in LA reservoir and contractile strains. Thus, acute changes in systemic BP should be considered when LA mechanics are evaluated.

Time-varying association between cigarette and ENDS use on incident hypertension among US adults: a prospective longitudinal study

ObjectiveElectronic nicotine delivery systems (ENDS) products have emerged as the most popular alternative to combustible cigarettes. However, ENDS products contain potentially dangerous toxicants and chemical compounds, and little is known...

61. Older Age is the Strongest Risk Factors for Hypertension in Indonesia: Subgroup Analysis of The National Basic Health Survey 2018

Introduction: Among the threat of non-communicable diseases, hypertension is one of the potential health problems causing significant cardiovascular morbidity and mortality. Our recent study observed the prevalence of hypertension is as high as 41%, but the exact risk factors for hypertension are unknown. In this study we analyze the risk factors for hypertension in the Indonesian population, based on data from the National Basic Health Survey (Riset Kesehatan Dasar – Riskesdas) 2018. Methods: We included subjects age &gt;18 years and analyzed a large set of risk factors for hypertension: age, gender, body mass index, occupation status, level of education, consumption of salty food, consumption of fruit and vegetables, smoking, alcohol consumption, physical activity, comorbid condition (heart disease, diabetes, stroke), and access to healthcare facility. Hypertension defined as measurement of blood pressure based on JNC VII criteria and previous diagnosis of hypertension made by a physician. The associations between hypertension and risk factors were examined using multiple logistic regression models. Results: We included 389,093 subjects out of 713,783 subjects participated in Riskesdas 2018 survey. The majority of hypertensive subjects was female (62.6%) and within the age of 40–59 years (50.2%). Compared to normal-blood pressure group, hypertensive subjects were likely having lower education status (36.9% vs 54.8%), were more obese (19.2% vs 34.3%), physically less active (47.5% vs 53.3%), had more heart disease (1.7% vs 3.9%), more diabetes mellitus (1.8% vs 5.65%), and more stroke (0.4% vs 3.7%). Older age (&gt;60 years) was identified as a robust independent risk factor for hypertension (OR 2.01; 95% CI 1.76–2.29; p &lt; 0.001), beyond the influence of other risk factors such as obesity (OR 1.47; 95% CI 1.04–2.07; p = 0.02), low education status (OR 1.37; 95% CI 1.35–1.39; p &lt; 0.001), and unemployed (OR 1.1; 95% CI 1.08–1.12; p &lt; 0.001). While interactions within other traditional risk factors were necessary for the occurrence of hypertension (i.e., heart disease∗age, heart disease∗alcohol consumption, heart disease∗stroke, heart disease∗salty food consumption, heart disease∗diabetes, heart disease∗less physical activity, diabetes∗gender, diabetes∗salty food consumption, diabetes∗less physical activity). Conclusion: This study confirmed traditional risk factors play an important role in the development of hypertension in Indonesian population, particularly older age.