Previous History Of Hypertension Research Articles

Simultaneous ST-elevation in lead augmented vector right (aVR) and III in non-ST-elevation acute coronary syndromes.

The value of ST-elevation in lead augmented vector right (aVR) remains controversial in clinical practice. This study aimed to investigate the association of simultaneous ST-elevation in lead aVR and III with angiographic findings and clinical outcomes in patients with non-ST-elevation acute coronary syndromes (NSTEACS). In this observational study, patients who had been diagnosed with NSTEACS and presented with ST-elevation in lead aVR and without ST-elevation in any other two contiguous leads were enrolled from January 2018 to June 2019. Demographic, baseline clinical, angiographic and interventional characteristics as well as clinical outcomes were collected and recorded on standardized case report forms. A total of 157 patients meeting the criteria were finally enrolled in this study and classified into two groups according to the presence of ST-elevation in lead III. Patients in the two groups were similar in average age and previous history of hypertension, diabetes mellitus, hyperlipidemia, chronic kidney disease, stroke, and peripheral vascular diseases (all P>0.05). Patients with ST-elevation in lead III tended to present with myocardial hypertrophy in the echocardiography (P=0.02). The cases with ST-elevation in lead III showed higher high sensitivity troponin T (hs-TnT; P=0.08) and creatinine kinase MB isoenzyme (CK-MB; P<0.01) whereas those without ST-elevation in lead III showed higher N-terminal pro brain natriuretic peptide (NT-proBNP; P=0.02). Of note, patients with ST-elevation in lead III presented with more ST-depression in multiple leads [especially in lead I, augmented vector left (aVL), V3-V6] as well as higher degree of ST-depression (all P<0.05) and were more likely to develop multi-vessel and left main trunk (LM) lesions (P=0.04), with 20% of the cases having a LM lesion and 60% having triple vessel lesions. Patients with ST-elevation in lead III were at increased risk of 3-year major adverse cardiovascular events (MACEs), despite no significant statistical difference between the two groups (hazard ratio =1.29; P=0.26). The NSTEACS cases with simultaneous ST-elevation in lead III and aVR tended to present with more multiple leads with ST-depression, higher degree of ST-depression, and more LM or multi-vessel lesions, suggesting a broader range of severe myocardial ischemia. The concurrent presentation of ST-elevation in lead III and aVR may play a vital role in the diagnosis, risk-stratification, and prediction of poor prognosis during the management of NSTEACS patients.

Determinants of maternal near-miss among women admitted to public hospitals in the Hadiya zone, central Ethiopia: a case-control study

One of the Sustainable Development Goals of the United Nations is to bring the global maternal mortality ratio down to less than 70 per 100,000 live births by 2030. Therefore, pinpointing the factors that influence maternal near-misses would help expedite the accomplishment of this goal. Studies on these topics are, nevertheless, scarce in the Hadiya zone and throughout Ethiopia as a whole. Therefore, the purpose of this study was to determine the factors that contribute to maternal near-misses among women who are admitted to public hospital maternity wards in the Hadiya zone in central Ethiopia. A facility-based, unmatched case-control study was conducted from February 17 to August 16, 2019. The study covered all secondary and tertiary public healthcare facilities in the Hadiya zone, which includes three district hospitals and one referral hospital offering comprehensive emergency obstetric care services. The study included 279 women in total (70 cases and 209 controls). Mothers who had had a near-miss were the cases, and mothers who had not had one were the controls. The Statistical Package for Social Sciences version 24 was used to analyze the data, and the multivariable binary logistic regression model was used to control confounders. The odds ratios (OR) and 95% confidence intervals (CI) were used to determine statistical significance at a p-value of less than 0.05. Living in a rural area [adjusted OR (AOR)=3.16; 95% CI: 1.62, 6.16], no birth preparedness (AOR=3.50; 95% CI: 1.66, 7.41), ever gave birth by cesarean section (AOR=3.68; 95% CI: 1.63, 8.31), previous history of hypertension (AOR=3.69; 95% CI:1.52, 8.96), and poor knowledge of pregnancy danger signs (AOR=3.15; 95% CI: 1.32, 7.52) were all determinants of maternal near-miss. Thus, strengthened public health and clinical interventions in these arenas need to prioritize rural women and women with a previous history of hypertension.

Burden of Long COVID-19 in a Cohort of Recovered COVID-19 Patients in Delhi, India.

The long COVID phase is characterized by signs and symptoms persisting for at least three months after recovery from acute COVID-19 illness. There is limited data on comprehensive long-term clinical follow-up of COVID-19 patients. This study aims to explore the burden and symptomatology of long COVID syndrome and its association with various health parameters. This prospective observational study was conducted in Delhi from May 2022 to March 2023. A total of 553 adult patients who had recovered from COVID-19 were enrolled in the study. A sociodemographic and clinical profile was obtained using validated questionnaires, along with an evaluation of biochemical parameters to assess the associated factors. Chi-square test, unpaired t-test, and bivariate regression analysis were applied using Statistical Product and Service Solutions (SPSS, version 28; IBM SPSS Statistics for Windows, Armonk, NY). A p value of <0.05 was considered significant. A total of 252 patients (45.6%) had long COVID syndrome, which was significantly associated with the presence of any pre-existing comorbidity (OR=1.46 (1.02-2.09); p=0.039), previous history of hypertension (OR=1.82 (1.07-3.09); p=0.027), and vaccination against COVID-19 (OR=1.392 (1.171-1.656); p=0.003). The most common symptoms reported were persistent fatigue (33.3%) and persistent dry cough (28.5%). Patients with long COVID syndrome are also reported to have poorer sleep quality. Biochemical findings showed abnormal T lymphocytes (9.3%) and raised HbA1c (11.9%). Multiple risk factors and symptoms associated with long COVID syndrome were identified in this study. Research efforts and knowledge regarding the pattern of illness will aid in long-term monitoring and development of interventional strategies and guidelines for the care of recovered COVID-19 patients.

Resposta Hipertensiva ao Exercício: uma Forma de Apresentação da Hipertensão Mascarada

Blood pressure measurements outside the office allowed the identification of two opposing phenotypes, commonly known as white coat hypertension and masked hypertension (MH). Whether the hypertensive response to exertion, also called exaggerated blood pressure response to exercise, represents a marker of MH in individuals without a previous history of hypertension is not yet clear, but several follow-up studies have indicated that this finding is associated with the highest future incidence of arterial hypertension, heart failure with preserved ejection fraction and cardiovascular events. Based on data from several studies, the most used definition for hypertensive response to exertion is 210/100 mmHg for men, 190/100 mmHg for women and 220/85mmHg for male athletes and 200/80 mmHg for female athletes. Measuring BP during a low-intensity exercise session (Bruce stage I/II or 70% of maximum theoretical heart rate) also seems to define increased cardiovascular risk, with good accuracy (values &gt;170 mmHg). When the BP values during exercise exceed normal limits, it should be suspected MH and recommended a subsequent study to revaluate BP at home and ABPM, as well as study the cardiorenal repercussion.

Stress and Heart in Remodeling Process: Multiple Stressors at the Same Time Kill.

Myocardial remodeling is developed by increased stress in acute or chronic pathophysiologies. Stressed heart morphology (SHM) is a new description representing basal septal hypertrophy (BSH) caused by emotional stress and chronic stress due to increased afterload in hypertension. Acute stress cardiomyopathy (ASC) and hypertension could be together in clinical practice. Therefore, there are some geometric and functional aspects regarding this specific location, septal base under acute and chronic stress stimuli. The findings by our and the other research groups support that hypertension-mediated myocardial involvement could be pre-existed in ASC cases. Beyond a frequently seen predominant base, hyperkinetic tissue response is detected in both hypertension and ASC. Furthermore, hypertension is the responsible factor in recurrent ASC. The most supportive prospective finding is BSH in which a hypercontractile base takes a longer time to exist morphologically than an acutely developed syndrome under both physiologic exercise and pressure overload by transaortic binding in small animals using microimaging. However, cardiac decompensation with apical ballooning could mask the possible underlying hypertensive disease. In fact, enough time for the assessment of previous hypertension history or segmental analysis could not be provided in an emergency unit, since ASC is accepted as an acute coronary syndrome during an acute episode. Additional supportive findings for SHM are increased stress scores in hypertensive BSH and the existence of similar tissue aspects in excessive sympathetic overdrive like pheochromocytoma which could result in both hypertensive disease and ASC. Exercise hypertension as the typical form of blood pressure variability is the sum of physiologic exercise and pathologic increased blood pressure and results in increased mortality. Hypertension is not rare in patients with a high stress score and leads to repetitive attacks in ASC supporting the important role of an emotional component as well as the potential danger due to multiple stressors at the same time. In the current review, the impact of multiple stressors on segmental or global myocardial remodeling and the hazardous potential of multiple stressors at the same time are discussed. As a result, incidentally determined segmental remodeling could be recalled in patients with multiple stressors and contribute to the early and combined management of both hypertension and chronic stress in the prevention of global remodeling and heart failure.

Cardiovascular risk factors predict who should have echocardiographic evaluation in long COVID

AbstractBackgroundThe need for echocardiograms among patients with long COVID is debatable. Our aim was to evaluate the prevalence of left ventricular (LV) dysfunction and identify predictors.MethodsWe conducted a cross‐sectional study and included all consecutive patients enrolled in our post‐COVID clinic. We included patients who had an echocardiogram and had no previous known heart disease. We defined LV dysfunction as a low ejection fraction or grade II to grade III diastolic dysfunction on an echocardiogram with evidence of elevated filling pressures. We calculated the prevalence of heart disease and predictors of heart disease using logistic regression.ResultsWe included 217 post‐COVID patients enrolled in the clinic. The prevalence of LV dysfunction is 24%; 95% CI 18–30. Predictors of heart disease include older age and a previous history of hypertension and diabetes or having an intermediate or high ASCVD score. Patients with low ASCVD score did not have low ejection fraction on the screening echocardiograms.ConclusionOur study found a considerable number of patients with LV dysfunction. Older patients with cardiovascular risk factors are at risk of long COVID associated heart disease.

O-13 Parathyroid carcinoma - a rare and challenging entity

Abstract Background Parathyroid carcinoma is a rare malignancy, accounting for less than 1% of all cases of primary hyperparathyroidism (HPT). This entity affects both men and women equally and is usually diagnosed in the fourth or fifth decade of life. It can occur sporadically or be associated with genetic syndromes such as hyperparathyroidism-jaw tumor syndrome. Its clinical presentation can overlap with that of primary HPT, with hypercalcemia that can lead to a range of symptoms, such as fatigue, weakness, bone pain, kidney stones, and gastrointestinal disorders. Distinguished by its rarity and clinical challenges, this condition requires a high level of suspicion and its initial surgical approach correlates with long-term prognosis. Clinical Case This is the case of a male patient, 39 years old, Caucasian, with a previous history of hypertension diagnosed 5 months earlier, deep vein thrombosis (DVT) diagnosed 2 months earlier, and active tobacco use. Additional study performed after the DVT episode found severe hypercalcemia (14.3 mg/dL, N 8.6-10.0), hypophosphatemia (2.2 mg/dL, N 2.5-4.5), and renal dysfunction (Creatinine 1.43 mg/dL). The patient was asymptomatic and was admitted to the Internal Medicine department, to correct the hypercalcemia and further investigation. Increased PTH levels (1555 pg/mL, N 15-65) were found, and a cervical ultrasound revealed, on the left thyroid lobe, a bilobed nodule, mainly solid, hypoechogenic, with irregular margins and macrocalcifications, with 34×22 mm. Full body CT showed osteolytic lesions on several ribs and both iliacs and kidney stones. A bone scintigraphy was also done, showing a diffuse fixation on the axial and appendicular skeleton, compatible with diffuse osteomedullary infiltration. Due to these findings, the collaboration of the Endocrinology department was requested. Based on the PTH levels and the characteristics of the cervical mass, suspicion arose regarding a potential case of parathyroid carcinoma. Subsequently, a parathyroid scintigraphy using Sestamibi was conducted, whose report revealed an intense hyperfixation at a nodular formation projecting on the lower two-thirds of the thyroid left lobe, without unequivocal identification of its origin - thyroid nodule vs. parathyroid tissue. Based on intraoperative findings and clinical suspicion, en bloc resection of the tumor along with the thyroid lobe and unilateral neck exploration was performed by the Surgery department, with the pathological assessment confirming the malignancy diagnosis. The patient was referred to an oncologic tertiary center, for follow-up and genetic testing. Conclusion We want to shed light on this rare entity and the importance of multidisciplinary critical thinking, alongside imaging. Markedly elevated PTH and/or calcium levels on a patient with a cervical mass should arouse suspicion of a parathyroid carcinoma, which must not be biopsied and warrants a more extensive surgery to ensure the best possible prognosis.

La hipertensión arterial intradiálisis, un diagnóstico por descubrir

IntroductionIntradialytic hypertension (IDH) is a poorly understood phenomenon with no consensus on its definition, etiology, or related factors, and there is limited evidence on its consequences. ObjectiveTo determine the prevalence of IDH according to different definitions in hemodialysis (HD) units, with different clinical practices and assessment of possible events after 18 months have passed. Materials and methodsA cross-sectional observational study was conducted in two HD units, including all prevalent patients from March 2021 to September 2022. We established three definitions of IDH: Def 1: Mean arterial pressure (MAP) difference pre- and pos-HD>15mmHg. Def 2: Systolic blood pressure (SBP) difference pre- and pos-HD>10mmHg. Def 3: SBP difference >0 and ultrafiltration rate (UFR)>5ml/kg/h.IDH was considered present if the criterion was met in more than 50% of the six consecutive sessions (2 weeks) of follow-up. Personal history, medications, dialysis characteristics, and pre- and post-HD biochemical data were collected. Residual renal function (RRF) was considered as urine output >250ml/24h. At 18 months, the possible events of the group were analyzed. ResultsWe included 169 patients (68% men) with a mean age of 67.9 (14.2) years and a median HD duration of 34.5 (IQR: 17.5-67.5) months. Of these, 94 come from one unit and 75 from the other. The prevalence of IDH was 8.3% according to Def 1, 27.2% according to Def 2, and 29.6% according to Def 3. Def 2 showed an association with a history of previous hypertension, use of renin-angiotensin system inhibitors (RASIs), and furosemide, as well as with patients with RRF. Def 3 showed an association only with coronary artery disease. There was an association with different prescriptions of dialysis fluids. Catecholaminergic hormones and aldosterone did not increase in patients with hypertension during the HD session. They did not present a higher incidence of cardiovascular events or mortality at 18 months. ConclusionsIDH has different prevalence rates depending on the definition used and the studied center. The future poses an important challenge: to determine which definition correlates with higher morbidity and mortality and the role of differences found in different HD units.

Safety and effectiveness of emergency stenting for acute anterior circulation large artery disease

Objective: To explore the safety and effectiveness of early stent implantation in patients with acute anterior circulation large artery disease. Methods: Patients were recruited from the RESCUE-RE study (a registration study for Critical Care of Acute Ischemic Stroke After Recanalization). Patients who were diagnosed with acute ischemic stroke within 24 hours of onset and given endovascular treatment after consultation from July 2018 to May 2019 from 18 sub-centers nationwide were retrospectively enrolled. According to whether the stents were placed during the operation, the patients were divided into two groups: stenting group and non-stenting group. The baseline between the two groups was matched by propensity score. The matching variables included age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline Glasgow Coma Scale (GCS) score, history of stroke, smoking and onset to hospital time. The primary clinical outcome was 90-day good neurological outcome [defined as modified Rankin score (mRS) 0-2]. Secondary outcomes include 90-day mortality, 24-hour re-occlusion of the responsible artery, and symptomatic intracranial hemorrhage. The differences in clinical endpoints between the two groups were compared. Result: A total of 899 patients with acute anterior circulation artery stenosis or occlusion were included in the study, with a mean age of(66±12)years,and 532(59.18%) were male. There were 193 patients in the stenting group and 706 patients in the non-stenting group. After the baseline data between the two groups were matched by propensity score, 169 patients were enrolled in each of two groups respectively. After matching, the proportion of patients in the stenting group with etiological diagnosis of large atherosclerosis [82.53% (137/166) vs 55.69% (93/167)] and the proportion of patients with previous history of hypertension [63.31% (107/169) vs 47.93% (81/169)] in the stenting group were higher than those in the non-stenting group (both P<0.05). While the proportion of patients in the non-stenting group with cardiogenic embolism [37.73%(63/167) vs 11.45%(19/166)]and the proportion of patients with atrial fibrillation [18.93% (32/169) vs 10.65%(18/169)]was higher(all P<0.05). In the stenting group, the time from onset to recanalization was longer[519 (408, 620)min vs 469 (365, 690)min], and the proportion of general anesthesia [50.89% (86/169) vs 35.50% (60/169)] was higher in the stenting group(both P<0.05). In addition, in the stenting group, the proportion of patients receiving mechanical thrombectomy[67.46% (114/169) vs 88.76% (150/169)] and arterial thrombolysis [2.37% (4/169) vs 18.93% (32/169)] was lower than non-stenting group during the operation, while the proportion of patients receiving balloon dilation [53.85% (91/169) vs 13.61% (23/169)]was higher(both P<0.05). The proportion of patients in stent group receiving antiplatelet drugs before operation was higher [13.46% (21/169) vs 8.70% (14/169)](both P<0.05). In terms of clinical outcome, compared with the non-stenting group, the proportion of patients in the stenting group with good neurological function in 90 days was lower [44.79% (73/169) vs 56.36% (93/169)], and the proportion of death at 90 days was higher[15.98% (27/169) vs 8.88% (15/169)] (both P<0.05). There was no significant difference between the two groups in 24-hour re-occlusion[8.88% (15/169) vs 9.47% (16/169)] and symptomatic intracranial hemorrhage[5.92% (10/169) vs 4.76% (8/169)](both P>0.05). Conclusion: For patients with acute anterior circulation artery disease, early stent therapy may increase the proportion of patients with adverse neurological outcomes.

Evaluation of the Factors Affecting of Epistaxis: A Study in a Tertiary Care Hospital, Dhaka.

Introduction: Epistaxis refers to the occurrence of bleeding from the nose or nasal cavity. It is widely recognized as one of the most common emergencies encountered in medical settings, particularly in the ear, nose, and throat departments, as well as in accident and emergency departments across the globe. The management of epistaxis depends on the severity of the bleeding and may involve various interventions, including conservative measures like nasal packing, cauterization techniques, or, in more severe cases, surgical interventions. Objective: The primary goal of this study was to investigate the various causes of epistaxis. Materials and Methods: This cross-sectional observational study was conducted at the Department of Otolaryngology and Head-Neck Surgery (ENT) in City Medical College &amp; Hospital from May 2021 to April 2023. The study involved 220 patients who presented with epistaxis complaints at the ENT Outpatient Department or Emergency unit of hospital. Diagnosis of the cases was based on their medical history, clinical examination, radiological and laboratory investigations. Result: 220 patients were studied during the period. The mean age ± standard deviation was determined to be 36.67 ± 18.06 years. The age range spanned from 1 to 85 years. Patients less than 25 years old were 124 (56.36%) and more than 25 years old were 96 (43.74%). Males (139) predominated in both indoor and outdoor patients with a male-to-female ratio of 1.7:1. The nasal cavity most involved was left 103 (47%) compared to right 85 (38.6%). Bilateral involvement was seen in 32 (14.4%) cases. Higher incidence was also noticed during winters 93 (42.1%), followed by summer 63 (28.7%), then autumn 38 (17.2%), and least in spring 26 (11.9%). The circadian rhythm was also noted where we found epistaxis to be more during night 82 (37.6%), followed by evening 78 (35.3%), and finally morning 60 (27.1%). Previous history of hypertension (HTN) is seen in 26.3% of cases (58). The history of taking medications with hemorrhagic risk currently or stopped within the last 10 days was 3.5% (8). We also found a relationship between the age group (&lt;25 years, &gt; 25 years) and the type of treatment. Conclusion: Epistaxis, or nosebleeds, can be caused by various factors such as trauma, inflammation, tumors, blood disorders, cardiovascular issues, and foreign bodies. Younger individuals are more prone to traumatic causes, while older individuals may experience more severe nosebleeds. Hypertension is a significant contributor, emphasizing the importance of blood pressure management. Understanding these diverse causes is crucial for effective treatment and prevention of potential complications. Medicine Today 2023 Vol.35(2): 124-128

THU367 Hyperosmolar Hyperglycemic State In A Middle-old Male With Primary Hyperparathyroidism

Abstract Disclosure: D.M. Dimayuga: None. M.C. Isidro: None. A 79-year-old male was brought to our hospital for drowsiness. He had low-grade fever with associated cough and anorexia 1 week prior. He had a previous history of hypertension and primary hyperparathyroidism (PHPT) maintained on cinacalcet. He did not have a history of diabetes and a family history of diabetes, and his HbA1c was 5.4% three months before. On admission, the results of his physical examination and vital signs were as follows: height, 152cm; weight, 56.0 kg; BMI, 24.2 kg/m2; temperature, 36.5C; heart rate, 85 beats/min; SpO2, 98% (on room air); respiratory rate, 22 breaths/min; and blood pressure, 115/60 mm Hg. His blood glucose level was 966 mg/dL, HbA1c 13.4%, and serum osmolality 324 mOsm/kg. Serum ketones were 15 mg/dL and blood gas analysis was normal. He was diagnosed with hyperglycemic hyperosmolar state (HHS) and infusion of insulin and saline was subsequently initiated. With clinical suspicion of chronic pancreatitis given the patient’s history of PHPT, serum lipase was checked, 105 U/L (NV: 12-53 U/L). Ionized calcium was 1.36 mmol/L. On CT scan of abdomen, there was no evidence of duct dilatation and calcification, and instead, “features of diffuse fatty atrophy of the pancreas” were seen. His endogenous insulin secretory capacity was sufficient (serum C-peptide: 2.76 ng/mL, NV: 0.78-5.19 ng/mL). Eventually, the patient’s level of consciousness improved and glycemic control was achieved. Soon after, insulin was shifted to basal-bolus regimen. On the 7th day of hospitalization, patient was discharged with minimal insulin requirements. Two weeks later, on follow up, his blood glucose levels were found to be stable. It was not clear whether our patient had new-onset autoimmune or type 2 diabetes. Although autoimmune diabetes generally occurs when about 90% of the pancreatic beta cells have been destroyed, the patient could have been in the honeymoon period wherein beta cell activity was transiently regained after commencement of insulin therapy. Our plan is to monitor his C-peptide titers and test his insulin antibodies. Evidence suggests that PHPT may cause insulin resistance and glucose intolerance. The rise in free intracellular calcium may reduce glucose transport in insulin-stimulated glucose transporters, increasing the need for insulin. This could be the case in our patient hence we diagnosed him with type 2 diabetes. To the best of our knowledge, this is the first case demonstrating the co-occurrence of HHS and PHPT. Presentation: Thursday, June 15, 2023

Acute cerebral edema: a lethal neurological complication in a patient with COVID-19 infection. Case report and literature review

Introduction. COVID-19 can damage the nervous system by direct viral damage to the neural cells or by immunopathology. More serious medical conditions such as cerebral edema, neuronal degeneration, encephalitis, acute disseminated encephalomyelitis, Guillain-Barre syndrome, Bickerstaff’s brainstem encephalitis, Miller-Fisher syndrome, polyneuritis, toxic encephalopathy, and stroke can occur.Case report. We report a case of a 40-year-old patient with previous history of hypertension and no other chronic disease who was admitted to the hospital with respiratory distress due to SARS-CoV-2-induced bilateral pneumonia. A few days later, he developed worsening respiratory function with an acute seizure episode. Head CT scan revealed subarachnoid hemorrhage with diffuse cerebral edema as a lethal neurological complication, possibly secondary to COVID-19.Discussion. COVID-19 induces CNS damage through various mechanisms including ACE-2 receptor damage, cytokine storm syndrome, secondary hypoxia, blood-brain barrier disruption, and neuroinflammation. Neurological symptoms correlate with the severity of COVID-19 disease and may range from asymptomatic infection to severe and lethal forms. Acute cerebral edema, as illustrated by our case, may result from a combination of diffuse en dothelial dysfunction, cytokine release syndrome, and hypoxic damage from pulmonary dysfunction.

Systolic inter-arm blood pressure difference and estimated glomerular filtration rate in type 2 diabetic patients in Palestine: a cross-sectional study

Objectives This study aimed to investigate the association between systolic inter-arm blood pressure difference (IABPD) and the estimated glomerular filtration rate (eGFR), as well as chronic kidney disease (CKD), in patients with type 2 diabetes mellitus (T2DM). Patients and methods This cross-sectional study included 189 Palestinians diagnosed with T2DM. Data were collected through personal interviews, medical records and three separate blood pressure measurements from both arms. Patients were stratified in two ways: based on systolic IABPD ≥15 mmHg and the presence of CKD, indicated by an eGFR of <60 mL/min/1.73 m2 over a three months period. We used simple and multiple linear regression analyses to clarify the association between systolic IABPD (mmHg) and eGFR and to identify independent predictors for eGFR. Results The mean age was 61.3 years, with a female percentage of 57.7%. The prevalence of systolic IABPD ≥15 mmHg and CKD was 27.5% and 30.2%, respectively. Among patients with eGFR <60 mL/min/1.73 m2, the median systolic IABPD was 12.5 mmHg (interquartile range (IQR), 13.5 mmHg), whereas in patients with eGFR ≥60 mL/min/1.73 m2, it was 7.5 mmHg (IQR, 9.8 mmHg) with a significant difference (p = .021). The results of the multiple linear regression model did not reveal an independent association between systolic IABPD and eGFR, with an unstandardized coefficient (B) of −0.257 (95% confidence interval (CI), −0.623 to 0.109; p = .167). However, older age (B, −0.886; 95% CI, −1.281 to −0.49; p < .001), hypertension (B, −12.715; 95% CI, −22.553 to −2.878; p = .012) and a longer duration of DM (B, −0.642; 95% CI, −1.10 to −0.174; p = .007) were significantly and negatively associated with eGFR. Conclusions Systolic IABPD did not exhibit an independent association with eGFR in T2DM patients. However, older age, a previous history of hypertension, and a longer duration of DM were all significantly associated with lower eGFR.

STUDY OF DETERMINANTS OF PERSISTENT POSTPARTUM HYPERTENSION AT 6 W IN WOMEN WITH PRE-ECLAMPSIA

Objective: Pre-eclampsia is a pregnancy disorder with hypertension and proteinuria. Abnormal placental development and maternal/fetal genetic factors contribute to its pathogenesis. Women with pre-eclampsia are at higher risk of chronic hypertension, emphasizing the importance of postnatal monitoring and preventive measures.&#x0D; Methods: The study was conducted at the Department of Obstetrics and Gynaecology, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, from November 2017 to March 2019. Ethical clearance and informed consent were obtained. A total of 150 consecutive women with pre-eclampsia were included. Detailed history, clinical examination, and investigations were conducted. Women were followed until discharge and at 6 w postpartum. Determinants of persistent postpartum hypertension were compared between two groups, and statistical analysis was performed.&#x0D; Results: This study aimed to investigate the clinical and biochemical determinants of persistent postpartum hypertension at 6 w in women with pre-eclampsia. A total of 125 out of 150 eligible women with pre-eclampsia were followed up at 6 w postpartum. Socio-demographic, clinical, obstetrical, and treatment-related parameters were analyzed, and logistic regression. A p-value of &lt;0.05 was considered significant.&#x0D; Conclusion: In conclusion, parity and previous history of hypertension consistently emerge as risk factors for persistent postpartum hypertension in women with pre-eclampsia, variations in the literature call for further research to reconcile discrepancies and enhance understanding.

Association of periodontitis with cognitive decline and its progression: Contribution of blood-based biomarkers of Alzheimer's disease to this relationship.

To assess whether periodontitis is associated with cognitive decline and its progression as well as with certain blood-based markers of Alzheimer's disease. Data from a 2-year follow-up prospective cohort study (n = 101) was analysed. Participants with a previous history of hypertension and aged ≥60 years were included in the analysis. All of them received a full-mouth periodontal examination and cognitive function assessments (Addenbrooke's Cognitive Examination (ACE) and Mini-Mental State Examination [MMSE]). Plasma levels of amyloid beta (Aβ)1-40 , Aβ1-42 , phosphorylated and total Tau (p-Tau and t-Tau) were determined at baseline, 12 and 24 months. Periodontitis was associated with poor cognitive performance (MMSE: β = -1.5 [0.6]) and progression of cognitive impairment (hazard ratio [HR] = 1.8; 95% confidence interval: 1.0-3.1). Subjects with periodontitis showed greater baseline levels of p-Tau (1.6 [0.7] vs. 1.2 [0.2] pg/mL, p < .001) and Aβ1-40 (242.1 [77.3] vs. 208.2 [73.8] pg/mL, p = .036) compared with those without periodontitis. Concentrations of the latter protein also increased over time only in the periodontitis group (p = .005). Periodontitis is associated with cognitive decline and its progression in elderly patients with a previous history of hypertension. Overexpression of p-Tau and Aβ1-40 may play a role in this association.

P141 ACUTE MYOCARDIAL INFARCTION OR SOMETHING MORE? CASE REPORT AND CHALLENGES ASSESSMENT OF GIANT CORONARY ANEURYSM MANAGEMENT

Abstract Background Coronary Artery Aneurysms (CAA) are defined as localized coronary artery dilations more than 1.5 times the diameter of the adjacent segments. Giant CAA (GCAAs) are rare coronary diseases and the presence of multiple CAAs, located in more than one coronary artery, is even more uncommon. The pathophysiology is unknown but the majority are due to atherosclerosis. There is currently no consensus concerning the management. Case presentation: We report the case of a 72–year–old man, referred to our emergency department due to chest pain. The patient’s electrocardiogram was consistent with myocardial infarction with inferior leads ST–segment elevation. Two-dimensional echocardiography showed hypertrophic Left Ventricle (LV) with akinesia of the infero–postero-lateral LV wall and hypokinesia of the remaining LV segments (LVEF = 40%). Coronary angiography and computed tomography revealed multiple CAAs, some of them giant, associated with significant coronary artery disease: two CAAs on the right coronary artery, including a giant one (Dmax 11 mm and Dmax 32 mm); one large aneurism on the circumflex artery (D max 20.5 mm) and one on the left main descendent artery (D max 8 mm). The patient had a previous history of hypertension, dyslipidemia and abdominal aortic aneurysm. He had no history of percutaneous coronary intervention or cardiac surgical procedures. Serological studies for vasculitis or connective tissue disease were all negative. The patient underwent surgical exclusion of the giant right CAA with ligation of the proximal and distal ends of the aneurysm and double bypass surgery to the obtuse marginal and right posterior descending coronary arteries. Conclusions CAAs’ treatment options include medical treatment, interventional or surgical management. No clear evidence about the better option exists, but it seems that surgical option should be favored in cases of bigger, more tortuous and more calcified CAAs. Based on these evidences and the anatomic lesions of our patient, we opted for surgery and he successfully underwent CAAs resection with coronary bypasses. We reported our experience and we examined the current knowledge on CAA/GCAA. Overall, management is hampered by lack of evidence. We need prospective studies and registries to further our knowledge in the management of this disorder and prognosis. From our attitude, surgical treatment should be performed for multiple GCAA to prevent fatal complications.

Metabolic Syndrome as a Risk Factor in Latin American Patients with Intracerebral Hemorrhage (P14-5.032)

<h3>Objective:</h3> To analyze those risk factors associated with metabolic syndrome in patients with intracerebral hemorrhage. <h3>Background:</h3> Intracerebral hemorrhage (ICH) is a public health problem that generates high morbidity and mortality in Mexico and Latin America. Metabolic syndrome (MS) is a risk factor for cardiovascular disease and ischemic stroke, but in ICH only the association between arterial hypertension and worse clinical outcomes is recognized. <h3>Design/Methods:</h3> Data from three, longitudinal multicenter, Latin American retrospective registries of cerebral vascular disease, with a total of 1130 subjects with ICH, were analyzed. To define the association of the different components of the metabolic syndrome with good prognosis, poor prognosis and death, logistic regression models were used and odd ratios (OR) were calculated according to the exponent of the resulting coefficient. Significant values when p&lt; 0.05. <h3>Results:</h3> In the univariate analysis for good prognosis, we identified an increased probability in patients with previous history of hypertension and smoking <b>(1.74 [1.09–2.92] p=0.024)</b> and <b>(1.43 [1.03–1.93] p=0.027)</b>, respectively. When assessing poor prognosis, only smoking history represented a protective factor (0.71 [0.53–0.96] p=0.030). Previous history of DM adjusted for metabolic syndrome and age was associated with an increased chance of reaching mRS 3–5 at discharge <b>(1.37 [1.02–1.83] P=0.032)</b> and <b>(0.38 [1.03–1.84] P=0.030)</b>respectively. Finally, only obesity was associated with an increased risk of death <b>(1.36 [1.05–1.76], P=0.017).</b> <h3>Conclusions:</h3> Metabolic syndrome factors in the Latino population play an important role in the functional prognosis of patients with intracerebral hemorrhage. Although hypertension is a risk factor, the fact of being hypertensive and having a previous management could predispose to a better prognosis. Diabetes mellitus itself predisposes to greater complications during hospitalization. Obesity is also attributed to be the cause of a worse functional status, as well as an unfavorable outcome due to the increase in morbidity and mortality. <b>Disclosure:</b> Dr. Ayala Alvarez has nothing to disclose. Dr. Roque Sanchez has nothing to disclose. Dr. GOMEZ FIGUEROA has nothing to disclose. Omar Cardenas-Sanchez has nothing to disclose. Dr. Jimenez-Ruiz has nothing to disclose. Dr. Ruiz-Sandoval has nothing to disclose. Dr. Arauz has nothing to disclose. Dr. Serrano-arias has nothing to disclose.

Periodontitis is associated with subclinical cerebral and carotid atherosclerosis in hypertensive patients: A cross-sectional study

ObjectiveTo examine the relationship between periodontitis and subclinical intracranial atherosclerosis. The association of periodontitis with preclinical markers of atherosclerosis in other vascular territories was also explored.Material and methodsThis was a cross-sectional study where 97 elderly subjects with a previous history of hypertension received an ultrasonographic evaluation to assess subclinical atherosclerosis in different vascular territories: (1) cerebral [pulsatility (PI) and resistance index (RI) of the middle cerebral artery], (2) carotid [intima-media thickness (IMT)], and (3) peripheral [ankle-brachial index (ABI)]. Additionally, participants underwent a full-mouth periodontal assessment together with blood sample collection to determine levels of inflammatory biomarkers (leukocytes, fibrinogen, and erythrocyte sedimentation rate), lipid fractions (total cholesterol and high- and low-density lipoprotein), and glucose.ResultsSixty-one individuals had periodontitis. Compared to subjects without periodontitis, those with periodontitis showed higher values of PI (1.24 ± 0.29 vs 1.01 ± 0.16), RI (0.70 ± 0.14 vs 0.60 ± 0.06), and IMT (0.94 ± 0.15 vs 0.79 ± 0.15) (all p < 0.001). No statistically significant differences were found neither for ABI or for other clinical and biochemical parameters. An independent association was found between periodontitis and increased intracranial atherosclerosis (ORadjusted = 10.16; 95% CI: 3.14–32.90, p < 0.001) and to a lesser extent with thicker carotid IMT (ORadjusted = 4.10; 95% CI: 1.61–10.48, p = 0.003).ConclusionsPeriodontitis is associated with subclinical atherosclerosis in both intracranial and carotid arteries in elderly subjects with hypertension.Clinical relevanceThe association of periodontitis with intracranial atherosclerosis implies that periodontitis patients might have greater chances to develop ischemic stroke in the future.

Influence of Acupuncture and Other Clinical Factors on the Recovery of Limb Motor Function in Patients After Stroke: A Retrospective Study.

Limb motor disorders after stroke are very common, and the clinical related factors of improving limb motor function are still unclear. As a part of comprehensive rehabilitation strategy, acupuncture has been widely used in rehabilitation after stroke in China. But more evidence is needed for the influence of acupuncture and some other clinical factors on post-stroke motor disorders. A retrospective study was conducted using the database of patients with post-stroke motor disorders admitted to the Neurological Rehabilitation Unit of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine. The included patients were grouped according to whether NIHSS improved or muscle strength improved. The positive logistic regression was used to analyze the influencing factors of possible NIHSS improvement. Combined with the influencing factors of NIHSS improvement and muscle strength improvement, the influencing factors of limb motor function recovery after stroke were obtained. When analyzing the baseline of the included patients, it was found that patients with NIHSS improvement had earlier acupuncture intervention time (M, (IQR):13.5 (14), OR=0.716, 95% CI [0.591-0.869], p=0.001), more cumulative acupuncture treatment times (M,(IQR):29 (12), OR=0.744, 95% CI [0.608-0.910], p=0.004), and less hypertension history (OR=0.256, 95% CI [0.082-0.801], p=0.019). Smoking history only has positive significance in univariate and multivariate analysis of NIHSS, not muscle strength (OR=0.274, 95% CI [0.097-0.779], p=0.015). The earlier acupuncture intervention and the more cumulative acupuncture treatment times are, the more beneficial the limb function of stroke patients with motor disorders will be. The previous history of hypertension is the influencing factor of limb motor function not improving in patients with limb motor disorder after a stroke. The effect of smoking history on limb movement function of patients with limb motor disorder after stroke needs further study.

Comprehensive Management of Blood Pressure in Patients with Septic AKI.

Acute kidney injury (AKI) is one of the serious complications of sepsis in clinical practice, and is an important cause of prolonged hospitalization, death, increased medical costs, and a huge medical burden to society. The pathogenesis of AKI associated with sepsis is relatively complex and includes hemodynamic abnormalities due to inflammatory response, oxidative stress, and shock, which subsequently cause a decrease in renal perfusion pressure and eventually lead to ischemia and hypoxia in renal tissue. Active clinical correction of hypotension can effectively improve renal microcirculatory disorders and promote the recovery of renal function. Furthermore, it has been found that in patients with a previous history of hypertension, small changes in blood pressure may be even more deleterious for kidney function. Therefore, the management of blood pressure in patients with sepsis-related AKI will directly affect the short-term and long-term renal function prognosis. This review summarizes the pathophysiological mechanisms of microcirculatory disorders affecting renal function, fluid management, vasopressor, the clinical blood pressure target, and kidney replacement therapy to provide a reference for the clinical management of sepsis-related AKI, thereby promoting the recovery of renal function for the purpose of improving patient prognosis.