Risk In Hypertensive Patients Research Articles

Correlation between plasma aldosterone concentration and bone mineral density in middle-aged and elderly hypertensive patients: potential impact on osteoporosis and future fracture risk.

Previous studies have suggested that aldosterone may play a major role in calcium-phosphorus homeostasis and bone metabolism. However, the relationship between plasma aldosterone concentrations (PAC) and bone mineral density (BMD) in middle-aged and elderly hypertensive patients remains unclear. Therefore, this study sought to investigate the relationship between PAC levels and BMD and explore PAC's potential impact on osteoporosis and future fracture risk in hypertensive patients. Our study included a total of 1430 participants. Associations are tested using multiple linear and logistic regression models. Nonlinearity was investigated using the restricted cubic spline (RCS). We also performed mediating analyses to assess mediating factors mediating the relationship between PAC and osteoporosis. The multiple linear regression showed a negative correlation between PAC and BMD and was generally positively associated with FRAX scores. Meanwhile, logistic regression analyses indicated that osteoporosis was highly correlated with PAC levels. In addition, a clear non-linear dose-response relationship was also shown in the constructed RCS model. Finally, mediation analyses showed that serum potassium played an important role in the development of osteoporosis. This study demonstrates that elevated PAC levels are strongly associated with decreased BMD, increased prevalence of osteoporosis, and the risk of future fractures in middle-aged and elderly hypertensive patients. Further studies are needed to confirm this relationship and reveal its underlying mechanisms.

Association of adiposity indicators with cardiometabolic multimorbidity risk in hypertensive patients: a large cross-sectional study.

Cardiometabolic multimorbidity (CMM) has emerged as a prominent public health concern. Hypertensive patients are prone to develop comorbidities. Moreover, the accumulation of visceral adipose tissue is the main cause for the development of cardiometabolic diseases. The cardiometabolic index (CMI), lipid accumulation product (LAP), visceral adiposity index (VAI), and Chinese visceral adiposity index (CVAI) not only assess adipose tissue mass but also reflect adipose tissue dysfunction. So far, no study has been reported to evaluate the association of CMI, LAP, VAI, and CVAI with CMM risk in hypertensive patients. Therefore, this study aimed to assess the association between these adiposity indicators and the risk of CMM among Chinese hypertensive patients. In this cross-sectional study, a total of 229,287 hypertensive patients aged 35 years and older were included from the National Basic Public Health Service Project. All participants underwent a face-to-face questionnaire survey, physical examination, and the collection of fasting venous blood samples. Multivariable logistic regression models were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Receiver operating characteristic curve was utilized to evaluate the identification ability for CMM. After adjusting for confounders, each 1-standard deviation increase in CMI, LAP, VAI, and CVAI was associated with a 14%, 8%, 12%, and 54% increased risk of CMM, respectively. When comparing the highest quartile of these indicators with the lowest quartile, individuals in the highest quartile of CMM, LAP, VAI, and CVAI had a 1.39-fold (95% CI 1.30, 1.48), 1.28-fold (95% CI 1.19, 1.37), 1.37-fold (95% CI 1.29, 1.46), and 2.56-fold (95% CI 2.34, 2.79) increased risk of CMM after adjusting for potential confounders. Notably, a nonlinear association was observed for CMI, LAP, and VAI with the risk of CMM (all P nonlinearity < 0.001). CVAI exhibited the highest area under the receiver operating characteristic curve (AUC) among all the included adiposity indices in this analysis. This study indicated the significant positive association of CMI, LAP, VAI, and CVAI with the risk of CMM in hypertensive patients. Among these indicators, CVAI demonstrated the most robust performance in predicting CMM risk and may serve as a valuable tool for identifying CMM risk in Chinese hypertensive patients.

Association of IL-17 Inhibitors with Hypertension in Patients with Autoimmune Diseases: A Systematic Review and Meta-analysis on Randomized Controlled Trials.

The influence of IL-17 inhibition on blood pressure in autoimmune disease patients remains inconclusive. Our objective is to examine the risk of hypertension in patients with autoimmune diseases undergoing IL-17 inhibition therapies via meta-analysis of randomized, placebo-controlled trials (RCTs). We obtained integrated data from PubMed, Embase, and ClinicalTrials.gov. Incident hypertension rates were calculated, and hazard ratios (HRs) with 95% confidence intervals (CIs) were analyzed, along with Ι^2 statistics to assess heterogeneity. Sequential analysis ensured conclusion reliability. In 30 RCTs involving 9,909 patients with diverse autoimmune diseases treated with anti-IL-17 agents, our meta-analysis revealed a significant increase in hypertension risk (RR 1.69, CI 1.24-2.31, p=0.001), robustly supported by trial sequential analysis. Among the four agents (secukinumab, ixekizumab, bimekizumab, and brodalumab), only secukinumab exhibited a notable association with hypertension. Patients with various primary autoimmune diseases, particularly those with psoriatic arthritis, had a higher likelihood of developing hypertension; in rheumatic arthritis patient cohorts, anti-IL-17 agents did not elevate hypertension risk. Prolonged treatment duration correlated with an increased hypertension risk. Stratifying by gender, studies with a female predominance demonstrated a higher risk ratio for hypertension compared to male-predominant studies. This highlights that anti-IL-17 treatment escalates hypertension risk, emphasizing the need for extra caution when managing autoimmune disease patients. (Registered by PROSPERO, CRD42016053112).

The impact of short-term exposure to meteorological factors on the risk of death from hypertension and its major complications: a time series analysis based on Hefei, China.

This study aimed to reveal the short-term impact of meteorological factors on the mortality risk in hypertensive patients, providing a scientific foundation for formulating pertinent prevention and control policies. In this research, meteorological factor data and daily death data of hypertensive patients in Hefei City from 2015 to 2018 were integrated. Time series analysis was performed using distributed lag nonlinear model (DLNM) and generalized additive model (GAM). Furthermore, we conducted stratified analysis based on gender and age. Relative risk (RR) combined with 95% confidence interval (95% CI) was used to represent the mortality risk of single day and cumulative day in hypertensive patients. Single-day lag results indicated that high daily mean temperature (T mean) (75th percentile, 24.9°C) and low diurnal temperature range (DTR) (25th percentile, 4.20°C) levels were identified as risk factors for death in hypertensive patients (maximum effective RR values were 1.144 and 1.122, respectively). Extremely high levels of relative humidity (RH) (95th percentile, 94.29%) reduced the risk of death (RR value was 0.893). The stratified results showed that the elderly and female populations are more susceptible to low DTR levels, whereas extremely high levels of RH have a more significant protective effect on both populations. Overall, we found that exposure to low DTR and high T mean environments increases the risk of death for hypertensive patients, while exposure to extremely high RH environments significantly reduces the risk of death for hypertensive patients. These findings contribute valuable insights for shaping targeted prevention and control strategies.

Association of Antihypertensive Drug-Related Gene Polymorphisms with Stroke in the Chinese Hypertensive Population.

Antihypertensive therapy is crucial for preventing stroke in hypertensive patients. However, the efficacy of antihypertensive therapy varies across individuals, partially due to therapy-related genetic variations among individuals. We investigated the association of antihypertensive drug-related gene polymorphism with stroke in patients with hypertension. Demographic information, medication, and outcome data were obtained from a hypertensive patient management system, and a PCR fluorescence probe technique was used to detect 7 gene polymorphic loci (CYP2D6∗10, ADRB1, CYP2C9∗3, AGTR1, ACE, CYP3A5∗3, and NPPA), and these loci were compared between patients with and without stroke. Logistic regression was performed to analyze the association of these genetic variations with stroke risk in hypertensive patients while controlling for potential factors. The prevalence of stroke in the hypertensive population in Changsha County of Hunan Province was 2.75%. The mutation frequencies of ADRB1 (1165G > C), CYP2D6∗10, CYP2C9∗3, AGTR1 (1166A > C), ACE (I/D), NPPA (2238T > C), and CYP3A5∗3 were 74.43%, 57.23%, 4.26%, 5.71%, 31.62%, 1.17%, and 69.58%, respectively. Univariate analysis revealed that ADRB1 polymorphism was associated with stroke (χ2 = 8.659, P < 0.05), with a higher stroke risk in the CC group than in the GC and GG groups (GC + GG). Multivariate unconditional logistic regression analysis showed that the CC genotype in ADRB1 (vs. the GC + GG genotype) was associated with an increased risk of stroke [odds ratio (OR) = 1.184, P<0.05] in hypertensive patients. No association was observed between CYP2D6∗10, CYP2C9∗3, AGTR1 (1166A > C), ACE (I/D), CYP3A5∗3, and NPPA (2238T > C) polymorphisms and stroke. ADRB1 (1165G > C) gene polymorphism is associated with the risk of stroke in Chinese hypertensive patients. The CC genotype is correlated with a higher risk of stroke than the GC + GG genotype.

Relationship between trimethylamine N-oxide and the risk of hypertension in patients with cardiovascular disease: A meta-analysis and dose-response relationship analysis.

The gut microbiota-dependent metabolite trimethylamine N-oxide (TMAO) has recently been recognized to be one of the risk factors for cardiovascular disease (CVD). However, there is a scarcity of data on the relationship between circulating TMAO levels and hypertension in patients with CVD. Meta analysis and a dose-response relationship were used in this study to assess the relationship between circulating trimethylamine N-oxide levels and the risk of hypertension in patients with CVD. CNKI, Wanfang Database, Pubmed, Embase, Cochrane Library, and Web of Science were searched up to June 01, 2023. Meta-analysis and dose-response analysis of relative risk data from prospective cohort studies reporting on the relationship between circulating TMAO levels and hypertension risk in patients with CVD were conducted. Fifteen studies with a total of 15,498 patients were included in the present meta-analysis. Compared with a lower circulating TMAO level, a higher TMAO level was associated with a higher risk of hypertension in patients with CVD (RR = 1.14,95%CI (1.08, 1.20)). And the higher the TMAO level, the greater the risk of hypertension. The dose-response analysis revealed a linear dose-response relationship between circulating TMAO levels and the risk of hypertension in patients with CVD. The risk of hypertension increased by 1.014% when the circulating TMAO level increased by 1 μ mol/L. In patients with CVD, the level of circulating TMAO is significantly related to the risk of hypertension. The risk of hypertension increased by 1.014% for every 1 μ mol/L increase in circulating TMAO levels.

Development and validation of a prediction model for hyperuricemia risk in hypertensive patients

Development and validation of a prediction model for hyperuricemia risk in hypertensive patients

A novel nomogram for predicting risk of hypertension in US adults with periodontitis: National Health and Nutrition Examination Survey (NHANES) 2009-2014.

The goal of our study was to create a nomogram to predict the risk of developing hypertension in patients with periodontitis. Our study used data from a total of 3196 subjects from the National Health and Nutrition Examination Survey 2009 to 2014 who had ever been diagnosed with periodontitis. The data set was randomly divided into a training set and a validation set according to a 7:3 ratio. The data from the training set was utilized to build the prediction model, while the validation set were used to validate the model. To identify the risk variables, stepwise regression was used to perform successive univariate and multivariate logistic regression analysis. The predictive ability of the nomogram model was evaluated using receiver operating characteristic curve. Calibration plots were used to assess the consistency of the prediction model. The clinical value of the model was evaluated using decision curve analysis and clinical impact curve. A nomogram for the risk of hypertension in subjects with periodontitis was constructed in accordance with the 8 predictors identified in this study. The areas under the receiver operating characteristic curve values for the training set and validation set were 0.922 (95% confidence interval: 0.911-0.933) and 0.918 (95% confidence interval: 0.900-0.935), respectively, indicating excellent discrimination. The decision curve analysis and clinical impact curve suggested that the model has significant clinical applications, and the calibration plots of the training set and validation set demonstrated good consistency. The nomogram can effectively predict the risk of hypertension in patients with periodontitis and help clinicians make better clinical decisions.

Ten-year follow-up of very-high risk hypertensive patients undergoing renal sympathetic denervation.

Renal denervation (RDN) has been proven to be effective in lowering blood pressure (BP) in patients, but previous studies have had short follow-ups and have not examined the effects of RDN on major cardiovascular outcomes. This study aimed to demonstrate the effectiveness and safety of RDN in the long-term treatment of hypertension and to determine if it has an effect on cardiovascular outcomes. All patients with resistant hypertension who underwent RDN between 2011 and 2015 at Tianjin First Central Hospital were included in the study. Patients were followed up at 1,5 and 10 years and the longest follow-up was 12 years. Data were collected on office BP, home BP, ambulatory BP monitoring (ABPM), renal function, antihypertensive drug regimen, major adverse events (including acute myocardial infarction, stroke, cardiovascular death and all cause death) and safety events. A total of 60 participants with mean age 50.37 ± 15.19 years (43.33% female individuals) completed long-term follow-up investigations with a mean of 10.02 ± 1.72 years post-RDN. Baseline office SBP and DBP were 179.08 ± 22.05 and 101.17 ± 16.57 mmHg under a mean number of 4.22 ± 1.09 defined daily doses (DDD), with a reduction of -35.93/-14.76 mmHg as compared with baseline estimates ( P < 0.0001). Compared with baseline, ambulatory SBP and DBP after 10-years follow-up were reduced by 14.31 ± 10.18 ( P < 0.001) and 9 ± 4.35 ( P < 0.001) mmHg, respectively. In comparison to baseline, participants were taking fewer antihypertensive medications ( P < 0.001), and their mean heart rate had decreased ( P < 0.001). Changes in renal function, as assessed by estimated glomerular filtration rate (eGFR) and creatinine, were within the expected rate of age-related decline. No major adverse events related to the RDN procedure were observed in long-term consequences. All-cause mortality and cardiovascular mortality rates were 10 and 8.34%, respectively, for the 10-year period. The BP-lowering effect of RDN was safely sustained for at least 10 years post-procedure. More importantly, to the best of my knowledge, this is the first study to explore cardiovascular and all-cause mortality at 10 years after RDN.

Abstract 14229: Cost-Effectiveness of a Multicomponent Intervention for Hypertension Control in Public Sector Primary Healthcare Services in Singapore

Introduction: Recently the SingHypertension cluster-randomized controlled trial investigated integrating a multicomponent intervention (MCI) into Singapore public sector primary care clinics for patients with uncontrolled hypertension. MCI consisted of physician training in risk-based treatment, antihypertensive medication subsidies, nurse-delivered motivational conversations and telephone follow-ups. While MCI improved blood pressure control and cardiovascular disease (CVD) risk scores relative to usual care (UC), the cost-effectiveness of MCI is unknown. Aim: We evaluated the incremental cost-effectiveness of MCI over a ten-year period following the intervention, from Singapore’s health system perspective. Methods: We used a Markov model to simulate the risks and outcomes associated with heart attacks and strokes for a hypothetical cohort of patients based on the trial profile. Costs included MCI administration and oversight, antihypertensive medications, consultations, diagnostics, and hospitalizations. Effectiveness was calculated in terms of disability-adjusted life years (DALYs) averted. Due to differences in outcomes by risk-group, we reported incremental cost effectiveness ratios (ICERs) separately for patients with low and high baseline risk of CVD, as well as an overall ICER. We also assessed the robustness of our results with deterministic and probabilistic sensitivity analyses. Results: Based on a willingness-to-pay threshold of USD 55,600 per DALY, MCI was incrementally cost-effective to UC for both low- (ICER: USD 35,700 per DALY averted) and high-risk patients (ICER: USD 55,500 per DALY averted), with a combined ICER of USD 45,400 per DALY averted. ICERs were most sensitive to the effectiveness of MCI; a reduction in QCVD TM 3 score of at least 0.56 for low-risk patients and 1.00 for high-risk patients was needed for cost-effectiveness. MCI had a 99% and 50% probability of being cost-effective for low- and high-risk patients respectively. Conclusions: MCI is likely cost-effective in reducing the incidence of heart attacks and strokes, especially for lower risk hypertensive patients. Wide-scale implementation of this intervention should be considered to improve blood pressure control in Singapore and beyond.

Evaluation of the risk of hypertension in patients treated with anti-CGRP monoclonal antibodies in a real-life study.

To explore the rate of hypertension incoming in patients treated with monoclonal antibodies against the calcitonin gene-related peptide. The monoclonal antibodies blocking the calcitonin gene-related peptide are unquestionable effective in the prevention of migraine. Despite this, the development of hypertension has been detected in some patients. This was a retrospective study conducted at the University Hospital of Modena. Patients were visited quarterly up to 1 year. Globally, no significant increase in the blood pressure was detected. The 5.7% of the patients developed a significant increase in their blood pressure. In particular, patients with a pre-existing hypertension were more likely to have a significant increase in the blood pressure. The risk of developing hypertension during a treatment with anti-calcitonin gene-related peptide monoclonal antibodies seems low. Anyway, patients with a pre-existing hypertension should be cautiously monitored because they are more likely to develop hypertension.

Validez en la predicción de riesgo de la escala SCORE en una población mediterránea con hipertensión arterial

Introduction and objectivesHypertension is the most prevalent risk factor globally. Calculation of cardiovascular risk in hypertensive patients before initiation of treatment is recommended. This study aimed to assess the predictive value and clinical utility of the SCORE scale in preventing cardiovascular events and all-cause mortality in patients with hypertension. MethodsPatients with hypertension from the ESCARVAL-RISK cohort were included. Cardiovascular risk was calculated using the SCORE scale. All deaths and cardiovascular events were recorded during a 5-year follow-up period. Sensitivity, specificity and predictive values were calculated for different cut-off points and the effect of different risk factors on the diagnostic accuracy of SCORE charts were assessed. ResultsIn a final cohort of 9834 patients, there were 555 cardiovascular events and 69 deaths. The recommended risk value for initiating drug treatment (5%) had a specificity of 92% for death and 91% for cardiovascular events, and a sensitivity of 20% for death and 22% for cardiovascular events. In addition, the scale classified 80.4% of patients who experienced a cardiovascular event and 78.3% of those who died as low risk. Age, body mass index, retinopathy and anticoagulant therapy were associated with reduced predictive ability of the SCORE scale, while being female was associated with better risk prediction. ConclusionsThe predictive ability of the SCORE scale for cardiovascular disease and total mortality in patients with hypertension is limited.

Body roundness index improves the predictive value of cardiovascular disease risk in hypertensive patients with obstructive sleep apnea: a cohort study

ABSTRACT Background Obesity, especially visceral obesity, plays an important role in the progression of cardiovascular disease (CVD). The body roundness index (BRI) is a new measure of obesity that is considered to reflect visceral obesity more comprehensively than other measures. This study aims to evaluate the relationship between BRI and CVD risk in hypertensive patients with obstructive sleep apnea (OSA) and explore its superiority in predicting CVD. Methods The Cox proportional hazards model was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD. The area under the curve (AUC), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to assess which measures of obesity had the best predictive value for CVD risk. Results During a median follow-up period of 6.8 years, 324 participants suffered a CVD event. After multivariable adjustment, compared with the reference group (the first tertile), the HRs (95% CI) of CVD were 1.25 (95% CI, 0.93–1.70) and 1.74 (95% CI, 1.30–2.33) for subjects in the tertile 2 and tertile 3 groups, respectively. Compared with other measurement indicators, BRI has the highest predictive value for CVD risk [AUC: 0.627, 95% CI: 0.593–0.661]. The addition of the BRI to the fully adjusted multivariate model improved the predictive power for CVD, which was validated in the continuous NRI and the IDI (all P < .05). Conclusions BRI was significantly associated with the risk of CVD in hypertensive patients with OSA. Furthermore, BRI may improve CVD risk prediction in hypertensive patients with OSA.

Association between office visit intervals and long-term cardiovascular risk in hypertensive patients.

Hypertension is a chronic disease that requires long-term follow-up in many patients, however, optimal visit intervals are not well-established. This study aimed to evaluate the incidences of major cardiovascular events (MACEs) according to visit intervals. We analyzed data from 9894 hypertensive patients in the Korean Hypertension Cohort, which enrolled and followed up 11,043 patients for over 10 years. Participants were classified into five groups based on their median visit intervals (MVIs) during the 4-year period and MACEs were compared among the groups. The patients were divided into clinically relevant MVIs of one (1013; 10%), two (1299; 13%), three (2732; 28%), four (2355; 24%), and six months (2515; 25%). The median follow-up period was 5 years (range: 1745±293 days). The longer visit interval groups did not have an increased cumulative incidence of MACE (12.9%, 11.8%, 6.7%, 5.9%, and 4%, respectively). In the Cox proportional hazards model, those in the longer MVI group had a smaller hazard ratio (HR) for MACEs or all-cause death: 1.77 (95% confidence interval [CI], 1.45-2.17), 1.7 (95% CI: 1.41-2.05), 0.90 (95% CI: 0.74-1.09) and 0.64 (95% CI: 0.52-0.79), respectively (Reference MVI group of 75-104 days). In conclusion, a follow-up visits with a longer interval of 3-6 months was not associated with an increased risk of MACE or all-cause death in hypertensive patients. Therefore, once medication adjustment is stabilized, a longer interval of 3-6 months is reasonable, reducing medical expenses without increasing the risk of cardiovascular outcomes.

ATRIAL FIBRILLATION AND MORTALITY RISK IN HYPERTENSIVE PATIENTS ACCORDING TO CARDIORESPIRATORY FITNESS

Objective: Atrial fibrillation (AF) is associated with increased risk of mortality. Epidemiologic evidence strongly supports an inverse and graded association between cardiorespiratory fitness (CRF) and mortality risk. The impact of CRF status on mortality risk in hypertensive patients with AF has not been assessed. The aim of the study was to evaluate the association between CRF and mortality risk in hypertensive patients with AF. Design and method: We identified 24,171 hypertensive patients (mean age 67.5±9.0 yrs), with documented AF who completed an exercise treadmill test (ETT) between years 1999 to 2020, with no evidence of ischemia. We established 5 fitness categories (quintiles) based on age-specific peak metabolic equivalents (METs) achieved: Least-fit (4.0±1.1 METs; n = 8,857); Low-fit (6.4±1.1 METs; n = 6,103); Moderate-fit (7.8±1.1 METs; n = 4,256); Fit (10.0±0.9 METs; n = 3,803) and High-fit (12.6±1.6 METs; n = 1,152). We used multivariable Cox proportional hazard models to estimate hazard ratios (HR) and 95% confidence intervals [CI] for mortality across CRF categories. The models were adjusted for age race, gender, resting blood pressure, comorbidities, and medications. Results: During follow-up (median = 8.8 years; 224,138 person-years), 10,499 individuals died (46.8 events per 1,000 person-years). The risk for stroke was 14% lower for each 1-MET increase in exercise capacity (HR = 0.86, CI: 0.85-0.87; p&lt;0.001). When considering CRF categories, mortality risk was 27% lower for the Least-Fit individuals (HR = 0.73; CI: 0.70-0.77) and declined progressively with increased CRF to approximately 45% t0 60% for Moderate-fit and Fit, and 67% (HR = 0.33; CI: 0.29-0.37) for High-Fit individuals. Conclusions: Increased CRF was inversely related to mortality in hypertensive patients with AF. The association was independent of comorbidities and graded.

IDENTIFYING HYPOKALEMIA RISK IN HYPERTENSIVE PEOPLE: USING MACHINE LEARNING IN THE UNITED STATES NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY 1999-2018

Objective: Hypokalemia is a side-effect of diuretics. We aimed to use machine learning to identify features predicting hypokalemia risk in hypertensive patients. Design and method: Participants with hypertension in the United States National Health and Nutrition Examination Survey 1999-2018 were included for analysis. To choose the optimal algorithm, we tested five machine learning algorithms (Logistic Regression, k-Nearest Neighbor, Random Forest, Recursive Partitioning and Regression Trees, and eXtreme Gradient Boosting) with 38 screened features. We selected the most appropriate model according to the area under the receiver operating characteristic curve (AUROC). We then selected the key hypokalemia-associated features in the hypertension group and their cardiovascular diseases (CVD) subgroup using the SHapley Additive exPlanations (SHAP) values. Using SHAP values, the key features and their impact pattern on hypokalemia risk were determined. Results: 21,096 hypertensive participants, of whom 3,540 had known CVD, were included for analysis. The Random Forest algorithm had the highest AUROC (hypertension dataset: 0.73 [95%CI, 0.70-0.75], P&lt;0.001; CVD subgroup: 0.76 [95%CI, 0.70-0.82], P&lt;0.001) and sensitivity (hypertension dataset: 0.62; CVD subgroup: 0.72) based on 38 features screened. Moreover, the nomogram based on the top fifteen key features screened by random forest retained good performance (hypertension dataset: 0.73 [95%CI, 0.70-0.75], P&lt;0.001; CVD subgroup: 0.74 [95%CI, 0.68-0.81], P&lt;0.001): gender, race, age, poverty income ratio, smoking status, body mass index, systolic and diastolic blood pressure, non-potassium-sparing diuretics use and duration, duration of renin-angiotensin blockers, potassium-sparing diuretics use, polypharmacy, and comorbid arthritis and diabetes in hypertension dataset; while in CVD subgroup, renin-angiotensin blockers use replaced potassium-sparing diuretics use. Conclusions: Our predictive model shows good performance, and hypokalemia-associated key features have been identified in hypertensive patients and the subgroup with CVD. These findings from machine learning facilitate the development of artificial intelligence to highlight hypokalemia risk in hypertension patients.

ACTUAL AND PERCEIVED BLOOD PRESSURE AND LDL-CHOLESTEROL CONTROL IN HYPERTENSIVE PATIENTS WITH DYSLIPIDEMIA: A CROSS-SECTIONAL EPIDEMIOLOGICAL STUDY IN CROATIA (SNAPSHOT STUDY)

Objective: Assess BP and LDL-C control rates and cardiovascular (CV) risk in hypertensive patients with dyslipidemia in Croatia, based on stricter recommendations from recent European guidelines, and compare them with physicians’ assessment. Design and method: The cross-sectional observational multicenter epidemiological SNAPSHOT study involved 116 general practitioners in Croatia and included 1298 hypertensive patients with dyslipidemia. Results: 91.7% of patients had additional risk factors. 57.9% were 65 years-old or older (65.8±9.7 years), 47.3% men, 42.6% obese (mean BMI 29.6±4.6 kg/m2) and 17.6% smokers. 55.4% had comorbidities: diabetes mellitus (34.1%), coronary artery disease (21.0%), and peripheral arterial disease (9.6%). Mean systolic/diastolic BP was 135.5±13.3 / 80.3±8.5 mmHg, total cholesterol 203.2±52.7 mg/dL, HDL-C 53.9±13.8 mg/dL, LDL-C 119.4±45.1 mg/dL, triglycerides 160.8±109.7 mg/dL. Cardiovascular risk was estimated by investigators as “high”/“very high” for 30.1% and 31.4% of patients, respectively, whereas calculated CV risk according to guidelines (SCORE CHART 2-OP) was “high”/“very high” for 38.0% and 38.5% of patients, respectively. These results showed that 46.6% of investigators estimated CV risk accurately, while 34.3% underestimated it. Hypertension was treated in 99.1% of patients and BP considered as controlled by investigators in 79.5% of patients, whereas actual control based on guidelines’ recommendations was achieved by 23.9%. Similarly, dyslipidemia was treated in 79.4% of patients and LDL-C considered as controlled by investigators in 54.2%, whereas actual control was achieved by only 12.8% according to guidelines. Only 2.9% of patients were actually controlled for both BP and LDL-C whereas 45.3% of patients were considered as controlled for both BP and LDL-C by investigators. 66.4% of patients were treated with single-pill combinations for hypertension, 8.6% for dyslipidemia, and only 5.5% received treatment for both hypertension and dyslipidemia in a single pill. Conclusions: Actual BP and LDL-C control rates in Croatia remain rather low and are often overestimated by physicians. Physicians often underestimate CV risk, which is difficult to evaluate in clinical practice. Improving physician education about guidelines’ recommendations and need for treatment intensification could offer an opportunity to further improve risk factor control. Single-pill combination usage for dyslipidemia and for both hypertension and dyslipidemia remains rather low.

COVID-19 AND MORTALITY IN HYPERTENSIVE PATIENTS ACCORDING TO CARDIORESPIRATORY FITNESS

Objective: COVID-19 mortality risk increases with the presence of underlying comorbidities, including hypertension. Epidemiologic evidence also suggests an inverse association between self-reported physical activity and COVID-19 cases and deaths. However, no information exists regarding the association between cardiorespiratory fitness (CRF) assessed objectively by a standardized exercise treadmill test (ETT) and mortality in hypertensive patients. We assessed the hypothesis that CRF is inversely and independently associated with COVID-19 mortality risk in non-vaccinated hypertensive patients Design and method: From 2020 to 2021, we identified 17,358 hypertensive patients (mean age: 60.3 ± 8.2 years) with a normal response to an exercise tolerance test (ETT), prior to COVID-19. We established five CRF categories based on age-stratified quintiles of peak metabolic equivalents (MET) achieved: Least-Fit (4.7 ± 1.2 METs; n = 3,486); Low-Fit (7.1 ± 1.3; n = 4,616); Moderate-Fit (8.4 ± 1.3 METs; n = 3,320); Fit (10.3 ± 0.9 METs; n = 4,084); and High-Fit (12.8 ± 1.6 METs; n = 1,852). Multivariable Cox proportional hazard models were constructed to estimate hazard ratios (HR) and 95% confidence intervals [CI] for mortality across CRF categories. The models were adjusted for age, gender, race, comorbidities, medications, hospitalization, intubation, and time elapsed between ETT and COVID-19. The Least-Fit category was used as the reference group. Results: Results: During the follow-up of 100 days, 1,853 individuals died (10.7%). The risk for death was 7% lower for each 1-MET increase in exercise capacity (HR = 0.93, CI: 0.92-0.95; p &lt; 0.001). The risk across fitness categories declined progressively with increased CRF and was 26% lower for the Least-Fit individuals (HR = 0.74; CI: 0.66 - 0.84), approximately 30% to 40% lower for Moderate-Fit and Fit, and 50% lower (HR = 0.50; CI: 0.41 - 0.62; p &lt; 0.001) for High-Fit patients. Conclusions: Increased CRF was inversely related to COVID-19 mortality risk in hypertensive patients. The association was graded and independent of comorbidities.

RELATIONSHIP OF HYPERURACEMIA WITH METABOLIC DISORDERS IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: To study the prevalence of hyperuremia and to study its role in development of metabolic disorders in patients with arterial hypertension (AH). Design and method: The study analyzed 188 case histories of patients with AH grades 1-3 (ESC/ESH, 2018). 109 women and 79 men were studied. Mean age 62.8±10.2 years. Hyperuricemia was established with an increase in the level of uric acid &gt; 7 mg / dl in men, &gt; 5.7 mg / dl in women. Results: Results: For analysis, patients were divided into 2 groups: the first group consisted of patients with hyperuricemia (n = 103), the second - patients with normal levels of uric acid (n = 85). The average level of uric acid in the 1st group was 7.44±1.33 mg/dl, and in the 2nd group - 5.06±0.98 mg/dl, p&lt;0.00001. The compared groups were similar in terms of age, office SBP and DBP. Age: 62.7±10.51 vs 62.8±10.01 years, p = 0.95; SBP - 136.82±22.09 mm Hg. vs 132.98±24.4 mmHg, p = 0.26; DBP - 85.17±10.27 mm Hg. vs 84.27±10.71 mmHg, p = 0.56. The groups also did not differ in BMI and WC: BMI-32.96±5.84 kg/m2 vs 31.24±5.00 kg/m2 p = 0.44; OT-105.44±13.75 cm vs 102.76±12.06 cm, p = 0.16. It should be noted that patients with hyperuricemia had a significantly high level of MAU: 63.24±104.06 vs 39.33±36.42 mg/l, p = 0.044. Patients with hyperuricemia had more pronounced dyslipidemia. Thus, total cholesterol was significantly high in group 1: 198.31±49.41 mg/dl vs 181.75±49.1 mg/dl, p = 0.04, LDL cholesterol 111.83±42.46 mg/dl dl vs 100.56±37.99 mg/dl, p = 0.04. TG and HDL-C did not differ between the groups. TG: 223.39±130.76 vs 189.69±122.18 p = 0.057. HDL-C: 41.92±13.54 mg/dl vs 43.30±12.87 mg/dl, p = 0.48. In the group of patients with hyperuricemia, there was a significantly high level of glucose compared with patients with normal levels of uric acid: 9.71±04.35 mmol/l vs 6.51±3.06 mmol/l, p = 0.0001. The creatinine level was also high in patients with hyperuricemia: 98.45±36.75 μmol/l vs 85.06±17.21 μmol/l, p = 0.003. Conclusions: Hyperuricemia should be considered as an additional cardiovascular risk in hypertensive patients. Hyperuricemia is associated with severe dyslipidemia and elevated levels of glycemia and creatinine in hypertensive patients.

THE INFLUENCES OF ACHIEVED BLOOD PRESSURE ON CARDIOVASCULAR OUTCOMES IN HYPERTENSIVE PATIENTS WITH DIFFERENT LEFT VENTRICULAR GEOMETRIC PATTERN: A PROSPECTIVE COHORT STUDY IN CHINA

Objective: Intensive antihypertensive therapy might bring additional benefits for hypertensive patients with high risks of cardiovascular diseases. The left ventricular(LV) geometric patterns could reasonably stratify cardiovascular risks in hypertensive patients, which might facilitate the selection of individuals who were more suitable for intensive antihypertensive therapy. Design and method: This investigation is a community-based, multi-center, prospective cohort study to investigate the geographical profile of cardiovascular disease risk across China. In total, 7680 hypertensive patients were recruited. Firstly, we divided all individuals into four subgroups, including normal geometry(NG), concentric remolding(CR), eccentric hypertrophy(EH) and concentric hypertrophy(CH) based on the diagnostic thresholds recommended by the EACVI/ASE and EMINCA study respectively, respectively. Secondly, we defined the primary endpoint as composite endpoints including the stroke, hospitalization for heart failure and coronary artery disease. We exhibited the hazard ratios of patients with different achieved systolic blood pressure (achieved SBP&gt;140mmHg, 130&lt;SBP&lt; = 140mmHg, and SBP&lt; = 130mmHg) after receiving anti-hypertensive therapy from general practitioners in the NG, CR, EH and CH subgroups based on the diagnostic thresholds of echocardiographic measurements from EMINCA study and EACVI/ASE guideline respectively. Results: We firstly validated that the diagnostic thresholds based on EMINCA study could preferably stratify cardiovascular risks for Chinese hypertensive patients considering the racial differences (Figure 1). And we demonstrated the additional benefits from intensive antihypertensive therapy featured by a SBP target lower than 130mmHg only occurred in the patients with CH regardless of according to the diagnostic thresholds from EMINCA study and EACVI/ASE guidelines (Figure 2). Intriguingly, we found the unexpected negative correlation between achieved SBP and occurrence of the primary endpoint in the patients with CR, exhibited by higher cardiovascular risks of patients with a achieved SBP below 130mmHg (Figure 2), which might be due to that CR patients were positively associated with extracardiac organ damage and might be more susceptible to the hypotension and organ hypoperfusion. Conclusions: The patients with CH might profit additionally from intensive anti-hypertensive therapy, but it needs to be more cautious in the patients with CR.