bluuebunny/crossref_metadata_2025 huggingface dataset:
O78 UNRAVELING THE RELATIONSHIP BETWEEN HYPERTENSION AND LIPOPROTEIN(A): INSIGHTS FROM THE GAELp(a) REGISTRY
Authors: Arrupe Matias , Renna Nicolás Federico , Cobo Augusto Lavalle , Mata Gabriela , Schreier Laura , Nogueira Juan Patricio , Prado Aldo , Gimenez Sergio , Lynch Santiago , Masson Walter , Soumoulou Juan Bautista , Corral Pablo
Published: September 2024

Introduction:

Hypertension (HT) and elevated levels of lipoprotein(a) (Lp(a)) are both significant risk factors for cardiovascular disease. Understanding the relationship between these factors can provide valuable insights into cardiovascular risk stratification. This study aims to analyze the association between Lp(a) levels and HT in hypertensive patients, with a focus on identifying predictors of major adverse cardiovascular events (MACE) within this population.

Methods:

Patients included in the Argentine Group for the Study of Lp(a) [GAELp(a)], who had a diagnosis of hypertension were selected for this study. Demographic characteristics, anthropometric variables, cardiovascular risk factors, laboratory variables, and the presence of cardiovascular disease were assessed. Lp(a) levels were measured in mg/dL or nmol/L, with values exceeding 50 mg/dL or 125 nmol/L classified as elevated. Multivariate analysis was conducted to identify predictors of MACE within the study population.

Results:

A total of 334 hypertensive patients with recorded Lp(a) levels were included in the analysis. Thirty-eight percent of the patients exhibited elevated Lp(a) levels. In the multivariate analysis, predictors of MACE were male sex (OR 2.36, 95% CI 1.33-4.16), current smoker (OR 3.29, 95% CI 1.56-6.96), and type 2 diabetes (OR 2.86, 95% CI 1.43-5.72). However, no significant association was found between MACE and elevated Lp(a) levels. Additionally, it was observed that a substantial proportion (71.56%) of the study population were taking statins.

CONCLUSION: This study underscores the importance of considering multiple risk factors, including sex, smoking status, and diabetes, in assessing cardiovascular risk among hypertensive patients. While elevated Lp(a) levels did not emerge as a predictor of MACE in this population, further research is warranted to elucidate the role of Lp(a) in cardiovascular risk stratification.
O86 EFFECTIVENESS OF A MHEALTH (MOBILE-BASED) INTERVENTION FOR THE MANAGEMENT OF CARDIOVASCULAR DISEASES IN SOUTH ASIAN COUNTRIES: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Bhattarai Buna Bhandari , Thapa Poshan , Maharjan Preeti , Subedi Aastha , Pradhan Pranil Man Singh , Tandan Meera
Published: September 2024

Background:

Cardiovascular disease (CVDs) is the leading cause of preventable death and disability, accounting for 18.6 million deaths and 393 million DALYs in 2019. The effectiveness of mobile health (mHealth) interventions for managing CVD in South Asia is poorly documented. This systematic review evaluates the impact of mHealth on cardiovascular health outcomes in this region.

Methods:

We conducted a systematic search of MEDLINE, EMBASE, CINAHL, Web of Science, and Scopus, covering the period from January 2000 to December 2023. Our search focused on studies employing mobile-based interventions, such as apps, SMS, video conferencing, or phone calls, to improve cardiovascular outcomes, including blood pressure, medication adherence, and physical activity. Data were synthesised using a random-effects meta-analysis, estimating summary hazard ratios (HRs) and 95% confidence intervals (CIs). This review was registered in PROSPERO (CRD42022340907).

Results:

We identified 1483 studies, of which 14 met our inclusion criteria, encompassing 30,939 participants (17,240 intervention; 14,984 control). Participants ages ranged from 46.4 to 60.6 years. Six studies reported improvement in systolic blood pressure (SBP), one reported improvement in cholesterol, two reported change in self-reported physical activity, and three reported improvement in medical adherence. Meta-analysis revealed a significant reduction in systolic blood pressure (SBP) by -2.32 (95% CI: -4.25 to -0.40; P=0.02) in the intervention arm. No significant changes were observed in diastolic blood pressure (DBP) or medication adherence, with DBP showing a reduction of -1.13 (95% CI: -1.69 to 1.42; P=0.87) and medication adherence an effect size of 0.44 (95% CI: -0.06 to 0.94; P=0.08).

Conclusions:

mHealth interventions in South Asia show promise in reducing SBP among individuals with CVD, though effects on DBP and medication adherence are less pronounced. The observed benefits are constrained by high heterogeneity and a limited number of studies, indicating the need for further research to consolidate these findings and explore additional CVD outcomes.
O95 HYPERTENSIVE RESPONSE TO EXERCISE RELATIVE-TO-FITNESS AND LEFT VENTRICULAR HYPERTROPHY ARE ASSOCIATED WITH INCREASED RISK OF CARDIOVASCULAR EVENTS: EVIDENCE FROM THE EXERCISE STRESS TEST COLLABORATION (EXERTION) STUDY
Authors: Silva Ruiz Catalina , Sharman James E. , Otahal Petr , Staton Tony , Wahi Sudhir , Hare James L. , Selvanayagam Joseph , Venn Alison , Marwick Thomas H. , Schultz Martin
Published: September 2024

Background.

A hypertensive response to exercise (HRE) is associated with a high prevalence of left ventricular hypertrophy (LVH), both being related to an increased risk of cardiovascular disease (CVD). However, these associations may be influenced by aerobic capacity (fitness). This study aimed to determine if an HRE considered relative-to-fitness and LVH are associated with increased risk for CVD events.

Methods.

Records for 4,307 individuals (aged 58.6±12.7 years, 52.0% male) who underwent exercise stress echocardiography were linked to administrative health datasets (hospital and emergency admissions) to ascertain CVD events (n=458, mean follow-up, 44.8±25.9 months). LVH presence/absence (LVH+/LVH-) was defined as LV mass index adjusted for body surface area around a cut point of ≥115 g/m2 for men and ≥95 g/m2 for women. HRE presence/absence (HRE+/HRE-) relative-to-fitness was defined as peak systolic blood pressure (SBP) divided by peak metabolic equivalents around a cut point of ≥90th percentile. Survival analysis using Cox-proportional hazard regression was used to compare CVD event rates across the four groups defined by the combinations of HRE+/HRE- with LVH+/LVH-, adjusted for age, sex, pre-exercise SBP, and CVD history.

Results.

Compared to the reference group (HRE-/LVH-), there was a stepwise increase in CVD event rate (Figure 1) across the following groups: HRE+/LVH- [Adjusted HR(95%CI), 1.34(1.02-1.76)], HRE-/LVH+ [Adjusted HR(95%CI), 2.1(1.6-3.76)], HRE+/LVH+ [Adjusted HR(95%CI), 2.55(1.64-3.97)]. Conclusion. Individuals with both HRE considered relative-to-fitness and LVH are at the highest risk of CVD events, greater than either clinical presentation alone. These results emphasise the need to address an HRE and low fitness in people with LVH to improve CVD risk management.
O97 RESPONSE TO AEROBIC TRAINING MAY DIFFER BETWEEN ELDERLY MEN AND WOMEN WITH TREATED HYPERTENSION
Authors: Azevêdo Luan , Silva-Junior Natan , Costa Luiz , Brito Leandro , Forjaz Claudia
Published: September 2024

Background and objective.

Hypertension incidence increases with aging, with expressive enhancement in women after the menopause due to the important physiological changes induced by the estrogen levels decline. Aerobic training is recommended for lowering blood pressure (BP) in men and women with hypertension. However, the possible gender-related differences in training responses have been poorly investigated, especially in elderly patients. Therefore, the objective of this study was to analyze responses to aerobic training in elderly men and women with treated hypertension.

Methods:

Thirty-one elderly hypertensives (15 women, 68±6ys and 16 men, 66±7ys) who were taking regular antihypertensive medication for at least 4 months participated in the study. They underwent 10 weeks of an aerobic training designed in accordance with the guidelines’ recommendations for hypertension (i.e. 3 session/week, cycle ergometer, 30-45 min, moderate intensity). Before and after the training period, peak oxygen uptake (VO2peak, cardiopulmonary exercise test), BP (auscultatory), systemic hemodynamics (CO2 rebreathing technique) and vascular function (brachial doppler ultrasound) were assessed. In each group (men and women), the training effects were evaluated using paired t-tests or Wilcoxon tests, considering p<0.05 as significant.

Results:

Aerobic training increased aerobic capacity in both sexes (men = 20.8±4.2 vs. 21.8±4.8 ml.kg-1.min-1, p=0.04 and women = 15.3±2.6 vs. 16.4±2.3 ml.kg-1.min-1, p=0.01). In men, systolic BP and systemic vascular resistance decreased (129±13 vs. 125±12 mmHg, p=0.003 and 21.0±3.8 vs. 18.9±4.1 u, p=0.02), while flow mediated dilation increased (5.5±2.9 vs. 7.2±3.1%, p=0.01) after the training period. On the other hand, in women, none of these variables changed with the training (124±15 vs. 126±12 mmHg, p=0.92; 23.2±5.5 vs. 23.5±5.6 u, p=0.80; and 4.2±3.2 vs. 5.4±3.5%, p=0.10). The other variables assessed did not change in either group.

Conclusions:

The proposed aerobic training program increased aerobic capacity in both male and female elderly hypertensives, but improved BP, systemic vascular resistance, and endothelial function only in males. Key-words: aerobic training, gender, blood pressure, hypertension. Financial Support: CAPES-0001, CNPq-302309/2022-5, and FAPESP- 2022/12605-3.
O103 ANTENATAL AND NEONATAL EXPOSURES AND CHILDHOOD HYPERTENSION: FINDINGS FROM THE BOSTON BIRTH COHORT
Authors: Makker Kartikeya , Kuieper Jordan , Hong Xiumei , Brady Tammy , Aziz Khyzer , Wang Xiaobin
Published: September 2024

Background:

Early-life factors impact the development of hypertension (HTN). Impact of antenatal exposures, prematurity and subsequent early life exposures (including those in the neonatal intensive care unit (NICU)) on the development of HTN warrants further investigation.

Objective: 1. Expand our prior findings on the association of maternal cardiometabolic conditions with childhood HTN in the Boston Birth Cohort (BBC). 2.Investigate the combined association between prematurity and NICU exposures with childhood HTN.

Methods:

We analyzed factors associated with childhood HTN up to 18 years. HTN was defined according to national guidelines. Composite categories were created based on gestational age and NICU comorbidities. Chi-square and ANOVA tests were used for categorical and continuous variables, respectively. Regression analyses explored the association with HTN, while repeated measures analysis assessed BP percentiles.

Results:

We analyzed 2461 infants (695 preterm), with a total of 19,689 repeated BP measurements. Maternal pre-existing diabetes, older maternal age, maternal stress in index pregnancy and chronic maternal stress, were positively associated with childhood HTN, after adjusting for important covariables.

HTN incidence (25.9% vs. 16.31%) was higher in children born preterm, with an inverse dose-response trend. Compared to children born term without NICU exposure, those born term with NICU stay (OR 1.65 CI: 1.03-2.65), and those born preterm with NICU stay even without complications (OR 1.84 CI:1.38-2.46) had higher odds of developing HTN. Preterm children with NICU stay had the highest odds of developing HTN (OR 2.36 CI: 1.38-4.04), if they also had one or more major comorbidities (sepsis, chronic lung disease, necrotizing enterocolitis and intraventricular hemorrhage).

Repeated measures analysis further revealed a positive association of systolic and diastolic BP percentiles with maternal cardiometabolic conditions, prematurity, and presence of NICU complications.

Results remained consistent after adjustment for child BMI.

Conclusion:

In this US minority cohort, we found various early life factors linked to childhood HTN. Notably, preterm infants with a history of major NICU complications were more likely to develop childhood HTN.
O107 A LONGITUDINAL STUDY ON THE IMPACT OF CHILDHOOD ELEVATED BLOOD PRESSURE ON TARGET ORGAN HEALTH IN ADOLESCENCE: THE EXAMIN YOUTH SA STUDY
Authors: Kruger Ruan
Published: September 2024

Background and objective:

Primary hypertension in children is becoming a global threat for the growing economic burden of hypertension management in adulthood and sustainable healthcare. We determined the associations of adolescent blood pressure (BP) with target organ damage markers (carotid intima-media thickness (CIMT) and left ventricular mass index (ilVM)) over a four year period, stratified by childhood BP status at baseline.

Methods:

We included 421 Black and 307 White South African adolescents (mean age: 11.04 years) with complete follow-up data for BP, CIMT and iLVM. Standard anthropometric measures and basic demographic information were collected.

Results:

Children were stratified by baseline BP status, i.e., normotensive; n=454 (57.5% Black and 57.7% female) and elevated BP; n=274 (58.4% Black and 52.2% female), with comparable proportions of ethnicity (p=0.81) and sex (p=0.15). Systolic BP (by 6mmHg; p<0.001), diastolic BP (by 3mmHg; p<0.001) and perfusion pressure (by 4mmHg; p<0.001) as well as sex-specific body mass index for age z-scores (BAZ; p<0.001) were all higher in the elevated BP compared to normotensive group. Groups were comparable for age (p=0.78), CIMT (p=0.28) and iLVM (p=0.64). In partial regression analysis (adjusting for ethnicity, sex, follow-up age and BAZ), systolic BP correlated positively with CIMT (r=0.125; p=0.041) and iLVM (r=0.184; p=0.002) in the elevated BP group only. Backward multiple adjusted linear regression analysis (adjustment for perfusion pressure at baseline, age, sex, ethnicity and BAZ) showed adverse associations of systolic BP with CIMT (β=0.126; p=0.046) and iLVM (β=0.199; p=0.001), and diastolic BP with iLVM (β=0.130; p=0.002), only in children with elevated BP at baseline.

Conclusion:

Elevated BP in early childhood contributes to the long-term impact on target organ health during adolescence independent of sex and ethnicity, while the association of BP with iLVM seems to be moderated by excess adiposity.
P005 CHILDREN WITH REPAIRED COARCTATION OF THE AORTA: FOLLOW-UP AND HYPERTENSIO5
Authors: Vaccari Marina , Maldonado Laura , Sardella Angela , Moros Claudio , Romo Miriam
Published: September 2024

Background and objective:

Coarctation of the aorta (CoA) is a congenital heart disease with high morbidity and mortality due to cardiovascular disease even after adequate therapeutic management. A fundamental factor is the development of high blood pressure over the years. The objective of this work is to analyze the blood pressure phenotype of the population under follow-up in a high blood pressure clinic.

Methods:

Retrospective review of medical records of patients aged 0 to 22 years with CoA corrected by surgery or interventional catheterizations, which were followed up between January 2017 and February 2023 in the high blood pressure clinic of a pediatric center. Variables to analyze: age at the time of correction, technique, time since correction, associated cardiac or extracardiac pathologies, office blood pressure, left ventricular hypertrophy. In patients with adequate height and tolerance to the procedure: Ambulatory Blood Pressure Monitoring (ABPM) and pulse wave velocity study were performed.

Results:

142 medical records were reviewed (see table 1). Two groups were formed according to the age of the patients due to the possibility of performing ABPM.

There were no significant differences between the age of surgical approach and the association with complex heart diseases between the groups.

The younger population presented a greater number of extended terminal anastomosis technique and increased concentric remodeling. The prevalence of hypertension and overweight obesity increased over the years.

The older group had 25% masked hypertension and 25% increased pulse wave velocity

Conclusion:

Our population has 28% of hypertension among those under 8 years of age and it increases to 46% among the eldest, coinciding with international reports that indicate that the evolution towards arterial hypertension in this population is progressive.

Lifelong follow-up of these patients with corrected CoA is important to detect recoarctation or the development of hypertension and act accordingly to improve morbidity and mortality.
P015 MULTICENTER, PROSPECTIVE, SINGLE-BLIND(SUBJECTS), NON-INFERIORITY VERIFICATION, CONFIRMATORY CLINICAL TRIAL FOR EFFECTIVENESS OF BLOOD PRESSURE ANALYSIS ARTIFICIAL INTELLIGENCE SOFTWARE THAT PREDICTS 4-WEEK BLOOD PRESSURE BASED ON 8-WEEK HOME BLOOD PRESSURE
Authors: Kim Ju Han
Published: September 2024

Background:

Hypertension is the leading cause of cardiovascular complications. Hypertension requires transformative solutions that can help reduce the global burden of the disease. Artificial intelligence (AI) and machine learning, which have made a substantial impact on our everyday lives over the last decade may be the route to this transformation. The purpose of the current study is to evaluate the efficacy of future blood pressure (BP) predicting AI software.

Methods:

2,057 patients were enrolled in the Dr. Answer hypertension project. Dr. Answer consists of 21 AI medical software that cover eight major diseases including hypertension. The Dr. Answer hypertension software was based on the Sequence-to-Sequence machine learning model. Patients were enrolled in 1 tertiary center (Chonnam National University Hospital) and other 21 non-tertiary centers from September 2021 to November 2022. The main object of Dr Answer hypertension AI software was to predict the patients 4 week office BP according to the 8 week home BP data. The primary efficacy endpoint was the mean absolute error (MAE) of the predicted office BP data.

Results:

The total of 610 patients and 2,405 home BP data were finally evaluated in the current study model. The mean participant age was 65.5 ± 13.1 years and 314 (51.5%) were male. 4 week average systolic/diastolic BP MAE was 3.96 mmHg and 2.14mmHg. Meanwhile, 4 week average root mean squared error of systolic/diastolic BP was 5.81mmHg and 2.88mmHg. Mean value of systolic BP accuracy was 74.1% and diastolic BP accuracy was 91.4%.

Conclusion:

The current study result proved the effectiveness of the future office BP predicting model of Dr. Answer AI medical software.
P020 GENDER AND CARDIOLOGY: EVALUATION OF DISCRIMINATION, HARASSMENT AND LABOR INEQUALITY IN THE DOMINICAN REPUBLIC
Authors: Cruz Licurgo , Tejada-Toribio Fiodor , Urraca-Mata Juan , Paulino-Then Jorge , Taveras-Franco Alvaro , Gutiérrez-Martínez Anthony
Published: September 2024

Introduction:

Gender disparity has been a topic of increasing interest and controversy in recent years. In the United States, women represent only 12.6% of cardiologists, a figure that reflects persistent inequalities in this specialty and often leads women to dismiss it as a viable career option. In addition, salary disparity remains an obvious problem, with a trend that tends to favor the male sex. On the other hand, in Japan, female cardiologists face professional limitations due to family and domestic responsibilities that restrict their development and advancement in the profession.

Objective: To analyze and understand the perceptions and experiences of discrimination, harassment and work obstacles among cardiologists in the Dominican Republic, with a focus on gender differences.

Methods:

An observational, descriptive and cross-sectional study was carried out, in which a sample was randomly selected from the directory of the Dominican Society of Cardiology. An online questionnaire was used to collect demographic and work-related information, as well as data on experiences of discrimination, harassment and professional obstacles.

Results:

A sample of 51 patients was obtained, with an average age of 47.8 years, of whom 56.9% were women. Thirty-six.4% of women reported experiencing discrimination, compared with 13.8% of men. In terms of employment barriers, 62.1% of men reported obstacles related to remuneration, despite having higher monthly earnings compared to women. Of the latter, 50.0% also faced difficulties in this aspect. With respect to work-life balance barriers, 40.9% of women and 13.8% of men reported them.

Conclusion:

The perception of disparities among cardiologists reveals a trend where men face barriers in economic development, while women struggle to find a work-life balance. This highlights the urgency of implementing proactive strategies to promote gender equality in cardiology and ensure an inclusive and equitable professional environment.
P027 MAKING HEARTS SUSTAINABLE: IMPLEMENTATION RESULTS FROM A HYPERTENSION CONTROL PROGRAM IN GUATEMALA
Authors: Wellmann Alicia , Rodríguez José Javier , Batzin Benilda , Hegel Guillermo , Ayala Luis Fernando , Ozano Kim , Fort Meredith , Flores Walter , Ramírez Lesly , Palacios Eduardo , Martínez Mayron , Ramírez-Zea Manuel , Flood David
Published: September 2024

Background:

More than 75% of deaths from cardiovascular diseases (CVD) occur in low- and middle-income countries, yet there is limited adoption of evidence-based interventions to prevent CVD in these settings. The HEARTS Technical Package in Primary Care is the model recommended by the WHO to address this implementation gap. A key barrier of HEARTS is that many health systems lack sufficient resources to provide free access to medications for CVD and lack a system for patient monitoring and follow-up.

Methods:

We evaluated the implementation of the first official HEARTS project in the Ministry of Health (MoH) of Guatemala. The project was carried out in 6 primary healthcare facilities across 3 rural municipalities over 8 months. The population were predominantly of Indigenous Maya ethnicity, an ethnic group historically underserved by the MoH. HEARTS consists of six evidence-based, cost-effective components. These were complemented by 3 patient-centered strategies to enhance sustainability: (1) community-based social accountability intervention; (2) revolving-fund pharmacy operated by municipal governments to provide low-cost generic medications; and (3) facility-based digital monitoring tool (DHIS2).

Results:

We observed a 4-fold increase in treatment rate and a 14% absolute increase in the proportion of patients achieving blood pressure control. The availability of free antihypertensive medications was enhanced through the MoH and the revolving-fund pharmacy, improving adherence in 37%. Additional process outcomes include: 28 health personnel received training on hypertension clinical management; 16 self-help groups for hypertensive patients were supported; 178 patient visits were tracked in the DHIS2 monitoring system.

Conclusions:

The results demonstrated significant improvements in hypertension control. The implementation of patient-centered strategies, coupled with intersectoral collaboration, contributed to the program's success. Challenges in the sustainability of the model were identified due to financial limitations. Overall, the project set an important precedent for addressing hypertension in rural communities. This pilot HEARTS project serves as a model for scaling-up hypertension management in the MoH primary care system.
P028 GLOBAL, REGIONAL, AND NATIONAL BURDEN OF HYPERTENSIVE HEART DISEASE ATTRIBUTABLE TO HIGH SODIUM INTAKE FROM 1990 TO 2021
Authors: Yin Zheng , Miao Huanhuan , Zhou Zhanyang , Yang Shijie , Zhang Yuqing
Published: September 2024

Background:

High sodium intake is associated with increased blood pressure. Hypertensive heart disease (HHD) is a structural and functional alteration of the left ventricle caused by long-term high blood pressure, which is closely related to many adverse events. We aimed to assess the level and trend of the burden of HHD associated with high sodium intake based on the latest global burden of disease (GBD) study from 1990 to 2021.

Methods:

Data were obtained from Global Burden of Disease (GBD) study 2021. We estimated HHD-related deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMRs), and age-standardized DALYs rates (ASDRs) attributable to high sodium intake, stratified by age, sex, socio-demographic index (SDI), region, and country. We also calculated estimated annual percentage changes (EAPC) to assess temporal trends in ASMR and ASDR for HHD attributable to high sodium intake from 1990 to 2021.

Results:

In 2021, the number of HHD deaths and DALYs attributable to high sodium intake was 303,967 (95% CI: 641,085 to 63,832) and 596,048 (95% CI: 1230,061 to 150,532), respectively. Deaths and DALYs showed an overall downward trend globally with an EAPC of -1.46 (95% CI: -1.68 to -1.23 and -1.77 (95% CI: -1.99 to -1.55), respectively. However, ASDR and ASMR increased in high SDI regions, with EAPC of 0.77 (95% CI: 0.48 to 1.07) and 1.12 (95% CI:0.84 to 1.4), respectively. Central Europe exhibited the highest rates of HHD deaths and DALYs. The burden of hypertensive heart disease due to high sodium intake was highest in people over 65 years in 2021 and was higher in women than in men.

Conclusion:

Our research findings indicate that high sodium intake leads to a significant burden of HHD, with notable gender and geographic disparities. To address this pressing global health issue, it is essential to improve HHD prevention and sodium intake management strategies, particularly for populations in high SDI regions, the elderly, and women.
P033 HYPERTENSION AND SOCIAL DETERMINANTS OF HEALTH IN A POPULATION OF YOUNG ADULTS REGISTERED IN A PRIMARY CARE UNIT IN RIO DE JANEIRO
Authors: Guizzo Maria Eduarda Bazzanelli , de Vasconcellos Clara Avelar Mendes , Guimarães Luana Moreira Senra , Ferreira Manuela Bartholo , de Carvalho Spinola Gabriel Pedrosa , Ribeiro Laura Rodrigues , Vogel Beatriz , de Melo Samuel Bueno Cruz Pedrosa , de Souza Thomas Barbosa Leal , Duarte João Felipe Assad , de Souza Victoria Fidalgo , da Veiga Silva Caroline , Tenenbaum Rafaela Miller , Muxfeldt Elizabeth Silaid
Published: September 2024

Background:

New cardiovascular (CV) risk factors have been studied (including social determinants of health - SDHs) that seems to influence the incidence of CV events, life expectancy and mortality rate.

Objective:

To evaluate the SDHs associated with high blood pressure (BP) in young adults living in the area of a primary care unit in Rio de Janeiro.

Methods:

Cross-sectional population study to assess the CV risk of adults aged between 20 and 50 years old. Sociodemographic characteristics, anthropometric measurements and CV risk factors were recorded. Pressure and HBPM were recorded. The race was self-declared. Low education was defined as having completed primary education or less. Those with formal or informal employment were considered to have a job.

Results:

483 individuals, 299 (62%) female with an average age of 37 ± 9 years. Non-whites people comprised 52% of the sample. 108 individuals (21%) have low education and 98 (20%) do not have a job. Sedentary lifestyle (44%), dyslipidemia (43%), obesity (26%) and hypertension (26%) were the most prevalent risk factors. Abdominal obesity was more prevalent among women (45% vs 26%) and high BP (33% vs 21%) and smoking (18% vs 9%) among men. Black people are older and have less education (24% vs 18%), but race had no relationship with BP levels. Lack of employment was more common among women (79% vs 58%) and in logistic regression it practically doubled the risk of hypertension (OR 1.76, 95%CI 1.02-3.04, p=0.042). Low education was prevalent among older men and logistic regression showed that it doubled the risk of smoking (OR 2.17: 95%CI 1.15-4.08, p=0.016) and high BP (OR 1. 82, 95%CI 1.10-3.03, p=0.021). Lack of employment was more common among women and was not associated with CV risk factors.

Conclusion:

Low education and lack of employment were the main social determinants of health associated with high BP.
P045 HEALTH AND CARE STATUS OF HYPERTENSIVE PATIENTS IN PRIMARY CARE UNITS IN THE CONOCOTO-QUITO-ECUADOR DISTRICT: BASELINE OF THE HEARTS INITIATIVE - 2019
Authors: Ortiz Patricia , Ortiz Alexis , Calderón Micaela , Pereira Hugo , Montero Verónica , Pesse Ph.D. Karen
Published: September 2024

Background:

Hypertension is a significant global public health problem due to the burden of disease and premature death it causes. Its control depends on the quality and timeliness of diagnosis, treatment, and patient follow-up. Studies show an increase in prevalence, poor control, and low coverage in the diagnosis, treatment, and follow-up of hypertensive patients. In response to this problem, since 2019 the Ministry of Health of Ecuador has implemented the HEARTS Initiative proposed by PAHO in primary health care units. This study is part of the baseline prior to its implementation.

Objective:

To identify the health and care status of hypertensive patients attending primary care units in the Conocoto district.

Methodology:

A descriptive retrospective study was conducted, reviewing the medical records of 681 patients who attended follow-up consultations in the 9 health units of the district.

Results: The average age of the patients was 67.12 years (SD 14.2), with 72.1% being women and 96.7% of mixed ethnicity. The average annual number of consultations was 4.24; 40.4% of the patients were overweight and 41% obese. Of the patients who underwent laboratory tests, 45.1% had hypercholesterolemia, 48% had low HDL, and 10.9% had impaired renal function. An electrocardiogram was performed in 3.4% and a funduscopy in 1.7%. Most patients received counselling on lifestyle changes; 31.9% of the patients had uncontrolled hypertension; depending on the health unit this ranged from 11.3% to 52.3%.

Conclusions:

The lack of hypertension control is lower than reported in other studies, although many patients do not have the minimum necessary tests. Follow-up should be improved, not only of blood pressure control but also of the patient's clinical condition.
P050 PITFALLS IN ESTABLISHING THE DIAGNOSIS OF PHEOCHROMOCYTOMA ILLUSTRATED BY THREE CASE REPORTS
Authors: Hausberg Martin , Teber Dogu , Dietrich-Mgbor Jeannine , Ruf Juri , Reimer Peter , Rüdiger Thomas , Kisters Klaus
Published: September 2024

Background and Objective:

Pheochromocytoma is a rare cause of secondary hypertension. Because of the low incidence, any diagnostic test has a low positive predictive value.

Methods:

We report three example cases with diagnostic pitfalls.

Results:

First case: A 72-year old Caucasian women was admitted for the evaluation of a right adrenal mass, measuring 4 cm. The patient was asymptomatic, never hypertensive. Standard endocrinological evaluation of the adrenal mass revealed significantly elevated plasma and urine normetanephrine (>2 fold upper normal range) and metanephrine levels (>10 fold upper normal range). Subsequent functional imaging with MIBG SPECT/CT confirmed catecholamine storage in the left adrenal mass. After pretreatment with phenoxybenzamine (causing hypotension) the mass was removed surgically and a pheochromcytoma confirmed histologically.

Second case:

A 59-year old Caucasian women with repetitive hypertensive crises for several years was screened for pheochromocytoma and significantly elevated plasma and urine normetanephrine levels (> 5 fold upper normal range) were observed. MRI demonstrated a small left adrenal mass of 2 cm. Although no relevant tracer uptake was observed on MIBG SPECT/CT, subsequent somatostatin receptor imaging with DOTA-TATE PET/CT suggested adrenal pheochromocytoma (Fig.). After pretreatment with doxazosine the mass was removed surgically and a pheochromocytoma confirmed histologically, blood pressure normalized after surgery.

Third case:

A 67 year old Asian woman was admitted for the evaluation of a large left adrenal mass measuring 7.5 cm. She had well controlled hypertension with dual antihypertensive medication and did not suffer from paroxysmal hypertensive crises. Plasma normetanephrine levels were substantially elevated (>20 fold upper normal range). MIBG SPECT/CT confirmed catecholamine storage in the adrenal mass that was partly necrotic. After pretreatment with doxazosine the mass was removed surgically, a largely necrotic pheochromocytoma was confirmed histologically. No further antihypertensive treatment was necessary.

Conclusions:

These cases demonstrate that a pheochromocytoma may be asymptomatic, any adrenal mass needs standard endocrinological workup. Standard functional imaging has a limited sensitivity, additional approaches have to be considered.
P055 ELECTROCARDIOGRAPHIC ABNORMALITIES AND ASSOCIATED FACTORS IN NORMOTENSIVE TYPE II DIABETIC PATIENTS
Authors: Udora Nneka Clara , Ejim Emmanuel Chukwudi
Published: September 2024

Background/Objective:

Type II diabetes mellitus (T2DM) is a coronary heart disease (CHD) equivalent in the presence of target organ damage or at least three cardiovascular disease (CVD) risk factors. Resting electrocardiography (ECG) is recommended in T2DM patients only in the presence of hypertension or on suspicion of CVD. ECG abnormalities occur early in T2DM, are associated with future cardiovascular events/mortality after adjustment for traditional CVD risk factors. Early screening and detection may improve long term survival in T2DM patients hence, aim of study- to assess the patterns and factors associated with ECG abnormalities in T2DM patients without co-existing hypertension.

Methods:

One hundred normotensive (BP<130/80mmHg, not on any antihypertensive agent) T2DM patients were recruited consecutively, from the Endocrinology and Diabetes clinics of the Medical Outpatient Clinic and Family Medicine department of the University of Nigeria Teaching Hospital. Consents were obtained, before interviewers, administered questionnaire to get the biodata, T2DM history, complications and treatment. Anthropometric and blood pressure readings were taken using standard methods. A 12-hour overnight fasting blood sample was taken for biochemical assessment of blood glucose, glycated haemoglobin, lipids, urea and creatinine. A 12 lead ECG was performed and interpreted by one cardiologist using the Minnesota ECG code criteria. Descriptive statistics was used for patterns of ECG abnormalities while association between categorical variables were cross tabulated and tested using chi square.

Results:

Participants were majorly females 68(68.0%), overweight/obese 52(52.0%) with a mean age of 55.56±9.89 years. Duration of T2DM illness post diagnosis was 6.57±6.26years. T2DM was poorly controlled in 92(92.0%) while 93(93.0%) had dyslipidaemia. ECG was abnormal in 56(56.0%) with multiple abnormality in 12(21.4)%. Left atrial abnormality was the commonest 14(25.0%) ECG abnormality. No factor was associated with ECG abnormality.

Conclusions:

ECG abnormalities are common in T2DM, occurring early in the absence of co-existing hypertension. ECG should be done at diagnosis of T2DM irrespective of CVD risk factors, with frequent monitoring than recommended by guidelines.

Table. Pattern of electrocardiographic abnormalities in normotensive type II diabetic patients.
P056 ANGIOTENSIN CONVERTING ENZYME I (ACE) ISOFORMS ASSOCIATION, THE GENETIC MARKER IN PARTICULAR, AND PRESENCE OF METABOLIC SYNDROME IN VOLUNTEERS FROM VITÓRIA – ES – BRAZIL
Authors: Gomes Andreia Cristina Febba , Ronchi Fernanda Aparecida , Magri Lucas , Mill José Geraldo , Casarini Dulce Elena
Published: September 2024

Introduction:

Socioeconomic and cultural modifications have directly influenced both population's lifestyle habits and health profile, about 75% of world deaths are characterized by the presence of Non-Transmissible Chronic Diseases (NTCD), such as Metabolic Syndrome (MS), which features the concomitance of cardiovascular risk factors, as arterial hypertension, hypercholesterolemia, and diabetes, central fat deposition, and insulin resistance. A two-phase populational study has researched the Angiotensin Converting Enzyme I (ACE) isoforms relating their presence, specially the 90 KDa one, as a possible biological marker in metabolic alterations and hypertension presence. Objectives: This study's objective is to evaluate whether the 90 kDa ACE isoform may be associated to MS presence in a sample population from the city of Vitoria/ES – Brazil (MONICA project, phase II).

Methods:

470 volunteers from the second phase of the MONICA project were assessed, including demographic information, clinical and biochemical parameters from biological samples. The Western Blotting technique was used for identifying ACE isoforms in urine, which were classified as follows: Group 1: 65, 90 and 190 kDa isoforms; Group 2: 65 and 90 kDa isoforms; Group 3: 65 and 190 kDa isoforms; and these groups distribution in positive and negative MS groups was also checked. Results: It was observed a higher percentage of women in the sample population (58.7% vs 41.3%), higher percentage of negative MS vs positive (74.8% vs 25.2%); both clinical and biochemical parameters presented significantly higher levels in the positive MS group; and MS was more frequently positive in Group 2 of ACE isoforms (Group 1: 44.4%; Group 2: 50%; Group 3: 5.6%).

Conclusion:

This study presenting significant results about the parameters that characterize the presence of MS. Further investigation is needed to identify whether there is a possible relation between 90 kDa ACE isoform and MS, increasing the chances of development and worsening the MS, emphasizing this isoform importance as a biological marker for NTCD.
P067 HOME BLOOD PRESSURE MEASUREMENTS ARE NOT PERFORMED ACCORDING TO GUIDELINES AND STANDARDIZED EDUCATION IS URGENTLY NEEDED: A MIXED-METHODS STUDY AMONG AUSTRALIAN ADULTS
Authors: Clapham Eleanor , Picone Dean , Carmichael Samuel , Sharman James , Chapman Niamh
Published: September 2024

Background and Objective.

Home blood pressure (BP) measurement should be undertaken according to guideline recommendations to ensure accurate BP measurement. Patient education is required to provide knowledge and skills for home BP measurement. However, little is known about how BP is measured at home and what education is provided to patients, which was the aim of this study.

Methods.

A 30-item survey (n=350) and interviews (n=34) among Australian adults who measure BP at home (June–December 2023). Survey questions included steps taken and education received for home BP measurement. Interviews were conducted among a purposive sample to explore survey topics in detail.

Results.

No participants reported always undertaking home BP measurement according to all the guideline recommendations (Figure 1). However, most participants measured BP seated (n=316, 90%), with the cuff on a bare arm (n=269, 77%) and legs uncrossed (n=232, 66%). In addition, most participants recorded their BP measurements (n=280, 80%) and reported them to a medical professional (n=232, 79%). Interview participants reported measuring BP in an ad-hoc manner, using different steps each time they measure BP at home. “I [measure BP] at different times of the day after doing different things”.

Only 37% (n=112) participants received education for home BP measurement. Interview participants who received education described healthcare practitioners giving verbal instructions for BP measurement. However, there were no differences in performing home BP measurement according to guideline recommendations between participants that received education and those that did not. In the absence of education, many interview participants described mimicking BP measurement methods of their healthcare provider. “I do it the way I’ve seen them do it”.

Conclusions.

This study found that home BP measurement is not performed according to guideline recommendations and standardised, high-quality education is rarely delivered on how to measure BP at home. These findings highlight an urgent need for effective education strategies to support high-quality home BP measurement to appropriately inform BP management.
P070 ROLE OF NOVEL BLOOD PRESSURE METRICS IN EARLY BLOOD PRESSURE CONTROL ASSESSMENT: INSIGHTS FROM THE SPRINT TRIAL
Authors: Li Moran , Shi Jieying , Zhao Yifan , Zhang Yi
Published: September 2024

Objective:

Innovative blood pressure (BP) metrics is pivotal to expedite the BP management among individuals with hypertension.

Methods and Findings:

This is a post-hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial). A total of 8369 participants, who had comprehensive BP records and experienced no adverse events during the initial 90-day follow-up, were included. Two novel BP metrics, systolic blood pressure (SBP) burden and Time-in-Target-Range (TTR), were calculated by employing three-month SBP recordings from follow-up data. SBP Burden were derived as the proportion of area under curve (AUC) over a specific SBP threshold (SBP values >130 mmHg) in a short-term exposure period (from the first month to third month). SBP TTR was estimated by the proportion of time in a specified SBP target range (110 to 140mmHg) in the same exposure period. Major adverse cardiovascular events (MACE), as the primary outcome of this analysis, was a composite endpoint including myocardial infarction, stroke, heart failure, and cardiovascular death. Secondary outcomes included individual components of the primary outcome, as well as all-cause mortality. The relationship of novel BP metrics and study endpoints was accessed by using adjusted Cox proportional hazards regression models.

Over a median follow-up period of 3.90 [3.88-3.94] years, 559 MACEs occurred. Both SBP burden (Hazard Ratio [HR]: 1.126 [1.039-1.221]) and SBP TTR (HR: 0.862[0.783-0.949]) were independently correlated with MACEs according to adjusted Cox models. Evaluation using C-statistic and Net Reclassification Indexes (NRI) revealed that both two novel SBP metrics outperformed mean SBP and SBP standard deviation (SD) in predicting MACEs. Furthermore, the predictive value of SBP burden and TTR was consistent across MACE(P=0.383) and secondary endpoints (all P value > 0.05) in this analysis.

Conclusions:

Among non-diabetic patients with hypertension, both the cumulative SBP burden and TTR independently predict MACEs, surpassing the predictive power of mean SBP and SBP SD. This study substantiates the application of innovative BP measurements for early-stage assessment of BP control.
P074 STRIDE BP SYSTEMATIC REVIEW OF PUBLISHED VALIDATION STUDIES OF BLOOD PRESSURE MEASURING DEVICES
Authors: Menti Ariadni , Mariglis Dimitrios , Kyriakoulis Konstantinos , Kollias Anastasios , Palatini Paolo , Parati Gianfranco , Wang Jiguang , Schutte Aletta , Stergiou George
Published: September 2024

Background and Objective:

The accuracy of blood pressure (BP) monitors is essential for an accurate diagnosis, yet few devices have been validated using an established protocol. This study assessed the published evidence on validation studies of BP monitors.

Methods:

STRIDE BP (www.stridebp.org) performs periodic systematic PubMed searches to identify published validation studies of automated cuff BP monitors. Validation studies conducted using an established protocol, including the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018), ANSI/AAMI/ISO 2013/2009, ESH-IP 2010/2002, AAMI 2002/1992/1987, and the BHS 1993/1990, were identified from the STRIDE BP database.

Results:

Of 569 validation studies included in the STRIDE BP database, 238 (42%) used the ESH-IP, 153 (27%) the AAMI/ISO, 132 (23%) the BHS, and 46 (8%) the AAMI/ESH/ISO Universal Standard. These studies evaluated 346 devices (upper-arm 290; wrist 56) intended for office (55), ambulatory (44), home (233), public space/kiosk (8), and hospital (6) BP measurements. Among the 569 reviewed studies the STRIDE BP review process rejected 202 (35.5%) due to major violation of the validation protocol and/or device failure to pass the protocol's requirements. Six of 46 validation studies that used the most recent AAMI/ESH/ISO Universal Standard were rejected (13%), versus 190 (36.3%) using older validation protocols. STRIDE BP concluded that 280 of total 346 BP devices (81%; upper-arm 236; wrist 44) fulfilled the protocol's requirements and can be recommended for clinical use. Among these 280 devices, 106 (37.6%) were selected by STRIDE BP as preferred devices (fulfilling additional requirements), and 182 (65%) are available on the market (Table).

Conclusions:

This analysis highlights a shortage of validated BP monitors available on the market, particularly for office and 24-hour ambulatory use. It is encouraging that fewer validation studies using the most recent AAMI/ESH/ISO Universal Standard were rejected by STRIDE BP than older studies using previous protocols, suggesting an improvement in the quality of published validation studies.

Table. STRIDE BP systematic review of published validation studies.
P079 HOME BLOOD PRESSURE SCREENING IN MAY MEASUREMENT MONTH 2022 USING THE ZOE HEALTH STUDY APP
Authors: Kerr Gabriele , Beaney Thomas , Schlaich Markus , Schutte Aletta , Stergiou George , Berry Sarah , Spector Tim , Poulter Neil
Published: September 2024

Background and Objective:

May Measurement Month (MMM) is a global blood pressure (BP) screening campaign with aims to raise awareness of raised BP. In 2022, MMM incorporated home BP measurements from UK users of the ZOE Health Study app. We compare rates of hypertension prevalence, treatment, and control amongst ZOE app users with other European non-ZOE MMM participants.

Methods:

Adult (≥18 years) UK ZOE app users were invited to participate in MMM in 2022. ZOE participants were advised on taking three home BP measurements and non-ZOE participants had three standardised seated BP measurements in a range of facilities outside the home. All participants completed a questionnaire including demographics and antihypertensive medication use. Hypertension was defined using thresholds for clinic BP (≥140/90 mmHg) for non-ZOE participants and thresholds for home BP (≥135/85 mmHg) for ZOE participants, based on the mean of the second and third measurements, and/or taking antihypertensive medication. Awareness was defined as having a previous diagnosis of hypertension or treatment with antihypertensive medication.

Results:

A total of 50,200 ZOE participants were screened in MMM22, of whom 94.0% were over 50 years of age and 65.8% were female. 24,967 (49.7%) were hypertensive, of whom 19,356 (77.5%) were aware, and 18,195 (72.9%) were taking antihypertensive medication, and 11,454 (45.9%) were controlled to <135/85 mmHg.

Compared to the other 64,256 MMM22 European participants (mean age 53.6 [SD 16.8] years, 58.7% female), ZOE participants had slightly higher rates of hypertension (49.7% vs 48.9%), and greater proportions of ZOE hypertensive participants were aware (77.5% vs 70.8%), treated (72.9% vs 63.3%), and controlled to <135/85 in ZOE participants and <140/90 mmHg in non-ZOE participants (45.9% vs 30.9%) (p<0.001 for all).

Conclusions:

In this large UK sample of ZOE users with hypertension, a higher proportion were aware, treated and controlled than amongst other European MMM screenees with hypertension. These digitally-enabled ZOE users apparently have greater access or engagement with effective BP management strategies.