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Abstracts / Journal of the American Society of Hypertension 8(4S) (2014) e81–e91

who had EH (OR, 1.75; CI, 1.08-2.8; p<0.05) and CH (OR 1.39; CI 1.021.90; p<0.05) respectively. Conclusion: Increase left atrial size of Nigerian hypertensive patients is strongly associated with increased left ventricular mass of which the eccentric type exerts the greatest influence. Keywords: Left ventricular geometry; Left atrial size; Hypertension; Nigerians

P-148 Relationship between prehypertension and socioeconomic level in a hispanic population Egle Silva, Jose J. Villasmil, Greily Bermudez, Emilio Clavell, Gustavo Calmon. Instituto De Investigaciones De Enfermedades Cardiovasculares De Luz, Maracaibo, Venezuela, Bolivarian Republic of To determine the relationship between prehypertension (PH) and socioeconomic factors in a Hispanic population, it was carried out this communitybase study, in Venezuela, that included 2109 adult subjects -males (n¼570) and females (n¼1539)- mean-age¼37 13 years, who were chosen from a random selection of households. Information about age, gender, educational level (EL) and blood pressure was collected at a single household visit. Pre-hypertension was defined as blood pressure values of 120-139/ 80-89 mmHg. Socioeconomic level was estimated using the educational level (EL) of each subject. The EL was classified in 4 categories: elementary, high and technical school and university degree. The Odds Ratio (OR) and 95% Confidence Interval (CI) were calculated through the Logistic Regression Analysis to know the relationship between PH and EL. The PH prevalence was 38.9% (n¼821) in all subjects, 57.0% (n¼325) in males and 32.2% (n¼496) in females (p<0.0001). The frequency of EL in all individuals was: 53.2% (n¼1121), 32.6% (n¼687), 7.5% (n¼159) and 6.7% (n¼142) for elementary, high and technical school and university degree, respectively. The logistic regression analysis showed that elementary and high school were statistically significant risk factors for PH in all subjects [OR: 1.841 (CI: 1.139 - 2.975), p<0.01 and OR: 1.766 (CI: 1.205 - 2.586) p<0.004 for elementary and high school, respectively]. However, the analysis by gender showed only elementary school as risk factor for PH in females (OR: 1.874, CI: 1.173-2.997, p<0.009), but not in males. This study showed that low education level is associated with PH in the Hispanic population analyzed, and this association is found only in female subjects. Keywords: Prehypertension; Socioeconomic; Hispanics

Coordination Institute (CCI). Inclusion criteria included: (1) black or white race (2) untreated BP 140/90 (3) no BP meds for 6 mo. before and 2 visits in 12-mo. after initial therapy. Descriptive data and multivariable Hazards Ratio (HR) of obtaining BP control with 95% Confidence Intervals (CI) were generated. * p<0.05, + p<0.01. Results: Baseline descriptive data and HR with 95% CI are summarized in the Table. Blacks had more Stage 2 Htn, fewer men, lower DBP, higher BMIs, equivalent visit frequency, and more diabetes and CKD than whites. Blacks were more likely to be started on SPC and FDC than whites (52.1% vs. 37.4%) and less likely to be started on M. Whites were more likely to attain BP control in the first year than blacks (70.9% vs. 65.0%, p<0.01) and had a shorter time to 50% control (213 vs. 254 days, p<0.01). In multivariable HR, BP control in the first year was similar in blacks and whites started on SPC. In patients who began treatment with FDC or M, blacks were less likely than whites to obtain control in the first year. For within race comparisons, SPC was better than FDC in controlling BP in the first year in blacks but not whites. SPC was better than M in both race groups. Conclusions: Blacks were less likely to attain BP control in the first year and required more days to reach 50% control than hites. Racial disparities in first year control were eliminated in patients begun on SPC. Beginning more black hypertensive patients on SPC could improve equity in BP control in the first treatment year.

Keywords: Hypertension control; racial differences; single-pill combinaton; monotherapy

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P-149 Single-pill combinations equalize black-white differences in time-tocontrol as initial therapy in previously untreated stage 1 and 2 hypertension Brent M. Egan,1 Nathan B. Spagnola,1 Joseph H. Henderson,1 A.H. Chandler,1 Walter A. Brzezinski,2 Angelo Sinopoli.1 1Greenville Health System, Greenville, SC, United States; 2Medical University of South Carolina, Greenville, SC, United States Background: Single-pill combinations (SPC), in contrast to monotherapy (M) or free-dose combination (FDC) therapy, improve adherence and accelerate time to control as initial therapy for uncontrolled hypertension (Htn). Blacks have lower blood pressure (BP) control rates than whites and a longer time to 50% control. This analysis assessed the impact of initial treatment with SPC vs. M and FDC on Htn control in the first year of therapy in previously untreated black and white patients with Stage 1 and 2 Htn. Methods: Electronic record data were obtained from >200 communitybased practice sites in the Southeast U.S. that participate in the Care

Sleep apnea syndrome and resistant hypertension in Romanian adult population Oana Tautu, Alexandru Deaconu, Silviu Ghiorghe, Maria Dorobantu. Emergency Clinical Hospital of Bucharest, Bucharest, Romania Our aim was to estimate the prevalence of sleep apnea syndrome and resistant hypertension in Romanian adult population. The study has been conducted on the subjects enrolled in SEPHAR II survey (1975 subjects, 52.6% females, 69,06% response rate). The blood pressure (BP) values were defined by the arithmetic mean of 2nd and 3rd measurements from each of the two study visits. High blood pressure and BP control were defined according to the 2013 ESH-ESC Guidelines. Treatment resistant hypertension was defined as BP values > 140/ 90mmHg in treated hypertensive subjects with at least three antihypertensive drugs including a diueretic. The probability of Sleep Apnea Syndrome (SAS) was estimated through the Berlin questionnaire. HT prevalence in the Romanian adult population is 40,41% (798 subjects). Although most subjects with hypertension were treated (472 subjects, 59,15%), BP control was recorded only in a quarter of them (118 subjects, 25%). Treatment-resistant HT was recorded in 98 cases, representing 12,28% of all hypertensive population, 20,76% of treated hypertensive

Abstracts / Journal of the American Society of Hypertension 8(4S) (2014) e81–e91

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population and 27,68% of treatment-resistant hypertensives. A high probability of SAS was recorded in 392 subjects (12.3%), the majority of them being hypertensive subjects (308, 78,6%). The majority of hypertensives with high probability of SAS were known hypertensives (231 subjects, 25.8%), unde current antihypertensive treatment (194 subjects, 41,1 %) and with moderate-severe BP values (161 subjects; 52,27%). Moreover, high probability of SAS was indentifed in one out of five adults with treatment-resistant HT (38 subjects, 38,77%). In Romania, SAS represents a real health problem, about 1 in 5 adults having an increased probability of SAS, and being both an etiological and an aggravating factor of HT in Romanian adult population. Control of blood pressure values is far from being adequate. Based on the results of this study the estimated prevalence of truly treatment-resistant HT in the adult population of Romania is < 7%. The results of this study were the basis of SAS-SEPHAR project, whose primary objective is the prevalence of SAS in the adult population of Romania. Keywords: Sleep Apnea Syndrome; Resistant Hypertension

P-151 The increasing trend in the admissions for malignant hypertension and hypertensive encephalopathy in the United States Linnea A. Polgreen, Barry L. Carter, Manish Suneja, Philip M. Polgreen. University of Iowa, Iowa City, IA, United States Malignant hypertension and hypertensive encephalopathy are life-threating manifestations of hypertension. These syndromes primarily occurin patients with a history of poorly controlled hypertension, especially following the cessation of antihypertensive therapy. Thus, monitoring trends in admission rates for these conditions may yield a population-based indicator for failures related to hypertension management and/or patient adherence. The purpose of this study was to investigate national trends in hospital admissions for both malignant hypertension and hypertensive encephalopathy. This was a retrospective cohort study that utilized the Nationwide Inpatient Sample (NIS). We identified all hospitalizations between 1993 and 2010 during which a primary diagnosis of either malignant hypertension (ICD 9 code: 401.0) or hypertensive encephalopathy (ICD 9 code: 437.2) was recorded. The NIS database is maintained as part of the Healthcare Cost and Utilization Project (HCUP) from the Agency for Healthcare Research and Quality and contains data from a 20% stratified sample of nonfederal acute care hospitals. Data are weighted to represent the United States population. Piecewise linear regression analyses were performed toinvestigate changes in the trends in these time series. The outcome variable was a count of hypertension discharges in each of the two diagnostic categories. The predictor variable was time. The estimated number of admissions for both malignant hypertension (Figure 1a) and hypertensive encephalopathy (Figure 1b) has increased recently. From 1993 to 2005 admissions were roughly stable fluctuating between 23,932 and 28,616 for malignant hypertension and between 4,761 and 6,437 for hypertensive encephalopathy, respectively per year. From 2006 to 2010 admissions for malignant hypertension increased 70% to 40,835, and admissions for hypertensive encephalopathy increased 60% to 12,016 per year (p<0.001 for changes in trend). The dramatic increase in the number of hospital admissions for hypertensive encephalopathy and malignant hypertension likely resulted in dramatic increases in morbidity and costs. A possible explanation for these findings may be changes in the economy that reduced the ability of some subjects to pay for medications or seek medical care. Further research is needed to explain these trends.

Keywords: malignant hypertension; hypertensive encephalopathy; trends; hospitalizations

P-152 The interplay of baseline weight, weight change, blood pressure change, and gender in clinical practice Eugene S. Chung, Cheryl Bartone, Stephanie Gilardi, Dean J. Kereiakes, John Szawaluk. The Christ Hospital, Cincinnati, OH, United States Background: The relationship between obesity and hypertension (HTN) is clearly established, and interventions to reduce body weight are associated with improved systolic blood pressures (SBP). However, in clinical practice, the interplay of baseline weight, change in weight (year to year), change in BP and gender are not well established. With the aid of electronic medical records (EMR), these data are more accessible on a practice wide level. Methods: EMR (NextGen) of an outpatient practice of 36 cardiologists was queried for weight and SBP recorded in 2008 and 2009. Further, to include only those already established in the practice, and not new patients who would be subject to significant medical changes, the study patients had to be in the practice as of 2007 and seen in the office at least once during 2008 and 2009. To account for erroneous data