Risk Factor For Cardiovascular Morbidity Research Articles

The Antioxidative Effects of Flavones in Hypertensive Disease.

Hypertension is the leading remediable risk factor for cardiovascular morbidity and mortality in the United States. Excess dietary salt consumption, which is a catalyst of hypertension, initiates an inflammatory cascade via activation of antigen-presenting cells (APCs). This pro-inflammatory response is driven primarily by sodium ions (Na+) transporting into APCs by the epithelial sodium channel (ENaC) and subsequent NADPH oxidase activation, leading to high levels of oxidative stress. Oxidative stress, a well-known catalyst for hypertension-related illness development, disturbs redox homeostasis, which ultimately promotes lipid peroxidation, isolevuglandin production and an inflammatory response. Natural medicinal compounds derived from organic materials that are characterized by their anti-inflammatory, anti-oxidative, and anti-mutagenic properties have recently gained traction amongst the pharmacology community due to their therapeutic effects. Flavonoids, a natural phenolic compound, have these therapeutic benefits and can potentially serve as anti-hypertensives. Flavones are a type of flavonoid that have increased anti-inflammatory effects that may allow them to act as therapeutic agents for hypertension, including diosmetin, which is able to induce significant arterial vasodilation in several different animal models. This review will focus on the activity of flavones to illuminate potential preventative and potential therapeutic mechanisms against hypertension.

ASSOCIATION BETWEEN VITAMIN D LEVEL AND ESSENTIAL HYPERTENSION

Introduction: There is relationship between vitamin D deficiency and hypertension (HTN). The mechanism causing the development of HTN, the Renin Aldosterone Angiotensin System, was discovered to be strongly inhibited by vitamin D. This study was piloted to assess the role of vitamin D deficiency in the development of essential hypertension (EH). Methods: A total of 50 patients with EH and 50 healthy participants participated in this study. Every participant was subjected to clinical history, physical examination, and other necessary blood testing, electrocardiography, and echocardiography. Results: There was a significant decrease in vitamin D in hypertensive group (20.25±3.28 ng/mL) than normotensive group (38.33±6.89 ng/mL). Vitamin D level was moderately negative correlated with systolic blood pressure (BP) (r – 0.43, p – 0.001), strong negative correlation with diastolic BP (r – 0.76, p<0.001), strong negative correlation with intimal thickness (r – 0.67, p<0.001), and moderate negative correlation with ventricular mass (r – 0.48, p<0.001). Intimal thickness and ventricular mass were significantly higher in patients with EH with low vitamin D than those with normal vitamin D levels. Conclusion: There is a strong inverse relationship between serum vitamin D and HTN. Vitamin D deficiency levels are considered an additional risk factor for cardiovascular morbidity and mortality.

Potassium and Hypertension: A State-of-the-Art Review.

Hypertension is the single most important and modifiable risk factor for cardiovascular morbidity and mortality worldwide. Non pharmacologic interventions, in particular dietary modifications have been established to decrease blood pressure (BP) and hypertension related adverse cardiovascular events. Among those dietary modifications, sodium intake restriction dominates guidelines from professional organizations and has garnered the greatest attention from the mainstream media. Despite guidelines and media exhortations, dietary sodium intake globally has not noticeably changed over recent decades. Meanwhile, increasing dietary potassium intake has remained on the sidelines, despite similar BP-lowering effects. New research reveals a potential mechanism of action, with the elucidation of its effect on natriuresis via the potassium switch effect. Additionally, potassium-substituted salt has been shown to not only reduce BP, but also reduce the risk for stroke and cardiovascular mortality. With these data, we argue that the focus on dietary modification should shift from a sodium-focused to a sodium- and potassium-focused approach with an emphasis on intervention strategies which can easily be implemented into clinical practice.

Abstract P405: Outcomes And Trends Of Hypertensive Crisis In Patients Aged 40 Years Or Younger: Results From National Inpatient Sample 2016-2020

Introduction: Hypertension is the leading modifiable risk factor of cardiovascular morbidity and mortality. The trends of hypertension and its complications in young individuals are not well studied. Methods: We examined hospitalized patients who were diagnosed with hypertensive crisis and were included in the National Inpatient Sample 2016-2020. Hypertensive crisis was defined by using international classification of disease -10. Patient aged less than 18 years and pregnant women were excluded. Multivariable logistic regression analysis was used to examine association of age 40 years or less and hypertensive crisis with primary outcome of mortality, and secondary outcomes. We also studied trends of hypertensive crisis in these patients. Results: There were 589,220 (mean age 61years±17, 55.7% female, 45% white) patients with hypertensive crisis. Out of these, 12.3% (n= 72,200) were aged less than 40 years. In the group of patients with age 40 years or younger, 0.13% (n= 90) died. The major secondary outcomes in this group were acute kidney injury (26%) with 15.4% requiring hemodialysis, acute heart failure (17.8%), and hypertensive encephalopathy (3.28%). The outcomes of hypertensive crisis in younger patients are shown in figure 1 . From 2016-2020, there are decreasing yearly trends of hypertensive crisis in these patients (p= 0.004) and no statistically significant trends in mortality (p =0.2)!. Conclusion: Hypertensive crisis brings morbidity and economic burden on the patients. A considerable number of young patients develop acute kidney injury and require hemodialysis. More studies directed towards young patients are needed to prevent these complications.

Thyroid function test variability and cardiovascular morbidity in hyperthyroidism.

The variability of thyroid function tests (TFTs) during antithyroid drug (ATD) therapy and its association with adverse health outcomes have not been previously studied. The aim of this study was to evaluate the association of TFT variability and cardiovascular morbidity during ATD therapy. Retrospective cohort study. Hyperthyroid patients (n = 394) treated with ATD therapy at Tampere University Hospital between March 2016 and December 2018 were followed up for a median time of 1.5 years (interquartile range 0.8-2.0). The coefficients of variation (CVs) of the follow-up thyroid-stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) measurements were determined. The associations of TFT variability and baseline clinical factors with cardiovascular disease (CVD) -associated hospital visits were assessed with logistic regression analyses. In the multivariable analyses, age (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.03-1.09), male gender (OR: 2.33, 95% CI: 1.03-5.28) and fT4-CV (OR: 1.02, 95% CI: 1.01-1.04) were independent risk factors for cardiovascular morbidity, whereas baseline positive thyrotropin receptor antibodies (TRAbs) were associated with lower cardiovascular morbidity (OR: 0.29, 95% CI: 0.14-0.61). When the patients with baseline TRAb positivity were studied separately, fT4-CV was associated with cardiovascular morbidity (OR: 1.03, 95% CI: 1.00-1.05). During ATD therapy, fT4 variability is associated with an increased cardiovascular morbidity. Although positive TRAbs are associated with a lower cardiovascular morbidity compared with hyperthyroidism with negative autoantibodies, the variability of fT4 is associated with cardiovascular morbidity also in patients with positive TRAbs.

Effect of Atherogenic Index of Plasma on Pre-Percutaneous Coronary Intervention Thrombolysis in Myocardial Infarction Flow in Patients With ST Elevation Myocardial Infarction.

Dyslipidemia is an important risk factor for cardiovascular morbidity and mortality. Although low-density lipoprotein (LDL) is primarily responsible, the importance of triglyceride (TG) and high-density lipoprotein (HDL) has also been recognized. The present study investigated the effect of the atherogenic index of plasma (AIP), in which atherogenic and protective lipoproteins were evaluated together, on the initial flow in patients with ST elevation myocardial infarction. AIP was calculated as log(TG/HDL-cholesterol). Patients included in the study (n = 1535) were divided into Thrombolysis in Myocardial Infarction (TIMI) flow grade 0 and >0. AIP was found to be significantly different between 2 groups (.55 ± .23 vs .67 ± .21; P < .001). AIP was an independent predictor for pre-intervention TIMI flow (Odds Ratio: 2.778). A moderate correlation was found between TIMI frame count measurements, calculated in patients with TIMI 2-3, and AIP (Pearson correlation coefficient: .63, P < .001). In the receiver operating characteristic analysis, AIP showed the highest area under curve (AUC) compared with other lipid parameters for predicting vascular patency. The AUC of AIP was .634, the cut-off value was .59, and the sensitivity and specificity were 67.6% and 68.4%, respectively (P < .001). In conclusion, AIP was found to be an important marker affecting pre-percutaneous coronary intervention TIMI flow.

A Retrospective Cohort Study of the Association Between Calcium Serum Level and Hypertension in Older Adults.

One of the major global risk factors for cardiovascular morbidity and death is hypertension.Earlier research has been conducted on the connection between calcium consumption and blood pressure. This study aims to investigate the association between calcium serum levels and hypertension in older hypertensive adults. A retrospective cohort study of 121 of hypertension patients was conducted inPrince Faisal Bin Khalid Cardiac Center.The data of all patients were collected by records, including lab, pathology, and medical review, in order to determine the effects on patients, providers, and institutions.Statistical analyses were performed using SPSS Statistics version 26.0.A p-value of <0.05 was considered statistically significant. The study included 121 adulthypertensive patients with a mean of age 60.29 ± 13.92.The majority of included patients were male (81%).More than one-third of patients were obese (39.7%), about one-third (33.9%) were overweight, and 26.4% of patients were in normal weight.The majority of patients had co-morbidities (68.3%); about one-half of them had diabetes mellitus (52.1%). The calcium level mean was 5.07 ± 1.26.The creatine kinase (CK) (initial day) mean ± SD was 813.22 ± 1146.37 became 221.4 ± 330.67 on the last day.The CK-myocardial band (CK-MB) (initial day) was 65.43 ± 118.9 and became 24.38 ± 23.26 on the last day.Additionally, the troponin (initial day) mean was 23.49 ± 104.26 and became 1.65 ± 2.66 on the last day.The most common discharge medications were anti-platelets (95%), beta-blockers (78.5%), statins (70.2%), and proton-pump inhibitors (PPI) (64.5%).The hospital stay days ranged from 1 to 20 days with a mean of 4.83 ± 3.38.The ICU stay days ranged from 1 to 15 days with a mean of 3.57 ± 2.72.Most of the patients (90.9%) improved. There is no significant correlationbetween calcium levels in hypertensive patients and the demographic characteristics of patients, home or current medications, ECHO findings, or procedures done.However, there is a significant correlation between the calcium level and CK level among patients with hypertension.Further investigations are required to verify the relationship between CK and calcium levels in hypertensive patients.

Chronic secondhand smoke exposure on cardiovascular regulation and the role of soluble epoxide hydrolase in mice

Background: Secondhand smoke (SHS) is a significant risk factor for cardiovascular morbidity and mortality. About 80% of SHS-related deaths are due to cardiovascular causes. Reducing SHS exposure with smoking bans is associated with improved cardiovascular outcomes in non-smokers. Soluble epoxide hydrolase (sEH) inhibitors have been shown to attenuate tobacco exposure-induced lung inflammatory responses, making them a great candidate for combating SHS exposure-induced cardiovascular outcomes. The goals of this study were to determine 1) the time course of environmentally relevant SHS exposure effects on cardiac autonomic function and blood pressure (BP) regulation and 2) whether prophylactic administration of a soluble epoxide hydrolase inhibitor (TPPU) can protect against SHS-induced autonomic and cardiovascular dysregulation. Methods: Male C57BL/6J mice (11 wk) implanted with BP/electrocardiogram (ECG) telemetry devices were exposed to 12 wks of either filtered air (FA, n=19) or 3 mg/m3 of SHS (6 hr/d, 5 d/wk, n=18), followed by 4 weeks recovery window (SHS substituted with FA). Separate mice were randomly assigned to one of the 3 groups: FA (n=12), FA+TPPU (n=12), and SHS+TPPU (n=22). TPPU (15 mg/l) was given by drinking water during the 12 weeks of exposure period (estimated dose = 3.75 ug/g/day). BP and ECG were recorded continuously for 36 hours every month when mice were not exposed. Data were stratified by 12-hour circadian window: The dark cycle (dark 1) immediately after the 5th day of exposure and the following light and dark (dark 2) cycles. Baroreflex sensitivity (BRS) was determined with the sequence method. Standard time domain heart rate variability (HRV) parameters were obtained from normal-to-normal R-R intervals. Results: SHS-exposed mice had significantly higher physical activity levels (~ 50% higher, p&lt;0.05), an effect that persisted 4 wks after cessation of SHS exposure. SHS exposure significantly decreased 1) short-term HRV (RMSSD) by ~20% as early as after 4 wks of exposure; 2) overall HRV (SDNN) with maximum effect at 12 wks (-15%, p&lt;0.05); 3) pulse pressure (-8%, p&lt;0.05) as early as week 4; and 4) BRS with maximum effect at 12 wks (-11%, p&lt;0.05). All SHS-induced changes in cardiovascular regulation were ameliorated by 4 weeks of recovery. Treatment with TPPU in drinking water eliminated SHS exposure-induced decreases in HRV, PP and BRS. However, SHS-induced increase in activity persisted (30% higher, p&lt;0.05) even with TPPU treatment. Conclusions: These data suggest that 1) Three months of environmentally relevant SHS significantly reduces cardiac autonomic function and BP regulation; 2) cardiovascular consequences from SHS can be rescued by removing from SHS exposure; and 3) oral TPPU can prevent SHS-induced cardiovascular dysregulation. R01 ES025229, T32 HL086350, T32 ES007059, R35ES030443 This is the full abstract presented at the American Physiology Summit 2023 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.

Joint statement for assessing and managing high blood pressure in children and adolescents: Chapter 2. How to manage high blood pressure in children and adolescents.

The joint statement is a synergistic action between HyperChildNET and the European Academy of Pediatrics about the diagnosis and management of hypertension in youth, based on the European Society of Hypertension Guidelines published in 2016 with the aim to improve its implementation. Arterial hypertension is not only the most important risk factor for cardiovascular morbidity and mortality, but also the most important modifiable risk factor. Early hypertension-mediated organ damage may already occur in childhood. The duration of existing hypertension plays an important role in risk assessment, and structural and functional organ changes may still be reversible or postponed with timely treatment. Therefore, appropriate therapy should be initiated in children as soon as the diagnosis of arterial hypertension has been confirmed and the risk factors for hypertension-mediated organ damage have been thoroughly evaluated. Lifestyle measures should be recommended in all hypertensive children and adolescents, including a healthy diet, regular exercise, and weight loss, if appropriate. If lifestyle changes in patients with primary hypertension do not result in normalization of blood pressure within six to twelve months or if secondary or symptomatic hypertension or hypertension-mediated organ damage is already present, pharmacologic therapy is required. Regular follow-up to assess blood pressure control and hypertension-mediated organ damage and to evaluate adherence and side effects of pharmacologic treatment is required. Timely multidisciplinary evaluation is recommended after the first suspicion of hypertension. A grading system of the clinical evidence is included.

Diagnosis, Prevention, and Control of Hypertension in Iran: A SWOT Analysis

Background: Hypertension is one of the most important risk factors of cardiovascular morbidity and mortality that holds a unique place in population health and health care.&#x0D; Objectives: Given the exponential rise of high blood pressure as one of the major health problems, this study aimed to investigate the current situation and provide a strengths, weaknesses, opportunities, and threats (SWOT) analysis in the management of hypertension&#x0D; Methods: A qualitative study of 12 interviews was conducted with policymakers and managers. The sampling method was purposive sampling. Data collection was performed from January to July 2020. A thematic approach was used to analyze the data. The consolidated criteria for reporting qualitative research 32-item (COREQ-32) checklist was applied to ensure quality control in the study design, analysis, and data reporting.&#x0D; Results: A total of 12 factors were identified as SWOT. The most important strengths included universal coverage of health services, provision of team-based care, and self-care training. The weaknesses were related to the therapeutic approach, long-term planning, and continuity of programs. Cooperation of other sectors with the health system and the existence of health management training centers were noted as opportunities to better implement hypertension management programs and confront threats such as conflicts of interest between guilds and organizations and crises.&#x0D; Conclusions: High blood pressure can be prevented. The present direction toward health-oriented policies can be changed in all sectors by taking advantage of the existing strengths and opportunities.

Abstract OT2-01-05: The CROWN Study (CaRdiac Outcomes With Near complete estrogen deprivation): A multicenter, prospective cohort study of cardiovascular outcomes in premenopausal women treated with ovarian suppression and an aromatase inhibitor

Abstract Background: Treatment for premenopausal women with high or intermediate risk hormone receptor (HR)+ breast cancer (BC) now includes the concurrent use of ovarian function suppression (OFS) and an aromatase inhibitor (AI) therapy to induce near complete estrogen deprivation (NCED). The long-term cardiovascular (CV) sequela for women treated with NCED is unknown. Premature menopause in the non-cancer population is associated with CV disease, including atherosclerosis and coronary artery disease, which can be detected pre-clinically by myocardial perfusion imaging and coronary artery plaques. This, together with the CV morbidity associated with other aspects of BC treatment and future life-years of these women, warrants further investigation with the goal of identifying pre-clinical markers of myocardial compromise. We seek to do this with the following specific aims: 1. Characterize and quantify the extent of coronary microvascular injury and perfusion changes experienced during early NCED therapy. 2. Characterize and quantify the extent of structural and functional alterations to the aorta and left ventricle while on NCED therapy. 3. Identify potential biomarkers and additional risk factors for CV morbidity in patients receiving NCEDTrial Design: This is a federally funded (NHLBI) prospective cohort study conducted at 3 regional NCI-supported Cancer Centers (Atrium Health Wake Forest Baptist, Virginia Commonwealth and Duke) that will include premenopausal women, age ≤ 55, with Stage I-III BC following completion of planned chemotherapy, surgery and radiation with an ECOG 0-1. HR+ BC patients will receive an AI and OFS. Women with HR- BC are included as comparators. CV imaging and biomarkers will be obtained at baseline, 1 year and 2 years (Table 1). These assessments will include serial cardiac magnetic resonance (CMR) and coronary computed tomography angiography (CCTA) imaging as well as laboratory measurements, including exploratory biomarkers. The primary outcome is myocardial perfusion reserve (MPR) as measured by CMR imaging stress studies. We will correlate CMR imaging with CCTA to provide complementary detail of coronary plaque changes. The study will also assess the relevance of pre-existing risk factors, including an emphasis on racial disparities, on study outcomes, and dynamic change in modifiable and treatment related risk factors. Statistical Methods: We plan to enroll 90 women, 67 in the NCED group and 23 in the HR-group, allowing for a 10% drop out rate. There are two primary types of statistical analyses. The first includes testing hypotheses between group (NCED vs HR-) and within group (longitudinal changes within the NCED group) for Aims 1 and 2. Comparisons will be made using longitudinal mixed models to examine effects on outcomes measured. The second analyses, for Aim 3, involve developing predictive equations utilizing a stepwise linear regression approach to determine if patient demographics, clinical parameters and serum biomarkers are associated with MPR. The sample size allows 80% power to address specific aims for between and within group comparisons, including a between group difference of 2.8% in our primary outcome, MPR. Present Accrual: 0 Target Accrual: 90 Contact information: Emily Douglas, MD; edouglas@wakehealth.edu Table 1: Study Procedures Citation Format: Emily Douglas, Nathaniel O’Connell, Mary Hackney, Wendy Bottinor, John Grizzard, Igor Klem, Carolyn Park, Sujethra Vasu, Karl Richardson, Susan Dent, Ralph D’Agostino, Gregory Hundley, Jennifer Jordan, Alexandra Thomas. The CROWN Study (CaRdiac Outcomes With Near complete estrogen deprivation): A multicenter, prospective cohort study of cardiovascular outcomes in premenopausal women treated with ovarian suppression and an aromatase inhibitor [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT2-01-05.

Knowledge of Primary Care Patients Living in the Urban Areas about Risk Factors of Arterial Hypertension.

Arterial hypertension (AH), one of the most common diseases of civilization, is an independent risk factor for cardiovascular morbidity and mortality. This disease is the second, after lipid disorders, the most common cardiovascular risk factor and a significant cause of premature death. In Poland, one in three adults (approximately 11 million people) suffers from it. The aim of our survey was to determine patients’ knowledge of the factors (e.g., age, smoking cigarettes, drinking coffee, shift work) that may influence the development of hypertension. The survey was conducted among 205 adult primary care patients living in urban areas. There was a high correlation between patients’ education and risk factors of AH, such: as excess salt in the diet (p = 0.038), smoking electronic cigarettes (p = 0.005), moderate alcohol consumption (p = 0.028), moderate daily physical activity (p = 0.011), female and male sex (p = 0.032 and p = 0.012), air pollution (p < 0.001) and others. In addition, a statistically significant factor shaping patients’ attitudes toward hypertension prevention was the correlation between the respondents’ education and their parents’ prevalence of hypertension (p = 0.40). This study increases the knowledge of patients’ awareness of hypertension. It may serve as guidance for primary care providers to pay special attention to environmental interviews with patients and the patient’s family history for the prevention of hypertension incidence.

Regression of cardiac hypertrophy in health and disease: mechanisms and therapeutic potential.

Left ventricular hypertrophy is a leading risk factor for cardiovascular morbidity and mortality. Although reverse ventricular remodelling was long thought to be irreversible, evidence from the past three decades indicates that this process is possible with many existing heart disease therapies. The regression of pathological hypertrophy is associated with improved cardiac function, quality of life and long-term health outcomes. However, less than 50% of patients respond favourably to most therapies, and the reversibility of remodelling is influenced by many factors, including age, sex, BMI and disease aetiology. Cardiac hypertrophy also occurs in physiological settings, including pregnancy and exercise, although in these cases, hypertrophy is associated with normal or improved ventricular function and is completely reversible postpartum or with cessation of training. Studies over the past decade have identified the molecular features of hypertrophy regression in health and disease settings, which include modulation of protein synthesis, microRNAs, metabolism and protein degradation pathways. In this Review, we summarize the evidence for hypertrophy regression in patients with current first-line pharmacological and surgical interventions. We further discuss the molecular features of reverse remodelling identified in cell and animal models, highlighting remaining knowledge gaps and the essential questions for future investigation towards the goal of designing specific therapies to promote regression of pathological hypertrophy.

S-58-3: HOW COULD CONTINUOUS CUFFLESS AUTOMATED BLOOD PRESSURE MEASUREMENT DEVICES CONTRIBUTE TO HYPERTENSION MANAGEMENT?

Evidence that hypertension is the most importat global risk factor for cardiovascular morbidity and mortality, and demonstration of the cardiovascular protection offered by antihypertensive treatment, have been based on upper-arm cuff blood pressure (BP) measurements. This approach is recommended by current hypertension guidelines for BP measurement in clinical practice, as well as for validation of novel BP measuring devices. However, the spot or intermittent BP measurements in static conditions allowed by arm-cuff devices are unable to identify and track the continuous and rapid BP changes characterizing daily life. Moreover, cuff-based BP measurements are exposed to errors related to cuff size, shape and positioning, and cuff inflation may itself induce an alerting response and produce discomfort in the users during daily activities and in particular during sleep, which may modify the measured BP levels. To face these issues, use of continuous recordings techniques, not based on arm-cuff inflation, would be required. This is possible through intra-arterial recordings, which however are not feasible in daily practice because of their invasiveness. An alternative solution is represented by photoplethysmographic volume-clamp method for finger BP monitoring which, however, is difficult to implement in clinical practice because of its cost and complexity. Technological progress is now offering an increasingly large and heterogeneous series of cuffless BP monitors, which estimate BP based on sensors, signal processing and algorithms embedded in wearable devices, smartphones or pocket devices. These cuffless devices might allow for comfortable and continuous BP recordings, detecting rapid BP changes during day and night sleep, thus offering information on both short, mid and long term BP variability. Cuffless devices might also be useful for continuous non invasive BP monitoring in different clinical settings, including ICUs, during anaesthesia, in patients with arrhythmias, hypotension/syncope, and other transient conditions affecting BP levels and variability. Moreover, cuffless BP measurement devices connected to telemonitoring facilities or smartphones apps may improve patients empowerment, adherence to treatment and long-term BP control. In spite of all these potential advantages, however, cuffless BP devices have to face specific accuracy issues, which would need refinement of specific validation protocols aimed at testing the need of individual calibration, the stability of measurements after calibration and the device actual ability to track BP changes before they might be recommended for clinical use.

Knowledge, attitude and practices about hypertension amongst adult residents in South-Eastern Nigeria

Background: Hypertension (HTN) is a global public health concern and has been identified as the leading risk factor for cardiovascular morbidity and mortality. The objective of this study is to assess the prevalence, knowledge, attitude and practices regarding HTN amongst adult residents in South-Eastern Nigeria. Aims: The objective of this study is to assess the prevalence, knowledge, attitude and practices regarding HTN amongst adult residents in South Eastern Nigeria. Materials and Methods: This cross-sectional survey was conducted amongst male and female adult residents of Anaocha local government area, Anambra State, South-Eastern Nigeria, 18 years and above. Data was collected using a pretested interviewer-administered questionnaire amongst 296 adults. Blood pressures and the body mass index of those found to be hypertensive were obtained. Results were analyzed using SPSS version 25.0. Results: The mean age was 41.7 years, with 55.1% being females and 44.9% males. The prevalence of HTN was 30%. Overall, 53.28% of the respondents had good knowledge of HTN, although knowledge of the risk factors was lower (43.41%), while 80.24% had good attitude and 62.16% had good practices regarding HTN. Gender showed a significant association with level of knowledge of HTN. Only tribe and occupation were associated with attitude of the respondents towards HTN. Practice regarding HTN showed no association with any of the socio-demographic factors. Conclusion: The study found an acceptable level of knowledge, attitude and practices regarding HTN amongst the respondents. The prevalence of HTN amongst the study group was high and more work needs to be done to improve awareness and reduce HTN risk factors amongst the people.

Effects of chronic secondhand smoke exposure on cardiovascular regulation and the role of soluble epoxide hydrolase in mice.

Background: Secondhand smoke (SHS) is a significant risk factor for cardiovascular morbidity and mortality with an estimated 80% of SHS-related deaths attributed to cardiovascular causes. Public health measures and smoking bans have been successful both in reducing SHS exposure and improving cardiovascular outcomes in non-smokers. Soluble epoxide hydrolase (sEH) inhibitors have been shown to attenuate tobacco exposure-induced lung inflammatory responses, making them a promising target for mitigating SHS exposure-induced cardiovascular outcomes. Objectives: The objectives of this study were to determine 1) effects of environmentally relevant SHS exposure on cardiac autonomic function and blood pressure (BP) regulation and 2) whether prophylactic administration of an sEH inhibitor (TPPU) can reduce the adverse cardiovascular effects of SHS exposure. Methods: Male C57BL/6J mice (11weeks old) implanted with BP/electrocardiogram (ECG) telemetry devices were exposed to filtered air or 3mg/m3 of SHS (6hr/d, 5d/wk) for 12weeks, followed by 4weeks of recovery in filtered air. Some mice received TPPU in drinking water (15mg/L) throughout SHS exposure. BP, heart rate (HR), HR variability (HRV), baroreflex sensitivity (BRS), and BP variability were determined monthly. Results: SHS exposure significantly decreased 1) short-term HRV by ∼20% (p < 0.05) within 4weeks; 2) overall HRV with maximum effect at 12weeks (-15%, p < 0.05); 3) pulse pressure (-8%, p < 0.05) as early as week 4; and 4) BRS with maximum effect at 12weeks (-11%, p < 0.05). Four weeks of recovery following 12weeks of SHS ameliorated all SHS-induced cardiovascular detriments. Importantly, mice exposed to TPPU in drinking water during SHS-related exposure were protected from SHS cardiovascular consequences. Discussion: The data suggest that 1) environmental relevant SHS exposure significantly alters cardiac autonomic function and BP regulation; 2) cardiovascular consequences from SHS can be reversed by discontinuing SHS exposure; and 3) inhibiting sEH can prevent SHS-induced cardiovascular consequences.

PS-P05-5: CHANGES IN BLOOD PRESSURE CONTROL, TARGET ORGAN DAMAGE AND CARDIOVASCULAR RISK FACTORS IN HYPERTENSIVE SUBJECTS UNDER ANTIHYPERTENSIVES DURING 9 YEARS

Objective: Since an increase in blood pressure is one of the most important risk factors for cardiovascular morbidity and mortality, appropriate blood pressure control is necessary to prevent target organ damages and cardiovascular diseases. We investigated changes in blood pressure control, target organ damage and cardiovascular risk factors of hypertensive subjects under antihypertensive medications from 2010 to 2019. Design and Methods: A total of 1679 and 1884 hypertensive subjects under antihypertensive medications (62.8 ± 9.8 and 65.8 ± 9.4 year-old, respectively) who visited our hospital for physical checkup in 2010 and 1019, respectively, were enrolled. Subjects were divided into two groups; controlled (blood pressure &lt; 140/90mmHg) and not-controlled groups (blood pressure &gt; = 140/90mmHg). Target organ damage defined as left ventricular hypertrophy (LVH) on electrocardiogram (Sokolow-Lyon voltage &gt; 3.8 mV and/or Cornell product &gt; 2440 mm ms) or decline of estimated glomerular filtration rate (eGFR; &lt; 60 mL/min per 1.73 m2) and other cardiovascular risk factors were investigated. Results: The results are summarized in the table. Blood pressure control was generally improved during the 9 years though the mean age of subjects was increased. The prevalence of impaired kidney function but not LVH and the number of subjects with risk factors were increased during the period. Sub-analysis in 537 subjects who visited in both 2010 and 2019 were performed and similar results were obtained (data not shown). Conclusions: Although blood pressure control was improved, total management of hypertensive subjects was not appropriate. Management of risk factors other than hypertension as well as blood pressure control is necessary in hypertensive subjects for extension of healthy life expectancy.

The effect of population-based blood pressure screening on long-term cardiometabolic morbidity and mortality in Germany: A regression discontinuity analysis.

Hypertension represents one of the major risk factors for cardiovascular morbidity and mortality globally. Early detection and treatment of this condition is vital to prevent complications. However, hypertension often goes undetected, and even if detected, not every patient receives adequate treatment. Identifying simple and effective interventions is therefore crucial to fight this problem and allow more patients to receive the treatment they need. Therefore, we aim at investigating the impact of a population-based blood pressure (BP) screening and the subsequent "low-threshold" information treatment on long-term cardiovascular disease (CVD) morbidity and mortality. We examined the impact of a BP screening embedded in a population-based cohort study in Germany and subsequent personalized "light touch" information treatment, including a hypertension diagnosis and a recommendation to seek medical attention. We pooled four waves of the KORA study, carried out between 1984 and 1996 (N = 14,592). Using a sharp multivariate regression discontinuity (RD) design, we estimated the impact of the information treatment on CVD mortality and morbidity over 16.9 years. Additionally, we investigated potential intermediate outcomes, such as hypertension awareness, BP, and behavior after 7 years. No evidence of effect of BP screening was observed on CVD mortality (hazard ratio (HR) = 1.172 [95% confidence interval (CI): 0.725, 1.896]) or on any (fatal or nonfatal) long-term CVD event (HR = 1.022 [0.636, 1.641]) for individuals just above (versus below) the threshold for hypertension. Stratification for previous self-reported diagnosis of hypertension at baseline did not reveal any differential effect. The intermediate outcomes, including awareness of hypertension, were also unaffected by the information treatment. However, these results should be interpreted with caution since the analysis might not be sufficiently powered to detect a potential intervention effect. The study does not provide evidence of an effect of the assessed BP screening and subsequent information treatment on BP, health behavior, or long-term CVD mortality and morbidity. Future studies should consider larger datasets to detect possible effects and a shorter follow-up for the intermediate outcomes (i.e., BP and behavior) to detect short-, medium-, and long-term effects of the intervention along the causal pathway.

Atherosclerotic renovascular disease and cardiovascular risk: new concepts.

Renal vascular hypertension (RVHT) is one of the most common secondary forms of hypertension. It is estimated that 1% to 5% of all cases of hypertension can be attributed to RVHT. RVHT is generally caused by progressive stenosis of the renal artery most often due to atherosclerosis, and less often caused by fibromuscular dysplasia. Atherosclerotic renal artery stenosis (ARAS) can lead to the development of resistant hypertension and can also cause progressive impairment of renal function. ARAS can also result in serious cardiac complications, such as flash pulmonary edema or congestive heart failure. Most patients with ARAS are characterized by the presence of left ventricular hypertrophy and diastolic dysfunction. The disease progression is associated with an increase in left ventricular mass index and cardiac dilatation. Atherosclerotic renovascular disease is recognized as a relevant risk factor for cardiovascular morbidity and mortality. Studies published so far documented ARAS as a predictor of higher cardiovascular risk and showed that mortality after incidental ARAS diagnosis is much higher than that observed in the general population. Proper recognition of the patients with ARAS who would benefit from interventional treatment is crucial, particularly for identification of patients with true resistant hypertension, flash pulmonary edema, and progressive impairment of renal function.

Monitoring Risk Factors and Improving Adherence to Therapy in Patients With Chronic Kidney Disease (Smit-CKD Project): Pilot Observational Study

Background Chronic kidney disease is a major public health issue, with about 13% of the general adult population and 30% of the elderly affected. Patients in the last stage of this disease have an almost uniquely high risk of death and cardiovascular events, with reduced adherence to therapy representing an additional risk factor for cardiovascular morbidity and mortality. Considering the increased penetration of mobile phones, a mobile app could educate patients to autonomously monitor cardiorenal risk factors. Objective With this background in mind, we developed an integrated system of a server and app with the aim of improving self-monitoring of cardiovascular and renal risk factors and adherence to therapy. Methods The software infrastructure for both the Smit-CKD server and Smit-CKD app was developed using standard web-oriented development methodologies preferring open source tools when available. To make the Smit-CKD app suitable for Android and iOS, platforms that allow the development of a multiplatform app starting from a single source code were used. The integrated system was field tested with the help of 22 participants. User satisfaction and adherence to therapy were measured by questionnaires specifically designed for this study; regular use of the app was measured using the daily reports available on the platform. Results The Smit-CKD app allows the monitoring of cardiorenal risk factors, such as blood pressure, weight, and blood glucose. Collected data are transmitted in real time to the referring general practitioner. In addition, special reminders improve adherence to the medication regimen. Via the Smit-CKD server, general practitioners can monitor the clinical status of their patients and their adherence to therapy. During the test phase, 73% (16/22) of subjects entered all the required data regularly and sent feedback on drug intake. After 6 months of use, the percentage of regular intake of medications rose from 64% (14/22) to 82% (18/22). Analysis of the evaluation questionnaires showed that both the app and server components were well accepted by the users. Conclusions Our study demonstrated that a simple mobile app, created to self-monitor modifiable cardiorenal risk factors and adherence to therapy, is well tolerated by patients affected by chronic kidney disease. Further studies are required to clarify if the use of this integrated system will have long-term effects on therapy adherence and if self-monitoring of risk factors will improve clinical outcomes in this population.