bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P320: Influence of Diabetes Mellitus on the Prevalence of Atrial Fibrillation in Patients With Diastolic Dysfunction in a Large Community Practice in Greenville, South Carolina
Authors: Saxena Naveen R , Srivastava Vinita , Saxena Juhi , Saxena Anju
Published: December 2018

Atrial Fibrillation and diastolic dysfunction causes adverse cardiovascular events. Review of medical literature shows prevalence of atrial fibrillation in diastolic dysfunction in the range of 8% to 24%. The aim of this study is to examine the influence of diabetes on the prevalence of atrial fibrillation in patients with diastolic dysfunction in a large community practice. This is a retrospective chart review of patients with diastolic heart disease and atrial fibrillation from 2013 to 2018. All patients underwent 2D color Doppler studies for the evaluation of diastolic dysfunction using American Society of Echocardiography criteria. E wave velocity, A wave velocity, E to A ratios, and deceleration time were measured. Patients with systolic heart disease and valvular heart disease were excluded from the study. Atrial Fibrillation was diagnosed using EKG and Holter Recording. The age distribution of the patients included in the study ranged from 50 to 75 years of age with a mean of 65. There were 1,047 patients with diastolic dysfunction and 93 patients had atrial fibrillation. There were 472 patients with diastolic dysfunction with diabetes and 575 patients with diastolic dysfunction without Diabetes. There were 569 females and 478 males in the study. The prevalence of atrial fibrillation in diastolic dysfunction with diabetes was 11%. The prevalence of atrial fibrillation in diastolic dysfunction without Diabetes was 7.1%. Given the data, we conclude that the presence of Diabetes increases the prevalence of atrial fibrillation in diastolic dysfunction.
Abstract P324: Role of GABAergic Signaling in AgRP Neurons in the Dipsogenic and Metabolic Responses to Brain Angiotensin
Authors: Morselli Lisa L , Deng Guorui , Pearson Nicole A , Grobe Justin L
Published: December 2018

Obesity is a major risk factor for development of hypertension, and evidence supports a role for the suppression of resting metabolic rate (RMR) in the development and maintenance of obesity. Angiotensin II (ANG) AT1A receptors, localized to cells expressing the leptin receptor and Agouti-related peptide (AgRP) within the arcuate nucleus of the hypothalamus (ARC), are involved in transcriptional control of
AgRP
and γ-aminobutyric acid (GABA) synthetic genes (
Gad65
,
Gad67
,
Slc32a1
) within the ARC, as well as the integrative control of thermogenic sympathetic nerve activity (SNA) and RMR responses in vivo to various stimuli including leptin and high fat diet. These data led us to hypothesize that AT1A functions to suppress GABA signaling in AgRP neurons, ultimately to disinhibit SNA and RMR. Treatment of cultured mouse hypothalamic N43/5 cells (which express endogenous
Agtr1a
,
AgRP
and
Gad67
) with 100 nM ANG for 1 hour (n=6) resulted in reduced
AgRP
(0.57-fold of control, p=0.03) and
Gad67
(0.72-fold of control, p=0.09) mRNA. Mice with targeted disruption of
Slc32a1
(vesicular GABA transporter; VGAT) in AgRP neurons (VGAT
AgRP-KO
mice) were generated on a mixed background. Compared to littermates (male n=9-17, female n=7-8), VGAT
AgRP-KO
mice (male n=8-13, female n=2-3) at 8 weeks of age exhibited normal body mass (genotype p=ns, sex p<0.05, interaction p=ns), no changes in food intake (genotype p=ns, sex p=ns, interaction p=ns), but a sex-dependent genotype effect on fluid intake was observed (male con 4.5±0.3 vs KO 5.1±0.4; fem con 5.1±0.4 vs KO 3.7±0.6 mL/d; interaction p<0.05). A preliminary study of male mice instrumented for chronic infusion of ANG (5 ng/hr, 21 days icv) was also performed. This caused modest increases in drinking (con+aCSF n=7, 3.3±0.8, con+ANG n=4, 5.2±1.0, KO+ANG n=3, 7.9±1.1 mL/d, p<0.05) but no change in energy efficiency (11.2±2.9, 11.3±3.5, 10.1±4.1 mg/kcal), indicating no change in energy expenditure, possibly due to the mixed background of this strain. We conclude that ANG acts at AgRP cells of the ARC to suppress GABA and AgRP signaling, and this contributes to energy and fluid homeostasis in a complex, strain- and sex-dependent manner.
Abstract P325: High-Fat Feeding Does not Alter the Sparse Sympathetic Nerve Density in Mesenteric Resistance Artery Perivascular Adipose Tissue in Male Sprague-Dawley Rats
Authors: Jackson William F , Fink Gregory D , Watts Stephanie W
Published: December 2018

Chemical signals from perivascular adipose tissue (PVAT) modulate the structure and function of blood vessels. This may be partially under sympathetic neural control, however, little is known about the density of sympathetic innervation of PVAT. We hypothesized sympathetic nerve (SN) density in PVAT surrounding mesenteric resistance arteries (MRAs) is similar to that in the adventitia of the MRAs, and that high-fat feeding (HFF, 16 weeks) would decrease the density of SNs on MRAs and in PVAT. To test these hypotheses, we labeled SNs on MRAs and in PVAT with rabbit anti-tyrosine hydroxylase (TH) antibodies/AlexaFluor488-conjugated donkey-anti-rabbit antibodies, ex vivo. TH staining density (fraction occupied by TH-labeled structures) was computed from thresholded, background subtracted, maximum intensity z-projections of image stacks. TH staining density was higher at the surface of MRAs (0.21±0.03, n = 14) than within PVAT (0.013±0.003, n = 42, p<0.0001, Fig. 1 - arrows point to TH-positive nerves). HFF increased PVAT adipocyte diameter from 39±0.5μm (n=672) to 72±0.6μm (n = 365, p<0.0001). However, HFF had no effect on TH staining density on MRAs or within PVAT (p=0.83). Thus, while MRA’s are robustly innervated by SNs, only the first layer of adipocytes adjacent to MRA adventitia is exposed to a similar SN density; SN density in PVAT more than one adipocyte away from MRAs is >16 fold lower. HFF does not affect SN density on MRAs or in PVAT. However, given the larger size of adipocytes in HFF rats, this may mean an increase in SN density/adipocyte. Nonetheless, the low density of SNs in mesenteric PVAT suggests limited direct SN control of PVAT function in the bulk of PVAT adipocytes.
Abstract P338: Aging and Inhibition of Nox1/4 Modulate Perivascular Inflammation in Spontaneous Hypertension
Authors: Nosalski Ryszard , Mikolajczyk Tomasz , Siedlinski Mateusz , Maciag Joanna , Guzik Tomasz
Published: December 2018

Introduction:
Hypertension is associated with enhanced oxidative stress and perivascular inflammation. Although, that aging and oxidative stress are major factors in the development of hypertension their effect on perivascular inflammation remains unclear.

Methods:
Using flow cytometry we studied leukocytes infiltrating perivascular adipose tissue (PVAT) in 1-, 3-, 6- and 12-month-old SHR (Spontaneously Hypertensive Rats) and normotensive WKY (Wistar-Kyoto) rats. Additionally, 1-month-old rats were treated with GKT137831 (60mg/kg) or ML171 (NOX1/4 and NOX1 inhibitor, respectively) for 4 weeks. Blood pressure (PB) was measured by the tail cuff.

Results:
Aging in SHRs was associated with elevation of BP (139±4 vs 180±4 vs 202±2 vs 208±2 mmHg; 1 vs 3 vs 6 vs 12-month-old, respectively) when this effect was not seen in WKY rats. While the total number of leukocytes infiltrating PVAT were comparable between 1-month-old WKY and SHR (p=0.8) aging escalated their numbers only in SHRs (2096±164 vs 1994±296 vs 2311±470 vs 3255±408 cell/mg; p
int
<0.001). Similar effect was observed among NK cells (p
int
<0.001) and macrophages (p
int
<0.001). Moreover, spontaneous hypertension was associated with 2-fold elevation of T cells residing in PVAT in comparison to WKY, however, aging did not affect their number in both groups. While the age-related increase of Nox4 mRNA was observed in both groups, this increase was more dynamic in SHRs, (p
int
<0.05). Furthermore, 5-, 6- and 9-fold induction of Nox1 mRNA was observed in the vessels of 3-, 6- and 12-months-old SHRs, respectively (p<0.01). GKT137831 treatment significantly increased BP (p<0.01, 2way ANOVA) in both WKY and SHR (150±2 vs 164±3 mmHg, 198±4 vs 209±3 mmHg, respectively). This was accompanied by elevation of the total number of leukocytes (988±180 vs 1471±88 cell/mg, 1487±945 vs 1878±164 cell/mg) and macrophages (107±14 vs. 153±14 cell/mg, 228±26 vs. 298±42) in PVAT of WKYs and SHRs treated with GKT137831. On the contrary, ML171 treatment protected against increased accumulation of CD45+ cells in PVAT, without affecting BP.

Conclusions:
Aging in spontaneous hypertension is associated with elevation of BP and aggravation of perivascular inflammation which are hastened after NOX1/4 inhibitor treatment.
Abstract P345: The Cost-Effectiveness of Home BP Telemonitoring in Patients With a Cerebrovascular Event
Authors: Padwal Raj , Wood Peter , So Helen , Klarenbach Scott
Published: December 2018

Background:
Home BP telemonitoring, with pharmacist case management, leads to clinically important BP reductions. Our objective was to determine the incremental cost-effectiveness of this intervention compared with usual care BP control in patients with cerebrovascular disease in Alberta, Canada.

Methods:
A cost-utility analysis using a Markov decision model was created, examining a cohort of high-risk patients with a recent cerebrovascular event residing in their own residence. A lifetime time horizon and health care payer perspective was used. Achieved BP and risk of future cardiovascular events (recurrent stroke, myocardial infarction, unstable angina, or death) were modelled, with attendant consequences on quality adjusted life years and costs. BP telemonitoring was assumed to occur monthly until BP was controlled, then quarterly. Canadian life tables were used to determine overall mortality, adjusted by CVD mortality. Relative efficacy on intervention-associated BP lowering were obtained from published data. Reduction in BP of 9.7/5.1 mmHg at 12-months was used in the base case. Resource use and costs were obtained from Canadian published literature.

Results:
Telemonitoring with case management led to net health care savings of $2326, and an additional 0.83 QALYs (see Table). Results were robust in sensitivity analysis (see Table).

Conclusion:
Home BP telemonitoring and pharmacist case management was a dominant strategy, as it lowered costs and improved QALYs, and should be implemented.
Abstract P347: How Did Another 30% of Americans Develop High Blood Pressure Overnight? An Analysis of the New AHA/ACC Blood Pressure Guidelines and Their Impact in Communities Across the Country
Authors: Siddiqui Khan , Goglia Ross , Wiley Nikole , Neems Daniel
Published: December 2018

According to data from retail blood pressure kiosks, almost one-third of Americans just moved into the hypertensive category, roughly doubling its size. National costs of hypertension treatment were already estimated at $40-50B, so understanding the detailed impact of this development is important for healthcare providers, payors, and policymakers alike. We leverage the 42,614,330 blood pressure readings that took place across the national network of 11K+ higi health kiosks in 2017 to study the effect of the new guidelines on both macro and micro (i.e. zip code) levels, and within sub-populations of interest. We find that new blood pressure guidelines do not impact all states, or all communities within a given metro area, equally. (It’s also not the case that size of impact positively correlates with rate of high blood pressure under the old guidelines - i.e. healthy populations often see greater impact.) Furthermore, the guidelines affect certain cohorts of patients differently than others. This study identifies the communities and cohorts that pose the blood pressure greatest risk post-2017.
Abstract P348: Evaluation of Check. Change. Control. in the Asian American & Pacific Islander Community
Authors: Lee Cevadne , Oh Sang-Mi
Published: December 2018

Background:
Heart Disease is the #1 cause of death and stroke is #3 for Asian Americans and Pacific Islanders (AAPI) 65 years and older. Approx. 21% of deaths among certain AAPIs are due to high blood pressure (HBP). In response, the Western States Affiliate (WSA)-American Heart Association (AHA) adapted our evidence-based self-monitoring community program to reduce and control HBP with AAPI senior citizens. Blood pressure (BP) awareness, treatment and control remains suboptimal among US adults with hypertension.

Objectives:
We evaluated the efficacy, acceptability, and cultural relevancy among Chinese, Korean, Vietnamese, Pacific Islander older adults in California and Washington.

Methods:
We collaborated with 4 community-based AAPI organizations and recruited 800+ AAPI senior citizens. We used a multi-pronged evaluation approach including pre and post surveys to determine existing lifestyle partners and readiness to change, health assessments to identify risk factors, monthly self-monitoring blood readings, and aggregated biometric data to demonstrate progress towards control and HBP reduction.

Results:
At baseline, more than 30% of participants experienced high blood pressure. There were significant reductions in both SBP and DBP overall and especially among those with elevated BP at baseline. SBP drop changes varied by site and by ethnic group from baseline to final visit. Each site implemented adapted self- monitoring program for cultural relevancy and readiness level.

Conclusion:
Adapting our self-monitoring program had a significant impact in reducing BP for AAPI participants, especially among those with elevated BP at baseline. Further study is needed across multiple sites and AAPI ethnicities.
Abstract P349: Establishing Correction Factors for Oscar and SpaceLabs 90207 Oscillometric Ambulatory Blood Pressure Monitors
Authors: Lombardi Vincent P , Reichhold Patrick C , Dietz Nicholas R , DeBell Natalie J , Pate Donald L
Published: December 2018

Purpose and Background:
To obtain a more accurate picture of diurnal variations in blood pressure (BP), we establish correction factors based on differences between mercury (Hg) column & 24-hr ambulatory blood pressure (ABPM) measurements in the lab. In normotensives, hypertensives & alcoholics, an
auscultatory
ABPM underestimated diastolic BP (DBP) & misclassified DBPs in > 75% of cases. Our goal was to explore
oscillometric
ABPMs accuracy & reliability.

Methods:
In the lab, simultaneous opposite arm BPs by the Oscar 2 and SpaceLabs 90207 ABPMs & simultaneous same arm BPs by observers (O1, O2) using a ThinkLabs digital electronic stethoscope with ambient noise reduction, were obtained in 5 subjects seated with arms at the phlebostatic axis. Postural tests included simultaneous, same arm Hg BPs by two observers & 45 sequential recordings by each ABPMs (SBP range 92-183; DBP range 30-124 mm Hg).

Results:
Baseline SBPs for O1, O2, Oscar & SpaceLabs were 112.8 ± 22.3, 114.0 ± 23.4 (O1 - O2 Δ = - 1.2), 123.7 ± 23.4 & 119.0 ± 19.4 (Oscar - SpaceLabs Δ 4.7) mm Hg, respectively. The Oscar overestimated O1O2 SBPs by 10.3 mm Hg (P < 0.05). DBPs for O1, O2, Oscar & SpaceLabs were 61.7 ± 22.2, 62.4 ± 22.4 (O1 - O2 Δ = -0.7), 66.5 ± 16.6 & 67.4 ± 15.7 (Oscar - SpaceLabs Δ -0.9) mm Hg, respectively. From postural tests, average SBP/DBP correction factors were -4.5/-3.2 mm Hg for the Oscar and -1.3/-2.4 mm Hg for the SpaceLabs, but with extreme variation from -25 to +16 mm Hg based on supine, seated, standing and normotensive vs. hypertensive conditions. The Oscar significantly (P <0.01) overestimated SpaceLabs 24-hr SBP (154 ± 11 vs 146 ± 10, Δ = 8 mm Hg) in a hypertensive, but overestimations were less pronounced for 24-hr DBP (101 ± 9 vs 98 ± 8, Δ 3 mm Hg). In a normotensive, SBP & DBP corrections for 24-hr ABPMs were less clinically significant, except during sleep.

Conclusions:
Our results though limited, indicate that recordings obtained may depend entirely upon the ABPM selected and the BP range and postures assumed by the subject over 24 hr, demanding further investigation and assessment of postural BPs. Unless correction factors are developed on an individual basis and subjects happen to match the population from which oscillometric nomograms were developed, the accuracy of 24-hr ABPMs should be questioned.
Abstract P351: Improving the Management of Hypertension for Adults: The Impact of Home Blood Pressure Monitoring and Lessons Learned from a System-Level Hypertension Control Initiative
Authors: Champion Roy R , Rice Zachary , Rouf Emran
Published: December 2018

Purpose:
To examine the effects of a pragmatic HBPM program on improving HTN control.

Methods:
SWHP commercial and Medicare members 18-85 y/o with persistently uncontrolled HTN were given a free home BP monitor and related educational tools to effective engage in and document HBPM via 3 separate cohorts: • Provider distribution during an office visit • Based on medical record reviews, mailed to the patient with PCP’s permission • Patient’s request at various health fairs Using the office-based BP readings in the EHR, we calculated the change in BP control for each subsequent visit and end of year.

Results:
From Sept 2016 through May 2017, with no undue burden placed on providers or their staff, 2550 members received the tools necessary to engage in HBPM. By the 3
rd
office visit, 66.79% [±3.7%; 95% CI] achieved office-based BP readings of less than 140/90 mmHg. It was also noted that by the 3
rd
office visit many providers were able to reduce the patient’s medications and still maintain control. The retrospective review, like that of previous studies, found HTN control rates continued to climb with 79.03% (78.18%-88.57%) [± 3.7%; 95%CI] achieving HTN control per HEDIS 2018 standards. The average sustained change in BP control was an 18.3 mmHg (11.9-19.0 mmHg) reduction in SBP and a 7.0 mmHg (4.2-9.5 mmHg) reduction in DBP. It is also worth noting 72.6% (71.1-77.14%) [± 3.7%; 95%CI] achieved HTN control per the new AHA/ACC guidelines.

Conclusions:
Clinical guidelines recommend HBPM to evaluate and treat HTN. Our HTN Control Initiative supports a multi-modality approach as being cost-effective and sets the groundwork for further QI efforts to better discern each process regarding the use of HBPM.
Abstract P357: A Pharmacy-Based Software as a Service (SaaS) Approach Improved Medication Adherence of Hypertensive Patients
Authors: Li Yingjie , Chen Ying , Li Dongxing , Wang Zhen , Zhang Hongguang , Liu Kai
Published: December 2018

Objective:
To enhance medication adherence of hypertensive patients by connecting them to a cloud healthcare knowledge platform which was synchronized to the pharmacy Enterprise Resource Planning (ERP) system.

Methods:
A cloud engine was developed to house a continuously growing knowledge database of 6,000 drugs. This database consisted of 5 different categories of text messages to provide educational materials for each drug’s 1) indication and dosage, 2) precautions and side effects, 3) relevant disease information, 4) relevant lab test interpretation, and 5) medication reminders. This cloud solution was offered as SaaS by connecting to pharmacies’ ERP, thus to identify the patients each time when they filled prescriptions within the drug store, triggering auto-sent text messages at dosage-adjusted intervals to the patients. During the past 12 months, 18,362 patients at 937 pharmacies in 13 cities in China received this intervention and medication adherence was measured by Proportion of Days Covered (PDC).

Results:
The study population demonstrated an improved overall PDC from 51.4% at baseline to 61.7% at last time, P<0.001. We further analyzed PDC changes by medications of use and intervention durations (Table 1 A&B), and found a cross-board enhancement of PDC even though a gradual reducing trend of PDC seemed to appear over time.

Conclusion:
The pharmacy SaaS offered an efficient way to auto-deliver text knowledge tailored to each prescription, leading to increased medication adherence of hypertensive patients.
Abstract P363: Risk Factors Associated With Uncontrolled Hypertension in Low Income Jordanians
Authors: Shara Mohd , Zayadeen Samar
Published: December 2018

Background:
Hypertension (HTN) is one of the most important modifiable and contributing factors to stroke, cardiovascular and renal disease. Globally, HTN control remains inadequate, with about half attaining BP goal. This study evaluated potential risk factors associated with uncontrolled HTN in a low income population managed by the ministry of health (MOH) which provides coverage for the vast majority of Jordan’s population.

Methods:
All subjects (400) in this multi-center, cross-sectional study, were recruited at MOH primary care clinics, were using the same HTN medication regimen for a minimum of 6 months and were all initiated on HTN therapy under JNC-7 guidelines. BP control was assessed based on JNC 7 and 8 guidelines. In addition, obesity, diabetes, metabolic syndrome (MetS), medication regimens and adherence, fat/salt intake, fasting blood glucose, lipids, leptin, adiponectin, hs-CRP and plasminogen activator inhibitor-1 (PAI-1) were examined for association with HTN control:

Results:
Less than half (178 of 400) of subjects BP was controlled per JNC 7, whereas 67% (268 of 400) were controlled based on JNC 8. Nearly 60% (238 of 400) were diabetic; a DM diagnosis was significantly (p<0.05) associated (2.5 fold higher vs non-diabetic) with uncontrolled HTN. Most subjects (93%, 371 of 400) were obese and 90% (360 of 400) met the International Diabetes Federation (IDF) and ATP-III criteria for MetS. Of the biomarkers examined, abnormal levels of PAI-1, adiponectine and hs-CRP were significantly associated with presence of MetS. MetS was associated with a 2.5 and 3.5 fold increase in the odds of having uncontrolled BP based on IDF and ATP-III criteria respectively. Elevated fasting blood sugar was also significantly associated with inadequate BP control.

Conclusions:
While some of this study’s findings such as the association with DM and MetS are in agreement with the literature, often reported patient-behavior risk factors such as medication adherence was not. Although HTN control is suboptimal in this population, it is higher than the previously reported national rate (45% vs 39%). This difference may be explained by the higher medication adherence (64%) observed in this population compared with previous national studies (43%).
Abstract P369: Non-Adherence to Antihypertensive Medications is Associated with Higher BP and Anxiety Levels.
Authors: El Hachem Maria , Siddiqui Mohammed , Thomas Stephen J , Dudenbostel Tanja , Valaiyapathi Badhma , Judd Eric , Patel Prashanth , Gupta Pankaj , Tomaszewski Maciej , Oparil Suzanne , Calhoun David A
Published: December 2018

Background:
Anxiety has been linked to higher blood pressure (BP) levels and a higher incidence of cardiovascular outcomes. Anxiety is also associated with antihypertensive medication non-adherence assessed indirectly by questionnaires, pill counts or pharmacy refill rates. In this study, we determine the association between anxiety and antihypertensive medication adherence measured directly by high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS).

Methods:
In this prospective study, 237 patients were recruited from the Hypertension Clinic at the University of Alabama at Birmingham. The State-Trait Anxiety Inventory (STAI) questionnaire, 24-hr urine collection for HP LC-MS/MS and 24-hour ambulatory blood pressure monitoring (ABPM) were done in all subjects as part of the study protocol. Patients who did not complete a 24-hr urine collection and/or an STAI questionnaire were excluded from the analysis.

Results:
Of the 180 patients included in the study, 137 participants were found to be adherent (taking all antihypertensive medications) (76%) and 43 patients were non-adherent to antihypertensive medications (24%). Group comparison using t-test revealed higher state (p=0.043) and trait (p=0.044) anxiety scores and higher ambulatory blood pressure levels (p<0.001) among non-adherent compared to adherent patients (Table 1).

Conclusion:
This is the first prospective study to demonstrate a strong association between antihypertensive medication adherence, higher anxiety levels and poorly controlled hypertension. These findings highlight the importance of a multidisciplinary approach in the management of hypertensive patients.
Abstract P372: The Effect of Periodic Fasting on Patients With Hypertension and Metabolic Syndrome
Authors: Balogh Andras , Steckhan Nico , Forslund Sofia K , Wilck Nicola , Hamad Ibrahim , Avery Ellen G , Šušnjar Urša , Hohmann Christoph , Strowig Till , Dechend Ralf , Kleinewietfeld Markus , Michalsen Andreas , Mueller Dominik N
Published: December 2018

Periodic fasting may serve as therapeutic strategy for the management of hypertension and metabolic syndrome. We hypothesize that fasting affects the gut microbiome and promotes immune cell homeostasis resulting in lower blood pressure. Patients suffering from metabolic syndrome and hypertension were randomized either to 7-day periodic fasting combined with lifestyle change or Dietary Approaches to Stop Hypertension (DASH) intervention. Data derived from clinical parameters, 16S sequencing of the gut microbiome and immunophenotyping were collected at baseline, at day 7 and 3 months post intervention. At baseline, 21 out 30 patients in the fasting and 23 out of 31 in the DASH group had elevated systolic office blood pressure (SBP >130 mmHg), which dropped significantly by 10 mmHg after fasting, and remained lower 3 months post intervention (7 mmHg). In the DASH group, SBP significantly decreased by 12 mmHg after 1 week and 8 mmHg after 3 months. At 3 months post intervention, 24-h ABPM confirmed the decrease in fasting, but not in DASH. Fasting, but not DASH significantly reduced body weight and BMI after 7 days compared to baseline, and this effect persisted for 3 months post-intervention. Furthermore, 50 % (15/30) of patients in fasting and 23 % (7/31) in DASH were able to decrease their use of medications for treatment of metabolic syndrome. Spearman correlation tests showed that fasting, but not DASH, altered the gut microbiome. After fasting
Bacteroides
,
Lachnoclostridium
,
Coprococcus
, and
Ruminococcus
Operational Taxonomic Units (OTUs) decreased, while the
Eubacterium rectale
OTU increased. In contrast to DASH, fasting significantly reduced the frequency of CD4+ Th17 cells, active CD69+ mucosa-associated invariant T cells (MAIT) and IFNg+IL-2+ or TNFa+ MAITs indicating the anti-inflammatory effect of fasting. While some of these changes reverted to baseline after 3 months, several persisted. Despite a similar decrease in office SBP in both study arms, the periodic fasting intervention is more beneficial in reducing body weight and BMI compared to baseline. Fasting altered the prevalence of certain gut microbes and influenced immune cell signatures whereas DASH did not, suggesting a distinct role of fasting for improving cardiometabolic health.
Abstract P373: Design for a Pragmatic Trial Comparing Telehealth Care and Clinic-Based Care for Uncontrolled High Blood Pressure
Authors: Margolis Karen L , Bergdall Anna R , Crain A L , O'Connor Patrick J , Solberg Leif I , Beran MarySue , Ziegenfuss Jeanette Y , Green Beverly B , Pawloski Pamala A , Rehrauer Daniel J , Appana Deepika , Sharma Rashmi , Norton Christine K , Haugen Patricia , Sperl-Hillen JoAnn M
Published: December 2018

The 2017 ACC/AHA hypertension guideline strongly recommends systematic follow-up and monitoring of treatment using team-based care and telehealth, based on Level A evidence. However, different models for organizing team-based care and telehealth have not been compared. We describe the design of a PCORI-funded pragmatic trial with the following objectives: Aim 1) compare the effects on BP and patient-reported outcomes of two models of team-based care for uncontrolled hypertension, and Aim 2) study how the two models are carried out in the real-world setting of a large health system. The study is a 5-year cluster-randomized trial in 2000 patients age 18-85 with uncontrolled hypertension cared for in 21 primary care clinics at HealthPartners, a large integrated healthcare system in the Twin Cities area of Minnesota and western Wisconsin. Clinic-based care uses recommended best practices and face-to-face visits primarily with physicians, nurses and medical assistants. The telehealth care approach adapts a research-tested model with systematic use of home BP telemonitoring and home-based telehealth care coordinated by a clinical pharmacist or nurse practitioner. Patients in both groups are recruited directly from primary care clinics using electronic health record (EHR) prompts. Exclusions are few: pregnancy, advanced kidney disease, hospice care, and nursing home residence. The primary outcomes for Aim 1 are:1) change in BP over 12 months, and 2) change in patient-reported outcomes over six months, including treatment side effects, experiences with hypertension care, self-monitoring rates, and confidence in self-care. Secondary outcomes include other heart- and stroke-related risk factors and safety. Patients contributed extensively to the selection of the outcomes. Outcomes are collected over 24 months without reliance on research visits: patient-reported outcomes are measured by surveys and BP and other clinical outcomes are measured using routinely collected data documented in the EHR. We also use EHR data supplemented by qualitative data to assess how the two care models are carried out in practice. The results of this comparative effectiveness trial will assess pragmatic methods for implementing hypertension guideline recommendations.
Abstract P381: Deletion of Na
+
/H
+
Exchanger 3 Selectively in the Proximal Tubule of the Kidney Augments Acute and Chronic Natriuretic Responses to Saline Volume Expansion in Mice
Authors: Li Xiao C , Soleimani Manoocher , Nugyen Hoang T , Zhuo Jia L
Published: December 2018

The Na
+
/H
+
exchanger 3 (NHE3), a ~85 kDa protein encoded by the
SLC9A3
gene, plays a key role in mediating Na
+
reabsorption in the proximal tubule of the kidney and in maintaining blood pressure homeostasis. In the present study, we tested the hypothesis that deletion of NHE3 selectively in the proximal tubule of the kidney, but not globally, augments acute and chronic natriuretic responses to saline volume expansion in mice. Adult male wildtype (

Nhe3
+/+

), global NHE3 knockout (

Nhe3
-/-

) and proximal tubule-specific NHE3 knockout mice (PT-

Nhe3
-/-

) (n=8-13/group) were subject to acute saline administration of 10% body wt., i.p., or a 2% high salt diet for 2 weeks to determine and compare acute or chronic natriuretic responses. In response to 10% acute saline volume expansion, urinary Na
+
excretion increased 6.5 fold from basal 18.9 ± 5.0 μmol/3h to 122.2 ± 7.7 μmol/3h in wildtype mice (
p
<0.01). By comparison, urinary Na
+
excretion increased 8.4 fold from basal 26.2 ± 3.9 μmol/3h to 206.5 ± 5.7 μmol/3h in PT-

Nhe3
-/-

mice (
p
<0.01), whereas the natriuretic response increased 4.8 fold in

Nhe3
-/-

mice (
p
<0.01). The differences in the natriuretic responses to acute saline expansion between

Nhe3
+/+

,

Nhe3
-/-

and PT-
Nhe3
-/-
mice were statistically significant (
p
<0.01). However, the diuretic response to acute water volume expansion (10% of body wt., i.p.) was not different between

Nhe3
+/+

and PT-
Nhe3
-/-
mice (
n.s.
). In response to 2% NaCl diet for 2 weeks, 24 h urinary Na
+
excretion increased 19% in

Nhe3
+/+

mice (
n.s.
), whereas the natriuretic response increased 43% in PT-

Nhe3
-/-

mice (
p
<0.01). Interestingly, the natriuretic responses to 2% high salt diet were greater in adult female wildtype (Δ66%,
p
<0.01) and PT-

Nhe3
-/-

mice (Δ62%,
p
<0.01), respectively. By contrast, the natriuretic response to 2% high salt diet was significantly attenuated in global

Nhe3
-/-

mice (
p
<0.01). These data suggest that the deletion of NHE3 selectively in the proximal tubule of the kidney, but not globally, augments the natriuretic responses to acute or chronic saline volume expansion in PT-
Nhe3
-/-
mice.
Abstract P386: Effects of Saccharina Japonica Intake on Blood Pressure in 2-Kidney, 1-Clip Renovascular Hypertensive Rats fed a High-Sodium Diet
Authors: Maruyama Saki , Segawa Yukiko , Hashimoto Hiroko , Osera Tomoko , Kurihara Nobutaka
Published: December 2018

Objective:
One of foods to Japanese cuisine “Washoku” is algae, including Saccharina japonica (SJ). The intake of SJ is reported to decrease blood pressure (BP) in spontaneously hypertensive rats in some studies, and in 2-kidney, 1-clip hypertensive (2K1C) rats in our studies. Water soluble-alginate is rich in SJ. Since alginate has a physiological function to suppress sodium absorption in the gastrointestinal tract, SJ intake may alleviate hypertension to the extent according to the salt intake in 2K1C rats. In the present study, we observed the effects of SJ intake on BP in 2K1C rats fed a normal-sodium (NS) or high-sodium (HS) diet.

Methods:
Male Sprague-Dawley rats (6 wks) were treated with sham operation (SHAM) or clipping the left renal artery (2K1C). After surgery, the rats started receiving a NS (0.7% NaCl) or HS diet (6.0% NaCl), with or without 5.0% (w/w) SJ for 6 consecutive weeks. Systolic BP (SBP) was measured by a tail-cuff method every week. At the end of the protocol, mean arterial pressure (MAP) was measured in each rat under anesthesia.

Results and Discussion:
Analysis of variance showed that SBP was significantly higher in 2K1C-NS-CTL than in SHAM-NS-CTL through the experiment period (P<0.001, Fig), and that SBP was higher in 2K1C-HS-CTL than in 2K1C-NS-CTL (P<0.05). It also demonstrated that 2K1C-HS-SJ provided a significant reduction in SBP compared with 2K1C-HS-CTL (P<0.05), while there were no significant differences in SBP between 2K1C-NS-CTL and 2K1C-NS-SJ. At the end of the protocol, MAP showed the similar trend to SBP. These results suggested that the intake of SJ decreases BP, probably by suppressing sodium absorption in 2K1C rats.
Abstract P387: Sub-Perception Transdermal Vagal Stimulation in Postural Tachycardia Syndrome
Authors: Diedrich André , Okamoto Luis , Black Bonnie , Hale Misty D , Biaggioni Italo
Published: December 2018

Postural Tachycardia Syndrome (POTS) is a clinical syndrome characterized by an excessive increase in heart rate (>= 30 bpm) on standing in the absence of orthostatic hypotension, and frequent orthostatic symptoms for more than 6 months. While most researchers focus on the hyperadrenergic features of POTS, these patients also have significant cardio-vagal (parasympathetic) impairment. We tested the hypothesis that transdermal electrical stimulation of the auricular branch of the vagus nerve will enhance cardio-vagal modulation, reduce heart rate, upright symptoms, and improve orthostatic tolerance. We studied 14 patients with POTS (31.5+/-11.7 years, BMI 22.6+/-3.9 kg/m
2
). Sham or sub-perception threshold transdermal electrical vagal stimulation was applied in random order to the auricular branch in the right ear in supine and during graded tilt maneuver. Patients with low vagal modulation (low high frequency HF < 200 ms
2
) responded to vagal stimulation (Kruskal Wallis p=0.01, n=7, Fig left) with significant increase in HF power (eg @50Hz: +51+/-10 ms
2
, p=0.0032). Vagal stimulation during upright tilt tended to reduce orthostatic tachycardia and overall orthostatic symptom score. It improved significantly tilt time (+5.3+/-2.6 min, p=0.0156, Fig right). Patients with higher baseline vagal modulation (HF >= 200 ms
2
) did not respond to vagal stimulation (interaction p=0.41). This proof of concept study indicates that auricular transdermal vagal stimulation improves supine cardio-vagal function in POTS patients with low vagal modulation. Further research will determine if this approach can be used therapeutically, alone or in combination with other therapies.
Abstract P400: Screening for Hypertension Using Retinal Vascular Calibre in Ultra-Widefield Fundus Imaging
Authors: Robertson Gavin , Fleming Alan , Williams Michelle C , Trucco Emanuele , Quinn Nicola , Hogg Ruth E , McKay Gareth J , Pellegrini Enrico , Newby David E , van Beek Edwin J , Peto Tunde , Dhillon Baljean , van Hemert Jano , MacGillivray Tom
Published: December 2018

Fundus images from the left eyes of 440 subjects aged 50-59 years enrolled in the Northern Ireland Cohort of Longitudinal Ageing were analyzed. Subjects were categorized as normotensive or hypertensive, according to thresholds on systolic/diastolic blood pressure measurement (140/90 mm Hg) averaged over two sitting measurements in a clinical setting. A fully automatic system to analyze each image used conventional and deep neural network machine learning techniques to locate retinal landmarks and detect, classify and measure retinal vessels. From this data, a measure of the arteriolar-venular ratio (AVR) in the peripheral retina was calculated. Semi-automatic analysis was also performed. Results are presented in Table 1. Subjects had mean age of 54.6 ± 2.9 years; 56.1% (247 of 440) females, with 34.3% (151 of 440) subjects categorized as hypertensive. Narrower arterioles and smaller AVR were observed in subjects with hypertension. This was also observed in fully-automated analysis, however 4% (17 of 440) subjects failed to be processed by the system. In fully-automated analysis the area under a receiver operator characteristic curve of AVR for hypertensive status was 0.69 (95% CI, 0.63 to 0.74).

Table 1 - Results for semi-automated and automated analysis of retinal vessel parameters. *p<0.005

Automated measurement of AVR in ultra-widefield fundus imaging was associated with hypertension. With further development, such as evaluation against diagnosis of hypertension obtained from ambulatory blood pressure monitoring clinics, this system could become a test for undiagnosed hypertension in people attending routine eye health check-ups.
Abstract P401: The Difference in Improvement of Kidney Function Between Febuxostat and Topiroxostat in Hypertensive Patients
Authors: Tezuka Yuta , Satoh Fumitoshi , Omata Kei , Ono Yoshikiyo , Morimoto Ryo , Kudo Masataka , Igarashi Yasuhiro , Ito Sadayoshi
Published: December 2018

Introduction:
Control of uric acid level (UA) plays an important role in the protection of organs in patients with hypertension (HTN). Newly developed xanthine oxidase inhibitors, febuxostat (FBX) and topiroxostat (TPX) are expected to lead to more reduction of organ damages. However, the effects of them in a clinical situation remain unclear. We hypothesized these drugs have different effects based on the difference in action mechanism.

Objective:
To reveal the effects of FBX and TPX on clinical parameters and compare them between the drugs.

Method:
We retrospectively collected stable HTN patients with hyperuricemia (HU) who newly received a prescription of FBX or TPX and continued at least 12 weeks. Those who had other uric acid-lowering drugs or severe proteinuria were excluded. Participants were divided into FBX and TPX groups matched for age and sex.

Result:
The almost baseline characteristics were not significantly different between both groups except the usage of renin-angiotensin inhibitors (Table). Administration of FBX or TPX lowered UA significantly (p<0.0001). Contrary to previous reports, blood pressure and urinary albumin-to-creatinine ratio were not significantly changed between both groups. However, eGFR in only TPX group was significantly increased from 57.2 ±15.0 to 60.6 ±15.7 mL/min/1.73m
2
(p=0.006), while FBX group was not. In TPX group, there was no significant difference in change of eGFR between patients using high and low amount of TPX.

Conclusion:
Our current study revealed TPX, not FBX, could improve eGFR in HTN patients. Moreover, the effect seemed to be independent of the amount of TPX. TPX could be 1st-line choice in HTN patients with HU.
Syndesmis patagonica n. sp. (Rhabdocoela: Umagillidae) from the sea urchin Arbacia dufresnii (Echinodermata: Echinoidea) in Patagonia, Argentina
Authors: BROGGER MARTÍN I. , IVANOV VERÓNICA A.
Published: December 2018

The umagillid Syndesmis patagonica n. sp. is described from the intestinal tract of the sea urchin Arbacia dufresnii, which represents a new host record for the genus. The hosts were collected from the coast of Patagonia (Argentina), and S. patagonica n. sp. is the first species of Syndesmis reported from South America. Syndesmis patagonica n. sp. can be distinguished from all other species in the genus by the possession of a stylet that is extremely short (less than 50 µm long), and a combination of other characters including the position of the testes, body size, body color and host. An updated overview of the distribution of all species of Syndesmis is also presented.
One new species and three newly recorded species of the genus Exaeretia Stainton, 1849 (Lepidoptera: Elachistidae: Depressariinae) from China
Authors: LIU SHURONG , WANG SHUXIA
Published: December 2018

Four species of the genus Exaeretia Stainton are recorded from China. Exaeretia liupanshana sp. nov. from Mt. Liupan, Ningxia Huizu Autonomous Region is described as new. Exaeretia lechriosema (Meyrick), E. indubitatella (Hannemann) and E. ciniflonella (Lienig & Zeller) are newly recorded for China. Photographs of the adults and genital structures are provided.
A review of the genus Hadrodemius Wood, with new synonymy and a key to species (Coleoptera: Curculionidae: Scolytinae)
Authors: BEAVER ROGER A.
Published: December 2018

The eight species included by Wood and Bright (1992) in the Palaeotropical scolytine genus Hadrodemius Wood are reviewed. The following new synonymy is proposed: Hadrodemius comans (Sampson) (= Xyleborus amorphus Eggers syn.n., = Xyleborus metacomans Eggers syn.n.), Hadrodemius globus (Blandford) (= Xyleborus tomentosus Eggers syn.n.), Hadrodemius pseudocomans (Eggers) (= Xyleborus artecomans Schedl syn.n.). Hadrodemius (Xyleborus) pubifer (Schedl) is transferred to the genus Coptodryas Wood. Xyleborus melli Schedl is misplaced by Wood & Bright (1992) as a synonym of Hadrodemius amorphus and is here transferred to Xylosandrus Reitter. The following new synonymy is proposed: Xylosandrus amputatus (Blandford) (= Xyleborus melli Schedl syn.n.). A key to the females of the three species now included in the genus is provided. The taxonomy, distribution and biology of the species are briefly reviewed, and some new records included.
A new species of the rare caridean genus Bresilia Calman (Crustacea: Decapoda: Bresiliidae) from the Ryukyu Islands, Japan, representing a family new to the North Pacific marine fauna
Authors: KOMAI TOMOYUKI , YAMADA YUSUKE
Published: December 2018

A new species of the rare caridean genus Bresilia Calman, 1896, B. gibbosa, is described and illustrated on the basis of one ovigerous female and one male specimens collected from a shallow water marine cave in Okinawa Island, Ryukyu Islands, Japan. The new species is morphologically similar to B. antipodarum Bruce, 1990, B. briankensleyi Bruce, 2005, B. plumifera Bruce, 1990 and B. saldanhai Calado, Chevaldonné & dos Santos, 2004 in the strongly produced third abdominal tergite, the presence of a long epistomal process, and the presence of an exopodal flagellum on the first maxilliped, but is easily distinguished from all these allied species by the possession of movable spines in the dorsal rostral series and the angular, instead of spinose, pterygostomial margin of the carapace. This new species is the first representative of Bresiliidae from the North Pacific Ocean.
Type specimens of Chrysomelidae (Coleoptera) in the Academy of Natural Sciences in Philadelphia
Authors: STAINES C. L.
Published: December 2018

Type specimens of 88 species of Chrysomelidae are housed in the Academy of Natural History of Philadelphia collection5 holotypes, 60 syntypes, 13 paratypes, and 10 paralectotypes.
Scale insects (Hemiptera: Sternorrhyncha: Coccoidea) of the Krakatau Islands including species from adjacent Java
Authors: WILLIAMS DOUGLAS J. , MILLER DOUGLASS R.
Published: December 2018

In this paper we provide a list of all species of scale insects that have been collected in the Krakatau Islands since the catastrophic eruption of 1883. Included in the list are species collected during the La Trobe University Expedition in 1984 from the islands and from the adjacent mainland in Java and also species collected in earlier expeditions, including those during 1919–1933, discussed by Dammerman (1948). In addition, we describe two new species of armoured scales, Aulacaspis thorntoni Williams & Miller and Greeniella calophylli Williams & Miller and provide a key to the species of Greeniella Cockerell.
The genus Anastoechus Osten Sacken, 1877 (Diptera: Bombyliidae) from China, with descriptions of four new species
Authors: YAO GANG , YANG DING , EVENHUIS NEAL L.
Published: December 2018

Four new species of the genus Anastoechus from China are described and illustrated, namely: Anastoechus candidus sp. nov., Anastoechus fulvus sp. nov., Anastoechus turriformis sp. nov., and Anastoechus xuthus sp. nov., and six previously known species are redescribed and illustrated, namely: Anastoechus asiaticus Becker, Anastoechus aurecrinitus Yang & Du, Anastoechus chakanus Du et al., Anastoechus chinensis Paramonov, Anastoechus doulananus Du et al., Anastoechus neimongolanus Du & Yang. A key to the species of the genus Anastoechus from China is given.
Revision of Isoplenodia Prout, 1932 with new records from continental Africa (Lepidoptera: Geometridae, Sterrhinae)
Authors: SIHVONEN PASI , STAUDE HERMANN S.
Published: December 2018

Three new species of Isoplenodia Prout, 1932 are described and illustrated from continental Africa, expanding the taxonomic scope and known geographic distribution of this previously endemic, monotypic Madagascan genus of geometrid moths. The new species are: I. vidalensis Sihvonen & Staude sp. n., from eastern South Africa; I. kisubiensis Sihvonen & Staude sp. n., from southern Uganda; and I. arabukoensis Sihvonen & Staude sp. n., from southeastern Kenya, central Zimbabwe and southwestern Rwanda. The paucity of available data suggest that the African species may be associated with wet forest or marsh mosaic habitats. Adults and genitalia of all known Isoplenodia species are illustrated, and the systematic position of the genus in relation to other genera in the tribe Scopulini is discussed.
A new species of Tafalisca Walker, 1869 from the Iguaçu National Park, Brazil (Grylloidea, Eneopteridae, Tafaliscinae)
Authors: DIAS PEDRO GUILHERME B. S. , DE ASSIS G. DE MELLO FRANCISCO
Published: December 2018

The aim of this work was to describe a new cricket species from the Iguaçu National Park, Southeastern Brazil. We characterize the genitalia and external morphology of Tafalisca paranaensis n. sp. and the genitalia of Tafalisca paulista Rehn, 1918 providing a comparison between these species.
The genus Sakencyrtus Hayat (Hymenoptera: Chalcidoidea: Encyrtidae) from India with description of a new species
Authors: USMAN SYEDA UZMA , ZEYA SHAHID BIN
Published: December 2018

Indian species of the genus Sakencyrtus Hayat are reviewed and illustrated. A new species, Sakencyrtus bialbifuniculus sp. nov., is described. The two species known from India, S. mirus Hayat and S. albiclavus Hayat, are redescribed. The macropterous forms and males of S. mirus are described for the first time. An identification key to species is provided.