Untreated Hypertensive Patients Research Articles

Relationship among Preoperative, Pre and Postinduction Blood Pressure in Normotensive and Hypertensive Patients

Abstract Objectives: This study aimed to verify the relationship between blood pressure (BP) obtained during preoperative evaluation at preinduction and compared to BP at 20 min after induction for normotensive and hypertensive patients. Methods: Data from patients who underwent elective surgical procedures from July 2018 to September 2019 were retrospectively extracted and analyzed. The data included patient characteristics (age, sex, weight, height, body mass index (BMI)), physical status (ASA classification), comorbidities, medications in use, and mean arterial BP (MAP) recorded preoperatively (MAPpre-op), before induction of anesthesia (MAPpre-ind), and 20 min after induction (MAPpost-ind). Results: A total of 1026 patients were selected, 341 were included in the final analysis (normotensive patients (GNT n = 203), treated hypertensive patients (GTREAT n = 98), untreated hypertensive patients (GNO TREAT n = 40). There was an increase in the median MAP from preoperation to preinduction in the total sample and the three groups (GNT, GTREAT, and GNO TREAT). There was a statistically significant reduction in MAPpost-ind concerning MAPpre-ind and MAPpre-op in the three groups. The three groups' comparison showed a statistically significant difference between MAPpost-ind and MAPpre-ind and between MAPpost-ind and MAPpre-op. Conclusions: Our study showed that normotensive and hypertensive patients showed a significant BP increase at the preinduction time point. Treated and untreated hypertensive patients had a more considerable increase in preinduction BP and BP reduction at 20 min after anesthesia induction than normotensive patients. These changes were more significant in hypertensive patients without treatment.

Impact of diastolic blood pressure on speckle tracking derived myocardial work components in a population of normotensive and untreated hypertensive patients

Abstract Background Arterial hypertension deeply influences left ventricular (LV) mechanics and global longitudinal strain (GLS). The effect of blood pressure (BP), in particular systolic BP burden, on speckle tracking derived myocardial work (MW) was demonstrated in both hypertensive and healthy subjects. Purpose Aim of our study was to evaluate the impact of diastolic BP (DBP) on MW components in a population of newly-diagnosed, never treated hypertensive patients and healthy subjects. Methods The study population included 105 newly-diagnosed, never treated hypertensive patients (M/F= 62/43; age=46.1±13.0 years, BP=145.1±10/89.8±7.4 mmHg), and 105 healthy normotensive subjects (BP=121.6±9.8/73.7±7.4mmHg), matched for age and sex. All participants underwent standard echo exam, including GLS evaluation (in absolute value). Cuff BP was employed as a surrogate of LV peak pressure for the assessment of global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). Exclusion criteria were diabetes mellitus, coronary artery disease, overt heart failure, valve heart disease, primary cardiomyopathies, atrial fibrillation and inadequate echo imaging. The study population was divided into two groups according to DBP threshold of normalcy defined by 2018 ESH/ESC guidelines: the first group including individuals with normal DBP (n=135, DBP<90mmHg) and the second group including patients with abnormal DBP (n=75, DBP ≥90 mmHg). Results The two groups were comparable for sex prevalence, age and heart rate. Body mass index (BMI), systolic and mean BP were higher in the group with abnormal DBP (all p<0.0001). Among echo data, no significant intergroup difference was found in LV mass index, relative wall thickness, ejection fraction and diastolic parameters. GLS was lower in patients with abnormal DBP (20.4±1.9 vs. 22.1±2.1%, p<0.0001). GWI (2443.0±403.1 vs. 2277.3±359.6 mmHg%, p<0.002), GCW (2733.5±406.0 vs. 2556.9±405.6 mmHg%, p=0.003) and GWW (112.8±84.4 vs. 76.8±45.1 mmHg%, p<0.0001) were significantly higher in patients with abnormal DBP, whereas GWE (95.3±2.8 vs. 96.2±1.7%, p<0.002) was lower in this group. In the pooled population, DBP was positively related to GWI, GCW (both r=0.30, p<0.0001) and GWW (r=0.26, p<0.0001), while negatively correlated with GLS (r=−0.37, p<0.0001) and GWE (r=−0.21, p<0.002). By separate multiple linear regression analyses, GWI (β=0.45, p<0.0001), GCW (β=0.47, p<0.0001), GWW (β=0.20, p=0.007) and GWE (β=−0.15, p<0.05) were all independently associated with DBP, after adjusting for male sex, age, BMI, heart rate, GLS and E/e' ratio. Conclusions In a population of untreated hypertensive patients and healthy subjects, increased DBP affects longitudinal function and MW. In particular, elevated diastolic BP induces an increase of wasted work which is only partially balanced by the increased constructive work, thus provoking a clear reduced efficiency of myocardial mechanics. Figure 1 Funding Acknowledgement Type of funding source: None

Association between office blood pressure, antihypertensive medication use and male sexual dysfunction: a penile Doppler study

Abstract Background Arterial hypertension is associated with an almost two-fold increase in the likelihood of having an abnormal penile blood flow. Recent evidence supports the independent of age and blood pressure (BP) level predictive value of severe penile arterial insufficiency for adverse cardiovascular events. Purpose Aim of this study is to quantify the association between BP level and severity of penile vascular disease and to examine the potential for differences in effect of BP lowering medication use on the associations between BP level and penile vascular damage. Methods We measured penile peak systolic velocity (PSV) in 356 consecutive men with erectile dysfunction (ED) and without a history of diabetes and cardiovascular disease; The cohort was divided according to office systolic BP (SBP) and diastolic BP in three BP categories: normal (SBP <130 and DBP <85 mmHg, n=117), high normal (130≤SBP<140 or DBP 85≤DBP<90mmHg, n=91), and hypertension (SBP≥140 or DBP≥90mmHg, n=148). 164 (46%) patients of the whole study population were treated with antihypertensive medications. Low PSV values after intracavernous injection of prostanglandin E1 indicate impaired penile blood inflow and severe vasculogenic ED. Results Figure shows PSV measurements of the three office BP categories subdivided according to use of antihypertensive therapy. Treated and untreated hypertensive patients had similar mean PSV. Interestingly, the mean PSV of men with high normal BP not receiving antihypertensive drugs was significantly higher compared to PSV of men with high normal BP under therapy and significantly lower compared to PSV of normotensive males without therapy (all P<0.05). Among males not receiving antihypertensive medications there was a progressive decrease in PSV values from normal BP, to high normal BP and to hypertension (P=0.01, after adjustment for age), while among males under antihypertension therapy, the three BP categories had similar PSV level (P=0.54 after adjustment for age) (figure). Conclusion The inverse associations observed between hypertension status and penile arterial insufficiency in men not taking antihypertensive medication were attenuated or disappeared among men reporting antihypertensive medication use reflecting a medication effect or structural effects of longstanding hypertension on the penile vasculature. BP level, hypertension therapy and PSV Funding Acknowledgement Type of funding source: None

Aortic stiffness and incident diabetes: the hard, bittersweet truth

Abstract Background/Introduction Aortic stiffness increases with advancing age and is a major risk factor for age-related morbidity and mortality. Aortic stiffness and glycaemic dysregulation are related; however, temporal relationships between aortic stiffness and incidence of diabetes have not been fully delineated. Purpose We sought to investigate the role of arterial stiffness in the prediction of incident diabetes. Methods 376 untreated hypertensive patients (mean age 52.6±12.5 years, 201 males) without known cardiovascular disease and without known history of diabetes, were included in the study. Markers of subclinical organ damage [carotid-femoral pulse wave velocity (PWV) and estimated glomerular filtration rate (eGFR)] were evaluated 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 prospectively followed-up, for incidence of diabetes as defined by the American Diabetes Association criteria. Results During a median 13.5 years follow-up, forty-six 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]: 1.002–1.612, P=0.048) was associated with higher risk of incident diabetes, which was independent of age, sex, pulse pressure, HbA1c, fasting blood glucose and eGFR. 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: 0.58–0.74, P=0.001) for PWV (Figure 1). Conclusions In our cohort, higher aortic stiffness was associated with higher risk of incident diabetes. Figure 1. ROC curve for the prediction of diabetes Funding Acknowledgement Type of funding source: None

Casein Hydrolysate Containing Milk-Derived Peptides Reduces Facial Pigmentation Partly by Decreasing Advanced Glycation End Products in the Skin: A Randomized Double-Blind Placebo-Controlled Trial.

Casein hydrolysate has been shown to improve arterial stiffness as estimated by brachial-ankle pulse wave velocity (baPWV) in untreated hypertensive patients. Facial pigmentation is associated with atherosclerosis, both of which are supposed to be modulated by tissue accumulation of advanced glycation end products (AGEs). However, effects of casein hydrolysate on facial pigmentation and AGEs remain largely unknown. This randomized double-blind placebo-controlled trial evaluated whether and how casein hydrolysate improves facial pigmentation in 80 nonhypertensive Japanese patients. Study participants were randomly assigned to receive either active tablets containing casein hydrolysate or placebo for 48 weeks. Facial pigmentation area, baPWV, and skin accumulation levels of AGEs were evaluated by Robo Skin Analyzer RSA50S II, volume-plethysmographic apparatus, and AGE Reader, respectively, at baseline and at the end of the intervention. Treatment with casein hydrolysate, but not placebo significantly reduced triglycerides and facial pigmentation area. There were significant differences of changes in triglycerides, facial pigmentation area, skin accumulation levels of AGEs, and baPWV between the two groups. Furthermore, changes in triglycerides and skin accumulation levels of AGEs were positively and independently associated with those in facial pigmentation area, whereas changes in baPWV were not. This study suggests that casein hydrolysate reduces facial pigmentation area in nonhypertensive participants partly by decreasing skin accumulation levels of AGEs. Clinical-Trials.gov ID: UMIN000027675.

Ferritin modifies the relationship between inflammation and arterial stiffness in hypertensive patients with different glucose tolerance

BackgroundFerritin, a crucial element for iron homeostasis, is associated with chronic diseases characterized by subclinical inflammation such as essential arterial hypertension and type 2 diabetes mellitus (T2DM), showing a prognostic value in different clinical settings. We investigated whether ferritin is associated with arterial stiffness (AS), an early indicator of atherosclerosis, and if it could act as effect modifier on the relationship between inflammation and AS in hypertensive patients with different glucose tolerance.MethodsWe enrolled 462 newly diagnosed untreated hypertensive (HT) patients. All subjects underwent an oral glucose tolerance test. Insulin sensitivity was assessed by MATSUDA index and ferritin levels were estimated by immunoradiometric assay. AS was defined by carotid-femoral pulse wave velocity (PWV).ResultsOut of 462 patients, 271 showed normal glucose tolerance (HT/NGT), 146 impaired glucose tolerance (HT/IGT) and 45 were diabetic (HT/T2DM). Iron levels significantly decreased and transferrin and ferritin significantly increased from the first to the third group. PWV values were significantly higher in HT/IGT and HT/T2DM patients. PWV was related directly with ferritin, high sensitivity C reactive protein (hs-CRP), transferrin, and inversely with MATSUDA index. Ferritin resulted the strongest determinant of PWV explaining a 14.9% of its variation; moreover it was a strong modifier of the relationship between hs-CRP and PWV. The estimated augmentation in PWV portended by a fixed increase in hs-CRP, was higher across increasing values of ferritin.ConclusionFerritin represents an independent risk factor of arterial stiffness in our study population and a strong effect modifier on the relationship between inflammation and PWV. However, further studies are needed to fully elucidate the potential role of this biomarker in human atherosclerosis.

Impact of different dipping patterns on left atrial function in hypertension.

We aimed to investigate left atrial phasic function in the recently diagnosed hypertensive patients and determine association between circadian blood pressure (BP) patterns and left atrial function. The present study involved 256 untreated hypertensive patients who underwent 24-h ambulatory BP monitoring and comprehensive echocardiographic examination. All patients were divided into four groups according to the percentage of nocturnal BP drop (dippers, extreme dippers, nondippers and reverse dippers). There was no significant difference in daytime BPs between the observed groups, whereas night-time BPs significantly and gradually increased from extreme dippers and dippers, across nondippers, to reverse dippers. Total, passive and active left atrial emptying fractions that correspond with left atrial reservoir, conduit and contractile function were lower in nondippers and reverse dippers than in dippers and extreme dippers. Reservoir and contractile left atrial strains were lower in reverse dippers than in dippers and extreme dippers, whereas conduit left atrial strain was lower in reverse dippers in comparison with extreme dippers. Nondipping and reverse dipping BP patterns were, independently of age, sex, nocturnal BPs, left ventricular mass index, E/e', associated with reduced reservoir function. Nevertheless, only reverse dipping profile was independently of other circadian BP profiles, nocturnal BP, demographic and echocardiographic parameters related with reduced conduit and contractile functions. Nondipping and reverse dipping BP patterns were related with impaired left atrial phasic function. However, reverse pattern was the only circadian profile that was independently of other clinical parameters, including night-time BP, associated with decreased reservoir, conduit and contractile function.

From short-term blood pressure variability to atherosclerosis: Relative roles of vascular stiffness and endothelial dysfunction.

Both arterial blood pressure (BP) average levels and short-term BP variability (BPV) relate to hypertension-mediated organ damage, in particular increased carotid artery intima-media thickness (IMT) and carotid-femoral pulse wave velocity (PWV). Endothelial dysfunction possibly mediates such damage. The authors aimed at further investigating such role in hypertensive patients. In 189 recently diagnosed, untreated hypertensive patients the authors evaluated, in a cross-sectional design, the relationships of BP average levels and short-term systolic (S) BPV (standard deviation of awake SBP or of 24-hour-weighted SBP) with IMT and PWV, and how much these relationships are explained by endothelial function parameters-brachial artery flow-mediated dilation (FMD) and digital reactive hyperemia index (RHI). Multivariable models assessed the strength of these relationships to derive a plausible pathogenetic sequence. Both average SBP values and our measures of SBPV were significantly related to IMT (24-hour mean SBP: r=.156, P=.034; 24-hour-weighted SBPV: r=.157, P=.033) and to PWV (24-hour mean SBP: r=.179, P=.015; 24-hour-weighted SBPV: r=.175; P=.018), but only poorly related to FMD or RHI (P>.05 for all). At univariable regression analysis, FMD and RHI were both related to IMT, (P<.001), but not to PWV. When FMD and RHI were added to average SBP and SBPV parameters in a multivariable model, both significantly (P<.005) contributed to predict IMT, but not PWV. Thus, endothelial dysfunction relates to IMT independently of BP parameters, but appears to play a minor role in the association between BP variability-related variables and arterial stiffening.

The prognostic importance of right ventricular remodeling and the circadian blood pressure pattern on the long-term cardiovascular outcome.

We sought to investigate the predictive value of right ventricular (RV) remodeling and 24-h blood pressure (BP) patterns on long-term cardiovascular prognosis in the initially untreated hypertensive patients. The current study included 505 initially untreated hypertensive patients who were consequently included in this study from 2007 to 2012. All the patients underwent laboratory analysis, 24-h BP monitoring and echocardiographic examination at baseline. The patients were followed for a median period of 9 years. The adverse outcome was defined as the hospitalization due to cardiovascular events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or cardiovascular death). During the 9-year follow-up period adverse cardiovascular events occurred in 82 hypertensive patients. Night-time SBP, the nondipping BP pattern, left ventricle hypertrophy, RV hypertrophy, right atrial enlargement, RV diastolic dysfunction, and RV systolic dysfunction were associated with adverse cardiovascular events. Nevertheless, night-time SBP, the nondipping BP pattern, mitral E/e', left ventricle hypertrophy, and RV hypertrophy were the only independent predictors of cardiovascular events. When all four BP patterns were included in the model, only the reverse dipping BP pattern was an independent predictor of cardiovascular events. The present investigation showed that RV hypertrophy and the reverse dipping BP pattern were independent long-term predictors of the cardiovascular outcome. Detailed echocardiographic evaluation and 24-h ambulatory blood pressure monitoring should be performed even in low-risk hypertensive patients.

The Effects of Salt and Glucose Intake on Angiotensin II and Aldosterone in Obese and Nonobese Patients with Essential Hypertension.

Background The exact mechanisms for the development of essential hypertension are not known. Activation of the renin-angiotensin-aldosterone system (RAAS) in adipose tissue may represent an important link between obesity and hypertension. This study investigates the effects of oral intake of glucose with and without NaCl on angiotensin II (AngII) and aldosterone in obese and nonobese patients with essential hypertension. Methods Twenty newly diagnosed untreated essential hypertensive patients and 15 normotensive control subjects matched for age, gender, and BMI were studied. Participants fasted overnight (8–10 hrs), and then each subject took 75 gm glucose alone and with 3 gm NaCl, each dissolved in 250 ml. Subjects were monitored for 2 hours. Half hourly BP, plasma glucose (PG), serum Na+, K+, insulin, AngII, and aldosterone were measured. Subjects were classified into obese (BMI >30 Kg/m2) (11 patients and 8 control) and nonobese (BMI <30 Kg/m2) (9 patients and 7 control). Results After intake of glucose with NaCl serum, AngII was significantly higher in obese hypertensive patients compared with nonobese patients (P = 0.016). Intake of glucose with NaCl resulted in a significantly higher serum Na in obese hypertensive patients compared with nonobese patients Na (P = 0.009). Serum aldosterone was significantly higher in obese patients (P = 0.03, after glucose; P = 0.003, after glucose with NaCl) and in nonobese patients (P = 0.000 and P = 0.000, respectively) compared with their respective normotensive control subjects. In obese and nonobese patients, intake of glucose and glucose with NaCl showed no significant change in the levels of serum AngII and aldosterone which was associated a significant increase in serum Na in obese patients (P = 0.03) and a highly significant reduction in serum K in nonobese patients (P = 0.001). Conclusion Failure of suppression or inappropriate maintenance of secretion of AngII and aldosterone in both hypertensive groups by intake of glucose with NaCl may indicate a possible mechanism of essential hypertension.

Hypertension, Antihypertensive Use and the Delayed-Onset of Huntington's Disease.

BackgroundHypertension is a modifiable cardiovascular risk factor implicated in neurodegeneration and dementia risk. In Huntington's disease, a monogenic neurodegenerative disease, autonomic and vascular abnormalities have been reported. This study's objective was to examine the relationship between hypertension and disease severity and progression in Huntington's disease.MethodsUsing longitudinal data from the largest worldwide observational study of Huntington's disease (n = 14,534), we assessed the relationship between hypertension, disease severity, and rate of clinical progression in Huntington's disease mutation carriers. Propensity score matching was used to statistically match normotensive and hypertensive participants for age, sex, body mass index, ethnicity, and CAG length.ResultsHuntington's disease patients had a lower prevalence of hypertension compared with age‐matched gene‐negative controls. Huntington's disease patients with hypertension had worse cognitive function, a higher depression score, and more marked motor progression over time compared with Huntington's disease patients without hypertension. However, hypertensive patients taking antihypertensive medication had less motor, cognitive, and functional impairment than Huntington's disease patients with untreated hypertension and a later age of clinical onset compared with untreated hypertensive patients and normotensive individuals with Huntington's disease.ConclusionsWe report the novel finding that hypertension and antihypertensive medication use are associated with altered disease severity, progression, and clinical onset in patients with Huntington's disease. These findings have implications for the management of hypertension in Huntington's disease and suggest that prospective studies of the symptomatic or disease‐modifying potential of antihypertensives in neurodegenerative diseases are warranted. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

Effect of nutrition education in reducing sodium intake and increasing potassium intake in hypertensive adults.

BACKGROUND/OBJECTIVESHypertension is the major risk factor for cardiovascular disease, a leading cause of deaths in Korea. The objective of this study was to evaluate the effect of a nutrition education in reducing sodium intake and increasing potassium intake in hypertensive adults.SUBJECTS/METHODSSubjects who participated in this study were 88 adults (28 males and 60 females) who were pre-hypertension or untreated hypertensive patients aged ≥ 30 yrs in Gyeonggi Province, Korea. These subjects were divided into 2 groups: a low-sodium education (LS) group and a low-sodium high-potassium education (LSHP) group. Nutrition education of 3 sessions for 12 weeks was conducted. Blood pressure, blood and urine components, nutrient intake, and dietary behavior were compared between the two education groups.RESULTBlood pressure was decreased in both groups after the nutrition education (P < 0.05). In the LSHP group, levels of blood glucose (P < 0.05), total cholesterol (P < 0.01), and low-density lipoprotein-cholesterol (P < 0.05) were decreased after the program completion. Sodium intake was decreased in both groups after the nutrition education (P < 0.05). However, Na/K ratio was only decreased in the LS group (P < 0.05). Intake frequency of fish & shellfish was only significantly reduced in the LS group (P < 0.05), while intake frequencies of cooked rice, noodles & dumplings, breads & snacks, stew, kimchi, and fish & shellfish were reduced in the LSHP group (P < 0.05). Total score of dietary behavior appeared to be effectively decreased in both groups after the education program (P < 0.001).CONCLUSIONSThis education for reducing sodium intake was effective in reducing blood pressure and sodium intake. The education for enhancing potassium intake resulted in positive changes in blood glucose and serum cholesterol levels.

Usefulness of Stress-Derived E/e’ Ratio in Asymptomatic Hypertensive Patients

Purpose: We sought to investigate the usefulness of stress echocardiography-derived E/e’ in predicting subclinical atherosclerosis in asymptomatic hypertensive patients. Materials and Methods: 71 newly diagnosed untreated hypertensive patients (48 ± 13 years, 65% males) and 30 age- and sex-matched healthy controls were recruited. Resting and exercise echocardiography was performed to assess resting diastolic blood pressure and the diastolic stress parameters. Coronary flow reserve (CFR) was evaluated as well. Results: Based on CFR values, newly diagnosed, untreated hypertensives were stratified into hypertensives with microvascular dysfunction (MVD; 34 patients had CFR <2.0) and those without MVD (37 patients had CFR ≥2.0). Patients with MVD had a significantly higher C-reactive protein level (p < 0.05) and lower metabolic equivalent values (p < 0.05). With resting echocardiography, only the left atrial volume index (LAVI) was significantly increased in those with MVD compared with those without MVD and controls (p < 0.05). With exercise echo, the E/e’ was significantly increased in MVD patients compared with those without MVD and controls (p < 0.001). Importantly, the percentage of subjects with exercise E/e’ ≥15 was 76.5% (26 patients in the group with MVD), 4.1% (3 patients in the group without MVD), and 0% in controls. At univariate analysis, high-sensitivity C-reactive protein (p < 0.05), LAVI (p < 0.05), and exercise E/e’ (p < 0.001) were independently associated with reduced CFR. On the other hand, at multivariate analysis, only exercise E/e’ was the independent predictor of reduced CFR in newly diagnosed hypertensives. Conclusion: We have demonstrated significant associations between exercise-derived raised left ventricular pressure and coronary MVD in newly diagnosed untreated hypertensive patients. Herein, we supposed that exercise-derived E/e’ could predict subclinical atherosclerosis and might be a risk parameter for newly diagnosed untreated hypertensive patients.

Echocardiography in Low-Risk Hypertensive Patients.

BackgroundIt is debated whether echocardiography should be part of the diagnostic workup in all hypertensive patients. We identified some factors potentially associated with left ventricular hypertrophy (LVH) at echocardiography in untreated hypertensive patients.Methods and ResultsWe studied 2150 patients without LVH at ECG. All patients underwent standard 12‐lead ECG and echocardiography. Mean age was 48.7 years, and mean office blood pressure was 154/97 mm Hg. Prevalence of echocardiographic LVH (LV mass >47.0 g/m2.7 in women and >50.0 g/m2.7 in men) was 37.1%. We developed a nomogram based on 7 items (age, smoking, body mass index, office systolic and diastolic blood pressure, Cornell voltage, and chronic kidney disease) on the basis of a multivariable logistic regression analysis. We internally validated the model by bootstrap recalibration and obtained a calibration curve to assess agreement in the validation data set. Probability of LVH at echocardiography ranged from <10% (score, ≤100 points) to >90% (score, ≥180 points). Proportion of patients with LVH progressively increased with the total score (χ2=444.8; P<0.001). Prevalence of LVH was <2% and 90% at the lower 5th and upper 95th percentile of its distribution, respectively.ConclusionsWe developed and validated a novel score to assess the probability of LVH at echocardiography in hypertensive patients without LVH at ECG. The score may guide the appropriateness of echocardiographic study in low‐risk hypertensive patients. Echocardiography appears most appropriate for score values >136 in men and >124 in women.

The Prognostic Effect of Circadian Blood Pressure Pattern on Long-Term Cardiovascular Outcome is Independent of Left Ventricular Remodeling.

We aimed to investigate the predictive value of 24 h blood pressure (BP) patterns on adverse cardiovascular (CV) outcome in the initially untreated hypertensive patients during long-term follow-up. This study included 533 initially untreated hypertensive patients who were involved in this study in the period between 2007 and 2012. All participants underwent laboratory analysis, 24 h BP monitoring, and echocardiographic examination at baseline. The patients were followed for a median period of nine years. The adverse outcome was defined as the hospitalization due to CV events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or CV death). During the nine-year follow-up period, adverse CV events occurred in 85 hypertensive patients. Nighttime SBP, non-dipping BP pattern, LV hypertrophy (LVH), left atrial enlargement (LAE), and LV diastolic dysfunction (LV DD) were risk factors for occurrence of CV events. However, nighttime SBP, non-dipping BP pattern, LVH, and LV DD were the only independent predictors of CV events. When all four BP pattern were included in the model, non-dipping and reverse dipping BP patterns were associated with CV events, but only reverse-dipping BP pattern was independent predictor of CV events. The current study showed that reverse-dipping BP pattern was predictor of adverse CV events independently of nighttime SBP and LV remodeling during long-term follow-up. The assessment of BP patterns has very important role in the long-time prediction in hypertensive population.

P38 Association of Daytime Augmentation Index with Brain-derived Neurotrophic Factor in Untreated Hypertensive Patients

Brain-derived neurotrophic factor (BDNF) is a neurotrophic molecule with impact on microvasculature and also with complex psychosomatic connections. The aim of our study was to evaluate its associations with 24-hour brachial and central hemodynamic parameters and arterial stiffness in untreated patients who were studied because of elevated office blood pressure. Mobil-O-Graph was used to measure the 24-hour brachial and central parameters. Serum BDNF was measured with ELISA, depression and anxiety were evaluated with questionnaires (Beck Depression Inventory and Hamilton Anxiety Scale, respectively). 73 patients were involved into the study. The average serum BDNF level was 28610 ± 7965 pg/ml. SeBDNF was correlated with daytime augmentation index (Aix, r = 0.234, p = 0.046). A borderline correlation was found with 24-hour total peripheral resistance (r = 0.227, p = 0.053). In multiple linear regression model the association between Aix and BDNF remained significant after the adjustment for age, depression and anxiety (B = 0.243, p = 0.034), but was attenuated after further adjustment for total vascular resistance (B = 0.186, p = 0.106). In conclusions, the impact of BDNF on microvasculature can have physiological importance as through the mediation of total vascular resistance it can influence pulse wave reflection.

P92 The Association of Agreeableness and Conscientiousness with 24-Hour Brachial Blood Pressure and Hemodynamic Parameters in Untreated Hypertensive Patients

BackgroundThere is growing evidence that Five Factor Model personality traits (extraversion agreeableness, conscientiousness, neuroticism, and openness) have an impact on cardiovascular (CV) risk. The aim of our study was to evaluate their associations with 24-hour brachial and central hemodynamic parameters and arterial stiffness in untreated patients who were studied because of elevated office blood pressure.MethodsMobil-O-Graph was used to measure the 24-hour brachial and central parameters. The Big Five Dimensions were evaluated with the BFI questionnaire. 68 patients were involved into the study (45 men).ResultsAgreeableness was inversely associated with nighttime brachial systolic blood pressure (r = −0.255, p = 0.036), with 24-hour heart rate (r = −0.243, p = 0.046), with 24-hour cardiac output (r = −0.314, p = 0.009) and with daytime cardiac output (r = −0.341, p = 0.004). Conscientiousness was inversely associated with 24-hour heart rate (r = −0.276, p = 0.023) and daytime heart rate (r = −0.283, p = 0.019).ConclusionIn conclusions, agreeableness and conscientiousness can have an impact on 24-hour hemodynamic parameters in untreated hypertensive patients.

Retinol-binding protein 4 is closely correlated to blood pressure level and E/A in untreated essential hypertension patients.

Hypertension, a common chronic disease, is a leading cause of death and other cardiovascular diseases. Recent studies show that an inflammatory factor named retinol binding protein 4 (RBP4) was increased with cardiovascular diseases. However, the relationship between RBP4 and hypertension in patients remains unclear. The study cohort was composed of patients with essential hypertension (EH) and healthy control (HC) subjects from the Second Affiliated Hospital of Nanjing Medical University [2017-2019]. The levels of RBP4 and echocardiography were compared in the current study. Statistical differences between two groups were analyzed using unpaired Student's t-tests and the correlation between the two variables adopts Pearson correlation analysis. SPSS 23.0 was used for all statistical analysis. Analysis of patient plasma samples revealed that RBP4 in EH group was greater than HC group (P<0.05). The area under the ROC curve was 0.717. Specificity and sensitivity were 80.4% and 60.8%, respectively. RBP4 had positive correlation with left ventricular systolic diameter (LVDs), interventricular septal thickness (IVS) and left ventricular posterior wall thickness (LVPW), negative correlation with left ventricular shortening fraction (FS) and ejection fraction (EF) (P<0.05), and no correlation with left ventricular end-diastolic diameter (LVDd) (P>0.05). RBP4 was closely related with E/A, evaluation method of left ventricular diastolic function, in patients with EH. RBP4 levels are closely correlated with blood pressure (BP) levels and might be involved in the regulation of left ventricular diastolic function in patients with EH.

Do reverse dippers have the highest risk of right ventricular remodeling?

We aimed to evaluate right ventricular (RV) deformation in recently diagnosed untreated hypertensive patients with different 24-h blood pressure (BP) patterns (dipping, nondipping, extreme dipping and reverse dipping). This cross-sectional study involved 190 untreated hypertensive patients who underwent 24-h ambulatory BP monitoring and a detailed two-dimensional echocardiographic examination, including the assessment of layer-specific strain. We found that 24-h and daytime BP values did not differ between the four groups. Nighttime BP significantly and gradually increased from extreme dippers across dippers and nondippers to reverse dippers. RV structure and systolic and diastolic function did not significantly differ among the four groups. However, RV global and RV free wall longitudinal strains were significantly lower in nondippers and reverse dippers than in dippers and extreme dippers. The endocardial and epicardial RV longitudinal strains of the whole RV and free wall RV were the lowest in reverse dippers and highest in extreme dippers. Multivariate logistic regression analysis demonstrated that only reverse dipping patterns were associated with reduced RV global longitudinal strain [OR 2.9 (95% CI: 1.5-8.2)], independent of age, sex, 24-h systolic BP, LV mass index, RV wall thickness and E/e't. Similarly, the reverse dipping pattern was associated with reduced RV free wall longitudinal strain, independently of the mentioned parameters [OR 3.8 (95% CI: 1.8-8.5)]. In conclusion, in the hypertensive population, the reverse dipping BP pattern had an adverse effect on RV deformation. RV remodeling progressively deteriorated from extreme dippers to reverse dippers, but only the reverse dipping BP pattern was independently associated with the reduction in RV longitudinal strain.

Nocturnal systolic hypertension is a risk factor for cardiac damage in the untreated masked hypertensive patients.

The nocturnal blood pressure (BP) has been identified as a prognostic factor for cardiovascular events. This study aimed to investigate the association between different patterns of nocturnal masked hypertension (MH) and the echocardiographic parameters in the untreated nocturnal MH patients. A total of 721 untreated MH patients (309 females and 412 males, mean age=56.59±15.20years) from June 2006 and June 2016 were included and divided into nocturnal systolic MH (n=77), nocturnal diastolic MH (n=232), and nocturnal systolic/diastolic MH (n=412) groups according to the ambulatory blood pressure monitoring. Baseline characteristics, office BP values, ambulatory BP monitoring parameters, and echocardiographic parameters were compared among the three groups. The independent factors associated with echocardiographic parameters were analyzed by multivariate linear regression. The nocturnal systolic group had the highest ratio of males, mean age, and office systolic BP (SBP), and the lowest office, 24-hour, daytime, nocturnal diastolic BP and heart rate among the three groups. The nocturnal diastolic group had the lowest interventricular septum (IVS) thickness, left atrium (LA) dimension, and left ventricular (LV) mass among the three groups. Multivariate linear regression analysis revealed that 24-hour, daytime, and nocturnal SBPs were all positively associated with LA dimension, IVS thickness, and LV mass (all B were positive and P<.050). Pearson's correlation analysis showed that nocturnal SBP was positively correlated with LA dimension, IVS thickness, and LV mass. These results suggested that different patterns of nocturnal MH had different echocardiographic outcomes. Nocturnal SBP was the independent factor associated with the echocardiographic parameters.