Systolic Blood Pressure Ratio Research Articles

#1642 Influence of potassium intake on the renoprotective response to sodium restriction and hydrochlorothiazide in patients with diabetic nephropathy

Abstract Background and Aims Both salt restriction and hydrochlorothiazide (HCT) potentiate the antihypertensive and antiproteinuric effects of renin-angiotensin-aldosterone-system inhibitors (RAASi) in chronic kidney disease (CKD). Potassium intake is another dietary component that influences blood pressure (BP) and albuminuria. The influence of potassium intake on the response to sodium restriction during RAASi treatment in diabetic nephropathy is unknown. Method We performed a post-hoc analysis of a randomised, double blind, placebo-controlled cross-over trial (n = 43) investigating the combined and separate effects of low sodium (LS; aim 50 mmol Na+/d) and HCT (50 mg/d) on BP and albuminuria during background ACE inhibition (ACEi; lisinopril 40 mg/d) in patients with diabetic nephropathy. Each treatment (normal sodium (NS), LS, NS+HCT, LS+HCT) period consisted of six weeks. Participants were categorised as above or below median 24-hour urinary potassium excretion (UKV) at baseline, stratified by sex. Effects on BP and albuminuria were defined as % reduction from baseline systolic BP (SBP) and urinary albumin-creatinine ratio (ACR). Changes over time within both UKV subgroups were compared to baseline using repeated measures ANOVA (SBP) or paired Wilcoxon rank sum analysis (log-transformed ACR). Post-hoc between-group comparison was performed using Bonferroni testing. Results 43 patients (6 female; mean age 64.9±1.4 yrs) had UKV data available and were included in analysis. 33 patients had complete ACR data. Mean estimated glomerular filtration rate (eGFR) was 65.2 (±3.9), mean SBP was 146.6±2.4 mmHg and median albuminuria 648.6 [251.2 - 1883.0] mg/24 h. Median UKV in the high and low potassium groups was 64 [IQR 49-71] and 94 [90 – 111] mmol/24 u, respectively (p<0.0001). Mean baseline sodium excretion was higher in the high potassium group (191 vs. 260 mmol/d; P = .002), but percentual reduction in sodium excretion at SR was comparable between the two groups. There were no significant differences in baseline SBP, ACR, age and estimated glomerular filtration rate between the groups. LS led to a significant reduction of ACR in the high potassium group (P = .011), whereas in the low potassium group the ACR reduction was not significant (P = .058; Fig. 1). Similarly, addition of HCT to background ACEi therapy without salt restriction reduced ACR compared to ACEi monotherapy in the high potassium group (P < .0001), not the low potassium group (P = .211). LS+HCT combined led to a reduction in ACR in both high (P < .0001) and low potassium (P = .034) groups. A post-hoc between-group analysis showed a significantly larger ACR reduction for the high potassium group (P = .01) upon HCT therapy, and a trend towards larger reduction for HCT+LS (P = .05). The effect of LS alone was similar between high and low potassium groups (P = .485). During LS, within-group analysis showed a significant reduction in SBP compared to baseline for the low potassium group (P = .003), but not for the high potassium group (P = .208). In all further conditions, SBP was significantly reduced from baseline in both groups. Post-hoc analysis showed no significant differences in SBP reduction between high and low potassium groups, although there was a trend towards larger SBP reduction in the low potassium group during LS (P = .07). Conclusion Higher baseline potassium excretion is associated with stronger albuminuria lowering effects of salt restriction and HCT in patients with diabetic nephropathy on background ACEi therapy. These effects were not driven by similar effects on BP.

Comparison of Postexercise Ankle Brachial Index in at Risk versus Diagnosed Peripheral Arterial Disease Population

Abstract Background: Peripheral arterial disease (PAD) is characterized by stenosis or occlusion in the arteries of the limb causing limitation in the distal blood flow. Out of the various risk factors identified, diabetes and cigarette smoking are the strongest predictors of PAD. PAD results from atherosclerosis of the vessel wall. Patients with lower extremity PAD have clinical presentation of intermittent claudication and atypical leg pain. In patients with arterial stenosis, there is a drop in pressure and flow across stenosis. Asymptomatic PAD approximately 20%–50% of total patients diagnosed with PAD. Ankle brachial index (ABI) is clinically widely used modality which helps to identify the disease. ABI test is the ratio of systolic ankle blood pressure and highest systolic brachial blood pressure. Population at risk with normal resting ABI may still have PAD. For such population, postexercise ABI is recommended. This study evaluated and compared ABI postexercise in normal healthy individuals without risk of PAD, at risk of PAD. Materials and Methods: This study is an observational study. Population with age more than 35 years were selected. Framingham Risk Score was taken for normal and at-risk population. Subjects were recruited in three groups: A, B, and C. ABI at rest was assessed. Individuals performed exercise treadmill test. Immediately, after completing the exercise, postexercise ABI was taken. Absolute systolic blood pressure values and postexercise ABI values were obtained in all three groups and then were compared. Data were analyzed using the SPSS software version 26. Results: The results of this study showed that for all the three groups, there was a significant difference in ABI at rest, postexercise ABI, and difference in systolic ankle pressure as P value was <0.001. When the Chi-squared test was done for postexercise ABI and postsystolic ankle pressure in between Group B and Group C, there was no significant difference found as the P value was >0.05. Conclusion: On comparison with at risk and normal individuals, no significant difference was found in terms of postexercise ABI and change in systolic ankle pressure.

Insulin resistance, C-reactive protein, diastolic to systolic blood pressure ratio and epicardial fat are related to sedentary time, and inversely related to physical activity in school-aged children.

Physical activity (PA) is beneficial for the overall health. Objectives are: (1) To compare metabolic (MRM) and cardiovascular-risk-markers (CRM) in children according to their PA-level; (2) to explore the associations of MRM and CRM with PA and sedentary time (ST); and (3) to identify the associations between MRM and CRM in less (LA) and more active (MA) children. A total of 238 apparently healthy school-aged children were enrolled (132 boys/106 girls; 9.1 ± 1.8 years) and body mass index standard deviation score (BMI SDS) and blood pressure were assessed. Fasting venous blood sampling was performed to assess insulin resistance (HOMA-IR) and high-sensitivity-C-reactive protein (hsCRP). Epicardial fat, interventricular septal and left ventricular posterior wall thicknesses were assessed by high-resolution ultrasonography. PA and ST were assessed by enKid-questionnaire. Children were classified based on enKid-score as being LA and MA (below and above 50th percentile for PA). MA-children had lower values for: BMI SDS, diastolic-to-systolic blood pressure ratio, HOMA-IR and hsCRP (7.02 to 61.5% lower, p = 0.040 to p < 0.0001) compared to LA-children. MRM and CRM were positively associated with ST (p = 0.003 to p < 0.001), and negatively associated with PA (p = 0.044 to p < 0.001). Finally, MRM were positively associated with CRM (p = 0.008 to p < 0.0001). Interestingly, the latter associations were observed in LA-children but were not present in MA-children. More PA is associated with better cardio-metabolic profile in school-aged children. PA seems to modulate the associations between MRM and CRM, thus reinforcing the idea that fostering PA in children may lower the risk for development of a cardio-metabolic disease.

Potential Mediators for Treatment Effects of Novel Diabetes Medications on Cardiovascular and Renal Outcomes: AMeta-Regression Analysis.

Prior research suggests clinical effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) are mediated by changes in glycated hemoglobin, body weight, systolic blood pressure, hematocrit, and urine albumin-creatinine ratio. We aimed to confirm these findings using a meta-analytic approach. We updated a systematic review of 9 GLP-1RA and 13 SGLT2i trials and summarized longitudinal mediator data. We obtained hazard ratios (HRs) for cardiovascular, renal, and mortality outcomes. We performed linear mixed-effects modeling of LogHRs versus changes in potential mediators and investigated differences in meta-regression associations among drug classes using interaction terms. HRs generally became more protective with greater glycated hemoglobin reduction among GLP-1RA trials, with average HR improvements of 20% to 30%, reaching statistical significance for major adverse cardiovascular events (ΔHR, 23%; P=0.02). Among SGLT2i trials, associations with HRs were not significant and differed from GLP1-RA trials for major adverse cardiovascular events (Pinteraction=0.04). HRs for major adverse cardiovascular events, myocardial infarction, and stroke became less efficacious (ΔHR, -15% to -34%), with more weight loss for SGLT2i but not for GLP-1RA trials (ΔHR, 4%-7%; Pinteraction<0.05). Among 5 SGLT2i trials with available data, HRs for stroke became less efficacious with larger increases in hematocrit (ΔHR, 123%; P=0.09). No changes in HRs by systolic blood pressure (ΔHR, -11% to 9%) and urine albumin-creatinine ratio (ΔHR, -1% to 4%) were found for any outcome. We confirmed increased efficacy findings for major adverse cardiovascular events with reduction in glycated hemoglobin for GLP1-RAs. Further research is needed on the potential loss of cardiovascular benefits with increased weight loss and hematocrit for SGLT2i.

Abstract WP289: Insufficient Low-Frequency Blood Pressure Activity Under Orthostatic Stress Predicts Blunted Night-to-Day Blood Pressure Dipping in Patients With Ischemic Cerebrovascular Disease

Introduction: Blunted night-to-day blood pressure (BP) dipping was common in ischemic cerebrovascular disease (ICVD). BP dipping could be influenced by baroreflex, which stabilized BP by regulating sympathovagal balance. We sought to determine the relationship between baroreflex function and BP dipping in patients with ICVD. Methods: Patients with ICVD stable for at least 3 days were enrolled. Beat-to-beat BP and ECG were monitored in 3 phases of active standing [supine (S), supine to upright (SU), upright (U), 4 min each]. Baroreflex function was evaluated by time-domain and frequency-domain baroreflex sensitivity (BRS) and by indices of sympathovagal balance [low (0.04-0.15 Hz) to high (0.15-0.4 Hz) frequency ratio (LHR) of systolic BP (SBP) and RR interval (RRI)]. BP dipping was measured as percentage with 24h ambulatory BP monitoring. SBP dipping &lt;0 was defined as reverse BP dipping. Results: Among 66 patients, mean SBP dipping was 3.54% ± 6.85%. SBP dipping was positively related to BP-LHR SU (Spearman r=0.258, p=0.036), but had no significant correlation with time-domain and frequency-domain BRS, LHR S and LHR U of BP and RRI, or RRI-LHR SU (Table 1). Lower log BP-LHR SU was indicative of less SBP dipping [β (95% CI): 6.53 (1.67-11.40), p=0.009] and the presence of reverse BP dipping [OR (95% CI): 0.11 (0.02-0.65), p=0.015], even after adjusting age, sex, vascular risk factors, 24h mean BP level, NIHSS and mRS scores (Table 2). Conclusions: Low BP-LHR SU , which suggested sympathetic underactivation of BP activity during the orthostasis-stimulated baroreflex engagement, might be a pathophysiological link between baroreflex impairment and blunted BP dipping in ICVD.

Biological response of nonhuman primates to controlled levels of acute blood loss.

The global shortage of human blood for medical use has prompted the development of alternative blood sources. Nonhuman primates (NHPs) are commonly used owing to their physiological similarities to humans. The objective of the current study was to establish a controlled-blood-loss model in NHPs to explore their clinical and biological responses. Blood was sequentially withdrawn from 10 cynomolgus monkeys (10, 14, 18, 22, and 25% of the total blood volume); their vital signs were monitored, and blood parameters were serially analyzed. Humoral mediators in the blood were measured using flow cytometry and enzyme-linked immunosorbent assays. In NHPs subjects to 25% blood loss and presenting with related clinical symptoms, the systolic blood pressure ratio on day 0 after bleeding was significantly lower than that of the animals from the other groups (median: 0.65 vs. 0.88, P = 0.0444). Red blood cell counts from day 0-14 and hematocrit levels from day 0-7 were markedly decreased relative to the baseline (P < 0.01). These parameters showed a direct correlation with the extent of blood loss. The levels of creatine phosphokinase, aspartate aminotransferase, and alanine aminotransferase exhibited increases in response to blood loss and had a stronger correlation with the hemoglobin ratio than the volume of blood loss. The levels of C3a and C4a, as well as interleukin (IL)-1α and IL-15, displayed a strong correlation, with no apparent association with blood loss. The findings of the present study showed that only NHPs with 25% blood loss exhibited clinical decompensation and significant systolic blood pressure reduction without fatalities, suggesting that this level of blood loss is suitable for evaluating blood transfusion efficacy or other treatments in NHP models. In addition, the ratio of hemoglobin may serve as a more dependable marker for predicting clinical status than the actual volume of blood loss. Thus, our study could serve as a basis for future xenotransfusion research and to predict biological responses to massive blood loss in humans where controlled experiments cannot be ethically performed.

Assessing Reverse Shock Index as a Survival Predictor for Trauma Patients in Emergency Settings: A Retrospective Observational Study

ntroduction: Identifying trauma patients with shock is crucial, as early intervention and prompt treatment improve patient prognosis and survival. To address this, the ratio of Systolic Blood Pressure (SBP) and Heart Rate (HR), known as the Reverse Shock Index (RSI), is measured. Aim: To evaluate the effectiveness of RSI calculation in assessing prognosis. Materials and Methods: This was a retrospective observational study in which data were retrospectively collected on trauma patients treated in the Emergency Room (ER) at Dhiraj Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India, from January 2021 to December 2022. Patients involved in road traffic accidents, fall from a height of ≥6 m, assault, and machinery injuries were included. Upon arrival, vital signs such as HR, SBP, Respiratory Rate (RR), Glasgow Coma Scale (GCS), associated injuries, and in-hospital mortality were documented. Any resuscitative procedures required, such as Cardiopulmonary Resuscitation (CPR), intubation, oxygen therapy, chest tube insertion, and blood transfusion, were also recorded. The RSI was calculated for all trauma patients and divided into two groups (RSI &lt;1 and RSI ≥1). The t-test was performed with a 95% Confidence Interval (CI). Results: Out of 363 patients, data from 320 patients were included. Among them, 55 patients (17.2%) had RSI &lt;1, and 265 patients (82.8%) had RSI ≥1. Patients with RSI &lt;1 exhibited lower GCS scores, tachypnoea (RR &gt;29), or bradypnoea (RR &lt;10), along with higher mortality rates. These patients also required resuscitative interventions. Those with RSI &lt;1 experienced more head injuries, thoracic trauma, and maxillofacial injuries (p&lt;0.001). Conclusion: The RSI &lt;1 in trauma patients demonstrated significantly higher predictive accuracy for adverse outcomes, serving as a primary tool for early intervention and aggressive care in the ER.

Abstract 12996: Association Between Blood Cadmium Level and Congestive Heart Failure: Analysis of the NHANES 2017 - 2020

Introduction: Cadmium toxicity affects various organs, including the heart and kidneys. Whether the relationship between a broad range of cadmium levels, from normal to highly toxic and congestive heart failure (CHF), remains unclear. Hypothesis: Blood cadmium (Cd) level is associated with a higher prevalence of CHF. Methods: A nationwide cross-sectional study involving participants (≥ 18 years old) in the 2017 - 2020 NHANES was examined by using multiple logistic regression to determine the association between Cd levels and history of CHF informed by a doctor or other health professional. Results: Of 12,102 participants with blood cadmium (Cd) results were identified, of which mean age was 37±24 years, and 50.6% were female. The majority were White (33%), followed by Black (25%), Mexican American (13%), and Asian (10%). Among 8,074 participants with Cd results, 304 participants (3.8%) had a history of CHF. The participants were stratified into quartiles (Q) based on their Cd levels, with mean Cd levels of 0.08, 0.16, 0.29, and 0.93 μg/L for each quartile, respectively. Individuals in Q2, Q3, and Q4 were 2.48, 3.20, and 4.29 times more likely to experience CHF than those in Q1. (Q2: 95% CI 1.22, 5.06; Q3: 95% CI 1.61, 6.37; Q4: 95% CI 2.18, 8.45).After adjusting for age, gender, race, BMI, smoking status, high systolic blood pressure (&lt;130 vs. &gt;130 mmHg), diabetic status, and urine albumin creatinine ratio, participants in Q3 and Q4 remained at a higher risk of CHF compared to an individual in Q1, with a risk increase of 2.18 and 3.04, respectively. (Q3: 95% CI 1.02, 4.68; Q4: 95% CI 1.41, 6.52; Figure 1). While CHF was 2.11 times as likely to occur among participants in Q2 but not statically significant (Q2: 95% CI 0.97, 4.59; Figure 1). Conclusions: A graded association exists between blood cadmium levels, even within the non-toxic range, and an increased prevalence of CHF. Further longitudinal cohort studies are required to elucidate this relationship.

Later circadian timing and increased sleep timing variability are associated with attenuations in overnight blood pressure dipping among chronic nightshift workers

ObjectiveDetermine relationships between overnight blood pressure, circadian phase, and sleep variability among dayshift and chronic nightshift nurses. MethodsTwenty participants working dayshift (n = 10) or nightshift (n = 10) schedules participated in a 7-day cross-sectional study. Participants underwent an evening in-laboratory melatonin assessment and wore ambulatory blood pressure devices to assess 24-hour blood pressure patterns. Overnight blood pressure dipping was calculated from sleeping/waking systolic blood pressure ratio and salivary dim-light melatonin onset determined circadian phase. Sleep variability was assessed using the standard deviation of 7-day sleep onset. ResultsNightshift workers had later circadian phase, greater sleep onset variability, and an attenuated overnight blood pressure dipping pattern. Later circadian phase was associated with attenuated dipping patterns and sleep onset variability was negatively correlated with blood pressure dipping magnitude in nightshift, but not dayshift workers. ConclusionsChronic circadian disruption via higher sleep onset variability among nightshift workers may contribute to attenuated blood pressure dipping and cardiovascular risk in this population.

Correlation between shock index and postoperative outcomes for patients undergoing on-pump coronary artery bypass graft surgery (an observational study)

ABSTRACT Introduction Shock index (SI) is defined as a ratio of heart rate and systolic blood pressure. It was originally employed to evaluate hemorrhage and acute circulatory failure. Recently, SI has been used as a morbidity and mortality predictor in various fields. An elevated SI was associated with higher morbidity. Objective To detect the sensitivity and specificity of SI in predicting major cardiac events. Methods We randomly enrolled 100 patients who were set to undergo on-pump coronary artery bypass graft (CABG) surgery in the study. The primary outcome was to detect the sensitivity and specificity of SI to predict the occurrence of major adverse cardiac events, occurrence of acute kidney injury (AKI) and the need for ventilator support for >48 h. The secondary outcome was to correlate between SI and need of inotropic support, length of hospital stay and in-hospital mortality. Results The main findings of our study were the presence of a good correlation between SI and occurrence of postoperative cardiovascular (CV) collapse, AKI and prolonged postoperative mechanical ventilation after on-pump CABG as primary outcomes as well as the presence of a significant correlation between the occurrence of in-hospital mortality and morbidities and high values of SI as secondary outcomes. Conclusions We believe that SI has a good prediction of postoperative CV collapse, AKI and prolonged postoperative mechanical ventilation >48 h.

0007 Later circadian phase and increased sleep variability are associated with overnight blood pressure dipping in chronic shiftworkers

Abstract Introduction Nighttime shift work is associated with adverse cardiovascular outcomes, including hypertension. Increased sleep variability and circadian disruption may increase sympathetic activity and waking blood pressure (BP), potentially constraining typical BP reductions during overnight sleep. However, the relationships between circadian phase, sleep variability, and overnight BP reduction (dipping) among day vs. chronic nightshift workers is unknown. Methods Ambulatory BP was monitored for up to 48-hours among 10 dayshift (mean□SD; age 33.1□7.0y; BMI 26.3□5.4 kg/m2) and 10 chronic (9.3□6.8y of shiftwork) nightshift workers (age 32.7□9.1y; BMI 27.9□7.6 kg/m2). Overnight BP dipping was calculated from the sleeping/waking systolic BP ratio. Variability in sleep timing was defined as the SD of self-reported daily-diary sleep onset across 1-week. Circadian phase was determined by salivary dim-light melatonin onset (DLMO; 3pg/ml threshold). Differences between groups were assessed using independent t-tests and linear mixed-effects models with group and time-from-sleep-onset or circadian phase as fixed-effects, and participant as a random effect. Relationships between overnight BP dipping and DLMO, sleep onset timing variability, and phase angle of entrainment (DLMO to sleep onset during ambulatory BP) were assessed using Pearson correlation analyses. Results Chronic nightshift workers had reduced overnight BP dipping (-9.3□1.5 % vs -13.4□4.4 %; p=0.04), later DLMO timing (21:08□0:53 vs 19:21□1:02; p=0.001), smaller phase angle of entrainment (3.7□1.0 h vs 5.0□0.90 h; p=0.02), and greater variability in sleep onset timing (3.2□1.5 h vs 0.87□0.34 h; p&amp;lt; 0.001). Significant group effects for higher systolic BP across circadian phase and time from sleep onset in the nightshift group were observed compared to dayshift (both p&amp;lt; 0.05). DLMO (r=0.49; p=0.04) and phase angle of entrainment (r=0.53; p=0.02) were associated with overnight BP dip magnitude (later circadian phase correlated with less dipping). Sleep onset timing variability was negatively correlated with magnitude of overnight BP dipping in nightshift (r= -0.76; p=0.04) but not dayshift workers (r=0.26; p=0.61). Conclusion Attenuated overnight BP dipping among chronic nightshift workers may be indicative of increased cardiovascular risk. Chronic circadian disruptions (i.e., smaller phase angle of entrainment) as a function of higher sleep variability among nightshift workers may mechanistically contribute to poorer health outcomes compared to dayshift workers. Support (if any) R01HL105495, K01HL146992

Association between annual exposure to air pollution and systolic blood pressure among adolescents in Montréal, Canada

In adults, chronic exposure to air pollution is associated with elevated blood pressure, but few studies have examined this relationship in youth. We investigated the association between annual ambient concentrations of air pollutants (fine particulate matter [PM2.5] and nitrogen dioxide [NO2]) and systolic blood pressure (SBP) among adolescents in Montréal, Canada. Participants were students aged 15 to 17 years who provided SBP and residential postal code data in 2004/05 through their enrolment in the Nicotine Dependence in Teens study. Annual estimates for 2004 of residential exposure to NO2 and PM2.5 were provided by the Canadian Urban Environmental Health Research Consortium and linked to participants' residential postal code. Elevated SBP was defined as SBP ≥ 90th percentile adjusted for age, sex and height. Logistic regression was used to estimate odds ratios and 95% confidence intervals (CIs) for each pollutant with respect to elevated SBP, adjusted for relevant confounders. The sample consisted of 508 adolescents (mean age: 16.9, 46% male); 4% had elevated SBP. Although estimates were not statistically significant, there were generally modest positive associations between pollutant levels and SBP. The adjusted prevalence odds ratio of elevated SBP was 1.33 (95% CI: 0.64, 3.05) for every interquartile range (IQR) increase in residential PM2.5 levels (2.1μg/m3). Similarly, the adjusted prevalence odds ratio of elevated SBP was 1.17 (95% CI: 0.47, 2.70) for every IQR increase in residential NO2 levels (10.2 ppb). Findings support a possible relationship between exposure to air pollutants and increased SBP in adolescents, warranting further investigation for this important public health concern.

Abstract P140: Potential Mediators for Cardiovascular Benefits of Novel Diabetes Medications: A Meta-Regression Analysis

Background: Prior research suggests cardiovascular (CV) benefits of glucose-lowering interventions may be mediated by changes in hemoglobin A1c (HbA1c), bodyweight, systolic blood pressure (SBP), hematocrit, and urine albumin-creatinine ratio (uACR). We evaluated the heterogeneity of CV benefits by these potential mediators for sodium-glucose transporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) using a meta-analytic approach. Methods: We performed a systematic review and meta-regression analyses of 12 SGLT2i and 9 GLP-1RA CV outcome trials using linear mixed models of treatment efficacy measured as log hazard ratios (HRs) vs changes in potential mediators. We extracted follow-up mediator data for treatment and control, preferably at 12 months post randomization. Outcomes included MI, stroke, and MACE (a composite of MI, stroke, or CV death). We investigated slope differences between drug classes using interaction terms and likelihood-ratio tests. Results: Treatment efficacy for MACE improved with more HbA1c reduction among GLP-1RA (slope .26; P slope .02) but not among SGLT2i trials (slope -.22; P slope .39; P interaction .06), see Figure . Treatment efficacy for MACE, MI, and stroke decreased with more weight loss for SGLT2i (slope –.17, –.29, –.39; P slope &lt;.05) but not for GLP-1RA trials (slope .05, .03, .07; P slope .30, .62, .32). Slopes differed significantly between drug classes: P interaction &lt;.05. For stroke, we observed a trend of less treatment efficacy with increases in hematocrit among five SGLT2i trials with available data (slope .96; P slope .07). We did not find any indication of mediation effects by SBP and uACR for SGLT2i or GLP-1RAs (slopes -.11 -.07; P slopes ≥ .05). Conclusion: We confirm previous findings of increased CV benefits with reductions in HbA1c for GLP1-RAs. Further research is needed to investigate the potential loss of SGLT2i efficacy with greater weight loss and increase in hematocrit.

Assessment of subclinical left ventricular systolic dysfunction in patients with type 2 diabetes: Relationship with HbA1c and microvascular complications.

We aimed to examine the association between glycated hemoglobin (HbA1c), microvascular complications, and subclinical left ventricular (LV) systolic dysfunction, and to determine the strength of the correlation in asymptomatic patients with type 2 diabetes mellitus (T2DM). Global longitudinal strain (GLS) was employed to assess the subclinical LV function of 152 enrolled T2DM patients with preserved LV ejection fraction, with the cutoff for subclinical LV systolic dysfunction predefined as GLS < 18%. According to univariate analysis, the reduced GLS exhibited association with the clinical features including HbA1c, triglyceride, systolic blood pressure, fasting glucose, heart rate, diabetic retinopathy, and urinary albumin creatinine ratio (UACR) (all p < .05). After the factors of gender, age, and related clinical covariables adjusted, multiple logistic regression analysis revealed the HbA1c (odds ratio [OR] 1.66; 95% confidence interval [CI] 1.30-2.13; p < .001), UACR (OR 2.48; 95% CI 1.12-5.47; p=.025) and triglyceride (OR 1.84; 95% CI 1.12-3.03; p=.017) as the independent risk factors for the reduced GLS. Receiver operating characteristic curve showed a predictive value of the HbA1c for the subclinical LV systolic dysfunction (area under curve: 0.74; p < .001). In asymptomatic T2DM patients, subclinical LV systolic dysfunction was associated with HbA1c, diabetic complications, and triglyceride. More prominently, HbA1c may exert a prognostic significance for the progression of myocardial damage.

Effect of Preoperative Antianxiety Medications on Blood Pressure and Blood Loss in Total Knee Arthroplasty: A Case-Control Study.

The increasing number of canceled operations in patients undergoing total knee arthroplasty (TKA) due to high blood pressure readings has put a considerable burden on surgeons. In this study, we aim to assess the effect of giving antianxiety drugs preoperatively on maintaining blood pressure (BP) and blood loss for patients undergoing TKA surgery. This retrospective case-control study included patients who underwent total knee arthroplasty and divided them into two main groups: those who had taken a 3 mg bromazepam oral tablet at the night preoperatively and the control group. The blood pressure of patients was then measured preoperatively (baseline), in the morning of surgery, in the operating room before anesthesia, and during the surgery. The percentage of measured BP was calculated by dividing the measured BP by the baseline, then multiplying by 100. 301 patients were included in our study: 137 received bromazepam and 164 as a control group. The ratio of systolic BP (SBP) in the morning of surgery to the baseline (percentage of morning SBP) decreased significantly in the bromazepam group compared with the controls. The ratio of SBP, in the operating room before anesthesia (percentage of preanesthesia SBP) also decreased significantly in the bromazepam group. However, the percentage of SBP in the middle of surgery did not change significantly. In addition, there was a significant difference change from the baseline in diastolic BP and mean arterial BP between the two groups in the morning of surgery, inside the theatre, and in the middle of the operation. The bromazepam group also showed a significant decrease in blood loss. Preoperative oral antianxiety drugs (bromazepam) helps in controlling hemodynamic changes associated with anxiety, including maintaining BP in well-controlled hypertensive and healthy patients undergoing TKA, and it plays a role in decreasing the total blood loss.

Bosentan Does Not Affect Renal Resistive Index in Scleroderma/Systemic Sclerosis Patients

Introduction: If properly evaluated, chronic kidney disease can be found in up to 50% of patients with systemic sclerosis (SSc). The renal resistive index (RRI) is a marker of intrarenal vascular resistance and can predict SSc-associated vasculopathy. This study aimed to determine the impact of bosentan, a nonselective endothelin-1 receptor antagonist, on RRI and kidney function in SSc patients with recurrent digital ulcers. Methods: Twenty-one patients (age 57 ± 9 years, 19 females) were recruited in a 16-week prospective open-label uncontrolled study. Standardized procedures were used to measure general clinical and laboratory characteristics, systolic, diastolic, and mean arterial pressure (MAP), pulse pressure (PP), diastolic to systolic blood pressure (D/S) ratio, and urinary endothelin-1 levels. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to calculate kidney function as an estimated glomerular filtration rate (eGFR). RRI was measured by Doppler ultrasound as the average of three samplings of intrarenal blood flow in different kidney regions of both kidneys. Patients with secondary causes of kidney disease or kidney diseases associated with albuminuria were excluded. Results: Bosentan treatment for 16 weeks did not change RRI (0.731 ± 0.049–0.730 ± 0.054, p = 0.925), but increased urine endothelin-1 to creatinine ratio (0.27 ± 0.15–0.49 ± 0.57 pg/mg, p = 0.032) and reduced MAP (123 ± 10–101 ± 11 mm Hg, p < 0.001), PP (76 ± 11–68 ± 10 mm Hg, p = 0.003), D/S ratio (0.563 ± 0.044–0.538 ± 0.031, p = 0.006), and eGFR (92 ± 20–84 ± 24 mL/min/1.73 m2, p = 0.003). Discussion/Conclusion: In conclusion, in patients with SSc complicated by digital ulcers and normal to mildly diminished kidney function, bosentan had no effect on intrarenal hemodynamics, but reduced blood pressure levels and kidney function.

PS-C10-1: BLOOD PRESSURE PROFILE AND CARDIO-VASCULAR FEATURES OF WOMEN WITH A PAST HISTORY OF PREECLAMPSIA

Introduction: Preeclampsia increases the longterm risk of cardiovascular disease. Some of the women affected by this condition remain hypertensive after delivery. Hypertensive phenotypes such as masked hypertension, sustained hypertension, white coat hypertension and an adverse systolic night-today blood pressure (BP) ratio are often unnoticed and can only be detected with ambulatory BP monitoring (ABPM). This study aimed to determine the prevalence of hypertension using ABPM and office measurements. Methods: We conducted a cross- sectional study which included women who delivered between January 2015 and June 2021 and were diagnosed and followed up for preeclampsia in three major obstetrical and gynaecologic units in Yaounde. We excluded from the study all women who had a history of chronic hypertension or a known Cardiopathy. Sociodemographic data and past history were recorded, a physical exam,ecg, an ultrasound and ABPM was performed to all participants. Results: 101 participants were included. The mean age was 30.56 years. 40.6% of women had hypertension (sustained hypertension, with sometime masked hypertension) with ABPM. Sustained hypertension was most common (26.7%), followed by masked hypertension (11.9%) and white-coat hypertension (2%). With office BP measurement, only 28.7% of women would have been diagnosed hypertensive. 29.8% of women had a disadvantageous dipping pattern. Among those that develop chronic hypertension, 18.8% had LVH at electrocardiography, 7.9% had both LVH and an abnormal left ventricular geometry on ultrasound while in normotensive women 1.9% had LVH at Ecg with 1% having both LVH and abnormal geometry at ultrasound. 20.8% of these women were obese during the follow up compared to 11.9% in the normotensive group. We had 26 patients (25,74%) with severe office hypertension and 32,3% were obeses. The fundus was normal in the majority of cases and we had no signs of neurological deficits or impaired cognition. Renal function was always normal or subnormal. Finally, we had two cases of heart failure. Conclusion: Many women affected by preeclampsia remain hypertensive after delivery. Masked hypertension and white-coat hypertension are risk factors for future cardiovascular disease and can only be diagnosed with ABPM. It is important to provide adequate follow-up for these women in order to intervene on the factors leading to this outcome.

The effectiveness of shock indices on prognosis in burn patients admitted to the emergency department.

Shock index (SI) is the ratio of heart rate (HR) to systolic blood pressure (SBP); modified SI (MSI) is the ratio of HR to mean arterial pressure; age SI (ASI) is age multiplied by SI; reverse SI (rSI) is the ratio of SBP to HR; and rSIG is rSI multiplied by Glasgow Coma Scale Score (rSIG). Studies have proven that shock indices are good tools in predicting mortality. This study aimed to evaluate the sensitivity of the shock indices SI, MSI, ASI, rSI, and rSIG in predicting mortality in burn patients. This is a retrospective cross-sectional study. The vital signs of the patients were recorded and their shock indices were calculated at the time of emergency department admission. The effectiveness of the shock indices SI, MSI, ASI, rSI, and rSIG in predict-ing mortality was compared in the burn patients included in the study RESULTS: A total of 913 patients were enrolled. rSIG and MSI were the shock indices with the highest area under the curve (AUC) values in predicting mortality in the burn patients. The AUC values of rSIG and MSI were 0.829 (95% CI: 0.739-0.919, P<0.001) and 0.740 (95% CI: 0.643-0.838, P<0.001), respectively. Vital signs are easily recorded and shock indices are easily calculated at the time of admission of burn patients to the emergency department; they also effectively predict mortality. rSIG and MSI are the best mortality predictors among the shock indices examined in this study.

Blood pressure postural changes variability is associated with cognitive decline: the S.AGES cohort

AbstractBackgroundOver the past decade, higher blood pressure (BP) variability has been associated with cognitive decline (CD). To date, only one study investigated the specific impact of visit‐to‐visit BP postural changes variability on dementia but its association with cognition is still unknown. We aimed to investigate the association between BP postural changes variability and cognitive function in noninstitutionalized subjects aged ≥ 65 years.MethodThe S.AGES (Sujets Âgés) cohort followed for three years noninstitutionalized subjects aged ≥ 65 years without major neurocognitive impairment at inclusion. At each visit, an orthostatic systolic BP (SBP) ratio was calculated using the formula (sitting SBP/standing SBP) x 100. An orthostatic diastolic BP ratio was computed using the same method. Subjects with a SBP ratio &gt; 100% had sitting SBP &gt; standing SBP. We assessed the visit‐to‐visit BP postural changes variability according to several indicators: standard deviation, coefficient of variation (CV), variation independent of mean, residual standard deviation, average real variability, and successive variation. Cognitive performances were evaluated using the Mini‐Mental State Examination. Linear mixed models were used for the analyses.ResultWe included 2,974 subjects (mean age 78 years, women 56%). After adjustment for age, sex, education, baseline body mass index, smoking, alcohol intake, atrial fibrillation, congestive heart failure, transient ischemic attack or stroke, coronary artery disease, type 2 diabetes, dyslipidemia, seated SBP/DBP and antihypertensive treatment, greater visit‐to‐visit systolic BP postural changes variability was significantly associated with CD over time (adjusted β [95% CI] = ‐0.17 [‐0.29; ‐0.06], p = 0.004 for CV). Similar results were found for visit‐to‐visit diastolic BP postural changes variability (adjusted β [95% CI] = ‐0.14 [‐0.25; ‐0.03], p = 0.017 for CV).ConclusionGreater visit‐to‐visit BP postural changes variability was associated with CD. Further studies are needed to assess whether controlling orthostatic BP instability over time could be a promising interventional target to preserve cognition among older adults.

Empagliflozin in South Asians with type 2 diabetes: Real world data on effects on cardiometabolic parameters, safety and determinants of response to therapy from a diabetes practice in Sri Lanka

AimsSGLT2 inhibitors provide cardiovascular and renal protection in people with type 2 diabetes (T2DM). Real-world data on their effect on improving glucose and cardiovascular risk factors, and adverse effects in South Asians are limited. MethodsWe retrospectively analyzed clinical, demographic, anthropometric and biochemical data among adults with T2DM, commenced on empagliflozin and followed up for at least one month in a diabetes clinic in Colombo. ResultsAmong 1523 participants (men 49.6 %, age 54.9 (± 10.8) years, diabetes duration 11.5 (± 7.6) years, body mass index 28.2 (± 4.5 kg/m2), over a median follow up of 12 months (range: 1–24 months), reduction in HbA1c, weight, systolic blood pressure (SBP) and urine albumin-creatinine ratio were evident within the first month. Benefits sustained up to two-years (mean changes from baseline: HbA1c − 0.31 (± 1.49), weight − 1.14 (± 4.17), SBP − 3.44 (± 21.75), UACR − 19.84 (± 108.22) follow up. eGFR declined by the third month, returned to baseline by 12th and remained stable over 24 months. Higher baseline HbA1c, weight and SBP predicted greater decline in HbA1c, weight and SBP respectively. Weight reduction independently predicted the SBP reduction. Eighteen participants per 100 patient-years discontinued therapy due to adverse effects: genital mycotic infections and features of hypovolaemia were the commonest. We observed only two events of diabetic ketoacidosis. ConclusionsEmpagliflozin effectively improves glucose, weight and SBP and retards progression of renal impairment in South Asians with T2D. Genital mycotic infections and hypovolaemia were the commonest reasons for discontinuation. Careful patient selection and advice can avoid other sinister complications.