Well-controlled Blood Pressure Research Articles

#1342 Updated results from the RUBY-3 study of povetacicept, an enhanced dual BAFF/APRIL antagonist, in autoantibody-associated glomerulonephritis

Abstract Background and Aims Inhibition of BAFF and/or APRIL has shown promise in IgA nephropathy (IgAN), systemic lupus erythematosus (SLE), lupus nephritis (LN), and primary membranous nephropathy (pMN), and has the potential to exert a disease-modifying effect. Povetacicept (ALPN-303) is an Fc fusion protein of a variant TACI domain engineered for more potent dual BAFF/APRIL inhibition than wild-type TACI or anti-BAFF or anti-APRIL antibodies. In a previous report, povetacicept 80 mg every 4 weeks was initially well tolerated and demonstrated promising, clinically meaningful reductions in urine protein to creatinine ratio (UPCR) and Gd-IgA1 in participants with IgAN (Tumlin J, et al. Poster TH-PO1125 presented at ASN 2023). Updated data are reported here. Method RUBY-3 is an open-label, multiple ascending dose, phase 1b/2a study of povetacicept 80 or 240 mg administered subcutaneously once every 4 weeks. Eligible participants are aged ≥18 years with biopsy-confirmed IgAN, LN, or pMN and on maximally tolerated ACE inhibitor/ARB therapy, with well-controlled blood pressure, and disease-specific immunosuppressive therapy where applicable. The primary objective is safety; secondary objectives include pharmacokinetics, pharmacodynamics, immunogenicity, biomarkers, and efficacy. Results As of 1 Dec 2023, 12 participants with IgAN have enrolled and received povetacicept 80 mg, with 7 (58%) having received ≥24 weeks of treatment. Povetacicept continues to be well tolerated, with the majority of treatment-emergent adverse events being of low grade. There have been no incidences of severe hypogammaglobulinemia (IgG <3 g/L) or severe infections. Povetacicept 80 mg was associated with a UPCR reduction of 52.6% at 24 weeks (n = 7). Reductions in Gd-IgA1, stable renal function, and pharmacodynamically expected decreases in immunoglobulin levels were also observed. Additional results from the 80 mg cohort with longer duration of follow-up, as well as initial results from the 240 mg dosing cohort, are planned to be presented. Conclusion Povetacicept remains well tolerated with multiple dosing and continues to demonstrate very promising activity in IgAN, strongly supporting further study in IgAN as well as other glomerulonephritis and autoantibody-associated diseases.

Home blood pressure telemonitoring in the Netherlands: a pilot study in GP practices

BackgroundHome Blood Pressure Telemonitoring (HBPT) has been proposed to improve drug adherence, blood pressure control, and efficient care delivery in patients with hypertension. Its adoption in GP practices however remains low. In this pilot study we evaluated barriers and facilitators for successful implementation, patient satisfaction, clinical effectiveness, and efficiency for a HBPT project in Dutch GP practices by means of the Quadruple Aim Model.MethodsGP practices included patients with hypertension that were part of their regular cardiovascular disease program. We conducted semi-structured interviews at 3- and 6-months to identify barriers and facilitators for successful implementation. Patient satisfaction was measured with Telehealth Usability (TUQ)—and Mhealth App Usability (MAUQ) Questionnaires. A SPRINT-protocol blood pressure measurement was performed after the pilot project to assess clinical effectiveness. Efficiency data were collected on the number of registered consultations and practice measurements performed during the 6-month project.ResultsThree GP practices included 19 patients. Barriers for implementation were a lack of a reimbursement structure, lack of information technology (IT) system integration and increased experienced workload when using HBPT. Facilitators included the positive effects on blood pressure control, increased sense of safety for patient and care provider, and increased disease-insight. Median satisfaction scores for TUQ and MAUQ questionnaires (scale 1–7) were 6 (IQR 5–6) and 6 (IQR 5–7). At baseline, 16% of the patients had a blood pressure < 140/90 mmHg. Based on the performed SPRINT measurements, 68% had a well-controlled blood pressure (< 140/90 mmHg) after 6 months. Average blood pressure improved from 151/89 mmHg to 132/81 mmHg (p = < 0.05). On average, one monthly contact moment related to hypertension between patient and GP practice was registered.ConclusionsWe found positive results following the introduction of HBPT in GP practices on clinical outcomes and patients’ satisfaction, however for large-scale implementation improvements with regards to organizational efficiency and a clear reimbursement structure are needed.

Primary Hyperaldosteronism: A Rare Potential Risk Factor for Acute Aortic Dissection, an Interesting Case Report

Primary hyperaldosteronism is overproduction of aldosterone from the adrenal cortex with wide electrolyte imbalance and cardiovascular complications like aortic dissection. While the association between primary hyperaldosteronism and aortic dissection has been a subject of interest, the exact relationship and potential causative mechanisms remain unclear. We present here a 51-year-old male with no significant past medical history who came to the emergency department with severe chest pain, sudden-onset radiating to the back, shortness of breath (SOB), and diaphoresis. A chest-to-abdominal Computed Tomography (CT) angiography showed a small tear in the inner lining of the aortic arch, just below the left subclavian artery. The descending aorta had a large mural thrombosis up to the T7 level. The pressure was controlled with intravenous drugs, and then oral antihypertensive drugs and electrolytes were corrected. The patient was recommended to go outside where cardiovascular surgery is available and is now doing well in cardiology outpatient follow-up with well-controlled blood pressure.

Abstract WMP104: Influence of Living Arrangements and Within Household Communications on Blood Pressure Control Among Stroke Patients

Introduction: Social support plays a vital role in shaping health behaviors and may impact disease outcomes such as blood pressure (BP) control. We aim to study the association between household living arrangements and BP control for stroke patients, over time and by household communication type. Methods: Discharge Educational Strategies for Reduction of Vascular Events (DESERVE), which aimed to improve post-stroke BP, randomized stroke survivors to skills-based intervention or usual care. Baseline, 6- and 12-month BP was measured according to AHA guidelines with BP control defined as no hypertension present or if follow-up BP was within normal range. We grouped baseline household arrangements as nuclear, multigeneration, spouse, alone, or other and household communication as engaging in conversations about stroke or not. We estimated adjusted odds of BP control by living arrangements and within household communication controlled for age, gender, race/ethnicity, education, Medicaid, and intervention status. Results: Among 540 participants with baseline BP data (72% with hypertension), 361 and 478 had 6- and 12-month data, respectively. Most patients lived in nuclear households (31%), followed by living alone (25%). About 36% participants achieved well-controlled BP after 6 months, increasing to 37% after 12 months. Living in a nuclear arrangement was associated with 2.59 (95% CI: 1.13-5.94) times higher odds of BP control at 6 months. Among participants with multigenerational families, those engaged in conversations about stroke within household showed 5.52 (1.25-24.3) times higher odds of BP control at 12 months. Conclusions: Our findings suggest that living arrangements are positively related to BP control outcomes in stroke patients, and communication with household members on health topics modifies this association. Within household social support to stroke patients may offer an opportunity for targeted secondary stroke prevention strategies.

Legacy benefits of blood pressure treatment on cardiovascular events are primarily mediated by improved blood pressure variability: the ASCOT trial.

Visit-to-visit systolic blood pressure variability (BPV) is an important predictor of cardiovascular (CV) outcomes. The long-term effect of a period of blood pressure (BP) control, but with differential BPV, is uncertain. Morbidity and mortality follow-up of UK participants in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure-Lowering Arm has been extended for up to 21 years to determine the CV impact of mean systolic blood pressure (SBP) control and BPV during the trial, and amongst those allocated to amlodipine- and atenolol-based treatment. Eight thousand five hundred and eighty hypertensive participants (4305 assigned to amlodipine ± perindopril-based and 4275 to atenolol ± diuretic-based treatment during the in-trial period (median 5.5 years) were followed for up to 21 years (median 17.4 years), using linked hospital and mortality records. A subgroup of participants (n = 2156) was followed up 6 years after the trial closure with a self-administered questionnaire and a clinic visit. In-trial mean SBP and standard deviation of visit-to-visit SBP as a measure of BPV, were measured using >100 000 BP measurements. Cox proportional hazard models were used to estimate the risk [hazard ratios (HRs)], associated with (i) mean with SBP and BPV during the in-trial period, for the CV endpoints occurring after the end of the trial and (ii) randomly assigned treatment to events following randomization, for the first occurrence of pre-specified CV outcomes. Using BP data from the in-trial period, in the post-trial period, although mean SBP was a predictor of CV outcomes {HR per 10 mmHg, 1.14 [95% confidence interval (CI) 1.10-1.17], P < .001}, systolic BPV independent of mean SBP was a strong predictor of CV events [HR per 5 mmHg 1.22 (95% CI 1.18-1.26), P < .001] and predicted events even in participants with well-controlled BP. During 21-year follow-up, those on amlodipine-based compared with atenolol-based in-trial treatment had significantly reduced risk of stroke [HR 0.82 (95% CI 0.72-0.93), P = .003], total CV events [HR 0.93 (95% CI 0.88-0.98), P = .008], total coronary events [HR 0.92 (95% CI 0.86-0.99), P = .024], and atrial fibrillation [HR 0.91 (95% CI 0.83-0.99), P = .030], with weaker evidence of a difference in CV mortality [HR 0.91 (95% CI 0.82-1.01), P = .073]. There was no significant difference in the incidence of non-fatal myocardial infarction and fatal coronary heart disease, heart failure, and all-cause mortality. Systolic BPV is a strong predictor of CV outcome, even in those with controlled SBP. The long-term benefits of amlodipine-based treatment compared with atenolol-based treatment in reducing CV events appear to be primarily mediated by an effect on systolic BPV during the trial period.

Carotid Intima-Media Thickness and Improved Stroke Risk Assessment in Hypertensive Black Adults.

We aim to determine the added value of carotid intima-media thickness (cIMT) in stroke risk assessment for hypertensive Black adults. We examined 1,647 participants with hypertension without a history of cardiovascular (CV) disease, from the Jackson Heart Study. Cox regression analysis estimated hazard ratios (HRs) for incident stroke per standard deviation increase in cIMT and quartiles while adjusting for baseline variables. We then evaluated the predictive capacity of cIMT when added to the pool cohort equations (PCEs). The mean age at baseline was 57 ± 10 years. Each standard deviation increase in cIMT (0.17 mm) was associated with approximately 30% higher risk of stroke (HR 1.27, 95% confidence interval: 1.08-1.49). Notably, cIMT proved valuable in identifying residual stroke risk among participants with well-controlled blood pressure, showing up to a 56% increase in the odds of stroke for each 0.17 mm increase in cIMT among those with systolic blood pressure <120 mm Hg. Additionally, the addition of cIMT to the PCE resulted in the reclassification of 58% of low to borderline risk participants with stroke to a higher-risk category and 28% without stroke to a lower-risk category, leading to a significant net reclassification improvement of 0.22 (0.10-0.30). In this community-based cohort of middle-aged Black adults with hypertension and no history of CV disease at baseline, cIMT is significantly associated with incident stroke and enhances stroke risk stratification.

Losartan: A Pharmacotherapy in Cardiovascular Disease

Background: A recently published article confirmed that in 2019, around 523 million people suffered from cardiovascular disease (including 18.6 million deaths) worldwide. Losartan, a drug, was patented 35 years ago and approved for medical use in the United States in 1995 (28 years ago). As an effective treatment for hypertension, losartan blocks the interaction of angiotensin II with its receptor by inhibiting the renin-angiotensin system. Objective: This article aims to review the available literature and recent studies demonstrating the efficacy, safety, mechanism of action and drug-drug interactions of losartan in cardiovascular disease. Methods: This is a focused literature review with the keywords relevant to the terms performed in PubMed, Scopus and Web of Science through May 28, 2023, according to the PRISMA guidelines. Based on the PICO standard format, fifty-two relevant in-depth consequent guide approaches and evidence-based choices were selected associated with a knowledgeable collection of current, high-quality manuscripts. Results: After oral administration, time to reach maximum concentration is about 1-2 hours. With a 78% binding to protein, it has a bioavailability of 25-35%. Losartan is not removed by hemodialysis. For the full effect to occur, it may take up to 6 weeks. The drug is mainly prescribed for patients with high blood pressure, diabetic nephropathy, hypertension and left ventricular hypertrophy. The publication reported higher drug exposures and adverse reactions in women than men with antihypertensive medications. Losartan could improve changes in gut microbiota that might be associated with hypertension. In the high-risk group of renal transplant recipients with arterial hypertension, research reported well-controlled blood pressure with losartan monotherapy. Conclusion: In addition to the major losartan interactions with captopril, enalapril, lisinopril, and lithium, there are moderate interactions with aspirin, pregabalin, alprazolam, amitriptyline, baclofen, betamethasone, buspirone. Muscle cramps, respiratory infection, cough, hyperkalemia, anemia and stuffy nose are the main reported side effects. As polypharmacy could hide pharmacokinetics interaction due to cytochrome P450, therefore, the combination of losartan with drugs such as phenobarbital, rifampin or fluconazole needs vigilant attention regarding therapeutic drug monitoring.

Different Home Blood Pressure Thresholds to Predict Perfect 24-Hour Ambulatory Blood Pressure Control in Treated Hypertension Based on an "All-in-One" Device.

Home blood pressure (BP) is an important component of digital strategies for hypertension management. However, no studies have used the same device to investigate 24-hour BP control status in relation to different home BP control thresholds. Participants in the general practitioner-based, multicenter HI-JAMP study (Home-Activity Information and Communication Technology-Based Japan Ambulatory Blood Pressure Monitoring Prospective) underwent office BP measurement, then 24-hour ambulatory BP monitoring, then home BP monitoring for 5 days. A validated all-in-one BP monitoring device was used to measure office, home, and ambulatory BP. Baseline data were used to investigate ambulatory BP control status in individuals with well-controlled home BP based on the different guideline thresholds (125/75 mm Hg, 130/80 mm Hg, and 135/85 mm Hg). Data from 2269 patients were analyzed. For individuals with well-controlled home BP <135/85 mm Hg (59.5% of the total population), the prevalence of uncontrolled 24-hour (≥130/80 mm Hg), daytime (≥135/85 mm Hg), and nighttime ambulatory BP (≥120/70 mm Hg) was 19.9%, 18.5%, and 33.6%, respectively. Corresponding prevalence rates in the 42.7% of participants with well-controlled home BP <130/80 mm Hg were 13.4%, 12.9%, and 26.0%, and when well-controlled home BP was strictly defined as <125/75 mm Hg (23.9% of the population), prevalence of rates of uncontrolled 24-hour, daytime, and nighttime ambulatory BP were 7.0%, 9.0%, and 15.3%, respectively. Home BP control status defined using different thresholds could predict 24-hour ambulatory BP control status in treated hypertension. One-third of individuals still had uncontrolled nocturnal hypertension when home BP was controlled to <135/85 mm Hg, but ambulatory BP was quite well controlled when home BP was <125/75 mm Hg.

Impact of Preprocedural Diastolic Blood Pressure on Outcomes in Patients Undergoing Percutaneous Coronary Intervention.

Recent US guidelines recommend lower blood pressure (BP) targets in hypertension, but aggressive lowering of diastolic BP (DBP) can occur at the expense of myocardial perfusion, particularly in the presence of coronary artery disease. We sought to establish the long-term impact of low DBP on mortality among patients undergoing percutaneous coronary intervention with well-controlled systolic BP. We analyzed data from 12 965 patients undergoing percutaneous coronary intervention between 2009 and 2018 from the Melbourne Interventional Group registry who had a preprocedural systolic BP of ≤140 mm Hg. Patients with ST-elevation myocardial infarction, cardiogenic shock, and out-of-hospital arrest were excluded. Patients were stratified into 5 groups according to preprocedural DBP: <50, 50 to 59, 60 to 69, 70 to 79, and ≥80 mm Hg. The primary outcome was long-term, all-cause mortality. Mortality data were derived from the Australian National Death Index. Patients with DBP<50 mm Hg were older with higher rates of diabetes, renal impairment, prior myocardial infarction, left ventricular dysfunction, peripheral and cerebrovascular disease (all P<0.001). Patients with DBP<50 mm Hg had higher 30-day (2.5% versus 0.7% for the other 4 quintiles; P<0.0001) and long-term mortality (median, 3.6 years; follow-up, 29% versus 11%; P<0.0001). Cox-regression analysis revealed that DBP<50 mm Hg was an independent predictor of long-term mortality (hazard ratio [HR], 1.55 [95% CI, 1.20-2.00]; P=0.001). In patients with well-controlled systolic BP undergoing percutaneous coronary intervention, low DBP (<50 mm Hg) is an independent predictor of long-term mortality.

Management of the 'wicked' combination of heart failure and chronic kidney disease in the patient with diabetes.

Patients with type 2 diabetes are at an increased risk of developing heart failure and chronic kidney disease. The presence of these co-morbidities substantially increases the risk of morbidity as well as mortality in patients with diabetes. The clinical focus has historically centred around reducing the risk of cardiovascular disease by targeting hyperglycaemia, hyperlipidaemia and hypertension. Nonetheless, patients with type 2 diabetes who have well-controlled blood glucose, blood pressure and lipid levels may still go on to develop heart failure, kidney disease or both. Major diabetes and cardiovascular societies are now recommending the use of treatments such as sodium-glucose co-transporter-2 inhibitors and non-steroidal mineralocorticoid receptor antagonists, in addition to currently recommended therapies, to promote cardiorenal protection through alternative pathways as early as possible in individuals with diabetes and cardiorenal manifestations. This review examines the most recent recommendations for managing the risk of cardiorenal progression in patients with type 2 diabetes.

Korelasi Tingkat Pengetahuan Terhadap Keberhasilan Terapi Pasien Hipertensi di Puskemas

Knowledge can affect the success of therapeutic outcomes in hypertensive patients. Blood pressure must be controlled to prevent risk factors for other cardiovascular diseases. The purpose of this study was to analyze the relationship between knowledge of patients with hypertension and the success of therapy outcomes that showed controlled blood pressure. This observational cross-sectional study was conducted from March to June 2021 at Tangerang District Health Centers. A sample of 85 outpatients with hypertension was administered the HK-LS questionnaire to measure their level of knowledge, while the results of therapeutic outcomes were measured using blood pressure. The results showed that 60% of patients had intermediate knowledge and only 28.24% of the subjects had well-controlled blood pressure. There was a correlation between knowledge and therapy outcomes (p&lt;0.05) with coef. correlation was -0.336, means a weak and inverse correlation. Comorbidity and sex were significantly correlated with knowledge (p&lt;0,05). The level of knowledge needs to be improved to decrease the number of comorbidities or risk of complications to raise the goal of therapy.

CLINICAL SIGNIFICANCE OF ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY AS A POTENTIAL INDICATOR OF MASKED HYPERTENSION AMONG THE KOREAN ELDERLY

Objective: Although masked hypertension links to adverse cardiovascular outcomes, it is challenging to distinguish individuals with masked hypertension. Studies have demonstrated a significant association between left ventricular hypertrophy (LVH) and masked hypertension. However, it remains unclear whether electrocardiographic LVH has the predictability for masked hypertension. Design and method: The study participants were 511 Korean elderly with well-controlled blood pressure (BP) or normotension who underwent electrocardiography and ambulatory blood pressure monitoring (ABPM). We categorized them into two groups by presence or absence of electrocardiographic LVH. We conducted Pearson correlation analysis (beta coefficient [95% confidence interval] and logistic regression analysis (odd ratio (OR) [95% CI]) to evaluate the association of electrocardiographic LVH with components of ABPM. The area under the receiver operator curve (AUC) was calculated to assess the predictability of electrocardiographic LVH for 24-hour average masked hypertension. Results: Electrocardiographic LVH significantly correlated with 24-hour mean systolic blood pressure (SBP) (5.83 [2.16-9.51]), daytime SBP (5.0 [1.27-8.72]), and nighttime SBP (7.89 [3.49-12.30]). Electrocardiographic LVH showed the increased OR for masked hypertension in 24-hour average BP (2.18 [1.17-4.07]), in daytime average BP (2.03 [1.09-3.79]), and nighttime average BP (1.83 [0.86-3.88]). The receiver operating curve indicated the significant predictability of electrocardiographic LVH for 24-hour average masked hypertension (area under the curve: 0.706 [0.604-0.809]). Conclusions: Electrocardiographic LVH is potentially effective in distinguishing individuals with masked hypertension.

Newly diagnosed PRES in a sickle cell diseased patient: a case report.

Sickle cell disease has many clinical impacts, one such rare finding is systemic hypertension although the literature to support it is debatable. Hypertension along with other key components of sickle cell pathology is one of the reversible causes of posterior reversible encephalopathy syndrome (PRES). Although its triggering factors and pathophysiology is not well documented, hypertension is one of the easily reversible causes of PRES. A well-controlled blood pressure is an aim for reversibility and future recurrence of PRES. However, the addition of other medications like anticonvulsants (levetiracetam and lacosamide) to prevent seizures as a consequence of PRES still remains debatable. Considering the case reported below, the addition of Hydroxyurea to the treatment can be another cause of the recurrence of PRES and needs to be weighed for its risks and benefits.

Activation of the Vascular Smooth Muscle GLP-1/NCX1 Pathway Regulates Cytoplasmic Ca2+ Homeostasis and Improves Blood Pressure Variability in Hypertension

Background: Hypertension is the most common cardiovascular disease, and its main harmful effect is chronic damage to target organs. In some patients with well-controlled blood pressure, target organ damage still occurs. GLP-1 agonists have significant cardiovascular benefits, but their antihypertensive effect is limited. The cardiovascular protective effect of GLP-1 is worth studying. Methods: The ambulatory blood pressure of spontaneously hypertensive rats (SHRs) was detected by ambulatory blood pressure monitoring, and the characteristics of blood pressure and the effect of subcutaneous intervention with a GLP-1R agonist on blood pressure were observed. To explore the mechanism of the cardiovascular benefit of GLP-1R agonists in SHRs, we evaluated the effects of GLP-1R agonists on vasomotor function and calcium homeostasis in vascular smooth muscle cells (VSMCs) in vitro. Results: Although the blood pressure of SHRs was significantly higher than that of WKY rats, the blood pressure variability of SHRs was also significantly higher than that of the control group. The GLP-1R agonist significantly reduced blood pressure variability in SHRs, but the antihypertensive effect was not obvious. GLP-1R agonists can significantly improve the cytoplasmic calcium overload of VSMCs in SHRs by upregulating the expression of NCX1, improving the systolic and diastolic functions of arterioles, and reducing blood pressure variability. Conclusions: Taken together, these results provide evidence that GLP-1R agonists improved VSMC cytoplasmic Ca2+ homeostasis through upregulated NCX1 expression in SHRs, which plays a key role in blood pressure stability and broad cardiovascular benefits.

Blood pressure goals in chronic kidney disease : What is the optimal blood pressure for inhibition of progression and risk reduction?

Well-controlled blood pressure is an essential factor in inhibiting the progression of renal failure and also in controlling cardiovascular mortality and morbidity. For decades there has been an intensive search for the optimal blood pressure target values in order to reduce the progression of renal insufficiency to aphysiological level as far as possible. In the last few decades, very different target blood pressure values have been defined, which time and again contribute more to confusion than clarity in everyday clinical practice. The present work considers the relevant guidelines; it analyzes the basis on which the sometimes widely varying guidelines were created. All guidelines agree that blood pressure control with atarget of less than 140 mm Hg systolic should be achieved in patients with impaired renal function. The European guidelines recommend aiming for atarget of 130-140 mm Hg systolic. The American guidelines go one step further and specify asystolic blood pressure target of less than 130 mm Hg. The Kidney Disease: Improving Global Outcomes (KDIGO) organization is even more ambitious. It recommends ablood pressure target of less than 120 mm Hg, whereby in contrast to the European and American guidelines, the level of evidence required in the guidelines is considered to be very weak and the goals should also be achieved if automated, standardized blood pressure measurement is carried out, which is rarely available in everyday practice and may not be feasible. The present overview discusses the arguments for lowering blood pressure with different goals and presents the evidence. Of course, the blood pressure goals in the presence or absence of albuminuria should also be considered.

Knowledge, attitude, and practices of high-blood-pressure patients attended at Mutare city clinics in Manicaland province in 2022–2023

Objective: The low socioeconomic status of Mutare city patients, shortage of medical staff, and lack of supported hypertension programs expose clients to poor or lack of counseling services; hence, the present study aimed to investigate the knowledge, attitude, and practices among those hypertensive patients. Materials and methods: A cross-sectional correlational investigation was conducted to find the amount of knowledge about hypertension on hypertensive clients and the association between hypertension knowledge and good blood pressure management. All the hypertensive patients who were diagnosed at least 2 months prior to the study were included. A sample of 88 participants was used for this study. Convenience quota sampling was used where every clinic out of the 8 clinics should have supplied 11 hypertensive clients. Data were collected using a structured interviewer administered questionnaire. Logistics regression analysis was done, and odds ratio was used to assess the relationship of variables. The statistical level of significance was set at P &lt; 0.05. Discussion and results: A total of 80% of the participants were concluded to have good hypertension knowledge. Those who had at least a discussion with a health worker were 9.31 (p-value 0.005) folds more prone to reflect good knowledge than patients who never had a discussion about hypertension. Those who were 50 years and above were less likely to possess good knowledge in comparison to clients below 50 years of age (odds ratio 0.21, P-value 0.049). Conclusion: There is a wrong belief of hypertensive medication causing diabetes, being addictive and traditional, with herbal medicines being cure to hypertension, and those with well-controlled blood pressure were found to have poorer knowledge compared to those with poorly controlled blood pressures.

S-04-4: INCONSISTENT GUIDELINES-BASED CONTROL STATUS OF OFFICE, HOME, AND AMBULATORY BLOOD PRESSURE MEASURED BY AN ALL-IN-ONE BP MONITORING DEVICE

Objective: Inconsistencies between office and out-of-office blood pressure (BP) values (described as white-coat hypertension or masked hypertension) may be attributable in part to differences in the BP monitoring devices used. We studied the inconsistency of the classification of BP control (well-controlled BP vs. uncontrolled BP) among office, home, and ambulatory BPs by using a validated all-in-one BP monitoring device. Design and method: In the nationwide, general practitioner-based multicenter HI-JAMP study, 2,322 hypertensive patients treated with antihypertensive drugs underwent office BP measurements and 24-h ambulatory BP monitoring (ABPM), consecutively followed by 5-day home BP monitoring (HBPM), using the same all-in-one device over a total of seven BP measurement days. Results: Using the thresholds of the JSH2019 and ESC2018 guidelines, the subjects with consistently well-controlled office (&lt;140mmHg) and home systolic BP (SBP) (&lt;135mmHg) (n = 970) also tended to have well-controlled 24-h SBP (&lt;130mmHg) (n = 808, 83.3%). The subjects with consistently uncontrolled office and home SBP (n = 579) also tended to have uncontrolled 24-h SBP (n = 444, 80.9%). Among the subjects with inconsistent classifications of office and home BP control (n = 803), 46.1% had inconsistent ABPM-vs.-HBPM out-of-office BP control status. When the 2017 ACC/AHA thresholds or JSH2019 target BP thresholds were applied as an alternative, the results were essentially the same. Conclusions: The combined assessment of office and home BP is useful in clinical practice. Especially for patients whose office BP classification and home BP classification conflict, the complementary clinical use of both HBPM and ABPM might be recommended.

PS-BPC03-4: DIAGNOSTIC AGREEMENT OF MASKED UNCONTROLLED HYPERTENSION DETECTED BY AMBULATORY BP AND HOME BP MEASURED BY AN ALL-IN-ONE BP MONITORING DEVICE

Objectives: Masked hypertension is a phenomenon in which office blood pressure (BP) is in the controlled BP range while out-of-office BP measured by ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) is in the uncontrolled BP range. Out-of-office BP control status may differ if defined by different BP indexes or measured under different conditions (resting or ambulatory), over different time-windows, or with different devices. This study aims to investigate the diagnostic agreement of masked uncontrolled hypertension (MUHT) detected by ABPM indexes (ABPM-MUHT) and HBPM indexes (HBPM-MUHT) using the same all-in-one device. Methods: Medicated hypertension patients enrolled in the Home-Activity ICT-based Japan Ambulatory Blood Pressure Monitoring Prospective (HI-JAMP) Study between 2017 and 2020 consecutively underwent office BP monitoring, 24-h ABPM (with 30-min intervals), and 5-day HBPM (twice each morning and evening) using the same device (TM-2441; A&amp;D Company, Tokyo). Controlled BP ranges for each BP index were as follows: office systolic BP [SBP] &lt; 140 mmHg; morning home, evening home, or morning-evening (ME) average SBP &lt; 135 mmHg; 24-h average SBP &lt; 130 mmHg; daytime SBP &lt; 135 mmHg; and nighttime SBP &lt; 120 mmHg. Results: Of 2322 patients (males 53.2%, average age 69.2 ± 11.5 years, average office SBP 132.8 ± 18.8 mmHg), the prevalences of ABPM-MUHT and HBPM-MUHT were 11.0% and 13.9%, respectively, when MUHT was defined only by 24-h average SBP or ME average SBP. Among the 445 patients with any MUHT according to this definition, the diagnostic agreement of MUHT detected by ABPM and HBPM was 29.7%. The prevalences of HBPM-MUHT defined by morning SBP and evening SBP were 22.4% and 11.6%, respectively, and those of ABPM-MUHT defined by daytime SBP and nighttime SBP were 11.8% and 13.8%. When MUHT was defined by any time-window index (ABPM: daytime, nighttime, and 24-h average SBP; HBPM: morning, evening, ME average SBP), the prevalences of ABPM-MUHT and HBPM-MUHT were 19.8% and 25.0%, respectively, and the diagnostic agreement of MUHT detected by ABPM and HBPM in patients with any MUHT (n = 743) increased to 40.1%. Conclusion: Even in treated patients with well-controlled office BP, the prevalence of MUHT in the morning and nighttime was high. Assessment of BP control status only by ME average or 24-h average SBP, without considering specific time-windows, might underestimate cardiovascular risk.

Pancreas fat content, insulin homeostasis and circulating endothelial microparticles inmale essential hypertensive patients.

Thepancreas fat contenthas been poorly investigated in essential hypertension. The authors aim to relatepancreas and liver fat contentwith parameters measuring insulin resistance, beta-cell function and also withmarkers ofendothelial dysfunction and platelet or endothelial cell destruction. The authors studied a group of 40malehypertensive patients with well-controlled blood pressure, maintaining a stable weight, and having not changed their medication during the last year. Pancreas fat content was correlated with HOMA-IR (r=.616, p<.001), HOMA-S (r=-.439, p<.005), beta cell function parameter (r=.457, p<.005), and QUICKI (r=.412, p<.01), whereas liver fat was not patients in thehighest quartileof pancreas fat content had more circulating endothelial microparticles than patients in the other quartiles (median 129 [94.3-200] vs. 60.9 [49.4-88.8], p=.002).However, patients in the highest quartile of the pancreas fat content distribution did not differ from the lowest in hyperemic response after ischemia nor circulating platelet microparticles count. Liver fat content was not related to any of the parameters studied. In a multivariate stepwise binary logistic regression analysis (Wald Method) circulating endothelial microparticles remain significantly associated with pancreas fat content after adjusting for confounding factors, such as tobacco, diabetes mellitus, hypercholesterolemia, or metabolic syndrome. Our results reflect that in essential hypertension,pancreas fat contentis superior toliver fatto study beta-cell functionality and insulin resistance. Moreover, the authors described for the first time thatpancreas fat content isrelated to endothelial cell destruction. Further studies are needed to confirm this point.

Association of caffeine intake with all-cause and cardiovascular mortality in elderly patients with hypertension.

Caffeine is widely consumed not only in coffee but also in soft drinks and tea. However, the long-term health effects of caffeine are still controversial, especially in people with high cardiovascular risk such as elderly patients with hypertension. This study analyzed data from the National Health and Nutrition Examination Survey 2003-2018. Caffeine intake was calculated by two 24-h dietary recall interviews. Complex sampling-weighted multivariable Cox proportional hazards models were used to compare the hazard ratios (HRs) of all-cause and cardiovascular mortality in elderly hypertensive patients with different caffeine intake (<10, 10 to <100, 100 to <200, 200 to <300, and ≥300 mg/day). This study included 6,076 elderly hypertensive patients. The mean ± standard error follow-up duration was 6.86 ± 0.12 years. During this period, a total of 2,200 all-cause deaths occurred, of which 765 were cardiovascular deaths. Taking patients with caffeine intake < 10 mg/day as a reference, patients with moderate caffeine intake (200 to <300 mg/day) had a lower risk of all-cause (HR, 0.70 [95% CI, 0.56-0.87]) and cardiovascular (HR, 0.55 [95% CI, 0.39-0.77]) mortality. The benefit of reducing all-cause mortality risk was significant in female patients (HR, 0.65 [95% CI, 0.50-0.85]) or patients with well-controlled blood pressure (HR, 0.63 [95% CI, 0.46-0.87]), but not in male patients or patients with poorly controlled blood pressure. In addition, non-linear relationship analysis also showed that moderate caffeine intake had the lowest HRs of all-cause (Non-linear p = 0.022) and cardiovascular mortality (Non-linear p = 0.032) in the present study. Moderate caffeine intake is associated with reduced risk of all-cause and cardiovascular mortality in elderly hypertensive patients.