bluuebunny/crossref_metadata_2025 huggingface dataset:
P001 AN UNCOMMON CAUSE OF HIGH BLOOD PRESSURE IN YOUNG BASKETBALL PLAYER
Authors: Cueva Torres Franklin Esteban , Guzmán García Santiago , Gupta Shyla , Garcia-Zamora Sebastián , Jaramillo Felipe Rodriguez , Vasquez Erick Hidalgo , Aguirre MD Jorge Nicolás , Samaniego Md Jose Elias
Published: September 2024

Paragangliomas are rare neuroendocrine tumors that affect approximately 1.5–9 patients per million. They originate from chromaffin cells of the adrenal medulla or sympathetic and parasympathetic ganglia. Paragangliomas account for 10%–20% of retroperitoneal tumors and can manifest at any age. These tumors can secrete catecholamines, leading to symptoms such as hypertension, headaches, and diaphoresis.However, palpitations or tachycardia may also be present. Definitive treatment entails surgical resection, with acceptable rates of morbidity and mortality, necessitating careful patient preparation and intraoperative management.

Case Presentation:

We present the case of a 29-year-old man with a BMI 26,5 kg/m2, who is physically active and without other cardiovascular risk factors, episodic hypertension, headaches and blush. A contrast CT scan of the abdomen revealed a retroperitoneal intercavoaortic mass and 24-hour urine Normetanephrines were significantly elevated, indicating a functional paraganglioma. Laboratory tests revealed an elevated plasma normetanephrine level of 1838 pg/ml (reference values 0 - 180 pg/ml). The patient was prepared for surgery with alpha blockers, followed by beta blockers. Intraoperative blood pressure elevation was managed with intravenous beta blockers. Postoperatively, the patient did not require anti-hypertensives. The tumor, measuring 6x4x3.5 cm, histopathology and immunohistochemistry confirmed the diagnosis of a normetanephrine producing paraganglioma. The genetic study revealed a pathogenic variant in the SDHB gene, specifically the c.166_170delCCTCA (p.Pro56Tyrfs*5) in heterozygosity. This variant is associated with a 49% risk of Pheochromocytoma and Hereditary Paraganglioma, a 14% risk of Renal Carcinoma and susceptibility to Gastrointestinal Stromal Tumors. The c.166_170delCCTCA variant follows an autosomal dominant inheritance pattern, indicating a 50% risk of recurrence.

Conclusions:

The diagnosis of extra-adrenal retroperitoneal paragangliomas remains challenging due to the silent evolution of the condition. It is essential to consider screening patients who are young, and present with resistant arterial hypertension for secondary hypertension.
P002 MICROALBUMINURIA PREDICTS MASKED HYPERTENSION IN CHILDREN WITH OVERWEIGHT AND OBESITY
Authors: Deregibus Maria Ines , Iturzaeta Adriana , Pompozzi Luis Alberto , Romero Cesar
Published: September 2024

Introduction:

Childhood overweight and obesity are known modifiable risk factors linked to the several forms of hypertension, including Masked Hypertension (MH). However, which are clinical predictors of MH in this special population is not know. Ambulatory blood pressure (ABP) is more often associated with early target organ damage, specifically, microalbuminuria, than on office blood pressure (OBP).

Objective

To evaluate the presence of predictors of MH in children with overweight and obesity.

Material and methods: Cross-sectional, analytical study. Children aged 5 to 16 years with overweight and obesity who consulted two tertiary hospitals in the Autonomous City of Buenos Aires. A standardized clinical history, OBP (Riester model aneroid blood pressure monitor) with a protocolized technique and Ambulatory Blood Pressure Monitoring (ABPM) (Spacelabs 90207 y 90217) were performed.

Several clinical and analytical variables, including Microalbuminuria dyslipidemia and insulin resistance were investigated.

Statistical models to predict ambulatory arterial hypertension (HTN) and MH were carried out using the SAS 9.4 software.

Results:

A total of 409 children were included, median age 11.36 years, 236 males (57.7%); 301 (73.6%) were found to be normotensive, 42 (10.2%) with white coat HTN, 66 (16.1%) had some form of ambulatory HTN: 27 (6%) with true HTN, 39 (9.5%) with MH. Of the total, 6 (1.5%) presented isolated nocturnal HTN. and The median BMI was 28.36.

The univariate and multivariate regression models, adjusted for age and sex, showed systolic OBP (OR 1.1, p<0.001) and microalbuminuria (OR 3.37, p=0.03) as independent predictors of ambulatory HTN. The presence of microalbuminuria was the only predictor of MH in obese children (OR 3.6, p<0,01).

Conclusions:

A prevalence of 9.5% of MH was identified in the overweight and obese pediatric population. The predictors of ambulatory HTN were systolic OBP and microalbuminuria. The latter being the only predictor of MH in this population.

The timely detection of MH and predictors, especially microalbuminuria, in this population shows the importance of using ABPM in pediatrics.

Table 1: Sample characteristics
P004 BODY MASS INDEX IS RELATED TO SUBTYPES OF ARTERIAL HYPERTENSION IN CHILDREN
Authors: Rubio-Elorza Liliana , Álvarez-Montoya Diego , López-Llano Manuela , Gallo-Villegas Jaime , Aristizábal-Ocampo Dagnovar
Published: September 2024

Background and Objective:

Arterial hypertension (AH) subtypes in the pediatric population may represent distinct pathophysiological subsets, potentially allowing for more targeted interventions and improved blood pressure (BP) management. Emerging evidence suggests that various hemodynamic mechanisms may underlie hypertension development across different age groups. Moreover, overweight and obesity, are closely linked to hypertension and other risk factors. Therefore, this study aims to investigate the relationship between body mass index (BMI) and (AH) subtypes in the pediatric population.

Methods:

A cross-sectional study was conducted, involving 195 records from 189 children referred to an outpatient cardiology center due to suspected BP abnormalities. Each participant underwent 24-hour ambulatory blood pressure monitoring (24-h ABPM) using a device validated. Demographic, clinical, and anthropometric data were collected. The American Heart Association (2022) criteria were utilized to ensure accurate 24-h ABPM recordings and to classify AH subtypes based on average BP, including: i) isolated diastolic hypertension (IDH); ii) non-divergent systolic-diastolic hypertension (ND-SDH) (pulse pressure [PP]<50 mmHg); iii) divergent systolic-diastolic hypertension (D-SDH) (PP>50 mmHg); and iv) isolated systolic hypertension (ISH). BMI Z-Score was calculated using Colombian reference tables, and nutritional status was determined based on World Health Organization recommendations.

Results:

Among the participants, 46.0% were male, with a distribution of nutritional status showing 3% underweight, 37% normal weight, 30% overweight, and 30% obese. The average age was 12.3±3.0 years (range: 5-17 years). 24-h ABPM records revealed that 34.0% had normotension, 33.0% had IDH, 16.0% had ND-SDH, 13.0% had D-SDH, and 3% had ISH. The ANOVA test indicated significant differences in BMI Z-Score values among AH subtypes (P value <0.001) (Figure).

Conclusions:

BMI is related with AH subtypes in children. Specifically, BMI tends to be higher in D-SDH and ISH, which could be characterized by a hyperdynamic state marked by increased activity of the sympathetic nervous system. This finding may help to elucidate the pathophysiology of hypertension in obese children.
P229 INFLUENCE OF ASTHMA ON BLOOD PRESSURE OF CHILDREN AND ADOLESCENTS: THE ASMAVIX PROJECT
Authors: Mill José Geraldo , Mendes Fernanda Duarte , Pimentel Enildo Broetto , Santos Jane Meri , Costa-Reis Neyval , Callo-Quintes Gabriela
Published: September 2024

Background and Objectives:

Asthma is a prevalent disease in children and the chronic inflammatory may affect blood vessel stiffness and blood pressure (BP). Systolic BP increases progressively along the childhood tending to reach stable values at the beginning of adulthood. Higher BP levels in infancy predispose to hypertension development hypertension in adulthood. Our aim was to investigate the influence of asthma on the age-dependent BP increase in children and adolescents.

Methods

Asthmatic (Asth, n = 166), 7-15 years (67% boys) attending to Public Health Units of Vitória (an industrialized city of the coastal plain of southeastern Brazil) were included. Non-asthmatic children (N-Asth, n =50; 33% boys) living in the neighborhood of Asth were used as controls. Clinic and laboratory exams were performed in an outpatient clinic at the University Hospital. BP was measured with an oscillometric device (Onrom HBP 1100) and large artery stiffness was estimated by carotid-to-femoral pulse wave velocity (cf-PWV; Complior SP-2). The 90th percentile of systolic or diastolic BP was used to identify high BP considering gender, age, and height. Age-dependent BP increase was determined by linear regression with and without adjustment for covariates (gender and body mass index). Statistical significance was set at p<0.05.

Results

Asth and N-Asth groups were similar (p>0.05) considering age (11.7 ± 2.3 vs 11.1 ± 2.1 years), body mass index (20.2 ± 4.2 vs 20.3 ± 5.7 kg/m2), systolic (102 ± 11 vs 104 ± 10 mmHg) and diastolic (62 ± 7 vs 63 ±8 mmHg) BP. However, cf-PWV was higher in Asth (48.9 ± 9.0 vs 44.0 ± 9.1 cm/s; p<0.01). The crude age-dependent systolic BP increase was 34% higher in the Asth group (1.74 mmHg/year; 95%CL 1.06;2.43 vs 1.37 mmHg/year; 95% CL 0.02;2.72). This difference remained similar after adjusting for gender and body mass index (1.47 mmHg/year; 95%CL 0.80; 2.14 vs 1.10; -0.47;2.67). The percentage of children with elevated BP was higher in the Asth group (10.2% vs 4.0%).

Conclusion:

The higher stiffness of large arteries seems to accelerate the systolic BP increase along childhood and adolescence and may predispose to an earlier onset of hypertension in adulthood.

Acknowledgment: This study was supported with grants from ArcelorMittal, CNPq and Fapes.
P017 AFTER 14 YEARS OF WAR - HYPERTENSION IN SYRIA: BETWEEN CLINICAL PRACTICE AND AVAILABLE MEDICATIONS (ANALYTICAL STATISTICAL STUDY)
Authors: Alanan Usama , Keder Houssim
Published: September 2024

Background:

Hypertension is one of the most common chronic diseases worldwide. It is also one of the most important risk factors related to public health that leads to multiple consequences. On the other hand, hypertension constitutes a heavy burden on health expenditures, especially in developing countries with limited income. Through this study, we aim to identify the reality of hypertension in Syria as a country that has been suffering from war for more than 14 years, through the distribution of doctors practicing and treating hypertension, the availability of various medications to treat it, and the extent to which international guidelines can be applied in clinical practice.

Methods:

Cardiologists and nephrologists were mainly counted and distributed in Syrian cities. Pharmaceutical companies and drug types produced by these companies were also counted, and drugs were distributed according to therapeutic drug groups. A questionnaire was conducted on the most important types of drugs used by doctors according to different indications.

Results:

We found that the largest number of cardiologists and nephrologists are located in the capital, Damascus, with a significant preponderance of cardiologists. We also found a significant shortage in the presence of specialists in the eastern governorates and a severe shortage in the number of kidney doctors in the central, northern and eastern governorates, with most of them being in the capital. There was diversity and distribution in most of the drug categories for treating high blood pressure in the first lines of treatment, noting the lack of sufficient intravenous categories.

Conclusions:

There is a clear shortage in cardiologists and nephrologists in most governorates, with an almost complete absence of intravenous hypertension medications.
P026 A PRESCRIPTION TREND ANALYSIS OF ANTIHYPERTENSIVE PHARMACOTHERAPY ACROSS DIFFERENT SPECIALTIES IN INDIA
Authors: Vishavadia Krunal , Solanki S , Kulkarni G , Prajapati H
Published: September 2024

Objective:

To evaluate the temporal trends in the prescription patterns of antihypertensive medications among healthcare practitioners in India.

Methods:

The IQVIA (formerly Quintiles and IMS Health) prescription audit data came from prescriptions of a panel of 6000 private sector primary care clinicians for the different classes of antihypertensive drugs; beta-blockers(BB), calcium channel blockers(CCB), angiotensin receptor blockers(ARB), angiotensin-converting enzyme(ACE) inhibitors, and diuretics were examined. The analysis encompassed the period from 2014 to 2022. Additionally, combinations of these drug classes involving two or three medications were also subject to analysis.

Results:

Cardiologists’ prescription rates for antihypertensive medications stood at 21% in 2017 and decreased to 19% by 2023. In 2023, the highest rate of prescribing antihypertensive drugs was observed among consultant physicians, with a rate of 30%, followed by general practitioners at 27%. In addition, during COVID-19, the prescription share of general practitioners was highest (31%). Among antihypertensive medications, the prescription rates for BBs were highest (32%), followed by ARBs & CCBs (25% & 24% respectively). Single-drug formulation of anti-hypertensive medications was the most preferred (60%) among Indian clinicians. Prescription shares of fixed-dose combinations (FDC) of two antihypertensive drugs showed a slight decline (36% in 2017 to 34% in 2023) & FDCs of triple-drug exhibited an upward trend (3% in 2017 to 5% in 2023). Among the two drug FDCs, ARB & diuretics were most preferred (25% prescription share) & triple drug FDCs, CCB, ARB & diuretics were most preferred.

Conclusions:

Cardiovascular medications are prominent in the Indian pharmaceutical market, with antihypertensives standing out as one of the most frequently prescribed treatments. Consultant physicians and general practitioners manage the majority of hypertension cases. Notably, there has been an observed rise in preference for triple-drug combinations of antihypertensive medications, indicating a trend toward a more aggressive approach to hypertension management among Indian clinicians. The insights gleaned from this investigation can further assist healthcare professionals in crafting tailored treatment strategies for individuals grappling with hypertension. Such personalized approaches hold promise in enhancing treatment adherence and ultimately improving the QoL.
P039 INTEGRATED SCREENING FOR HYPERTENSION AND DIABETES MELLITUS IN ROUTINE TUBERCULOSIS CARE IN DELHI, INDIA
Authors: Anand Tanu , Grover Shekhar
Published: September 2024

Background:

Evidence supports the integration of prevention and management for tuberculosis (TB) with non-communicable diseases (NCDs) like hypertension and diabetes mellitus (DM). Bi-directional screening for TB and DM is already implemented in India, a country with a dual burden of TB and NCDs. However, very limited programmatic data are available on the feasibility of adding other NCDs and their risk factors in such screening programme.

Objective:

To assess the yield, feasibility, and acceptability of a two-stage integrated screening for NCDs and risk factors for NCDs among patients with TB ≥20 years and treated in DOTS centres of two medical colleges in Delhi, between October 2016 and March 2017.

Methods:

It was a mixed-methods, triangulation study with a quantitative component (cross-sectional study using questionnaires, anthropometric measurements and records review) and a qualitative component (descriptive study using interview data).

Results:

Amongst 403 patients screened, the prevalence of hypertension was 7% (n = 28) with 20 new cases detected and 8% for DM (n = 32) with 6 new cases diagnosed. The number needed to screen to find a new case was 20 and 63 for hypertension and DM respectively. The most frequent NCD-risk factors were inadequate vegetable (80%) and fruits (72%) intake, alcohol use (34%), use of smokeless tobacco (33%) and smoking (32%). Clustering of four or more risk factors was associated with increasing age and male sex (p<0.05). Both patients and health providers considered the screening relevant and acceptable. However, waiting time and costs involved in blood tests were considered as bothersome by the patients, while health providers perceived increased workload, inadequate medical supplies and inadequate skills and knowledge as key challenges in implementation of the screening.

Conclusion:

Integrating screening for hypertension and DM and their risk factors in the existing TB programme produces high yield and it is feasible and acceptable by patients and health providers provided the challenges are overcome.
P041 COMMUNITY-BASED STRATEGIES TO IMPROVE HEALTH-RELATED OUTCOMES IN PEOPLE LIVING WITH HYPERTENSION IN LOW MIDDLE-INCOME COUNTRIES: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Boateng Daniel , Nyame Solomon , Heeres Pauline , Gyamfi Joyce , Gafane-Matemane Lebo F , Iwelunmor Juliet , Ogedegbe Gbenga , Grobbee Diederick , Asante Kwaku Opoku , Klipstein-Grobush Kerstin
Published: September 2024

Background and objective:

Hypertension affects one billion people globally and is a major risk factor for cardiovascular diseases. Currently, it is estimated that high blood pressure (BP) is related to the deaths of more than 10 million people every year. Interventions to mitigate the looming hypertension crisis in low- and middle-income countries (LMIC) need strong community involvement whilst concurrently addressing access to care and quality of care issues. The objective of this systematic review was to evaluate community-level interventions to improve hypertension control among patients living in LMICs.

Methods:

Nine databases were searched (July 22, 2023) for randomized controlled trials (RCTs) and cluster randomized control trials (cRCTs) implementing community-level interventions in adults with hypertension in LMICs. Studies were included based on an explicit focus on BP control. Quality assessment was done using the Revised Cochrane Risk of Bias tool for randomized trials (ROBS 2). Results were presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Fixed-effect meta-analysis were conducted for studies that reported continuous outcome measures.

Results:

We identified and screened 7125 articles. Eighteen studies were included in the analysis, 7 RCTs and 11 cRCTs. The overall summary effect of BP control from the meta-analysis was significant, risk ratio = 1.48 (95%CI = 1.40–1.57, n=12). For the RCTs risk ratio was 1.68 (95%CI = 1.40–2.01, n=5), and for the cRCTs 1.46 (95% CI = 1.32 – 1.61, n=7). For studies that reported on the individual components of the composite interventions, the risk ratio was 1.27 (95%CI = 1.04–1.54, n=3).

Conclusions:

Community-based strategies are relevant in addressing the burden of hypertension in LMICs. Community-based interventions can help decentralize hypertension care in LMIC and address the access to care gap without diminishing the quality of hypertension control.
P049 RENOVASCULAR HYPERTENSIVE RATS (2K1C) HAVE REDUCED INTRACRANIAL COMPLIANCE INDUCED BY RAISED VENTRICULAR VOLUME COMPARED TO NORMOTENSIVE RATS
Authors: Medeiros Fernanda , Katayama Pedro , Menani José , Andrade Rodrigo , Colombari Eduardo , Colombari Débora
Published: September 2024

Background and Objective:

Intracerebroventricular (ICV) infusions of increased volumes of saline can be used to study intracranial compliance (ICC). Since the two-kidneys,1-clip (2K1C) rat model of renovascular hypertension has an enhanced baseline level of intracranial pressure (ICP), the present study aimed to verify the effect of ICV infusions of 0.15 M NaCl on ICP and ICC in 2K1C rats.

Methods:

Male Holtzman rats (180-210 g) were randomly separated to be normotensive (NT; sham surgery, n = 5) or with 2K1C (n = 5), done by a partial left renal artery occlusion. Six weeks after, rats were anaesthetized with urethane (1.2 g/kg body weight, i.v.), tracheostomized, placed under artificial ventilation, and had an ICP sensor and a needle inserted into the lateral ventricle for, respectively, ICP recording and ICV 0.15 M infusions (30, 60 and 90 μL, at 100 μL/min). There was a 20-minute interval between each infusion. ICC was calculated by the ratio of volume change to ICP change [ICC = ΔV (μL)/Δ ICP (mmHg)].

Results:

Baseline MAP, ICP, and P2/P1 ratio of 2K1C rats (166 ± 6 mmHg; 15.7 ± 1.7 mmHg; 1.6 ± 0.1, respectively) were higher than the ones in NT rats (94 ± 5 mmHg; 10.1 ±1.4 mmHg; 0.7 ± 0.1 respectively; p<0.05 vs 2K-1C). ICV infusions induced increased ICP in 2K1C rats (19 ±0.5; 42 ±1.2 and 55 ±5.5 mmHg, vs NT: 8 ±0.6; 25 ±3.2 and 36 ± 4.9 mmHg, respectively at 30, 60 and 90 μL infusion; p<0.05). In addition, 2K1C rats presented a reduced ICC only at 30 μl infusion (5.6 ±1.4, vs NT: 11.4 ±0.9; p<0.05).

Conclusions:

These findings suggest that renovascular hypertension impairs ICC to the well-documented increase in ICP.

Support:

FAPESP, CNPq.
P069 VALIDATION STATUS OF BLOOD PRESSURE MONITORS FOR PUBLIC SPACES (KIOSK): STRIDE BP SYSTEMATIC REVIEW
Authors: Kyriakoulis Konstantinos , Menti Ariadni , Mariglis Dimitrios , Kollias Anastasios , Palatini Paolo , Parati Gianfranco , Wang Jiguang , Schutte Aletta , Stergiou George
Published: September 2024

Background and Objective:

Blood pressure (BP) measurement in public spaces using kiosk devices may be useful in improving hypertension awareness and control. Validation studies of kiosk devices using an established protocol are necessary prior to their use.

Methods:

A PubMed search was performed using the following algorithm: (kiosk OR “public spaces” OR “public space” OR pharmacy OR “public use” OR “waiting room” OR “self-screening”) AND (“blood pressure”), until May 25, 2024.

Results:

An initial search retrieved 307 articles of which 8 were included in the systematic review (Table). 11 validation studies were conducted according to established validation protocols evaluating the accuracy of 8 kiosk BP monitors. All devices were single solid wide-range cuff devices, 3 were embedded in health stations, and 5 were portable. Four validation studies used the Association for the Advancement of Medical Instrumentation (AAMI) 1987/1992/2002 protocol, 4 used the British Society of Hypertension (BHS) 1993 protocol, and each of the remaining studies used the European Society of Hypertension International Protocol (ESH-IP) 2010, the American National Standards Institute (ANSI)/AAMI/International Organization for Standardization (ISO) 2013 protocol, and the 2018 AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018), respectively. All studies were conducted in general populations. Two validation studies regarding a single device concluded that the accuracy criteria were not fulfilled and the device cannot be recommended for use. The remaining studies concluded that the devices under test were accurate and can be recommended for use. However, two of these validation studies were rejected by the STRIDE BP review process due to major protocol violations (single observer for reference BP measurement in one study; no report of validation criterion 2 in the second).

Conclusions:

Kiosk BP measurement in public spaces is an emerging but inadequately investigated BP monitoring method. Although kiosk BP measurement has considerable potential in hypertension screening and monitoring, more research is needed to promote the use of properly validated devices.

Table. Published validation studies of kiosk blood pressure monitors.
P071 ASSOCIATION BETWEEN DIFFERENT TIMEPOINT AND THRESHOLD-CALCULATED TIME-IN-SYSTOLIC-BLOOD-PRESSURE-TARGET-RANGE AND INCIDENT MAJOR ADVERSE CARDIOVASCULAR EVENTS: INSIGHT FROM THE SPRINT TRIAL
Authors: Li Moran , Shi Jieying , Hou JingJing , Zhao Yifan , Zhang Yi
Published: September 2024

Objective:

To evaluate the prognostic value of different timepoint and threshold of systolic blood pressure (SBP) Time in Target Rang (TTR) in Major Adverse Cardiovascular Events (MACEs).

Method: A post-hoc analysis of the SPIRNT trial was conducted. Participants with complete BP data and no adverse events occurred in next 2-years follow-up were enrolled. SBP TTR was calculated at different timepoints (3, 12, 24 months) and thresholds (110-130mmHg; 110-140mmHg; 110-130mmHg for intensive and 120-140mmHg for standard treatment groups)(Fig 1). The primary outcome was MACEs occurred 2 years later, defined as the composite of myocardial infarction, stroke, heart failure and cardiovascular death.

Results:

7134 participants in SPIRNT were enrolled in this study. SBP TTR indexes with independent predictive value of MACEs were selected by multivariable COX models adjusted for basic cardiovascular risk factors (Fig 2). Multivariable COX models identified SBP TTR calculated with 110-140mmHg threshold over 3 months (3month SBP TTR110-140) as the best predictor of MACEs. (Table 1). the nonlinear trend of 3month SBP TTR110-140 was also evaluated. (Fig 3) Then, a cut-off value of 0.65 for 3month SBP TTR110-140 was obtained by the point with the largest likelihood value in the RCS curve.(Fig 3). Patients with 3month TTR110-140 > 0.65 had 23.9% lower incidence of MACEs than patients with TTR ≤ 0.65 (HR 0.761[0.592-0978], P=0.033).(Table 2) In addition, for patients with early SBP well-control (3month SBP TTR110-140 >0.65), there was no significant difference in mean SBP between 110-130 mmHg and 130-140 mmHg (Fig4). Lasso regression also suggests that TTR110-140 has more informatics advantages than TTR110-130 in cox model at different timepoints (Fig5).

Conclusions:

3month SBP TTR110-140 was considered to be the best predictor of MACEs occurred 2 years later in different SBP TTR indexes, which indicated the importance of early SBP control. This study also proposed 0.65 as the critical value of 3-month SBP TTR110-140 for prevention of the incident of MACEs.
P083 CHANGES IN STANDARD CUFF AND CENTRAL BLOOD PRESSURES ARE EQUALLY ASSOCIATED WITH CHANGES IN LEFT VENTRICULAR MASS: LONGITUDINAL ANALYSIS FROM THE UK BIOBANK COHORT STUDY
Authors: Sharman James , Takeuchi Fumihiko , Protogerou Athanase , Weber Thomas , Wassertheurer Siegfried , Marwick Thomas
Published: September 2024

Background and objective.

Central blood pressure (BP) measurement purports to aid hypertension management. This concept is founded on cross-sectional studies, however, findings are mixed and none report longitudinal relationships between changes in BP and outcomes. This study aimed to determine associations of changes in cuff BP and central BP with changes in left ventricular mass index (LVMi), as an important hypertension-related clinical outcome.

Methods.

Standard cuff BP and central BP (Vicorder, Skidmore Medical, UK; SBP/DBP calibration of waveforms) were measured at the same time as cardiac magnetic resonance imaging for LVMi among a cohort of adults from the UK Biobank Cohort Study assessed at two time points (2014+ and 2019+). Linear regression adjusted for demographic and clinical characteristics were used to determine cross sectional associations and associations between changes in cuff BP and central BP with LVMi.

Results.

Data were evaluable for 681 participants (aged 50.1±7.1 years, 54% female) followed over 1161±582 days (mean ± SD). Cross-sectional analysis showed the association of cuff systolic BP with LVMi (β±SE 3.47x10-2±6.38x10-3 g/m2.7/mmHg) and central systolic BP with LVMi (β±SE=3.52x10-2±6.40x10-3 g/m2.7/mmHg) were comparable (p<0.001 both). In the longitudinal analysis, associations between the changes in BP and changes in LVMi were identical for both central and cuff systolic BP (β±SE=0.011±0.003 g/m2.7/mmHg; p<0.001 both).

Conclusion.

Changes over time in standard cuff BP provides similar information to central BP on risk for hypertension-related changes in LVMi. These findings are likely to be generalisable to central BP devices using SBP/DBP calibration.
P088 VASCULAR HYPERREACTIVITY IS RELATED TO SHORTENING FRACTION AND LEFT VENTRICULAR MASS IN YOUNG NORMOTENSIVES
Authors: Rufino Nuñez Harline Raquel , Carmona Puerta Raimundo , Lorenzo Martinez Dra Elizabeth , Sanchez Dra Marielys del Carmen Martinez , Batista Dra Yahaira A. Flete , Gómez Calderón Jose B. , Peñaló Batista Joel
Published: September 2024

Background and objective:

Vascular reactivity has been related to left ventricular hypertrophy, but there are insufficient data on whether this relationship involves left ventricular (LV) contractility. Our aim was to relate the degree of cardiovascular reactivity to LV mass and contractility.

Methods:

A cross-sectional study was carried out in normotensive men aged 16-40 years, divided into 2 groups of 30 individuals according to the degree of vascular reactivity determined by the sustained weight test. The LV mass index (LVMI) and the shortening fraction were determined by transthoracic echocardiography.

Results:

LVMI was found to be significantly higher in hyperreactive than in normoreactive patients (123.57 g/m2 vs. 105.10 g/m2 p<0.01) and the shortening fraction in hyperreactive patients was significantly lower than in normoreactive patients (31.21% vs. 33.78% p<0.05). This difference increased in the subgroup of hyper-reactive patients with left ventricular hypertrophy and disappeared in hyper-reactive patients without hypertrophy when compared in each case with normoreactive patients.

Conclusions:

Hyperreactivity status is related to lower shortening fraction and greater left ventricular mass in young normotensive males.
P092 THE EFFECT OF HYPERTENSION ON THE UTILITY OF ECHOCARDIOGRAM AS AS SUBSTITUTE OF CARDIAC SCNINTIGRAPHY TO DETECT CARDIAC ISCHEMIA
Authors: Miyahara Yuiko , Hirai Takumu , Sakida Miho , Kubo Kazuhiko
Published: September 2024

Background and Objective:

The cardiac scintigraphy is worthwhile to detect ischemia instead of cardiac catheterization, whereas the echocardiogram is useful to detect movement of myocardium and valves but not to detect ischemia. It is beneficial to predict ischemia by echocardiogram because the disadvantage of cardiac scintigraphy is to be expensive and to expose radiation. The objective of the current study is to evaluate whether the echocardiogram is substituted for the cardiac scintigraphy in the patients with ischemic heart disease and to assess the effect of hypertension on the correlation of two examinations.

Methods:

We recruited 101 patients with ischemic heart disease who were admitted to Chidoribashi General Hospital and underwent both echocardiogram and cardiac scintigraphy from April 2021 to March 2023. They were divided to two groups by the presence and absence of hypertension at admission. The various parameters of echocardiogram and cardiac scintigraphy were collected retrospectively. The correlation was statistically tested using JMP Pro 17. This study was approved by our ethical committee.

Results:

In the risk factors of poor prognosis, left ventricular end-systolic volume, summed stress score and ejection fraction (EF) from cardiac scintigraphy were correlated with left ventricular internal dimension (LVD) on echocardiogram. In contrast, summed difference score was correlated with LVD in systole and EF on echocardiogram in the patients without hypertension but not in the patients with hypertension.

Conclusions:

These results suggest that LVD of echocardiogram may become an indicator to detect cardiac ischemia instead of cardiac scintigraphy.
P097 SEXUAL DIMORPHISM IN A HYPERTENSIVE MODEL OF FRUCTOSE PLUS HIGH SALT DIET
Authors: Araos Patricio , Marfull BS. Rominna , Durán Anyelo , Alfaro Juan José , Fernand Matthias , Torres Sven , Gutiérres Harold , Sáez Javiera , Amador Cristián A. , Wynne Brandi
Published: September 2024

High salt diet (HSD) and fructose are both consumed in excess and contributes to hypertension (HTN). Fructose is commonly used to sweeten soft drinks, and studies have linked soft drink consumption to salt-sensitive HTN. However, full mechanisms aren’t understood. Previous data indicates that an acute fructose-enriched diet (FED) increases Na/K/2Cl cotransporter (NKCC2) activity, promoting salt-sensitive HTN in rats; however, there is no research on long-term consumption. Here, our goal was to evaluate whether a FED, coupled to HSD, can induce HTN. Given the known sex-dependent differences in salt-sensitive HTN, we also hypothesized differences between male and female mice.

Male and female C57BI/6 mice (10 weeks old, n=4-6) were treated with vehicle or fructose (10% in drinking water) plus HSD (4% in food) for 28 days. Systolic blood pressure (SBP) was measured by tail-cuff plethysmography, and cardiac hypertrophy (morphometry). We performed an acute diuresis test using furosemide to inhibit NKCC2 (20 mg/kg bw, ip) at day 26, and then measured natriuresis (metabolic cages) for 2-hrs. All data are presented by mean standard deviation.

Fructose+HSD increased SBP in male mice after 28 days (Veh=110.5±4.6 vs. Frucose+HSD=130.2±5.6 mmHg; p<0.01); in contrast, HTN was completely prevented in female mice (Veh=109.8±6.8 vs. Fructose+HSD=114.0±11.0 mmHg; ns). We did not observe changes in cardiac hypertrophy in either sex. We observed a significant decrease in natriuresis (∼20%) after furosemide injection in male mice (Veh=5.9±1.1 vs. Fructose+HSD=4.7±0.8 μEq/2 h/g bw; ns). Surprisingly, we observed an increase in natriuresis following furosemide injection in female mice (Veh=3.8±5.0 vs. Fructose+HSD= 7.7±2.7 μEq/2 h/g bw; p<0.01).

We observed HTN in males following a FED combined with HSD, which was not associated with increased NKCC2 activation. In contrast, female mice showed a resistance to HTN, and yet an apparent increase in NKCC2 activity. This probably suggests a dysregulation of other transporters not evaluated in this work. Finally, we demonstrate that long-term FED, with HSD, induces HTN with a sexual dimorphic effect, apparently through differential renal sodium handling.
P099 EXERCISE TRAINING FURTHER ATTENUATES BLOOD PRESSURE VARIABILITY AND RENAL DAMAGE IN HYDROCHLOROTHIAZIDE TREATED-HYPERTENSIVE AND POSTMENOPAUSAL RATS
Authors: Neves Pietra Petrica , Ferreira Maycon Junior , Shecaira Tânia Plens , Rascio Henriques Dutra Marina , Kimura Débora Conte , Gomes Guiomar Nascimento , Irigoyen Maria Claudia , De Angelis Katia
Published: September 2024

Background and Objective:

Considering that blood pressure variability (BPV) has been associated with damage to target organs such as the kidney, this study aimed to investigate the effects of hydrochlorothiazide (HCTZ) combined with exercise training (CET) on BPV, as well as renal tissue morphology, function, inflammation, and oxidative stress.

Methods:

Female spontaneously hypertensive rats (SHR) were divided into 4 ovariectomized groups (n=5-6/group): sedentary (OS), sedentary + HCTZ (OSH), trained (OT), and trained + HCTZ (OTH). Both HCTZ (3 mg/kg) and CET (3 days/week) were administered for 8 weeks. Blood pressure was directly recorded for BPV analysis.

Results:

Renal function, morphology, inflammation and oxidative stress were assessed. The OSH, OT, and OTH groups had lower systolic BP (OSH: 189±13; OT: 179±5; OTH: 174±15 mmHg) compared to the OS group (208±15 mmHg). Only the combination of the drug with CET promoted a reduction in BPV variance. The HCTZ-treated groups showed lower plasma creatinine levels and increased creatinine clearance compared to the OS group. Treated groups showed a reduction in fields of 51–100% of interstitial tubule fibrosis when compared to the OS group; and the OTH group also showed reduction in fields in the range of 26–50% vs. other groups. The HCTZ-treated groups showed a reduction in protein oxidation. Renal catalase and IL10/TNF-alpha ratio were increased in the OTH group. Positive correlations were obtained between SBP variance and SBP (r=0.72), plasma creatinine (r=0.58), and levels of TNF-α (r=0.69), hydrogen peroxide (r=0.61), and protein oxidation (r=0.66) in renal tissue.

Conclusions:

Our results highlight the enhanced efficacy of the combination of HCTZ and CET compared to the use of either drug alone in the model studied. This combination effectively reduced BPV, resulting in beneficial changes in renal inflammatory and redox profiles, inducing morphological and functional benefits in hypertensive ovariectomized rats.

Financial support: FAPESP (2022/04050-1), CNPq, CAPES-PROSUP, UNINOVE.
P101 LEFT VENTRICULAR MASS INDEX (LVMI) IS UNLIKELY TO NORMALISE WITH TREATMENT USING CURRENTLY RECOMMENDED BLOOD PRESSURE TARGETS
Authors: Jedrzejewski Dawid , Lacy Peter , Williams Bryan
Published: September 2024

Background and Objectives:

LVMI is one of the strongest predictors of cardiovascular events. However, it's unclear whether current blood pressure (BP) targets normalise LVMI relative to a truly normotensive population. We therefore compared achieved LVMI in a younger cohort of hypertensive patients (< 55 years) treated for one year to conventional blood pressure targets (< 140/90 mmHg) versus the LVMI of a truly normotensive age-matched healthy population from the UK Biobank (BP ≤ 120/80 mmHg).

Methods:

The normotensive cohort comprised 101 treatment-naïve men (mean ± SD age: 52 ± 2 years, BP: 112 ± 7/68 ± 7 mmHg) from 77,983 UK Biobank participants who had undergone cardiac Magnetic Resonance Imaging (cMRI) to determine LVMI. The treated hypertensive cohort comprised 44 men from the TREAT CASP study* (mean age: 49 ± 6 years) who achieved mean BP of 129 ± 10/78 ± 8 mmHg after one-year treatment. LVMI in both cohorts was measured accurately via automated analysis of cMRI and manually reviewed for accuracy.

Results:

LVMI in Biobank cohort was 51.3 ± 6.0 g.m-2 (95% CI: 50.1 to 52.4 g.m-2). In the hypertensive cohort, after one year of treatment, LVMI was reduced (59.2 ± 7.0 versus 56.0 ± 7.0 g.m-2, P <0.001) but remained higher than the Biobank cohort (56.0 ± 7.0 versus 51.3 ± 6.0 g.m-2, P <0.001). Mean LVMI of treated-hypertensive patients achieving truly normotensive BP (≤ 120/80 mmHg) was 52.7 ± 5.7 g.m-2 (95% CI: 48.9 to 56.4 g.m-2; n = 9).

Conclusions:

This study identified optimal cMRI LVMI for healthy middle-aged men. Antihypertensive treatment reduces but does not restore LVMI to normal levels, suggesting much lower BP targets than currently recommended are likely to be necessary to normalise LVMI in hypertensive patients.

*Reference:

Lacy, P. S., Jedrzejewski, D., McFarlane, E., & Williams, B. (2023). Blood pressure measurement modalities and indexed left ventricular mass in men with low-risk hypertension confirmed by ambulatory monitoring. Journal of Hypertension, 41(6), 941-950.
P109 AMINOPEPTIDASE A: A POTENTIAL NOVEL THERAPY FOR ANGIOTENSIN-DEPENDENT HYPERTENSION?
Authors: Forster Peter , Gonzalez Crisel Rivero , Mantilla Carlos Rueda , Wysocki Jan , Batlle Daniel
Published: September 2024

Background:

We have shown that mice with a genetic deficiency in Aminopeptidase A (APA) have elevatedblood pressure. APA is an enzyme that removes a single aspartate residue from the amino-terminus of several peptides in the renin-angiotensin systems (RAS), including angiotensin (Ang) II. In this study, we investigated the impact of a recombinant APA on the cleavage of various RAS peptides and its effect on blood pressure.

Methods:

An in vitro assay was used to identify Ang peptides as substrates for APA. Ang peptides identified as APA substrates using this assay were then injected to anesthetized WT and APA-deficient mice to assess their pressor effect by measuring systolic blood pressure (SBP). Subsequently, murine recombinant (r)APA was used to evaluate its action on the acute SBP elevation elicited by Ang peptides that were identified to trigger pressor response.

Results:

In the in vitro assay, Ang II (22427±3353, n=12), Ang I (21883±1692, n=3), Ang1-7 (15833±3395,n=3), Ang1-9 (15773±3395, n=3) and Ang1-12 (13170±220, n=3), were identified as a substrate for rAPA as indicated by a strong aspartate-driven fluorescence formation. When these five Ang peptides were administered to WT mice, only Ang I, Ang II and Ang 1-12 caused a significant increase in SBP. This effect was exaggerated in APA deficient mice. The SBP increase elicited by Ang II in WT mice was markedly reduced by the pre-administration of rAPA (Fig).

Conclusion:

Aminopeptidase A can cleave the N-terminal aspartate from Ang II as well as from other RASpeptides that elicit (Ang 1-12, Ang I) and do not elicit (Ang 1-9, Ang 1-7) pressor response in mice. APA deficiency is associated with an exaggerated SBP response to Ang I, Ang II and Ang 1-12 while the recombinant enzyme mitigates the acute hypertensive effect. rAPA markedly reduced the increase in SBP caused by AngII infusion suggesting that it may be used to treat hypertension caused by excess of AngII.
P111 INTER-ARM DIFFERENCE IN SYSTOLIC BLOOD PRESSURE AMONG YOUNG POPULATION IN ABEOKUTA, NIGERIA
Authors: Adebayo Oladimeji , Ayowole Damilola , Inofomoh Francisca , Kanmodi Kehinde , Oiwoh Sebastine , Ojo Oluwaseyi , Williams Adedayo , Ibiyo Morohunmubo , Samuel Akinjopo , Ogunjimi Luqman
Published: September 2024

Background and Objective:

Inter-arm blood pressure differences (IABPD) are linked to higher cardiovascular mortality and morbidity. Unfortunately, the profile and associated risk factors of IABPD in sub-Saharan Africa, particularly Nigeria are poorly studied. This study aims to determine the profile and associated correlates of systolic IABPD among the participants in the profile of anthropometry and psychosocial issues on campus (TERRACE) study, a cohort of young persons on selected tertiary educational campuses in Abeokuta metropolis aged 16-35years.

Methods:

This was a cross-sectional study. Basic demographic, anthropometric, and clinical data were collected. Brachial Blood Pressure (BP) were recorded in both arms, using validated electronic devices. Three standard measurements were performed on both arms. The IABPD was defined as the absolute value of the difference in systolic blood pressure(SBP) between the left and right arms of BP averages. Significant IABPD ≥10 mmHg. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 23. The level of statistical significance was set at <0.05.

Results:

A total of 301 participants with age, 21.8±4.9 years and female proportion of 65.1%. The mean±SD of neck circumference, weight, height, right SBP, left SBP were 26.2 ± 3.6 cm, 58.0 ± 10.0 kg, 164.1 ± 10.4 cm, 112.9± 11.6mmHg and 112.0 ± 11.1 mmHg respectively. The median systolic IABPD was 0.6 mmHg, and the prevalence of significant systolic IABPD is 9.0% (11.4% in males and 7.7% in females, p- value: 0.275). Among our participants, there were 6.0%, 2.3% and 0.7% with a systolic IABPD in the ranges: 10-14.9mmHg, 15-19.9mmHg and ≥ 20mmHg respectively. The proportion with dominantly high right SBP was 54.4% in males compared to females (41.9%), p- value: 0.209. There was a correlation between height and IABPD (r2=0.177, p-value=0.002)

Conclusion:

Our study found that this young population have high IABPD, suggesting increased cardiovascular risk. Routine measurement in both arms is advised.
P113 CARDIOVASCULAR RISK FACTOR CONTROL IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES: A CROSS-SECTIONAL EPIDEMIOLOGICAL STUDY IN COLOMBIA (SNAPSHOT STUDY)
Authors: Quintero-Baiz Adalberto , Buelvas Herazo Jannes Jose , Gomez Jaime Orlando Ibarra , Etayo Ruiz Edwin Harbey , Jattin Fernando Gabriel Manzur , Tamayo Maya Juan Guillermo , Valiente Jose Mario Porto , Correa Luis Eduardo Echeverria , Barrios Gilberto Amed Castillo , Moreno Cortes Javier Alfredo , Gutierrez Tomasa Bermudez
Published: September 2024

Background and objective:

Hypertension is the leading preventable cause of cardiovascular (CV) disease and frequently occurs with other risk factors such as elevated blood glucose and cholesterol. This study aimed to assess the control rates of blood pressure (BP), glycated haemoglobin (HbA1c), and LDL-cholesterol (LDL-C) according to CV risk in hypertensive patients with type 2 diabetes in Colombia.

Methods:

SNAPSHOT, a cross-sectional, observational, multicenter, epidemiological study, involved patients enrolled by 20 investigators (mostly cardiologists [75.0%] and internists [20.0%]) in Colombia. CV risk was assessed based on the European Society of Cardiology CV disease prevention 2021 (SCORE2&2-OP) guidelines.

Results:

The analysis set included 459 patients; mean age (SD) was 68.7 (10.5) years, most patients were female (58.0%), and overweight or obese (73.4%). Most patients (91.7%) had at least 1 comorbidity in addition to hypertension and type 2 diabetes, including dyslipidemia in 85.6% of patients.

Hypertension was treated in 97.6% of patients and considered by investigators to be controlled in 72.8% of patients, whereas only 44.4% of patients were controlled according to guidelines. Type 2 diabetes was treated in 92.2% of patients and controlled in 55.5% according to guidelines. In the subset of patients with concomitant dyslipidemia, LDL-C was treated in 95.2% and controlled according to guidelines in 25.6% of patients. The proportion of patients controlled for both hypertension and diabetes was 24.0% and the proportion controlled on all three parameters was 9.5% (Figure). Single-pill combinations were used to treat diabetes in 39.7%, hypertension in 21.4%, and dyslipidemia in 16.8% of patients. Mean (SD) systolic and diastolic BP were 131.3 (18.0) and 77.5 (10.1)mmHg, respectively; mean (SD) HbA1c was 7.0 (1.5)%; and mean (SD) LDL-C was 91.0 (43.4)mg/dL.

Conclusions:

This study showed a substantial unmet medical need: control rates for BP, HbA1c, and LDL-C in Colombia fell short among patients examined, emphasizing the urgency for enhanced therapeutic strategies.
P116 ANTHROPOMETRIC INDICES AND DYSLIPIDAEMIA IN A SEMI-URBAN NIGERIAN POPULATION
Authors: Udora Nneka Clara , Ajulufo IJ , Ossai EN , Ejim EC , Ekwe EA , Nwajiobi CE
Published: September 2024

Background/Objective:

Obesity and dyslipidaemia are cardiovascular/metabolic risk factors. Dyslipidaemia's intricacy with obesity is dependent on several individual factors and hyperinsulinaemia is a major drive for obesity induced dyslipidaemia. Cost remains a challenge for lipid assay in our locality as majority pay out of pocket for healthcare. Hence, aim of the study- to correlate anthropometric indices with dyslipidaemia and determine which amongst six anthropometric indices best predicts dyslipidaemia.

Methods:

Consents were obtained from two hundred and sixteen subjects recruited consecutively, from three primary health care centres in a semi-urban Nigerian population. Biodata and cardiovascular risk factors’ history were obtained using interviewer administered questionnaire. Bodyweight, height, waist and hip circumferences were obtained using standard methods. Oscilliometric method was used for blood pressure check while body mass index (BMI), ratios of waist to hip (WHR) circumference and waist to height(WHtR), a body shape index (ABSI) and body roundness index (BRI) were calculated using online calculators. Fasting blood glucose (FBG) was performed using hexokinase method while enzymatic method was used for serum total cholesterol (TC), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C) and triglyceride (TGD) assays after a 12hr overnight fast. Correlation, ROC curve and multivariate analysis using binary logistic regression analysis were used in the analysis.

Results:

Mean age of participants was 54.8±15.0years. Majority, (71.8%) were females. The prevalence of dyslipidaemia was 94.9%. A weak positive correlation exists between BRI and TC (r =0.134, p=0.049) and with LDL (r =0.182, p=0.007). The AUC was 0.686 (0.516-0.856) for ABSI, cut-off of -1.479, (sensitivity 81.0%; specificity 54.5%). Predictors of dyslipidaemia included age <60years (AOR=15.94, 95%CI: 1.8-143.2) and male gender(AOR=0.08, 95%CI: 0.02-0.50).

Conclusions:

There is a high prevalence of dyslipidaemia. Lipid levels increases as anthropometric readings rise. ABSI best predicted dyslipidaemia though moderately specific therefore, can be used to screen individuals and identify those in whom lipid assay must be done at all cost during management of cardiovascular/metabolic risk factors.

Table: Area under ROC curve (AUC), optimal cut-off points, sensitivities and specificities of anthropometric indices in predicting dyslipidaemia.