Abstract P182: Microangiopathic Complications In Malignant Hypertension: An Under-appreciated Form Of Target Organ Damage

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Akhil Jain ◽  
Bhumika Singhal ◽  
Rishabh Jindal ◽  
Chinmay Jani ◽  
Puneet K Gupta
Keyword(s):  
Target Organ Damage ◽  
Organ Damage ◽  
Pooled Analysis ◽  
Target Organ ◽  
Malignant Hypertension ◽  
Forest Plot ◽  
Significant Heterogeneity ◽  
Therapeutic Implications ◽  
Increased Risk ◽  
Hematological Changes

Fig 1: Summary of Malignant Hypertension Studies having Microangiopathic Complications along with Forest Plot Microangiopathic Complications in Malignant Hypertension: An underappreciated form of Target Organ Damage Background: Renal thrombotic microangiopathy is a clinically important complication of malignant hypertension (MHT), but its incidence in MHT has been sparsely studied. Our aim was to study the incidence of microangiopathic changes (MaC) in MHT. Methods: We searched Google Scholar database studies directly reporting MaC (mentioning either microangiopathic hemolytic anemia or thrombotic angiopathy) in presence of MHT. We used OpenMeta[Analyst] for the pooled analysis. Results: From 1967 to 2019, 9 studies were included. Maximum likelihood random-effects method showed pooled proportion estimate of having MaC in MHT to be 0.4 (95 CI: 0.3, 0.5; p<0.1). Significant heterogeneity with I 2 =82.56%, p <0.1 was found. Subgroup analysis showed pooled proportion of MaC in MHT to be 0.5 (95 CI: 0.4,0.7, p<0.1) for studies before 2000; whereas 0.2 (95 CI: 0.2, 0.3, p<0.1) for studies after 2000. Sex-wise distribution was reported in 7 studies, risk ratio of having MaC in MHT in female was found to be 1.24 compared to male. Conclusion: Our analysis suggests decreasing incidence of MaC in MHT over the past couple of decades and increased risk of this complication in females, although significant heterogeneity exists among studies reporting microangiopathic changes in malignant hypertension. More prospective observational studies are needed to better define the epidemiology of the hematological changes that occur in MHT since they have important therapeutic implications.

P3833Low heart rate variability is associated with future arrhythmic events in hypertension

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Terentes-Printzios ◽  
C Vlachopoulos ◽  
L Korogiannis ◽  
G Christopoulou ◽  
P Xydis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Primary Endpoint ◽  
Target Organ Damage ◽  
Roc Curves ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Increased Risk

Abstract Background/Introduction Cardiac autonomic dysfunction and target organ damage are associated with increased cardiovascular mortality and arrhythmias. Purpose The aim of the study was to investigate the effect of heart rate variability (HRV) and markers of target organ damage in the prognosis of future arrhythmic events. Methods We studied 292 untreated at baseline hypertensives (mean age 53±13, 153 males). Cardiac autonomic function was evaluated by analysis of short-term HRV measures over 24-h using 24-h ambulatory blood pressure monitoring and the standard deviation of the measurements. Echocardiography was also performed and left ventricular mass index (LVMI) was estimated with the Demereux formula. Aortic stiffness was assessed with carotid-femoral pulse wave velocity (cfPWV) and wave reflections with aortic augmentation index corrected for heart rate (Alx@75). Patients were followed up for a median period of 13 years. The primary endpoint was a composite of atrial/ventricular tachycardias, symptomatic multiple premature ventricular contractions, second and third-degree heart blocks and pacemaker/defibrillator placement. Results In comparison without events, patients with the primary endpoint (n=37, 13%) had lower 24-h daytime HRV (9.6 beats per minute vs. 11.1 beats per minute, p=0.005), higher systolic blood pressure (168 mmHg vs. 163 mmHg, p=0.003), higher cfPWV (8.4 m/s vs. 7.7 m/s, p=0.005), higher LVMI (133 g/m2 vs. 122 g/m2, p=0.002) and higher AIx@75 (29.0% vs. 26.3%, p=0.043). In further analysis, receiver operating characteristic (ROC) curves were generated to evaluate the ability of HRV, cfPWV, LVMI and AIx@75 to discriminate subjects with arrhythmic events. The area under the curve (AUC) and 95% CIs of the ROC curves were AUC=0.35 (95% CI: 0.26–0.44, p=0.003) for HRV, AUC=0.64 (95% CI: 0.54–0.73, P<0.006) for cfPWV, AUC=0.67 (95% CI: 0.58–0.75, P=0.001) for LVMI and AUC=0.55 (95% CI: 0.47–0.64, P=0.298) for AIx@75 (Figure). In Cox regression analysis, only HRV was associated with increased risk of arrhythmic events (Hazard ratio per 1 unit =0.87, 95% Confidence intervals 0.76 to 0.995, p=0.043) when adjusted for age, gender, cfPWV, LVMI and AIx@75. ROC curves of HRV & target organ damage Conclusions Low heart rate variability is associated with increased risk of future arrhythmic events suggesting an early sympathovagal imbalance that could lead to future events in hypertension.

scholarly journals Circulating let-7g-5p and miR-191-5p Are Independent Predictors of Chronic Kidney Disease in Hypertensive Patients

2020 ◽  
Vol 33 (6) ◽  
pp. 505-513 ◽  
Author(s):  
Olga Berillo ◽  
Ku-Geng Huo ◽  
Júlio C Fraulob-Aquino ◽  
Chantal Richer ◽  
Marie Briet ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Target Organ Damage ◽  
Kidney Injury ◽  
Organ Damage ◽  
Target Organ ◽  
Small Rna Sequencing ◽  
Therapeutic Implications ◽  
The Metabolic Syndrome ◽  
Circulating Rna

Abstract BACKGROUND Hypertension (HTN) is associated with target organ damage such as cardiac, vascular, and kidney injury. Several studies have investigated circulating microRNAs (miRNAs) as biomarkers of cardiovascular disease, but few have examined them as biomarker of target organ damage in HTN. We aimed to identify circulating miRNAs that could serve as biomarkers of HTN-induced target organ damage using an unbiased approach. METHODS AND RESULTS Fifteen normotensive subjects, 16 patients with HTN, 15 with HTN associated with other features of the metabolic syndrome (MetS), and 16 with HTN or chronic kidney disease (CKD) were studied. Circulating RNA extracted from platelet-poor plasma was used for small RNA sequencing. Differentially expressed (DE) genes were identified with a threshold of false discovery rate &lt;0.1. DE miRNAs were identified uniquely associated with HTN, MetS, or CKD. However, only 2 downregulated DE miRNAs (let-7g-5p and miR-191-5p) could be validated by reverse transcription-quantitative PCR. Let-7g-5p was associated with large vessel stiffening, miR-191-5p with MetS, and both miRNAs with estimated glomerular filtration rate (eGFR) and neutrophil and lymphocyte fraction or number and neutrophil-to-lymphocyte ratio. Using the whole population, stepwise multiple linear regression generated a model showing that let-7g-5p, miR-191-5p, and urinary albumin/creatinine ratio predicted eGFR with an adjusted R2 of 0.46 (P = 8.5e−7). CONCLUSIONS We identified decreased circulating let-7g-5p and miR-191-5p as independent biomarkers of CKD among patients with HTN, which could have pathophysiological and therapeutic implications.

Premenopausal Women Have Increased Risk of Hypertensive Target Organ Damage Compared with Men of Similar Age

2011 ◽  
Vol 20 (8) ◽  
pp. 1175-1181 ◽  
Author(s):  
Paolo Palatini ◽  
Lucio Mos ◽  
Massimo Santonastaso ◽  
Francesca Saladini ◽  
Elisabetta Benetti ◽  
...  
Keyword(s):  
Target Organ Damage ◽  
Premenopausal Women ◽  
Organ Damage ◽  
Target Organ ◽  
Increased Risk

scholarly journals Impact of Uric Acid on Hypertension Occurrence and Target Organ Damage: Insights From the STANISLAS Cohort With a 20-Year Follow-up

2020 ◽  
Vol 33 (9) ◽  
pp. 869-878 ◽  
Author(s):  
Mehmet Kanbay ◽  
Nicolas Girerd ◽  
Jean-Loup Machu ◽  
Erwan Bozec ◽  
Kevin Duarte ◽  
...  
Keyword(s):  
Uric Acid ◽  
Diastolic Dysfunction ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Urine Albumin ◽  
Increased Risk ◽  
Older Subjects

Abstract BACKGROUND Recent studies have shown that hyperuricemia may be associated with incident hypertension (HTN). We examined whether serum uric acid (SUA) is a predictor of HTN and target organ damage (TOD) 20 years later in initially healthy middle-aged individuals. METHODS Participants from the Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux (STANISLAS) a single-center familial longitudinal cohort study (961 initially healthy adults and 570 children) underwent clinical and laboratory measurements at baseline and after approximately 20 years. Blood pressure (BP: using ambulatory BP measurements), urine albumin-to-creatinine ratio, estimated glomerular filtration rate (eGFR), left ventricular hypertrophy (LVH), diastolic dysfunction, and carotid–femoral pulse wave velocity (PWV) were measured at the end of follow-up. RESULTS In the parent population, higher baseline or last SUA levels and higher change in SUA (ΔUA) were significantly associated with an increased risk of HTN development, even after adjusting for known HTN risk factors (all P &lt; 0.01). Higher baseline SUA was marginally associated with an increased risk of having high carotid–femoral PWV (P = 0.05). The association of SUA with BP increase was body mass index dependent (the increase in BP being greater in leaner subjects; interactionp &lt; 0.05), and the association of SUA with eGFR decline was age dependent (the decline in eGFR being greater in older subjects; interactionp &lt; 0.05). There was no significant association between SUA and diastolic dysfunction or LVH. In the whole population (i.e. including children), a significant association between SUA at baseline and the risk of HTN and higher carotid–femoral PWV was also found (both P &lt; 0.02). CONCLUSIONS Increased SUA is associated with the development of HTN and vascular/renal TOD in initially healthy midlife subjects.

scholarly journals State-of-the-Art review: Home blood pressure monitoring: current status and new developments

2021 ◽  
Author(s):  
Kazuomi Kario
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Home Blood Pressure ◽  
Target Organ ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Increased Risk

Abstract Home blood pressure monitoring (HBPM) is a reliable, convenient and less costly alternative to ambulatory blood pressure monitoring (ABPM) for the diagnosis and management of hypertension. Recognition and use of HBPM has dramatically increased over the last 20 years and current guidelines make strong recommendations for the use of both HBPM and ABPM in patients with hypertension. The accuracy and reliability of home BP measurements requires use of a validated device and standardized procedures, and good patient information and training. Key HBPM parameters include morning BP, evening BP and the morning-evening difference. In addition, newer semi-automatic HBPM devices can also measure nighttime BP at fixed intervals during sleep. Advances in technology mean that HBPM devices could provide additional relevant data (e.g. environmental conditions) or determine BP in response to a specific trigger (e.g. hypoxia, increased heart rate). The value of HBPM is highlighted by a growing body of evidence showing that home BP is an important predictor of target organ damage, and cardiovascular disease- and stroke-related morbidity and mortality, and provides better prognostic information than office BP. In addition, use of HBPM to monitor antihypertensive therapy can help to optimize reductions in BP, improve BP control, and reduce target organ damage and cardiovascular risk. Overall, HBPM should play a central role in the management of patients with hypertension, with the goal of identifying increased risk and predicting the onset of cardiovascular disease events, allowing proactive interventions to reduce risk and eliminate adverse outcomes.

scholarly journals Anesthetic management of hypertensive patients

2020 ◽  
Vol 63 (9) ◽  
pp. 519-525
Author(s):  
Duk Kyung Kim
Keyword(s):  
Angiotensin Receptor Blockers ◽  
Anesthetic Management ◽  
Target Organ Damage ◽  
Perioperative Period ◽  
Organ Damage ◽  
Target Organ ◽  
Clear Understanding ◽  
Converting Enzyme Inhibitors ◽  
Hypertensive Patients ◽  
Increased Risk

It is important for the clinicians to have a clear understanding of the anesthetic implications and increased risks due to hypertension to ensure safe surgical procedures in hypertensive patients. Preoperative hypertension is associated with greater intraoperative hemodynamic lability and an increased risk of perioperative cardiovascular complications. In addition to the patients’ baseline blood pressure (BP), the presence and severity of target organ damage and cardiovascular comorbidities should be evaluated preoperatively. Delaying surgery in hypertensive patients may be justified if there is an evidence of target organ damage that can be improved by such a delay. Further evaluation of suspected target organ damage before the surgery is also justified. Except withholding angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 10 to 24 hours before the surgery, the continuation of preoperative antihypertensive therapy is generally recommended. Though maintaining perioperative BP within the range of 80%–90% to 110%–120% of the baseline BP (permissible BP decrease/increase ≤10%–20%) is generally recommended, an individualized and pathophysiology-based approach to control BP might be the best option throughout the perioperative period. In other words, BP targets in the perioperative period should be determined based on the type of surgery, patients’ baseline BP, risks of hypotension-related organ ischemia, and hypertension-related bleeding.

scholarly journals Prevalence of Hypokalemia and Primary Aldosteronism in 5100 Patients Referred to a Tertiary Hypertension Unit

Hypertension ◽  
2020 ◽  
Vol 75 (4) ◽  
pp. 1025-1033 ◽  
Author(s):  
Jacopo Burrello ◽  
Silvia Monticone ◽  
Isabel Losano ◽  
Giovanni Cavaglià ◽  
Fabrizio Buffolo ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Primary Aldosteronism ◽  
Multivariate Regression ◽  
Cardiovascular Events ◽  
Target Organ Damage ◽  
Multivariate Regression Analysis ◽  
Organ Damage ◽  
Secondary Hypertension ◽  
Target Organ ◽  
Increased Risk

Primary aldosteronism (PA) was considered a rare disorder almost always associated with hypokalemia. The widespread screening of patients with hypertension unveiled an increased prevalence of PA with normokalemic hypertension the prevailing phenotype. Many studies have reported the prevalence of hypokalemia in patients with PA; conversely, the prevalence of PA in patients with hypokalemia is unknown. In this retrospective observational study, we define the prevalence of hypokalemia in referred patients with hypertension and the prevalence of PA in patients with hypokalemia and hypertension. Hypokalemia was present in 15.8% of 5100 patients with hypertension, whereas 76.9% were normokalemic, and 7.3% hyperkalemic. The prevalence of PA in patients with hypokalemia was 28.1% and increased with decreasing potassium concentrations up to 88.5% of patients with spontaneous hypokalemia and potassium concentrations <2.5 mmol/L. A multivariate regression analysis demonstrated the association of hypokalemia with the occurrence of cardiovascular events independent of PA diagnosis. An association of PA with the occurrence of cardiovascular events and target organ damage independent of hypokalemia was also demonstrated. In conclusion, our results confirm that PA is a frequent cause of secondary hypertension in patients with hypokalemia, and the presence of hypertension and spontaneous hypokalemia are strong indications for PA diagnosis. Finally, we show that PA and hypokalemia are associated with an increased risk of cardiovascular events.

Abstract 048: Systolic and Diastolic Ambulatory Blood Pressure Affect Target Organ Damage Differently in Adolescents: The SHIP AHOY Study

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Gilad Hamdani ◽  
Elaine M Urbina ◽  
Marc Lande ◽  
Kevin Meyers ◽  
Joshua Samuels ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Linear Models ◽  
Pulse Wave ◽  
Systolic Function ◽  
Target Organ Damage ◽  
Global Longitudinal Strain ◽  
Organ Damage ◽  
Target Organ ◽  
Weak Association ◽  
Increased Risk

Hypertensive target organ damage (TOD) is associated with increased risk for CV events. Ambulatory BP (ABP) measures are more strongly related to TOD than casual BP in adults but data in youth are lacking. Our objective was to determine which ABP parameters associated with TOD in adolescents. We evaluated casual BP (mean of 6 measures by auscultation), ABP (Spacelabs OnTrak), anthropometrics, labs, LVM, pulse wave velocity (PWV), diastolic function (E/E’ ratio), and systolic function (global longitudinal strain, GLS) in 132 adolescents (mean 15.8 + 1.4 yrs, 66% white, 57% male). Day, night and 24H SBP and DBP index (mean/95 th %ile for sex and height) and loads (%readings above the 95 th %ile) were defined according to sex and height-specific pediatric cut-points. General linear models were used to determine independent associations between ABP and TOD. Only systolic ABP means and loads were associated with LVMI and diastolic function, while both systolic and diastolic ABP means and loads were associated with PWV. There was a weak association between systolic and diastolic loads and GLS. In multiple regression analysis (full model: demographics, age, BMI, HR, ABP, metabolic profile, CRP) day SBP index was the strongest predictor of LVMI (β=15.2, R 2 0.4, p=0.006) and E/E’ (β=5.2, R 2 0.23, all p=0.007), while day DBP index was the strongest predictor of PWV (β=3.0, R 2 0.37, p<0.0001). Day DBP load was the sole independent ABP predictor of GLS (β=0.05, R 2 0.25, p=0.02). We conclude that during adolescence, systolic and diastolic ABP parameters are differentially associated with TOD: SBP predicted LVMI, while DBP predicted PWV. ABP parameters may be used to evaluate risk for BP-related TOD.

scholarly journals Risk of target organ damage in patients with arterial hypertension and various numbers of metabolic syndrome components

2014 ◽  
Vol 11 (1) ◽  
pp. 40-44
Author(s):  
Yu V Zhernakova ◽  
G Kh Sharipova ◽  
I E Chazova
Keyword(s):  
Metabolic Syndrome ◽  
Arterial Hypertension ◽  
Clinical Medicine ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Cardiovascular Complications ◽  
Target Organ ◽  
The Metabolic Syndrome ◽  
Increased Risk ◽  
Metabolic Syndrome Components

The metabolic syndrome is one of most socially significant and strategic problems of clinical medicine. It is known that metabolic syndrome promotes earlier and more expressed target organ damage in patients with arterial hypertension. However, correlation of the number of metabolic syndrome components with target organ damage, selection of metabolic syndrome components, influencing expressiveness on target organ damage, are studied insufficiently. In this study it is determined that with the elevating number of the metabolic syndrome components, the frequency and expressiveness of heart, kidney and vessel damage, accompanied by the increased risk of development of cardiovascular complications, increase in patients with the maximum number of the metabolic syndrome components. Moreover, it is revealed that the relative risk of simultaneous damage of heart, kidneys and vessels in patients with arterial hypertension and metabolic syndrome, apart from high blood pressure and abdominal obesity is associated with the increase of fasting glucose level.

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