Young Hypertensive Patients Research Articles

Congenital coarctation of the aorta: Role of peripheral vascular ultrasound in young hypertensive patients.

Congenital coarctation of the aorta: Role of peripheral vascular ultrasound in young hypertensive patients.

Angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers vs. calcium channel blockers for 12,478 young hypertensive patients under 40 in 10-year follow-up

Abstract Background It is uncertain whether angiotensin-converting enzyme inhibitors (ACEIs)/ angiotensin-receptor blockers (ARBs) is superior to calcium channel blockers (CCBs) in young hypertensive patients. Purpose To compare ACEIs/ARBs with CCBs in hypertensive patients <40 years for 10years. Methods We enrolled adults aged 20-39 with hypertension from 2007-2010 using the Korean national Insurance. Among 409,151 hypertensive patients, we made propensity matched analysis to compare the 2 drugs. Results 12,478 patients were enrolled, 6239 in ACEIs/ARBs and 6239 in CCBs group. Primary endpoint of a composite of myocardial infarction (MI), heart failure (HF), stroke, and total death was similar in 2 groups in young hypertensive patients in 10-year follow-up: 662 (ACEIs/ARBs) vs. 642/10000 (CCBs) with hazard ratio (HR) of 1.03 (reference, CCBs) (CI 0.90-1.18, P=0.657). In individual event of a MI, HF, stroke and total death, there was no difference in 2 groups: 99 vs 128/10000 persons (ACEIs/ARBs and CCBs respectively) with HR 0.77 (CI 0.56-1.08, P=0.13) in MI, 114 vs. 87/10000 (HR 1.32, P=0.123) in HF, 314 vs. 306 /10000 (HR 1.03, CI 0.64-1.20, P=0.795) in stroke and 184 vs. 167/10000 (HR 1.11, CI 0.85-1.44, P=0.454) in total death. Conclusions In young hypertensive patients, ACEIs/ARBs did not superior to CCBs in 10year clinical follow-up in large population.

Use of Beta-Blockers as a First-Line Treatment for Primary Hypertension

Background: Even though beta-blockers had been used as a first-line therapy for hypertension, since the late 1960s, the Eighth Joint National Committee, JNC 8, decided to recommend them no longer. This decision was based on relatively weak evidence from previous studies, which found that first-line beta-blockers were less effective in reducing stroke and heart failure, the main outcomes of hypertension. Despite the general perception, the most common events caused by hypertension are death and MI, not stroke or heart failure. Therefore, this study aimed to clarify beta-blocker efficacy by incorporating the data from all relevant beta-blocker trials, using the composite outcome of major cardiovascular events. Method: A search was conducted on MEDLINE, PubMed, Embase, and the Cochrane Library, restricted to published, peer-reviewed, human, meta-analysis, and controlled clinical trials. The term words used were “beta-blockers or adrenergic beta antagonists”, “hypertension”, and “death or coronary heart disease or stroke or congestive heart failure or myocardial infarction”. For this research, we selected six randomized controlled trials, and three meta-analyses were also chosen. Results: The results showed that beta-blockers were as effective as other first-line medications in younger hypertensive patients. On the other hand, in the patients aged above 60, the results were mixed. Beta-blockers were more effective than diuretics, but inferior to angiotensin receptor blockers. Also, beta-blockers were as safe and effective as angiotensin-converting enzyme inhibitors in reducing coronary heart disease, myocardial infarction, heart failure, and sudden death. However, beta-blockers were inferior to calcium channel blockers in reducing strokes. Conclusions: Beta-blockers were found to be the most effective in many aspects except for strokes. Further studies are needed to assess beta-blockers’ effectiveness in treating primary hypertension.

Self-management in young and middle-aged patients with hypertension: a systematic review and meta-synthesis of qualitative studies

BackgroundThere has been a sharp increase in the prevalence of hypertension in young and middle-aged people at high risk of the disease. Despite the fact that good self-management can be effective in controlling blood pressure, patients do not perform well in this area, resulting in poor blood pressure control. It is therefore particularly important to gain a thorough understanding of patients’ attitudes to self-management and the factors that influence them. The aim of this study was to synthesise the qualitative research on attitudes, motivations and challenges of self-management in young and middle-aged hypertensive patients, to analyse the synthesised results using the COM-B model and to propose appropriate improvement actions.MethodsFrom the time of construction until May 2023, the system searched PubMed, Web of Science, ProQuest, Embase, MEDLINE, CINAHL, PsyCINFO and CNKI databases. The analyses were carried out using a thematic synthesis approach to summarise the key findings. The findings were then mapped and analysed using the COM-B model.ResultsA total of 11 studies were included, involving 250 patients between the ages of 18 and 64. Four themes with ten sub-themes were identified: Poor disease recognition (low disease perception, fuzzy disease knowledge); Barriers to doctor-patient interactions (short communication time, unmet knowledge needs, incomplete guidance for disease management); Living in a hostile environment (heavy workload, lack of companionship, ignorance of families); Expectations for a healthy body (responsibility of family roles, witness the cruelty of illness). Analysis of the composite results based on the COM-B model showed that low disease perceptions, barriers to doctor-patient interactions and life circumstances with enemies on all sides were the main challenges faced by young and middle-aged hypertensive patients, whereas the expectation of a healthy body was a motivation to promote self-management of blood pressure in patients.ConclusionsThis study shows that family responsibilities are a particular motivator for self-management in young and middle-aged hypertensive patients. In response to the problems they face, we believe that meeting patients’ knowledge needs, improving healthcare professionals’ communication skills and valuing the role of community hospitals are effective ways to promote patient self-management. In the future, telemedicine, mobile healthcare and intelligent monitoring devices will provide a solution to reduce the burden on medical resources.Systematic review registrationPROSPERO CRD42018100810.

Position of Beta-blockers in the Treatment of Hypertension Today: An Indian Consensus.

Management of essential hypertension (HTN) remains challenging, with contemporary control being achieved in <1/10 of the cases, especially when aligned with the recently updated guidelines of American College of Cardiology (ACC) or International Society of Hypertension (ISH). The place and positioning of beta-blockers have been evolving, with recent focused updates, such as the European Society of Hypertension (ESH) 2023 guidelines, that may hold relevance for the Indian phenotypic traits of premature cardiovascular disease (CVD), fragile coronary architecture, and/or high resting heart rate. To further develop consensus on the clinical role and relevance of beta-blockers, including nebivolol, an Indian consensus was evolved with graded recommendations on their clinical role in HTN, HTN with additional cardiovascular (CV) risk, or type 2 diabetes mellitus (T2DM). An expert review panel was constituted, comprising interventional and clinical cardiologists as experts, to synthesize the literature for the development of a validated knowledge, attitude, and practice (KAP) survey questionnaire. Research databases, including Cochrane Systematic Reviews, PubMed, and Google Scholar, were accessed for contemporary information and guidelines on beta-blockers updated until Dec 2023. Delphi rounds were conducted to develop graded recommendations based on the strength, quality of evidence, and the agreement among the panelists (n = 9). Consensus was achieved on the graded recommendations, with ≥70% of national panelists in agreement. Ninety-six percent of respondents opined that the new ESH HTN guidelines (2023) help gain confidence in using beta-blockers, which are considered first-line drugs for the treatment of HTN. Beta-blockers, including nebivolol, can be recommended in patients with HTN with high resting heart rates, including young hypertensive patients under 40 years of age. For people under 60 years old with HTN, regardless of whether they have comorbid diseases, beta-blockers are the recommended drug choice. Ninety-five percent of respondents opined that nebivolol is the preferred beta-blocker in hypertensive patients with T2DM, followed by bisoprolol and metoprolol. More than 90% of respondents opined that the three most commonly preferred beta-blockers by experts in patients with angina were nebivolol, metoprolol, and bisoprolol. Beta-blockers, including nebivolol, can be considered initial-line therapy for HTN management in real-life settings in India and nebivolol is preferred because of its two important properties: highest beta-1 selectivity and endothelial-dependent vasodilation.

YOUNGER HYPERTENSIVE PATIENTS HAVE LOWER HEALTH-RELATED QUALITY OF LIFE AND DIFFERENT HYPERTENSION CORRELATES. EVIDENCE FROM BULGARIA

The purpose of this study was to determine hypertension correlates among the patients' survey characteristics after splitting the sample into two groups based on their age and perform this assessment separately for each of the groups. Materials and methods. A cross-sectional retrospective study among 647 patients was conducted using self-administered EQ-5D 3L, as well as demographic, economic and health questions. Results. The overall self-reported arterial hypertension (AH) prevalence was 36.9%. The sample was split into two groups: 18-54 and 55+ years, with AH prevalence of 23.5% and 51%, respectively. The differences between AH and non-AH patients in each age group were explored. Younger AH patients significantly more often reported fatigue, headache, chest pain and having at least 1 acute condition for the last year than non-hypertensive ones at the same age. Diabetes, asthma/chronic bronchitis and joint pain/arthritis were also more common among younger AH patients. The overall HRQol and self-perceived health were significantly lower among young hypertensive patients, and their median severity index was higher compared to non-hypertensive adults of the same age. They more often experienced moderate pain/discomfort and moderate anxiety/depression. Despite of this, older AH patients reported similar HRQoL compared to non-AH patients. Conclusions. Different comorbidities were found amongst younger and older hypertensive patients. Most of the already known AH correlates were confirmed only among younger adults (18-54 years old). Arterial hypertension leads to significantly lower health-related quality of life, self-perceived health and higher severity index only among the younger group, mainly due to the depression and pain they experience.

P133 ALTERED P-WAVE DISPERSION IN NEWLY DIAGNOSED YOUNG HYPERTENSIVES

Background and objective: P wave dispersion (Pd) is a useful electrocardiographic marker for predicting the onset of atrial fibrillation. It has been little studied in recent hypertension. The aim was to determine the behavior of maximum P wave duration (Pmax) and Pd in young hypertensive patients with recent onset and its relationship with other variables. Methods: A cross-sectional, prospective, comparative study was performed in 60 young men (30 hypertensive and 30 non-hypertensive). P wave measurements were obtained with 12-lead electrocardiogram. Statistical analysis included applications of simple linear correlation, sample means were compared by Student's t-test. Results: There were no significant differences in the baseline characteristics of both groups. Pmax (78.67 ± 5.71 ms) and Pd (42.33 ± 6.26ms) were found to be significantly prolonged (p&lt;0.001) in the hypertensive group compared to normotensive subjects (Pmax 61.00 ± 7.69 ms; Pd 25.00 ± 8.61 ms). Pd correlated significantly (r = 0.716; p&lt;0.001) with systolic and diastolic blood pressure (r = 0.696; p&lt;0.001). Conclusions: Pmax and Pd are found to be increased in young patients with recent-onset hypertension, and these values increase in direct proportion to blood pressure figures.

Diffuse pulmonary hemorrhage as a rare presentation of pheochromocytoma: a case report with review of the literature

A 37-year-old male patient with a past history of fluctuating hypertension and insulin-treated diabetes mellitus presented to our clinic with a 1-year history of sudden-onset cough, dyspnea, and frank hemoptysis. Examination showed asthenia, moderate anemia, uncontrolled blood pressure, and a past history of one admission for management of hemoptysis and cardiac failure. The evaluation showed mild anemia, azotemia, low ejection fraction, contrast-enhanced computed tomography (CECT) of the chest, and sputum suggestive of pulmonary hemorrhage. Investigation during current admission revealed proteinuria, left suprarenal mass on USG, and clear lung parenchyma on chest X-ray and CECT. Autoimmune workup for vasculitis was negative and 24-h urinary catecholamine levels were elevated with CECT abdomen confirming pheochromocytoma. His blood pressure was controlled and he underwent laparoscopic left adrenalectomy with confirmation on histopathology. Postoperatively he is doing well with minimal requirement of antihypertensive, and diabetes is controlled with diet and exercise only. This case highlights diffuse alveolar hemorrhage as a rare presentation of pheochromocytoma. This case also highlights that secondary cause of hypertension should always be ruled out in case of uncontrolled hypertension in young patients to prevent devastating complications.

Prevalence and Risk Factors of Diastolic Dysfunction in Young Hypertensive Patients From Obstructive Sleep Apnoea

Prevalence and Risk Factors of Diastolic Dysfunction in Young Hypertensive Patients From Obstructive Sleep Apnoea

Hyperuricemia as a risk factor for cerebral hemorrhage in young and middle-aged hypertensive patients at high altitude

Background: The purpose of this research was to investigate the effect of uric acid on hypertensive intracerebral hemorrhage (HICH) in young and middle-aged hypertensive patients at high altitude. Methods: High-altitude and low-altitude HICH patients were analyzed retrospectively, and the influence of uric acid on hemorrhage was analyzed by the correlations between age and uric acid, between age and hemoglobin, and between uric acid and hemoglobin. The individuals in the high- and low-altitude groups were assigned to a young/middle-aged group and an elderly group, and the correlation between age and uric acid was analyzed. The risk factors for HICH were analyzed by logistic regression analysis. ROC curve analysis was used to investigate the relationship between risk factors and cerebral hemorrhage. Results: Age was negatively correlated with uric acid concentration in patients with HICH at high altitudes but not in patients with HICH at low altitudes. In addition, age was negatively correlated with hemoglobin in patients with HICH at high altitudes but not in patients with HICH at low altitudes. Uric acid was negatively correlated with age in young and middle-aged adults at high altitudes but not in elderly individuals. Diastolic pressure, uric acid and sex were risk factors for HICH in young and middle-aged adults at high altitudes. ROC curve showed that uric acid and diastolic pressure had diagnostic significance. Conclusions: High levels of uric acid is correlated with increased risk of cerebral hemorrhage in young and middle-aged adults with hypertension in high altitude.

Health literacy and self-management among middle-aged and young hypertensive patients: a parallel mediation effect of illness perception and self-efficacy.

Hypertension is increasingly prevalent among young and middle-aged populations in rural China, accompanied by suboptimal self-management. Given that this population forms the backbone of the labor force, enhancing their self-management capabilities is crucial for improving overall population health. Studies indicate that individuals with good health literacy are more likely to effectively manage their health. Grounded in the health literacy skills framework, a model was constructed in this study to examine the impact of health literacy on self-management among young and middle-aged hypertensive patients in rural China. Meanwhile, the mediating roles of illness perception and self-efficacy were also verified. Using a multi-stage stratified random sampling method, 338 patients were recruited to participate in the study. Structural equation modeling was utilized to establish the relationship model, and bootstrap tests were carried out to examine the mediating effects. The average self-management score was 70.45 ± 11.36. Health literacy exhibited a positive correlation with self-management (standardized β = 0.372, p < 0.001). The mediating effects through illness perception and self-efficacy were 0.040 and 0.236, constituting 6.68 and 39.31% of the total effect, respectively. Illness perception and self-efficacy serve as parallel mediators amid the association between health literacy and self-management. Implementing psychological counseling and health education is imperative for augmenting self-management competence and cultivating an adaptive coping mentality.

ARTERIAL HYPERTENSION PROFILE IN PATIENTS WITH KIDNEY DISEASES

Objective: Arterial hypertension is a global public health worldwide. It is a risk factor for cardiovascular events which represent major cause of morbidity and mortality as it contributes to the development and progression of kidney diseases. The aim of the study was to investigate the profile of arterial hypertension in patients with kidney diseases. Design and method: It is a prospective study that entails young hypertensive patients aged between 18 and 65 years old in the course of six months from 1st January 2022 to June 30th 2022 within the nephrology department in which we assessed an array of parameters. Results: Hypertension prevalence represented 75% (81 patients) among 107 hospitalized patients with a male predominance of 59%, a sex ratio of 1.45 and was widespread among patients aged from 55-65 years old. The mean age of our patients was 48.98±14.066 years. History of hypertension was observed in 85,2% followed by diabetes in 40,7%. 14,8% among hypertensives were newly detected. The main cardiovascular risk factors were diabetes (65%), obesity (15%) and sedentary lifestyle (11%). Systolo-diastolic hypertension was present in 57% whereas grade 2 hypertension affected 30% of patients aged from 18 to 34 years old. Our patients presented left ventricular hypertrophy in 19,61% of the cases while 80% manifested renal failure which was chronic in 50% of the patients. 58% of the patients were on monotherapy, followed by dual (35%) and triple therapy (7%). The most prescribed treatment was either calcium channel blockers in monotherapy or combined with angiotensin receptor blockers/angiotensin-converting enzyme inhibitors inhibitor in dual therapy or with angiotensin-converting enzyme inhibitors + diuretic/beta-blocker in triple therapy. Control rate was 54.3%, majorly, observed among women and patients who belong to the 55- 65 years old age category. Conclusions: In order to reduce the hypertension prevalence and prevent the occurrence of its renal complications. The application of an intensive management of hypertension as well as the cardiovascular risk factors should be integrated into primary care systems. Beside treatment, lifestyle modifications should be implemented in the first line as they exert blood pressure lowering effects additionally to therapeutic treatment.

Prevalence and Patterns of Cardiovascular Risk Factors in Young Hypertensive Patients

Prevalence and Patterns of Cardiovascular Risk Factors in Young Hypertensive Patients

Changes in the indicators of stiffness and remodeling of magistral arteries in young patients at the early stage of essential hypertension under conditions of syntropy with obesity.

Aim: The study and analysis of indicators of remodeling and rigidity of magistral vessels in young essential hypertension patients with abdominal obesity and determination of the detected changes as a possible criterion for their remodeling.. Materials and Methods: 98 young people with essential hypertension and obesity were included in the study. The structure of the carotid artery and its stiffness were assessed using the ultrasound method, and the level of abdominal fat was determined using dual-energy X-ray absorptiometry. Results: Carotid Intima-Media Thickness in patients with essential hypertension reliably exceeded the corresponding indicator of the control group. We observed a significant increase in arterial stiffness indicators, which is explained by the increased stiffness of blood vessels in patients with obesity. During the correlation analysis, it was established that the relationship between the level of abdominal fat and the elasticity of the vascular wall was positive and strong, which indicated the dominant role of the abdominal type of obesity in the remodeling of the vascular wall in young patients with essential hypertension in combination with obesity. Conclusions: In young patients at the early stage of the formation of essential hypertension, there are signs of a decrease in resilient-elastic properties and remodeling of magistral vessels, whose severity is significantly stronger in combination with abdominal obesity.

Transcranial Electrostimulation as a Non-pharmacological Method of Treating Arterial Hypertension I Degree in young patients

Purpose: The authors determined the efficacy of transcranial electrostimulation (TES) in treating arterial hypertension I degree in young patients and compared it with electrically induced sleep therapy. Materials and Methods: The performed study is a prospective randomized controlled trial that enrolled 212 patients aged 18-20years with arterial hypertension I degree. Patients were divided into two groups. Group 1 consisted of 110 patients who underwent transcranial electrostimulationusing a method developed at the Institute of Physiology named after I. P. Pavlov, Russian Academy of Sciences in Saint Petersburg. Group 2 included 112 patients who underwent electrically induced sleep therapy procedures with the orbital-retro mastoidal technique of electrode application in a "sedative" mode. The control group included 45 patients with normal blood pressure. All patients underwent 24-hour ambulatory blood pressure monitoring, determination of central hemodynamic parameters, diurnal heart rate variability, and endothelial function parameters. Results: As a result of TES therapy in patients significantly decreased the average diurnal SBP and DBP values, pressure load, normalized the diurnal BP profile, AT, and EF values. As a result of electrosleep therapy, average diurnal SBP, and DBP values decreased unreliably, decreased pressure load, and signs of sympathicotonia, but AT and EF values did not change significantly. TES therapy's effectiveness for treating stage 1 hypertension in young patients is significantly higher by 1.9 times in comparison with electrosontherapy. Conclusion: This study has shown that the TES treatment is more effective than traditional non-pharmacological electrosleep therapyin a "sedative" mode. TES normalizes hemodynamics, BP levels, and EF indicators and can be recommended as one of the methods of antihypertensive therapy in young patients.

Association between obstructive sleep apnea and vascular injury in hypertensive patients

Objective: To investigate the relationship between obstructive sleep apnea (OSA), apnea hypopnea index (AHI) and vascular injury in hypertensive patients. Methods: This cross-sectional study enrolled patients admitted to the Hypertension Department of TEDA International Cardiovascular Hospital from April 2020 to April 2023, who finished portable sleep monitoring. Sleep monitoring indicators, flow-mediated vasodilation (FMD), carotid artery ultrasound, carotid intima-media thickness, cervical and femoral pulse wave conduction velocity (cfPWV), brachial and ankle pulse wave conduction velocity (baPWV) were analyzed. OSA was classified into mild (5 times/h≤AHI<15 times/h), moderate (15≤AHI<30 times/h), and severe (AHI≥30 times/h) based on AHI levels. FMD<6.0% was defined as vascular endothelial injury, and cfPWV>10 m/s and/or baPWV>18 m/s was defined as arterial stiffness. Multivariate logistic regression analysis was used to explore the correlation between AHI, OSA severity and vascular injury, and subgroup analysis was performed in young (age≤45 years) and middle-to-old patients (age>45 years). Sensitivity analysis was performed by excluding patients with diabetes, cerebrovascular disease and coronary heart disease. The correlation between AHI and vascular injury index was analyzed by restricted cubic spline. Results: A total of 555 adult hypertensive patients were included, the mean age was (39.7±9.2) years, 422 were males (76.0%), and the prevalence of OSA was 66.7% (370/555). Multivariate logistic regression analysis showed that moderate OSA (OR=2.83, P=0.019) and severe OSA (OR=3.40, P=0.016) were positively correlated with vascular endothelial injury after adjusting for age, sex, body mass index and mean arterial pressure. Subgroup analysis showed that log AHI (OR=1.99, P=0.035), moderate OSA (OR=4.83, P=0.010) and severe OSA (OR=4.64, P=0.015) were associated with vascular endothelial injury in young hypertensive patients. The results of sensitivity analysis were similar to the above results. The results of restricted cubic spline analysis showed that AHI was correlated with FMD (P=0.022), and the slope of the curve was the largest when AHI was between 0 and 10 times/h. There was no correlation between log AHI and OSA severity and carotid intima-media thickening and arterial stiffness (all P<0.05). Conclusions: OSA is associated with vascular endothelial injury in hypertensive patients, especially in young patients.

Ten year follow-up study regarding treatment compliance and cardiovascular events in young first diagnosed and never treated hypertensives of a European Society of Hypertension Excellence Center

Abstract Background Early onset arterial hypertension (AH) is associated with a considerably increased risk for cardiovascular (CV) disease if left untreated. Treatment is based on the estimation of CV risk in each hypertensive patient. The compliance of each individual hypertensive in proposed life style changes and medical treatment is paramount. We aimed to investigate the compliance in medical treatment and we set as primary endpoint of the study the incidence of any CV events [CV death, acute myocardial infarction (AMI), stroke] and all-cause death of a cohort of young first diagnosed and never treated hypertensives of a European Society of Hypertension (ESH) Excellence Center. Population and Methods: We studied 220 young, non-diabetic (&amp;lt;50 years old) first diagnosed and never treated hypertensive patients (42+7 years, 70% males, 41% smokers, BMI=29+5, 24-h ambulatory blood pressure monitoring (ABPM) =142+10/91+9 mmHg, LDL=133+36 mg/dl, 49% had &amp;gt;1 HMOD) visiting our ESH Excellence Center (2004-2021). All patients were apparently healthy with no co-morbidities. In each patient, the presence of hypertension mediated organ damage (HMOD) was evaluated at baseline (aortic stiffness, left ventricular hypertrophy, coronary flow reserve, diastolic dysfunction. The cohort was re-evaluated at 10+4 years post-medical treatment initiation regarding compliance as well as the primary endpoint of the study. Results 191/220 (87%) young hypertensives (at baseline, 42+7 years, 70% males, 40% smokers, BMI=29.5, 24-h ABPM=142+10/91+9 mmHg, LDL=133+36 mg/dl, 49% had&amp;gt;1 HMOD) participated in the follow-up study while 29 (13%) patients were lost. We found that 17/191 (9%) quit medical treatment. Home or office BP was confirmed as controlled (&amp;lt;140/90 mmHg) in 151/191 (79%) patients. Regarding CV events, 7/191 (4%) hypertensive patients (at baseline, 44+4 years, 86% males, 71% smokers, BMI= 30+4, 24-h ABPM=142+12/89+10 mmHg, LDL=175+33 mg/dl, 87% had&amp;gt;1 HMOD) had an acute myocardial infarction (AMI) at 6+4 years post-treatment initiation while 1/191 (0.5%) patient died due to lung cancer. Hypertensive patients with CV events differed regarding increased LDL levels at baseline (168+35 vs.131+36, p=0.007), more smokers (p=0.04) and HMOD &amp;gt;1 (p=0.02) compared to the rest of the young hypertensive population. Conclusions Compliance regarding medical treatment was sustained in 9/10 young hypertensive patients during the 10-year follow-up. Just 4% of the population, smokers with increased LDL and HMOD&amp;gt;1, suffered an AMI despite compliance in medical antihypertensive treatment. Subsequently, treating AH in young people needs both life style changes (quit smoking) and medical treatment (hypertension plus hyperlipidemia) in order to prevent future CV events.CV events in young hypertensives

Male patients with first diagnosed and never treated essential hypertension accompanied by organ damage are at high risk for non-alcoholic fatty liver disease indicated by Hepatic steatosis index

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is closely related to the metabolic syndrome as well as to arterial hypertension and overall cardiovascular (CV) disease. We aimed to investigate if those first diagnosed and never treated patients with essential hypertension at high risk for NAFLD, measured by the Hepatic Steatosis Index (HSI), already have an impaired CV risk profile estimated by increased blood pressure burden and accompanied by the presence of hypertension-mediated organ damage (HMOD). Methods We studied 300 non-diabetic, first diagnosed and never-treated young hypertensive patients [mean age=51+11 years, 60% males, 32% smokers]. Ambulatory blood pressure monitoring (24h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac hypertrophy (LVMI), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) and endothelial dysfunction (PBR5-25)] were estimated in each patient before treatment initiation. HIS was calculated as 8 times (ALT/AST ratio) +BMI (+2, if female; +2, if diabetes mellitus). Increased HIS levels predispose for augmented risk for NAFLD. Results The whole hypertensive population was divided regarding HSI median value=39.5 in two groups, Group A (higher risk for NAFLD group, n=150, age=50+10, 59% males, 33% smokers) and Group B (lower risk for NAFLD group, n=150, age=51+11, 60% males, 31% smokers). Group A patients had increased BMI (32+5 vs. 27+3, p&amp;lt;0.001), systolic night-time ABPM (127+15 vs. 124+11, p=0.05), office systolic (152+19 vs. 145+17 mmHg, p=0.004) and diastolic BP (94+11 vs. 90+11 mmHg, p=0.002), central systolic BP (146+20 vs. 137+15, p=0.006), Chol (216+39 vs. 206+35, p=0.02), LDL (138+35 vs.130=33 mg/dl, p=0.04) and Trigl (139+75 vs. 112+63, p=0.001), E/Ea (7+2 vs. 6+2, p=0.01) and LVMI (83+18 vs. 79+17, p=0.03) compared to Group B. All other studied demographic, laboratory, ABPM and HMOD parameters (PWV, MAU, CFR and cIMT) were similar between groups. HSI was related to BMI (p&amp;lt;0.001) and office BP, both systolic (p=0.001) and diastolic (p=0.008) in total population as well as to LVMI (r=0.17, p=0.02) in males. Finally, in multiple regression analysis, we found that HSI was independently associated with LVMI (beta=0.14, p=0.05) only in male hypertensives. Conclusions Patients first diagnosed arterial hypertension and augmented CV risk (smoking, obesity, hyperlipidemia, BP burden and HMOD) are also at high risk for NAFLD. As successful antihypertensive treatment may lead to HMOD regression, probably there is still time for those patients to be treated for hypertension disease and hyperlipidemia and quit smoking, in order to reduce future CV risk.LVMI and HSI in male hypertensives

Factors Affecting Mortality in Elderly Hypertensive Hospitalized Patients with COVID-19: A Retrospective Study.

Corona Virus Disease 2019 (COVID-19) endangers the health and survival of the elderly. We tried to explore factors especially kidney function which affected mortality in elderly hypertensive patients with COVID-19. We conducted a retrospective research of 748 COVID-19 elderly patients (≥65 years old) at Zhejiang Hospital. This study compared demographic data, laboratory values, comorbidities, treatments, and clinical outcomes of hypertension and non-hypertension participants, and subgroup analysis of age and frailty was conducted in the hypertension population. Survival analysis was used to determine risk factors for death in elderly patients with COVID-19. Our study revealed that the elderly hypertensive patients with COVID-19 had higher blood urea nitrogen (BUN), serum uric acid (UA), serum creatinine (Scr), lower estimated glomerular filtration rate (eGFR), higher incidence of severity, admission to intensive care unit (ICU) and death, and longer in-hospital stay than non-hypertensive patients, which also occurred in the very elderly hypertensive patients compared with younger hypertensive patients and frail hypertensive patients compared with no-frail hypertensive patients. In addition, the prevalence of acute kidney injury (AKI) was higher in the oldest old hypertensive patients and frail hypertensive patients. Multivariate survival analysis indicated that the independent risk factors for death from COVID-19 were age ≥80 years, heart failure, antiviral therapy, calcium channel blocker (CCB) therapy, mechanical ventilation, AKI, and eGFR<60 mL/min per 1.73 m2. The results of the present study suggested that the elderly hypertensive patients with COVID-19 would have more serious kidney injury, more serious disease progression and higher mortality, which also occurred in very elderly and frailty subgroup. Kidney dysfunction was closely related to mortality in elderly patients with COVID-19.

Effect of quality control circle activities on the blood pressure control rate in young and middle-aged hypertensive patients

Effect of quality control circle activities on the blood pressure control rate in young and middle-aged hypertensive patients