bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP17: Angiotensin II Inhibits Renin Secretion Directly By Eliciting Robust Calcium Oscillations In Juxtaglomerular Cells
Authors: Yamaguchi Hiroki , Guagliardo Nick , Medrano Silvia , Gomez Ariel , Sequeira Maria Luisa
Published: October 2024

Background:
Renin secretion from the juxtaglomerular (JG) cells controls circulating Angiotensin II (AngII), a critical blood pressure determinant. AngII is believed to suppress renin release from JG cells to prevent excessive blood pressure elevation. However, a direct negative feedback mechanism has yet to be established in JG cells. In JG cells, Ca
2+
is a crucial second messenger that governs renin secretion by suppressing cAMP, a potent renin secretion stimulator. Thus, in contrast to most secretory cells, renin secretion from JG cells is inversely related to the intracellular Ca
2+
level. However, the role of AngII in modulating JG cell Ca
2+
dynamics remains unclear.

Objective:
Define intracellular Ca
2+
responses to AngII and identify the critical channels to suppress renin secretion in JG cells.

Methods:
Kidney slices from mice expressing JG-specific GCaMP6f, a genetically encoded Ca
2+
indicator under the control of the

Ren1
c

promoter, were imaged
ex vivo
on a widefield fluorescent microscope for 30 min per experiment (n = 5). In each experiment, slices were continuously perfused with buffer containing variable Ca
2+
and AngII concentrations, ± specific Ca
2+
channel inhibitors. Images were captured at 10 Hz and analyzed using Mesmerize Ca
2+
imaging software to identify and plot fluorescent intensity over time for each JG cell. Additional kidney slices were incubated in 24-well plates with buffer containing vehicle or AngII ± Ca
2+
channel inhibitors for 30 min. ELISA determined renin concentration.

Results:
1) AngII dose-dependently evoked robust and periodic Ca
2+
-oscillations (Ca
2+
spikes) in JG cells (mean spikes/min; 50 pM: 5.4, 300 pM: 7.7, 3 nM: 13.2, and 300 nM: 17.6). 2) AngII-elicited Ca
2+
activity was markedly reduced with “Ca
2+
-free” buffer. 3) L-type voltage-dependent Ca
2+
channel (VDCC) blocker nifedipine moderately decreased AngII-elicited Ca
2+
spikes, while T-type VDCC blocker TTA-P2 did not. 4) Blocking endoplasmic reticulum (ER) Ca
2+
-release drastically reduced Ca
2+
activity. 5) AngII dose-dependently decreased renin secretion in kidney slices, congruent with the AngII-elicited Ca
2+
activity in imaging studies.

Conclusion:
AngII dose-dependently and directly elicited large, periodic Ca
2+
-oscillations in JG cells that suppressed renin release. Both extracellular Ca
2+
influx and intracellular Ca
2+
release from ER stores are required for sustained Ca
2+
activity. L-type, but not T-type, Ca
2+
channels participate in JG cell Ca
2+
-oscillations.
Abstract MP24: Relationship of Socioeconomic Position on Incident Hypertension-related Hospitalization and Blood Pressure Control among participants in the Coronary Artery Risk Development in Young Adults (CARDIA)
Authors: Ghazi Lama , Lewis Cora , Jaeger Byron , Kiefe Catarina , Foti Kathryn , Gabriel Kelley , Allen Norrina , Abdalla Marwah , Levy Phillip , Hardy Shakia , Muntner Paul
Published: October 2024

Background:
Hypertension hospitalization, defined as being admitted to the hospital with a primary diagnosis of hypertension, has been increasing among US adults. Individuals with low socioeconomic position have higher rates of uncontrolled blood pressure (BP). We evaluated the relationship of socioeconomic position on incident hypertension hospitalization and BP control rates following hospitalization.

Methods:
We analyzed data from CARDIA, a prospective cohort that enrolled 5,115 adults (2,637 self-identified Black and 2,478 White adults) 18 to 30 years old from 4 urban US areas in 1985-1986. Hypertension hospitalizations were ascertained by manual chart review over 34 years of annual follow-up. We compared the incidence rate of hypertension hospitalization and prevalence of uncontrolled BP, systolic/diastolic BP ≥140/90 mm Hg, at the study visit after hospitalization by socioeconomic position. Socioeconomic position included education, income, insurance status and neighborhood deprivation factor score at the last visit before hypertension hospitalization or last CARDIA visit attended for participants who were not hospitalized.

Results:
Overall, 67 CARDIA participants (1.3%) were hospitalized for hypertension. Participants hospitalized for hypertension had a median age of 47 years at time of hospitaliization, 51% were male, and 87% were Black. Among those hospitalized for hypertension, 12% had less than high school education, 44% had a family income < $25,000, 30% were on Medicaid or Medicare, and 58% lived in a socially deprived neighborhood. The risk of hypertension hospitalization was higher for participants with less education and who lived in more socially deprived neighborhoods (
Table 1
). At the first study visit following hospital discharge, 67% of participants had uncontrolled BP and there was no difference by socioeconomic position.

Conclusion:
The incidence rate of hypertension hospitalization was higher among people with low socioeconomic position. Uncontrolled BP was common following hypertension hospitalization.
Abstract P110: Analysis of Community-Level High Blood Pressure Awareness Efforts for Philadelphia's Unhoused Population
Authors: Parikh Manav , Krishnan Aravind , Yuan Aurora , Bream Kent , Potluri Vishnu
Published: October 2024

Introduction:
The University of Pennsylvania Shelter Health Outreach Program (SHOP) is a student-led community health initiative where volunteers go weekly to various sites around Philadelphia and take blood pressure (BP) for unhoused guests at no cost. The objective of the study is to estimate the prevalence of high BP among the unhoused population in Philadelphia and its association with various factors relating to health access.

Methods:
SHOP BP screening tables were set up at six food and housing sites once a week from September 2022 to December 2023. The study cohort included guests who voluntarily came to the tables for BP measurement. High BP was defined as having a single measurement systolic BP over 130 mmHg and/or having a diastolic blood pressure over 80 mmHg. BP results and responses to survey questions about health status and momentary social situation were stored in a secure cloud server. The data were analyzed using the R statistical software.

Results:
We surveyed 2,138 guests across the 6 sites. Among the guests who were surveyed, 73.6% had high BP and of these 65% of guests had at least stage 2 hypertension as defined by the American Heart Association Guidelines. In addition, a higher proportion of high BP was observed among guests who were returning to a SHOP table for a repeat screening after one or more weeks. A higher proportion of high BP was also observed for guests who reported having had a physical exam in the past year. At least one-third of the guests reported as returning to the screening site after having received a prior BP screening from a SHOP table.

Conclusions:
Our results show a high burden of hypertension, especially severe hypertension, in the unhoused population in Philadelphia. Although significant challenges exist to ascertain accurate BP readings at the community level, SHOP demonstrated relatively high retention. This model of BP screening represents a distinct opportunity to introduce community-based interventions to manage hypertension in such a highly disadvantaged population.
Abstract P118: Effect of renal denervation on the blood pressure and progression of diabetic kidney disease in T2DN rats
Authors: Xu Biyang , Lowe Melissa , Levchenko Vladislav , Klemens Christine , Banek Christopher , Staruschenko Alexander
Published: October 2024

Background:
As a common complication of diabetes, diabetic kidney disease (DKD) is a chronic progressive disorder that can lead to kidney failure, and it is currently the leading cause of kidney replacement therapy in the USA and worldwide. Although renal denervation (RDNx) has recently been approved by the FDA to treat hypertension, contradictory findings have been reported on the effect of RDNx on the blood pressure and progression of DKD in type 2 diabetic mellitus. Here, we used type 2 diabetic nephropathy (T2DN) rats, a well-established non-obese model that displays similar renal abnormalities and hyperglycemic levels as seen in humans, to evaluate the effect of RNDx on the blood pressure and progression of DKD.

Methods:
Bilateral RDNx or sham surgeries were performed on male T2DN rats with mild and severe stages of DN (~20 or >35 weeks old). The blood pressure was monitored chronically using radio telemetry throughout the entire experiment. 24-hr urine collection, glucose tolerance test, and GFR measurement were performed at baseline and at the end of the experiments. Blood and urine electrolytes were measured using a blood gas analyzer. The amount of norepinephrine in the kidney was evaluated by ELISA.

Results:
Bilateral RNDx were successfully performed on T2DN rats with a significant reduction of norepinephrine in the kidneys of the RDNx group (244±13 vs. 8±1 pg/mg for >35 weeks old rats). The mean arterial pressure (MAP) and heart rate remain the same between the Sham and RDNx groups. The glucose tolerance test also indicates no difference between the two groups. While there is a significant decrease in the GFR in Sham group from baseline to week 3, the GFRs between Sham and RDNx groups are not different. Similarly, total body weight, kidney to total body weight ratio, heart to total body weight ratio, and blood and urine electrolytes are also not different between Sham and RDNx groups. Analysis of the younger group (~20 weeks old) is in progress.

Conclusion:
In summary, our data suggests that RDNx does not affect the blood pressure and progression of DKD in male T2ND rats, at least at the stage of severe kidney injury (>35 weeks old).

Funding sources:
National Institute of Health R01 DK135644 and R01 DK129227, Department of Veterans Affairs I01 BX004024 (to AS), and APS Postdoctoral fellowship (to BX).
Abstract P128: Endothelial Nitric Oxide Determines Hematopoietic Cell Fate and Osteoclastogenesis By Modulating CSF1 During Hypertension
Authors: Hennen Elizabeth , Nyman Jeffry , Harrison David
Published: October 2024

Introduction:
Loss of endothelial nitric oxide (NO) is common in hypertension (HTN). The bone marrow niche contains endothelial cells; however, how endothelial NO affects hematopoiesis and bone in HTN remains undefined.

Hypothesis:
We hypothesized that NO loss in HTN drives hematopoiesis in the bone marrow, later favoring osteoclastogenesis and bone resorption.

Methods and Results:
By microcomputed tomography, eNOS deficient mice (eNOS
-/-
) had reduced femoral cortical area (Figure 1A) and trabecular bone volume fraction (Figure 1B) compared to wildtype mice (WT). Flow cytometry showed that granulocyte-monocyte (Figure 1C) and common lymphoid progenitors (Figure 1D) were markedly higher in eNOS
-/-
than in WT. mRNA analysis revealed loss of endothelial NO increased expression of cathepsin K (Ctsk), colony stimulating factor-1 receptor (CSF1R), and tartrate resistant acid phosphatase (TRAP) in the bone marrow. We exposed murine bone-marrow endothelial cells (BMECs) to 5% (normotension), 5% with L-NAME, or 10% (HTN) cyclic strain. Compared to 5% strain, BMECs exposed to L-NAME or 10% strain exhibited markedly increased CSF1 production, an essential cytokine for myelopoiesis and osteoclastogenesis (Figure 1E and F). In coculture experiments, we also found that macrophages cultured with BMECs undergoing 5% strain with L-NAME or 10% strain exhibited higher expression of Ctsk, CSF1R, and TRAP, indicating osteoclast formation.

Conclusion:
Endothelial NO likely inhibits osteoclastogenesis and bone resorption. The loss of NO through mechanical stretch or inhibiting eNOS increases CSF1 production and hematopoiesis. This shows a potential mechanism by which NO loss leads to pathological hematopoiesis and bone resorption during HTN.
Abstract P135: Evaluating the Impact of Cumulative Blood Pressure and Metabolic Indicators on Long-Term Cardiovascular Risk: Insights from a 9-year Nationwide Prospective Cohort Study
Authors: Chen An-Tian , Zhang Jian , Zhang Yuhui
Published: October 2024

Background:
Cardiovascular diseases (CVD) are a global health challenge, particularly for older adults. Blood pressure and the Triglyceride-Glucose (TyG) index, an insulin resistance indicator, are key predictors of cardiometabolic risks.

Methods:
Using data from the China Health and Retirement Longitudinal Study (CHARLS), this study followed participants without baseline CVD over 9 years. We stratified subjects by cumulative TyG and TyG-BMI indices, applying Cox proportional hazards adjusted by age and gender, and restricted cubic spline regression for CVD risk evaluation.

Results:
From 11,847 participants, 4,751 were analyzed, mainly females (55.25%), with a median age of 57. BMI, TyG, and TyG-BMI indices increased significantly (23.16 to 23.51 for BMI; 8.59 to 8.62 for TyG, 199.14 to 204.22 for TyG-BMI) over 4 years. Participants were categorized based on cumulative TyG and TyG-BMI medians at 25.84 and 606.43, respectively. In the lower TyG group, each SBP unit increment raised CVD risk by 0.5% at 4 years (HR = 1.005, 95% CI 1.003–1.007, p<0.001) and 9 years (HR = 1.005, 95% CI 1.004–1.006, p<0.001). Each 10-unit rise in cumulative DBP corresponded to an 8-9% higher CVD risk at the 4 and 9-year follow-ups. In the higher TyG group, SBP increases were significantly associated with CVD risk changes. Each 10-unit DBP rise corresponded to a non-significant 2% risk elevation at 4 years, but a significant 3% risk increase at 9 years (HR = 1.003, 95% CI 1.000–1.005, p=0.023). For those with a TyG-BMI below 606.43, minor SBP increases significantly impacted CVD risk at both 4 and 9 years. Meanwhile, each 10-unit DBP increment resulted in a 6-8% risk increase, which grew over time. Above a TyG-BMI of 606.43, SBP changes resulted in a notable 2% risk rise by 9 years, and 10-unit DBP increases resulted in a 2-3% risk rise by 9 years. Restricted cubic spline regression showed the 4 and 9-year CVD risk increased with each rise in cumulative SBP and DBP when cumulative TyG was <25.84 or cumulative TyG-BMI <606.43, and DBP had a more profound impact. In contrast, trends were unclear when cumulative TyG ≥25.84 or cumulative TyG-BMI ≥606.43.

Conclusion:
Cumulative SBP and DBP increases are linked to higher CVD risks, especially in individuals with lower cumulative TyG or TyG-BMI indices. DBP effects were more substantial, particularly noticeable over 9 years. This study underscores the nuanced impacts of blood pressure and metabolic indicators on long-term cardiovascular health.
Abstract P142: Cross Sex Steroid Therapy and Cardiac Function in a Rodent Model of Gender Affirming Hormone Therapy in the Male Rat.
Authors: Crudup Breland , Mallette Jordan , Nabors Harley , Willis Alex , Cockrell Kathy , Da Alexandre , Yanes Cardozo Licy , Alexander Barbara
Published: October 2024

Transgender females (
TGF
) are individuals born biologically male, but identify as female. Gender-Affirming Hormone Therapy (
GAHT
) consists of 17β-Estradiol (
E2
) supplementation with androgen suppression or a surgical intervention in order to match physical characteristics with perceived gender. Whether the prevalence of cardiovascular (
CV
) disease is enhanced in TGFs on GAHT is not clear. We previously reported that baseline cardiac morphology and function is not altered in a rat model of cross sex hormone therapy (
CSHT
) that mimics GAHT in the TGF. This study tested the hypothesis that myocardial ischemia will result in enhanced cardiac susceptibility in the male rat on CSHT. Adult male Sprague Dawley rats (13 weeks of age) were randomly assigned to either
Control
or
E2+CTX
; E2 at 5 mg/day, pellet sc, replaced every 3 weeks with castration (
CTX
) performed at 15 weeks of age. At 25 weeks of age, rats in each group were randomly subdivided into
Sham
(n=8) or myocardial ischemia/reperfusion (
MIR
)
,
1 hour occlusion, n=6-7.
Statistics:
Two-way ANOVA with Tukey’s post-hoc test. *Denotes significance vs. Control Sham.
Results
(
Table
): At 27 weeks of age, total lean mass (EchoMRI) was significantly decreased in Sham and I/R E2+CTX (p<0.05). At one week post I/R, stroke volume and cardiac output (echocardiogram, VEVO 3100) were significantly decreased in E2+CTX Sham vs. Control Sham (p<0.05); yet, ejection fraction, end-diastolic volume, and end-systolic volume did not differ. Thus, these data suggest that the biological effects of CSHT in the male does not enhance susceptibility to cardiac ischemia in young adulthood; yet, the long-term effect of CSHT on CV health remains unknown.
Abstract P144: Estrogen Worsens Kidney Function in Hypertensive Menopausal Rats
Authors: Leite Ana Paula , Petillo Hannah , Blessinger Sophia , Daniel Jill , Lindsey Sarah
Published: October 2024

Introduction:
Before menopause, women generally have lower rates of hypertension and cardiovascular events compared with men. After menopause, women lose significant cardiovascular and renal protection. Estrogen's effect on kidney function is controversial, with some studies showing protection and others, including ours, indicating long-term estrogen exposure causes renal damage. The relationship between estrogen, hypertension, and kidney function is still not fully understood.

Aim:
Our aim was to investigate the interaction between hypertension and menopause on kidney function and determine whether the timing of disease initiation, pre- or post-menopause, influences these effects.

Methods:
Female Long-Evans rats were ovariectomized at 46 weeks of age to simulate menopause and treated with estradiol (E2) or vehicle. Some groups were infused with angiotensin II (Ang; 700ng/kg/min), either 4 weeks before or at the time of ovariectomy. Blood pressure (BP), proteinuria, creatinine clearance, osmolality, glomerular (GLOM) area, GLOM collagen deposition, and GPER and ERα receptor by droplet digital PCR were assessed by two-way ANOVA.

Results:
BP was higher with Ang (P=0.003) but was not affected by E2 (P=0.85) or timing (P=0.49). E2 significantly increased kidney hypertrophy (P<0.001) independent of Ang (P=0.27), especially when hypertension was initiated at the time of menopause (P<0.001). Both E2 and Ang increased water intake and urine output (P<0.05), especially when hypertension was initiated at the time of menopause. Proteinuria, an indicator of renal damage, was significantly higher with E2 (P=0.03), Ang increased GLOM area (P<0.05) with no effect of E2. There was no change in the urinary osmolality due to either Ang or E2. GLOM collagen deposition was not different between groups. In the renal cortex, E2 decreased ERα mRNA (P<0.01), with no difference in GPER.

Conclusion:
Although E2 did not affect blood pressure, it worsened the impact of hypertension on kidney function, particularly when started at the time of ovariectomy. This may be due to decreased ERα in the cortex and likely unrelated to damage in the glomerulus.

Keywords:
Menopause, hypertension, renal damage
Abstract P156: Timing of Orthostatic Blood Pressure Changes is Associated with Orthostatic Symptoms in Very Old Adults: Findings from the ARIC Study.
Authors: Khan Md Marufuzzaman , Col Hannah , Larbi Fredrick , Patil Dhrumil , Zhang Mingyu , Turkson-Ocran Ruth-Alma , Ngo Long , Cluett Jennifer , Mukamal Kenneth , Coresh Joe , Selvin Elizabeth , Wagenknecht Lynne , Hughes Timothy , Windham B Gwen , Mosley Thomas , Lutsey Pamela , Ring Kimberly , Juraschek Stephen
Published: October 2024

Background:
The timing of orthostatic changes in blood pressure (BP) and their associations with orthostatic symptoms among very old adults is undercharacterized.

Objective:
To determine the prevalence of distinct orthostatic BP patterns and their relationships with orthostatic symptoms.

Methods:
We measured three supine and six standing BP readings (timed at 0, 1, 2, 3, 4, and 5 minutes after standing) among ARIC participants (2021-2023). OH patterns (primary, initial, early, delayed, and sustained) were based on when a drop in BP (systolic ≥20 or diastolic ≥10 mmHg) occurred (see
Figure
for definitions). We quantified OH prevalence overall and by anti-hypertensive medication use and determined the associations of OH patterns with orthostatic symptoms, both concurrent with positional change and in the prior 30-days via logistic regression adjusted for age, sex, and Black race.

Results:
Of 1,044 participants (58.8% female, 16.5% Black, mean age 83.9±3.7 years), 24.5% had primary OH. Initial and early OH were more common than sustained and delayed OH. Participants using any hypertension medications had a higher prevalence of most types of OH (
Panel 1
). Primary, early, and sustained OH were associated with orthostatic symptoms during the rise from supine to standing or when standing, while initial OH was associated with orthostatic symptoms only during the rise from supine to standing (
Panel 2
). Sustained OH was associated with higher odds of prior light-headedness or dizziness and early OH with higher odds of prior imbalance.

Conclusion:
Clinicians should consider timing of BP changes when screening for OH and evaluating its contribution to orthostatic symptoms among very old adults.
Abstract P183: Peripheral Blood Mononuclear Cells from Patients with Systemic Lupus Erythematosus Induce Inflammation and Salt Sensitivity of Blood Pressure in Humanized Mice
Authors: Saleem Mohammad , Ahmad Taseer , Haynes Alexandria , Albritton Claude , Arshad Suha , Kulapatana Phicharmon , Posey Olivia , Major Amy , Stein Charles , Ormseth Michelle , Kirabo Annet
Published: October 2024

Salt sensitivity of blood pressure (SSBP) is an independent risk factor for cardiovascular disease (CVD), even in normotensive people. Systemic lupus erythematosus (SLE) is also a risk factor for CVD and hypertension. SLE and CVD are on the rise, and it is not known if this is attributable to the increased dietary salt in the modern diet and SSBP. Isolevuglandins (IsoLGs) adduct self-proteins forming neoantigens in antigen-presenting cells (APC), activate T cells, and produce cytokines that promote sodium retention, kidney damage, SLE, and SSBP. We hypothesized the adoptive transfer of peripheral blood mononuclear cells (PBMCs) from patients with SLE into immunodeficient mice (NSG/MHCI/MHCII-/-) would increase inflammation and SSBP after high salt feeding. In vitro studies were performed using PBMCs from patients with SLE and treated with and without high salt, and myeloid cell activation and cytokine expression were measured with flow cytometry. We humanized mice with PBMCs from patients with SLE (n=7) and controls without autoimmune disease (n=7) in animal studies. The mice were fed a 4% high-salt diet for two weeks. Blood pressure was measured with radiotelemetry, immune phenotyping was performed with flow cytometry, and vascular reactivity was assessed in mesenteric arteries using wire myography. A high salt diet significantly increased systolic blood pressure in lupus mice compared to the controls (133.0 vs.116.4 mmHg, p=0.001). APC infiltration (macrophages, monocytes, dendritic cells), proinflammatory markers, and oxidative stress (Isolevuglandins, Nox2) were significantly higher in the kidneys of lupus mice. In lupus mice, classical monocyte and proinflammatory markers were significantly elevated in the spleen lymphocytes, and proinflammatory markers were increased in the kidney, spleen, and aorta in lupus mice. These mice also exhibited mesenteric artery vascular dysfunction (p<0.05). Lupus mice tended to excrete more urinary albumin than the controls (25.89 vs. 17.24 µg/ml p=0.142), suggesting kidney injury. High salt treatment in vitro increased intermediate and nonclassical monocytes with increased CD86, IsoLG, and TNF-alpha expression compared to normal salt-treated cells. In conclusion, our findings suggest that immune cells from patients with SLE, in response to high salt, increase SSBP and the proinflammatory milieu in the kidney, aorta, and spleen; impair vascular function; and worsen albuminuria in immunodeficient mice.
Abstract P186: Current practices and interest in mobile health among individuals with or at risk for hypertensive disorders of pregnancy
Authors: Denu Mawulorm , Tak Katherine , Shao Cassie , Singh Ganeev , Sadaniantz Katherine , Kovell Lara
Published: October 2024

Background:
The integration of smartphones, mobile health (mHealth) apps, and digital therapeutics into healthcare has transformed remote monitoring and patient-provider communication. Such technologies are currently underutilized, but could provide value to those in need of more frequent monitoring. Pregnant individuals with or at risk for hypertensive disorders of pregnancy (HDP) could potentially benefit from this technology.

Methods:
Pregnant individuals, ages 20-50, with a diagnosis of or risk factors for HDP, were recruited from a large academic medical center from June 2020 to January 2024 to complete an electronic survey. Data on sociodemographic variables, smartphone/wearable device use, health app and patient portal (MyChart) use, and interest in mHealth apps were collected. Statistical analysis was done using STATA/BE 18.0.

Results:
Of the 103 participants, the mean age was 31.9 (SD 5.5) years, 44.6% were Hispanic or Black, and 98.1% used smartphones (
Table
). Individuals over age 30 had lower smartphone use than those under 30 (p=0.04) and most with a smartphone had mhealth apps (64.4%). Interest in wearing a smartwatch for remote monitoring and communicating with providers via a secure mhealth app was high among participants (88.3% and 78.6% respectively). No significant differences in these interests were observed by race, age, and residence (urban/suburban vs. rural).

Conclusion:
Pregnant individuals with or at risk for HDP demonstrated high interest in using mhealth applications and smartwatches for communication with providers and remote monitoring. Effectively integrating these technologies into patient care may enhance access to and increased engagement with care among individuals with high-risk pregnancies.
Abstract P190: Blood pressure monitoring and knowledge in the first year after a hypertensive disorder of pregnancy
Authors: Cameron Natalie , Begna Hannah , Schwarz Eleanor
Published: October 2024

Introduction:
In the first year postpartum, hypertension (HTN) is a leading cause of morbidity and mortality, particularly for those with hypertensive disorders of pregnancy (HDP). Timely recognition of HTN is key to reducing short- and long-term cardiovascular risk among birthing people. Therefore, we assessed knowledge of when to seek medical attention for blood pressure (BP) elevations and rates of BP measurement in the first year postpartum among those with and without HDP.

Methods:
This was a secondary analysis of primiparas who participated in a randomized trial of prenatal counseling to improve postpartum health. We included 405 participants who self-reported information on postpartum BP assessment. We calculated (1) the proportion of participants who stated they would contact a clinician for a systolic BP above 140 and a diastolic BP above 90 at 3-months postpartum and (2) the frequency and location of BP checks reported from 3-12 months postpartum among those with and without HDP. Subgroup analyses compared BP knowledge by sociodemographic and health-related factors.

Results:
Participants were 32 +/-5 years, 16% reported a HDP, 60% identified as White, 75% had private insurance, and 84% had ≥ college education. For systolic BP, 44.6% with HDP and 23.5% without HDP identified a BP of 140 as the threshold above which they would contact a clinician (p<0.01); for diastolic BP, 52.4% with HDP and 28.5% without identified a BP threshold of 90 (p<0.01).From 3-12 months postpartum, 83.1% with HDP and 59.4% without HDP had a BP check (p < 0.01); 41.6% with HDP and 9.7 % without HDP checked their BP at home (p<0.01). Home monitoring was not associated with awareness of when to contact a physician for hypertension among those with HDP (TABLE). BP awareness was higher among people who had private health insurance, ≥ college education and were non-smokers.

Conclusions:
Efforts are needed to improve postpartum BP assessment, self-monitoring, and awareness of when to seek medical attention for HTN, among birthing people with and without HDP.
Abstract P200: Immune memory contributes to chronic hypertension recurrence
Authors: Deck Katherine , Liu Yunmeng , Mora Christoph , Guo Yunping , Rafferty Tonya , Benson Lance , Mu Shengyu
Published: October 2024

Keeping blood pressure under control is a challenge in hypertension treatment because high blood pressure quickly returns with a momentary lapse in treatment or a high-salt diet. We have previously reported the CD8+ T cells (CD8Ts) in the kidney can drive aberrant sodium handling to aggravate blood pressure. Recently, our new findings suggest that these CD8Ts remain long-term within the kidney.
Here, we propose these CD8Ts have developed into a resident memory (Trm) population with the aid of TGFβ signaling, and this residency continually aggravates and leads to the recurrence of hypertension
.

To explore this hypothesis, we utilized two mouse models of hypertension, including a classic DOCA-salt model and a novel Angiotensin II (Ang II) induced salt memory model, with continuous blood pressure monitored by radiotelemetry. In the Ang II-induced salt memory model, the mice were administered Ang II and high salt for a week before a resting period to restore normal blood pressure. Thereafter, the mice were given a second high salt challenge to model the high salt-driven recurrence of hypertension. Mouse strains include both wild-type (WT) and a T-cell specific TGFβRII KO (Tsp-TGFβR KO), which has T cells unable to develop into Trm due to the reliance of Trm on TGFβ signaling. T cells were analyzed with flow cytometry.

In the DOCA-salt model, WT mice developed a significant CD8Trm population within the kidney. In contrast, TSP-TGFβR KO mice, which lack the ability to develop Trm, had an attenuated development of hypertension with DOCA-salt treatment. Testing the capability for hypertension to recur, both WT and Tsp-TGFβR KO mice experienced a similar degree of hypertension with Ang II-salt treatment. However, only the WT had a significant expansion of Trm and demonstrated the clinical manifestation of recurring hypertension with the rapid increase of blood pressure with a high salt challenge. Isolating the T cells from the kidneys confirmed that the significant CD8Trm population development in the WT was not present in the Tsp-TGFβR KO.

In summary, our findings suggest that the memory T cell population developed in the kidney during hypertension instills a perpetual memory for salt sensitivity in hypertension. Without the ability to develop this memory population, mice are protected against this recurrence of high-salt-induced hypertension.
Abstract P210: IDENTIFICATION OF ALAMANDINE-(1-5) AS A NEW ANTI-HYPERTENSIVE PEPTIDE OF THE RENIN-ANGIOTENSIN SYSTEM
Authors: Ferraz Kamylle , Monteiro Adelson , Chaves Sthefanie , Barros Carolina , Soares Nicia , Campagnole-Santos Maria Jose , Santos Robson
Published: October 2024

It is currently accepted that angiotensin-(1-7) [Ang-(1-7)] and alamandine [Ala
1
-Ang-(1-7)] are members of the counterregulatory axis of the renin-angiotensin system (RAS). Both peptides can undergo hydrolysis by angiotensin-converting enzyme and form Ang-(1-5) and Alamandine-(1-5), respectively. Recently, we have shown that Alamandine-(1-5) is present in human and mice circulation. Here, we evaluated the cardiovascular effects induced by intravenous (i.v.) administration of these peptides in conscious normotensive Wistar (n=6 for each peptide) and spontaneously hypertensive rats (SHR) (n=6 for each peptide). After a period of one hour for stabilization of the cardiovascular parameters, Alamandine-(1-5) or Ang-(1-5) were injected at a dose of 3µg/ 100g of b.w. A similar volume (0.1 ml/ 100g b.w.) of sterile saline was injected into SHR and Wistar rats for control. Alamandine-(1-5) injection produced a progressive decrease in systolic blood pressure (SBP, SHR, reaching -33±3.0 mmHg six hours after injection (Baseline SBP: 208±8 mmHg before and 175±10 mmHg, six hours after the injection). In contrast, SBP did not significantly change after the administration of Ang-(1-5) (Baseline SBP: 198±13 mmHg before and 199±8 mmHg six hours after injection). There was no significant change in heart rate (HR) in SHR after Alamandine-(1-5) (Baseline HR: 342±14 beats/min before and 341±18.8 beats/min after six hours) or after Ang-(1-5) (Baseline HR: 333±18 beats/min before and 326±19 beats/min after six hours). Alamandine-(1-5) injection in Wistar rats produced only small changes in BP (Baseline SBP: 109±10 mmHg before injection and 99±11 mmHg six hours after injection, p<0.05). No differences were observed for Ang-(1-5) injection in Wistar rats (Baseline SBP: 118±8 mmHg before injection and 115±9 mmHg six hours after injection) or in HR for Alamandine-(1-5) or Ang-(1-5). Saline injection did not change BP or HR in SHR or in Wistar rats. These results show that Alamandine-(1-5), but not Ang-(1-5), triggers a long-lasting fall in BP in hypertensive animals. These data indicate that we have identified a new vasodilatory peptide of the RAS, increasing our understanding of the complexity of this system and opening a possibility for future development of a new pharmacological target for hypertension treatment.
Abstract P217: The Prevalence And Clinical Characteristics Of Apparent And True Resistant Hypertension
Authors: Liu Xueting , zhang xin , Ye Runyu , Sun Lirong , Chen Xiaoping
Published: October 2024

Objective:
We enrolled patients with essential hypertension at 15 medical centers and design a prospective clinical study to investigate the prevalence and clinical characteristics of apparent and true resistant hypertension(ATRH). In addition, we explored the effect of duration of diuretic use on blood pressure(BP) control in ATRH patients. This study aims to provide evidence for further exploring the diagnosis and treatment of ATRH.

Methods:
At the beginning, the patient who met the inclusion criteria were included in the study and took one tablet of O/A (20/5mg) every day. Thereafter, ambulatory blood pressure monitoring(ABPM) were completed every four weeks. During the follow-up, the drug dose of patients with controlled BP remained unchanged. Patients with uncontrolled BP were given additional drugs, and so on, until the BP controlled. The longest follow-up period was 24 weeks. Statistical analysis was performed using SPSS26. Depending on the data distribution, baseline data were evaluated using Student's t test, Mann-Whitney U test, or χ2 test. Binary logistic regression was used to further analyze the independent risk factors of ATRH.

Results:
A total of 772 patients were screened in this study, and finally, 545 patients' completed follow-up datas were obtained. We conluded that the incidence of ATRH was 5.13%, and only 3.18% of the patients failed to control BP after further extension of diuretic use to 3 months. A baseline comparison showed that the proportion of males, overweight (25.68±3.22 kg/m2 vs 28.85±3.32 kg/m2, P < 0.001) and eGFR < 60% were higher in the ATRH group; the patients in the ATRH group had a higher BMI, RBC count, CREA, UR concentrations and a lower HDL-C concentrations; ATRH patients exhibited higher ABPM, SBP load and nighttime DBP load than the non-ATRH group; the non-ATRH group had a more obvious BP dipping at night, and the BP rhythm was more regular. Further binary logistic regression analysis found that BMI (OR 1.25, 95% CI 1.10-1.42) and a < 10% decrease in nocturnal DBP (OR 3.24, 95% CI 1.19-8.79) were independent risk factors for ATRH.

Conclusion:
Under the stepwise titration of the standard treatment regimen, the prevalence of ATRH in the our study was 5.13%, and prolongs the duration of diuretic use can further promote the BP control of patients. ATRH is more common in male patients with obesity and kidney failure. Patients with a higher ABPM, BMI and a < 10% decrease in nocturnal DBP were more likely to develop ATRH.
Abstract P218: Resistant hypertension is associated with elevated 24-hour cortisol to cortisone ratios in black patients.
Authors: Sehar Alina , Roth Kaehler , Bag Soumyadeep , Rathi Hinal , Patel Aesha , Fanning John , Qamar Aleeza , Dudenbostel Tanja
Published: October 2024

Background:
RHTN is defined as blood pressure above goal despite using ≥3 antihypertensive medications. Patients with RHTN are at an increased risk for cardiovascular (CVD) compared to those with more easily controlled hypertension (HTN). Blacks With RHTN are at a specifically high risk for CVD. Mineralocorticoid receptor activation has been found as an important mechanism of RHTN. However, aldosterone levels are not different in blacks versus whites. The role of 24-hour cortisol-to-cortisone ratios in this group has not been investigated.

Methods:
We conducted a cross-sectional analysis of a large cohort of 2397 black and white patients with RHTN who were referred to the RHTN Clinic at the University of Alabama at Birmingham and who underwent 24-hour urine collection including cortisol and cortisone. Patients with HTN served as a control group.

Results:
Black patients with RHTN compared to whites had a trend to higher 24h cortisol levels (17.7±27.6 vs 16.9±14.9, p =0.70, significantly lower 24h cortisone levels (60.45±37.7 vs 75.3±40.0, p 0.000234), and significantly higher 24h cortisol-to-cortisone ratios (0.23±0.14 vs 0.20 ±0.10, p=0.027). They were younger (53.3±11.6 vs 59.4±12.9 years), more obese (BMI 34.9±7.6 vs 30.8±6.1 kg/m2, p<0.001), had earlier onset of HTN (35.6±12.5 vs 41.4±11.6 years of age, p<0.001), higher 24-hour urinary sodium excretion (188.2±92.5 vs 174.9±83.1 mmol, p=0.006) and lower potassium excretion (54.5 ±28.6 vs 65.5 ±30.5 mmol, p<0.001). Furthermore, they had a significantly higher rate of heart failure (p=0.000455) and diabetes (p=0.0006).

Conclusion:
Cortisol dysregulation and a higher cortisol-to-cortisone ratio as an index of 11beta HSD2 activity may play a role in black patients with RHTN and may be related to adverse outcomes in this population.
Abstract P225: Persistent Vascular Dysfunction and Blood Pressure Elevation Over 12 Months After COVID-19 Recovery in Non-Hypertensive Adults – LOCHINVAR Study
Authors: Lip Stefanie , Tran Tran QB , Hanna Rebecca , Nichol Sarah , McClure John , Delles Christian , McCallum Linsay , Berry Colin , Touyz Rhian , Padmanabhan Sandosh
Published: October 2024

Background:
The potential long-term vascular consequences of COVID-19, particularly in relation to future hypertension risk, remain poorly understood. This study aims to elucidate the longitudinal blood pressure trajectories in individuals who have recovered from COVID-19 but were not hypertensive prior to their infection, over a 12-month observational period.

Methods:
This study enrolled participants who had recovered from a hospital-admitted COVID-19 infection at least 12 weeks prior and had no history of hypertension. A control group was established from individuals with no prior SARS-CoV-2 infection, confirmed by a negative antibody test. All participants underwent ambulatory blood pressure monitoring (ABPM), flow-mediated dilation (FMD), and 6-minute walk test (6MWT) both at baseline and after 12 months. RAAS phenotyping was conducted at baseline. Paired t-tests and multivariable adjusted regression models were employed in the analyses of the full-dataset and per-protocol subset (because of variation in participant characteristics due to changing COVID-19 landscape during the recruitment period).

Results:
The full dataset had 97 participants (SARS-CoV-2 Negative:Positive 60:37) and per protocol data set had 66 participants (SARS-CoV-2 Negative:Positive 51:15). The median age was 50 (IQR:42-54) years with majority females. Per-protocol analysis revealed the positive group showed an increase in systolic and diastolic blood pressure (SBP/DBP) by 4.6/4.5 mmHg, a decrease in FMD by 3.2%, and an improvement in the 6MWT distance by 145.6 meters over 12 months, compared to the negative group (Figure 1). Baseline RAAS phenotyping showed no significant differences between groups.

Conclusions:
Our study demonstrates a significant increase in diastolic blood pressure 12 months following COVID-19 recovery in previously non-hypertensive individuals, accompanied by a decline in FMD. These findings suggest a possible vascular basis for the development of hypertension post-COVID-19 recovery.
Abstract P233: Amyloid Beta Plaque Deposits Co-Localize with Endothelial Cells in the Hippocampus of Female APPswe/PSEN1dE9 Mice During the Onset of Amyloid Pathology
Authors: Waigi Emily , Pernomian Laena , Crockett Alexia , JanuarioDa Costa Tiago , Townsend Paul , Webb R Clinton , McQuail Joseph , McCarthy Cam , Hollis Fiona , Wenceslau Camilla
Published: October 2024

Increasing evidence shows that cardiovascular diseases are associated with an increased risk of cognitive impairment and Alzheimer’s diseases (AD). It is unknown whether systemic vascular dysfunction occurs prior to the development of AD, if this occurs in a sex-dependent manner, or whether endothelial cells play a role in the deposition of amyloid beta (Aβ) peptides. We hypothesized that female mice present with an exacerbated formation of Aβ peptides, and vascular dysfunction would occur during the onset of amyloid pathology, thus escalating its progression. To test this hypothesis, we used a double transgenic mouse model of early onset AD (APPswe/PSEN1dE9) prior to the onset of amyloid pathology (3 months of age) and during the onset of amyloid pathology (7 months of age). Immunofluorescence was performed in the hippocampus stained with Aβ
1-42
and CD31 antibodies. High resolution images were acquired on the confocal microscope. Acetylcholine-induced relaxation (1pM-30µM) was evaluated in mesenteric resistance arteries (MRA), and the data analyzed as non-linear curve regression and maximum effect (Emax). The statistical analysis was performed using Student’s
t
test, or two-way ANOVA followed by Tukey post-hoc (
p
<0.05*). We observed that during the onset of amyloid pathology (7-months-old), there was elevated Aβ deposition which co-localized with endothelial cells in the hippocampus from female but not male APP/PS1 mice [females colocalization rate (%): control 12.9 ± 2.0
vs
. APP/PS1 25.1 ± 7.8, n=4; males colocalization rate (%): control 23.2 ± 6.5
vs.
APP/PS1 15.3 ± 3.3, n=4]. In addition, the 7-month-old female APP/PS1 mice showed an exacerbated endothelium-dependent relaxation compared to the 3-month-old group (female APP/PS1 7-month-old ACh Emax: 97.1 ± 1.6*%, n=4
vs.
3-month-old ACh Emax: 70.1 ± 8.3%, n=6). Furthermore, endothelial dysfunction occurred prior to the onset of amyloid pathology irrespective of sex. Overall, these data showed that the endothelial dysfunction prior to the onset of amyloid pathology may be an early marker of AD. Further, a greater burden of Aβ formation in hippocampal endothelial cells from female but not male APP/PS1 mice may be associated with vascular abnormalities and dysfunction.
Abstract P304: A Prescription Trend Analysis of Antihypertensive Pharmacotherapy across Different Specialties in India
Authors: Vishavadia Krunal , Solanki Sandip , Kulkarni Girish , Prajapati Hiren
Published: October 2024

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

Methods:
The prescription audit data utilized in this study, sourced from IQVIA, originated from a panel comprising 6000 clinicians practicing within the private sector. These prescriptions encompassed various classes of antihypertensive drugs, namely beta-blockers (BB), calcium channel blockers (CCB), angiotensin receptor blockers (ARB), angiotensin-converting enzyme (ACE) inhibitors, and diuretics. The analysis spanned the period from 2014 to 2022. The study also included an examination of combinations involving two or three medications from these drug classes.

Results:
Cardiologists' prescription rates for antihypertensive medications stood at 21% in 2017 and decreased to 19% by 2023. In 2023, the highest rate of prescribing antihypertensive drugs was observed among consultant physicians, with a rate of 30%, followed by general practitioners at 27%. Among anti-hypertensive medications, the prescription rates for BBs were highest (32%), followed by ARBs & CCBs (25% & 24% respectively); which remained almost constant throughout the study period. Single-drug formulation of antihypertensive medications was the most preferred (60%) among Indian clinicians. Prescription shares of fixed-dose combinations (FDC) of two antihypertensive drugs showed a slight decline (36% in 2017 to 34% in 2023) & FDCs of triple-drug exhibited an upward trend (3% in 2017 to 5% in 2023). Among the two drug FDCs, ARB & diuretics were most preferred (25% prescription share) & triple drug FDCs, CCB, ARB & diuretics were most preferred (76% prescription share).

Conclusions:
Antihypertensive drugs are the most commonly prescribed medication in the cardiology segment. Consultant physicians and general practitioners manage the majority of hypertension cases. Notably, there has been an observed rise in the preference for triple-drug combinations of antihypertensive medications, indicating a trend toward a more aggressive approach to hypertension management among Indian clinicians. The insights gleaned from this investigation can further assist healthcare professionals in crafting tailored treatment strategies for individuals grappling with hypertension. Such personalized approaches hold promise in enhancing treatment adherence and ultimately improving the quality of life for patients.
Abstract P312: Comparing Activity Logs in 24-hour Ambulatory Blood Pressure Monitoring
Authors: Baughman Carter , Monroe Janet , Hanlon Emma , Bandi Keerthi , Larbi Fredrick , Cluett Jennifer , Turkson-Ocran Ruth-Alma , Hadrick Lariel , Juraschek Stephen
Published: October 2024

Background:
Growing evidence suggests that activities during ambulatory blood pressure monitoring (ABPM) may affect measurement. While activity logs are often used to characterize context of measurements, there is little evidence to inform strategies to optimize the collection of these data from patients.

Objective:
To compare different log formats and their impact on data collection from activity logs of events occurring during ABPM.

Methods:
We performed a quality improvement project in our Hypertension Center using three different types of 24-hour ABPM logs (unstructured, semi-structured, and structured). Each log asked patients to record their daily activities including sleep, meals, physical activity, pain or other symptoms, medications, stress, caffeine, and tobacco use. The structured logs requested patients document activities with check boxes, the unstructured logs requested documentation with free text, and the semi-structured log combined check boxes and free text. Over a 12-month period, patients received one of the three versions of the ABPM logs in an alternating non-randomized schedule. We used linear regression models with adjustments for age, sex, and Black race to determine the association between items reported and log structure.

Results:
Between September 2022-2023, patients returned 47 unstructured, 26 semi-structured, and 31 structured logs (N=104). Patients were an average age of 58.9 years (SD, 17), 63% female and 23% Black. Compared with the unstructured log, the semi-structured log was associated with frequent reports of physical activity (0.05,
P
= 0.03), while the structured log was associated with more reports of pain (0.03,
P
=0.037) and stress (0.03,
P
=0.01). Compared to the semi-structured log, the structured log was associated with more reports of stress (0.03;
P
=0.032) .

Discussion:
In this quality improvement project of patients undergoing ABPM, adding structure to the log increased reporting of clinically relevant information related to pain and stress. Whether these data are related to changes in blood pressure should be a focus of subsequent work.