Markers Of Target Organ Damage Research Articles

O107 A LONGITUDINAL STUDY ON THE IMPACT OF CHILDHOOD ELEVATED BLOOD PRESSURE ON TARGET ORGAN HEALTH IN ADOLESCENCE: THE EXAMIN YOUTH SA STUDY

Background and objective: Primary hypertension in children is becoming a global threat for the growing economic burden of hypertension management in adulthood and sustainable healthcare. We determined the associations of adolescent blood pressure (BP) with target organ damage markers (carotid intima-media thickness (CIMT) and left ventricular mass index (ilVM)) over a four year period, stratified by childhood BP status at baseline. Methods: We included 421 Black and 307 White South African adolescents (mean age: 11.04 years) with complete follow-up data for BP, CIMT and iLVM. Standard anthropometric measures and basic demographic information were collected. Results: Children were stratified by baseline BP status, i.e., normotensive; n=454 (57.5% Black and 57.7% female) and elevated BP; n=274 (58.4% Black and 52.2% female), with comparable proportions of ethnicity (p=0.81) and sex (p=0.15). Systolic BP (by 6mmHg; p<0.001), diastolic BP (by 3mmHg; p<0.001) and perfusion pressure (by 4mmHg; p<0.001) as well as sex-specific body mass index for age z-scores (BAZ; p<0.001) were all higher in the elevated BP compared to normotensive group. Groups were comparable for age (p=0.78), CIMT (p=0.28) and iLVM (p=0.64). In partial regression analysis (adjusting for ethnicity, sex, follow-up age and BAZ), systolic BP correlated positively with CIMT (r=0.125; p=0.041) and iLVM (r=0.184; p=0.002) in the elevated BP group only. Backward multiple adjusted linear regression analysis (adjustment for perfusion pressure at baseline, age, sex, ethnicity and BAZ) showed adverse associations of systolic BP with CIMT (β=0.126; p=0.046) and iLVM (β=0.199; p=0.001), and diastolic BP with iLVM (β=0.130; p=0.002), only in children with elevated BP at baseline. Conclusion: Elevated BP in early childhood contributes to the long-term impact on target organ health during adolescence independent of sex and ethnicity, while the association of BP with iLVM seems to be moderated by excess adiposity.

Perfusion and pulsatile pressure: their relationship with target organ damage in the African-PREDICT study

BackgroundHypertension is the leading risk factor for subclinical target-organ damage (TOD) and cardiovascular disease (CVD). Little is known about the relationship between different pressure measures and subclinical TOD, especially in young populations. We compared the strength of associations of subclinical TOD markers with perfusion and pulsatile pressure in young adults.MethodsA total of 1 187 young adults from the African-PREDICT study were included. Ambulatory mean arterial pressure (MAP) and pulse pressure (PP) was obtained. Markers of subclinical TOD were measured and included left ventricular mass index (LVMi), carotid intimamedia thickness (cIMT), carotidfemoral pulse wave velocity (cfPWV), central retinal arteriolar equivalent (CRAE) and albumin to creatinine ratio (ACR).ResultsMeasures of sub-clinical TOD (cIMT, cfPWV and CRAE), associated stronger with perfusion pressure (all p < 0.001) than pulsatile pressure in unadjusted models. Stronger associations were found between cfPWV (adjusted R2 = 0.26), CRAE (adjusted R2 = 0.12) and perfusion pressure (all p ≤ 0.001) than pulsatile pressure independent of several non-modifiable and modifiable risk factors.ConclusionsIn young, healthy adults, perfusion pressure is more strongly associated with subclinical TOD markers than pulsatile pressure. These findings contribute to the understanding of the development of early cardiovascular changes and may guide future intervention strategies.

Variability in home blood pressure and its association with renal function and pulse pressure in patients with treated hypertension in primary care

Blood pressure variability (BPV) represents a cardiovascular risk factor, regardless of mean level of blood pressure (BP). In this post-hoc analysis from the PERson-centredness in Hypertension management using Information Technology (PERHIT) study, we aimed to explore BPV in daily home measurements in hypertensive patients from primary care, to identify factors associated with high BPV and to investigate whether estimated glomerular filtration rate (eGFR) and pulse pressure, as markers of target organ damage (TOD), are associated with BPV. For eight consecutive weeks, 454 participants reported their daily BP and heart rate in their mobile phone, along with reports of lifestyle and hypertension-related factors. Systolic BP (SBP) values were used to calculate BPV with coefficient of variation (CV) as primary estimate. Background characteristics and self-reports were tested between fifths of CV in a linear regression model, adjusted for age and sex. Associations between BPV and eGFR and pulse pressure were tested with linear and logistic regression models. Higher home BPV was associated with higher age, BP, heart rate, and smoking. BPV was lower for participants with low alcohol consumption and treatment with calcium channel blockers. There was a significant association between BPV and pulse pressure (P = 0.015), and between BPV and eGFR (P = 0.049). Participants with high BPV reported more dizziness and palpitations. In conclusion, pulse pressure and eGFR were significantly associated with home BPV. Older age, high BP, heart rate, and smoking were associated with high BPV, but treatment with calcium channel blockers and low alcohol consumption was associated with low BPV. Trial registration: The study was registered with ClinicalTrials.gov [NCT03554382].

Persistently elevated sFlt-1 and recovery of reduced ADAMTS13 activity in malignant hypertension.

Malignant hypertension (MHT) characterized by acute hypertension with retinopathy or multiorgan damage, is a severe form of hypertensive emergency and associated with target organ involvement and poor kidney outcome. However, the underlying mechanisms are unclear. Eighty-four patients with acute severe hypertension from the Nephrology Department and Emergency Department in a single center during January 2016 and December 2017 were prospectively enrolled and divided into MHT ( n = 48) and non-MHT ( n = 36) subgroups according to target organ evaluation. Forty healthy controls were recruited. Serum soluble Fms-like tyrosine kinase-1 (sFlt-1) levels and plasma ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 motif, member 13) activity were examined at baseline and 12-month follow-up. Renal endpoints were defined as a significant decrease in the estimated glomerular filtration rate (eGFR) of more than 40% or the occurrence of end-stage renal disease. Serum sFlt-1 levels were persistently elevated in MHT. Baseline serum sFLT-1 levels were correlated with plasma ADAMTS13 activity and markers of target organ damage. Plasma ADAMTS13 activity was reduced in both MHT and non-MHT patients and recovered to the normal range at 12-month follow-up. During an average follow-up time of 53 ± 13 months, the restoration of reduced ADAMTS13 activity was correlated with the improvement of kidney function and independently reduced the risk of renal endpoints. Abnormal angiogenesis and endothelial damage are involved in the pathophysiology of hypertensive emergency. Evaluation of ADAMTS13 and sFlt-1 may help in the diagnosis and assessment of MHT. Recovery of ADAMTS13 predicts better renal outcome in patients with hypertensive emergencies.

Arterial hypertension and stiffness in women of different age groups and reproductive status

Objective: study of the relationship between arterial hypertension and arterial stiffness in women to identify potential markers of target organ damage and therapeutic targets of antihypertensive therapy.Materials and methods: the study involved 161 women who were divided into three groups depending on age and reproductive function. Group 1 consisted of 52 women aged 18 to 30; group 2 – 54 women aged 31 years before menopause; 3rd group – 55 women in the postmenopausal period. All women were questioned, clinical examination, determination of anthropometric data, measurement of carotid-femoral pulse wave velocity, determination of arterial stiffness by volumetric sphygmography, 24-hour blood pressure monitoring with assessment of aortic stiffness and characteristics of the central pulse wave.Results: 24-hour blood pressure monitoring revealed arterial hypertension in 38 (34,8%) women: 15 (27,8%) women in the 2nd group and 23 (41,8%) women in the 3rd group. Correlation analysis revealed the most significant correlations between the presence of arterial hypertension (R=0,45-0,71; p&lt;&lt;0,01) with central aortic pressure, double product index and average daily aortic pulse wave velocity in the aorta (PWVao), regardless of the state reproductive function. For women of reproductive age with arterial hypertension, the ambulatory vascular stiffness index (AASI: R=0,36; p=0,01) is more significant, while in the menopausal period, the arterial stiffness index (ASI: R=0,33; p=0,01). Correlation analysis did not reveal significant relationships between carotid-femoral pulse wave velocity and cardio-ankle vascular index (CAVI) with arterial hypertension in women of the 2nd and 3rd groups. The relationship between carotid-femoral pulse wave velocity and arterial hypertension in women was confirmed by analysis of variance (p=0,007).Conclusion: Central aortic pressure, carotid-femoral pulse wave velocity, AASI, ASI, PWVao – direct and indirect indicators of arterial stiffness – are interconnected with the presence of arterial hypertension in women of reproductive and menopausal age. In this regard, these indicators are potential markers of target organ damage in arterial hypertension.

Thoracic and abdominal aortic alterations in dogs affected with systemic hypertension

Aortic remodeling is the consequence of untreated systemic hypertension along with aortic dilatation as a marker for target organ damage in human literature. Therefore, the present study was planned to detect the changes in aorta at the level of aortic root via echocardiography, thoracic descending aorta via radiography and abdominal aorta via ultrasonography in healthy (n = 46), diseased normotensive (n = 20) and systemically hypertensive dogs (n = 60). The aortic root dimensions were measured at the level of aortic annulus, sinus of valsalva, sino-tubular junction and proximal ascending aorta via left ventricular outflow tract view of echocardiography. The thoracic descending aorta was subjectively assessed for any disparity in size and shape of aorta via lateral and dorso-ventral view of chest radiography. The abdominal aorta was assessed via left and right paralumbar window for calculating the aortic elasticity along with aortic and caudal venacaval dimensions to calculate the aortic-caval ratio. The aortic root measurements were dilated (p < 0.001) in systemically hypertensive dogs with a positive correlation (p < 0.001) with systolic blood pressure (BP). Thoracic descending aorta was also (p < 0.05) altered in the size and shape (undulation) of systemically hypertensive dogs. Abdominal aorta was markedly stiffened with reduced elasticity (p < 0.05) along with dilatation (p < 0.01) in hypertensive dogs. Also, there was a positive correlation (p < 0.001) of aortic diameters and aortic-caval ratio and negative correlation (p < 0.001) of aortic elasticity with systolic BP. Therefore, it was concluded that aorta could be considered as an important target organ damage of systemic hypertension in dogs.

Predyktory ta kryterii prohnozuvannia kardiovaskuliarnykh podii za rezultatamy ambulatornoho monitoruvannia arterialnoho tysku u khvorykh iz arterialnoiu hipertenziieiu (ohliad literatury; rezultaty vlasnykh doslidzhen)

Introduction. Studies on the clinical significance of ambulatory blood pressure monitoring in patients with arterial with hypertension as predictor of future adverse cardiovascular events are far from complete. The aim of the study. To analyze current literature database and own results in the evaluation of clinical significance of ambulatory blood pressure monitoring in patients with arterial hypertension as predictors and criteria for predicting adverse cardiovascular events. Materials and methods. As much as 56 sources of literature and results of own research evaluating clinical significance of ambulatory blood pressure monitoring in patients with arterial hypertension predicting adverse cardiovascular events was highlighted. Results. The analysis of available literature and results of our own research prove that ambulatory blood pressure monitoring is a powerful prognostic marker of target organ damage. It is the indisputable advantage of ambulatory blood pressure monitoring with regard to the detection of prognostic unfavorable cardiovascular events in patients with arterial hypertension. Conclusions. The high informative value of ambulatory blood pressure monitoring for predicting future adverse cardiovascular events has been proven and the criteria for their prediction have been clarified.

PS-BPC02-8: EARLY VASCULAR AGING IN HYPERTENSION IS A PREDICTOR OF INCIDENT DIABETES

Objective: Diabetes is associated with vascular aging and arteriosclerosis. Arterial stiffness can be used to assess vascular aging and is an independent predictor of cardiovascular events and mortality. However, the role of arterial stiffness in the incidence of diabetes and especially in patients under treatment with statins has not been investigated. We sought to investigate the role of carotid-femoral pulse wave velocity (PWV) in the prediction of incident diabetes in hypertensives and hypertensives under treatment with statins. Design and method: 376 never treated hypertensives (mean age 53 ± 13 years, 175 females) without a known history of diabetes or cardiovascular disease at baseline, were included in the study. Markers of target organ damage [carotid femoral PWV, aortic augmentation index (AIx), and estimated glomerular filtration rate (eGFR)] were evaluated at baseline in all patients. eGFR was estimated using the Cockcroft Gault formula. Hemoglobin A1c (HbA1c) and blood glucose were measured in venous blood samples. Patients were followed up prospectively for the incidence of diabetes as defined by the American Diabetes Association criteria. One hundred and thirty-nine patients received statins during follow up. Results: During a median of 13.5 years of follow up, 46 patients (12.2%) patients were diagnosed with diabetes. In multivariable logistic regression analysis, only higher PWV (Odds Ratio [OR] = 1.271, 95% Confidence intervals [CI]: 1.002 to 1.612, P = 0.048) was associated with a higher risk of incident diabetes, which was independent of age, sex, pulse pressure, HbA1c, fasting blood glucose and eGFR (Figure). In further analysis, receiver operating characteristic (ROC) curves were generated to evaluate the ability of PWV to discriminate subjects with diabetes. The area under the curve (AUC) and 95% CIs of the ROC curve was AUC = 0.66 (95% CI: 0.58 to 0.74, P = 0.001) for PWV. In the subgroup of patients under treatment with statins, higher PWV (OR = 1.51, 95% CI: 1.09 to 2.11, P = 0.014) was associated with higher risk of incident diabetes, which was independent of the abovementioned confounders. AIx was not associated with the incidence of diabetes. Conclusions: Higher arterial stiffness, a marker of early vascular aging, is associated with the incidence of diabetes and also can identify subjects under treatment with statins that are more likely to present with diabetes in the future.

PS-C28-2: STROKE RISK OF THE ELDERLY PATIENTS WITH NOCTURNAL HYPERTENSION DEFINED USING HOME BLOOD PRESSURE MONITORING IN JAPANESE GENERAL PRACTICE POPULATION

Objective: To investigate the association between nocturnal hypertension defined using home blood pressure (BP) monitoring (HBPM) and the prevalence, extent of cardiovascular target organ damage (TOD), and cardiovascular disease (CVD) event risks in participants with ≧ 65 years in general clinical practice. Design and method: We used the dataset of the Japan Morning Surge-Home BP (J-HOP) Study that recruited 4,310 participants with cardiovascular risk factors. Among them, we assessed the participants with ≧ 65 years who measured nocturnal home BP (n = 1,349, mean age 72.0 year, 48.6% men). We define nocturnal hypertension as nocturnal systolic (SBP) ≧ 120 mmHg or diastolic (DBP) ≧ 70 mmHg, using HBPM. Nocturnal home BP was automatically measured at least 1 day within the 14 days (2 AM, 3 AM, and 4 AM). We use the average of all nocturnal home BP values. N-terminal pro-brain natriuretic peptide (NT-proBNP) and urine albumin: creatinine ratio (UACR) were used as surrogate markers of TOD. The CVD outcomes were incident stroke and coronary heart disease (CHD) events. Results: The prevalence of nocturnal hypertension defined by HBPM was 61.7% of all study participants with ≧ 65 years. The participants with nocturnal hypertension defined by HBPM presented higher levels of log-transformed NT-proBNP and UACR at baseline compared to those with controlled nocturnal BP group. Over a median 4.0-year follow-up (5,453 person-years), 36 stroke events and 31 CHD events occurred, respectively. The nocturnal hypertension group had a higher incidence rate of stroke events compared with the controlled BP group. Concerning CHD, the incidence rate of CHD was similar between two groups (Figure). Cox model results suggested that the participants with nocturnal hypertension had a higher risk of stroke compared to those with controlled nocturnal BP group after adjustments for log-transformed NT-proBNP and UACR levels (adjusted hazard ratio 3.42; 95% confidence interval 1.15–10.19). Conclusions: In this Japanese population with ≧ 65 years, the participants with nocturnal hypertension defined by HBPM was significantly associated with stroke risk, independently of the extent of TOD.

Markers of Target Organ Damage in Children with Essential Hypertension

Markers of Target Organ Damage in Children with Essential Hypertension

Prevalence of hypertensive retinopathy among the known diabetics in a community-based setting using a non-mydriatic fundus camera

Hypertension is a leading cause of morbidity and mortality and is associated with the risk of cardiovascular, cerebrovascular disease, and target organ damage. The risk increases exponentially in individuals with diabetes. Hypertensive retinopathy is a marker for target organ damage, so screening for hypertensive retinopathy helps in cardiovascular risk stratification. This study was conducted with an objective to screen for hypertensive retinopathy among known diabetics using a portable non-mydriatic fundus camera to ascertain its prevalence. The study was conducted in three selected field practice areas of the Department of Community Medicine. A house-to-house survey was performed using a predesigned, pretested questionnaire among 302 known diabetics. The study participants were subjected to visual acuity examination using Snellen's chart and retinal fundus examination using a portable non-mydriatic Bosch Mobile Eye Care Solutions fundus camera. The fundus images were transferred to a laptop and were reviewed and graded by an experienced Ophthalmologist. Among the 302 participants studied, 60 were diagnosed with hypertensive retinopathy. The prevalence of hypertensive retinopathy among diabetic patients was 19.9 % (95% CI: 15.7% - 24.6%). The prevalence was found to be higher in ** (21.8%; 95% CI: 16% - 28.6%) as compared to ** (17.5%; 95% CI: 11.8% - 24.6%). Early detection of hypertensive retinopathy with cardiovascular risk stratification and initiation of prompt treatment among the high-risk individuals will help reduce the morbidity caused due to end-organ damage and premature mortality to a greater extent and will pave the way forward to achieving sustainable developmental goals.

Silent brain infarcts, peripheral vascular disease and the risk of cardiovascular events in patients with hypertension.

We aimed to study the relationship between cerebral small vessel disease (cSVD) lesions, as markers of subclinical target organ damage (TOD) in the brain, and incident cardiovascular events (CVE). Data from the ISSYS (Investigating Silent Strokes in hYpertensives Study), which is a longitudinal and observational study conducted in patients with hypertension aged 50-70 years, and stroke-free at the inclusion. At the baseline visit, participants underwent a clinical interview, a brain MRI, urine and blood sampling collection and vascular testing studies. Therefore, we obtained markers of TOD from the brain [white matter hyperintensities, silent brain infarcts (SBI), cerebral microbleeds and enlarged perivascular spaces (EPVS)], from kidney (microalbuminuria, glomerular filtration) and regarding large vessels [ankle-to-brachial index (ABI), carotid-femoral pulse wave velocity]. Survival analyses were used to assess the relationship between these predictors and the incidence of cardiovascular events (CVE). We followed-up 964 individuals within a median time of 5 years (4.7-5), representing 4377.1 persons-year. We found 73 patients presenting incident CVE, which corresponds to a rate of 8.2%. We found ABI less than 0.9 [hazard ratio, 2.2; 95% confidence interval (CI) 1.17-4.13, P value = 0.014] and SBI (hazard ratio, 2.9; 95% CI 1.47-5.58, P value = 0.002) independently associated with higher risk of incident CVE. The inclusion of both variables in a clinical model resulted in an increased discrimination of individuals with new CVE of 4.72%, according to the integrated discrimination index. Assessment of SBI and ABI less than 0.9 may refine the cardiovascular risk stratification in patients with hypertension.

ASSOCIATION OF CEREBRAL OXYGENATION DURING EXERCISE WITH TARGET ORGAN DAMAGE IN HYPERTENSIVE AND NORMOTENSIVE INDIVIDUALS

Objective: To investigate whether indices of cerebral oxygenation during exercise correlate with subclinical markers of target organ damage (TOD), namely carotid intima-media thickness (cIMT), arterial stiffness, and retinal vessel diameter in newly diagnosed hypertensives and healthy individuals. Design and method: Hypertension was diagnosed using 24-hour ambulatory blood pressure (BP) monitoring. Patients with white coat or masked hypertension were excluded. Cerebral oxygenation was measured continuously during a three-minute isometric hand grip exercise at 30% of maximal voluntary contraction using near infrared spectroscopy. The average response during exercise in oxygenated-hemoglobin (O2Hb), deoxygenated-hemoglobin (HHb), and total-hemoglobin (tHb, reflecting changes in regional blood volume) were examined. CIMT was measured using ultrasound, arterial stiffness was estimated with augmentation index and pulse wave velocity, and retinal vessel diameters were estimated by the central retinal arteriolar (CRAE) and vein (CRVE) equivalent and retinal arteriovenous ratio (AVR). Univariate analyses were performed and partial correlation was used to account for traditional cardiovascular risk factors to identify independent associations between cerebral oxygenation indices and TOD. Results: Fifty-two newly-diagnosed, never treated hypertensives and 41 healthy normotensive individuals with no known medical history of any other disease were included in our study. There were no differences in anthropometric and laboratory variables between groups except for their BP levels, as expected by study design. Mean cIMT was negatively correlated with the average exercise response in cerebral oxygenation (rhoO2Hb = -0.348, pO2Hb = 0.001; rhotHb = -0.253, ptHb = 0.02). Augmentation index was negatively correlated with cerebral-oxygenation during exercise (rhoO2Hb = -0.374, p &lt; 0.001; rhotHb = -0.332, p = 0.02), whereas no significant correlation was observed between pulse wave velocity and cerebral oxygenation indices. In the adjusted analysis, cerebral oxygenation was correlated with central retinal arteriolar diameter (CRAE rO2Hb = 0.233, pO2Hb = 0.043). Conclusions: Our novel findings suggest that indices of cerebral oxygenation during a submaximal physical task are associated with markers of early, subclinical target organ damage, namely increased carotid intima-media thickness, arterial stiffness and retinal arteriolar narrowing in a population of newly diagnosed hypertensive individuals.

Cardiovascular Risk Factors and Target Organ Damage in Adolescents: The SHIP AHOY Study.

Development of cardiovascular disease in adults has been directly linked to an adverse metabolic phenotype. While there is evidence that development of these risk factors in childhood persists into adulthood and the development of cardiovascular disease, less is known about whether these risk factors are associated with target organ damage during adolescence. We collected data from 379 adolescents (mean age 15.5, 60% male) with blood pressure between the 75th and 95th percentile to determine if there is a metabolic phenotype that predicts cardiovascular changes (left ventricular mass, systolic and diastolic function, pulse wave velocity, and renal function). We determined the number of risk factors for cardiovascular disease (hypertension, dyslipidemia, obesity, and insulin resistance) present in each participant. Generalized linear models were constructed to determine if the number of cardiovascular risk factors (CVRFs) were associated with measures of target organ damage. The number of CVRFs present were associated with statistically significant differences in increased left ventricular mass index, increased pulse wave velocity, decreased peak longitudinal strain, urine albumin to creatine ratio and echocardiographic parameters of diastolic dysfunction. Generalized linear models showed that dyslipidemia and insulin resistance were independently associated with markers of diastolic dysfunction (P ≤ .05) while increased blood pressure was associated with all makers of target organ damage (P ≤ .03). These data suggest the of the number of CVRFs present is independently associated with early changes in markers of target organ damage during adolescence.

Association of Cerebral Oxygenation During Exercise With Target Organ Damage in Middle-Aged Hypertensive and Normotensive Individuals.

The brain is one of the main target organs affected by hypertension. Impaired cerebral oxygenation during exercise is an indicator of cerebral dysfunction. We aimed to investigate whether cerebral oxygenation during exercise correlates with subclinical markers of early target organ damage in a population of middle-aged, newly diagnosed hypertensive and healthy individuals. Carotid intima-media thickness (cIMT) was measured using ultrasound, arterial stiffness was estimated measuring the augmentation index and pulse wave velocity, and retinal vessel diameter was assessed via the central retinal-arteriolar and vein equivalent and retinal-arteriovenous ratio. Participants (n = 93) performed a 3-minute isometric handgrip exercise. Cerebral prefrontal oxygenation was measured continuously using near infrared spectroscopy. The average exercise responses in oxygenated hemoglobin (O2Hb), deoxygenated hemoglobin (HHb), and total hemoglobin (tHb) were assessed. Univariate analyses were performed; partial correlation was used to account for traditional cardiovascular risk factors to identify independent associations between cerebral-oxygenation indices and early markers of target organ damage. Mean cIMT was negatively correlated with the average exercise response in cerebral oxygenation (rhoO2Hb = -0.348, PO2Hb = 0.001; rhotHb = -0.253, Pthb = 0.02). Augmentation index was negatively correlated with cerebral oxygenation during exercise (rhoO2Hb = -0.374, P < 0.001; rhotHb = -0.332, P = 0.02), whereas no significant correlation was observed between pulse wave velocity and cerebral-oxygenation indices. In the adjusted analysis, cerebral oxygenation was correlated with central retinal arteriolar diameter (CRAE r = 0.233, P = 0.043). Our novel findings suggest that indices of lower cerebral oxygenation during a submaximal physical task are associated with markers of early, subclinical target organ damage, namely increased cIMT, arterial stiffness, and arteriolar retinal narrowing in newly diagnosed, untreated, hypertensive individuals.

Role of homoeopathic management in the reduction of microalbuminuria of essential hypertension

Hypertension is the most common risk factor for cardiovascular disease. The effect of elevated blood pressure has increased the death and disability rates in recent years. There is an increase frequency of cardiovascular events in hypertensive patients with microalbuminuria compared to those with normal urine albumin excretion. Microalbuminuria is a marker of target organ damage in hypertension, as it results in functional and structural changes. This study is an attempt to evaluate the role of homoeopathic medicines in reduction of microalbuminuria of essential hypertension.Objective: To evaluate the role of homoeopathic medicines in lowering Microalbuminuria in patients with Essential Hypertension.Methods: The study design adopted was quasi experimental prospective, non-randomized without control. Each case was subjected to systolic blood pressure (SBP), diastolic blood pressure (DBP) and Urine albumin excretion (UAE) at baseline, three months after the treatment and six months after the treatment.Result: All parameters showed significant ‘p’ values. There was a mean fall of SBP, DBP and Urine albumin level after 6months of homoeopathic treatment. Conclusion: In this study the Homoeopathic management is found to be effective in reducing the urine microalbumin of essential hypertension.

Renal biomarkers reflect overall hypertensive organ damage: “one organ to rule them all”

Abstract Background/Introduction Hypertension is associated with higher cardiovascular risk as well as several markers of subclinical target organ damage (TOD). Albumin to creatinine ratio (ACR) in urine has been recognized as an independent risk factor for cardiovascular events. Purpose We hypothesized that there is a relationship between ACR and markers of TOD in never-treated hypertensives. Methods We enrolled 924 consecutive essential hypertensives (mean age 53±12 years, 486 males) without known cardiovascular disease (CVD). Markers of subclinical TOD [left ventricular mass index (LVMI), pulse wave velocity (PWV), ankle-brachial index (ABI) and estimated glomerular filtration rate (eGFR)] were evaluated in all patients. LVMI was assessed echocardiographically using the Devereux formula. Carotid-femoral PWV was estimated with the Complior device. eGFR was calculated by the Cockcroft-Gault formula. ABI was calculated by dividing the highest ankle systolic blood pressure by the highest brachial systolic blood pressure. Results ACR exhibited significant association with LVMI (r=0.277, p&amp;lt;0.001, Figure), PWV (r=0.277, p&amp;lt;0.001) ABI (r=−0.078, p=0.018) and eGFR (r=−0.100, p=0.002). In further analysis, ACR was associated with TOD as suggested by the 2018 European Guidelines for Hypertension [left ventricular hypertrophy (LVMI&amp;gt;115 g/m2 in men and &amp;gt;95 g/m2 in women), increased PWV (PWV&amp;gt;10m/s), decreased ABI (ABI&amp;lt;0.9) and decreased renal function (eGFR&amp;lt;60ml/min)]. Specifically, ACR exhibited significant association with the number of TOD and this association was independent of age and gender (p&amp;lt;0.05). Conclusions Our findings support the close relationship between ACR and TOD in hypertension, as well as, the predictive ability of ACR for TOD. Funding Acknowledgement Type of funding sources: None. Association between LVMI and ACR

Association of common carotid artery measurements with the incidence of hypertension: a retrospective cohort study

Abstract Background Diameter, intima–media thickness (IMT), and flow parameters, including resistance index (RI) and pulsatility index (PI), in the common carotid artery (CCA) are markers of arterial remodeling, atherosclerosis, and vascular resistance, respectively. These CCA parameters have usually been evaluated as markers of target organ damage. Little is known about whether these parameters predict a new onset of hypertension. Purpose In this study, we investigated the association of CCA parameters including IMT, diameter, RI, and PI with the incidence of hypertension. Methods This is an observational study involving 1249 participants (656 women, mean age 69.6 years) without hypertension, who underwent carotid artery ultrasonography at baseline. The participants were divided into elderly group (defined as age ≥70 years) and a middle-aged group. We defined obesity as BMI ≥25 kg/m2. CCA diameter was defined as the distance between the adventitia–media interface on the near wall and the media–adventitia interface on the far wall. IMT was defined as the distance between the lumen–intima and media–adventitia interfaces. RI was calculated as [peak systolic velocity (PSV)- end-diastolic velocity (EDV)]/PSV. PI was calculated as (PSV-EDV)/Vmean. Larger CCA diameter, increased IMT, high RI, and high PI were determined based on the optimal cutoff values from ROC curve analysis. Results Over a mean 5.1-year follow-up period, 524 participants developed hypertension. Multivariate logistic regression analyses showed that larger CCA diameter and increased IMT were significant predicators for incident hypertension in elderly group, but not in middle-aged group. High RI, and high PI were significant predicators for incident hypertension in both the two groups. CCA diameter, IMT, and RI predicted the incidence of hypertension only in nonobesity group, whereas PI predicted it in both obesity and nonobesity groups (Table). Conclusion CCA parameters assessed by ultrasonography are useful markers to estimate the risk of hypertension. In particular, PI is a better predictor for the incidence of hypertension. Funding Acknowledgement Type of funding sources: None.

Role of Microalbuminuria and Insulin Resistance as Predictive Biomarkers for Nephropathy in Obese Individuals – A Study Protocol

Background: Obesity is a compounded, multifactorial, and largely curable disease, affecting over a third of the public community today. The World Health Organization (WHO) has declared obesity as a global epidemic, also stressing that in many cases it remains an under-recognized problem of the public health agenda. It is a global health concern and a major risk factor for diabetes, hypertension, and dyslipidemia, which may lead to decrease in renal function and ultimately obesity related nephropathy.&#x0D; As per, the epidemiological and experimental data have indicated, microalbuminuria (MAU) is an early marker of target organ damage and is associated with all-cause mortality, cardiovascular diseases (CVDs) incidence, and progression of nephropathy in non-diabetic subjects. Insulin resistance is present in obese individuals. Obesity related insulin resistance may arise from defects in fatty acid oxidation, and secondary β-cell lipotoxicity.&#x0D; The present study is a Cross-sectional analytical observational study; the study will be carried out in the Dept. of Biochemistry at Jawaharlal Nehru Medical College, ABV Rural Hospital, Sawangi (M), Wardha. Participants will be outpatients of this institution. Any participant fulfilling the eligibility criteria will be included in the study. Protocol amendments are not expected. However, if necessary, any modification to the protocol will be reported to the entire investigational team through a conference. All changes will be included in the final manuscript prior to submission.&#x0D; Aim and Objectives: Present study is targeted to assess role and correlation of microalbuminuria and insulin resistance as predictive biomarkers for nephropathy in obese subjects.&#x0D; Implications: Present study will be helpful to decrease morbidity and mortality, specifically associated with comprised renal status and prevent nephropathy. The study will be helpful to detect early clinicopathological phase of comprised renal status.&#x0D; Conclusion: The purpose of this study is to investigate role of microalbuminuria and insulin resistance as predictive markers of nephropathy in obese individuals.

A predictive marker for target organ damage in primary hypertension: serum uric acid levels

Background: This study aims to investigate the relationship between serum uric acid levels, the left ventricular mass index (LVMI), and carotid intima-media thickness (CIMT) in primary hypertension patients. Material and Method: A total of 139 primary hypertension patients, including 45 (32.4%) men and 94 (67.6%) women were involved in the study. The laboratory and clinical demographic findings, as well as the LVMI and CIMT levels of the patients, were collected from patient files. Results: 37% of the study population were found to have hyperuricemia. LVMI (99.75}13.4 vs 86.17±17.6; p=0.010) and CIMT (0.88±0.26 vs 0.75±0.17; p=0.023) levels were found to be higher in the hyperuricemia versus the non-hyperuricemia group. According to the correlation analysis, there was a positive correlation between uric acid and LVMI (r=0.282, p=0.032) and CIMT (r=0.285, p=0.002) levels. Robust regression analysis showed that uric acid was an independent risk factor for both the LVMI (β±SE: 1.615±1.03, p&lt;0.05) and CIMT (β±SE: 0.251±0.09, p&lt;0.05). Conclusion: We found serum uric acid levels to be closely related to the target organ damage associated with primary hypertension, and even related with target organ damage independent from blood pressure.