bluuebunny/crossref_metadata_2025 huggingface dataset:
P107 THE EFFECT OF MELDONIUM ON THE ENDOTHELIAL FUNCTION ASSESSED BY PLASMA ENDOCAN LEVEL IN PATIENTS WITH ESSENTIAL HYPERTENSION
Authors: Rekhviashvili Ann , Ratiani Nana
Published: September 2024

Background and Objective:

Endothelial dysfunction is one of the main findings in patients with arterial hypertension. It is associated with atherosclerosis initiation and progression. Lately, a soluble dermatan sulfate proteoglycan Endocan is used as a marker of endothelial dysfunction in patients with big variety of diseases. Hence, aim of our study was to assess effect of competitive inhibitor of carnitine-dependent fatty acid oxidation and promoter of anaerobic oxidation via the glycolytic pathway, Meldonium, on endothelial function in patients with arterial hypertension.

Methods:

30 nonsmoker, non-obese male patients with stage II hypertension (ESH/ESC 2018) were involved in a study. 15 patients were put on recommended antihypertensive treatment plan and other 15 patients on conventional plus Meldoneum 1000 mg per day treatment for 3 months. Endocan level was tested before and after 3 months of treatment period. Hypertension was diagnosed as an average office blood pressure of three different visits equal or more than 140/90 mmHg. Written informed consent letters were obtained from all the participants.

Results:

Mean age and average blood pressure of study groups were not different between conventional and conventional plus Meldonium groups (48.6±6.94 vs 51.53±7.22 years old and 148/94 vs 151/95; P= NS for both). Initial plasma endocan level also was similar between the two groups (1.920±0.625 for Meldonium and 1.854±0.391 for conventional treatment; P=NS). In comparison with initial level, plasma endocan level significantly decreased after 3 months of treatment with conventional plus Meldonium treatment (1.920±0.625 vs 1.344±0.041; P<0.05). Statistically significant difference of endocan level change after 3 month of treatment with conventional antihypertensive agents was not observed (1.854±0.391 vs 1.75±0.649; P=NS).

Conclusion:

Obtained results indicate, that 1 g/day Meldonium on top of conventional guideline recommended antihypertensive regimen significantly improves endothelial function assessed via plasma endocan level. Further studies are needed to confirm these results on a bigger population samples.
P124 CARDIOVASCULAR RISK RE-CLASSIFICATION BY IMPLEMENTING CAROTID ULTRASONOGRAPHY IN PRIMARY CARE
Authors: Kyriakoulis Konstantinos , Menti Ariadni , Komnianou Aikaterini , Stathopoulou Panagiota , Ntousopoulos Vasileios , Mariglis Dimitrios , Theodosiadi Aikaterini , Stergiou George , Kollias Anastasios
Published: September 2024

Background and Objective:

The accurate assessment of the total cardiovascular risk (CVR) using risk calculation algorithms in individuals with CVR factors in the primary prevention setting is essential for optimal management decisions, including drug treatment initiation and treatment goals. The aim of this study was to evaluate the contribution of ultrasonographic identification of asymptomatic carotid atherosclerosis in the re-classification of the CVR assessed with the reference SCORE2/2-OP algorithm.

Methods:

In individuals aged ≥40 years without established cardiovascular disease, the 10-year CVR was calculated using the SCORE2/2-OP algorithm (3 risk categories: low/moderate, high, and very high). Carotid ultrasound study was applied using a portable handheld device (Lumify, Philips) to classify CVR as follows: (i) low/moderate (absence of atherosclerotic plaque), (i) high (atherosclerotic plaque with <50% stenosis), (iii) very high (atherosclerotic plaque with ≥50% stenosis).

Results:

Data from 332 participants were analysed [age 59±7.5 years, men 41%, current smokers 26%, body mass index 28±5 kg/m2, office blood pressure 125±15/77±10 mmHg (systolic/diastolic), LDL-cholesterol 111±33 mg/dl]. Based on SCORE2/2-OP, 49/46/5% participants were categorised as of low/moderate, high, and very high CVR, respectively. Based on carotid ultrasound, the rates were 39/59/2%, respectively. 44% of individuals categorized as of low/moderate CVR based on SCORE2/2-OP were re-classified into a higher CVR category based on carotid ultrasound. The agreement between the 2 methods (ultrasound versus algorithms) in categorizing low/moderate and high CVR was 67% (kappa 0.35, P<0.001) and 61% (kappa 0.23, P<0.001), respectively. Among 204 participants categorized as of high/very high CVR according to carotid ultrasound, only 15 (7%) had LDL-cholesterol levels <70 mg/dl.

Conclusions:

These findings suggest that carotid ultrasonography using a portable handheld device may significantly contribute to assess CVR more accurately in primary care, especially in individuals classified as of low/moderate CVR using reference algorithms.
P132 CARDIOVASCULAR RISK ASSESSMENT IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES: A CROSS-SECTIONAL EPIDEMIOLOGICAL STUDY IN COLOMBIA (SNAPSHOT STUDY)
Authors: Quintero-Baiz Adalberto , Ceron Benavides Juan Alberto , Correa Ricardo Cesar Restrepo , Conta Lopez John Alexander , Ocampo Jose Dagnovar Aristizabal , Rodriguez Augusto Melendez , Triana Eric Hernandez , Serrano Osmán Alberto Perez , Cardenas Juan Mauricio , Perez Perez Julio Emiro , Rozo Vanstrahlen Jose Medardo , Gutierrez Tomasa Bermudez
Published: September 2024

Background and objective:

Cardiovascular (CV) risk is determined by an interplay of risk factors. The goal of the study was to assess 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 by investigators and compared to the calculated CV risk based on ESC 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/obese (73.4%), 21.4% were former smokers and 2.4%, active smokers. A combination of risk factors (male gender, age ≥65years, BMI≥30 kg/m2, smoking) was reported for most patients: 43.8% of patients had 1 of these risk factors, 38.1% had 2 risk factors, 6.1% had 3 risk factors, and 0.2% had all 4 risk factors. Most patients (91.7%) had at least 1 comorbidity in addition to hypertension and type 2 diabetes. Overall, 85.6% of patients had dyslipidemia, 39.7% had chronic kidney disease, and 33.8% had at least one additional CV comorbidity, mainly coronary or other arterial revascularization (18.1%) and acute coronary syndromes (13.5%). 48.4% of patients had diabetes-related target organ damage.

CV risk perceived by investigators was low (0.7%), moderate (20.9%), high (35.7%) or very high (42.7%), whereas calculated CV risk according to SCORE2&2-OP was either high (34.6%) or very high (65.4%) (Figure). The prevalence of high and very high CV risk was similar when calculated according to the 2016 (SCORE1) guidelines. Investigators estimated CV risk accurately versus SCORE2&2-OP in only 41.6% of patients, while they underestimated it in 47.9% of patients.

Conclusions:

Hypertensive patients with diabetes in Colombia are at very high risk of CV disease, but this risk is frequently underestimated by physicians. Enhancing physician education on guideline recommendations and treatment intensification could improve risk factor control.
P137 ACE AND ACE 2 ENZYMES POLYMORPHISM IN DIFFERENT CLINICAL COVID-19 MANIFESTATIONS IN HOSPITAL-ADMITTED PATIENTS
Authors: Gomes Roberto , Gomes Andreia Febba , da Silva Martins Mariana , Bello Marina Moura , Magri Lucas , dos Santos Lilian , de Oliveira Lilian Gonçalves , Torres Leuridan Cavalcante , Casarini Dulce Elena
Published: September 2024

Introduction:

The affinity of SARS-CoV-2 for the Angiotensin Converting Enzyme 2 (ACE2), component of the Renin-Angiotensin System (RAS), is responsible for the COVID-19 virus internalization, and the ACE and ACE2 genes polymorphisms may contribute for the disease outcome. Objective: To correlate the I/D ACE and the G8790A ACE2 polymorphisms and their enzymatic activity to the virus susceptibility and the disease's clinical severity.

Methods:

408 patients from Alfa Hospital, Recife – PE, were assessed. ACE activity was measured by fluorometry and the real time PCR technique was used to assess ACE's DD, ID, and II polymorphisms.

Results:

71.9% of COVID-19 affected patients needed hospitalization, with 56.8% being male ranging from 40 to 59 years old. In the positive group, there were more patients with blood hypertension (80.6% vs 19.4%), diabetes (88.2% vs 11.8%), and obesity (87.5% vs 12.5%). ACE activity was higher in positive patients (46.5 vs 43.5 nmol/mL/min), with greater prevalence of the DD genotype, 85.6% of frequency between negatives and positives. When it comes to DD genotype, ACE activity was higher (48.5 nmol/mL/min). In patients with blood hypertension, ID genotype was more frequent than the DD one.

Conclusion:

The interaction of genetic and risk factors may lead to different COVID-19 symptomatology. The scientific literature states that ACE polymorphism may contribute for the development of blood hypertension, as the DD genotype being the susceptible one for developing cardiovascular complications by the higher concentration of Angiotensin II converted from Angiotensin I by ACE, increasing the hypertensive effects in relation to the anti-hypertensive ones of Angiotensin 1-7. The positive group showed more incidence of blood hypertension, diabetes and obesity, as well as higher frequency of the DD genotype, which is already established in literature to lead to blood hypertension due to increased ACE activity. From the observed in these results, it is suggested a correlation between ACE polymorphism and the factors that may aggravate COVID-19
P138 CORRELATION OF THE NDUFV2 RS874250 LOCUS OF THE MITOCHONDRIAL RESPIRATORY COMPLEX I NUCLEAR GENE WITH SUSCEPTIBILITY TO ESSENTIAL HYPERTENSION IN YUNNAN REGION
Authors: Guo Hao , Wu Yu Xian , Guo Li
Published: September 2024

Background and Objective:

Essential hypertension is a multifactorial disease characterized by the interaction of genetic and environmental factors, with genetic factors accounting for 30-50%. Currently, the relevant SNPs identified through genome-wide screening analysis explain only 2-3% of the blood pressure variance. It is suggested that there is a large number of undiscovered genetic variants associated with essential hypertension. The NADH-ubiquinone oxidoreductase core subunit V2 (NDUFV2) is one of the key subunits of mitochondrial respiratory Complex I, which plays an important role in oxidative stress, inflammation, and cell death, and those are associated with endothelial cell damage, vascular remodeling, and hypertension. The study aims to investigate whether the NDUFV2 rs874250 is associated with essential hypertension.

Methods:

In total of 1437 subjects, were Chinese-Han from Yunnan province, including 824 patients with essential hypertension (378 males and 446 females) and 613 healthy controls (240 males and 373 females). NDUFV2 rs874250 was selected for genotyping and establishing 2 genetic models: a genotypic model (GG vs GA vs AA) and a super-dominant model [GA vs (GG+AA)] for all subjects.

Results:

In this study, the frequency distribution of genotypes conformed to the HWE test (p>0.05). The super-dominant model was the best genetic model for the rs874250 locus of the NDUFV2 gene. Under the super-dominant model, we found that the distribution frequency of the GA genotype in the essential hypertension group was higher than that in the control group (P<0.05), and the GA genotype was a risk factor for hypertension (OR=1.30, P<0.05). Diastolic blood pressure (DBP) and mean arterial pressure were significantly higher in GA genotype carriers than in GG+GA genotype carriers after correction for sex, age, and BMI (P<0.05).

Conclusions:

Our study indicated that the NDUFV2 rs874250 is likely to be involved in essential hypertension, especially in diastolic pressure. We postulate that GA genotype may be a risk factor for elevated DBP, which requires further validation.
P141 CHARACTERIZING HYPERTENSION AMONG RECREATIONAL CYCLISTS: THE ATLÁNTICO CYCLISTS STUDY (ACS)
Authors: Hernández-Nieto Bryan , Urina-Jassir Manuel , Mantilla-Morrón Mirary , Charris Carolina , Granadillo Anamileth , Martinez Yuliana , Mercado-Marchena Riguey , Urina-Jassir Daniela , Urina-Triana Manuel , Urina-Triana Miguel
Published: September 2024

Background and Objective:

Physical activity is a crucial component for the prevention of chronic diseases including hypertension, diabetes, and coronary artery disease. Recent studies suggest a higher prevalence of hypertension among young athletes and active individuals. Exercise-induced hypertension (EIH), defined by elevated systolic blood pressure during exercise, is now recognized as a potential risk factor for sudden cardiac death. Cycling, a high-impact dynamic exercise, is associated with EIH. Our study aimed to determine the frequency of hypertension, EIH, and pre-exercise medical evaluation among recreational cyclists.

Methods:

A cross-sectional study was conducted on adult (≥18 years) recreational cyclists in the Department of Atlántico, Colombia. Participants were selected via convenience sampling and a structured survey was applied including demographic data, past medical history, and exercise habits. Blood pressure was measured using a validated automatic sphygmomanometer, with two post-exercise measurements taken 3 minutes apart. Weight, height, waist circumference, heart rate, and oxygen saturation were also collected. Descriptive statistics were used to summarize the findings (SPSS version 26 for Mac).

Results:

A total of 355 individuals were included. They were mostly male (84.5%) and older than 45 (75.8%). The most common comorbidities and risk factors were hypertension (22%), hypercholesterolemia (11.8%), and hypertriglyceridemia (7.3%). Furthermore, 10.4% had tobacco use disorder and 65.3% had a body mass index consistent with overweight/obesity (Table 1). No patients fulfilled the criteria for EIH (defined as systolic blood pressure exceeding 210 mmHg for men and 190 mmHg for women). Only 20.6% (n=73) underwent medical evaluation before starting to cycle.

Conclusions:

In this sample of recreational cyclists, we did not identify any cases of exercise-induced hypertension. Despite the number of comorbidities, only one of every five participants had a prior medical evaluation before exercising. Further measures to encourage routine health screening in this population are needed.

Table 1. Baseline characteristics and blood pressure results among recreational cyclists (n = 355)
P146 EFFECT OF HOME BLOOD PRESSURE TELE-MONITORING PATHWAY WITH PHARMACIST CASE MANAGEMENT TO SUPPORT PATIENTS DISCHARGED FROM EMERGENCY DEPARTMENT WITH ASYMPTOMATIC HYPERTENSION: A STUDY PROTOCOL FOR MULTICENTRE RANDOMIZED CONTROLLED TRIAL (TEC4HOME-BP)
Authors: Tran Karen , Kuyper Laura , Mangat Birinder , Ringrose Jennifer , Kim-Sing Chad , Lindsay Heather , Dahri Karen , Dawes Martin , Wong Hubert , Coderio Jennifer , Mak Meagan , Novak-Lauscher Helen , Khan Nadia , Ho Kendall
Published: September 2024

Background and Objectives:

Severely elevated blood pressure (BP) in the emergency department (ED) has recently been associated with undiagnosed hypertension and adverse cardiovascular outcomes, regardless of the initial reason (e.g.: pain or anxiety) for the ED visit. Clinical uncertainty exists on how best to manage severe asymptomatic BP post-discharge from the ED. In this study protocol, we propose home BP telemonitoring with pharmacist case management intervention on participants discharged from the ED with severe asymptotic hypertension. The overall purpose of this trial is to evaluate whether home BP telemonitoring and pharmacist case management can improve BP management in participants discharged from the ED with severe asymptotic hypertension and whether participants find this intervention to be acceptable.

Methods:

The study is a multi-centre, randomized controlled trial of 408 participants discharged from the ED with severe hypertension (defined as average of 3 readings systolic blood pressure [SBP] ≥ 160 mm Hg and/or diastolic blood pressure [DBP] ≥ 100 mm Hg over 3 readings). Participants will be randomized to either usual care or home BP telemonitoring and pharmacist case management for 12-months. The primary outcome is proportion achieving disease specific SBP control using 24 h ambulatory BP monitoring (ABPM) at 12-months. Secondary outcomes are change in SBP and DBP based on 24 h ABPM and home BP averages at 6- and 12-months. Patient acceptability and satisfaction will be assessed using EuroQoL 5-level EQ5 version and patient Satisfaction Questionnaire Short Form. Exploratory outcomes include adverse events, prescription of anti-hypertensive medications, fidelity of interventions and health care utilization.

Conclusions:

Results from this study will advise the integration of home blood pressure telemonitoring and pharmacist case management pathway as key clinical strategy to improve patient flow in the ED, reduce length of stay in the ED, and improve BP control in patients with asymptomatic severe hypertension in the ED.

Trial registration:

ClinicalTrials.gov: NCT 06303206
P148 EFFICACY AND SAFETY OF SACUBITRIL/ALLISARTAN FOR THE TREATMENT OF PRIMARY HYPERTENSION: A PHASE 3 RANDOMIZED, DOUBLE-BLIND STUDY
Authors: Zhang Wei , Zhang Jin , Yan Jie , Ge Qian , Lu Xiao-Hong , Chen Shao-Xing , Xu Wen-Jie , Sun Jing-Chao , Li Jin-Feng , Liu Zi-Chen , Wang Qiang , Zhou Xiang-Nan , Li Yan , Wang Ji-Guang
Published: September 2024

Background:

This randomized, double-blind, phase 3 study assessed the efficacy and safety of sacubitril/allisartan, an angiotensin receptor neprilysin inhibitor, compared with olmesartan in Chinese patients with mild to moderate hypertension.

Methods:

Eligible patients aged 18-75 years (n=1197) with mild to moderate hypertension were randomized to receive sacubitril/allisartan 240 mg (n=399), sacubitril/allisartan 480 mg (n=399), or olmesartan 20 mg (n=399) once daily for 12 weeks. Patients who completed the 12-week treatment then received another 12-week extended treatment (n=1084) and 28-week prolonged treatment (n=189). The primary end point was a reduction in clinic mean sitting systolic blood pressure (msSBP) from baseline with various doses of sacubitril/allisartan versus olmesartan at 12 weeks. Secondary efficacy variables included clinic and 24-h ambulatory blood pressure for the comparison between sacubitril/allisartan and olmesartan at week 12, 24, and 52.

Results:

Sacubitril/allisartan 240 mg/day provided a greater reduction in msSBP than olmesartan at 12 weeks (between-group difference: -1.9 mmHg [95% confidence interval -4.2 to 0.4 mmHg], P=0.0007, for non-inferiority). Sacubitril/allisartan 480 mg/day provided a significantly greater reduction in msSBP than olmesartan at 12 weeks (between-treatment difference: -5.0 mmHg [95% confidence interval -7.3 to -2.8 mmHg], P<0.001, for superiority). Greater reductions in 24-h, daytime and nighttime systolic and diastolic blood pressure were also observed with both doses of sacubitril/allisartan compared with olmesartan (P≤0.001 for 480 mg/day). The blood pressure reductions tended to be dose-dependent for sacubitril/allisartan. Sacubitril/allisartan was well tolerated, and no cases of angioedema or death were reported.

Conclusions:

Sacubitril/allisartan is effective for the treatment of hypertension and well tolerated in Chinese patients.
P162 THE CORRELATION BETWEEN VITAMIN D WITH ARTERIAL HYPERTENSION, ARTERIAL STIFFNESS AND CORONARY CALCIUM SCORE
Authors: Sokolovic Sekib , Sokolovic-Tahtovic Imana
Published: September 2024

Background Introduction:

Vitamin D plays significant role in calcium metabolism and in bone and vascular calcifications.

Objective:

To investigate the association between vitamin D level, arterial hypertension, arterial stiffness and coronary calcifications detected by MSCT. Method: A 2 female case report comparative to each other investigated the correlation between vitamin D serum level, blood pressure, arterial stiffness and severity of the coronary calcification using MSCT diagnostic tool estimating the calcium score.

Results:

The first case report showed that decreased level of vitamin D is correlated with increased blood pressure, increased arterial stiffness and with a severe coronary calcifications. The second case report showed normal blood pressure, normal vascular age and low calcium score in a no-defficient vitamin D female.

Conclusion:

Vitamin D has impact on blood pressure, arterial stiffness, coronary calcifications and coronary heart disease. The lower vitamin D, the higher arterial blood pressure, arterial stiffness and coronary calcium score.
P163 EMPAGLIFLOZIN AND ITS CARDIOPROTECTIVE EFFECTS IN THE HEART DURING VOLUME OVERLOAD IN AN EXPERIMENTAL MODEL INDUCED BY AORTOCAVAL FISTULA
Authors: Sykora Matus , Andelova Katarina , Farkasova Veronika , Benova Tamara Egan , Honetschalgerova Zuzana , Goncalvesova Eva , Tribulova Narcis , Bacova Barbara Szeiffova
Published: September 2024

Mitral regurgitation causes volume overload of the heart, and due to the deregulation of extracellular matrix proteins, the electrical communication between cardiomyocytes provided by connexin channels is disturbed. The aim of this study was to investigate the effect of cardiac volume overload (VO) on its functional parameters, structural remodeling, and connexin43 (Cx43), a protein ensuring electrical synchronization of the heart, and the cardioprotective effect of empagliflozin. Cardiac VO was induced by surgical aortocaval fistula (ACF) in adult, 6-month-old male Wistar rats. Mitral regurgitation and VO developed within four weeks. Subsequently, empagliflozin was administered daily for five weeks at a dose of 10 mg/kg of body weight. Echocardiographic examination showed increased cardiac output and increased Vmax of the aortic valve, decreased ejection fraction and fractional shortening due to ACF-VO. Echocardiographic parameters showed an increase in the diameter of the left ventricle in both systole and diastole, as well as an increase in the volume of the left ventricle at the end of systole and diastole. Empagliflozin normalized the negative parameters in the ACF-VO group. Myocardial protein Cx43 levels were reduced by ACF-VO but normalized by empagliflozin treatment. In addition, empagliflozin suppressed the ACF-VO-induced increase in interstitial collagen detected by van Gieson staining. These findings were consistent with increased protein expression of MMP-2, which is involved in structural remodeling of the extracellular matrix, and was normalized by empagliflozin. Protein kinase C epsilon levels associated with Cx43 and extracellular matrix modulation were reduced by ACF-VO and normalized by empagliflozin. However, protein levels of pro-apoptotic and pro-hypertrophic protein kinase C delta were increased by ACF-VO and normalized by empagliflozin. Protein expression of transforming growth factor beta as well as fibroblast growth factor 21 was increased by ACF-VO and normalized by empagliflozin. The results indicate a cardioprotective effect of empagliflozin due to suppression of myocardial structural remodeling and preservation of Cx43 in an experimental model simulating volume overload. The research was supported by grants APVV-21-0410,VEGA-2/0006/23,VEGA-2/0133/24,VEGA-2/0002/20
P167 DIFFERENCES IN PULSE WAVE VELOCITY ESTIMATED USING TOTAL ARTERIAL COMPLIANCE BETWEEN SUBTYPES OF ARTERIAL HYPERTENSION
Authors: Aristizabal-Ocampo Dagnovar , Alvarez-Montoya Diego , Fernandez-Ruiz Ricardo , Madrid-Muñoz Camilo , Gallo-Villegas Jaime
Published: September 2024

Background and Objective:

Different clinical phenotypes of arterial hypertension (AH) are identified through current oscillometric blood pressure (BP) measurements. Recently, our group described hemodynamic characteristics of AH subtypes utilizing 24-hour ambulatory blood pressure monitoring (24-h ABPM). It remains unclear whether differences in PWV exist among AH subtypes, which could potentially enhance diagnostic accuracy and guide antihypertensive treatment selection. The objective was to assess the relationship between PWV, estimated using Ct, and AH subtypes.

Methods:

A cross-sectional study was conducted, involving 13,027 untreated patients referred for 24-h ABPM. PWV was estimated using a novel method based on Ct, derived from BP and heart rate measurements obtained during 24-h ABPM. This estimation method was developed based on the relationship between Ct and PWV as described by Vardoulis et al., utilizing the Bramwell-Hill theory and experimental research. The formula used for PWV estimation was PWV = √(36.7/(Ct/(log[age]))).

Results:

Among the participants, 46.5% were men, with an average age of 50.2±14.1 years and a body mass index of 27.1±4.1 kg/m2. Isolated systolic hypertension (ISH) (3.9%) exhibited the highest arterial stiffness, with the highest PWV (10.2±1.4 m/s) and pulse pressure (PP) (60.0±6.6 mmHg), and the lowest Ct (0.67±0.16 mL/mmHg). In contrast, isolated diastolic hypertension (IDH) (26.3%) showed the lowest PWV (7.9±0.8 m/s) and PP (40.6±3.6 mmHg), and the highest Ct (1.01±0.18 mL/mmHg). As Ct decreased, PWV increased. Thus, PWV based on Ct from 24-hour ABPM showed clear differences between AH subtypes (ANOVA; p value < 0.001) (Figure).

Conclusions:

PWV is related with AH subtypes, exhibiting a progression from IDH to ISH. Patients with IDH typically have the lowest PWV, whereas those with divergent systolic-diastolic hypertension (D-SDH) and ISH have the highest PWV values. These findings underscore the significance of Ct in determining PWV values and carry diagnostic and prognostic implications concerning arterial function across various AH subtypes.
P177 MICROBIAL TRYPTOPHAN-INDOLE PATHWAY REGULATES BLOOD PRESSURE (BP) IN A SEX SPECIFIC MANNER
Authors: Bardhan Pritam , Mei Xue , Lai Khanh , Mell Blair , Tummala Ramakumar , Atluri Rohit , Kyoung Jun , Joe Bina , Yang Tao
Published: September 2024

Introduction:

Aberrant tryptophan absorption promotes hypertension as gut microbiota converts tryptophan to pro-hypertensive indole. Intestinal Ace2 regulates tryptophan homeostasis, but its role in salt-sensitive hypertension is unknown. Ace2 functions differently in males and females. Therefore, we hypothesized that sex-specific intestinal ACE2 dependent transport of tryptophan contributes to salt-sensitive hypertension via microbiota-indole axis.

Methods:

10-week-old Dahl salt-sensitive (S) rats and novel Ace2 KO S rats of both sexes were maintained on either a low (LS) or high (HS) salt diet for 21 days. BP was measured by radiotelemetry. Gut microbiota and indole were analyzed.

Results:

Mean arterial BP of S Ace2 KO rats on LS was elevated in females by 38 mmHg (SAce2KO 170 ± 10 vs. S 132 ± 3; P=0.0028) and in males by 18 mmHg (SAce2KO 140 ± 6 vs. S 122 ± 1.5; P=0.01), and further elevated on HS by 68 mmHg in females (SAce2KO 211 ± 14 vs. S 143 ± 4.5; P=0.0003) and by 40 mmHg in males (SAce2KO 182 ± 9 vs. S 142 ± 3; P=0.0009). These were associated with elevated serum indole mainly in male SAce2KO rats, compared to S rats on both LS (1.2 ± 0.2 vs. 0.3 ± 0.2 μM; P=0.02) and HS (1.5 ± 0.25 vs. 0.2 ± 0.03 μM; P=0.0001). Microbiota analysis revealed significant shifts in β-diversity in Ace2 KO rats of both sexes with more changes in HS males; and Ace2 KO induced more tryptophan-utilizing, indole-producing bacteria Escherichia-Shigella in males on both LS (P<0.05) and HS (P<0.0001). Strikingly, none of these differences were found in females.

Conclusions:

Lack of Ace2 increased BP regardless of sex and salt. In males, Ace2 KO increased indole levels and abundance of Escherichia-Shigella. Microbial changes by salt and ACE2 KO were found mainly in males, suggesting a more resilient microbiota in females. Thus, the microbiota-indole axis may be a therapeutic target for BP control in males with altered tryptophan metabolism.
P181 AGE-RELATED CHANGES IN THE PROTECTIVE AXIS OF THE RENIN-ANGIOTENSIN SYSTEM IN THE BRAIN OF NORMOTENSIVE AND SPONTANEOUSLY HYPERTENSIVE RATS
Authors: Pineda Angélica , Rukavina-Mikusic Natalia , Sirri María F. , Nuñez Myriam , Dominici Fernando , Gironacci Mariela M.
Published: September 2024

Background and Objective.

Aging is a major risk factor for the development of hypertension, that leads to end organ damage and cognitive dysfunction. The axis of the renin-angiotensin system composed of angiotensin (Ang) (1-7) the Mas receptor (MasR) and angiotensin converting enzyme 2 (ACE2) plays a cerebroprotective role by increasing blood flow, angiogenesis and improving cognitive function among others. Evidence on the expression of this axis with age is limited. We investigated Ang-(1-7)/Mas/ACE2 axis in different areas of the brain from normotensive and spontaneously hypertensive rats (SHR).

Methods.

Hypothalamus (HT), brainstem (BS), hippocampus (HC) and cerebral cortex (CC) were isolated from Wistar normotensive rats and SHR of 1, 3 and 12 months. Ang-(1-7) levels were measured by radioimmunoassay and ACE2 and MasR abundance was determined by immunoblotting.

Results.

Ang-(1-7) levels decreased with age in all the areas from normotensive rats and in CC from SHR, while it increased from 1 to 3 months but then decreased at 12 months in BS, HC and HT from SHR. There was no difference in Ang-(1-7) levels between normotensive and SHR except at 1 month of age where Ang-(1-7) levels were lower in BS, HC and HT but the same in CC from SHR compared to normotensive rats. MasR and ACE2 expression did not change with age in all the investigated areas from normotensive rats and in CC from SHR. However, MasR and ACE2 increased with age in HC from SHR and they were higher than in normotensive rats.

Conclusions.

Our results showed changes in the expression of the brain Ang-(1-7)/Mas/ACE2 axis which may contribute to deleterious functions observed in the brain with age.
P183 PERIPARTUM CARDIOMYOPATHY: MONOCENTRIC DESCRIPTION AT THE NORTHERN REGIONAL MATERNITY HOSPITAL OF THE DOMINICAN REPUBLIC
Authors: Rodríguez-Román Allyson , Fernandez-Mendez Lisbeth , Gómez-Jackson Julia , López-Zabala Luis Ariel , Gutiérrez-Martínez Anthony , Cruz Licurgo
Published: September 2024

Background:

Peripartum cardiomyopathy (PPCM) is a pathology in which the woman's heart dilates and displays signs and symptoms of heart failure. It is a rare pathology, with a high mortality rate, and predominance in black patients. Its diagnosis and management are not standardized, nor adapted to low income countries. This leads to barriers in identifying and treating the disease in higher-risk countries such as Haiti, making it a relevant issue in the Dominican Republic due to high immigration of haitians to the country. Therefore we aimed to evaluate the association of risk factors and the pharmacological regimen of patients in a public healthcare center in the Dominican Republic.

Methods:

An observational, retrospective, cross-sectional study was carried out with convenience sampling. This included patients who had been admitted to the Presidente Estrella Ureña Regional Hospital with suspected PPCM during the last 3 years. Variables studied include: sociodemographic factors, toxic habits, pathological and gynecological-obstetric history, cardiovascular, pulmonary and general signs and symptoms.

Results:

A sample of 19 patients with a median age of 27 years was obtained, 73.4% of them were black. All of the patients who had illness onset in the peripartum period (first 28 days after labor) presented adverse events, infectious comorbidities and “other comorbidities” while 75% of them presented cardiac and pulmonary comorbidities. Regarding treatment, only 77.8% of patients with antepartum onset received treatment in this period. Additionally, 66.7% of patients with antepartum onset developed adverse events that required oxygen-supplementation, versus only 33% of those without adverse events.

Conclusions:

It is relevant to design tools for calculating the risk of developing PPCM and standardize its disparate diagnosis and treatment, particularly aimed at countries with limited resources. This aims to improve the prognosis in patients with risk factors such as: black race, age over 30 years and living in low/middle-resource countries.
P189 HYPERTENSION AND OBSTRUCTIVE SLEEP APNOEA SYNDROME IN ADULTS WITH HEART FAILURE IN NIGERIA: CLINICAL CORRELATES AND ASSOCIATION WITH CLINICAL OUTCOMES
Authors: Amusa D Ganiyu , Chun-Gyang S.D , Awokola Babatunde
Published: September 2024

Rationale:

Heart failure (HF) is a common endpoint for cardiovascular diseases. It is a major cause of morbidity and mortality worldwide. Hypertension is a leading cause of HF; a significant proportion of HF patients also have obstructive sleep apnea syndrome (OSAS) which is known to impact clinical outcomes adversely. The diagnosis of OSAS is often missed due to inadequate clinical diagnosis and diagnostic backup. This study aims to add to the body of evidence thereby improving outcomes in HF patients.

Methods:

This cross-sectional descriptive study involved 200 consenting adults with HF at Jos University Teaching Hospital, Nigeria. Each participant had relevant medical history, physical examination (including a six-minute walk test distance) and relevant investigations. OSAS was diagnosed using high-risk scores obtained using Berlin and STOP-Bang questionnaires, daytime somnolence was assessed by Epworth questionnaire and quality of life by Minnesota living with HF questionnaire. Comorbidities were assessed using Charlson comorbidity index (CCI)) and hospitalizations in the preceding 12 months documented. Data was analyzed using Stata version 13.

Results:

Hypertension was the aetiology of HF in 41% of the study population and 62.8% of the subset with OSAS (p=0.001). OSAS was identified in 47% and 45.5% by high-risk scores obtained using Berlin and STOP-Bang questionnaires respectively. Significant daytime somnolence was identified in 56.0% of the study population and 93.6% of those with OSAS, (p<0.001). Those with OSAS had a significant association with hypertension (p=0.001), atrial fibrillation (p<0.001), obesity (p=0.002), higher comorbidity index (p=0.001), HF with preserved ejection pattern (p=0.001) and NYHA ≥3 (p<0.001). OSAS was significantly associated with six-minute WTD ≤ 300m, hospitalizations (p<0.001) and sub-optimal quality of life (p=0.003).

Conclusion:

Hypertension and OSAS are significantly associated and are common in HF. It is recommended to routinely screen HF patients for OSAS as the diagnosis is often missed with consequent adverse clinical outcomes. This will facilitate prompt diagnosis, enhance management and favourable clinical outcomes in HF patients.
P198 SOCIODEMOGRAPHIC, ANTHROPOMETRIC, PHYSIOLOGICAL, AND ELECTROCARDIOGRAPHIC RISK FACTORS ASSOCIATED WITH ELEVATED SYSTOLIC BLOOD PRESSURE IN YOUNG POPULATION
Authors: Villa Andrea Navarro , Álvarez Santiago Garzón , Suárez Brochero Óscar Felipe , Toquica Alex Rivera , Nieto García Carlos Eduardo
Published: September 2024

Background:

Hypertension is a major challenge today. Although young individuals present lower risk, it's important to identify factors predisposing to elevated blood pressure from early years.

Objectives

Identify associated factors with elevated systolic blood pressure (SBP) in medical students, Pereira-2022.

Methodology

A cross-sectional study was conducted on medical students at a public university in Pereira, in which sociodemographic, anthropometric, physiological, and electrocardiographic variables were collected. A bivariate analysis was made comparing individuals with an SBP>130mmHg to those below. A multivariate analysis was performed using logistic regression.

Results:

201 medical students were interviewed (mean age=21.4 years), 56.7% women. 17.4% presented high-normal blood pressure or grade I hypertension. 24 students were found with an SBP>130mmHg (11.9%). The factors significantly related with this variable were being a woman (OR= 0.11 95% CI= 0.03-0.39), family history of deceased by chronic kidney disease (OR= 3.83 95% CI= 1.05-12.86), a parent with hypertension (OR=3.91 95% CI=1.41-10.80), diastolic blood pressure >85mmHg (OR=6.60 95% CI= 1.96- 22.27) and wrong progression of the R-wave on the anteroseptal wall (OR=11.03 95% CI= 2.32-52.22).

Conclusions:

even though the population of youth has a lower prevalence of arterial hypertension, in this study, it was found that 11.9% of the participants present an SBP>130mmHg. In this demographic group, there must be considered certain factors, such as a family history of chronic kidney disease and hypertension, a personal finding of elevated diastolic blood pressure, and electrographic changes, like a wrong progression of the R-wave on the anteroseptal wall.
P201 SEVERITY OF STRESS DISORDERS IN UKRAINIAN REFUGEE WOMEN: IS THERE ANY ASSOCIATION WITH THE PRESENCE/ABSENCE OF HYPERTENSION?
Authors: Shalimova Anna , Stoenoiu Maria S. , CubaŁa WiesŁaw J. , Burnier Michel , Persu Alexandre , Wilgusz Mariusz S. , Narkiewicz Krzysztof
Published: September 2024

Background and Objective:

Refugees exhibit a notably high prevalence of post-traumatic stress disorders (PTSD). PTSD has been associated with hypertension, particularly in military servants, war veterans and more recently in populations exposed to chronic violence. In this prospective study, we explored the association between hypertension and the severity of emotional distress and PTSD in Ukrainian women seeking asylum in Poland.

Methods:

The study included 504 refugee women: 301 non-hypertensive and 203 hypertensive subjects (mean blood pressure (BP) levels: 119±11.8 and 144±11.7 mmHg, respectively). BP was measured using validated oscillometric devices. Participants filled validated questionnaires to assess emotional distress (DASS) and PTSD (PCL-5). Subjects with and without hypertension were compared for both general and psychological characteristics.

Results:

There were no significant differences in non-hypertensive and hypertensive subjects in terms of socio-economic status before the war and the intensity of hostilities in the regions of Ukraine where the refugees came from. Compared to non-hypertensive subjects, hypertensive refugees had significantly higher DASS score (26.8±14.3 vs. 23±14.2,p=0.003) and general emotional distress (72.4 vs 50.4%,p<0.0001). Significant differences were found between groups for all indicators of DASS questionnaire (depression, anxiety and stress) with a predominance of their severity among hypertensive women (p<0.01). Hypertensive refugees had also significantly higher PTSD score (29.9±14.7 vs. 25.5±14.6,p=0.001) and presence of PTSD (41.1 vs 28.3%,p=0.01). Dimensions of all PTSD clusters were significantly higher in hypertensive women: intrusion (cluster B,p<0.0001), avoidance (cluster C,p=0.027), negative alteration in cognition (cluster D,p=0.036) and hyper-arousal (cluster E,p=0.028). At the same time, logistic regression analysis revealed a significant relation between hypertension and only one indicator of stress – PTSD cluster B (p<0.0001).

Conclusion

Hypertensive refugee women had more pronounced emotional distress and PTSD than non-hypertensive participants. Among all studied indicators of emotional distress and PTSD, re-experiencing traumatic events was the stress element most strongly associated with hypertension. Our findings will be further explored with a detailed cardiovascular assessment, re-evaluation of stress questionnaires and psychiatric consultation of refugees.
P204 BANGLADESH HEARTS: LESSONS LEARNED FROM A NATIONAL HYPERTENSION CONTROL PROGRAM, 2018-2024
Authors: Jubayer Shamim , Ahsan-uz-zaman  , Abrar Ahmad Khairul , Aimiosior Obehi , Bhuiyan Mahfuzur Rahman , Banigbe Bolanle , Gupta Reena , Moran Andrew E. , Amin Mohammad Robed , Choudhury Sohel Reza
Published: September 2024

Background and Objective:

In Bangladesh, 21% of all adults aged >=18 years have hypertension but among hypertensives, only 14.1% have blood pressure (BP) controlled (<140/90 mmHg) .1 To improve hypertension control and prevent cardiovascular disease, the Non-Communicable Disease Control Program under the Ministry of Health & Family Welfare launched the Bangladesh Hypertension Control Initiative (BHCI) with technical support from the National Heart Foundation of Bangladesh and Resolve to Save Lives.

Method: The BHCI gradually implemented the World Health Organization (WHO) HEARTS standardized hypertension control package in 172 sub-district facilities (35% of all sub-district facilities) & 10 district-level facilities in 23 districts from 2018 to 2024. BHCI facilities implemented a simple, evidence-based, step-by-step, and drug & dose-specific hypertension treatment protocol, a reliable supply of protocol medicines free of charge to patients, team-based care including non-physician members, and the Simple digital hypertension management app to collect real-time data and facilitate patient and program monitoring over time. A continuous quality improvement initiated in 2020 focused on lowering missed visit rate and raising blood pressure control. Missed visit rate was the proportion of all enrolled patients failing to attend a scheduled clinic visit in the prior three months; BP control was proportion with BP <140/90 mmHg at their last visit in the prior three months.

Results:

From March 2019 to February 2024, the BHCI had enrolled 364,038 hypertensive patients in treatment (Figure). Facility-based BP control increased from 37% in July 2020 when the quality improvement program started to 57% by April 2024. Missed visits decreased from 53% in July 2020 to 29% by April 2024.

Conclusion:

BHCI is on track for national scale-up in Bangladesh and can serve as a model for WHO-HEARTS hypertension control programs in other LMIC countries.

Reference:

1. World Health Organization. National STEPS survey for non-communicable diseases risk factors in Bangladesh 2018.

Panel A: number of hypertension patients enrolled in treatment.

Panel B: rates of missed hypertension management visits and blood pressure controlled <140/90
P205 HYPERTENSION AWARENESS, TREATMENT, AND CONTROL RATE IN NEPAL: AN EFFECTIVENESS OF WHO-PEN PACKAGE INTEGRATION THROUGH PRIMARY CARE TO ADDRESS THE NCDs
Authors: Mehata Suresh , Mehta Ranju Kumari , Thapa Astha
Published: September 2024

WHO-PEN, the essential NCD services even in resource constraint settings through PHC approach has been implemented in Nepal since 2017. PEN approach consists of set of protocols for the management of listed major diseases and behavioral interventions to address the associated major modifiable risk factors. The major focused diseases in PEN includes cardiovascular diseases, diabetes, cancer and chronic respiratory diseases. By 2021 it has been expanded across all 77 districts of Nepal. The aim of this analysis is to assess the before and after PEN package changes in hypertension prevalence, awareness, treatment and control rate in Nepal.

This analysis used the 2016 Nepal demographic and health survey (NDHS) data as a baseline(N=14,823) and 2022 NDHS data as an Edline(N=10,022). Awareness, treatment and control rate was calculated from the population aged 15 years and above along with the concentration Index (CI) to assess the changes in magnitude and inequalities before and after the intervention. Cluster sampling design was considered for all the inferential statistics and sample weight was used to obtain the population estimates. P<0.05 were considered statistically significant.

The study revealed a non-significant change in the hypertension prevalence before and after the intervention (19.6% vs 20.1%;p>0.05). However, a significant change was observed in the awareness rate (40% vs 50.2%,p<0.05) and treatment rate (20.2% vs 31.7%,p<0.05). A significant wealth inequality was observed in awareness ((CI:0.12,p<0.001 in 2016) and (CI:0.13,p<0.001 in 2022)) and treatment rate ((CI:0.24,p<0.001 in 2016) and (CI:0.21,p<0.001 in 2022)) over the period of time. We did not find a significant change (51.7% vs 56.7%, p>0.05) and wealth inequalities in control rate (figure 1).

The improvement in awareness and treatment rate over the period entails the integration of WHO-PEN package through primary care is effective, however, the persistent wealth inequalities indicate next level community-based intervention should be instrumental to address the NCDs burden targeted to ultra-poor/poor and marginalized population of Nepal.
P208 MAY MEASURE MONTH 2023: AN ANALYSIS OF BLOOD PRESSURE SCREENING RESULTS FROM ULAANBAATAR, MONGOLIA
Authors: Myanganbayar Maral , Davaadamdin Orkhonselenge , Badamjargal Tuyajargal , Erdenebat Solongo , Beaney Thomas , Poulter Neil R , Dashtseren Myagmarsuren , Amartuvshin Tsolmontuya , Dashdorj Naranjargal
Published: September 2024

Background and Objectives:

In Mongolia, 1 in 3 people have high blood pressure and mortalities due to ischaemic heart disease and haemorraghic stroke has hit record high in the past years. Since 2019, Mongolia has been participating in the world's largest hypertension screening campaign, May Measure Month. After skipping the screening campaign for 2 years, we aimed to screen people for hypertension after the COVID-19 pandemic.

Method

Screening sites were set up in 14 primary healthcare centers (PHC) of 4 districts in Ulaanbaatar, Mongolia between June and September 2023. Screenees came into the PHC and participated voluntarily and they were aged 18 and above. Questionnaire was completed with three sittings BP measured. Definition was hypertension was as a systolic BP at least 140 mmHg and/or a diastolic BP at least 90 mmHg (using the mean of the second and third readings) or taking antihypertensive medication. We used SPSS version 29.0.2.0 and RStudio for data analysis.

Result

Total of 5036 respondents were participated. Of which, 44.8% were male and female were 55.2% with mean age 46.8 (±15.8). Hypertensive adult proportion was 42.6% (2143), of whom 85.1% (1823) were aware and 84.0% (1800) were on hypertension treatment. Of those on medication, control rate 53.8% had controlled blood pressure (<140/90). Noncommunicable disease factors including smoking was 26.6%, current vaper 7.6%, alcohol consumption 28.8%, diabetes 7.2%, previously diagnosed heart attack was 3.7% while stroke was 3.5%. Overweight and obese were 36.8% and 14.6% respectively.

Conclusion

The high hypertension prevalence and inadequately treated hypertension demonstrates that hypertension treatment management is needed to be prioritized.