Blood Pressure Medication Use Research Articles

Abstract 4136930: Plasminogen Activator Urokinase Receptor (PLAUR) Levels are a Predictor of Adverse Cardiovascular Outcomes in the General Population, Independent of High-Sensitive CRP (hs-CRP)

Background: The gene Plasminogen Activator Urokinase Receptor (PLAUR) encodes the urokinase plasminogen activator surface receptor (uPAR), which upon cleavage releases Soluble Urokinase Plasminogen Activator Receptor (suPAR). SuPAR has emerged as a novel biomarker of inflammation and immunity and is associated with adverse cardiovascular events, particularly coronary artery disease (CAD), regardless of hs-CRP levels, a well-established inflammatory biomarker. However, whether the PLAUR gene predicts adverse cardiovascular events remains uncertain. Methods: We investigated the relationship between PLAUR levels, measured via Olink Immunoassay, in 40,790 individuals from the UK Biobank, and the occurrence of adverse cardiovascular events such as myocardial infarction (MI), as well as all-cause and cardiovascular mortality. Our analysis involved the use of Cox and Fine and Gray proportional hazards models, adjusting for age, sex, race, HDL, LDL, triglyceride levels, BMI, prevalence of hypertension (HTN), prevalence of type 2 diabetes (T2D), smoking history, and use of blood pressure and cholesterol medications. Main Outcomes: The primary outcome was a composite outcome of cardiovascular mortality and MI and the secondary outcome was all-cause mortality. Results: The mean (SD) age was 58 (8) years, 45% men and 94% white. During a median follow-up of 14 (interquartile range 12.3 – 15) years, 7.9% of the population had an MI, 2.7% suffered cardiovascular death, 9.5% all-cause mortality. After adjusting for aforementioned demographic and clinical factors, as well as medication usage, each standard deviation increase in PLAUR levels was associated with a heightened risk of incident non-fatal MI and cardiovascular (CV) death, with a hazard ratio (HR) of 2.31 (95% CI 2.00-2.45), and all-cause mortality, with an HR of 3.81 (95% CI 3.48-4.18). Even after further adjustment for hs-CRP levels, PLAUR levels remained predictive of non-fatal MI and CV death (HR 2.03, 95% CI 1.83-2.26) and all-cause mortality (HR 3.43, 95% CI 3.12-3.77). Furthermore, in a fully adjusted Cox regression model, a significant interaction between PLAUR levels and sex (p = 0.0003) was observed in predicting the primary outcome. The interaction was found to have a stronger predictive value in females compared to males. Conclusion: PLAUR levels are a strong predictor of adverse cardiovascular outcomes in the general population, independent of traditional risk factors and inflammation.

Sarcopenia severity is related to arterial stiffness and hypertension in older Korean population without underweight and obesity: population based cross-sectional study.

Aging and obesity are considered causes of arterial stiffness, which triggers hypertension in the older population. However, a substantial number of older adults without obesity have hypertension, suggesting that arterial stiffness and hypertension are related to different risk factors in older adults without obesity. This cross-sectional study aimed to determine whether sarcopenia is related to arterial stiffness or hypertension in older Korean adults without underweight and obesity. A total of 2,237 male and female adults in the Korea National Health and Nutritional Examination Survey who were ≥60 years and did not have underweight and obesity (18.5 ≤ body mass index <25.0 kg/m2) were involved. They were classified as moderate- (n = 276) or severe-sarcopenia (n = 528) as their sarcopenia index was 1 or 2 standard deviations lower than the mean of the young reference group. Arterial stiffness was confirmed using an estimated pulse wave velocity (ePWV) formula, and hypertension was diagnosed based on blood pressure or antihypertensive medication use. Arterial stiffness and systolic and diastolic blood pressure showed an increasing trend from normal to moderate-to-severe sarcopenia (p < 0.001 for both). The distribution of subjects in the highest ePWV tertile and hypertension from normal to moderate-to-severe sarcopenia showed an increasing trend (p < 0.001 for both). Subjects with moderate or severe sarcopenia were 3.545 or 8.903 times more likely to be in the highest tertile of ePWV, and those with moderate or severe sarcopenia were 2.106 or 11.725 times more likely to be hypertension (p < 0.001 for all). Sarcopenia severity is related to arterial stiffness and hypertension in older Korean populations without underweight and obesity.

Abstract P113: Hypertension Prevalence, Awareness, Treatment, and Control in Community-Dwelling Adults in Low-Resource Areas of Chicago, Illinois

Background: Hypertension (HTN) is an established risk factor for cardiovascular disease that disproportionately affects adults in low-resource communities. We examined hypertension prevalence, awareness, treatment, and control—the HTN control cascade—in low-resource neighborhoods in Chicago, Illinois. Methods: Using data from Keep Your Heart Healthy, a Northwestern Feinberg School of Medicine student-led community health program, we evaluated a convenience sample of adults who completed three blood pressure (BP) measurements at a community screening event between 2013 and 2019. Among adults with HTN (average systolic BP ≥140 mmHg, average diastolic BP ≥90 mmHg, or self-reported BP medication use), HTN awareness (self-reported history of HTN), HTN treatment (self-reported treatment among those who were aware), and HTN control (systolic BP &lt;140 mmHg and diastolic BP &lt;90 mmHg, among those who were aware and treated) rates were calculated. Results: Among 11,167 adults (mean age 50.9±14.8 years; 58.6% female; 63.9% Hispanic/Latino, 28.0% Black), HTN was prevalent in 45.3%. Of participants with HTN, 66.7% were aware of the diagnosis. Of those who were aware, 65.3% reported taking BP medication, of whom 48.3% achieved BP control. Overall, 21.0% of participants with HTN were aware, treated, and controlled (Figure). Additionally, 37.6% of all participants met criteria for pre-HTN (120-139 or 80-89 mmHg). Conclusions: In low-resource communities of Chicago, only 21.0% of participants with HTN were aware, treated, and controlled. Less than half of patients on treatment for HTN were controlled, revealing significant opportunity to improve HTN control in low-resource communities.

Predicting the risk of type 2 diabetes: Standardized diabetes risk score among the Khmer ethnic minority in Vietnam.

Predicting the risk of progression to type 2 diabetes, as well as identifying the factors that increase this risk, helps the population adjust the modifiable risk factors, improve quality of life, and reduce the disease burden. A cross-sectional study was conducted on 918 ethnic Khmer minority people aged 40 and above in Vietnam who had never been diagnosed with type 2 diabetes. To predict the 10-year risk of type 2 diabetes, the Finnish Diabetes Risk Scoring Scale, adjusted for the Asian population with modification of the waist circumpherence and Body Mass Index Cut-Offs, was used. The 10-year predicted risk of progression to type 2 diabetes in ethnic Khmer people aged 40 years and older in southern Vietnam, using the Asian-modified Finnish Diabetes Risk Scoring Scale, resulted 10.54% in the total population study, females have a higher risk at 12.62% compared to 8.01% of males. Among the items that make up the Finnish Diabetes Risk Scoring Scale, age, waist circumference, BMI, family history of diabetes, history of high blood glucose, and use of blood pressure medication were the most accurate predictors, with the area under the Receiver operating characteristic (ROC) curve at 0.83, 0.81, 0.77, 0.75, 0.74 and 0.73 respectively. The optimal cut-off score to identify progression to tipe 2 diabetes was 13.5 points (Se = 1.00, Sp = 1.00, p < 0.001). The multivariable logistic regression model shows that factors associated with high risk of type 2 diabetes progression in 10 years are age, gender, occupation, economic status, education level and regular alcohol consumption (p < 0.05). The study results provide a basis for proposing potential solutions to reduce modifiable risk factors for type 2 diabetes in the population. These include providing culturally appropriate health education and changing behavior to address alcohol consumption. The use of the Asian-modified Finnish Diabetes Risk Scoring Scale to predict the risk of progression to type 2 diabetes and as a screening tool for undiagnosed type 2 diabetes is appropriate for the Vietnamese Khmer population.

The Effects of Bariatric Surgery on the Requirement for Antihypertensive Treatment in Type 2 Diabetes: Insights from a Long-Term Follow-Up Study.

Bariatric surgery (BS) has emerged an effective intervention in achieving significant and sustained weight loss in patients with type 2 diabetes (T2D). However, comprehensive data on the long-term impact of BS on hypertension is scarce. We aimed to investigate the long-term impact of BS on blood pressure management in individuals within a T2D cohort. This retrospective cohort study was conducted on 119 patients who underwent BS between 2009 and 2012. Baseline and follow-up observations, including blood pressure, HbA1c, BMI, and antihypertensive medication use were obtained from electronic patient records at regular intervals up to and beyond 10-year follow-up. The median follow-up period for the 119 patients was 11.5years. Mean fall in BMI 4-8weeks post-surgery was 12%. A sustained reduction in systolic BP was observed up to 10years post-surgery (154.5mmHg pre-op vs. 132.8mmHg at 10years; p < 0.0001. From 5years onwards, there were increases in mean glycated hemoglobin (HbA1c) and body mass index (BMI). At latest follow-up (> 5years after bariatric surgery), the number of individuals prescribed an antihypertensive agent started to increase. This is in the context of the number of the number of individuals on 2-3 antihypertensive agents declining up until 5years post-BS. Specifically, there was a reduction in the number of prescriptions of an antihypertensive agent over time from 164 prescriptions pre-operatively to 81 at 8weeks post-operatively, 78 at 6months, 72 at 1year, 66 at 5years before rising at 10years to 95 prescriptions. Our study shows an overall benefit in the years after bariatric surgery in terms of blood pressure and requirement for antihypertensive medication. However, at 5years and beyond after surgery, the beneficial effect of bariatric surgery diminishes with respect to an increase in number of antihypertensive medication prescriptions, BMI, and HbA1c.

Assessment of workhour feeding practices, healthy behaviour score and body mass index of physicians in Northern Nigeria: a cross-sectional multi-centre study.

The increasing prevalence of obesity and overweight among health workers calls for an appraisal of their lifestyle. This study assessed medical practitioners' workhour feeding and lifestyle practices and explored the relationship between these practices and their body mass index (BMI). The survey involved 321 medical practitioners selected from 9 northern Nigeria hospitals in 2021. Data collected included biodata, medication history, workhour feeding characteristics, lifestyle behaviours, blood pressure, height, and weight measurements. Data were analyzed using Epi info software (version 7). Most respondents were male (70.7%). Their mean age was 38 ± 7.4 years. During their last workhours, 84.1% had lunch, and 46.4% took sugary drinks. Usually, 41.7% source their lunch from the hospital canteen, and 18.7% patronize their canteen at least weekly. Most reported healthy behaviour towards alcohol consumption (99.7%), fruit and vegetable consumption (54.8%) and smoking (98.4%). However, only 22.4% were physically active. Their mean healthy behaviour score and BMI were 2.8 ± 0.7 and 26.1 ± 4.6 kg/m2, respectively. The obesity and overweight rates were 18.4% and 37.7%, respectively. Their source of lunch during workhours, age, sex, years of practice, employment duration, marital status, job category, systolic blood pressure, anti-hypertensive, and antidiabetic medication use were significantly associated with mean BMI. However, only antihypertensive medication use, being married, inadequate fruit/vegetable consumption and workhour sugary drinks consumption predicted obesity. The predictors of overweight/obese were years of practice (< 10 y) and use of antihypertensive medications. Obesity and overweight rates were high. Most were physically inactive. Workhour sugary drink consumption predicted obesity. Effective workplace and community interventions to improve practitioners' lifestyle behaviour and curtail obesity and overweight are needed.

(159) Characteristics and Hypertension Management Trends in Hypertensive Men With and Without Erectile Dysfunction

Abstract Introduction Hypertension, defined as a blood pressure (BP) ≥ 130/80 mmHg and/or use of BP lowering medications, affects 47% of the U.S. population and is the most important modifiable risk factor for cardiovascular disease (CVD) prevention. Prevalence of BP control appears to be decreasing in the U.S. and currently only 1 in 4 adults with hypertension have controlled BP. Erectile dysfunction (ED), an early marker of subclinical CVD, often accompanies hypertension. Most BP lowering medications have been shown to not affect sexual function, but the drug class of angiotensin receptor blockers (ARBs) have generally been found to have favorable effects on erectile function through their inhibition of angiotensin II. Therefore, exploring the relationship between hypertension management and ED is advantageous for the ultimate control and treatment of these two common and highly prevalent diseases. Objective Assess the demographics of hypertensive men with and without ED and examine associations of ED with hypertension management and BP control outcomes Methods All men presenting for an initial visit for hypertension (ICD-10 codes I10, I11.0, and I11.9) between January 2017-December 2022 at an academic medical center were included for analysis. The electronic health record was queried for patient demographics, the diagnosis of ED, cardiovascular comorbidities, major drug classes of antihypertensives, and major PDE5-inhibitors. Descriptive statistics was used to describe patient characteristics by ED status. Chi-squared, t-test, and Mann-Whitney U tests was used to compare characteristics of patients by presence of ED. Results Of 24,723 hypertensive men in our health system during the study period, only 1,119 men (4.5%) were noted to have ED (Table 1). Hypertensive men with ED were younger (56 ± 11), than those without ED (61±15). There was no statistically significant difference in the use of ARBs amongst hypertensive men with and without ED. Initial systolic and diastolic BP was significantly higher amongst men with ED. After pooling all outpatient clinic visits prior to and after the diagnosis of ED, BP control did improve mildly over the study period, but this was coupled with a decrease in BP medication use across all drug classes. Finally, there was a significant increase in hypertensive males who were on a either sildenafil or tadalafil after their ED diagnosis (Table 2). Conclusions This study elucidates several key points in conceptualizing the ED and hypertension problem and lays a foundation for the next phase in addressing critical gaps in care. This research further validates the underdiagnoses and thus undertreatment of ED overall, with a significantly lower than expected number of men with ED. Despite the well-established benefits of ARBs in hypertensive men with ED, we observed a trend of underutilization of this beneficial BP medication option. Improvements in BP control over time for hypertensive men with ED emphasize the role ED could play in hypertension management. Leveraging ARBs and education on the interplay of ED and hypertension could lead to improved rates and control of both diseases. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals, ForHims.

Blood Pressure, Hypertension, and Antihypertensive Medication Use and Risk of Total and Fatal Prostate Cancer in Black and White Men in the Atherosclerosis Risk in Communities (ARIC) Study

Blood Pressure, Hypertension, and Antihypertensive Medication Use and Risk of Total and Fatal Prostate Cancer in Black and White Men in the Atherosclerosis Risk in Communities (ARIC) Study

Abstract 17965: Hypertension Cascade and Social Determinants of Health in Women of Reproductive Age

Introduction: Studies examining hypertension (HTN) among women of reproductive age (18-44 years) are sparse. We sought to evaluate HTN awareness, diagnosis, treatment, and social determinants of health among women aged 18-44 years, in a national registry. Methods: We analyzed cross-sectional data from participants enrolled in the American Heart Association Research Goes Red (RGR) Registry, an online platform powered by Verily, who responded to the Project Baseline and RGR enrollment questionnaires. HTN outcomes were examined as self-report awareness of blood pressure (yes/no), HTN diagnosis (yes/no), and current HTN medication use (yes/no). Multinomial logistic regression models were used to assess the association between HTN cascade outcomes and social determinants of health, adjusting for age. Results: In a sample of 2,422 adult women (mean age 36 ± 6 years); non-Hispanic Black women were 3-times more likely have HTN (adjusted Odds ratio [aOR] 3.08; 95%CI 1.67-5.66) and be treated (aOR 3.21; 95%CI 1.67-6.03) compared to non-Hispanic White women ( Table ). The odds of HTN prevalence were higher (aOR 1.82; 95%CI 1.11-2.94) and HTN awareness lower (aOR 0.62; 95%CI 0.39-0.98) among Hispanic women compared to non-Hispanic White women. Compared to college graduates, high school graduates had 43% lower odds of HTN awareness, 85% high odds of HTN diagnoses. Persons with lower income were more likely to have HTN diagnoses and treatment and less likely to be aware. Conclusions: Social determinants of health including race, education and income were associated with HTN cascade outcomes. Tailored public health interventions and policies for improving HTN outcomes among women of reproductive age must address social needs.

Hubungan Tingkat Pengetahuan, Dukungan Keluarga, dan Peran Petugas Kesehatan Terhadap Kepatuhan Minum Obat pada Lansia Penderita Hipertensi di Puskesmas Kintamani V

Hypertension or better known as high blood pressure is often experienced by the elderly where blood pressure is above the normal limit of 120/80 mmHg. Adherence to taking medication in the elderly is very important because regular use of blood pressure medication can keep blood pressure under control and controlled. This study will be carried out at Kintamani V Health Center, because it is the highest hypertension sufferer after Bangli Health Center. This study aims to examine the relationship between the level of knowledge, family support, and the role of health workers on medication adherence in elderly people with hypertension at Kintamani V Health Center. The research method used is a type of quantitative research using a cross-sectional design. Data were collected using questionnaires.&#x0D; The results showed that the majority of respondents had a high level of knowledge (68.3%), as 51.7% of respondents received good family support, and the majority of respondents had the role of health workers as many as 73.3% of respondents. Statistical analysis showed that there was a significant relationship between the level of knowledge (p-value = 0.000), family support (p-value = 0.000) and the role of health workers (p-value = 0.000) with medication adherence in elderly people with hypertension. In conclusion, this study shows that there is a significant relationship between the level of knowledge, family support, and the role of health workers on medication adherence in elderly people with hypertension at Kintamani V Health Center.&#x0D;

Factors Influencing Postoperative Complications Following Minimally Invasive Ivor Lewis Esophagectomy: A Retrospective Cohort Study.

Complications arising following minimally invasive Ivor Lewis esophagectomy often result from inadequate enteral nutrition, highlighting the need for proactive measures to prevent such issues. One approach involves identifying high-risk cases prone to complications and implementing percutaneous endoscopic jejunostomy (PEJ) tube placement during esophageal resection to ensure timely enteral nutrition. In this single-center, retrospective cohort study, we examined patients who underwent minimally invasive esophagectomy for esophageal cancer at a high-volume center. The dataset encompassed demographic information, comorbidities, laboratory parameters, and intraoperative details. Our center utilized the EndoVac system pre-emptively to safeguard the anastomosis from harmful secretions and to enhance local oxygen partial pressure. All patients received pre-emptive EndoVac therapy and underwent esophagogastroduodenoscopy in the early postoperative days. The need for multiple postoperative EndoVac cycles indicated complications, including anastomotic insufficiency and subsequent requirement for a PEJ. The primary objectives were identifying predictive factors for anastomotic insufficiency and the need for multi-cycle EndoVac therapy, quantifying their effects, and assessing the likelihood of postoperative complications. 149 patients who underwent minimally invasive or hybrid Ivor Lewis esophagectomy were analyzed and 21 perioperative and demographic features were evaluated. Postoperative complications were associated with the body mass index (BMI) category, the use of blood pressure medication, and surgery duration. Anastomotic insufficiency as a specific complication was correlated with BMI and the Charlson comorbidity index. The odds ratio of being in the high-risk group significantly increased with higher BMI (OR = 1.074, p = 0.048) and longer surgery duration (OR = 1.005, p = 0.004). Based on our findings, high BMI and longer surgery duration are potential risk factors for postoperative complications following minimally invasive esophagectomy. Identifying such factors can aid in pre-emptively addressing nutritional challenges and reducing the incidence of complications in high-risk patients.

Blood pressure medication use and postpartum hospital readmission among preeclampsia patients

ABSTRACT Background Blood pressure medication is often prescribed to patients with preeclampsia. We are not aware of any study on readmission of those with preeclampsia to the hospital that considers blood pressure medication use or dose. Methods This was a retrospective study of 440 preeclampsia patients diagnosed during the antepartum, intrapartum, or immediate postpartum period prior to discharge from the hospital. The outcome was hospital readmission. One analysis compared blood pressure medication (oral labetalol and oral extended release nifedipine) use and nonuse. Another analysis compared low-dose and high-dose blood pressure medication use. Results Blood pressure medication use was not significantly associated with readmission (OR: 0.79, 95% CI: 0.39, 1.63, p = 0.53). Low dose of blood pressure medication was significantly associated with increased odds for readmission (OR: 2.29, 95% CI: 1.00, 5.25, p = 0.05). Conclusion We found that low dose of blood pressure medication was associated with increased odds for readmission within 6 weeks among those with preeclampsia. We recommend that clinicians balance the preference to reduce a blood pressure medication dose with the possible concern that too low a dose may place certain patients on track for hospital readmission after discharge.

Workplace Discrimination and Risk of Hypertension: Findings From a Prospective Cohort Study in the United States.

Background Mounting evidence has demonstrated a role of psychosocial stressors such as discrimination in hypertension and cardiovascular diseases. The objective of this study was to provide the first instance of research evidence examining prospective associations of workplace discrimination with onset of hypertension. Methods and Results Data were from MIDUS (Midlife in the United States), a prospective cohort study of adults in the United States. Baseline data were collected in 2004 to 2006, with an average 8-year follow-up period. Workers with self-reported hypertension at baseline were excluded, yielding a sample size of 1246 participants for the main analysis. Workplace discrimination was assessed using a validated 6-item instrument. During follow-up with 9923.17 person-years, 319 workers reported onset of hypertension, and incidence rates of hypertension were 25.90, 30.84, and 39.33 per 1000 person-years among participants with low, intermediate, and high levels of workplace discrimination, respectively. Cox proportional hazards regression analyses demonstrated that workers who experienced high exposure to workplace discrimination, compared with workers with low exposure, had a higher hazard of hypertension (adjusted hazard ratio, 1.54 [95% CI, 1.11-2.13]). Sensitivity analysis excluding more baseline hypertension cases based on additional information on blood pressure plus antihypertensive medication use (N=975) showed slightly stronger associations. A trend analysis showed an exposure-response association. Conclusions Workplace discrimination was prospectively associated with elevated risk of hypertension among US workers. The adverse impacts of discrimination on cardiovascular disease have major implications for workers' health and indicate a need for government and employer policy interventions addressing discrimination.

Abstract 11861: Reach Out Behavioral Intervention for Hypertension Initiated in the Emergency Department Connecting Multiple Health Systems: A Randomized Control Trial

Introduction: Hypertension (HTN) is the most important modifiable risk factor for cardiovascular disease and disproportionally impacts Black and low-income people. The emergency department (ED) cares for medically underserved populations, many of whom have HTN. Mobile health (mHealth) strategies initiated in safety-net EDs may be one approach to control blood pressure (BP) in a medically underserved population. Hypothesis: A multicomponent, ED initiated multiphase optimization strategy would identify intervention components that reduce BP at 12 months. Methods: Reach Out is a health system focused, health theory based, mHealth 2x2x2 factorial behavioral trial to reduce BP among hypertensive patients evaluated in a safety-net ED. Intervention components included: 1) healthy behavior text messaging (yes vs. no), 2) prompted BP self-monitoring (SMBP) (weekly vs. daily), and 3) facilitated primary care provider (PCP) appointment scheduling and transportation (yes vs. no). The primary outcome was change in systolic BP (SBP) from baseline to 12 months. We fit linear regression models accounting for intervention components, age, sex, race and prior use of BP medications. Results: We randomized 488 participants to the intervention and 211 (43%) participants completed 12-month follow-up. The mean age was 45.5 years, 61% were women, 54% were Black people, 22% did not have a PCP, 10% were uninsured, 21% lacked transportation, 21% did not have a previous diagnosis of HTN and 51% were not taking BP medications. SBP declined in all 8 groups. Overall, across all groups, SBP declined (-9.2 mmHg, 95%CI, -12.2 to -6.3) after 6 months and (-6.6 mmHg, -9.3 to -3.8) after 12 months. In fully adjusted models, no intervention components were associated with a change in systolic BP at 12 months. Conclusions: Higher intensity of the intervention components were not associated with greater reduction in BP. Overall, participants receiving lower intensity levels of our intervention had reductions of BP that were clinically relevant. Future studies should focus on further tailoring intervention components to the needs of participants.

Estimated Atherosclerotic Cardiovascular Disease Risk Score: An Automated Decision Aid for Statin Therapy

Estimation of atherosclerotic cardiovascular disease (ASCVD) risk is a key step in cardiovascular disease (CVD) prevention, but it requires entering additional risk factor information into a computer. We developed a simplified ASCVD risk score that can be automatically calculated by the clinical laboratory when a fasting standard lipid panel is reported. Equations for an estimated ASCVD (eASCVD) risk score were developed for 4 race/sex groups (non-Hispanic White/Black, men/women), using the following variables: total cholesterol, high-density lipoprotein cholesterol, triglycerides, and age. The eASCVD score was derived using regression analysis to yield similar risk estimates as the standard ASCVD risk equations for non-diabetic individuals not on lipid-lowering therapy in the National Health and Nutrition Examination Survey (NHANES) (n = 6027). At a cutpoint of 7.5%/10-year, the eASCVD risk score had an overall sensitivity of 69.1% and a specificity of 97.5% for identifying statin-eligible patients with at least intermediate risk based on the standard risk score. By using the sum of other risk factors present (systolic blood pressure >130 mmHg, blood pressure medication use, and cigarette use), the overall sensitivity of the eASCVD score improved to 93.7%, with a specificity of 92.3%. Furthermore, it showed 90% concordance with the standard risk score in predicting cardiovascular events in the Atherosclerosis Risk in Communities (ARIC) study (n = 14 742). Because the automated eASCVD risk score can be computed for all patients with a fasting standard lipid panel, it could be used as an adjunctive tool for the primary prevention of ASCVD and as a decision aid for statin therapy.

Oral Microbiome Is Associated With Incident Hypertension Among Postmenopausal Women.

BackgroundOral microbiota are thought to influence blood pressure (BP) regulation. However, epidemiological data supporting this hypothesis are limited. We examined associations between oral microbiota, BP, and incident hypertension in postmenopausal women.Methods and ResultsBaseline (1997–2001) examinations were completed on 1215 women (mean age, 63 years) during which subgingival plaque was collected, BP was measured, and medical and lifestyle histories and medication inventory were obtained. Microbiome composition of subgingival plaque was measured using 16S ribosomal RNA gene amplicon sequencing. Baseline measured BP was defined as normotensive (systolic <120 mm Hg and diastolic <80 mm Hg, no BP medication use; n=429); elevated (systolic ≥120 mm Hg or diastolic ≥80 mm Hg, no medication use; n=306); or prevalent treated hypertension (history of physician diagnosis treated with medications; n=480). Incident hypertension (375 cases among 735 without baseline treated hypertension) was defined as newly physician‐diagnosed hypertension treated with medication reported on annual health surveys (mean follow‐up, 10.4 years). Cross‐sectional analysis identified 47 bacterial species (of 245 total) that differed significantly according to baseline BP status (P<0.05). Prospective analysis identified 15 baseline bacterial species significantly (P<0.05) associated with incident hypertension: 10 positively (age‐adjusted hazard ratios [HRs], 1.10–1.16 per SD in bacterial abundance) and 5 inversely (HRs, 0.82–0.91) associated. Associations were materially unchanged after further adjustment for demographic, clinical, and lifestyle factors; were similar when analysis was restricted to the normotensive group; and were of consistent magnitudes between strata of baseline age, smoking, body mass index, and BP categories.ConclusionsSpecific oral bacteria are associated with baseline BP status and risk of hypertension development among postmenopausal women. Research to confirm these observations and elucidate mechanisms is needed.

Assessing proximate intermediates between ambient temperature, hospital admissions, and mortality in hemodialysis patients.

Typical thermoregulatory responses to elevated temperatures among healthy individuals include reduced blood pressure and perspiration. Individuals with end-stage kidney disease (ESKD) are susceptible to systemic fluctuations caused by ambient temperature changes that may increase morbidity and mortality. We investigated whether pre-dialysis systolic blood pressure (preSBP) and interdialytic weight gain (IDWG) can independently mediate the association between ambient temperature, all-cause hospital admissions (ACHA), and all-cause mortality (ACM). The study population consisted of ESKD patients receiving hemodialysis treatments at Fresenius Medical Care facilities in Philadelphia County, PA, from 2011 to 2019 (n=1981). Within a time-to-event framework, we estimated the association between daily maximum dry-bulb temperature (TMAX) and, as separate models, ACHA and ACM during warmer calendar months. Clinically measured preSBP and IDWG responses to temperature increases were estimated using linear mixed effect models. We employed the difference (c-c') method to decompose total effect models for ACHA and ACM using preSBP and IDWG as time-dependent mediators. Covariate adjustments for exposure-mediator and total and direct effect models include age, race, ethnicity, blood pressure medication use, treatment location, preSBP, and IDWG. We considered lags up to two days for exposure and 1-day lag for mediator variables (Lag 2-Lag 1) to assure temporality between exposure-outcome models. Sensitivity analyses for 2-day (Lag 2-only) and 1-day (Lag 1-only) lag structures were also conducted. Based on Lag 2- Lag 1 temporal ordering, 1°C increase in daily TMAX was associated with increased hazard of ACHA by 1.4% (adjusted hazard ratio (HR), 1.014; 95% confidence interval, 1.007-1.021) and ACM 7.5% (adjusted HR, 1.075, 1.050-1.100). Short-term lag exposures to 1°C increase in temperature predicted mean reductions in IDWG and preSBP by 0.013-0.015% and 0.168-0.229mmHg, respectively. Mediation analysis for ACHA identified significant indirect effects for all three studied pathways (preSBP, IDWG, and preSBP+IDWG) and significant indirect effects for IDWG and conjoined preSBP+IDWG pathways for ACM. Of note, only 1.03% of the association between temperature and ACM was mediated through preSBP. The mechanistic path for IDWG, independent of preSBP, demonstrated inconsistent mediation and, consequently, potential suppression effects in ACHA (-15.5%) and ACM (-6.3%) based on combined pathway models. Proportion mediated estimates from preSBP+IDWG pathways achieved 2.2% and 0.3% in combined pathway analysis for ACHA and ACM outcomes, respectively. Lag 2 discrete-time ACM mediation models exhibited consistent mediation for all three pathways suggesting that 2-day lag in IDWG and preSBP responses can explain 2.11% and 4.41% of total effect association between temperature and mortality, respectively. We corroborated the previously reported association between ambient temperature, ACHA and ACM. Our results foster the understanding of potential physiological linkages that may explain or suppress temperature-driven hospital admissions and mortality risks. Of note, concomitant changes in preSBP and IDWG may have little intermediary effect when analyzed in combined pathway models. These findings advance our assessment of candidate interventions to reduce the impact of outdoor temperature change on ESKD patients.

Abstract P149: The Relationship Between Daytime Sleepiness, Exhaustion, Fatigue, And Arterial Stiffness. The Atherosclerosis Risk In Communities (ARIC) Study

Background: Excessive Daytime Sleepiness (EDS) is positively associated with the risk of cardiovascular disease (CVD) events and CVD mortality. However, the association between EDS and subclinical markers of CVD, such as arterial stiffness, is not fully understood and could have implications for CVD screening. EDS is multifactorial in origin, thus we incorporated measures of exhaustion and fatigue in order to comprehensively assess the association of lethargy and central artery stiffness. We examined the separate relationships between EDS, exhaustion, fatigue, and aortic stiffness via carotid-femoral pulse wave velocity (cfPWV) in a large population-based study. Methods: A cross-sectional analysis of ARIC Study participants (n=2500, mean age: 79.7, 57.2% female) who underwent arterial stiffness measurements (cfPWV) and completed the Epworth Sleep Scale (ESS) questionnaire in 2016-2019. EDS was defined as ESS 11. Exhaustion was derived from the Center for Epidemiological Study’s Depression (CES-D) scale, with positive exhaustion corresponding to increased effort in daily activities and noticeable difficulty in getting “going’. Fatigue was assessed at annual follow up calls in 2012-2013 and calculated as a summary score with participants responses about feeling tired in various scenarios in the past 7 days noted as a numeric value (1-5: never, rarely, sometimes, often or always). We used multivariable linear regression to estimate the association between ESS, exhaustion, and fatigue with cfPWV, adjusting for age, race-study center, body mass index, diabetes, heart rate, mean arterial pressure, and blood-pressure medication use. We evaluated potential effect modification by race, sex, diabetes, and hypertension. Results are presented as unstandardized beta coefficients (β) and 95% confidence intervals (CI). Results: A total of 14.2% participants reported EDS, 17.2% reported exhaustion, and the average fatigue score was 8.0. ESS was not associated with cfPWV when adjusting for covariates (β; 95% CI: -1.4; -4.7, 1.9). Similarly, EDS was not associated with cfPWV (β; 95% CI: -4.9; -40.4, 30.6), nor was there an association between ESS quartiles and cfPWV. However, both exhaustion (β; 95% CI: 40.4; 7.8, 73.0) and fatigue (β; 95% CI: 5.4; 0.6, 10.3) were positively associated with cfPWV after adjusting for covariates. There was no evidence of effect modification by race, sex, diabetes, or hypertension. Conclusion: EDS was not associated with arterial stiffness. A (positive) association was observed for both exhaustion and fatigue with cfPWV, suggesting a need for further investigation of fatigue related conditions and arterial stiffness in older adults.

Abstract WMP98: Association Between Serotonin Receptor Antidepressant Use And 90-day Mortality After Acute Ischemic Stroke: Propensity Score Analysis Of 10-year Real-world Data

Introduction: Post-stroke depression is associated with higher mortality. Unfortunately, the use of antidepressants (AD) as stroke treatment adjuvants has not been established due to a lack of placebo controls and concerns that selective serotonin reuptake inhibitor (SSRI) initiation after stroke may increase mortality. Methods: Using ICD-10 diagnosis/procedure, procedural terminology codes and medications, we identified index ischemic strokes (IS) with and without AD use (SSRIs, Serotonin Antagonist Reuptake Inhibitors, Serotonin Norepinephrine Reuptake Inhibitors) 1 year pre and post event, using deidentified pooled data from a 50 healthcare organization network (8/2011-7/2021). Non adult (&lt;18 yrs) and intracerebral hemorrhage were excluded. AD and no AD patients were propensity score (PS) matched for demographic, comorbidity and clinical variables. Standardized mean difference (SMD) assessed match adequacy. Absolute Risk Difference (RD) and Risk Ratios (RR) with 95% Confidence Intervals (CI) were reported for 90-day mortality in the PS-matched sample. Kaplan-Meier (KM) analysis with log rank test (LRT) was performed. Results: Among 910,749 patients with an index IS, 634,599 met the inclusion criteria, of whom 136,219 (21.5%) had AD use before and after IS. Significant pre-match differences in demographic and clinical parameters were observed between the AD and no-AD groups (table). PS algorithm generated a 1:1 optimally matched sample (95% SMD reduction) of 78,815 AD and no AD IS patients each, with significant covariate differences for female sex, mood disorder diagnosis, systolic blood pressure and cardiovascular medication use (table). In the matched sample, the 90-day mortality risk post-IS was significantly lower in the AD group. RD: -3.4%, RR(CI) 0.54(0.52-0.56). LRT P&lt;0.0001, KM curve shown in the graphic. Conclusion: AD utilization before and after IS demonstrates significantly lower 90-day mortality in real world multicenter data.

Frailty and cardiovascular mortality in more than 3 million US Veterans.

Frailty is associated with an increased risk of all-cause mortality and cardiovascular (CV) events. Limited data exist from the modern era of CV prevention on the relationship between frailty and CV mortality. We hypothesized that frailty is associated with an increased risk of CV mortality. All US Veterans aged ≥65 years who were regular users of Veteran Affairs care from 2002 to 2017 were included. Frailty was defined using a 31-item previously validated frailty index, ranging from 0 to 1. The primary outcome was CV mortality with secondary analyses examining the relationship between frailty and CV events (myocardial infarction, stroke, revascularization). Survival analysis models were adjusted for age, sex, ethnicity, geographic region, smoking, hyperlipidaemia, statin use, and blood pressure medication use. There were 3 068 439 US Veterans included in the analysis. Mean age was 74.1 ± 5.8 years in 2002, 76.0 ± 8.3 years in 2014, 98% male, and 87.5% White. In 2002, the median (interquartile range) frailty score was 0.16 (0.10-0.23). This increased and stabilized to 0.19 (0.10-0.32) for 2006-14. The presence of frailty was associated with an increased risk of CV mortality at every stage of frailty. Frailty was associated with an increased risk of myocardial infarction and stroke, but not revascularization. In this population, both the presence and severity of frailty are tightly correlated with CV death, independent of underlying CV disease. This study is the largest and most contemporary evaluation of the relationship between frailty and CV mortality to date. Further work is needed to understand how this risk can be diminished. Can an electronic frailty index identify adults aged 65 and older who are at risk of CV mortality and major CV events? Among 3 068 439 US Veterans aged 65 and older, frailty was associated with an increased risk of CV mortality at every level of frailty. Frailty was also associated with an increased risk of myocardial infarction and stroke, but not revascularization. Both the presence and severity of frailty are associated with CV mortality and major CV events, independent of underlying CV disease.