Systolic Blood Pressure Control Research Articles

Abstract 12895: Blood Pressure Outcomes After 9 Months With Remote Patient Monitoring For Hypertension in Primary Care: A Prospective Cohort Study in Electronic Health Records Using Propensity Score Matching

Introduction: Remote patient monitoring (RPM) for blood pressure (BP) in primary care may support hypertension control. Hypothesis: Among Medicare patients enrolled from six pilot primary care clinics, those prescribed RPM would have better BP control (BP <140/90 mm Hg), and lower office SBP at 3, 6 and 9 months compared with matched controls. Methods: This was a pragmatic observational study. Patients were included if they belonged to any of six primary care practices that were in pilot studies of the Omron VitalSight TM RPM system which enabled transmission of BP and pulse from a BP monitor into the electronic health record without manual entry. We used 1:4 propensity score matching to identify contemporary matches for 288 RPM-prescribed patients from the same clinics, based on age, sex, systolic BP (SBP), marital status, and several other clinical and healthcare use characteristics. Outcomes included controlling high blood pressure (most recent primary care office or RPM BP <140/90 mm Hg), most recent primary care office SBP, and most recent primary care or RPM SBP, and were assessed after 3, 6, and 9 months. Results: Baseline characteristics of the 288 RPM patients and 1152 controls were similar. The mean ages (SD) were 73.6 (7.4) and 73.8 (7.9) years, respectively. Corresponding mean (SD) SBPs were 142.7 (19.5) and 141.2 (18.7) mm Hg. Controlling high blood pressure was greater in the RPM-prescribed cohort than in matched controls at 3, 6 and 9 months (Table). Mean of last office SBPs did not differ. Means of most recent SBP that included remote values were lower for the RPM-prescribed cohort at 3, 6 and 9 months. Conclusions: BP control and mean of last office or remote SBP diverged quickly and were partially sustained at 9 months. As mean office SBPs did not differ, additional evaluation is needed to assess the degree to which observed differences were due to greater declines in BP overall among RPM patients vs. differences between measured home and office blood pressures.

Abstract 14598: Relationship of Ambulatory Blood Pressure Profiles on Progression of Aortic Atheroma in Patients With Stroke

Introduction: Aortic atherosclerotic burden is known to be associated with an increased risk of ischemic stroke. However, longitudinal data and the risk factors about aortic plaque progression are limited. Hypothesis: We hypothesized that ambulatory blood pressure (BP) variables would play a role in progression of aortic atheroma over 2 years in patients with stroke Methods: 115 patients with who underwent serial transesophageal echocardiography (TEE) over 2 years were enrolled. Aortic atheroma was graded as mild (2-3mm), moderate (3-5 mm), severe (>5mm), or complex (ulceration and/or mobile component) using TEE. Progression of aortic atheroma was defined as an increase of maximal plaque thickness by ≥1 grade. Ambulatory BP monitoring (ABPM) was performed when BP was stabilized. The association between ABPM variables and aortic atheroma progression was assessed. Results: During the median follow-up of 25.0 months, 10 (8.7%) were regressed, 13 (11.3%) were progressed, and 92 (80.0%) remained unchanged. Female had more progression of aortic atheroma (p=0.007). However, baseline LDL cholesterol, change of LDL cholesterol, intensity of statin and baseline plaque thickness were not significantly associated with change of aortic plaque. Regarding ABPM variables, systolic ABPM variables including 24 hour, daytime and nighttime mean systolic BP were associated with progression of aortic atheroma, whereas diastolic BP variables were not associated with change of aortic atherosclerosis. 24 hour, daytime and nighttime mean systolic BP were significantly related to plaque progression even after adjusting for clinical parameters (p=0.007 for 24 hour and daytime SBP, p=0.003 for nighttime SBP). Conclusions: Systolic BP variables were associated with progression of aortic atheroma in patients with stroke, which suggests systolic BP control can be a key to suppress progression of aortic plaques.

Abstract 9705: Diastolic Blood Pressure and Intensive Blood Pressure Control on Cognitive Outcomes: Insights From the SPRINT Trial

Introduction: The potential benefits or harms of intensive systolic blood pressure (SBP) lowering on cognitive function in individuals with low diastolic blood pressure (DBP) remain unclear. Hypothesis: The effects of intensive SBP lowering on cognitive outcomes were consistent across baseline DBP levels. Methods: In this post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT), 8563 participants with at least one follow-up cognitive assessment were included. Cognitive outcomes were the occurrence of probable dementia, mild cognitive impairment (MCI), and a composite of probable dementia or MCI. Cox regression models and likelihood ratio tests were used to assess the interaction between DBP quartiles and intensive SBP control on cognitive outcomes. Results: The incidence rates of cognitive outcomes among participants in the lowest DBP quartile were higher than those in the other three DBP quartiles (Figure 1). However, participants in the intensive group had a lower incidence rate of probable dementia or MCI than those in the standard group, regardless of DBP quartiles. There were no significant interactions between SBP intervention and DBP quartiles for probable dementia ( P for interaction =0.06), MCI ( P for interaction =0.80), or a composite of probable dementia or MCI ( P for interaction =0.24) (Figure 2). Conclusions: In this post hoc analysis of the SPRINT study, patients with lower DBP had a higher incidence of cognitive impairment. However, the effects of intensive SBP lowering on cognitive outcomes were consistent across different DBP groups.

Attenuated Relationships Between Indexes of Volume Overload and Atrial Natriuretic Peptide in Uncontrolled, Sustained Volume-Dependent Primary Hypertension.

Whether systolic blood pressure (SBP) control in sustained volume-dependent primary hypertension is associated with blunted ANP (atrial natriuretic peptide) relationships with indexes of volume load is unknown. Systemic hemodynamics (central pressure, echocardiographic aortic velocity and diameter measurements in the outflow tract), circulating ANP concentrations (ELISA assays) and glomerular and tubular function (24-hour urine collections [n=519]) were determined in a community of African ancestry (n=772). As compared with those with a controlled SBP, those with an uncontrolled SBP (n=198) showed lower ANP concentrations (P<0.005) despite higher stroke volume and cardiac output (P<0.0001) and renal differences consistent with enhanced fluid retention. In those with a controlled SBP, fractional Na+ excretion (FeNa+; P<0.0005) and creatinine clearance (glomerular filtration rate; P<0.005) were inversely associated with ANP concentrations independent of confounders. Moreover, in those with a controlled SBP, stroke volume and cardiac output (P<0.0001) were independently and positively associated with ANP concentrations. In addition, in those with a controlled SBP, ANP concentrations were independently and inversely associated with systemic vascular resistance (SVR; P<0.0001) and aortic characteristic impedance (Zc; P<0.005). By contrast, in those with uncontrolled SBP, no relationships between either stroke volume (P>0.25), cardiac output (P>0.29), FeNa+ (P>0.77), or glomerular filtration rate (P>0.47) and ANP concentrations were noted. Furthermore, in those with an uncontrolled SBP, no relationships between ANP concentrations and SVR or Zc were observed (P>0.34). In a population where primary hypertension is strongly volume-dependent, those with an uncontrolled SBP have an attenuated relationship between ANP and both renal and hemodynamic indexes of volume overload and the vascular effects of ANP.

A nationwide cross-sectional analysis of biopsy-proven Fabry nephropathy: the Japan Renal Biopsy Registry

BackgroundFabry disease (FD) is an X-linked inherited disease where renal complications are associated with a poor prognosis. However, little is known about the prevalence of Fabry nephropathy (FN) in patients with chronic kidney disease (CKD). We extracted FN data from the Japan Renal Biopsy Registry, analyzed the prevalence of FN, and examined the correlation between clinical characteristics and renal involvement according to sex differences and hemi- and heterozygosity in patients with FD.MethodsA total of 38,351 participants who underwent renal biopsy were retrospectively enrolled, and FN was determined. The clinical characteristics of FD patients were examined based on sex differences.ResultsTwenty-nine patients (0.076%) (19 males and 10 females, mean age: 43.7 ± 15.5 years old) were diagnosed with FN. Median estimated urinary protein (UP) and mean eGFR levels were 0.9 [interquartile range (IQR) [0.7–1.6] g/gCr and 67.1 ± 36.8 mL/min/1.73 m2, respectively. Mean systolic blood pressure (SBP) was 126.4 ± 17.1 mmHg and diastolic blood pressure was 76.1 ± 12.6 mmHg. An inverse correlation between eGFR and logarithm UP levels was observed (r2 = 0.23, p = 0.02), SBP was positively associated with logarithm UP (r2 = 0.34, p = 0.004) overall and inversely associated with eGFR (r2 = 0.25, p = 0.007) regardless of sex, and SBP was an independent determinant of proteinuria (p = 0.004) and eGFR (p = 0.007).ConclusionsThe prevalence of biopsy-proven FN was 0.076%. Since SBP is associated with eGFR regardless of zygosity, strict SBP control might be necessary to prevent progression to end-stage kidney disease in both male and female patients with FN.

Differential Control of Systolic and Diastolic Blood Pressure in Kidney Transplant Recipients

Differential Control of Systolic and Diastolic Blood Pressure in Kidney Transplant Recipients

Relation Between Labetalol and Methyldopa in Treatment of Pregnancy Induced Hypertension

Background: Hypertensive disorder is the most common medical problem encountered in pregnancy with a high perinatal and maternal mortality &amp; morbidity. Worldwide about 76,000 pregnant women die each year from preeclampsia and related hypertensive disorders. Objective: To assess the relation between labetalol and methyldopa in treatment of pregnancy induced hypertension. Methods: This study was hospital based comparative prospective study was conducted at Dept. of Obstetrics &amp; Gynaecology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January to June 2021. The study consisted of 100 patients with pregnancy induced hypertension attending outpatient department and admitted in ANW, or who directly came to labour room. These patients were randomly selected on lottery basis after they fulfilled the inclusion criteria. Total patients were taken for the study and divided into 2 groups of 50 patients in each group. Results: A total 100 patients were included. The mean age in Group I was 24.4±4.55 years and in Group-II, 23.95±4.28 years. Maximum number of patients was between 19- 24 years in both the groups. In Group-I, 26 (52%) patients and in Group-II, 25 (50%) patients were in this age group. The maximum age in the Group I was 34 years and 35 years in the Group-II. The minimum age was 17 years in both the groups. The inter group difference was not statistically significant (p&gt;0.05) thus the two groups were comparable by age. At baseline no significant difference was seen in SBP in both treatment groups. However after 8 days post testament SBP of women was significantly lower in Group-I patients as that of Group-II patients. i.e. Group-I: 123.41 vs. Group-II: 126.62, p- value=0.009. At baseline no significant difference was seen in DBP in both treatment groups. However at 8th day post treatment DBP of patients was significantly lower in Group-I patients. i.e. 77.18 vs. Group-II 79.64, p-value=0.005. For SBP more effective control was seen in women whose parity was 3-4 and for DBP notable difference was seen in women whose parity was 1-2. The control of systolic blood pressure was more effective in patients with normal body mass index and for Diastolic blood pressure (DBP) more effective control was seen in patients who were obese. On comparison methyldopa significantly causes more drowsiness, headache and nasal congestion and the incidence of Postural hypotension and dysponea in both groups were not significantly different. The patient who required additional drugs to control the uncontrolled hypertension. In Group I, 2 (4%) patients and in Group II, 3 (6%) patients did not respond with starting drug. The inter group difference was not statistically significant (p&gt;0.05). Conclusion: Labetalol had less maternal adverse effect compared to methyldopa but fetal outcome was not observed in this study. Labetalol and methyldopa are equally efficacious in controlling blood pressure in new onset hypertension in pregnancy. This study is just a step in this long way. Therefore, labetalol can be considered positively in the treatment of pregnancy induced hypertension.

Intensive blood pressure control after endovascular thrombectomy for acute ischaemic stroke (ENCHANTED2/MT): a multicentre, open-label, blinded-endpoint, randomised controlled trial

The optimum systolic blood pressure after endovascular thrombectomy for acute ischaemic stroke is uncertain. We aimed to compare the safety and efficacy of blood pressure lowering treatment according to more intensive versus less intensive treatment targets in patients with elevated blood pressure after reperfusion with endovascular treatment. We conducted an open-label, blinded-endpoint, randomised controlled trial at 44 tertiary-level hospitals in China. Eligible patients (aged ≥18 years) had persistently elevated systolic blood pressure (≥140 mm Hg for &gt;10 min) following successful reperfusion with endovascular thrombectomy for acute ischaemic stroke from any intracranial large-vessel occlusion. Patients were randomly assigned (1:1, by a central, web-based program with a minimisation algorithm) to more intensive treatment (systolic blood pressure target &lt;120 mm Hg) or less intensive treatment (target 140-180 mm Hg) to be achieved within 1 h and sustained for 72 h. The primary efficacy outcome was functional recovery, assessed according to the distribution in scores on the modified Rankin scale (range 0 [no symptoms] to 6 [death]) at 90 days. Analyses were done according to the modified intention-to-treat principle. Efficacy analyses were performed with proportional odds logistic regression with adjustment for treatment allocation as a fixed effect, site as a random effect, and baseline prognostic factors, and included all randomly assigned patients who provided consent and had available data for the primary outcome. The safety analysis included all randomly assigned patients. The treatment effects were expressed as odds ratios (ORs). This trial is registered at ClinicalTrials.gov, NCT04140110, and the Chinese Clinical Trial Registry, 1900027785; recruitment has stopped at all participating centres. Between July 20, 2020, and March 7, 2022, 821 patients were randomly assigned. The trial was stopped after review of the outcome data on June 22, 2022, due to persistent efficacy and safety concerns. 407 participants were assigned to the more intensive treatment group and 409 to the less intensive treatment group, of whom 404 patients in the more intensive treatment group and 406 patients in the less intensive treatment group had primary outcome data available. The likelihood of poor functional outcome was greater in the more intensive treatment group than the less intensive treatment group (common OR 1·37 [95% CI 1·07-1·76]). Compared with the less intensive treatment group, the more intensive treatment group had more early neurological deterioration (common OR 1·53 [95% 1·18-1·97]) and major disability at 90 days (OR 2·07 [95% CI 1·47-2·93]) but there were no significant differences in symptomatic intracerebral haemorrhage. There were no significant differences in serious adverse events or mortality between groups. Intensive control of systolic blood pressure to lower than 120 mm Hg should be avoided to prevent compromising the functional recovery of patients who have received endovascular thrombectomy for acute ischaemic stroke due to intracranial large-vessel occlusion. The Shanghai Hospital Development Center; National Health and Medical Research Council of Australia; Medical Research Futures Fund of Australia; China Stroke Prevention; Shanghai Changhai Hospital, Science and Technology Commission of Shanghai Municipality; Takeda China; Hasten Biopharmaceutic; Genesis Medtech; Penumbra.

Individualising intensive systolic blood pressure reduction in hypertension using computational trial phenomaps and machine learning: a post-hoc analysis of randomised clinical trials

The cardiovascular benefits of intensive systolic blood pressure control vary across clinical populations tested in large randomised clinical trials. We aimed to evaluate the application of machine learning to clinical trials of patients without and with type 2 diabetes to define the personalised cardiovascular benefit of intensive control of systolic blood pressure. In SPRINT, a trial of intensive (systolic blood pressure <120 mm Hg) versus standard (systolic blood pressure <140 mm Hg) systolic blood pressure control in patients without type 2 diabetes, we defined a phenotypic representation of the study population using 59 baseline variables. We extracted personalised treatment effect estimates for the primary outcome, time-to-first major adverse cardiovascular event (MACE; cardiovascular death, myocardial infarction or acute coronary syndrome, stroke, and acute decompensated heart failure), through iterative Cox regression analyses providing average hazard ratio (HR) estimates weighted for the phenotypic distance of each participant from the index patient of each iteration. Next, we trained an extreme gradient boosting algorithm (known as XGBoost) to predict the personalised effect of intensive systolic blood pressure control using features most consistently linked to increased personalised benefit, before evaluating its performance in the ACCORD BP trial of patients with type 2 diabetes randomly assigned to receive intensive versus standard systolic blood pressure control. We stratified patients based on their predicted treatment effect, and key demographic groups (age, sex, cardiovascular disease, and smoking). We assessed the presence of heterogeneity with an interaction test, and assessed the performance of the algorithm in a simulation analysis of SPRINT in the presence or absence of an artificially introduced heterogeneous treatment effect. From SPRINT, we included all 9361 study participants (mean age 67·9 years [SD 9·4], 3332 [35·6%] female) who underwent randomisation to either intensive (n=4678) or standard (n=4683) treatment. The median individualised HR for MACE was 0·63 (IQR 0·53-0·78). An eight-feature tool built for this analysis to predict personalised benefit in SPRINT was externally tested in ACCORD BP (4733 participants (mean age 62·7 years [SD 6·7], 2258 [47·7%] female), wherein it successfully identified individuals with differential benefit from intensive versus standard systolic blood pressure control (adjusted HR for MACE of 0·70 [95% CI 0·55-0·90] in individuals with above-median MACE benefit versus 1·05 [95% CI 0·84-1·32] for below-median predicted benefit; pinteraction=0·0184). Subgroup analysis based on age (<65 years: HR 0·89 [95% CI 0·71-1·12]; ≥65 years: 0·85 [0·67-1·09]), sex (male: 0·89 [0·72-1·10]; female: 0·85 [0·65-1·10]), established cardiovascular disease (no: 0·89 [0·70-1·14]; yes: 0·84 [0·67-1·06]), or active smoking (no: 0·85 [0·71-1·02]; yes: 1·01 [0·64-1·60]) did not identify groups with heterogeneity of treatment effect. In a simulation analysis of SPRINT, the proposed algorithm detected groups with heterogeneous treatment effects in the presence, but not absence, of simulated subgroup differences. By use of machine learning to define an individual's personalised benefit through phenotypic representations of clinical trials, we created a practical tool for individualising the selection of intensive versus standard systolic blood pressure control in patients without and with type 2 diabetes. National Heart, Lung, and Blood Institute of the US National Institutes of Health.

Influence of Baseline Diastolic Blood Pressure on the Effects of Systolic Blood Pressure Lowering on Cognitive Function in Type 2 Diabetes Mellitus.

Lowering of systolic blood pressure (SBP) in patients with low diastolic blood pressure (DBP), can further lower DBP. This can potentially decrease cerebral perfusion and cognition. We examined the influence of baseline DBP on the effect of lowering SBP on cognition. This is a post hoc analysis of the Memory in Diabetes (MIND) substudy (N = 1,430) of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study (NCT00000620). Standard neuropsychological tests (Digit Symbol Substitution Test [DSST], Mini-Mental State Examination [MMSE], Rey Auditory Verbal Learning Test [RAVLT], and Stroop test) were performed at baseline and months 20 and 40. We compared the effects of intensive (goal SBP <120 mm Hg) vs. standard (goal SBP <140 mm Hg) SBP control on the changes in the 4 test scores from baseline to the averages of months 20 and 40 across the range of baseline DBP using cubic spline terms. Mean age was 63 ± 6 years, 55% were women and 66% White. Participates with lower baseline DBP were older, had more cardiovascular events and a longer duration of diabetes. There was no difference in the change in DSST (-0.22; 95% CI -0.97, 0.52), MMSE (-0.14; 95% CI -0.34, 0.06), RAVLT (-0.12; 95% CI -0.29, 0.06), and Stroop interference (-0.47; 95% CI -1.76, 0.82) in the intensive vs. standard SBP intervention. There was no interaction between baseline DBP and change in scores with the SBP intervention. Intensive SBP reduction does not adversely affect cognition, even in those with low baseline DBP.

Systolic blood pressure time in range and long-term clinical outcomes in patients with ischaemic cardiomyopathy

Abstract Background The relationship between systolic blood pressure (SBP) control and long-term clinical outcomes in patients with ischaemic cardiomyopathy remains unclear. It has been previously reported that either too high or too low SBP may lead to a poorer prognosis. But current SBP control metrics may not take into account the possible effects of fluctuating SBP overtime on patients. Purpose This study aimed to estimate the association between time in range (TIR) of SBP and long-term clinical outcomes in patients with ischaemic cardiomyopathy. Methods This study was a post-hoc analysis of The Surgical Treatment of Ischaemic Heart Failure (STICH) trial, a randomized controlled trial with two hypotheses that enrolled participants with coronary artery disease and left ventricular ejection fraction ≤35%. The SBP target range of the TIR was defined as 110 to 130 mmHg and the SBP TIR was calculated by linear interpolation method. Patients were equally divided into four groups by quartiles of TIR. Multivariable-adjusted Cox proportional hazards regression models were constructed to compare the effects of different levels of TIR on a 10-year prognosis. The primary outcome was all-cause mortality. Subgroup analyses were performed according to whether patients were assigned to coronary artery bypass grafting (CABG) or medical therapy (MED), and in populations with different baseline SBP. Results A total of 1194 eligible patients were included according to the purpose of our study. Compared with patients in the quartile 4 group (TIR 77.87–100%), the fully adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of all-cause mortality were 1.32 (0.98–1.78) for quartile 3 group (TIR 54.81–77.63%), 1.40 (1.03–1.90) for quartile 2 group (TIR 32.59–54.67%), and 1.53 (1.14–2.04) for quartile 1 group (TIR 0–32.56%) (P for trend = 0.005). When evaluated TIR as a continuous variable, per 1-SD decrement (29.28%) in TIR significantly increased the incidence of all-cause mortality [1.15 (1.04–1.26)]. Similarly, the decrement in TIR significantly elevated the risk of cardiovascular (CV) mortality and the risk of all-cause mortality plus CV rehospitalization. Consistent results were also observed in subgroup analyses of either CABG or MED, or different baseline SBP, indicating the robustness of our findings. Conclusions This study suggested that in patients with ischaemic cardiomyopathy, a higher SBP TIR was significantly associated with a decreased risk of all-cause mortality, CV mortality and the composite of all-cause mortality plus CV rehospitalization, regardless of whether the patient received CABG or MED, and the level of baseline SBP. Our findings support that TIR might be a substitutable metric of SBP control for long-term clinical outcomes in patients with ischaemic cardiomyopathy. Funding Acknowledgement Type of funding sources: None.

Intensive Blood Pressure Lowering in Patients With Malignant Left Ventricular Hypertrophy

BackgroundLeft ventricular hypertrophy (LVH) combined with elevations in cardiac biomarkers reflecting myocardial injury and neurohormonal stress (malignant LVH) is associated with a high risk for heart failure and death. ObjectivesThe aim of this study was to determine the impact of intensive systolic blood pressure (SBP) control on the prevention of malignant LVH and its consequences. MethodsA total of 8,820 participants in SPRINT (Systolic Blood Pressure Intervention Trial) were classified into groups based on the presence or absence of LVH assessed by 12-lead ECG, and elevations in biomarker levels (high-sensitivity cardiac troponin T ≥14 ng/L or N-terminal pro–B-type natriuretic peptide ≥125 pg/mL) at baseline. The effects of intensive vs standard SBP lowering on rates of acute decompensated heart failure (ADHF) events and death and on the incidence and regression of malignant LVH were determined. ResultsRandomization to intensive SBP lowering led to similar relative reductions in ADHF events and death across the combined LVH/biomarker groups (P for interaction = 0.68). The absolute risk reduction over 4 years in ADHF events and death was 4.4% (95% CI: −5.2% to 13.9%) among participants with baseline malignant LVH (n = 449) and 1.2% (95% CI: 0.0%-2.5%) for those without LVH and nonelevated biomarkers (n = 4,361). Intensive SBP lowering also reduced the incidence of malignant LVH over 2 years (2.5% vs 1.1%; OR: 0.44; 95% CI: 0.30-0.63). ConclusionsIntensive SBP lowering prevented malignant LVH and may provide substantial absolute risk reduction in the composite of ADHF events and death among SPRINT participants with baseline malignant LVH.

Parameters Predicting Poor Blood Pressure Control among Male Hypertensives in A Primary Care Setting, Kwara State Nigeria

Background: Poor blood pressure control is a global challenge and male hypertensives constitute an important group of patients that should be treated with utmost priority because previous studies have associated male gender with high prevalence of hypertension and poor blood control. Aim: This was to determine the level of blood pressure (BP) control and to find the relationship between the demographic, clinical and laboratory parameters that can predict uncontrolled BP among male hypertensives. Material and Method: This study was a hospital-based descriptive cross-sectional descriptive study done in Family Medicine department of the University of Teaching Hospital, Ilorin, Kwara State, Nigeria. The study population was male hypertensives. Interviewers’ questionnaires were used to obtain information and clinical measurements such as BP and body mass index were taken with appropriate instruments. Laboratory measurement including fasting blood glucose and fasting lipid profile were also carried out. Data was collected using the Version 20 software packages of the Statistical Package for Social Sciences (SPSS-20). Result: About half (48%) of the respondents had control atBP ≤140/90 mmHg, 34.9% at ≤130/80 and only 15.7% had optimum BP control. The diastolic BP control 154(67.2%) was higher than those with systolic BP control 107(46.2%). Multiple regression analysis shows that only increasing age (P value = 0.003) and low level of education (P value = 0.009) can predict the development of uncontrolled hypertension. Conclusion: This study shows that there is poor BP control among male hypertensives and increasing age and low level of education can predict uncontrolled hypertension.

Emergent anticoagulation reversal and BP control are key for ICH

Emergent anticoagulation reversal and BP control are key for ICH

Abstract 098: Double Deletion Of At 1a Receptors And Na + /h + Exchanger 3 In The Proximal Tubules Attenuates Angiotensin Ii-induced And 2k1c Goldblatt Hypertension In Proximal Tubule-specific Pt- Agtr1a -/- / Nhe3 -/- Mice

We have previously shown that genetic deletion of AT 1 (AT 1a ) receptors or Na + /H + exchanger 3 (NHE3) selectively in the proximal tubules attenuated the development of angiotensin II (Ang II)-induced hypertension in mice. The present study determined whether double deletion of AT 1a receptors and NHE3 selectively in the proximal tubules further attenuates the development of Ang II-induced or 2-kidney, 1-clip (2K1C) Goldblatt Hypertension. Proximal tubule-specific AT 1a receptor and NHE3 double knockout mice, PT- Agtr1a -/- / Nhe3 -/- , were generated using the iL- Sglt2-Cre / LoxP approach. Adult male wild-type (WT), PT- Agtr1a -/- , PT- Nhe3 -/- , and PT- Agtr1a -/- / Nhe3 -/- double knockout mice were treated with vehicle (or sham as time-controls), a slow pressor dose of Ang II infusion for 2 weeks (500 μg/kg body wt./day, i.p.), or induction of 2K1C Goldblatt hypertension by placing a silver clip (0.12 mm) on the left renal artery for 4 weeks, respectively. In WT mice, control systolic blood pressure was 118 ± 3 mmHg (n=9), which increased to ~143 ± 5 mmHg in response to Ang II infusion ( P &lt;0.01, n=10) or to induction of 2K1C Goldblatt hypertension (n=12, P &lt;0.01). By comparison, control systolic blood pressure was 15 ± 2 mmHg lower in age-matched PT- Agtr1a -/- mice ( P &lt;0.01), or 13 ± 3 mmHg lower in PT- Nhe3 -/- mice than WT mice ( P &lt;0.01). Double deletion of AT 1a receptors and NHE3 selectively in the proximal tubules further but only moderately decreased basal blood pressure to 98 ± 2 mmHg in PT- Agtr1a -/- / Nhe3 -/- double knockout mice ( P &lt;0.05, n=10). In response to Ang II infusion, systolic blood pressure increased only to ~126 ± 3 mmHg in PT- Agtr1a -/- or PT- Nhe3 -/- mice ( P &lt;0.01). Interestingly, 2K1C Goldblatt hypertension was markedly attenuated in PT- Agtr1a -/- (108 ± 3 mmHg, P &lt;0.01, n=10), PT- Nhe3 -/- (110 ± 2 mmHg, P &lt;0.01, n=10), or PT- Agtr1a -/- / Nhe3 -/- double knockout mice (103 ± 2 mmHg, P &lt;0.01, n=8), respectively. Taken together, these data strongly support the hypothesis that the intratubular Ang II/AT 1a receptor/NHE3 signaling plays a key role in maintaining basal blood pressure homeostasis and the full development of Ang II-induced or 2K1C Goldblatt hypertension.

P8.081: Differential Control of Systolic and Diastolic Blood Pressure in Renal Transplant Recipients

P8.081: Differential Control of Systolic and Diastolic Blood Pressure in Renal Transplant Recipients

Blood Pressure Intervention and Control in SPRINT.

The SPRINT (Systolic Blood Pressure Intervention Trial) demonstrated reductions in major cardiovascular disease events and mortality with an intensive systolic blood pressure (SBP) goal intervention. However, a detailed description of the blood pressure intervention, antihypertensive medication usage, blood pressure levels, and rates and predictors of blood pressure control has not been reported previously. Hypertensive participants (n=9361) 50 years and older with elevated cardiovascular disease risk were randomized 1:1 to SBP goal <120 mm Hg or SBP goal <140 mm Hg. Guideline-recommended antihypertensive medications and dosing were provided at no cost. Intensive group participants were started on at least 2 medications, and medications were adjusted monthly until SBP goal was achieved, if feasible. Standard group participants were treated to achieve SBP 135 to 139 mm Hg. Baseline blood pressure (median±interquartile range) was 138±19/78±16 mm Hg. For intensive group participants, percent at goal rose from 8.9% at baseline to 52.4% at 6 months and average antihypertensive medications rose from 2.2 to 2.7; SBP was <120 mm Hg in 61.6% and <130 mm Hg in 80.0% at their final visit. For the standard group participants, percent at goal rose from 53.0% at baseline to 68.6% at 6 months, while antihypertensive medications fell from 1.9 to 1.8. From 6 to 36 months, median SBP was stable at 119±14 mm Hg for intensive and 136±15 mm Hg for standard participants, with stable numbers of medications. Few predictors of SBP control were found in multiple regression models. These results may inform and help replicate the benefits of SPRINT in clinical practice. URL: http://www. gov; Unique identifier: NCT01206062.

A machine learning approach identifies modulators of heart failure hospitalization prevention among patients with type 2 diabetes: A revisit to the ACCORD trial

BackgroundTo examine patient characteristics that may modulate the heterogeneous treatment effect of intensive systolic blood pressure control (SBP) and intensive glycemic control on incident heart failure (HF) risk in people with type 2 diabetes. MethodsWe analyzed 10,251 participants from the ACCORD glucose trial, and 4733 from the SBP sub-trial separately. We applied a robust machine-learning (ML) algorithm, namely the causal forest/causal tree analysis, to each trial to identify participants' characteristics that modulate the effectiveness of each trial intervention. ResultsDiastolic blood pressure (DBP) was found to interact with intensive glycemic control and impact outcomes. An increased HF risk associated with intensive glycemic control (absolute risk change (ARC): 2.28 %, 95 % confidence interval (CI): 0.69 % to 3.90 %; relative risk (RR):1.57, 95 % CI: 1.15 to 2.20; P < 0.05) was observed in individuals with baseline DBP at the lowest tertile (45–69 mmHg), while no changes in HF risk associated with intensive glycemic control were observed in individuals with baseline DBP at the middle (70–79 mmHg) and the highest tertiles (80–100 mmHg). Liver function was identified as a modulator of intensive BP control, and baseline Alanine transaminase (ALT) level was a sensitive marker for the modulating effect. Only individuals with baseline ALT at the lowest tertile (8–19 mg/dl) benefited from the intensive BP control for HF prevention (ARC: −1.95 %, 95 % CI: −4.06 % to 0.11 %; RR:0.62. 95 % CI: 0.27 to 0.94; P < 0.05). ConclusionsOur study is the first to observe and quantify the potential synergistic harmful effect when low DBP was combined with an intensive blood glucose intervention. Recognizing these may help clinicians develop a more precise approach to such treatments, thus increasing the efficiency and outcomes of diabetes treatments.

Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women.

Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women.

The Efficacy of Telemedicine for Secondary Prevention and Management Among Stroke Survivors: A Systematic Review and Meta-analysis

Stroke has high mortality and high recurrence rate. Telemedicine usage is rapidly growing as a strategy to optimize stroke secondary prevention by managing stroke risk factors. In order to comprehensively assess the impact of telemedicine intervention, an updated review of more outcomes is required. This systematic review and meta-analysis of randomized controlled trials (RCTs) aim to assess the telemedicine effects on systolic blood pressure, diastolic blood pressure, stroke recurrence, and mortality in post-stroke patients. A literature search of RCTs related to telemedicine intervention from PubMed, Science Direct, Scopus, Web of Science, and ProQuest from 2018 to 2022 was included in this study. The quality of the study was evaluated using the Cochrane RoB 2 tool. We presented the pooling analysis of our result in the form of mean difference (MD) and odd ratio (OR) with 95% CI using RevMan 5.4 software. Six trials involving 3,942 patients met the eligibility criteria to conduct the meta-analysis. Telemedicine intervention had a significant effect on the change of systolic (MD -6.05; 95% CI -6.23, -5.87; p < 0.00001; I2=84%) and diastolic (MD -2.76; 95% CI -4.13, -1.39; p < 0.0001; I2=89%) blood pressure control. Telemedicine intervention was also associated with lower stroke recurrence (OR 0.82; 95% CI 0.42, 1.59; p=0.55; I2= 70%) and mortality rate (OR 0.87; 95% CI 0.68, 1.12; p=0.28; I2=0%). Therefore, telemedicine applications may be a promising strategy to optimize the implementation of stroke secondary prevention. More up-to-date trials with higher quality are needed to confirm our findings and assess the other outcomes of telemedicine intervention, such as cost-effectiveness, medical adherence, and quality of life outcomes.