bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P133: Treating Hypertension With An Anti-inflammatory Formyl Peptide Receptor Agonist
Authors: Jackson Kristy L , Ritchie Rebecca H , Giddy Thomas , Deo Minh , Woodman Owen L , Head Geoff , Qin Chengxue H
Published: September 2020

Background:
Inflammation can play an important role in the progression of hypertension and end organ damage, yet anti-inflammatory drugs remain relatively underexplored as antihypertensive therapeutic options. Formyl peptide receptors (FPR) are integral to the regulation and resolution of inflammation and may be an attractive target for the treatment of hypertension-induced end organ damage, especially given our previous observation that a small molecule FPR prototype molecule reduced cardiac inflammation and fibrosis in a model of myocardial infarction and exhibited vasodilator effects in isolated blood vessels.

Objective:
The aim of the present study is to determine whether Cmpd17b has antihypertensive and antifibrotic effects in a mouse model of spontaneous hypertension.

Methods:
Hypertensive BPH/2J (n=14) and normotensive BPN/3J mice (n=12) were treated daily with Cmpd17b (50mg/kg/day, i.p.) or vehicle (8% tween80 and 10% dimethyl sulfoxide in saline, i.p.) for 4 weeks. Mean arterial pressure (MAP) was measured via pre-implanted radiotelemetry probes at baseline and throughout the treatment period. Sirius red staining of left ventricle tissue was used as a marker of cardiac fibrosis.

Results:
MAP in BPH/2J mice was markedly greater than BPN/3J mice at baseline (126±2 vs 106±1mmHg respectively,
P
<0.001). Cmpd17b resulted in a 6±1mmHg reduction in MAP from baseline in the BPH/2J mice (
P
<0.001), whereas MAP was unchanged from baseline in Cmpd17B treated BPN/3J mice (1±1mmHg,
P
=0.533) and vehicle treated BPH/2J mice (1±1mmHg,
P
=0.316). Collagen content in the left ventricle (%LV) was greater in vehicle treated BPH/2J compared with BPN/3J mice (
P
<0.05). BPH/2J mice treated with Cmpd17b had lower collagen content compared with vehicle treated BPH/2J (0.7±0.1 vs 1.2±0.2% respectively,
P
<0.05) whereas collagen content was comparable in BPN/3J treated with Cmpd17b versus vehicle (0.5±0.1 vs 0.5±0.1%).

Conclusion:
These findings suggest that targeting FPR with the agonist Cmpd17b, has both antihypertensive and antifibrotic effects in hypertensive mice, thus supporting further assessment of FPR based therapeutics for the treatment of hypertension and end organ damage.
Abstract P138: Controlling For Hypertension Does Not Alter Sex Differences In Renal T Cell Profiles In Doca-Salt Rats.
Authors: Belanger Kasey , Sullivan Jennifer C
Published: September 2020

Our lab has shown that there are sex differences in the renal T cell profile in deoxycorticosterone acetate salt (DOCA) hypertension. The current study tested the hypothesis that sex differences in renal T cells in DOCA-salt rats is blood pressure (BP) dependent. At 10 wks of age, male and female Sprague-Dawley rats (N=9-12/group) were anesthetized, a telemeter was implanted for BP measurement, and a right uni-nephrectomy was performed. After one wk, all rats received a subcutaneous slow-release DOCA pellet (200 mg) with 0.9% saline to drink. To prevent DOCA-salt induced increases in BP, a subset of rats were randomized to receive hydrochlorothiazide (HCTZ; 55 mg/kg/day) and reserpine (4.5 mg/kg/day) combined with saline in drinking water. After 3 wks, the remaining kidney was isolated for flow cytometric analysis of T cells. After 3 wks of DOCA-treatment, males had a higher BP than females (P
sex
=0.0001). Treatment with HCTZ and reserpine prevented DOCA-induced increases in BP in both sexes (P
t
x
t
<0.0001; P
int
=0.307). With DOCA-salt induced hypertension, males had more renal CD4
+
T cells (P
sex
=0.4) and Th17 (P
sex
=0.02) than females. HCTZ and reserpine decreased both CD4
+
cells (P
t
x
t
<0.0001) and Th17 cells (P
t
x
t
<0.0001) and the decreases were comparable between sexes (CD4
+
: P
int
=0.86; Th17: P
int
=0.55). With DOCA alone, females had more renal Tregs than males (P
sex
<0.0001). HCTZ and reserpine did not significantly change renal Tregs in either sex (P
t
x
t
=0.11; P
int
=0.38).Our data suggests that while preventing DOCA-salt induced increases in BP attenuates the increase in renal pro-inflammatory T cells, sex differences in renal T cells is not BP dependent.
Abstract P144: Covid-19 And The Use Of Angiotensin-converting Enzyme Inhibitors And Receptor Blockers. Real World Experience.
Authors: AL Abbasi Baher , Dewaswala Nakeya , Ramos Fergie , Abdallah Ahmed , Torres Pedro , Chen Kai , Abdul Qader Mohamed , Aboulenain Samar , Dziadkowiec Karolina , Pino Jesus , Chait Robert D
Published: September 2020

Background:
Concerns exist that angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) increase susceptibility to coronavirus SARS CoV-2 (the virus that causes the disease COVID-19) and the likelihood of severe COVID-19 illness.

Methods:
This is a single-center retrospective cohort study of 172 patients diagnosed with 2019 Novel Coronavirus (SARS-CoV-2) between March of 2020 and May of 2020. Our study aimed to investigate the impact of ACEI and/or ARBs on the in-hospital mortality, intensive care unit (ICU) admission, hospital length of stay (LOS), and ICU LOS of patients with COVID-19.

Results:
This cohort of 172 patients included 88 (51%) women with a mean age of 58±17 years. Patients who had a history of using ACEI/ARBs were older 68±14 vs. 54±17 (P<0.0001). They were more likely to be obese 28(65%) vs. 52(40%) p=0.0054, have hypertension 44(100%) vs 42(33%) p<0.0001, diabetes mellitus 18(40%) vs 13 (10%) p<0.0001, and chronic kidney disease 5(11%) vs. 1(0.8%) p= 0.0011 than patients not using ACEI/ARBs. On the other hand, the prevalence of coronary artery disease (p=0.3791), and chronic heart failure (p=0.8037) was similar between the two groups.

Outcomes:
There was significantly higher in-hospital mortality in patients who used ACEI/ARBs than non-users (33% vs. 13%, p=0.0039, respectively). To evaluate the effect of ACEI/ARBs on mortality after controlling for confounding factors, multivariable logistic regression (MLR) was performed based on age (p=0.0003), obesity (p=0.3394), hypertension (p=0.4159), diabetes mellitus (p=0.0144), and chronic kidney disease (0.3189). The MLR showed no significant differences in mortality between patients who used ACEI/ARBs and non-users (p= 0.8372). Admission to ICU was more likely in patients who used ACEI/ARBs than non-users (28% vs. 13%, p=0.0384 respectively), while hospital LOS (6±9 vs. 4±6, p=0.1240 respectively), and ICU LOS (12±12 vs. 8±5, p= 0.3253 respectively) were similar between the two groups.

Conclusion:
This study suggests that the use of ACEI/ARBs associated with higher mortality in patients with COVID-19. This is likely attributed to the fact that patients who use these medications are older and are more likely to have diabetes mellitus and hypertension.
Abstract P148: Sex-dependent Colonic Immune Responses In Salt-sensitive Hypertension
Authors: Mei Xue , CHAKRABORTY Saroj , Cheng Xi , Yang Tao , Joe Bina
Published: September 2020

Introduction:
Hypertension affects almost half of the adults in the US. Overactivation of immune system results in pathogenesis of hypertension. Given that sex differences are reported in salt-sensitive hypertension and that the gut is an important organ at the interface between gut microbiota and the host, we hypothesized that differential colonic immunity exists between male and female rats on high and low salt diets.

Methods:
Total RNA was isolated from the colons of male and female Dahl Salt-Sensitive (S) rats fed with either high-salt (2% NaCl) or low-salt (0.3% NaCl) diet at 9-10 weeks old (n=3/sex/diet) and subjected to transcriptome followed by pathway analyses to detect differentially enriched transcripts and biological processes (FDR<0.05). The transcripts overexpressed in the sex-matched S rats on high salt diets were defined as hypertension-associated genes. Among them, the transcripts upregulated in both sexes were inferred as sex-independent, while those upregulated exclusively in either sex were considered as sex-dependent.

Results:
Upregulation of colonic immunity was evident through the transcriptomic signatures of both sexes with hypertension. Among the upregulated 38 male sex-dependent transcripts, 20 were related to T cell activation including co-receptor
Cd4
, co-stimulators
Cd80
and
Cd86
, and Th1 and Treg cells-related receptors and cytokines
Tgfbr2
,
Il1r1
,
Il18r1
and
Lif
, whereas 17 out of 27 upregulated female sex-dependent transcripts were related to T cell activation including co-receptor
Cd8
, co-stimulators
Cd40
,
Icoslg
,
Cd27
, and
Tnfsf9
, and Th2 and Th17-related cytokines
Tgfb1
,
Tgfb3
,
Il1b
,
Il23a
and
Gata3
. In addition, antigen presenting cells were observed with upregulated MHC II in males, whereas upregulated both MHC I and II in females with hypertension. Further, 12 out of 20 sex-independent transcripts were suggestive of B cell activation.

Conclusion:
Marked sex differences were noted in the levels of colonic immune function- related transcripts of S rats on high salt diet. In the colonic T cell activation related transcripts,
Cd4
and MHC II were predominant in males, while
Cd8
and both MHC I and II were more prevalent in females. Additionally, colonic B cell activation was relatively less dependent on sex.
Abstract P149: Germ-free Rats Reveal An Obligatory Role Of Microbiota In Blood Pressure
Authors: CHAKRABORTY Saroj , Cheng Xi , McCarthy Cam , Mell Blair , Yeo Ji-youn , Golonka Rachel , Yeoh Beng San , Mandal Juthika , Yang Tao , Saha Piu , Wenceslau Camilla F , Kumar Matam Vijay , Joe Bina
Published: September 2020

Elevated blood pressure or hypertension is the single largest risk factor for cardiovascular diseases which are the leading cause of human deaths. Current clinical management of blood pressure is focused on restoring homeostasis of the host alone, without accounting for commensal gut microbiota. Recent evidence from the CARDIA study in humans and multiple studies using animal models suggest that development of hypertension in the host is associated with alterations in microbiotal communities. Here we examined whether microbiota is necessary for blood pressure and vascular homeostasis by functional evaluation of the gut homeostasis, hemodynamic, and vascular function of gnotobiotic rats reconstituted with microbiota to represent the complete holobiont. Gnotobiotic rats were used to represent incomplete holobionts. To reconstitute complete holobionts, gnotobiotic rats were co-housed with conventionally-raised rats. Acquisition of microbiota was evaluated through monitoring of gross ceca and fecal samples by metagenomic 16S sequencing. BP was recorded and vascular, renal, hepatic, cardiac and gut features were assessed using histology and ex vivo myography. Markers of innate immune effectors (Immune cell population, level of Lcn2, Gut permeability) were used to examine the nature and extent of host immune cell processes concomitantly occurring along with observations of host hemodynamics. Compared to the reconstituted holobiont represented by the animals exposed to microbiota, the incomplete-holobiont represented by gnotobiotic rats, had significantly lower BP (SBP of germ free:109±8 mmHg, SBP of conventionalized:138±10mmHg
*
) and vascular contractility responses to phenylephrine (Emax (mN): germ-free: 6.9±1.3, GFC: 11.7±0.7*). Acute exposure of the host to microbiota reconstituted gut microbiotal communities, significantly boosted their gut epithelial cell proliferation, innate immune function and restored vascular contractility. These data indicate that in addition to the dependency of the host on microbiota for essential bodily functions such as digestion of plant-derived complex carbohydrates, the host is also dependent on microbiota for maintaining blood pressure and vascular function
Abstract P154: Results From A Randomized Trial Of Different Rest Times Before Initiating BP Measurements
Authors: Brady Tammy M , Ishigami Junichi , Miller Edgar R , Matsushita Kunihiro , Appel Lawrence J , Charleston Jeanne
Published: September 2020

Background:
BP measurement guidelines recommend ≥5 min of rest before initiation of readings; this wait time is challenging to implement, especially in resource-constrained settings.

Objective:
Compare the effects of resting 0 or 2 min vs. 5 min on BP.

Design and methods:
RCT of community-dwelling adults, 18-80yrs. Participants had 4 sets of BP measurements (Omron HEM 970XL). In a cross-over design, the order of rest for the 1
st
3 sets [0min, 2min, 5min
1
] was random. The 4
th
set was always a 2nd 5min rest period (5min
2
) to estimate repeatability. Mean BP for each rest period, mean absolute difference between each participant’s mean BP after 5min
1
and the other rest periods were determined. To determine if resting 0min and/or 2min was non-inferior to 5min
1
, we calculated the difference of differences, with ≤ ±2 mmHg considered non-inferior. Analyses were for the population overall and stratified by SBP ≥ vs. < 140mmHg.

Results:
N=113, mean age 55yrs, 36% male (n=41), 74% AA (n=84), 28% SBP
>
140mmHg (n=32). Overall, mean 5min
1
BP was 128/75 and 5min
2
BP was 127/76 (p=NS), similar to mean BP at 2min and 0min (127/74 for both). The absolute difference of differences between 2min and 5min
1
SBP for the population overall was > ±2 mmHg, but for those with SBP <140, resting 2min and 0min BP was ≤ ±2 mmHg (Table).

Conclusion:
In this RCT, mean differences in BP by rest period were small. BPs obtained after shorter rest periods were non-inferior than those obtained after 5min when SBP <140. This suggests shorter rest times, even 0 min, may be reasonable for screening when the initial SBP is <140. These findings could improve the efficiency of hypertension screening, especially in resource-constrained settings.
Abstract P157: Challenging Blood Pressure Control In Heart Failure Patients And Related Factors
Authors: Lee Hong Seok c , Lee Hong Seok c , Lee Hong Seok c , Lee Hong Seok c
Published: September 2020

Background:
The 2017 ACC/AHA hypertension guidelines were released, and it specified blood pressure (BP) control goals in diverse situation. We will determine how the guideline can affect heart failure blood pressure control and risk factors for the control. There is not enough data how BP is controlled and what risk factors are related to controlled BP in heart failure patients according to the 2017 hypertension guideline.

Method:
3276 heart failure patients who visited a community hospital for any medical reason were included and analyzed retrospectively from November 2017 to December 2018. Control of blood pressure will be defined based on the guidelines which show that heart failure patients’ blood pressure target is less than 130 /80 mmHg. ACE inhibitors/Aldosterone receptor blocker, diuretics(HCTZ, Furosemide, Butamex), Spironolactone, calcium channel blocker, and Angiotensin Receptor Neprilysin Inhibitor( Entresto), comorbidities(diabetes, chronic kidney disease, hyperlipidemia), age, gender, and ethnicities were collected and used for multi-variable adjusted logistic regression model.

Results:
29.6% (555/1873) male patients were controlled based on the guidelines, on the contrary, 34.3%(482/1403) female patients revealed blood pressure control.The African american population’s BP was the most uncontrolled among all ethnicities. Multivariable logistic regression analysis was performed. Age of less than 65 years old [Odds ratio (OR): 2.81,95% Confidence Interval(CI): 2.41-3.26] was associated with controlled blood pressure. DM [OR: 0.71,95% CI: 0.61-0.82], beta-blocker [OR: 0.79,95% CI: 0.64-0.96] and LDL of more than 100mg/dl [OR: 0.57,95%, CI: 0.45-0.71] were noted to have significantly the uncontrolled BP.

Conclusion:
It appears about only one third of heart failure patients may be having their BP controlled based on 2017 ACC/AHA guideline. Beta-blocker were associated with uncontrolled blood pressure, which might suggest their dose of beta-blocker was not maximized for heart failure patients’ care. Clinicians may need to consider to try the higher dose if patients are tolerating. Elderly heart failure patients with DM or high LDL level (>100mg/dl)may need strict blood pressure control by better management of DM and LDL.
Abstract P162: Drug Adherence In Hypertensive Patients And Variables Associated With Nonadherence.
Authors: CHOUDHARY RAHUL , Gautam Dinesh K , Sharma Shashi M
Published: September 2020

Introduction:
The prevalence of systemic hypertension has increased considerably in India over the past few decades from 5 percent to between 20-40 percent in urban population and 12-17 percent in rural population. Although there is availability of numerous affordable antihypertensive drugs, hypertension is still poorly controlled, leading to an epidemic of non-communicable diseases. Drug nonadherence is implicated as a major factor responsible for poorly controlled hypertension.

Aim:
This study was undertaken to gather data regarding drug adherence among hypertensive cohort and factors responsible for poor adherence.

Methods:
We prospectively studied 1468 hypertensive patients at a tertiary care hospital. Assessment of antihypertensive medication adherence was determined using the instrument validated by Morisky et al. Poor medication adherence was defined as answering yes to three or more of eight questions. Office reading and 24-hr ABPM were used to assess the level of hypertension control.

Result:
The mean age of the included patients was 61.2 ± 10.6 years and 63.5 % were male. Among the studied cohort, 55.8 % (819 out of 1468) patients were highly adherent to antihypertensive medication and adequate BP control was achieved in only 39.10 % (574 out of 1468) patients. Independent predictors of drug non-adherence in a multivariate analysis model were illiteracy (hazard ratio [HR] 3.06; 95% confidence interval [CI], 1.31-7.16), low socioeconomic status (HR 2.6; 95% CI, 1.28-4.89), presence of drug side effect (HR 1.7; 95% CI, 1.54-1.95), number of drugs (HR 1.8; 95% CI, 1.4-2.2), number of years on treatment (HR 1.4; 95% CI, 1.1-1.8), incognizant of long term risk of uncontrolled hypertension (HR 1.5; 95% CI, 1.31-1.74), irregular BP monitoring (HR 1.3; 95% CI, 1.1-1.6), and associated CKD and/or DM (HR 2.74; 95% CI, 1.065-7.05)

Conclusion:
Antihypertensive drug non adherence is a prevalent behavior among patients and since many of the attributed factors are modifiable, they signal opportunities to improve adherence, and thus, BP control in clinical practice
Abstract P165: Improvement In Self-monitoring Frequency, Electronic Data Sharing, And Medication Changes In A Pragmatic Cluster-randomized Trial Of Home Blood Pressure Telemonitoring And Pharmacist Care (Hyperlink 3)
Authors: Margolis Karen L , Sperl-Hillen JoAnn M , Crain Lauren A , Ziegenfuss Jeanette Y , Solberg Leif I , Bergdall Anna R , Beran MarySue , Anderson Jeffrey P , Pawloski Pamala A , Rehrauer Daniel J , Norton Christine , Haugen Patricia K , Green Beverly B , McKinney Zeke J , Kodet Amy J , Appana Deepika , Sharma Rashmi , Trower Nicole K , Crabtree Benjamin , Haapala Jacob L , Kottke Thomas E , O'Connor Patrick J
Published: September 2020

Introduction:
Telehealth and remote monitoring have become critical to patient access to care during the COVID-19 pandemic. We measured the effect of a telehealth care intervention on frequency, sharing methods, and clinical usage of home blood pressure (BP) measurements.

Methods:
Hyperlink 3 is an ongoing pragmatic cluster-randomized trial in 3072 patients with uncontrolled hypertension in 21 primary care clinics in an integrated health system. Clinics were randomized to Clinic-based Care (CC, 9 clinics, 1648 patients) or Telehealth Care (TC, 12 clinics, 1424 patients). TC patients were offered home BP telemonitoring with pharmacist care management. Patients were surveyed at baseline (Nov 2017 - Apr 2019) and after 6 mo of study enrollment.

Results:
In the TC group, about 37% of patients attended an intake pharmacist visit and 434 (30%) participated in home BP telemonitoring. Baseline surveys were completed by 1719 (56%) of patients at baseline (goal 50%) and 1301 (76%) of those completing the baseline survey completed the 6 mo survey (goal 75%). Baseline survey respondents' mean age was 62, 46% were men, 19% were black, and mean BP was 164/93 mm Hg. Nearly all patients (>90%) took antihypertensive medications (median 2). The odds ratio (OR) for change in measuring BP
>
2 times/week vs. less often was 0.97 (95% CI 0.87 - 1.42) in CC, and 2.01 (95% CI 1.56 - 2.59) in TC. The OR for change in frequent measurement in TC vs CC was 2.08 (95% CI 1.45 - 2.97).

Conclusions:
A telehealth care intervention markedly increased the frequency of home BP self- monitoring, electronic data sharing, and data-driven BP medication changes, even though only a minority of TC patients received the intervention.
Abstract P168: A Novel Protocol Using Ambulatory Blood Pressure Monitoring To Assess The Impact Of Prescription Stimulants On Blood Pressure In Adults
Authors: Cluett Jennifer L , Ishak Anthony , Mukamal Kenneth J , Juraschek Stephen P
Published: September 2020

Background:
Prescription stimulant medications are an important cause of secondary hypertension (HTN) and use is increasing in US adults. Although stimulants are known to increase blood pressure (BP), a systematic approach to assess impact in individual patients is lacking. Further, treating HTN secondary to stimulant use may differ from treatment of essential HTN.

Objective:
To develop a protocol using ambulatory blood pressure monitoring (ABPM) to differentiate HTN secondary to stimulant use from essential HTN.

Methods:
We used ABPM to evaluate pre- and post-stimulant systolic blood pressure (SBP) and diastolic blood pressure (DBP) for patients referred to the BIDMC Hypertension Center. Patient charts were reviewed by a clinical pharmacist to ensure the safety of holding the stimulant medication and to determine the duration of action. Average daytime BP on day 1 (off stimulant) was compared to day 2 (on stimulant) to assess the impact of stimulant on BP. We defined normotension as BP <135/<85 on both days, sustained HTN as BP ≥135/≥85 on both days and stimulant-induced HTN as BP <135/<85 on Day 1 and ≥135/≥85 on Day 2. We also defined an increase of SBP≥10 and/or DBP≥ 5 while taking the stimulant as a clinically significant effect on BP.

Results:
Eleven patients were assessed (see Table). Four had sustained normotension, six had sustained HTN, and one had stimulant-induced HTN. In addition, four of the patients had a clinically significant increase in their BP while on a stimulant. Overall, average increase in SBP was 6.7 mmHg and average increase in DBP was 3.2 mmHg.

Conclusion:
This novel ABPM protocol was useful for differentiating secondary HTN from stimulant use from essential HTN.
Abstract P169: Change In Blood Pressure Level And Its Association With Cardiovascular Events In The Healthy Elderly: Findings From The Aspirin In Reducing Events In The Elderly Trial
Authors: Chowdhury Enayet K , Ernst Michael E , Nelson Mark R , Beilin Lawrence J , Margolis Karen L , Wolfe Rory , Tonkin Andrew , Woods Robyn , McNeil John J , Reid Christopher
Published: September 2020

Blood pressure (BP) increases with age and is a major risk factor for cardiovascular disease (CVD). We examined change in BP level over a median of 4.7 years in ASPirin in Reducing Events in the Elderly trial participants, and its association with CVD events. Participants with baseline and at least one in-trial BP measurement were included. Since CVD event can affect BP (before and after), participants having a non-fatal CVD event in between in-trial BP records were excluded. Participants were classified according to baseline BP level, irrespective of antihypertensive use, into three groups (A) normal (SBP<130 & DBP<80 mmHg), (B) elevated (SBP 130-139 and/or DBP 80-89) and (C) high (BP≥140/90). Thereafter, based on the average of their in-trial BP level, participants were again classified into three BP categories (i.e. normal /elevated /high). Cox proportional hazards regression was used to examine the association of CVD events with change in BP group in relation to their baseline. 17543 ASPREE participants were included in the analysis. At baseline, 26% had normal, 25% had elevated and 49% had high BP. Participants’ BP status during the trial period and its association with CVD events in relation to baseline BP category are summarized in the Figure. Among those with high BP at baseline, 60% remained with high BP, 28% moved down to elevated BP, and 11% moved to normal BP. Reduced CVD risk was observed among participants who reduced BP to elevated BP category from high BP during the trial period. However, no difference was observed in risk reduction among those achieving normal BP levels from baseline high BP. An increase in BP from normal category demonstrates a two times increase in CVD risk.
Abstract P173: Role Of Potassium Intake On Hypertensive Cardiovascular Damage In Apolipoproteine-deficient Mice Under Normal And High Salt Conditions
Authors: Yakoub Mina , Arifaj Denada , Argov Doron , Rahman Masudur , Temme Sebastian , Hering Lydia , Rump L Christian , Stegbauer Johannes
Published: September 2020

Reduced potassium (k+) intake has been linked to cardiovascular diseases. The underlying mechanisms remain unknown. Here, we investigate the effect of low (0%), normal (0.5%) and high K+ (5%) diet on the development of atherosclerosis and hypertensive cardiac damage. To induce atherosclerosis, apolipoprotein-deficient mice were infused with angiotensin (Ang) II (500ng/kg/min) for 28 days. Potassium treatment was initiated 2 weeks before Ang II infusion. Cardiac function was assessed by MRI. Levels of K+ in the serum and urine were significantly different between groups. The Ang II infused mice from the K+ low group had significantly higher atherosclerotic plaques in the aortic arch (21±3%) compared to K+ high (10±2%) and K+ normal (11±2%) groups. The atherosclerosis development was blood pressure independent since no differences in blood pressure between the groups were observed. Although heart to body-weight ratio did not differ between three groups, K+ low diet was associated with a lower ejection fraction rate and increased mRNA expression levels of cardiac ANP, BNP, collagen and fibronectin compared to the K+ normal and K+ high group. After Ang II infusion, assessment of aldosterone levels in urine showed significant higher aldosterone levels in the high K+ (214±72ng/24h) compared to normal K+ (26±6ng/24h) and low K+ (18±4ng/24h) groups. Aldosterone induced cardiovascular damage is known to be aggravated by sodium. To, evaluate whether high sodium diet unmask aldosterone mediated cardiovascular damage in the high K+ group, mice fed a high or normal K+ diet were additionally treated with high sodium (1% NaCl) in the drinking water. During Ang II treatment, high salt diet accelerated atherosclerosis in the aortic arch of both groups but no differences were observed between the high K+ high/high Na+ (41±7%) and normal K+/high Na+ (49±2%) group. In contrast, high K+/high Na+ group have significantly more severe cardiac hypertrophy compared to normal K+ high Na+ group (8.9±0.7 vs 6.4±0.7mg/g). These results were confirmed by MRI. K+ deficient diet induces atherosclerosis and cardiac damage during Ang II induced hypertension. K+ enriched diet exacerbates cardiac hypertrophy only under high Na+ conditions most likely in an aldosterone-dependent mechanism.
Abstract P175: A Twitter Analysis Of Hypertension And Allergies: Discordance Between Social Media Discussion And Disease Morbidity
Authors: Kim Elizabeth H , Henglin Mir , Rushakoff Joshua A , Ebinger Joseph E , Cheng Susan
Published: September 2020

Background:
Social media data may be used to shed light on how engaged the general public is in conversations surrounding elevated blood pressure (BP) as an important health problem.

Methods:
We gathered Twitter data from 1/1/2016 to 11/23/2019 using the ‘TweetScraper’ program (https://github.com/jonbakerfish/TweetScraper). We scraped tweets with content related to BP and, to generate comparator data, we similarly collected tweets related to allergies during the same time period. We then plotted the number of tweets over time (in days) for each health topic and compared the between-group frequency of tweets over time.

Results:
We observed that the frequency of tweets related to BP was consistently lower than that related to allergy, notwithstanding lower rates of allergy related tweets during the non-peak allergy seasons (
Figure
). The number of tweets related to BP never exceeded those related to allergy, per month, but there were single day anomalies: BP tweets exceeded allergy tweets by 78% on 11/13/2017 and by 96% on 11/14/2027, following the release of updated hypertension guidelines.

Conclusions:
We demonstrate both the feasibility and utility of using social media data to assess the general public’s interest level in certain health topics over time. We found persistently lower levels of engagement around elevated BP (asymptomatic but conferring high mortality risk) compared to allergies (symptomatic but conferring low mortality risk) despite their similarly wide prevalence. As popular social media methods of communication evolve, so will the challenges and opportunities related to harnessing these data as part of efforts to improve public health.
Abstract P176: Metabolic Side Effects Of Systemic Corticosteroids - A Systematic Review
Authors: Kulkarni Spoorthy , Durham Hannah , Glover Luke , Cousens Leslie , Blomgran Parmis , Ather Osaid , Ambery Philip
Published: September 2020

Introduction:
Metabolic adverse events associated with corticosteroid therapy (CT) are seen as a necessary evil in the management of a wide variety of inflammatory conditions. Evidence on the burden of dysglycaemia associated with CT strategies is mostly based on case- control studies. The aim of this study was to quantify metabolic side effects of systemic steroids as reported in randomised clinical trials (RCT).

Methods:
We searched Medline, Embase, Cochrane Library, Web of Science and Scopus for studies reporting adverse effects of CT in trials since database inception to 13/01/2020. We used a standardised data extraction form to collect information from eligible studies using predefined inclusion and exclusion criteria. Cochrane risk of bias tool 2 (ROB2) was used to assess risk of bias in the RCTs. The study was registered prospectively with PROSPERO (CRD42020161270).

Results:
The search identified 5446 studies. In total 120 blinded studies were identified for the mixed method review of AEs. There was significant heterogeneity with respect to steroid dose, treatment duration, condition treated, exclusion criteria in the studies, data collection methods for adverse events (AE) and definition for specific AEs. A significant increase in cases of new onset diabetes, hyperglycaemia, episodes of rise in blood pressure (BP) was noted. Average adverse event rate for new onset of diabetes in the studies (N=21, 27 CT arms) was 4.8% (72 events in 1477 participants, range: 0.85%-18.75%). Event rate of hyperglycaemia in the CT arms was 11.8% approximately (53 CT arms, 222 events in 1854 participants, range: 2.5%-69%). Rise in BP was reported in 53 CT arms in 42 studies, with average event rate of 12.8% (160 events in 1251 participants, range: 0.94%-30.4%). Other significant AEs associated with steroid use included weight gain, dyslipidaemia, insomnia, infections, osteoporosis and fractures.

Conclusions:
Risk of new onset diabetes and worsening of diabetes control is significant in patients treated with CT, although available evidence to estimate risk is heterogenous. Both, alternatives to corticosteroids which do not elevate blood glucose and accurate estimation of risk of dysglycaemia from well-designed prospective RCTs are urgently required.
Abstract P177: Treatment Of Resistant Hypertension In Hypertrophic Cardiomyopathy And Left Ventricular Outflow Tract Obstruction
Authors: Morris Sean M , Laffin Luke J
Published: September 2020

Background:
Lowering blood pressure (BP) in patients with resistant hypertension (RH) is challenging. When RH co-exists with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction, nuanced management is required. Diuretics and medications with vasodilating effects are commonly used for the treatment of hypertension; however they can worsen LVOT obstruction, leading to harm in patients with HCM. There is limited data for the treatment of RH in this patient population.

Methods:
Seven patients were referred to a RH clinic with uncontrolled BP and HCM with LVOT obstruction. Antihypertensive medications and BP were assessed at initial (T
0
) and follow up (T
1
) visits. Change in LVOT gradients - both at rest and provoked - were reviewed from echocardiographic data before and after adjustment of medications.

Results:
Medication regimens were personalized to eliminate dihydropyridine calcium-channel antagonists and renin-angiotensin system antagonists. When required, they were dosed once nightly. Beta blocker and non-dihydropyridine calcium channel antagonist dosages were optimized. Thiazides were prescribed at lowest dose possible and spironolactone was used in the majority of patients (Table 1). Patients experienced an average reduction of 21 mmHg in office systolic BP (4 - 57 mmHg) and 15 mmHg reduction in diastolic BP (3- 39 mmHg). LVOT gradient at rest decreased by an average of 23.8 mmHg, while provoked gradient decreased by 23 mmHg.

Conclusions:
Improved BP control and lower LVOT gradients were observed among HCM patients with RH through personalized adjustment of their medication regimen.
Abstract P183: Human Blood Pressure On Low- Or High-sodium Intake Is Associated With Divergent Changes Of Serum And Urine Metabolites
Authors: Pan Xiaoqing , Katz Jonathan , Liu Pengyuan , Usa Kristie , Tian Zhongmin , Liang Mingyu
Published: September 2020

Intermediary metabolism, including renal metabolism, is increasingly recognized as an important contributor to the regulation of blood pressure and the development of hypertension, a leading risk factor for disease burden worldwide. Dietary salt intake has significant effects on blood pressure. We test the hypothesis that human blood pressure on low- or high-sodium intake is associated with divergent changes of serum and urinary metabolites. A gas chromatography and mass spectrometry analysis of 192 serum samples from the Dietary Approaches to Stop Hypertension 2 (DASH2 or DASH-Sodium) trial detected 384 metabolites and identified 116. Serum levels of citraconic acid, 1-monostearin and serotonin were associated with systolic or diastolic blood pressure on low- or high-sodium intake after adjustment for covariates (FDR < 0.05). Serum levels of 2-ketoisocaproic acid, glyceric acid, 1-monostearin, ornithine, and β-aminoisobutyric acid were associated with blood pressure differences between low- and high-sodium intakes (FDR < 0.05). An integrated analysis of 33 amino compounds and tricarboxylic acid cycle intermediates indicated that serum and urinary levels were not significantly correlated (FDR < 0.05) for the majority of these metabolites. Blood pressure appeared to be associated with serum, but not urinary, levels of leucine and cystine and urinary, but not serum, levels of β-aminoisobutyric acid. These novel findings support a role for several serum metabolites and renal handling of metabolites in the regulation of human blood pressure on low- or high-sodium intake.
Abstract P184: Sex Differences In Hypertension Associated With Tobacco And Electronic Cigarette Use
Authors: Vindhyal Mohinder Reddy , Ablah Elizabeth , Okut Hayrettin , Ndunda Paul M , Kallail K James , Choi Won
Published: September 2020

Introduction:
Hypertension is one of the leading cardiovascular risk factors, with a prevalence of almost 875 million individuals worldwide. Hypertension prevalence is higher among men than women until after menopause. No studies have determined a relationship between hypertension and the use of electronic cigarettes (E-Cig). This study sought to determine the relationship and sex differences in hypertension associated with tobacco and E-Cigarette use

Methods:
National Health Interview Survey Data from the years 2014, 2016, 2017, and 2018 were analyzed. Multivariate logistic regression analyses with Fisher’s Scoring iterative algorithm determined the covariate-adjusted and weighted odds ratios of clinical cardiovascular outcomes (i.e., hypertension) and their potential association with the use of tobacco or e-cigarettes by sex after controlling for age and body mass index (BMI).

Results:
A total of 121,705 participants completed the survey and met inclusion criteria, of which 66,762 were female users, and 54,943 were male users. Female e-cigarette users were 2.23 times more likely (95% CI:1.29 - 3.86, P < 0.05) to report hypertension than those who never used cigarettes or e-cigarettes. Female cigarette smokers were 1.63 times more likely (95% CI:1.32 - 2.01, P < 0.05), and male cigarette smokers were 1.34 times more likely (95% CI:1.12 -1.60, P < 0.05) to report hypertension than those who never used cigarettes or e-cigarettes. Female and male dual users (of E-Cig and tobacco) had similar odds of 1.40 (95% CI:1.08 -1.83, P < 0.05), and 1.41 (95% CI: 1.13 - 1.77, P < 0.05) to report hypertension than those who never smoked.

Discussion:
The findings from this study suggest that females reporting current e-cigarette use had the highest odds of reporting hypertension, followed by female tobacco smokers. Both male and female dual users had a similar risk of hypertension.
Abstract P185: Using Electronic Health Records To Identify Patients With Apparent Treatment Resistant Hypertension
Authors: Solanki Priyanka , Ajmal Imran , Ding Xiruo , Cohen Jordana , Cohen Debbie , Herman Daniel
Published: September 2020

Introduction:
Apparent treatment resistant hypertension (aTRH) affects 10-20% of hypertensive adults and increases risk of cardiovascular events and mortality. Fewer than half of these patients have true resistant hypertension. The majority experience pseudo-resistant hypertension due to inadequate medication adherence, white coat hypertension, and secondary causes of hypertension. We hypothesize that electronic health records can be leveraged to identify aTRH patients who would benefit from targeted counseling, medication reconciliation, and screening for secondary causes of hypertension.

Methods:
We studied electronic health record (EHR) data from 395 hypertensive adults in our primary care population who received longitudinal care between 2007 and 2017. Patients who met the 2008 AHA definition of resistant hypertension by chart review were considered to have aTRH. We also included 100 patients identified by heuristics targeting secondary hypertension. We extracted from the EHR demographics, vitals, laboratory results, diagnosis codes, and medications. Results outside of physiologic range were excluded and median imputation was used to handle missing data. Random forest model performance was assessed by 5-fold cross validation. Model discrimination was evaluated at an estimated positive predictive value of 75%.

Results:
The prevalence of aTRH in our randomly selected and full cohorts was 20.3% (n=295) and 25.8% (n=395), respectively. In cross-validation, the random forest model demonstrated a median sensitivity of 65% (IQR: 60% - 65%) and a median AUROC of 0.92 (IQR: 0.90 - 0.92). The most influential variables were related to the prescription of three or more hypertension medications; number of days on diuretics, angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers; systolic blood pressure measurements; and hypertension or diabetes diagnosis codes.

Conclusion:
EHR data can be used to accurately identify patients with aTRH. We expect the implementation of a clinical decision support system leveraging such models could lead to the improved care for aTRH patients.
Abstract P190: Antihypertensive Monotherapy And Risk Of Depression Incidence
Authors: Alnakhli Anwar , Shaw Richard , Smith Daniel , Padmanabhan Sandosh
Published: September 2020

Background:
Recent theory suggests that antihypertensive medications may be useful as repurposed treatments for mood disorders, however, empirical evidence is inconsistent

Objective:
We aimed to assess the risk of depression incidence as indicated by first-ever prescription of antidepressant in patients newly exposed to antihypertensive monotherapy and whether there is a dose-response relationship.

Method:
This study enrolled 2406 new users of antihypertensive monotherapy aged between 18 and 80 years with no previous history of antidepressant prescriptions. The exposure period (EP) to antihypertensive medication was fixed at one year starting from the first date of antihypertensive prescription between Jan 2005 and Mar 2012 and extended up to 12 months. Follow-up commence after the EP until March 2013. To test for dose-response relationship the cumulative defined daily dose (cDDD) of antihypertensive during the EP were stratified into tertiles. Cox proportional hazards models were used to estimate hazard ratios (HR) for depression incidence.

Results:
Among the five major classes of antihypertensive medications, calcium channel blocker (CCB) had the highest risk of developing depression after adjusting for covariates (HR = 1.40 95%CI 1.11,1.78) compared to angiotensin-converting enzyme inhibitor (ACEI). Angiotensin-receptor blocker (ARB) treatment showed higher risk of depression incidence with tertile 2(HR= 1.46, 95%CI 0.88,2.44) and tertile 3 (HR= 1.75, 95%CI 1.03,2.97) compared to tertile 1 of cDDD.

Conclusion:
Our findings confirmed previous evidence suggesting that CCB is associated with increased risk of depression incidence compared to ACEI. Risk of developing depression is also linked to ARB, though it might be dose dependent.
Abstract P194: Compliance With 2017 AAP Guidelines For Childhood Hypertension: Diagnosis And Management Of Pediatric Hypertension
Authors: Burke Brendan J , Liu Wei , Worley Sarah , Bou Matar Raed N
Published: September 2020

Background:
Hypertension (HTN) is an important modifiable risk factor for cardiovascular disease that is becoming more prevalent in children. HTN in children is historically under-diagnosed (23-26%).

Objective:
Our objective was to evaluate the rate of recognition and compliant management of childhood HTN in the primary care setting based upon the latest 2017 AAP Guidelines.

Methods:
A single-center retrospective chart review was conducted of pediatric well-child encounters over a period of 12 months (March 2018 - April 2019). Children aged 3 to 17 years and those 1 to 2 years of age with risk factors for HTN were included in the study.

Results:
A total of 100,512 well-child encounters were included in the analysis. 69.3% had blood pressure (BP) screening during the encounter. Of those, 9.9% were classified as elevated, 7.6% as stage 1, 0.6% as stage 2, and 0.02% as severe HTN. In a representative subgroup of children with elevated BP or higher (n = 200), a proper diagnosis was documented in only 3 patients (1.5%). The documented plan of care was fully consistent with the 2017 AAP guidelines in only 1 patient (0.5%). In another subgroup of patients with 3 sequential elevated BPs (or higher) (n = 100), a proper diagnosis was documented in 12 patients (12%). The plan of care was partially consistent with the 2017 AAP guidelines in 9 patients (9%) and completely compliant in 1 patient (1%). Rates of compliance by age, weight, BP class, and presence of risk factors for HTN are summarized in Figure 1.

Conclusions:
HTN remains under-recognized in the pediatric population. In this primary-care single-center cohort of children with elevated BP, the latest guidelines were not commonly followed.
Abstract P195: Prevalence, Awareness, Treatment And Control Of Hypertension In Awareness Campaigns
Authors: Bareta Sironi Brenda , Komagome Bruno Jun , Bueno Junior Carlos Roberto , Seixas da Silva Carol Esli , Carnaval Chitolina Felipe , Barbosa de Oliveira Joanna , de Lamare dos Santos Paula Luísa , Martins Prizão Vitoria , Passos Okawa Rogério Toshiro
Published: September 2020

Introduction:
Hypertension is a major cause of death and cardiovascular disease. In Brazil , hypertension heart disease is responsible for 14% of all cardiovascular deaths. Hypertension awareness campaigns are an initiative aimed at raising awareness of high blood pressure, as measurement of blood pressure is a cheap, simple and noninvasive technique to detect hypertension. The awareness of hypertension, and its treatment and control could avoid many deaths and disabilities.

Objective:
The objective is to describe hypertension prevalence, awareness, treatment and control in a population in MaringÅ, Southern Brazil, during hypertension awareness campaigns.

Methods:
Cross- sectional analysis from five hypertension awareness campaigns where 1495 participants were included. Blood pressure was measured by an automated electronic device, two readings were taken and recorded, with 1 minute between readings. Hypertension was defined as an average over 140/90 mmHg, and controlled as those with BP under 140/90 mmHg.

Results:
1495 individuals were screened, mean age was 54 years, 58% ( 868 of 1495) were female. Mean SBP was 128,8 mmHg and mean DBP was 78,9 mmHg.Hypertension prevalence was 37,9% ( 567 of 1495), 61,9% (926 of 1495) were aware of hypertension diagnosis, and 64 % ( 363 of 567) were receiving treatment. Only 33,4% (122 of 363 ) of patients receiving medical treatment had their blood pressure controlled.

Conclusion:
Hypertension prevalence was high, but blood pressure control was low in this population, and 36 % ( 204 of 567) were unaware of their hypertension, demonstrating the importance of hypertension awareness campaigns.
Abstract P200: Oscillometric Ambulatory Blood Pressure Monitors Are Prone To Clinically & Statistically Significant Errors When Tested In A Controlled Laboratory Setting
Authors: Lombardi V. P , Reichhold Patrick C , Cramer Jennifer L , Harkness Hannah P , DeBell Natalie J , Dietz Nicholas R , Krus Tova J , Lutz Savannah S , Pate Donald L
Published: September 2020

Purpose:
To compare the accuracy & level of agreement of Oscar 2 & Spacelabs 90207 ABPMs with 2 observers (O1O2) using an Hg column & ThinkLabs digital stethoscope.

Methods:
O1O2 measured simultaneous same arm Hg column BPs & ABPMs assessed simultaneous opposite arm BPs in triplicate in 17 seated subjects (7 ♀, 10 ♂). Supine, seated & standing BPs were measured using non-dominant relaxed arms in 12 subjects.

Hypotheses:
ABPM & O1O2 BPs would differ clinically & statistically with accuracy based on posture because ABPM proprietary equations are derived from seated BPs & use peak cuff pressure to estimate systolic (SBP) & diastolic (DBP) pressures.

Results:
For seated subjects, the Oscar overestimated O1O2 SBP by ~ 10 mm Hg (Δ = -9.8 ± 9.4 mm Hg, P < 0.001), but with extreme variability as 95% of Oscar SBPs were 9.0 mm Hg below to 28.7 mm Hg above O1O2. The Spacelabs overestimated O1O2 SBP by ~ 5 mm Hg (Δ = -5.2 ± 7.8 mm Hg, P < 0.001) with 95% of Spacelabs SBPs 10.5 mm Hg below to 20.9 mm Hg above O1O2. There was a stepwise increase in the Oscars’ SBP overestimation of Hg column BPs from supine (-3.1 mm Hg, P < 0.01), to seated (-5.3 mm Hg, P < 0.001) to standing (-6.6 mm Hg, P < 0.01). The Oscar overestimated supine (-7.0 mm Hg, P < 0.001), but underestimated standing (3.9 mm Hg, P < 0.05) DBPs. The Spacelabs also overestimated supine (-6.5 mm Hg, P
<
0.001), but underestimated standing (4.8 mm Hg, P < 0.01) DBPs.

Conclusions:
Our results confirm that leading oscillometric ABPMs are prone to clinically & statistically significant errors even in a controlled lab setting. Given that ABPMs are motion intolerant & unable to assess & adjust for a patient’s posture, errors will be compounded during 24-hr field testing. Results will vary based on the ABPM & postural %s assumed by each patient. International & national ABPM testing protocols must be strengthened & require postural testing as an essential component of validation.