Increase In Systolic Blood Pressure Research Articles

6618 Risks for Cardiovascular Comorbidities Associated with Desiccated Thyroid Extract Administration

Abstract Disclosure: S.C. De La Torre: None. C. Godar: None. K. Flynn: None. A.A. Patel: None. D. Maxwell: None. M.K. Shakir: None. T.D. Hoang: None. Introduction: Levothyroxine (LT4), synthetic thyroid hormone (T4), is considered the standard of care for the management of hypothyroidism based on the current American Thyroid Association (ATA) guidelines. However, there is a small subset of patients demonstrating symptomatic improvement with desiccated thyroid extract (DTE), which is composed of desiccated porcine thyroid containing T4 and triiodothyronine (T3). Limited data or studies are available exploring long-term cardiovascular effects associated with DTE use. In this retrospective review, we aim to identify possible cardiovascular comorbidities associated with DTE use. Methods: The charts of 77 patients at a tertiary hospital center (64 females and 13 males) over the age of 18 who were prescribed DTE were reviewed. Data collected include duration of treatment, dose of treatment, pre-treatment and current weight, blood pressure (BP), TSH, free T4, and total T3 levels. New cardiovascular and other events following initiation of treatment (hypertension, coronary artery disease (CAD), myocardial infarction (MI), stroke, transient ischemic attack (TIA), atrial fibrillation, type 2 diabetes, fractures) were also obtained. Averages, medians, and totals of patient data were used for analysis. Results: Average patient age was 54 years, average duration of therapy was 77.5 months, and median DTE dose was 75 milligrams per day. Review of chart documentation from DTE initiation compared to current values identified a 2.5% increase in weight, 3.6% increase in systolic BP, 0.8% decrease in diastolic BP, 60.9% decrease in TSH, 5.2% decrease in free T4, and 14.4% increase in total T3. 19.5% patients (15 total, 80% of which were female) had recorded new cardiovascular events at any time following initiation of therapy. 15 patients developed HTN, 5 developed CAD, 2 developed atrial fibrillation, 5 developed type 2 diabetes, 5 new fractures, 0 MI, 0 stroke, and 0 TIA. Conclusion: These results demonstrate new cardiovascular events in our study population following the initiation of DTE, but it is unclear whether these events were directly associated with DTE use versus other factors based on our available data. Limitations of our study include small study size, uneven gender distribution, and data significance would be improved with comparison to a control group. Additional studies are needed to further evaluate long-term cardiovascular risk factors associated with DTE use. Presentation: 6/2/2024

Orthostatic blood pressure phenotypes prevalence in type 2 diabetes mellitus

Background and aims Orthostatic hypotension (Ohypo) and hypertension (Ohyper) have emerged early markers for high risk of cardiovascular events. Data on the prevalence and risk factors of Ohypo and Ohyper in patients with type 2 diabetes (T2D) are scarce. Methods Within the framework of the Brazilian Diabetes Study, this is an observational, cross-sectional study. The diagnosis of Ohypo was based on drops in systolic blood pressure (SBP) ≥20mmHg or diastolic blood pressure (DBP) ≥10mmHg when transitioning from sitting to standing. Ohyper was defined by either a SBP increase ≥20mmHg during this transition or a sustained elevation to 140 mmHg in otherwise normotensive individuals. Results The study population (n = 900) had a mean age of 57 ± 8 years, 57% male and the median T2D duration was 8 years. Sitting SBP and DBP were 140 ± 20 mmHg and 82 ± 11 mmHg, respectively. Of the total sample, 108 (12%) had Ohypo and 83 (9%) had Ohyper. Each 1-year increase in age was associated with 3.7% higher odds of orthostatic hypotension (OHypo). Additionally, each 1 mmHg increase in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) corresponded to a 3.0, 5.5, and 5.4% increase in the odds of OHypo, respectively. Ohyper risk did not associate with age but showed an inverse relationship with sitting BP values. Conclusions Ohypo and Ohyper are common occurrences in patients with T2D. Advanced age significantly elevates the risk of developing Ohypo, whereas sitting BP emerges as an independent risk factor for both Ohypo and Ohyper.

Fluid bolus resuscitation with hypertonic saline albumin solution in critically ill children: a prospective observational pilot study

To evaluate the hemodynamic effects and the safety profile of fluid bolus resuscitation with hypertonic saline albumin (HSA) in critically ill children, we performed a prospective observational pilot study between October 2018 and May 2021 in the pediatric intensive care unit (PICU) in a tertiary hospital in Madrid, Spain. Sixty-four HSA boluses were analyzed in 23 patients. A mean volume of 5.7 ml/kg (Standard Deviation, SD 2.3 ml/kg) per bolus was infused. Acute hypotension was the main indication. 91% of the patients had a cardiac disease, 56% of them had undergone cardiac surgery in the previous 72 h, and 47.8% associated right ventricular dysfunction. A significant increase in systolic, mean, and diastolic blood pressure and a decrease in the vasoactive index was observed after the infusion of HSA. This effect lasted for twenty-four hours (p < 0.05). Moreover, the amount of fluid requirements decreased significantly in the 6 h following HSA infusion [8.7 ml/kg (SD 9.6) vs. 15.1 ml/kg (SD 13.6) in the previous 6 h (p < 0.05)]. Serum levels of sodium and chloride increased after the infusion, reaching their peak concentration after one hour (143 mEq/L (SD 3.5) and 109.7 mEq/L (SD 6) respectively). HSA-related metabolic acidosis or acute kidney injury were not observed in this study. Hypertonic saline albumin is safe and effective when infused at a dose of 5 ml/kg in critically ill children. However, further research is required to confirm our findings.

Overview of Medication Administration to Hypertension Patients at Harapan Raya Community Health Center

Hypertension or high blood pressure is an increase in systolic blood pressure of more than 140 mmHg and diastolic blood pressure of more than 90 mmHg in two measurements with an interval of five minutes in a state of sufficient rest/calm. This research is a descriptive observational study. The research was conducted at Harapan Raya Community Health Center in April 2024. The sample in this study was hypertension patients who received treatment at Harapan Raya Community Health Center in March 2024. The instrument used in this research was secondary data from the monthly report of Harapan Raya Community Health Center in March 2024. The data used obtained and then analyzed by calculating the percentage of drug use. Based on the results at the Harapan Raya Community Health Center, it can be concluded that: Patients who consume a lot of hypertension medication are female with 75 respondents and 39 male respondents. The highest number of patients who took hypertension medication were in the elderly age range, with 68 respondents, 44 respondents for middle adults, and 2 respondents for early adults. The drug that is often used in community health centers is amlodipine 10 mg.

Evaluation of the use of Antihypertensive Drugs in Outpatient Hypertension Patients at the Lasinrang Regional General Hospital, Pinrang Regency in 2023

Hypertension is a complex condition in which blood pressure is permanently above normal. Hypertension is an increase in systolic blood pressure of more than equal to 140 mmHg and diastolic more than equal to 90 mmHg. This study aims to identify how antihypertensive drugs are used in hypertensive patients at the Lasinrang Regional General Hospital, Pinrang Regency. This study is a non-experimental research with a descriptive design taken retrospectively. The sample in this study is all outpatients with a diagnosis of hypertension at the Lasinrang Regional General Hospital in 2023. The sampling technique used is purposive sampling. The sample of this study is medical record data on hypertension patients in 2023 which is adjusted to the inclusion criteria. The results of the study showed that from 83 samples consisting of 50 women and 33 men, all of which met the inclusion and exclusion criteria, and showed a prevalence of age that dominated around 58-65 years (49,40%). In the evaluation of drug use, outpatient hypertension patients at the Lasinrang Regional General Hospital, Pinrang Regency had an indication accuracy of 100%, 100% drug accuracy, and 100% dose accuracy.

Association of mid-regional pro-adrenomedullin with office and 24-h ambulatory blood pressure in a Swiss general population sample.

Adrenomedullin (ADM) is a potent vasodilator. The association between plasma ADM levels and blood pressure (BP) remains unclear. We assessed the association between mid-regional-pro-ADM (MR-proADM) and BP in a multicenter population- and family-based cohort. We used data from the Swiss Kidney Project on Genes in Hypertension (SKIPOGH). We included participants present at both baseline and 3-year follow-up (N = 843). We examined the association of baseline MR-proADM with baseline office and 24 h ambulatory BP as well as the 3-year change in office BP. In secondary analyses, we studied the association between baseline MR-proADM and 3-year changes in pulse wave velocity (PWV), renal resistive index (RRI) and augmentation index (AI). Mixed-effects linear regression models were used. In cross-sectional analyses, MR-proADM was negatively associated with office, 24-h and daytime diastolic BP (DBP). MR-proADM was positively associated with nighttime systolic BP (SBP). In longitudinal analyses, baseline MR-proADM was associated with an increase in office SBP and pulse pressure (PP) over 3 years [β (95% CI): 8.2 (0.4, 15.9) and β (95% CI): 6.4 (0.3, 12.4), respectively] but not with changes in PWV, RRI and AI. The cross-sectional negative association of MR-proADM with DBP is in line with known vasodilatory properties of ADM. The positive association between MR-proADM and nighttime SBP at baseline may reflect endothelial dysfunction believed to be part of the pathogenesis of nocturnal hypertension. The association of higher baseline MR-proADM levels with increased SBP and PP at 3-year follow-up suggests that ADM levels could be a marker of cardiovascular risk.

Unravelling the interplay between Harmattan wind and baroreflex functions: implications on environmental health and cardiovascular pathophysiology

Harmattan is a season characterized by dust, cold, and sub-humid trade winds in Sub-Saharan countries. It’s similar to meteorological phenomena like Asian dust storms, Santa Ana winds, Australian bushfires, and Saharan dust in the Caribbean. It causes profound changes in the cardiorespiratory system in apparently healthy individuals and increases the risk of hospitalization in susceptible individuals. Exposure to these extreme conditions has been associated with alterations in autonomic function and baroreceptor sensitivity thus resulting in dysregulation of blood pressure control mechanisms. Baroreceptors are critical regulators of hemodynamics and cardiovascular function. They play a vital role in the short-term responses to blood pressure perturbation and are essential for acute restoration of blood pressure following cold exposure. Harmattan wind contains a barrage of chemicals, dust, and particulate matters depending on industrialization, natural and human activities. Particulate matter from Harmattan dust can trigger systemic inflammation and oxidative stress, exacerbating endothelial dysfunction and impairing vascular reactivity thus contributing to the pathogenesis of alterations in baroreceptor insensitivity, and cardiovascular diseases, including hypertension and atherosclerosis. Furthermore, fine particulate matter from dust may penetrate deep into the respiratory tract, activating pulmonary sensory receptors and eliciting reflex responses that influence autonomic tone. The presence of rich acrolein smokes and non-essential heavy metals such as cadmium, lead, and mercury in Harmattan wind also reduces baroreflex sensitivity, culminating in a sustained increase in diastolic and systolic blood pressure. This integrated review aims to provide valuable insights into how changes in each of these environmental constituents alter vital pathophysiologic and immunologic mechanisms of the body leading to baroreceptor instability and ultimately hemodynamic imbalance using available primary studies. Understanding this intricate interplay is crucial for implementing targeted interventions and informed public health strategies to mitigate the adverse effects of extreme environmental exposure and ultimately reduce poor health outcomes in the affected regions.

Impact of mRNA COVID-19 Vaccines on Blood Pressure in Hypertensive Patients: A Retrospective Observational Study

The COVID-19 pandemic necessitated rapid vaccine development, with mRNA vaccines (Moderna or Pfizer) emerging as frontrunners. While effective, concerns arose regarding their impact on blood pressure (BP), particularly in hypertensive individuals, a population already at increased cardiovascular risk. The study aimed to investigate the effects of mRNA COVID-19 vaccines on BP in hypertensive patients. A retrospective observational study was conducted at the Mrebet Community Health Center. Data from hypertensive patients receiving the second dose of either Moderna or Pfizer vaccine were analyzed. Pre- and post-vaccination BP readings, patient demographics, medication profiles, and hypertension severity were assessed. Statistical analysis was performed to evaluate changes in BP and identify potential associations. The study included 33 hypertensive patients (mean age: 55.2 years, 84.8% female). The majority (84.8%) received the Moderna vaccine. Pre- and post-vaccination BP readings showed a slight increase in systolic BP (133 mmHg to 137 mmHg) and a minor decrease in diastolic BP (85 mmHg to 84 mmHg). Statistical analysis revealed a significant association between vaccination and changes in diastolic BP (p &lt; 0.05), but not systolic BP (p &gt; 0.05). In conclusion, mRNA COVID-19 vaccines may have a modest impact on BP in hypertensive patients, particularly on diastolic BP. The clinical significance of these changes warrants further investigation. Close monitoring of BP in hypertensive individuals post-vaccination is recommended.

Euterpe Oleracea Martius (Açaí) Extract and Resistance Exercise Modulate Cardiac Parameters of Hypertensive Rats.

The study evaluated the effects of resistance exercise training and açaí supplementation on cardiac parameters in hypertensive animals. For this study, rats from the Wistar and SHR lines (spontaneously hypertensive rats) were used. The animals were divided into 5 groups: Wistar Control (C); Control Hypertensive (H); Trained Hypertensive (HT); Hypertensive and Supplemented with Açaí (HA); and Hypertensive Trained and Supplemented with Açaí (HAT). Resistance exercise training was carried out through climbing. The supplemented groups received 3 g of açaí/kg of body mass. The animals' systolic blood pressure (SBP), body mass, and physical test were measured at the beginning and end of the intervention. At the end, an echocardiographic analysis was performed. Histological analysis and oxidative stress of the LV were performed. It was found that hypertensive animals showed an increase in SBP, and the treatments reduced this parameter. The trained groups achieved higher values of maximum carrying load. Hypertension increased the dimension of the left ventricular free wall in diastole and reduced ejection and shortening fractions. The trained groups showed improvement in ejection and shortening fractions. The H group increased the proportion of extracellular matrix and reduced the proportion of cells, with the HAT group attenuating this change. Cell diameter was greater in group H, and all treatments reduced this parameter. Hypertension increased the concentration of malondialdehyde and decreased catalase activity in LV. The treatments managed to mitigate this damage. It is concluded that the treatments managed to generate positive cardiovascular adaptations, and their combination enhanced these effects.

Abstract P426: Reduced Nfatc1 Expression Results in Enhanced Pressure Natriuresis and Resistance to Salt-Sensitive Hypertension

Background: Nuclear factor of activated T cells-cytoplasmic 1 (NFATc1) has recently been shown to have a non-canonical role in chronic kidney disease in humans by a trans-ethnic meta-analysis of genome-wide associate studies (GWAS). Follow-up studies in a salt-sensitive mouse model showed that Nfatc1 mRNA expression was suppressed in the kidneys when animals were fed a high-salt diet. Here, we further explore the link between NFATc1 and salt-sensitive (SS) hypertension. Methods: Adult male wild-type (WT) and heterozygous Nfatc1 knockout (Het) mice (2-5 months of age) on the SS 129S6 background were started on standard chow (0.8% NaCl, NSD) and then switched to a high-salt diet (6% NaCl, HSD). Systolic blood pressure (SBP) was measured by either tail cuff manometry with at least 2 weeks of training or implantable radiotelemetry transmitters with at least 2 weeks of post-surgical recovery. Immediately before and for 2-3 days after the change in diet, 24 h urine was collected using metabolic cages, and urinary sodium was measured by flame photometry. Sigmoid pressure-natriuresis curves were generated and the Hill slope was compared between genotypes. Results: WT mice showed a significant increase in SBP between NSD and after 3 weeks on HSD (127.8±9.9 vs 143.4±8.9, p = 0.0089, n = 9). In contrast, Het mice had no change in SBP (125.8±8.7 mmHg vs. 125.7±10.6 mmHg, p = 1.0, n = 9). During the initial switch to the HSD, SBP was not significantly different between WT and Het mice (133.2±2.9 vs. 134.4±3.0, p = 0.45, n = 7/group). However, WT mice had a shallower pressure-natriuresis curve (Hill slope of 0.58 vs. 0.93, 7 mice/group, 25/26 data points). Conclusion: Our data illustrates that decreasing Nfatc1 expression in a mouse model is protective against SS hypertension. While acute increases in SBP in response to HSD remained in Het mice, sodium excretion was increased and SBP remained unchanged after 3 weeks, indicating that NFATc1 has the potential to be a therapeutic target against SS hypertension.

P109 AMINOPEPTIDASE A: A POTENTIAL NOVEL THERAPY FOR ANGIOTENSIN-DEPENDENT HYPERTENSION?

Background: We have shown that mice with a genetic deficiency in Aminopeptidase A (APA) have elevatedblood pressure. APA is an enzyme that removes a single aspartate residue from the amino-terminus of several peptides in the renin-angiotensin systems (RAS), including angiotensin (Ang) II. In this study, we investigated the impact of a recombinant APA on the cleavage of various RAS peptides and its effect on blood pressure. Methods: An in vitro assay was used to identify Ang peptides as substrates for APA. Ang peptides identified as APA substrates using this assay were then injected to anesthetized WT and APA-deficient mice to assess their pressor effect by measuring systolic blood pressure (SBP). Subsequently, murine recombinant (r)APA was used to evaluate its action on the acute SBP elevation elicited by Ang peptides that were identified to trigger pressor response. Results: In the in vitro assay, Ang II (22427±3353, n=12), Ang I (21883±1692, n=3), Ang1-7 (15833±3395,n=3), Ang1-9 (15773±3395, n=3) and Ang1-12 (13170±220, n=3), were identified as a substrate for rAPA as indicated by a strong aspartate-driven fluorescence formation. When these five Ang peptides were administered to WT mice, only Ang I, Ang II and Ang 1-12 caused a significant increase in SBP. This effect was exaggerated in APA deficient mice. The SBP increase elicited by Ang II in WT mice was markedly reduced by the pre-administration of rAPA (Fig). Conclusion: Aminopeptidase A can cleave the N-terminal aspartate from Ang II as well as from other RASpeptides that elicit (Ang 1-12, Ang I) and do not elicit (Ang 1-9, Ang 1-7) pressor response in mice. APA deficiency is associated with an exaggerated SBP response to Ang I, Ang II and Ang 1-12 while the recombinant enzyme mitigates the acute hypertensive effect. rAPA markedly reduced the increase in SBP caused by AngII infusion suggesting that it may be used to treat hypertension caused by excess of AngII.

P229 INFLUENCE OF ASTHMA ON BLOOD PRESSURE OF CHILDREN AND ADOLESCENTS: THE ASMAVIX PROJECT

Background and Objectives: Asthma is a prevalent disease in children and the chronic inflammatory may affect blood vessel stiffness and blood pressure (BP). Systolic BP increases progressively along the childhood tending to reach stable values at the beginning of adulthood. Higher BP levels in infancy predispose to hypertension development hypertension in adulthood. Our aim was to investigate the influence of asthma on the age-dependent BP increase in children and adolescents. Methods Asthmatic (Asth, n = 166), 7-15 years (67% boys) attending to Public Health Units of Vitória (an industrialized city of the coastal plain of southeastern Brazil) were included. Non-asthmatic children (N-Asth, n =50; 33% boys) living in the neighborhood of Asth were used as controls. Clinic and laboratory exams were performed in an outpatient clinic at the University Hospital. BP was measured with an oscillometric device (Onrom HBP 1100) and large artery stiffness was estimated by carotid-to-femoral pulse wave velocity (cf-PWV; Complior SP-2). The 90th percentile of systolic or diastolic BP was used to identify high BP considering gender, age, and height. Age-dependent BP increase was determined by linear regression with and without adjustment for covariates (gender and body mass index). Statistical significance was set at p&lt;0.05. Results Asth and N-Asth groups were similar (p&gt;0.05) considering age (11.7 ± 2.3 vs 11.1 ± 2.1 years), body mass index (20.2 ± 4.2 vs 20.3 ± 5.7 kg/m2), systolic (102 ± 11 vs 104 ± 10 mmHg) and diastolic (62 ± 7 vs 63 ±8 mmHg) BP. However, cf-PWV was higher in Asth (48.9 ± 9.0 vs 44.0 ± 9.1 cm/s; p&lt;0.01). The crude age-dependent systolic BP increase was 34% higher in the Asth group (1.74 mmHg/year; 95%CL 1.06;2.43 vs 1.37 mmHg/year; 95% CL 0.02;2.72). This difference remained similar after adjusting for gender and body mass index (1.47 mmHg/year; 95%CL 0.80; 2.14 vs 1.10; -0.47;2.67). The percentage of children with elevated BP was higher in the Asth group (10.2% vs 4.0%). Conclusion: The higher stiffness of large arteries seems to accelerate the systolic BP increase along childhood and adolescence and may predispose to an earlier onset of hypertension in adulthood. Acknowledgment: This study was supported with grants from ArcelorMittal, CNPq and Fapes.

Pericardial tamponade: a new perspective on echocardiographic features and application of a prediction score.

Few clinical decision rules have been used to guide clinical management and predict outcomes in patients with pericardial tamponade. The objectivesof this study are to identify the echocardiographic features associated with adverse outcomes in patients with pericardial effusions requiring pericardiocentesis and to apply a previously described four-point clinical and echocardiographic score to predict clinical outcomes over 24-hr, 30-day, and 1-year intervals. We performed a retrospective cohort review of patients who had transthoracic echocardiogram (TTE) performed and underwent pericardiocentesis within 48h of emergency department presentation at two large tertiary care institutions. We constructed different stepwise logistic regression models and examined the associations of TTE characteristics and clinical features with ICU admission, hospital length of stay (h-LOS), and survival. The data set was then employed against a previously proposed scoring system to predict factors associated with clinical outcomes over 24hr, 30days, and 1year. Two hundred thirty-nine patients were included in the final analysis. Echocardiographic characteristics of patients with pericardial tamponade who underwent pericardiocentesis are as follows: 69.1% right ventricular (RV) diastolic collapse, 62.3% exaggerated mitral valve (MV) inflow velocities, 56.4% inferior vena cava (IVC) plethora, and 53.4% right atrial (RA) systolic collapse. Increase in systolic blood pressure and increased variation in MV inflow velocity were associated with reduced ICU admission [OR: 0.94 (CI 0.90, 0.99), 0.28 (CI 0.09, 0.89), respectively]. In addition, a history of malignancy increased the length of hospital stay by about 3.89days (CI 1.43-6.35, p < 0.01) and prior pericardiocentesis history was associated with 4.82-day increase in hospital stay (CI 1.19-8.45, p = 0.01). In utilizing the previously published prediction score, we found no statistically significant correlation in predicting survival. RV diastolic collapse and exaggerated MV inflow velocity were the most common echocardiographic findings in patients requiring pericardiocentesis. Contrary to prior studies, exaggerated MV inflow velocity was associated with reduced ICU admission. In addition, a previously described prediction score did not correlate with decreased survival in this cohort.

Abstract P422: Neuropeptide FF and Its Receptor NPFFR2 Decrease Renal Sodium Excretion and Increase Blood Pressure in Mice

The kidney is critical in the overall regulation of fluid and electrolyte balance and blood pressure. Neuropeptide FF (NPFF), a morphine-modulating peptide, regulates cardiovascular function through its interaction with two receptors, NPFFR1 and NPFFR2. We now report that NPFF and its receptors, mainly NPFFR2, are expressed in the kidney. NPFF (9.25 mmol, 0.5 mL/hr, 0.05 nmol/day, 7 days) chronically infused underneath the renal capsule, decreased renal sodium excretion (UNaV) from 0.68±0.07 mEq/day, n=5 to 0.43±0.06 mEq/day (n=6/group) in conscious C57BL/6 mice. This was accompanied by an increase in systolic blood pressure (SBP, 114.5±5.0 mm Hg, n=4); the infusion of vehicle (saline) did not affect the blood pressure (96.4±3.0 mm Hg, n=4). The renal subcapsular injection of a single dose (10 µg in 100 µL) of NPFF also increased SBP within 15-35 min (NPFF: 105.5±3.44 mm Hg, n=6); saline injection did not affect SBP (82.6±5.65 mm Hg, n=4). RF-9 (10 µg in 100 µL), an antagonist of NPFF receptors prevented the NPFF-mediated increase in SBP (NPFF alone: 105.5±3.44 mm Hg, n=6; RF+NPFF: 88.5±5.90 mm Hg, n=5), whereas RF-9, alone, had no effect (Baseline: 97.6±2.70 mmHg; RF-9: 90.9±4.70 mm Hg, n=5). The renal subcapsular injection of scrambled peptide (10 µg in 100 µL) had no effect on SBP (86.1±1.83 mm Hg, n=4). However, SBP was decreased by the renal subcapsular infusion of Npffr2 siRNA (98±4 vs 113±3 mmHg; P &lt; 0.05; n=3-5/group) in C57Bl/6 mice fed with a high salt diet (4% NaCl). Furthermore, the SBP of conventional germline Npffr2 knockout (KO) mice fed a high salt (4% NaCl) diet was lower than the SBP of wild-type (WT) littermates (WT: 105.6±2.9 mm Hg, n=5; KO: 90.5±5.5 mm Hg, n=4, P &lt; 0.05). By contrast, in mice fed normal salt (0.8% NaCl) diet, SBP was not different between Npffr2 KO mice and WT littermates (WT: 96.5±4.5 mm Hg, n=5; KO: 98.7±11.7 mm Hg, n=4, P &gt; 0.05). Taken together, NPFF and its receptor, NPFFR2, in the kidney cause salt-sensitive hypertension in mice. Uncovering the functional relevance of renal NPFF in the dynamic regulation of renal sodium transport will lead to a better understanding of blood pressure homeostasis.

Abstract 05: Renal Resident Tissue Macrophages Contribute to Salt-Dependent Increases in IL-6

Salt-Sensitive hypertension is associated with an increase in pro-inflammatory cytokines and immune cells. We previously showed an acute increase in systolic blood pressure following IL-6 + high salt (HS) after 3 days, coupled with an immediate (1 day) reduction in sodium excretion. Renal resident tissue macrophages (rRTMs) form an intricate network within the kidney and function to both maintain homeostasis and secrete pro-inflammatory cytokines. We hypothesize that rRTMs are primary contributors to the immediate increases in IL-6 following high salt. To test this hypothesis, male wild-type mice lacking a functional CX 3 CR 1 chemokine receptor (CX 3 CR 1 - EGFP+/+ ) or wild-type (Wt, C57Bl6) were used. CX 3 CR 1 is required for RTM localization to the kidney; thus, these mice are rRTM-depleted. Mice were fed HS (1% saline or 4% HS chow) or normal chow (NC) for 6 days and kidneys harvested. Kidneys were digested and FACS analysis performed on total immune cell populations or used for RT-PCR (n=4-5 Wt &amp; rRTM-depleted). Cells were gated on: Live + CD45 + + MHCII + Lyc6C - + B220 - + CD64 + + F4/F80 hi + CD11b lo. Or Lyc6C hi . Lyc6C hi and rRTMs were pre-stimulated (LPS, 1mg/mL, 3hrs) before staining with intracellular IL-6 antibody. FACS data were analyzed as a percent increase (mean fluorescence intensity, MFI) of IL-6 over control. RT-PCR data were analyzed as DCt/housekeeping. Our data show that rRTMs are the most abundant immune cell in the kidney (23.4% of total CD45 + ) and predominantly reside in the cortex and outer medulla (&gt;99%). HS feeding (4%) significantly increased whole kidney IL-6 mRNA (12.0 ± 0.5 vs . 15.3 ± 0.6 DCt Wt NC, **p&lt;0.01). This increase was completely prevented in rRTM-depleted mice. While intracellular IL-6 levels were generally increased in LPS-stimulated Lyc6C hi inflammatory monocytes, the rRTMs showed a preferential increase in intracellular IL-6 with both hyperosmolar saline (1%, &gt;13% increase) and HS chow (4%, &gt;50%). Here, we show that rRTM-depletion prevents the HS-induced increase in kidney IL-6. We additionally show that rRTMs are preferentially increasing intracellular levels of IL-6 following an acute HS load of hyperosmolar saline (1%) or HS chow (4%). We previously demonstrated that IL-6 contributes to increased blood pressure and sodium retention, and these data suggest that rRTMs preferentially contribute to the increased IL-6.

P135 FITNESS INFLUENCES THE RELATIONSHIP BETWEEN EXERCISE BLOOD PRESSURE AND LEFT VENTRICULAR STRUCTURE: EVIDENCE FROM THE EXERCISE STRESS TEST COLLABORATION (EXERTION) STUDY

Background. A hypertensive response to exercise is associated with left ventricular (LV) remodelling, a principal sign of hypertensive heart disease. Fitness may modify this relationship, making clinical interpretation of peak exercise systolic blood pressure (SBP) challenging. This study examines the influence of fitness on the relationship between peak exercise SBP and LV structure. Methods. Cardiovascular structure and function (LV mass index (LVMI), LV relative wall thickness (RWT), cardiac output (CO) and total peripheral resistance (TPR)) were assessed at rest by echocardiography on 4,309 individuals (aged 58.6±12.7 years,52.0% male). SBP was measured at peak treadmill exercise, and fitness (exercise duration (minutes)) was grouped into thirds. Multiple regression analysis was conducted with fitness as an interaction term with peak exercise SBP, adjusted for age, sex, pre-exercise SBP, and cardiovascular disease (CVD) history. Results. Peak exercise SBP was similar across low (180±26.5mmHg), moderate (181±26.3mmHg) and high (182±24.5mmHg) fitness groups. Fitness modified the relationship between exercise SBP and LVMI; each 5mmHg increase in exercise SBP was associated with LVMI in moderate [0.27(0.10–0.43) and high [0.25(0.06–0.43)] fitness groups, which was not observed among those with low fitness [-0.05(-0.22–0.12)]. RWT increased with higher peak exercise SBP at all fitness levels (all p&lt;0.001), with higher values among those with low fitness. Prevalence of LV concentric remodelling was highest in those with low fitness (29.9%) and lowest in those with high fitness (10.8%). A lower CO and higher TPR were observed in the low fitness group (7.5±2.5L/min and 14.3±5.1mmHg min/L) compared to those with high fitness (10.9±3.1L/min and 9.2±2.09mmHg min/L). Conclusion. Whilst a small effect, fitness modified the peak exercise SBP-LV structure relationship, such that for similar peak exercise SBP, those with low fitness exhibit a more adverse LV remodelling, with lower CO and higher TPR, compared to those with higher fitness. Considering fitness when interpreting SBP and cardiac imaging results from exercise stress testing may be relevant in identifying CVD risk and optimal patient management.

Abstract P225: Persistent Vascular Dysfunction and Blood Pressure Elevation Over 12 Months After COVID-19 Recovery in Non-Hypertensive Adults – LOCHINVAR Study

Background: The potential long-term vascular consequences of COVID-19, particularly in relation to future hypertension risk, remain poorly understood. This study aims to elucidate the longitudinal blood pressure trajectories in individuals who have recovered from COVID-19 but were not hypertensive prior to their infection, over a 12-month observational period. Methods: This study enrolled participants who had recovered from a hospital-admitted COVID-19 infection at least 12 weeks prior and had no history of hypertension. A control group was established from individuals with no prior SARS-CoV-2 infection, confirmed by a negative antibody test. All participants underwent ambulatory blood pressure monitoring (ABPM), flow-mediated dilation (FMD), and 6-minute walk test (6MWT) both at baseline and after 12 months. RAAS phenotyping was conducted at baseline. Paired t-tests and multivariable adjusted regression models were employed in the analyses of the full-dataset and per-protocol subset (because of variation in participant characteristics due to changing COVID-19 landscape during the recruitment period). Results: The full dataset had 97 participants (SARS-CoV-2 Negative:Positive 60:37) and per protocol data set had 66 participants (SARS-CoV-2 Negative:Positive 51:15). The median age was 50 (IQR:42-54) years with majority females. Per-protocol analysis revealed the positive group showed an increase in systolic and diastolic blood pressure (SBP/DBP) by 4.6/4.5 mmHg, a decrease in FMD by 3.2%, and an improvement in the 6MWT distance by 145.6 meters over 12 months, compared to the negative group (Figure 1). Baseline RAAS phenotyping showed no significant differences between groups. Conclusions: Our study demonstrates a significant increase in diastolic blood pressure 12 months following COVID-19 recovery in previously non-hypertensive individuals, accompanied by a decline in FMD. These findings suggest a possible vascular basis for the development of hypertension post-COVID-19 recovery.

Long-lasting effects of post-traumatic stress disorder in Yazidi women living in Northern Iraqi camps

The severity of post-traumatic stress disorder and its long-lasting effects among the Yazidi population has not yet been investigated. ObjectivesThis study evaluated the impact of PTSD severity and chronicity on physiological and anthropometric parameters in women survivors of the genocide-related events after the so-called Islamic State of Iraq and Syria (ISIS) attack in 2014. MethodsThe diagnosis PTSD was assessed using PTSD Checklist for DSM-5 (PCL-5). Participants were divided into: External control (healthy individuals living outside the camps), Internal control (healthy individuals living in the camps), and PTSD group (individuals diagnosed with PTSD). The PTSD group was subdivided according to chronicity <2 years, 2–5 years, and >5 years and subdivided according to PTSD severity into “Moderate”, “Severe” and “Extreme”. Systolic blood pressure (SBP), diastolic blood pressure (DBP), blood oxygen saturation (SPO2) and heart rate (HR) were evaluated. Weight, height and waist circumference were measured. Body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. ResultsThe PTSD group showed significant increases in SBP, DBP, heart rate, BMI, WC, weight, and WHtR compared to the control groups. SPO2 values decreased in the PTSD group. As the disease progressed, there were further increases in SBP, DBP, heart rate, BMI, WC, WHtR, and weight. Similar increases were observed with the severity of the disease. ConclusionOur data indicates that a long-term impact on physiological and anthropometric parameters is present in women diagnosed with PTSD which might be aggravated by the severity and chronicity of the disease.

Comparison of Systemic Exposure Between Epinephrine Delivered via Metered-Dose Inhalation and Intramuscular Injection.

Background: Primatene® MIST, an epinephrine metered-dose inhaler (MDI), has long been questioned by some medical professionals for asthma treatment despite having been approved by the Food and Drug Administration. One of the primary reasons for their concerns stemmed from potential cardiovascular complications following epinephrine administration. However, the majority of documented cardiovascular complications seemed to occur following the injection route of the epinephrine. The aim of this study was to evaluate the systemic exposure of epinephrine delivered through different administration routes and to understand its relationship with cardiovascular effects. Since albuterol inhalers are commonly recommended for asthma, albuterol was also studied as a comparator drug. Method: A randomized, evaluator-blinded, three-arm crossover study was conducted in 28 healthy adult subjects to compare the profiles of systemic exposure for epinephrine delivered by MDI versus epinephrine intramuscular (IM) injection and albuterol MDI. Serially sampled plasma epinephrine and albuterol levels were measured and compared between treatment groups. Safety was assessed by adverse events, serial vital signs, electrocardiograms (ECGs), and clinical laboratory tests obtained at each crossover dosing visit. Results: Systemic exogenous drug exposure for inhaled epinephrine MDI (39 pg/mL × hour) was ∼9 times lower than that of epinephrine IM (435 pg/mL × hour) and 122 times lower than that of albuterol MDI (3453 pg/mL × hour) after dose normalization. The Cmax in epinephrine MDI (345 pg/mL) was approximately half of that of epinephrine IM (816 pg/mL) and that of albuterol MDI (681 pg/mL). Plasma drug concentrations for epinephrine MDI dropped rapidly to baseline (∼0.6 hour), while epinephrine IM took ∼8 hours, and albuterol MDI required more than 24 hours. Epinephrine MDI and albuterol MDI resulted in minimal, clinically insignificant changes in vital signs and ECGs, whereas epinephrine IM led to mild transient increases in systolic blood pressure, heart rate, and corrected QT interval. Conclusion: Epinephrine MDI (Primatene MIST) had ∼9 times lower systemic drug exposure (SDE) than that of epinephrine IM and ∼122 times lower than that of albuterol MDI. The lower SDE of inhaled epinephrine also correlated with reassuring safety findings, with no significant cardiovascular adverse effects found, compared with transient effects seen after IM epinephrine. Clinical trial registration number: NCT04207840.

Dietary Sodium-Potassium Intake and Risk of Hypertension: A Literature Review

Hypertension is a disease with a high mortality rate in Indonesia. Hypertension is an increase in systolic blood pressure &gt;140 mmHg and diastolic blood pressure &gt;90 mmHg. The prevalence of hypertension has increased significantly in patients aged 60 years and over. Many factors cause hypertension, one of which is a poor diet. The purpose of this study was to determine the effect of sodium and potassium intake on the incidence of hypertension in the elderly. The data or sources related to the relationship between potassium and potassium intake with hypertension in the elderly was used as a method in this research. The influence of sodium and potassium intake on the incidence of hypertension in the elderly is the result of research