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Relation between adiposity and microvascular function in HIV infected women
Abstracts / Journal of the American Society of Hypertension 10(4S) (2016) e19–e38 Positive pressure (PP) treadmills are used to rehabilitate orthopedic/neurological patients. Lower body (LB) PP lowers musculoskeletal strain and load, compresses the lower body and increases intrathoracic volume. These changes should result in baroreceptor activation, which in turn should evoke bradycardia and arterial vasodilation. We hypothesized that LB PP would elicit brachial arterial (BA) vasodilation and decrease BA mean flow velocity (MFV) in normal subjects and that patients with heart failure (HF) would exhibit blunted responses. We prospectively studied short-term effects of progressive LE PP of 25%, 50%, and 75% of body weight on heart rate (HR) and BA MFV and BA dimensions in 21 healthy male subjects (N) and 28 male patients with HF. At baseline, MFV was lower (144cm/s vs 2310cm/s, p<.001) and there was a trend towards larger BA diameter (.417.098 vs .383.054cm, p¼.14) in the HF group. After age adjustment, BA dimension increased more upon LB PP in N compared to HF subjects (122%, vs 22%, p¼.011). MFV responses were similar between the 2 groups (-1011%, vs +18%, p¼.56). Heart rate decreased in both groups, but less so in the HF group (138% vs 87%, p¼.013), whereas systolic and diastolic blood pressures remained unchanged in either group. In conclusion, progressive LB PP elicits a decrease in HR and BA dilation in the N group whereas HR lowering is blunted and BA MFV and BA dimension remain unchanged in HF patients. These differential responses likely represent differences in baroreceptor activation and suggest the potential for LB PP to be used to assess baroreceptor mediated arterial vasodilation. Keywords: pressure support; brachial artery; baroreceptor P-22 Relation between adiposity and microvascular function in HIV infected women Muhammad Ihsan, Arismendy Nunez, Anthony Uglialoro, Susan Holman, Deborah Gustafson, Jason Lazar. Downstate Medical Center, Brooklyn, NY, United States Obesity is well known to be associated with microvascular dysfunction. Obesity and overweight is common in the setting of HIV infection, which in turn is also associated with microvascular abnormalities. The objective of this study was to determine whether body composition is related to microvascular function among HIV infected women. We prospectively examined 80 HIV infected women (Mean age 519 yrs, BMI 328 kg/m2, SBP 127 17 mmHg, CD4 Count 625280, and Viral load 2000 9000 IU/ml) in the Women’s Interagency HIV Study. Post occlusive hyperemic changes were assessed by using near infrared spectroscopy (InSpectra 650). Hyperemia was induced by occluding the brachial artery for five minutes at 50 mmHg over the systolic blood pressure. The overshoot area (OSA) of the tissue oxygen saturation curve was used as an index of microvascular function. Body composition (lean mass, fat mass) was determined by dual-energy X-ray absorptiometry (DEXA). On univariate analysis OSA was correlated with percent android fat(AF) ( r¼-0.30, p ¼ 0.008) but not with BMI (r¼-0.185, p¼0.07), lean mass (LM) (r¼ -0.143; p¼.218) or gynoid fat (GF) ( r¼-0.17; p¼0.15). On multivariate analysis AF was independently associated with OSA after correcting for age, viral load, and CD4 count (R square 0.130, p¼0.006). In conclusion impaired microvascular response was associated with AF but not with BMI, LM or GF among women with HIV infection. Keywords: Microvascular function; HIV; Adipose ANTIHYPERTENSIVE DRUGS AND PHARMACOLOGY P-23 Strategies for optimal blood pressure management in the hospital Ovais Inamullah,1,2 Tanna Lim.1 1Atlanta Medical Center, Atlanta, GA, United States; 2Ross University School of Medicine, Dominica Introduction: Research for the management of hypertension, including the JNC 8 guidelines, generally provides advice for the outpatient
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management of blood pressure, since blood pressure traditionally is most relevant for long-term consequences. There are, however, short-term sequelae from fluctuations in blood pressure that make the management of blood pressure in the hospital very important. The study intends to provide insight into the relative costs and benefits of different management strategies in the hospital. It will hopefully give physicians important information to gauge what decisions they should make in this regard. Methods: This is a retrospective cross-sectional study approved by the IRB at the Atlanta Medical Center. 100 patients were selected with a diagnosis of benign essential hypertension or hypertension NOS, and a length of stay between 3 and 10 days. Medications used in the hospital to manage blood pressure were recorded and compared to home medication lists. The systolic blood pressure of these patients as recorded during the hospital stay was then recorded and analyzed, taking note of cases where the systolic blood pressure exceeded 180 or fell below 90. These outcomes were compared to various parts of the patients’ blood pressure management such as whether home medications were given, which classes of medications were used, and whether IV medication was used. Results: The main results identified can be grouped into three categories: adherence to home medications, use of IV medications, and looking at individual classes of medications. For adherence to home medications, it was noted that altering the home medication regimen was associated with a higher rate of hypotension, with an odds ratio of 1.53. Use of IV medications was seen to increase the risk of hypotension, with an odds ratio of 1.83. Of the drug classes, beta-blockers were associated with the largest increase in hypotension, producing an odds ratio of 2.06. Use of diuretics was also associated with an increase in hypotension, with an odds ratio of 1.96. Calcium channel blockers and RAAS drugs were both associated with a decrease in hypotension. Conclusion: There was a trend toward increased risk of hypotension with non-adherence to home medication, use of IV medications, use of betablockers, and use of diuretics. The odds ratios calculated suggest that physicians should perhaps exercise caution in these situations. Medication regimens are altered for many reasons, including comorbities, efficacy, and adverse effects. This study provides valuable information when making these medication decisions. This study can be generalized to the broader population since a variety of patients in a large sample size were used, but including more patients in the study would produce more reliable results. Keywords: Hypertension; Hypotension; Blood Pressure; Overmedication
P-24 Randomised controlled clinical trials of azilsartan: a systematic review and evidence based perspectives Uday Jadhav,2 Navneet Wadhwa.1 1AUW Global, Mumbai, India; 2 MGM New Bombay Hospital, Navi Mumbai, India Objectives: Azilsartan medoxomil is the most recently approved angiotensin receptor blocker for management of hypertension. We evaluated the evidence for its efficacy and safety across the published randomised controlled clinical trials (RCCTs), the highest level of evidence. Methods: RCCTs evaluating the effect of azilsartan were searched using the systematic review techniques, through the electronic databases (PubMed, Cochrane Library Central, IndMed) upto December 15, 2015 using the specific MeSH, boolean operators with limits for RCCTs. The search yielded 17 titles, abstracts were identified and 15 comparable trials were selected for a comprehensive review. Mann Whitney test used for statistical analysis. Results: Total of 15 trials were identified, 10 comparing azilsartan monotherapy and 4 comparing combination of azilsartan with diuretics (chlorthalidone / hydrochlothizide) and 1 trial comparing azilsartan with fixed dose combination of azilsartan with amlodipine. RCCTs evaluating the treatment effect ranged 6 weeks to 32 weeks, with cumulative duration 194 weeks (mean¼ 13.8 weeks, 95% confidence interval 9.2-18.4 weeks; p < 0.0001). The maximum dose of azilsartan (80mg) used in titrate to
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management of blood pressure, since blood pressure traditionally is most relevant for long-term consequences. There are, however, short-term sequelae from fluctuations in blood pressure that make the management of blood pressure in the hospital very important. The study intends to provide insight into the relative costs and benefits of different management strategies in the hospital. It will hopefully give physicians important information to gauge what decisions they should make in this regard. Methods: This is a retrospective cross-sectional study approved by the IRB at the Atlanta Medical Center. 100 patients were selected with a diagnosis of benign essential hypertension or hypertension NOS, and a length of stay between 3 and 10 days. Medications used in the hospital to manage blood pressure were recorded and compared to home medication lists. The systolic blood pressure of these patients as recorded during the hospital stay was then recorded and analyzed, taking note of cases where the systolic blood pressure exceeded 180 or fell below 90. These outcomes were compared to various parts of the patients’ blood pressure management such as whether home medications were given, which classes of medications were used, and whether IV medication was used. Results: The main results identified can be grouped into three categories: adherence to home medications, use of IV medications, and looking at individual classes of medications. For adherence to home medications, it was noted that altering the home medication regimen was associated with a higher rate of hypotension, with an odds ratio of 1.53. Use of IV medications was seen to increase the risk of hypotension, with an odds ratio of 1.83. Of the drug classes, beta-blockers were associated with the largest increase in hypotension, producing an odds ratio of 2.06. Use of diuretics was also associated with an increase in hypotension, with an odds ratio of 1.96. Calcium channel blockers and RAAS drugs were both associated with a decrease in hypotension. Conclusion: There was a trend toward increased risk of hypotension with non-adherence to home medication, use of IV medications, use of betablockers, and use of diuretics. The odds ratios calculated suggest that physicians should perhaps exercise caution in these situations. Medication regimens are altered for many reasons, including comorbities, efficacy, and adverse effects. This study provides valuable information when making these medication decisions. This study can be generalized to the broader population since a variety of patients in a large sample size were used, but including more patients in the study would produce more reliable results. Keywords: Hypertension; Hypotension; Blood Pressure; Overmedication
P-24 Randomised controlled clinical trials of azilsartan: a systematic review and evidence based perspectives Uday Jadhav,2 Navneet Wadhwa.1 1AUW Global, Mumbai, India; 2 MGM New Bombay Hospital, Navi Mumbai, India Objectives: Azilsartan medoxomil is the most recently approved angiotensin receptor blocker for management of hypertension. We evaluated the evidence for its efficacy and safety across the published randomised controlled clinical trials (RCCTs), the highest level of evidence. Methods: RCCTs evaluating the effect of azilsartan were searched using the systematic review techniques, through the electronic databases (PubMed, Cochrane Library Central, IndMed) upto December 15, 2015 using the specific MeSH, boolean operators with limits for RCCTs. The search yielded 17 titles, abstracts were identified and 15 comparable trials were selected for a comprehensive review. Mann Whitney test used for statistical analysis. Results: Total of 15 trials were identified, 10 comparing azilsartan monotherapy and 4 comparing combination of azilsartan with diuretics (chlorthalidone / hydrochlothizide) and 1 trial comparing azilsartan with fixed dose combination of azilsartan with amlodipine. RCCTs evaluating the treatment effect ranged 6 weeks to 32 weeks, with cumulative duration 194 weeks (mean¼ 13.8 weeks, 95% confidence interval 9.2-18.4 weeks; p < 0.0001). The maximum dose of azilsartan (80mg) used in titrate to