Primary Hypertensive Patients Research Articles

Association between the triglyceride–glucose index and carotid artery plaque burden in patients with primary hypertension: A cross-sectional study

ABSTRACT Background Studies have shown an association between the triglyceride–glucose (TyG) index and carotid artery plaque (CAP). However, the relationship between the TyG index and plaque burden in individuals with primary hypertension remains uncertain. Our study specifically aimed to explore this relationship among primary hypertension patients. Methods This study involved 5,153 hospitalized patients diagnosed with primary hypertension who were undergoing treatment at the Affiliated Hospital of Jiangxi University of Chinese Medicine. We utilized multivariate logistic regression, penalized spline regression, and generalized additive models to assess the association between the TyG index and CAP burden. Results There were 2,400 patients with primary hypertension in all. The multivariate study, which took into account all covariables, showed a positive correlation between the TyG index and CAP (OR: 1.25, 95% CI: 1.04–1.5). When the TyG index was evaluated as quartiles, the risk of CAP in the Q3 and Q4 levels of the TyG index were 1.4 (95% CI: 1.03–1.91) and 1.54 (95% CI: 1.11–2.14) times greater than in the Q1 level after adjusting for all covariables (P for trend < .05). Regardless of whether the TyG index was used as a continuous variable or a categorical variable, it has no significant association with the risk of single plaque after adjusting for all confounders (p ≥ .05). The TyG index was found to be substantially correlated with the presence of multiple plaques when analyzed as a continuous variable (OR: 1.32, 95% CI: 1.09–1.59, p = .004). When the TyG index was evaluated as quartiles, the adjusted OR in Q3 and Q4 were 1.49 (95% CI: 1.06–2.1) and 1.67 (95% CI: 1.16–2.41), respectively, with Q1 as reference (P for trend = .005). The relationship between the TyG index and the presence of multiple plaques is also consistent in all subgroups. Conclusion The TyG index is positively associated with the presence of multiple plaques in patients with primary hypertension, whereas no association is found between the TyG index and the presence of a single carotid plaque.

The Effect of Edamame Jelly on Lowering Blood Pressure in Primary Hypertension Patients

Hypertension is the cause of death in Indonesia, with 23.8% of the 1.7 million population. Management of primary hypertension is non-pharmacological therapy carried out by modifying lifestyle, namely increasing consumption of nuts that contain bioactive components that are beneficial for sufferers of primary hypertension, such as edamame (Glycine max (L.) Merrill). This study aims to determine how giving edamame jelly reduces blood pressure in primary hypertension patients. This research was quasi-experimental and used a pre-post-test control group design. The study population consisted of outpatients at the Sumbersari Jember Community Health Center who met the inclusion and exclusion criteria, totaling 42 subjects. Subjects were randomly divided into treatment and control groups. The intervention group was given amlodipine 5 mg/day and edamame jelly 150 grams/day. The control group was only assigned 5 mg of amlodipine. Statistical tests use the Paired t-test, Wilcoxon signed-rank test, and Mann-Whitney U-tests. The test results showed a significant difference in systolic and diastolic blood pressure between the control and treatment groups with a p-value &lt;0.001. The median systolic blood pressure of the control group was 147.5 mmHg, and that of the treatment group was 130 mmHg. The median diastolic blood pressure in the control group was 90 mmHg, and the treatment group's was 80 mmHg. The reduction in systolic blood pressure in the treatment group was 17.5 mmHg greater than in the control group. The decrease in diastolic blood pressure in the treatment group was 10 mmHg greater than in the control group. Giving 150 grams of edamame jelly/day for 30 days effectively reduces blood pressure in sufferers of primary hypertension.

Evaluation of the lamina cribrosa after topical latanoprost therapy in primary open-angle glaucoma or ocular hypertension

PurposeTo investigate that the changes of lamina cribrosa (LC) thickness and depth after latanoprost therapy in primary open-angle glaucoma (POAG) and ocular hypertension (OHT) patients. MethodsIn this single-center prospective cross-sectional study, 35 eyes from 35 patients with POAG or OHT (study group) and 26 age- and gender- matched healthy individuals (control group) were included. All participants were examined by spectral domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI) mode for LC thickness and depth measurements at the first visit before latanoprost therapy and at visits after 1 (second visit) and 3 (third visit) months of latanoprost therapy. ResultsThe mean LC thickness in both horizontal and vertical scans of the study group were thinner than the control group (p < 0.001, for both). During latanoprost therapy in the study group, the LC thickness values in horizontal scans significantly differed over the three visits, gradually increased (p < 0.05). There was significantly decrease in LC depth in horizontal scans between the first and third visits, and the second and third visits (p = 0.003 and p = 0.008, respectively). The gradual decrease in LC depth in vertical scans was observed at all visits, but the statistically significant difference was between the first and third visits only (p = 0.048). ConclusionPOAG/OHT patients showed more LC thinning compared with healthy individuals. The significant increase in LC thickness and the significant decrease in LC depth were detected after IOP reduction therapy with latanoprost in ocular hypertensive/ glaucomatous eyes.

Effects of DASH diet with or without time-restricted eating in the management of stage 1 primary hypertension: a randomized controlled trial

BackgroundTime-restricted eating (TRE), a popular form of intermittent fasting, has shown benefits for improving metabolic diseases and cardiometabolic health. However, the effect of TRE in the regulation of blood pressure in primary hypertension remains unclear.MethodsA 6-week randomized controlled trial was conducted, in which a total of 74 stage 1 primary hypertensive patients without high-risk were randomly assigned to Dietary Approaches to Stop Hypertension (DASH) group (n = 37) or DASH + TRE group (n = 37). Participants in the DASH + TRE group were instructed to consume their food within an 8-h window. Scientific research platform in We Chat application was used to track participants. The primary outcome was blood pressure. The secondary outcomes included body composition, cardiometabolic risk factors, inflammation-related parameters, urinary Na+ excretion, other clinical variables and safety outcomes.ResultsThe reduction of systolic blood pressure and diastolic blood pressure were 5.595 ± 4.072 and 5.351 ± 5.643 mm Hg in the DASH group and 8.459 ± 4.260 and 9.459 ± 4.375 mm Hg in the DASH + TRE group. DASH + TRE group improved blood pressure diurnal rhythm. Subjects in DASH + TRE group had decreased extracellular water and increased urinary Na+ excretion. Furthermore, the decrease in blood pressure was associated with a reduction of extracellular water or increase in urinary Na+ excretion. In addition, safety outcomes such as nighttime hunger were also reported.ConclusionOur study demonstrated that 8-h TRE + DASH diet caused a greater decrease in blood pressure in stage 1 primary hypertensive patients than DASH diet. This study may provide novel insights into the benefits of lifestyle modification in the treatment of primary hypertension.Trial registrationhttps://www.chictr.org.cn/ (ChiCTR2300069393, registered on March 15, 2023).

Assessment of Intra Renal Arterial Resistivity Index (RI) in Primary Hypertensive Patients and Its Correlation with Those of Normotensive Population

Assessment of Intra Renal Arterial Resistivity Index (RI) in Primary Hypertensive Patients and Its Correlation with Those of Normotensive Population

Glucocorticoid receptors regulate hypothalamic CRH neuron activity in primary hypertension

The hypothalamic-pituitary-adrenal axis is important in maintaining homeostasis in response to physical and psychological stressors. The corticotropin-releasing hormone (CRH) is a neuropeptide synthesized by CRH neurons in brain regions including paraventricular nucleus (PVN) of the hypothalamus. The glucocorticoids synthesized and released in adrenal gland act on hypothalamic CRH-expressing neurons inhibit the CRH production and maintain the level of glucocorticoids. The glucocorticoid receptor (GR) is critical for this negative feedback to regulate CRH synthesis and release. Hypertension is associated with high stress response and CRH mRNA levels. The number of CRH-expression neurons are significantly increased in PVN of the hypothalamus in primary hypertension patients. this study determined if the HPA axis negative feedback is altered and contribute to maintaining hypertension. We measured mRNA expression levels of GRs and MR in PVN tissue obtained from adult Wistar-Kyoto normotensive rats (WKYs) and spontaneously hypertensive rats (SHRs) and found that the GR mRNA expression level was significantly lower in SHRs that in WKY rats, while the MR gene expression did not differ between WKY rats and SHRs. Furthermore, we found that acute perfusion of dexamethasone (DEX), a synthetic glucocorticoid, significantly decreased frequency of spontaneous excitatory postsynaptic synaptic currents (EPSCs) in identified PVN-CRH expressing neurons in brain slices prepared from WKY and SHRs. DEX caused a greater reduction of frequency of EPSCs in SHRs was than in WKY rats. Acute perfusion of DEX significantly increased the firing rate of PVN-CRH neurons in WKY rats but did not change the firing rate in SHRs. In addition, incubation of brain slices with DEX for 1 hr significantly inhibited the firing activity of PVN-CRH neurons in WKY rats but did not change the firing activity of PVN CRH neurons in SHRs. These data suggested that the glucocorticoid excites PVN-CRH neurons in acute phase while inhibits these neurons in chronic phase in normotensive rat. In hypertension, downregulated GR may be responsible for impaired the HPA axis feedback and contribute to hypertension. HL139523, HL142133, and HL159157. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Dry eye rate and its relationship with disease stage in patients with primary hypertension: a cross-sectional study in Vietnam.

To determine the dry eye (DE) rate and its relationship with disease stage in patients with primary hypertension. A cross-sectional study included 432 patients with primary hypertension (with an equal number of patients in each group: 144 in stage I, II, and III hypertension) and 144 healthy subjects as a control group. The Ocular Surface Disease Index (OSDI) and Schirmer I test without anesthetics were conducted on all 576 subjects. Subjects with OSDI scores <13 and Schirmer I values equal to or under 10 mm were diagnosed with DE. The ratio of DE in hypertension patients was higher than in the control group (41.7% versus 18.8%; P<0.001). The proportion of patients with DE increased gradually according to the hypertension stage: 27.1% in stage I, 40.3% in stage II, and 57.6% in stage III, P<0.001. Age, duration of hypertension, plasma urea, creatinine, and high-sensitivity C-reactive protein (CRP-hs) levels in hypertension patients with DE were higher than those without DE, P<0.001. Advanced age, a long duration of hypertension, diabetes mellitus, elevated plasma creatinine, and CRP-hs levels were independent factors associated with DE in primary hypertension patients, P<0.001. DE is a common disorder associated with advanced age, a long duration of hypertension, diabetes mellitus, elevated plasma CRP-hs, and creatinine levels in patients with primary hypertension.

Association of adrenal steroids with metabolomic profiles in patients with primary and endocrine hypertension.

Endocrine hypertension (EHT) due to pheochromocytoma/paraganglioma (PPGL), Cushing's syndrome (CS), or primary aldosteronism (PA) is linked to a variety of metabolic alterations and comorbidities. Accordingly, patients with EHT and primary hypertension (PHT) are characterized by distinct metabolic profiles. However, it remains unclear whether the metabolomic differences relate solely to the disease-defining hormonal parameters. Therefore, our objective was to study the association of disease defining hormonal excess and concomitant adrenal steroids with metabolomic alterations in patients with EHT. Retrospective European multicenter study of 263 patients (mean age 49 years, 50% females; 58 PHT, 69 PPGL, 37 CS, 99 PA) in whom targeted metabolomic and adrenal steroid profiling was available. The association of 13 adrenal steroids with differences in 79 metabolites between PPGL, CS, PA and PHT was examined after correction for age, sex, BMI, and presence of diabetes mellitus. After adjustment for BMI and diabetes mellitus significant association between adrenal steroids and metabolites - 18 in PPGL, 15 in CS, and 23 in PA - were revealed. In PPGL, the majority of metabolite associations were linked to catecholamine excess, whereas in PA, only one metabolite was associated with aldosterone. In contrast, cortisone (16 metabolites), cortisol (6 metabolites), and DHEA (8 metabolites) had the highest number of associated metabolites in PA. In CS, 18-hydroxycortisol significantly influenced 5 metabolites, cortisol affected 4, and cortisone, 11-deoxycortisol, and DHEA each were linked to 3 metabolites. Our study indicates cortisol, cortisone, and catecholamine excess are significantly associated with metabolomic variances in EHT versus PHT patients. Notably, catecholamine excess is key to PPGL's metabolomic changes, whereas in PA, other non-defining adrenal steroids mainly account for metabolomic differences. In CS, cortisol, alongside other non-defining adrenal hormones, contributes to these differences, suggesting that metabolic disorders and cardiovascular morbidity in these conditions could also be affected by various adrenal steroids.

Untargeted metabolomics reveals potential plasma biomarkers for diagnosis of primary aldosteronism using liquid chromatography-mass spectrometry.

Metabolite profiling has the potential to comprehensively bridge phenotypes and complex heterogeneous physiological and pathological states. We performed a metabolomics study using parallel liquid chromatography-mass spectrometry (LC-MS) combined with multivariate data analysis to screen for biomarkers of primary aldosteronism (PA) from a cohort of 111 PA patients and 218 primary hypertension (PH) patients. Hydrophilic interaction chromatography and reversed-phase liquid chromatography separations were employed to obtain a global plasma metabolome of endogenous metabolites. The satisfactory classification between PA and PH patients was obtained using the MVDA model. A total of 35 differential metabolites were screened out and identified. A diagnostic biomarker panel was established using the least absolute shrinkage and selection operator (LASSO) binary logistic regression model and receiver operating characteristic analysis. Joint analysis with clinical indicators, including plasma supine aldosterone level, plasma orthostatic aldosterone level, body mass index, and blood potassium, revealed that the combination of metabolite biomarker panel and plasma supine aldosterone has the best clinical diagnostic efficacy.

Evaluating Serum Apelin and Nitric Oxide in Primary Hypertensive Patients with or without Microalbuminuria: A Cross-sectional Study

Introduction: Hypertension (HTN) is the third leading risk factor contributing to the disease burden in Southeast Asia. Understanding its underlying mechanism, such as endothelial dysfunction, is very important. Apelin is a recently discovered endogenous peptide hormone that, along with Nitric Oxide (NO), is implicated in endothelial dysfunction and the severity of HTN. This can significantly reduce renal function and lead to microalbuminuria/proteinuria in 5-15% of patients. Aim: To measure serum apelin and NO in patients with newly diagnosed primary HTN with or without microalbuminuria and to investigate the correlation of serum apelin with HTN in the same study population. Materials and Methods: This cross-sectional study was conducted from February 2019 to January 2021 in the Department of Biochemistry In collaboration with the Department of Medicine at SCB Medical College and Hospital, Cuttack, Odisha, India. A total of 180 participants were included in the present study. Among them, 90 were newly diagnosed hypertensive patients, and 90 were non hypertensive. The study comprised of 90 hypertensive patients, with 46 having microalbuminuria (Group-A), 44 without microalbuminuria (Group-B) and 90 normotensive controls (Group-C). All participants underwent evaluation of their biochemical profile which included Fasting Plasma Sugar (FBS), serum urea, creatinine, Total Cholesterol (TC), Triglyceride (TG), High-density Lipoprotein cholesterol (HDL-c), Low-density Lipoprotein cholesterol (LDL-c), Very Low-Density Lipoprotein (VLDL), serum apelin and NO levels, and urine albumin. The comparison between the three groups was done by using Analysis of Variance (ANOVA) test with post-hoc analysis. The Chi-square test was used to compare categorical variables. Results: The mean age of the participants was 50.48±9.73 years. study comprised of 90 hypertensive patients, with 46 having microalbuminuria, 44 without microalbuminuria, and 90 normotensive controls. The mean serum apelin levels were 394.45±84.2, 386.9±86.12, and 62.73±22.87 ng/L, respectively, among patients with microalbuminuria, without microalbuminuria, and normotensive patients. Similarly, the mean serum NO levels were 6.31±2.94, 8.32±2.63, and 20.15±4.37 µmol/L, respectively, among the three groups. The comparison of mean values indicated a significant (p&lt;0.001) positive correlation between the level of serum apelin and HTN and its complications, such as microalbuminuria. Conclusion: The positive correlation between serum apelin levels and blood pressure underscores the potential role of apelin in hypertensive pathophysiology.

Correlation of Serum Plasminogen Activator Inhibitor-1 with Body Mass Index and Blood Pressure among Newly Diagnosed Primary Hypertensive Patients: A Cross-sectional Study

Introduction: Plasminogen Activator Inhibitor-1 (PAI-1), a serine protease inhibitor expressed in adipose tissue, causes inflammation in hypertension and vice versa. The excess adipose tissue increases the production of PAI-1. There have been no relevant studies conducted on PAI-1 in southern Odisha in relation to Body Mass Index (BMI) and hypertension. Aim: To compare the BMI, Waist Hip Ratio (WHR), Waist Circumference (WC), and serum levels of PAI-1 in hypertensive cases with controls, and also to correlate the serum level of PAI-1 with BMI and blood pressure. Materials and Methods: This cross-sectional study was conducted in the Department of Biochemistry in collaboration with the Department of Medicine of MKCG Medical College and Hospital, Berhampur, Odisha, India from November 2020 to August 2021. A total of 45 newly diagnosed primary hypertensive patients and 43 healthy age and sex-matched individuals between the ages of 18 to 60 years were enrolled in the study. Serum PAI-1 was measured by Enzyme-Linked Immunosorbent Assay (ELISA). BMI, WC, hip circumference, WHR, and blood pressures of the controls as well as cases were recorded. Data were statistically analysed using the Student’s t-test and Pearson’s correlation coefficient. Results: The proportion of males was higher (56%) than females (44%). The cases had a significantly higher level of serum PAI-1 (203.36 ng/mL) compared to the control group (60.11 ng/mL) (p-value&lt;0.001). The cases had a higher BMI, WC (meters), and WHR compared to the control group. The serum PAI-1 level positively correlated with Systolic Blood Pressure (SBP) (r-value=0.852, p-value&lt;0.001), Diastolic Blood Pressure (DBP) (r-value=0.726, p-value=0.000), BMI (r-value=0.620, p-value=0.001), WC (r-value=0.444, p-value=0.002), and WHR (r-value=0.593, p-value&lt;0.001). Conclusion: A high serum PAI-1 level was found in the newly diagnosed hypertensive cases, and a significant positive correlation was observed between PAI-1 and systolic and diastolic blood pressure, along with BMI, WC, and WHR.

Jujubes and Rosuvastatin: Comparison of Two Hypolipidemic Agents in Primary and Secondary Hyperlipidemic and Hypertensive Patients

Biotransformation in human body results accumulation of free radicals (reactive oxygen species or ROS). If patients LDL particles are more than normal in systemic circulation, get interacted with free radicals and form foamy cells; initial stage of coronary artery disease (CAD). Hyperlipidemia may be primary (genetic reason) or secondary which is acquired type of dyslipidemia. Free radicle formation in human body is very much normal phenomenon. Just reducing LDL or raising HDL may prevent interaction of LDL with reactive oxygen species (free radicals), escaping patient to develop CAD. Commonly used drugs in prophylaxis or treatment of dyslipidemia include statins (HMGCo-A reductase inhibitors), niacin, bile resins and fibric acids. There are alternative therapies for dyslipidemia including use of fibers, fruits, and vegetables. In Pakistan there are huge number of fruits and herbs which are getting popularity as hypolipidemic agents. One of the important fruit in Pakistan having hypolipidemic potential is JUJUBES (in urdu called Bair). In this study we have compared hypolipidemic effects of Bair with statin in hyperlipidemic patients. This study was conducted at Begum Jan hospital, Islamabad-Pakistan. Sixty hyperlipidemic patients were selected and divided in two groups. Their lipid profile (LP) was determined in the hospital and blood pressure (BP) was recorded at start of treatment. Group-1 was advised to take 10 mg tablet Rosuvastatin in divided doses, and group-2 was advised to use 500 mg Bair (JUJUBES) in divided times per day for the period of 2 months. RESULTS: after two months therapy their lipid profile and BP was re-determined and analyzed statistically by using SPSS version 22.00.01. It was observed that Rosuvastatin decreased systolic BP and LDL-c highly significantly (p-value &lt; 0.001), while diastolic BP was reduced significantly (p-value &lt;0.01) and HLD-c was increased significantly with p-value &lt;0.01. In group-2 JUJUBES (Bair) reduced systolic BP and LDL-c significantly (p-value &lt;0.01) but no significant changes were observed in diastolic BP and HDL-c in this group. CONCLUSION: It was concluded from the research study that Jujubes reduce LDL-c and systolic BP in hyperlipidemic patients, but lesser than statin group of antihyperlipidemic agents.

Higher plasma aldosterone concentrations in patients with aortic diseases and hypertension: a retrospective observational study

BackgroundAortic diseases remain a highly perilous macrovascular condition. The relationship between circulating aldosterone and aortic diseases is rarely explored, thus we investigated the difference in plasma aldosterone concentration (PAC) between patients with and without aortic disease in hypertensive people.MethodsWe analyzed 926 patients with hypertension, ranging in age from 18 to 89 years, who had their PAC measured from the hospital's electronic database. The case group and control group were defined based on inclusion and exclusion criteria. The analysis included general information, clinical data, biochemical data, and medical imaging examination results as covariates. To further evaluate the difference in PAC between primary hypertension patients with aortic disease and those without, we used multivariate logistic regression analysis and also employed propensity score matching to minimize the influence of confounding factors.ResultsIn total, 394 participants were included in the analysis, with 66 individuals diagnosed with aortic diseases and 328 in the control group. The participants were predominantly male (64.5%) and over the age of 50 (68.5%), with an average PAC of 19.95 ng/dL. After controlling for confounding factors, the results showed hypertension patients with aortic disease were more likely to have high PAC levels than those without aortic disease (OR = 1.138, 95% CI [1.062 to 1.238]). Subgroup analysis revealed consistent relationship between PAC and primary hypertensive patients with aortic disease across the different stratification variables. Additionally, hypertensive patients with aortic disease still have a risk of higher PAC levels than those without aortic disease, even after propensity score matching.ConclusionsThe results of this study suggest that primary hypertensive patients with aortic diseases have elevated levels of PAC, but the causal relationship between PAC and aortic disease requires further study.

Characteristics of cardiac arrhythmia and heart rate variability in Chinese patients with primary aldosteronism.

We applied 24-h Holter monitoring to analyze the characteristics of arrhythmias and heart rate variability in Chinese patients with primary aldosteronism (PA) and compared them with age-, sex-, and blood pressure-matched primary hypertension (PH) patients. A total of 216 PA patients and 261 PH patients were enrolled. The nonstudy data were balanced using propensity score matching (PSM), and the risk variables for developing arrhythmias were then analyzed using logistic regression analysis. Before PSM, the proportion of PA patients with combined atrial premature beats and prolonged QT interval was higher than the corresponding proportion in the PH group. After PSM, the PA group had a larger percentage of transient atrial tachycardia and frequent atrial premature beats, and it had higher heart rate variability metrics. The proportion of unilateral PA combined with multiple ventricular premature beats was higher than that of bilateral PA. Older age, grade 3 hypertension, and hypokalemia were independent risk factors for the emergence of arrhythmias in PA patients. PA patients suffer from a greater prevalence of arrhythmias than well-matched PH patients.

Preliminary Consequences of Blood Pressure Management and Blood Homocysteine Levels with Perindopril in Newly Diagnosed Hypertensive Patients in the Vietnamese Population.

Perindopril is an ACE inhibitor that aids in both blood pressure regulation and homocysteine reduction. Our study aimed to evaluate the results of controlling blood pressure and blood homocysteine levels by perindopril in patients with primary hypertension. A cross-sectional descriptive study with a longitudinal follow-up was conducted on 105 primary hypertensive patients treated with perindopril. The results of our study showed that after 6 weeks of treatment with perindopril, the proportion of patients with the target blood pressure (BP) level accounted for 70.5%, the rate of grade 1 hypertension decreased from 61.0% to 25.7%, grade 2 blood pressure decreased from 17.1% to 3.8%, and there was no case of grade 3 hypertension. At the same time, we also found that the rate of BP control in the group of patients who controlled Hcy below a threshold of 15 μmol/L was significantly higher than in the other group (p < 0.05). Concerning the efficacy of decreasing homocysteine in blood, we discovered that after 6 weeks of treatment with perindopril, the proportion of patients with elevated homocysteine reduced considerably from 74.3% to 40% (p < 0.05). In addition, the homocysteine concentration was 4.33 mol/L lower after treatment than before treatment (95% CI: 3.69-4.97) (p < 0.05). Perindopril helps control blood pressure and reduces blood homocysteine levels in patients with primary hypertension.

FRI135 Differential Expression Of Circulating MicroRNAs In Primary Aldosteronism: Potential Biomarkers For Improved Diagnosis

Abstract Disclosure: S. Lamprou: None. S.M. MacKenzie: None. J.D. McClure: None. S. Robertson: None. A. Riddell: None. J.C. van Kralingen: None. A. Gimenez-Roqueplo: None. P. Reel: None. S. Reel: None. G. Assié: None. A. Laurence: None. F. Beuschlein: None. G. Rossi: None. J. Deinum: None. M. Reincke: None. G. Eisenhofer: None. E. Jefferson: None. M. Zennaro: None. E. Davies: None. Primary Aldosteronism (PA) is the most common endocrine hypertension subtype, caused by autonomous aldosterone secretion. While readily treatable, accurate diagnosis of PA – particularly its differentiation from primary hypertension (PHT) – is a complex and protracted process that can entail delays in effective treatment and lead to more severe comorbidities. Given the established role of microRNAs (miRNA) in regulating aldosterone biosynthesis, we hypothesize that circulating miRNAs are potentially viable biomarkers for PA that could inform more accurate and rapid diagnosis. To detect changes in circulating miRNA profiles specific to PA, we analyzed plasma levels of 172 selected microRNAs in a retrospectively-generated cohort of PHT (n=111) and PA patients (n=109). The dataset consisted of ΔCt values for each miRNA (normalized to multiple endogenous miRNAs), as determined by real time RT-qPCR assay. Two-sample t-tests were used to assess whether the means of the two disease groups are equal, corrected using False Discovery Rate (FDR; significance level q &amp;lt; 0.05). Ingenuity Pathway Analysis software (QIAGEN) was employed to analyze the miRNAs bioinformatically and identify mRNA targets involved in blood pressure regulation. Pathway analysis was performed to discover associations between PA and differentially-expressed miRNAs. We identified 83 circulating microRNAs that showed significant differential expression: 27 were upregulated and 56 downregulated in PA relative to PHT. The upregulated miRNA demonstrating the greatest fold change was hsa-miR-451a (FC:1.8, q=0.001), while the most downregulated was hsa-miR-409-3p (FC:0.5, q=0.001). Bioinformatics analysis predicted several dysregulated miRNAs to target mRNAs in PA-related pathways. For example, the most upregulated miRNA, hsa-miR-451a, is predicted to target mRNAs in biochemical pathways relevant to PA pathophysiology, including SGK1 and MAP3K1. SGK1 contributes to the signaling cascade induced by the mineralocorticoid receptor-aldosterone complex that stimulates Na+ reabsorption in the kidney, while MAP3K1 participates in the Renin-Angiotensin system, a key regulator of aldosterone secretion, as part of a signaling cascade that leads to the activation of the AP1 complex in the nucleus. In addition to hsa-miR-451a, other differentially-expressed miRNAs were also revealed to target multiple mRNAs with direct and indirect connections to PA. In summary, analysis has identified miRNAs that are significantly differentially expressed in the plasma of PA patients compared to PHT patients, indicating promise for a biomarker-based approach to PA diagnosis utilizing distinctive circulating microRNA signatures. Further analysis is now being conducted to validate our findings in an independent population of hypertensive patients. Presentation: Friday, June 16, 2023

COMfort Eye Trial (COMET) results - a non-inferiority, randomized, investigator-masked, two-parallel group, phase III clinical trial, to evaluate the efficacy and safety of a preservative free formulation of latanoprost versus a reference drug (Xalatan®) in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT)

ABSTRACT Aim To prove non-inferiority of preservative-free (PF) latanoprost versus benzalkonium chloride (BAK) containing latanoprost in lowering intraocular pressure (IOP) in primary open-angle glaucoma (POAG) or ocular hypertension (OHT) patients. Design and methods This phase III, randomized, investigator-masked trial primarily aimed to demonstrate non-inferiority of YSLT PF latanoprost 50 μg/ml (Yonsung GmbH) to latanoprost (Xalatan®) 50 μg/ml (Pfizer) in reducing IOP from Baseline to Week 12. Secondary aims included conjunctival hyperemia evaluation and difference in ocular comfort levels. Total 130 patients with POAG or OHT were enrolled and randomized (1:1 ratio) to receive YSLT or latanoprost, instilling eye drops daily for 12 weeks. Results At Week 12, mean diurnal IOP reduction was −7.67 ± 2.104 mmHg for YSLT PF latanoprost and −7.77 ± 2.500 for latanoprost. The 97.5% confidence interval of between-treatment group difference in IOP reduction from Baseline to Week 12 was [−0.846, +∞), not crossing the non-inferiority margin of −1.5 mmHg. A low incidence of mild topical treatment emergent adverse events (TEAEs) was observed in both groups, while no serious TEAEs were reported. Conclusions YSLT eye drops demonstrated non-inferiority to latanoprost in reducing IOP. Both products were well tolerated without serious TEAEs reported.

24-Hour efficacy of single primary selective laser trabeculoplasty versus latanoprost eye drops for Naïve primary open-angle glaucoma and ocular hypertension patients

This prospective, observer-masked, randomized clinical trial was conducted between December 2018 and June 2021 at Eye Hospital, China Academy of Chinese Medical Sciences. A total of 45 glaucoma patients from Beijing, China, were enrolled in this clinical trial to compare the short-term efficacy of primary single-selective laser trabeculoplasty (SLT) to 0.005% latanoprost eye drops for the treatment of 24-h intraocular pressure (IOP) in patients with newly diagnosed primary open angle glaucoma (POAG) and ocular hypertension (OHT). Both SLT and latanoprost significantly decreased mean 24-h IOP and peak IOP, although the latanoprost group effect was more potent when compared to the SLT group (both Ps < 0.05). Compared with the SLT group, the latanoprost group had a significant and stable decrease in IOP after treatment. The latanoprost group had a more pronounced reduction in IOP at weeks 4 and 12 (P < 0.05) but had no difference at week 1 (P = 0.097). As a first-line treatment, both SLT and latanoprost eye drops are effective in newly diagnosed POAG and OHT patients. However, the latanoprost eye drops may be better in decreasing mean and peak 24-h IOP and thus controlling 24-h IOP fluctuation compared to SLT.

Comparison of the Effect of Morning Versus Night Amlodipine Administration on Blood Pressure Reduction in Primary Hypertensive Patients

Comparison of the Effect of Morning Versus Night Amlodipine Administration on Blood Pressure Reduction in Primary Hypertensive Patients

P-wave peak time and P-wave dispersion in surface electrocardiography as initial predictors of new-onset atrial fibrillation in early-onset hypertension.

Atrial fibrillation (AF) is common in hypertension, and electrophysiological remodelling may contribute to the early stage of the disease. This study aimed to develop electrocardiography (ECG) prediction models on new-onset AF (NAF) in early-onset hypertension (e-HTN). This matched case-control study included primary hypertension patients with onset <5 years defined as e-HTN and without documented AF. Developed NAF was the risk group and non-developed NAF was control group with 1:2 ratio. Group was matched according to age, gender, follow-up time, and duration of hypertension. Parameters of ECG and echocardiography between the groups at the baseline and end of follow-up will be compared. A total of 348 e-HTN with 116 developed NAF during follow-up (60.2 ± 14.5 months) were included. At baseline ECG, duration of QRS (100.84 ms ± 15.69 ms vs 94.80 ms ± 15.68 ms), Pmax (106.75 ms ± 7.93 ms vs 101.77 ms ± 6.78 ms), Pmin (70.24 ms ± 5.59 ms vs 68.17 ms ± 5.61 ms), P-wave dispersion (PD) (36.50 ms ± 5.25 ms vs 33.60 ms ± 5.46 ms), P-wave Peak Time (PWPT) II (62.01 ms ± 3.92 ms vs 54.29 ms ± 6.73 ms), and PWPT V1 (55.31 ms ± 2.89 ms vs 51.24 ms ± 4.05 ms) were significantly higher in developed NAF (all P-value < 0.05). LVMI was also significantly higher in bivariate analysis, but only Pmax, Pmin, PD, PWPT, non-RAAS inhibitor, and uncontrolled hypertension were independently associated with developed NAF. Baseline PWPT II with cut-off ≥57.9 ms and PD ≥ 35.5 ms has high sensitivity and specificity on NAF prediction. In conclusion, baseline PWPT and PD are potential electrophysiological parameters for predicting NAF in e-HTN.