Evaluation of Serum Lipid Profile in Hypertensive Patients at Mirpur Khas, Sindh, Pakistan

Aim: To assess the lipid profile of hypertensive patients. Study Design: Evaluation-based study. Place and duration of study: Department of Medicine, Muhammad Medical College Hospital, Mirpurkhas, Sindh, Pakistan for a period of one year from 1stJuly 2020 to 30thJune 2021. Methodology: Three hundred and fifty-three hypertensive patients were enrolled in the study based on Rao-soft formula. Only those hypertensive patients who had confirmed diagnosis of hypertension were enrolled. The patients were requested for fasting to take the blood sample. Results: 64.87% were males and 35.1% were females. 39.6% patients were above 60 years old and highest range values for systolic blood pressure 201-220mmHg. The majority of the patients 26.34% showed 91-100 mm Hg. The 11.05% of the patients were prescribed with the Atenolol, 7.08% of patients were prescribed with another beta blocker medication Propranolol. The majority of patients were prescribed with Rosuvastatin as antilipidemic drugs however the least majority i.e. 11.61 were prescribed with Simvastatin.The 16.9% patients showed HDL40mg/dL, higher LDL<100mg/dL, total glycerides<150mg/dL, total cholesterol<200mg/dL HDL30-39mg/dL, LDL100-150mg/dL, total glycerides150-200 mg/dL, total cholesterol200-250mg/dL among 31.73% of the patients. The 28.9% of the patients showed the pattern HDL20-29mg/dL. Conclusion: The dyslipidemia associated with the hypertension and hypertensive patients. The irregular values and alteration of in the serum cholesterol and total cholesterol levels of lipid profile proves the association of lipid profile with the elevated systolic blood pressure levels. The total cholesterol, LDL and HDL can be controlled with an appropriate controlling of high blood pressures, thus preventing the cardiovascular diseases and cardiovascular diseases. Key words: Lipid, Hypertension, Assess

Passive leg cycling increases activity of the cardiorespiratory system in people with tetraplegia

Individuals with cervical spinal cord injury (SCI) are at an increased risk for cardiovascular disease. Exercise is well-established for preventing cardiovascular disease, however, there are limited straightforward and safe exercise approaches for increasing the activity of the cardiorespiratory system after cervical SCI. The objective of this study was to investigate the cardiorespiratory response to passive leg cycling in people with cervical SCI. Beat-by-beat blood pressure, heart rate, and cerebral blood flow were measured before and throughout 10 minutes of cycling in 11 people with SCI. Femoral artery flow-mediated dilation was also assessed before and immediately after passive cycling. Safety was monitored throughout all study visits. Passive cycling elevated systolic blood pressure (5±2 mmHg), mean arterial pressure (5±3 mmHg), stroke volume (2.4±0.8 mL), heart rate (2±1 beats/min) and cardiac output (0.3±0.07 L/min; all p<0.05). Minute ventilation (0.67±0.23 L/min), tidal volume (70±30 mL) and end-tidal PO2 (2.6±1.23 mmHg) also increased (all p<0.05). Endothelial function was improved immediately after exercise (1.62±0.13%, p<0.01). Passive cycling resulted in one incidence of autonomic dysreflexia. Therefore, passive leg cycling increased the activity of the cardiorespiratory system, improved endothelial function, indicating it may be a beneficial exercise intervention for the cardiovascular and respiratory systems in people with cervical SCI. Novelty: ● Passive leg cycling increases the activity of the cardiorespiratory system and improves markers of cardiovascular health in cervical SCI. ● Passive leg cycling exercise is an effective, low-cost, practical, alternative exercise modality for people with cervical SCI.

Metabolically Abnormal But Normal-Weight Individuals Had a Higher Risk of Type 2 Diabetes Mellitus in a Cohort Study of a Chinese Population

AimsObesity is a heterogeneous disease in terms of body mass index (BMI) and metabolic status. The purpose of this study was to investigate the risk of type 2 diabetes mellitus (T2DM) in subjects with metabolically abnormal but normal weight (MANW) in China.Materials and MethodsA prospective cohort with a total of 17,238 participants of the Zhejiang metabolic syndrome cohort was recruited. According to the standard of the Working Group on Obesity in China, general obesity is defined. Metabolic abnormality was defined as two or more abnormal components (elevated triglycerides (TG), low high-density lipoprotein cholesterol (HDL-C), elevated systolic blood pressure (SBP) or diastolic blood pressure (DBP) or use of antihypertensive therapy, and elevated fasting plasma glucose or antidiabetic treatment). The hazard ratio (HR) and its 95% CI were calculated using a multiple regression model, adjusted for the potential confounding factors.ResultsCompared with metabolically normal and normal weight (MNNW) subjects, the metabolically abnormal and obesity/overweight (MAO) subjects had the highest risk of T2DM disease, with an HR of 4.67 (95% CI: 3.23–6.76), followed by MANW subjects (HR = 2.61, 95% CI: 1.74–3.92) and metabolically normal but obesity/overweight (MNO) subjects (HR = 2.09, 95% CI: 1.29–3.38) after adjusting for age, sex, smoking, drinking, physical activity, and family history of diabetes. Compared with that in the MNNW subjects, the HR in MANW subjects was significantly higher than that in MNO subjects. In normal-weight subjects, the HR of T2DM was significantly positively correlated with the number of components with metabolic abnormalities.ConclusionsMANW subjects had a higher risk of T2DM. MANW subjects should be given more attention in the prevention and control of common chronic diseases.

Abstract 1122‐000166: Stroke Severity Factors in patients with Acute Ischemic Stroke and Heart Failure Stratifying by Age

Introduction : The goal of this study is to investigate the clinical risk factors associated with acute ischemic stroke (AIS) severity in heart failure (HF) patients above and below 70 years old using the National Institutes of Health Stroke Scale (NIHSS) as a measure for stroke severity. Methods : This study uses retrospective analysis of AIS patients who were previously diagnosed with HF. Data was collected from a regional stroke center from January 2010 to June 2016. Multivariate logistic regression identified the factors associated with stroke severity, with a NIHSS score <7 indicating low severity and a score ≥7 indicating high severity. These results were stratified by patient ages of < and ≥70 years old. Results : A total of 590 patients presented with AIS and a previous diagnosis of HF. The AIS‐HF population contained 223 patients that were <70 years old and 367 that were ≥70 years old. In the AIS‐HF population, patients who were ≥70 years old who presented with coronary artery stenosis (CAS) (OR = 8.592, 95% CI, 2.123‐34.772, P <0.003), prosthetic heart valve (OR = 22.028, 95% CI, 1.454‐333.746, P <0.026), elevated systolic blood pressure (OR = 1.014, 95% CI, 1.002‐1.026, P < 0.024), and tissue plasminogen activator (tPA) administration (OR = 4.002, 95% CI, 1.912‐8.377, P < 0.001) were associated with a higher NIHSS. Alternatively, those that presented with gender differences (OR = 0.466, 95% CI, 0.235‐0.925, P < 0.029), family history of stroke (OR = 0.084, 95% CI, 0.010‐0.726, P < 0.024), obesity (OR = 0.493, 95% CI, 0.261‐0.930, P < 0.029), smoking (OR = 0.253, 95% CI, 0.063‐1.022, P < 0.054), serum creatinine (OR = 0.629, 95% CI, 0.399‐0.992, P < 0.046), INR level (OR = 0.457, 95% CI, 0.191‐1.094, P < 0.079) were associated with a lower NIHSS. Conclusions : The data revealed a variety of components that may affect Stroke Severity in AIS patients with HF. The associated factors exhibited significant differences between distinct age groups. AIS‐HF patients ≥70 years old who presented with CAS, prosthetic heart valve, elevated systolic blood pressure, and received tPA administration were associated with higher stroke severity (≥7 NIHSS) compared to <70 years old group. Identifying more concrete clinical and demographic associations may aid in the identification and evidence‐based management of patients who suffer from AIS.

Impact of Elevated Systolic Blood Pressure Levels on Mortality and Life Expectancy in Southeast Chinese Residents

Background: We aimed to analyse the impact of elevated systolic blood pressure (SBP) levels on mortality and life expectancy among ≥25 yr adults in the municipality of Ningbo, China. Methods: The death cause data were collected from the Internet-based Comprehensive Chronic Disease Surveillance System in Zhejiang Province in 2015, and SBP level data were obtained from the Ningbo Adult Chronic Disease Surveillance survey. According to the comparative risk assessment theory, the population attributable fraction (PAF) of elevated SBP levels by gender and urban-rural regions has been calculated. The deaths and life expectancy loss due to elevated SBP levels were estimated. Results: In 2015, the average SBP level among ≥25 yr adults in Ningbo was 129.01 ± 17.73 mmHg, which was higher in men (131.67 ± 16.89 mmHg) than in women (126.24 ± 18.15 mmHg) and was higher among adults in rural regions (130.55 ± 18.75 mmHg) than among adults in urban regions (127.15 ± 16.19 mmHg). A total of 6181 deaths were attributed to elevated SBP levels among adults in Ningbo. The PAF of deaths caused by elevated SBP levels among adults was 16.14%, which was higher in women (18.73%) than in men (14.31%). The overall loss of life expectancy caused by elevated SBP levels among adults was 1.76 yr, which was higher in women (1.99 yr) than in men (1.53 yr) and was higher in rural regions (1.91 yr) than in urban regions (1.49 yr). Conclusion: Elevated SBP levels had a serious impact on the death and life expectancy loss of residents in Ningbo.

Abstract P188: Blood Pressure Control And Glaucoma Risk In Older Women

Objective: Individuals with elevated systolic blood pressure (BP) or low diastolic BP, whether or not on antihypertensive treatment, may be at higher risk for developing glaucoma. We aimed to investigate BP levels in relation to risk of incident glaucoma in a large cohort of elderly women. Methods: Prospective follow-up of 101,447 postmenopausal women without prior history of glaucoma enrolled in the Women’s Health Initiative Study (WHI). Blood pressure was measured in-clinic at baseline and after 3 years using standardized procedures and average BP was calculated. Antihypertensive medication use was determined by drug inventory at baseline and year 3. Women self-reported incident newly diagnosed glaucoma annually. Hazard ratios (HRs) and 95% confidence intervals (95% CI) were estimated using Cox proportional hazards analyses adjusting for demographic, medical history, and lifestyle covariates. Results: During a mean follow-up of 4.7 years, we documented 7,514 glaucoma cases. Among women not on antihypertensive treatment, those with systolic BP ≥140 mmHg or diastolic BP ≥80 mmHg were not at higher risk of developing glaucoma (HR 0.97, 95% CI 0.88-1.08 and HR 1.00 [0.93-1.08], respectively), compared to women with a systolic BP <120 mmHg or a diastolic BP 60-<80 mmHg. Among women on antihypertensive treatment, neither systolic BP ≥140 mmHg nor diastolic BP ≥80 mmHg was associated with an increased risk of glaucoma (HR 0.91 [0.82-1.01] and HR 0.97 [0.90-1.05], respectively). A diastolic BP <60 mmHg was not associated with a higher risk compared to a diastolic BP 60-<80 mmHg. Conclusions: BP control is not associated with an increased or decreased glaucoma risk in elderly women.

Elevated complement mediator levels in endothelial-derived plasma exosomes implicate endothelial innate inflammation in diminished brain function of aging humans

We test the hypothesis that endothelial cells adopt an inflammatory phenotype in functionally intact aged human subjects with radiographic evidence of white matter hyperintensity (WMH) suggestive of small cerebrovascular disease. Components of all three complement effector pathways and regulatory proteins were quantified in extracts of plasma endothelial-derived exosomes (EDE) of 11 subjects (age 70–82) with and 15 without evidence of WMH on MRI. Group differences and associations with plasma markers of immune activation (IL6, ICAM1), cognition and neuroimaging were calculated via regression modelling. EDE complement factors within the alternative and classical pathways were found to be higher and regulatory proteins lower in subjects with WMH. EDE levels of some complement components demonstrated significant associations with cognitive slowing and elevated systolic blood pressure. The inhibitor of the membrane attack complex, CD46, showed a significant positive association with cerebral grey matter volume. Plasma inflammatory markers, IL6 and ICAM1, were positively associated with EDE levels of several complement components. These findings provide the first in vivo evidence of the association of endothelial cell inflammation with white matter disease, age-associated cognitive changes, and brain degeneration in functionally normal older individuals. Future endothelial biomarker development may permit recognition of early or preclinical stages of vascular contributions to cognitive impairment and dementia.

Self-Nanoemulsifying Drug Delivery System Loaded with Psiadia punctulata Major Metabolites for Hypertensive Emergencies: Effect on Hemodynamics and Cardiac Conductance

Vasodilators are an important class of antihypertensive agents. However, they have limited clinical use due to the reflex tachycardia associated with their use which masks most of its antihypertensive effect and raises cardiac risk. Chemical investigation of Psiadia punctulata afforded five major methoxylated flavonoids (1–5) three of which (1, 4, and 5) showed vasodilator activity. Linoleic acid-based self-nanoemulsifying drug delivery system (SNEDDS) was utilized to develop intravenous (IV) formulations that contain compounds 1, 4, or 5. The antihypertensive effect of the prepared SNEDDS formulations, loaded with each of the vasodilator compounds, was tested in the angiotensin-induced rat model of hypertension. Rats were subjected to real-time recording of blood hemodynamics and surface Electrocardiogram (ECG) while the pharmaceutical formulations were individually slowly injected in cumulative doses. Among the tested formulations, only that contains umuhengerin (1) and 5,3′-dihydroxy-6,7,4′,5′-tetramethoxyflavone (5) showed potent antihypertensive effects. Low IV doses, from the prepared SNEDDS, containing either compound 1 or 5 showed a marked reduction in the elevated systolic blood pressure by 10 mmHg at 12 μg/kg and by more than 20 mmHg at 36 μg/kg. The developed SNEDDS formulation containing either compound 1 or 5 significantly reduced the elevated diastolic, pulse pressure, dicrotic notch pressure, and the systolic–dicrotic notch pressure difference. Moreover, both formulations decreased the ejection duration and increased the non-ejection duration while they did not affect the time to peak. Both formulations did not affect the AV conduction as appear from the lack of effect on p duration and PR intervals. Similarly, they did not affect the ventricular repolarization as no effect on QTc or JT interval. Both formulations decreased the R wave amplitude but increased the T wave amplitude. In conclusion, the careful selection of linoleic acid for the development of SNEDDS formulation rescues the vasodilating effect of P. punctulata compounds from being masked by the reflex tachycardia that is commonly associated with the decrease in peripheral resistance by most vasodilators. The prepared SNEDDS formulation could be suggested as an effective medication in the treatment of hypertensive emergencies, after clinical evaluation.

Trier Social Stress Test Elevates Blood Pressure, Heart Rate, and Anxiety, But a Singing Test or Unsolvable Anagrams Only Elevates Heart Rate, among Healthy Young Adults

The Trier Social Stress Test (TSST) is a psychosocial stressor that effectively stimulates the stress response but is labor and time intensive. Although other psychological stressors are often used experimentally, none are known to comparably elevate stress. Two stressors that may potentially elevate stress are a singing task (ST) and unsolvable anagrams, but there are not enough data to support their effectiveness. In the current experiment, 53 undergraduate males and females (mean age = 21.9 years) were brought into the laboratory, and baseline blood pressure, heart rate, self-rated anxiety, and salivary cortisol were recorded. Then, participants were randomly assigned to one of three stress conditions: TSST (n = 24), ST (n = 14), or an unsolvable anagram task (n = 15). Stress measures were taken again after the stressor and during recovery. The TSST significantly elevated systolic blood pressure, diastolic blood pressure, heart rate, and self-rated anxiety from pre-stress levels, replicating its stress-inducing properties. However, the ST and unsolvable anagrams only elevated heart rate, indicating that these methods are not as able to stimulate physiological or psychological stress. Overall, results indicate that out of these three laboratory stressors, the TSST clearly engages the stress response over the ST or unsolvable anagrams.

MO570PULSE PRESSURE: A PREDICTOR OF CARDIOVASCULAR CALCIFICATION AND CARDIOVASCULAR MORTALITY IN HEMODIALYSIS PATIENTS

Background and Aims The mortality rate is extremely high in chronic kidney disease (CKD), primarily due to the high prevalence of cardiovascular disease (CVD). Increased pulse pressure (PP), defined as the difference between inappropriately elevated systolic blood pressure (SBP) and reduced diastolic blood pressure (DBP) at any value of mean arterial pressure (MAP), is a surrogate measure of increased arterial stiffness of central elastic arteries (aorta and its major branches). CKD-MBD anomalies leading to calcification contribute to increased arterial stiffness and pulse pressure. This study aimed to evaluate the relationship of pulse pressure parameter with valve calcification and abdominal aortic calcification in hemodialysis patients and its impact on cardiovascular mortality. Method We performed a prospective case series study with 3 years follow- up. Plain X-ray images of the lateral lumbar spine from all subjects were studied to obtain images of the lower abdominal aorta using semiquantitative scores as described by Kauppila et al. Cardiac valve calcifications were evaluated by two-dimensional echocardiography with an HDI 5000 Sono CT echocardiographic machine with a 3.3-MHz multiphase array probe in subjects lying in the left decubitus position an according to the recommendations of the European Association of Echocardiography. The patient was evaluated as having vascular calcification if he had the presence of calcification in at least one of the site examined: a mitral valve, aortic valve or abdominal aorta. Results We studied 85 chronic stable hemodialysis patients. Mean age and meantime is therapy was 49.9±12.4 years and 51.5±28.7 months, respectively. Mean pulse pressure was 55.72±14.2 mmHg. Fifty-nine patients (69.4%) were identified with aortic abdominal calcification, and the mean Kauppila score was 4.91 ± 4.05. Sixty patients (70.5%) had at least one valve calcified, while thirty-three patients (38.8%) had both valves calcified. Univariate analysis revealed that every 1 mmHg increase in pulse pressure was associated with increased cardiovascular calcification risk p=0.020. In multivariate analysis, after adjustment for age, gender, diabetes mellitus, cholesterol, and triglyceride serum levels, the association also remained strong, where every increase of 1 mm Hg in pulse pressure was associated with increased risk for cardiovascular calcification (HR 1.02, 95% CI (1.00-1.03), p= 0.038). Besides, pulse pressure was an independent predictor for cardiovascular mortality (HR 1.03, 95% CI (1.02-1.05), p=0.002). Conclusion Pulse pressure may identify hemodialysis patients with subclinical cardiovascular calcification who need further evaluation. Wide pulse pressure is associated with increased cardiovascular mortality.