Background
Arterial stiffness (AS) is a key predictor for cognitive decline, particularly in older adults with mild cognitive impairment (MCI).
Aims
This study aims to investigate the longitudinal relationship between AS and cognition in older adults with MCI.
Method
The MetMemory Trial recruited participants ≥60 years with MCI (Montreal Cognitive Assessment [MoCA] score ≤26/30). Global MoCA score, focusing on memory function (delayed recall (DR) score and memory index score (MIS)) were recorded. The vascular parameters included blood pressure (brachial (BSP) and central systolic (CSP), and central pulse (CPP) pressures), pulse wave analysis (reflection magnitude (RM)), and carotid-femoral pulse wave velocity (PWV). These parameters were assessed at baseline (BL), 6-months follow-up (6MFU) and 12-month follow-up (12MFU). Statistical analysis assessed changes in cognition and vascular parameters at these timepoints.
Results
We included 52 participants with complete data at BL, 6MFU and 12MFU (mean age 72.4 years, 18 females). Repeated-measures ANOVA tests found significant changes across all timepoints for BSP (F(2, 102)=7.901, p=0.001), CSP (F(2, 102)=8.877, p<0.001), CPP (F(2, 102)=3.669, p=0.029), DR (F(2, 102)=5.156, p=0.007) and MIS (F(2, 102)=6.594, p=0.002). Post-hoc pairwise comparison using the Bonferroni correction revealed that there were significant reductions in blood pressure parameters between BL and 6MFU for BSP (143.61mmHg BL, 136.2mmHg 6MFU, p=0.001) and CSP (132.39mmHg BL, 125.31mmHg 6MFU, p<0.001), while memory function significantly improved; DR (1.87 BL, 2.46 6MFU, p=0.034) and MIS (9.54 BL, 10.89 6MFU, p=0.003). These parameters remained significant at 12MFU compared to BL; BSP (136.73mmHg 12MFU, p=0.007), CSP (126.67mmHg 12MFU, p=0.007), DR (2.56 12MFU, p=0.025), and MIS (10.67 12MFU, p=0.027). Reductions in CPP were only significant between BL and 12MFU (49.47mmHg BL, 46.69mmHg 12MFU, p=0.04). There were no significant differences between 6MFU and 12MFU in any parameter. Significant changes were not observed in PWV nor global MoCA scores. Furthermore, there was no correlation found between these changes in vascular and cognitive parameters between timepoints.
Conclusion
Despite negligible changes in AS, significant reductions were observed in systolic and pulse pressures, which may contribute to improvements in participants’ memory function observed at 6MFU and sustained at 12MFU. The MetMemory study is ongoing.

Background: New to market automatic blood pressure (BP) devices should undergo clinical validation according to a scientifically recognised protocol to ensure accurate measurements. Some recent research suggests a reduced accuracy of automated cuff BP in females compared to males. Females have been underrepresented in many areas of clinical research, but it is unknown whether this is common among BP device validation studies and if it is a contributory factor to reduced accuracy in females. The aim of this study was to determine the proportion of females compared to males recruited to validation studies and whether there is any relationship with the accuracy of automated BP measurement.
Methods: A systematic review of BP device validation studies published between 1987 and 2023 was conducted. Studies that tested automated, upper-arm devices compared to auscultatory BP in a general population, including children, were included. Descriptive statistics were used to determine the proportion of females and males recruited and weighted meta-regression analyses were used to assess the relationship between sex and measurement accuracy.
Results: Out of 319 eligible validation studies, the proportion of females and males recruited was reported in 284 (89.0%) studies. Only six (2.1%) studies included <30% females or males, which is the current minimum requirement of international standards. An average of 50.8% females were recruited to validation studies, and this was consistent across different validation protocols and year of study publication. There was no relationship between sex and measurement accuracy (p>0.05), except for a weak tendency of automated devices to overestimate manual measurements of diastolic BP among studies with a greater proportion of females (R²=0.019, p=0.022).
Conclusion: Females are not underrepresented in BP device validation studies. There was no meaningful relationship between the proportion of females recruited and measurement accuracy. These findings indicate current protocols are adequate to ensure representation of females and males in validation studies.

Background and Aims: Relatively few blood pressure (BP) devices have been validated for children and adolescents. This is a critical undertaking given the increasingly recognised need for childhood BP screening to detect long-term cardiovascular risk. Therefore, the aims of this study were to 1) assess the accuracy of the Uscom BP+ oscillometric upper-arm professional blood pressure (BP) monitor in children and adolescents as per the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) and 2) assess the impact of motion artefact on accuracy and precision.

Methods: Children and adolescents were recruited to fulfil the sex/cuff distribution criteria of the Universal Standard. Single arm sequential BP measurements were used, the test device measured on deflate with an altered child/adolescent algorithm (constant offsets applied after pilot analysis at n=58 to counteract systematic over/underestimation of systolic/diastolic BPs), and four test device cuffs were used across arm circumferences 12-42 cm. The presence of motion artefact was determined and its impact on BP assessed.

Results: One-hundred-twenty-three participants were included for analysis. When using all four test device cuffs, the BP+ did not meet either criterion 1 or 2 (109 participants, 321 pairs), but without the Wide Range cuff (which displayed particularly poor precision), it passed both criteria (95 participants, 279 pairs, Criterion 1: -0.1±7.3/-1.6±7.6 mmHg, threshold 5±8 mmHg; Criterion 2: 5.72/6.50 mmHg, threshold (≤6.95≤6.76); systolic/diastolic). When measurements with motion artefact were included, precision was substantially worse (0.0±8.8/-1.4±8.6 mmHg) than when motion artefact was excluded based on 1) visual inspection of cuff pressure signals (-0.3±6.9/-1.8 ± 7.0 mmHg) or 2) an automatic algorithm developed by the manufacturer (-0.1±6.9/-1.5±6.9 mmHg).

Conclusion: The Uscom BP+ fulfilled the requirements of the Universal Standard in children and adolescents when using the altered algorithm with the Extra Small, Small Adult or Adult cuffs and can be recommended for clinical use with these cuffs. The Wide Range cuff cannot be recommended in this population in measure-on-deflate mode and the accuracy of the Large Adult cuff could not be determined due to poor fitment in this population. Additionally, BP measurement accuracy in children and adolescents can be improved through inclusion of a motion artefact detection system.

Background. Advances in technology mean that accurate BP measurements can be automatically performed, allowing widescale use of self-BP measurement at home. Despite these advances, some health professionals and patients question the accuracy of devices that are designated for use at home, compared to in-clinic BP devices.

Aim: To determine if there were differences in the accuracy of home BP devices compared with in-clinic BP devices.

Methods. A systematic review of BP measurement validation studies of automated, upper-arm devices in adults published between 1987-2023. Intended primary use of each device was extracted from the published validation study. A random effects meta-analysis was performed to estimate pooled mean BP differences across validation studies for home BP and in-clinic BP devices, compared to manual BP.

Results. There were 202 home device, and 55 in-clinic device validation studies that met inclusion criteria. In comparison to manual systolic BP, the mean difference (95% CI) for home device systolic BP was -0.0 mmHg (95% CI: -0.11, 0.09), and the mean difference for in-clinic device systolic BP was -0.0 mmHg (95% CI: -0.17, 0.16). There was no significant difference in the accuracy of home vs. in-clinic systolic BP (p=0.98).
In comparison to manual diastolic BP, the mean difference (95% CI) for home device diastolic BP was -0.2 mmHg (95% CI: -0.25, -0.1), and the mean difference for in-clinic device diastolic BP was -0.6 mmHg (95% CI: -0.77, -0.47). There was no significant difference in the accuracy of home vs. in-clinic device diastolic BP (p=0.16).

Conclusion. There were no meaningful differences in accuracy between home BP devices and in-clinic BP devices, showing that any validated device will yield accurate BP results if used according to standardized measurement principles.

Background. Since 2016, Australian clinical guidelines recommend using automated office blood pressure (AOBP) for hypertension management. However, AOBP is not routinely used in clinical practice, and the end-users of AOBP (patients and health professionals) have not been consulted on using the method in practice. This study aimed to understand the enablers and challenges to the clinical use of AOBP in general practice.
Methods. Design Thinking methodology guided 14 face-to-face and online co-design workshops with 44 health professionals who perform BP measurement (general practitioners, nurses, health workers, pharmacists) and 47 community members (adults with known or suspected hypertension; 50% female; age range 32 – 84 years) across three Tasmanian regions between June and August 2024. Recruitment was purposive via snowballing technique. Participants were asked about the perceived enablers and challenges to conducting AOBP in general practice. Inductive and deductive thematic data analysis was performed.
Results. Both community members and health professionals indicated their strong support for enabling AOBP measurement in general practice. High-priority enablers and challenges that were common across both participant groups were ensuring: availability of validated AOBP equipment; adequately trained staff; perceived trustworthiness of staff; appropriate and private spaces to conduct AOBP; integration of data to the general practitioner electronic management software, and; provision of education and resources to correctly interpret AOBP information aimed at both patients and health professionals. To increase utility, general practitioners suggested including standing BP and atrial fibrillation screening to the AOBP protocol for specific subgroups of patients.
Conclusions. There is strong support from community members and health professionals to integrate AOBP into routine general practice. The enablers and challenges identified in this study can help inform implementation of AOBP in Australian general practice.

Background. For accurate and reliable office blood pressure (BP) measurement, it must be performed using a standardised, guideline-recommended protocol. This takes at least 10 minutes, with no talking or other distractions. Feasibility of this approach in clinical practice has not been examined. This study explored the use and feasibility of office BP measurement among health professionals and community members in the clinical setting.
Methods. Design Thinking methodology guided 14 face-to-face and online co-design workshops with health professionals who perform BP measurement (general practitioners, general practice staff, nurses, health workers, pharmacists, n=44) and community members (adults with known or suspected hypertension, n=47) across three Tasmanian regions. Workshops discussed the guideline-recommended protocol for BP measurement, including whether health professionals adhered to this protocol, and if community members’ BP measurements were taken according to the protocol (and if not, why not). Inductive and deductive thematic analysis was applied.
Results. There was high awareness among health professionals of the guideline-recommended protocol and the correct way to measure BP. However, none reported measuring BP strictly according to the protocol, instead advising this was not feasible in practice. The most common reason given for this was time constraint, summarised by one general practitioner as there was “no way [the protocol can be performed].” It was common for health professionals to report that they performed a modified protocol to try and adhere to rigorous BP measurement (these approaches varied between practitioners). Community members reported never having received protocol-driven BP measurement from a health professional, also citing time constraint as the main cause. Community members were also concerned that BP was often not taken. All participants supported finding better ways to perform higher quality office BP measurement.
Conclusions. The guideline-recommended protocol for measuring BP is not feasible for health professionals to undertake in routine clinical practice. The study results suggest there is an urgent need for guideline review and developing an updated protocol that is feasible for implementation in primary care.

Background and Aim:
The association between blood pressure variability (BPV) and mental health is a critical area of research, yet the role of central BPV remains poorly understood. This study aims to explore the relationship between central BPV with anxiety, depression, and sleep quality.

Methods:
We recruited 94 participants across three hospitals, primary care centers, and the general community in metropolitan Adelaide and Sydney. Participants underwent 24-hour ambulatory BP monitoring (SunTech® Oscar 2) with an algorithm for estimating central BPV. Mental health symptoms were evaluated using the Generalized Anxiety Disorder-7 scale, Patient Health Questionnaire-9, and Sleep Condition Indicator. The 24-hour ambulatory BP recordings were used to calculate the coefficient of variation in BPV (overall, awake, asleep), along with central BPV and central augmentation index (a measure of pressure in the central arteries).

Results:
Linear bivariate correlations revealed significant associations between central systolic BPV and anxiety (r = -.215, p = .045). When controlling for age and gender, central augmentation index variability demonstrated an inverse relationship with anxiety symptoms across all timeframes, with partial correlations ranging from (r = -.241, p = .026) during awake periods to (r = -.278, p = .010) during sleep. Variability in diastolic blood pressure during both overall and awake periods was inversely correlated with sleep quality, with correlations of (r = -.216, p = .044) and (r = -.250, p = .019) respectively. Notably, mean blood pressure was not associated with mental health, indicating that fluctuations in BP were more strongly correlated with mental health symptoms and specifically anxiety and sleep quality.

Conclusions:
These findings indicate that higher central BPV and central augmentation index were associated with lower and therefore better anxiety and sleep quality. These findings generally contrast with what is known and reported regarding brachial measures of BPV from ambulatory blood pressure studies.

Background and Aim: Adiposity is associated with early signs of cardiometabolic dysfunction and negative effects on brain structure and function. Whether alterations in brain neuronal activity is associated with vascular and metabolic health remain unknown. Therefore, we investigated resting-state brain dynamics and its link with vascular and metabolic profile in healthy individuals with varying adiposity levels.
Methods: Magnetoencephalography (MEG) was performed in 29 healthy participants (BMI 16.7 to 33.8kg/m2 and body fat percentage 7 to 45.3%). MEG data was co-registered with structural T1-MRI and source activity determined using Linearly Constrained Minimum Variance (LCMV) beamformer. Source activity was expressed as neural activity index (NAI) for brain regions-of-interest, selected based on their role in obesity-related cardiometabolic dysfunction, in physiological frequency bands: delta (1-4Hz), theta (4-8Hz), alpha (8-13Hz), beta (13-30Hz) and gamma (30-120Hz). Brachial blood pressure (BP) was obtained using OMRON Automatic Blood Pressure Monitor. Vascular function was assessed using SphygmoCor XCEL to derive central BP and arterial stiffness measurements. Metabolic parameters were obtained from a fasting-state blood sample. Correlations between NAI’s in regions-of-interest and vascular-metabolic parameters were assessed using linear regression, adjusted for sex, age and fat percentage.
Key results: Brachial diastolic BP correlated positively with NAI in right parahippocampus, insula and amygdala (alpha band) while central systolic and diastolic BP correlated with NAI in left orbitofrontal cortex (theta, alpha and beta bands). Arterial stiffness measured via augmentation index correlated negatively with NAI in left and right medial prefrontal cortex (delta, theta and gamma bands) while pulse wave velocity correlated positively with NAI in left caudate (theta and alpha bands). NAI in several brain regions correlated with metabolic parameters (glucose, creatinine and liver proteins) including left hippocampus, parahippocampus, putamen and right anterior cingulate gyrus and caudate (over several frequency bands).
Conclusion: We have shown that key brain regions including medial prefrontal, orbitofrontal and cingulate cortices, insula, hippocampus, parahippocampus, putamen, caudate and amygdala are associated with vascular and metabolic profile in healthy individuals with varying adiposity levels. These findings suggest that specific brain regions involved in cognitive and emotional processing may be influenced or contribute to vascular and metabolic health.

Background: Recruiting renal functional reserve (RFR), the capacity of the kidneys to increase glomerular filtration rate (GFR) with amino acid/protein loading has the potential to diagnose kidney disease. However, the safety and reliability of RFR recruitment to detect the risk of acute kidney injury (AKI) transitioning to chronic kidney disease (CKD) after cardiac surgery requiring cardiopulmonary bypass (CPB) is unclear.
Aim: To evaluate the safety and efficacy of RFR recruitment via intravenous amino acid infusion as a diagnostic tool for detecting transition of AKI to CKD after CPB in a clinically relevant sheep model
Methods: Ten healthy adult female sheep were subjected to mildly hypothermic CPB with a 2-hour aortic cross-clamp. An RFR test was conducted before CPB and weekly over 4-weeks post-CPB in non-anaesthetised sheep. RFR was recruited with an intravenous infusion of a clinically approved amino acid solution (50 g of amino acids in 500 mL) over 30 min. Mean arterial pressure (MAP), RFR (Peak GFR – resting GFR), renal blood flow (RBF), medullary and cortical tissue perfusion and oxygenation were measured.
Results: In sheep undergoing CPB, there was a 42% incidence of AKI at 48-hours postoperatively. Despite functional recovery, renal histopathological injury characterised by peritubular inflammation (8/8 vs. 1/5, P=0.007, compared with the healthy controls), tubular casts (8/8 vs. 1/5, P=0.007) and interstitial fibrosis (6/8 vs. 0/5, P=0.021) were observed at four weeks post-CPB. RFR recruitment caused a transient, significant increase in MAP and RBF from baseline levels both pre-CPB (86.4±7.4 to 95.1±6.8 mmHg and 6.60±1.68 to 8.56±1.78 mL/kg/min) and post-CPB (85.9±10.0 to 92.3±8.5 mmHg and 5.56±1.56 to 8.45±2.06 mL/kg/min at four weeks). Recruitment of RFR did not significantly alter renal cortical and medullary tissue perfusion and oxygenation. RFR pre-CPB was not significantly different from the level 4 weeks after CPB (52.6±22.0 mL/min pre-CPB vs. 69.7±44.2 mL/min, P=0.49).
Conclusion: Amino acid loading in healthy sheep undergoing CPB was safe for the renal macro- and microcirculation, and RFR was unchanged after CPB. The effectiveness of RFR to predict risk of AKI transitioning to CKD in the presence of pre-existing comorbidities warrants further investigation.

Introduction:
Sodium Glucose Co-transporters (SGLTs) are transport proteins expressed in various organs and play an important role in glucose regulation. Inhibitors of SGLT family members are a novel therapeutic strategy for managing glycaemic control in diabetes, with proven cardiorenal benefits. Recently, dual SGLT1/2 inhibitors such as Sotagliflozin (SOTAG) were developed targeting both SGLT1 and 2 proteins to further optimise glucose control and reduce adverse cardiovascular and renal events in diabetes. We have identified that SGLT2 inhibition results in a compensatory increase of SGLT1 in the kidney, with the potential consequence of reduced efficiency of SGLT2 inhibitors. This finding highlights the critical need for dual SGLT1/2 inhibition to fully understand the benefits and the mechanism of action of this drug class.

Aim:
Investigate whether SGLT1/2 inhibition with SOTAG exerts cardiorenal protection in a mouse model of Type 1 Diabetes (T1D).

Method:
Sotagliflozin (SOTAG) or Vehicle was administered to T1D Akimba mice (21-week-old) for 2 weeks at a dose of 25 mg/kg/day in drinking water. Urine glucose levels, water consumption and body weight were measured weekly. Urine and blood pressures (BP) measurements were collected before and 2 weeks after treatment. Serum, kidney and heart tissues were harvested under terminal anaesthesia at the end of the experiment. Tissues were assessed using immunohistochemistry or biochemistry techniques.



Results:
Treatment with SOTAG significantly improved fasting blood glucose levels (Veh vs SOTAG: 33.3 vs 20.3 mmol/l; p=0.01), polydipsia, kidney/body weight ratio (Veh vs SOTAG: 0.0108 vs 0.0101 p=0.05) and systolic BP (Veh vs SOTAG: 4 vs -19 mmHg; p=0.01) in diabetic Akimba mice. Furthermore, short-term SOTAG treatment in T1D mice improved kidney function, as evidenced by reduced levels of albuminuria, blood urea nitrogen (Veh vs SOTAG: 14.11 vs 10.63 mmol/l), serum creatinine (Veh vs SOTAG: 8.28 vs 7.23 umol/l)and improved kidney pathology. Additionally, SOTAG improved mild interstitial fibrosis observed in the T1D heart.
Conclusion:
SOTAG lower BP and improved kidney function in our T1DM mouse model. Our data suggests that SGLT1/2i could be a relevant therapeutic in protecting the heart and kidneys in T1D. Early initiation of treatment may help prevent severe multi-organ damage due to diabetes.

Background and Aim: Since renal injury is implicated in the pathophysiology of preeclampsia (PE), detecting renal dysfunction early will improve the management of this maternal syndrome. This study thus aimed to evaluate renal dysfunction associated with an arginine vasopressin (AVP) induced rat model of PE to confirm the potential applications of this model in studying the mechanisms underlying renal damage in PE.

Methods: Female Sprague Dawley rats (n=24; non-pregnant saline, pregnant saline, non-pregnant AVP and pregnant AVP) were infused with saline or AVP for 18 days. Blood pressures were recorded throughout gestation. Urine samples were collected to determine proteinuria and levels of glomerular and tubular toxicity markers, albumin and beta-2-microglobulin (β2M) respectively, using a Multiplex ELISA immunoassay. Histological and ultrastructural changes in the kidneys were determined by immunohistochemistry, to assess podocalyxin expression, and transmission electron microscopy respectively.

Results: AVP significantly elevates systolic [143.00 (139.67–144.00) mmHg vs 125.00 (124.00–127.00) mmHg; p<0.05] and diastolic blood pressures [103.50 (100.33–106.88) mmHg vs 81.00 (80.00–87.00) mmHg; p<0.001], as well as proteinuria [0.45 (0.42-0.48) g/L vs (0.24 (0.21-0.32) g/L; p<0.05] in pregnant rats. Urinary albumin (2.84x105 ± 2.02x104 ng/mL vs 7.64x104 ± 2.42x103 ng/mL; p<0.001) and β2M (7.27x104 ± 7.63x103 ng/mL vs 1.03x104 ± 5.48x102 ng/mL; p<0.05) levels are significantly higher in the pregnant AVP vs pregnant saline group, which are indicative of glomerular and tubular injury respectively. Qualitative analysis revealed weak immunostaining of podocalyxin within glomeruli of pregnant AVP treated rats, indicative of glomerular dysfunction. Ultrastructural findings in treated rats further confirmed renal injury via the observation of the effacement and fusion of podocyte foot processes and glomerular basement membrane abnormalities.

Conclusions: In conclusion, AVP infusion increases blood pressure, proteinuria, urinary albumin and β2M levels, downregulates podocalyxin immunoexpression and induces ultrastructural abnormalities. Our findings demonstrate that AVP induces both glomerular and tubular dysfunction in this model and supports the use of this model in future studies investigating the pathogenesis of preeclampsia.

Background and Aims
Primary Aldosteronism (PA) is a leading cause of secondary hypertension which confers a high risk of cardiovascular disease. In particular, the risk of atrial fibrillation (AF) is 3.5-folder higher in people with PA compared to those with blood pressure matched essential hypertension. A recent prospective study reported that 42% of patients with non-valvular AF may have PA. However, it is unclear what proportion of AF patients are screened for and diagnosed with PA in routine clinical practice. This study aimed to assess the proportion of patients with AF in cardiology outpatient clinics who have an Endocrine Society guideline indication for PA screening, their characteristics compared to those without an indication with screening, and the actual rate of screening/diagnosis.

Methods
Data was collected from the medical records of patients who attended cardiology rhythm clinics in one of two tertiary hospitals in Melbourne, Australia, between July 2021 and June 2022. Patients with pre-diagnosed PA or non-AF/multiple arrhythmias were excluded. Recorded data included details of AF, comorbidities, family, and medical history.

Results
Of the 390 patients with AF (median age 64 years, 42% female), 60 (15%) had an indication for PA screening. Of the 192 patients with both AF and hypertension, 56 (29%) had an indication for PA screening. However, none of the patients were screened for or diagnosed with PA. The most frequent indications for PA screening were hypertension controlled with ≥ 4 medications (20/60), and hypertension resistant to 3 or more medications (18/60). Compared to those without, those with an indication for PA screening were significantly older (p=0.02), had higher BMI (p=0.001) and a higher prevalence of ischaemic heart disease (p=0.01), type II diabetes (p=0.01), and persistent or permanent AF (p=0.02).

Conclusions
Screening for PA in patients with AF, particularly those with hypertension, is underutilised in current clinical practice. In view of the higher risk of AF in patients with PA, implementing routine screening for PA in hypertensive patients who attend cardiology rhythm clinics may facilitate timely diagnosis and targeted treatment to prevent the cardiovascular sequelae of untreated PA.

Background: The role of diet in the development and maintenance of the hypertensive state is well-established. Short-chain fatty acids (SCFAs), metabolites of colonic microflora fermentation of dietary fibre, have been implicated in experimental models and clinical trials to impact blood pressure regulation. Dietary interventions increasing serum SCFA levels, particularly acetate, show reductions in 24-hour systolic blood pressure in patients with hypertension. The underlying mechanism of these antihypertensive effects has, however, remained elusive. Given the role of the gut-brain axis and clear evidence for autonomic nervous system activation as important modulators of blood pressure, we examined the relationship between sympathetic drive and SCFA concentration in resistant hypertensives (RH) and healthy controls (HC).

Methods: 25 RH (68.6±9.7 years, 46.6% male) and 28 HC (34.6±16.7 years, 74% male) were recruited. Patients underwent sympathetic microneurography for determination of muscle sympathetic nerve activity (MSNA). Increased burst frequency following a Valsalva maneuverer confirmed electrode placement within a muscle fascicle. Automated analysis of burst counts, baroreflex gain and sympathetic vascular transduction was completed in Ensemble compared against manually calculated values. Patients also underwent blood collection for serum SCFA and automated office blood pressure (AOBP).

Results: AOBP indicated a mean of 156.2±20.9 mmHg and 115.3±10.4mmHg systolic for RH and HC, respectively (p<0.0001). Serum acetate levels were 1340±115.4umol/L for HC and 724.5±116.9umol/L (p<0.0001). Butyrate and propionate concentrations did not significantly differ between groups. MSNA burst frequency was markedly elevated in RH compared to HCs (p<0.001) at 25.3±7.4 burst/minute in HC compared to 40.24±8.3 burst/minute in RH. Higher serum acetate correlated with reduced MSNA burst frequency (p=0.0267, R2=0.4) along with increased sympathetic vascular transduction (p=0.0008, R2=0.82) in RHs. Burst frequency and acetate did not correlate in HCs (p=0.11).

Conclusions: For the first time, this work provides evidence of a sympathetically mediated antihypertensive mechanism of SCFAs in patients with resistant hypertension. This is in contrast to previous understanding which implies a strongly parasympathetically driven response.

Background and Aim:
According to the World Health Organization (WHO), as of 2023, 1.28 billion adults between ages 30-79 were living with hypertension, with approximately two-thirds of that number from low- and middle-income countries (LMICs). By 2025, the number of individuals with hypertension is expected to have reached 1.5 billion, with Sub-Saharan Africa alone projected to have 74.7 million cases. In recent years, Artificial Intelligence (AI) has demonstrated the potential to improve the accuracy of risk assessment tools for predicting, managing, and diagnosing diseases before they escalate. This paper aims to conduct a scoping review to identify current research, innovations, and developments in the application of AI-based tools for hypertension prediction and risk assessment specifically in LMICs.

Methodology:
This scoping review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines to ensure proper representation and organization of the literature. A search was conducted across multiple databases, including PubMed, Elsevier, Google Scholar, Scopus, IEEE Xplore, and the ACM Digital Library. From an initial result of 1,370 papers, four were selected based on predefined inclusion and exclusion criteria. These studies focused on AI-based risk assessment and prediction of hypertension in LMICs.

Results:
The review identified significant research on AI applications for hypertension risk prediction in LMICs. Notable studies include an Ethiopian study on using machine learning algorithms for hypertension risk prediction, and another involving hypertensive patients from South Asian countries (Bangladesh, Nepal, India) that employed non-invasive information and machine learning tools for accurate hypertension prediction. Algorithms discussed in these papers include Logistic Regression, Decision Trees, and Naïve Bayes.

Conclusion:
The reviewed studies highlight the promising potential of AI to enhance hypertension prevention and management in LMICs. Successful implementation of AI tools requires the development of locally contextualized models and the availability of validated local data. AI can significantly impact hypertension outcomes in LMICs, provided these conditions are met.

Objective: To determine the preclinical potential of nicotinamide in regulating blood pressure, placental and foetal development in a Sprague Dawley rat model of preeclampsia.
Methods: Twenty-four female Sprague Dawley rats were subcutaneously administered arginine vasopressin (AVP) at a rate of 200 ng/h via mini osmotic pumps for 21 gestational days (GD). From GD7, the AVP treated rats [pregnant saline (PS), pregnant AVP saline (PAVPS), pregnant AVP nicotinamide (PAVPN), and pregnant AVP captopril (PAVPC: control)], were orally administered with either Nicotinamide [200 mg/kg body weight (BW)] or captopril (40 mg/kg BW)] over a 2-week period. Blood pressure and urinary output were measured on GD 7, 14 and 18, whereas foetal and placental weights were recorded on sacrifice (GD21). Urinary levels of vascular endothelial growth factor (VEGF) and osteopontin (OPN) was measured using a Multiplex kidney toxicity immunoassay.
Results: A statistically significant reduction was observed for blood pressures (systolic and diastolic) and urine output in treated (PAVPN and PAVPC) versus untreated (PAVPS) groups. Placental and individual pup weights was significantly different between the normal control (PS) and the AVP-control (PAVPS) groups, increasing notably following oral treatment with nicotinamide and captopril respectively. A significant reduction was observed for urinary protein and creatinine levels in the nicotinamide and captopril-treated groups versus the AVP-control (PAVPS) group. VEGF levels increased significantly in the nicotinamide-treated (PAVPN) versus the AVP-control (PAVPS) groups (p <0.05). In contrast, OPN levels were lower in the PAVPN compared to the PAVPS groups, albeit non-significant.
Conclusion: Our findings demonstrates that nicotinamide effectively reduced both systolic and diastolic blood pressure in AVP-treated rats as well as significantly increased urine output, and placental and individual pup weights. A significant reduction was also noted in urinary protein, creatinine and OPN levels whilst VEGF was increased, indicative of an improved renal function. These findings underscore the preclinical effectiveness of oral administration of nicotinamide in mitigating the symptoms associated with hypertension in pregnancy and thus improved both maternal and foetal well-being.

Background: Meta-analysis of long-term follow-up studies in patients with heart failure and diabetic nephropathy treated with glucagon-like peptide-1 (GLP-1) agonist and sodium-glucose cotransporter-2 (SGLT-2) inhibitors has demonstrated a lower incidence of acute kidney injury (AKI). Whilst SGLT2 inhibitors and GLP-1 agonists may be nephroprotective in chronic kidney disease, the effects of these drugs in acute critical illnesses such as septic AKI has not been previously investigated.
Aims: To test the safety and efficacy of empagliflozin and the GLP-1 peptide hormone in septic sheep with established AKI.
Methods: Adult female sheep were instrumented with laser doppler and oxygen-sensing probes in the renal medulla. Sepsis was induced via a continuous intravenous infusion of live Escherichia.coli for 24-hours. From 24 to 30 hours, sheep were randomised to receive an intravenous infusion of empagliflozin (0.2 mg/kg; N=8), GLP-1 peptide (216 pg/kg; N=8) or fluid-matched vehicle (N=8) treatment. At necropsy, renal tissue was collected for histopathological studies.
Results: By 24-hours of sepsis, sheep developed hypotension, tachycardia, fever, and hyperlactatemia which persisted until 30-hours in all treatment groups. Septic AKI was characterised by renal medullary ischemia (982.6±125.1 to 566.3±91.7 blood perfusion units, P=0.02) and tissue hypoxia (33.6±2.8 to 25.4±3.7mmHg, P=0.04), elevated plasma creatinine (64.8±1.8 to 105.3±5.3µmol/L, P<0.0001) and oliguria (51.9±4.5 to 37.1±5.5ml/h, P=0.04). Neither empagliflozin nor GLP-1 treatment significantly altered medullary hypoperfusion (P>0.63) or hypoxia (P>0.26) compared with vehicle treatment. Furthermore, empagliflozin and GLP-1 did not improve indices of kidney function as plasma creatinine levels remained elevated (P=0.65). The incidence of acute tubular necrosis (ATN) was comparable in empagliflozin compared to vehicle treatment (1/8 sheep in each group). In contrast, the incidence of ATN was higher in septic sheep treated with GLP-1 (3/8 sheep).
Conclusion: In a clinically relevant sheep model of established septic AKI, treatment with SGLT2 inhibitors and GLP-1 peptide hormone did not confer renoprotection against sepsis-induced renal medullary hypoxia and AKI. The higher incidence of ATN with GLP-1 peptide hormone treatment raises safety concerns on its utility as a therapeutic for septic AKI.

Background and Aim: Pre-eclampsia, or pregnancy-associated hypertension, represents an escalating public healthcare concern, emerging as a prominent contributor to both fetal and maternal morbidity and mortality. Increasing interest is directed towards natural products, especially plant extracts, as potential therapeutic agents. Medicinal plants offer accessibility, minimal side effects, and potential new treatment options. Therefore, this study evaluated the preclinical effectiveness of a methanol extract of Dombeya rotundifolia on hematological and angiogenic outcomes in an arginine vasopressin (AVP) rat model of pre-eclampsia.

Methods: Pregnant Sprague-Dawley rats were implanted with mini-osmotic pumps to deliver AVP (200 ng/h). They were treated via oral gavage with saline solution (normal control), AVP + saline (AVP-control), AVP + methanol extract of D. rotundifolia (plant-treated; 200 mg/kg BW), or captopril (20 mg/kg BW) for 14 days.

Results: Systolic [130.74±7.08 mmHg vs. 157.17±6.1 mmHg] and diastolic [85.21±2.72 mmHg vs. 92.91±2.01 mmHg] blood pressures were significantly reduced (p<0.05) in the plant-treated group compared to the AVP-control. Urinary volume excretion was lower in the AVP-control group [8.17±1.07 ml] compared to the normal control group [23.8±2.48 ml], with a notable increase following plant treatment, though non-significant. Red cell distribution width (RDW) and mean corpuscular hemoglobin (MCH) levels were significantly lower in the plant-treated group [RDW: 11.30±0.22 %; MCH: 29.76±0.77 g/dL] compared to the AVP-control group [RDW: 14.66±0.91 %; MCH: 27.97±0.47 g/dL; p<0.05]. Significant differences were observed in white blood cell counts between the plant-treated and AVP-control groups [neutrophils: 14.38±3.74 % vs. 1.00±4.27 %; lymphocytes: 82.49±4.70 % vs. 63.78±1.9 %; eosinophils: 0.97±0.42 % vs. 2.30±0.82 %]. Placental weight [0.44±0.3 g vs. 0.74±0.2 g; p<0.05] and individual pup weight [4.47±0.44 g vs. 6.0±0.24 g; p<0.01] were significantly higher in the plant-treated group. Endoglin levels were reduced in the plant-treated group compared to the AVP-control, while placental growth factor (PGF) was lower in the AVP-control group relative to the plant-treated group (p<0.05).

Conclusions: Oral administration of D. rotundifolia resulted in reduced blood pressures and endoglin levels as well as improved placental and pup weights. These findings suggest potential benefits of D. rotundifolia in mitigating pre-eclampsia-associated physiological changes in a rat model.

Background and aims: Micro- and macroalbuminuria measured by urinary albumin-to-creatinine ratio (UACR) (30–300 mg/g and > 300 mg/g, respectively) is associated with higher risk of mortality, CV disease and CKD progression. In the PRECISION trial, the endothelin ETA/ETB receptor antagonist aprocitentan added to standard background therapy including valsartan, reduced UACR in patients with confirmed resistant hypertension (RHT) by 30% compared to placebo with aprocitentan 12.5 mg (LS Geom Mean [95CL] 0.70 [0.61, 0.80], p<0.0001) and by 34% with 25 mg aprocitentan (0.66 [0.58,0.75] p<0.0001) at the end of double-blind part 1 (4 weeks) in the overall population. In this analysis, we evaluated the effect of aprocitentan on UACR at both doses according to the baseline (BL) albuminuria (30–300 mg/g and >300mg/g).

Methods: 730 patients with RHT on a standardized fixed-dose combination of amlodipine/ valsartan/hydrochlorothiazide were randomized to aprocitentan (12.5 mg or 25 mg) or placebo. Of these, 174 and 90 had BL microalbuminuria or macroalbuminuria, respectively. Changes from BL in UACR and office systolic blood pressure measured at trough (SBP, the primary endpoint in PRECISION) after 4 weeks of double-blind treatment.

Results: In subjects with microalbuminuria, aprocitentan reduced UACR by 43% in the 12.5 mg group (0.57 [0.42, 0.78], p=0.0005) and by 45% in the 25 mg group (0.55 [0.40,0.77] p=0.0004) compared to placebo. In subjects with macroalbuminuria, aprocitentan reduced UACR by 48% with 12.5 mg (0.52 [0.37, 0.75],
p=0.0006) and by 61% with 25 mg (0.39 [0.27,0.57] p<0.0001) compared to placebo. In contrast, placebo did not have any noticeable effect on albuminuria in any group. The effect of aprocitentan in lowering blood pressure, measured at trough, was independent of the level of albuminuria at baseline.
After 4 weeks, 53.3% and 60% of patients achieved a decrease of ≥10 mmHg from baseline with 12.5 mg aprocitentan, respectively in the microalbuminuria and macroalbuminuria groups, compared to 64% with aprocitentan 25 mg (both cohorts) and 48% and 29% in the placebo group.

Conclusion: Aprocitentan produced a major decrease of albuminuria regardless of baseline level in patients with RHT. These findings suggest substantial clinical benefit of aprocitentan in CKD patients.

Background and Aim: The phase-3 PRECISION study demonstrated the efficacy of aprocitentan to lower both office and ambulatory blood pressure (BP) in patients with resistant hypertension. Increased arterial stiffness has been associated with less favorable responses to pharmacologic BP lowering therapies. In this post-hoc analysis, we investigated the impact of arterial stiffness on the BP lowering effect of aprocitentan.

Methods: The study included a 4-week double blind period (aprocitentan 12.5 mg, 25 mg, or placebo) and a 32-week single blind period (aprocitentan 25 mg). A total of 730 patients with resistant hypertension were randomized and 633 had available ambulatory BP monitoring (ABPM) results at baseline. The ambulatory arterial stiffness index (AASI) was calculated from ABPM data as 1 minus the regression slope of diastolic on systolic BP. The patient population was dichotomized into two groups according to baseline median AASI.

Results: Patients with higher baseline AASI (≥0.54) tended to be older (63±11 vs 60±10yrs) and have higher 24-hour ambulatory systolic BP (140±14 vs 135±14 mmHg) than patients with lower AASI (<0.54). The BP lowering effect of aprocitentan at Week 4 was similar for both the patients with stiffer vasculature who have a higher baseline AASI (≥0.54) and for those with a lower AASI (<0.54) (Table 1). No relevant change in AASI was reported with aprocitentan treatment at Week 4 (end of double-blind period) or Week 36 (end of single-blind period).

Table1: Changes from baseline to Week 4 in 24-hour mean systolic BP measured by ABPM versus placebo using an analysis of covariance (ANCOVA) with a covariate for baseline 24-hour mean systolic BP.
Treatment effect
Aprocitentan 12.5 mg versus placebo Aprocitentan 25 mg versus placebo
n LS Mean (mmHg) p-value n LS Mean(mmHg) p-value
Patients with
AASI<0.54 99 -4.44 0.0020 86 -5.96 <0.0001
AASI≥0.54 76 -3.87 0.0145 96 -5.83 <0.0001

No correction for multiplicity was applied
AASI: ambulatory arterial stiffness index; LS: Least square

Conclusion: Aprocitentan is an effective BP lowering therapy across the arterial stiffness continuum observed in patients with resistant hypertension. Longer observation time is needed to fully assess the impact of treatment on this structural and functional parameter.

Background: A significant challenge faced by Australian researchers is the capacity to efficiently identify and recruit eligible research participants from the community. Few studies enroll enough participants to meet planned recruitment targets, within scheduled timelines, and in line with the intended budget. Join Us seeks to address this problem with a disease-agnostic national research register that connects researchers with Australian community members interested in participating in research studies. Methods: All Australians above 18 years of age are eligible to register online (www.joinus.org.au). Participants consent to be contacted about research studies and provide their contact and health-related information at the time of registration. Researchers seeking study participants provide Join Us with key eligibility criteria, and participants are matched accordingly. The Join Us team then extends the research study invitations to eligible participants via email. Join Us sources its recruitment through face-to-face interactions at events, digital and print media advertisements, stakeholder collaborations, and is currently piloting a mail-out via Services Australia. Current Status: With current funding from the Australian Stroke and Heart Research Accelerator (ASHRA), Join Us has recruited 5000 participants and facilitated recruitment invitations on behalf of 85 research studies from 30 different institutions as of date. Of the total participants enrolled to date, 45% have reported cardiovascular disease conditions and comorbidities including diabetes, hypertension, high cholesterol, and peripheral vascular disease. Conclusion: Join Us is intended as a national resource that will make community engagement in health research more equitable, rapid and efficient, thereby improving Australia’s global competitiveness in health care and medical research.

Background
Increased blood pressure (BP), especially sudden, unexpected and severe rises in women with preeclampsia considerably increases the risk of peripartum complications. These risks are even more acute in the context of general anaesthesia (GA). These sudden rises in BP are sometimes unpredictable and in some settings when beat to beat blood pressure monitoring or automated BP is not available, may be difficult to monitor.

Aim
This study aimed to explore alternative approaches to BP measurement that capture nuance often lost in single clinical BP measurements.

Methods
Blood Pressure was measured under GA in nine, pregnant Papio hamadryas (baboons) with experimental preeclampsia (EPE). Animals were given antihypertensives commonly used to manage preeclampsia: labetalol, methyldopa and hydralazine at equipotent doses equivalent to mild starting dose rates commonly used in women with preeclampsia. Blood pressure was analysed with four different methods: average BP, BP load (percentage of readings within one and two standard deviations of the average), variability analysis (expressed as SD calculated by Poincare plots) and a chaos algorithm (categorises BP as stochastic, periodic or chaotic).

Results
The average systolic BP before/on antihypertensive drug treatment (labetalol, methyldopa, hydralazine combined) during ketamine GA was 136 and 137 mmHg versus 112 and 104 mmHg for sevoflurane GA (p=0.003). BP load during GA (ketamine, propofol or sevoflurane) before and on labetalol, methyldopa or hydralazine treatment was calculated. BP load reduced significantly on methyldopa treatment during propofol GA (p < 0.01) and increased on hydralazine treatment (p = 0.02). BP load also increased significantly on labetalol treatment during sevoflurane GA (both p < 0.05) whereas BP load decreased significantly on methyldopa and hydralazine treatment during sevoflurane GA (all p < 0.01).

Variability analysis identified a significant decrease in long-term variability/SD2 on labetalol treatment during propofol GA (p = 0.02) and a significant increase on methyldopa treatment during ketamine GA (p = 0.002). There were no other significant differences between the different antihypertensive drug treatments during the different GA.

The chaos algorithm classified BP data from the propofol GA group primarily as chaotic or periodic and the ketamine and sevoflurane GA groups were largely classified as stochastic.

Conclusion
Ketamine GA with antihypertensives showed a higher average BP, and more BP variability with a stochastic pattern in a chaos algorithm suggesting ketamine may not provide optimal GA conditions for EPE.

Background: Hypertension is the leading cause of cardiovascular diseases and premature deaths worldwide. It contributes about 1.6 million deaths annually in India of which 50% related to stroke and 24% related to coronary heart disease. It is a common and manageable chronic condition. People with high blood pressure may not feel symptoms. The only way to know is to get your blood pressure checked which is an inexpensive technique. Screening and early diagnosis is important to plan appropriate interventions.
Aim : In the present study screening of rural population aged 45 years and above for diagnosis of hypertension and to identify the association with poor screening for hypertension, if any. Improved screening and awareness can prevent later cardiovascular risks and premature deaths in India.
Methods: A cross-sectional study was conducted in consecutive households of a rural area in Salem, India among individuals aged 45 years and above. All eligible participants were given a pretesting questionnaire, asked if they have tested themselves for hypertension in the past one year and their blood pressure were measured till the required sample size of 475 was achieved.
Results: 68% had checked blood pressure by self or at a hospital and had not screened for hypertension at least once were 32%.Out of 68% the prevalence of hypertension screening incidentally without any symptoms was 22% and with symptoms include 46%. Screening for hypertension among females (61.5%) as compared to males (38.5%). Of the unscreened 32% population, 29% lies at the age group between 45 to 49 years who were at a higher risk to land in complications in the later age.
Conclusion: The prevalence of hypertension screening incidentally by self without any symptoms was 22%. Unscreened 29% among the age 45 to 49 years are the target population to be educated about the early diagnosis of hypertension, its advancing complications like cardiovascular risks and planning appropriate treatment interventions. The future is about hypertension prevention and control but early detection and prevention of complications should go hand in hand.

Background: Most neglected sector of population in each country is migrant workers . Migration and health are increasingly recognised as a global health priority. Non communicable diseases contribute to ill health, poverty and inequities and slow the development of countries. Every year 15 million people die before the age of 70 years in relation to non communicable diseases, with 86% of these premature deaths occurring in low and middle-income countries . Migrant and host populations have inequalities in access/uptake of preventive interventions and in treatment outcomes.
Aim : The present study was to assess the prevalence of hypertension and diabetes among the migrants workers at construction sites of Salem, India. Premature deaths from non communicable diseases are largely caused by modifiable behavioural risk factors such as tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol.
Methods : A cross sectional study involving 699 construction site workers 471 were males and 228 were females who were construction site migrant workers from other states as well as other districts of Tamilnadu during their working hours. During the study blood pressure measurement, anthropometric measures-height, weight measurement and investigation-random blood sugar were taken for all workers involved in the study.
Results : 13.16% were found to be hypertensive , 4.7 % were found to be both diabetic and hypertensive , 12.73% were found to be diabetic. Gender wise prevalence is 57.6% males and 42.4% females are hypertensive. Association between alcohol and non communicable disease among males shows about 79% of hypertensive males are alcoholic.
Conclusion : Long working hours, including nights and weekends with no paid time off make it impossible for workers to access health clinics during standard operating hours . Behavioural changes, communication to focus on life style modifications, counselling to be done continuously . Early case detection and regular follow up will prevent complications in patients as well as it will in turn increase the productivity by labourers.

Key words : hypertension, migrant workers, alcohol, diabetes mellitus, salem

Background and aim
Sub-Saharan Africa is increasingly facing a dual burden of diseases. Patients living with long-term conditions like hypertension are a neglected group when it comes to their emotional and social needs in sub-Saharan Africa because of the traditional focus on communicable diseases like HIV. We explored the experiences, perspectives, challenges, and coping strategies of people living with hypertension, and how the health system can better respond to their needs.
Method
The study design was a qualitative case study. Data collection involved in-depth interviews with patients living with hypertension, and their healthcare workers in one district of the Greater Accra region of Ghana. Interviews were analyzed with NVIVO software.
Results
Patients living with hypertension experience emotional challenges (frustration, fear, and sadness) and psychological difficulties (stress and anxiety) associated with living with and managing their condition. Many are breadwinners or sometimes unemployed and face the challenges of financially supporting their families while dealing with lifestyle changes and care costs. Structured social support within the community is generally unavailable and they rely informally on friends, family, neighbors, or religion to access healthcare services and cope with anxiety, stress, and sadness. Although National health insurance reduces the financial burden by covering the cost of antihypertensive medications, implementation challenges reduce its effectiveness. The consequences of these challenges of living with hypertension are treatment non-adherence, worsening of symptoms, and strained family and social ties. Community social support such as hypertension support groups, addressing and enabling navigation of the implementation barriers in the National Health Insurance Scheme, integration of mental health screening and support, and regular counseling services are all interventions that can potentially make a major difference to primary care and outcomes for people living with hypertension.
Conclusion
Living with hypertension in a resource-constrained setting creates social, financial, and emotional vulnerability. It is important for public health policies and programs to be designed to adequately support patients in navigating through the challenges of living with hypertension.

Background and Aim:
Despite its relevance for pediatric blood pressure (BP) screening, the long-term predictive utility and natural progression of pediatric BP classification remains understudied. To evaluate BP tracking from childhood to mid-adulthood using the American Academy of Pediatrics (AAP) thresholds and estimate transition probabilities among BP classifications over time considering multi-time-points.

Methods:
Using data from the longitudinal Cardiovascular Risk in Young Finns Study, the sample included 2918 participants, with BP examined up to nine times over 38 years, from childhood (aged 6-12 years) or adolescence (15-18 years) to young adulthood (21-27 years), late young adulthood (30-37 years), and mid-adulthood (39-56 years). BP classifications (normal, elevated, hypertension) were based on AAP guidelines for children and adolescents and the 2017 American guidelines for adults. Outcomes were BP classifications at follow-ups. Tracking coefficients were calculated using generalized estimated equations. Transition probabilities among BP classifications were estimated using multi-state Markov models.

Results:
Over 38 years, the tracking coefficient (odds ratio) for maintaining elevated BP/hypertension was 2.16 (95% confidence interval: 1.95-2.39). Males had a higher probability than females of progressing to and maintaining hypertension and a lower probability of reverting to normal BP. For both sexes, the probability of transitioning from adolescent hypertension to normal BP in mid-adulthood was lower (0.16 to 0.44) compared to childhood hypertension (0.23 to 0.63). The probability of maintaining normal BP sharply decreased in the first 5-10 years, stabilizing thereafter. Children with normal BP generally maintained this status into adolescence (males: 0.64, females: 0.81), but decreased by young adulthood (males: 0.41, females: 0.69).

Conclusions:
There is an enduring association of childhood and adolescent BP (according to AAP-thresholds) on later BP. While childhood normal BP tends to be maintained into adolescence, the probability of reverting to and sustaining normal BP decreases notably from adolescence to young adulthood. These findings underscore the importance of prevention starting in childhood to maintain normal BP, suggesting adolescence as a potential critical period. The results suggest the potential for less frequent screenings for children with initially normal BP.

Background and Aim
There is much interest in the potential pleiotropic effects of antihypertensive class on multiple end organs beyond that of their direct blood pressure lowering effect. The results of recent work suggests that some antihypertensive agent classes may have beneficial or detrimental influences on cognition and subsequent dementia risk. These studies are frequently limited by the contribution of ischaemic heart disease and stroke. We therefore aimed to examine the cross-sectional association between antihypertensive class and cognitive performance in a large cohort without overt cardiovascular disease nested within a randomized controlled trial.

Methods
We identified all people taking a single antihypertensive agent at baseline when recruited into the STAtins in Reducing Events in the Elderly (STAREE) trial, a randomized placebo-controlled trial investigating the effects of atorvastatin on disability-free survival and major cardiovascular events in Australians aged ≥70 years without overt cardiovascular disease. After categorising participants into common antihypertensive classes, we compared mean modified mini-mental state (3MS) examination scores across classes. We then used multivariable linear regression to test whether any differences remained when adjusting for age, gender, education, mood, blood pressure and body mass index.

Results
Of 9971 participants recruited into the trial, 3065 (31%) took one antihypertensive medication (mean age 75 years). The most used antihypertensive class was angiotensin 2 receptor blockers (52%) followed by angiotensin-converting-enzyme inhibitors (26%), β-blockers (10%), calcium channel blockers (7%), diuretics (3%) and α-blockers (2%). Those taking α-blockers had a lower mean 3MS score (91.6/100, SD=5.3) than those taking any of the other agents (all p<0.001). This difference remained in fully adjusted models (all p<0.03). The mean 3MS was similar between those taking other antihypertensive agents, angiotensin 2 receptor blockers (93.7/100), angiotensin-converting-enzyme inhibitors (93.5/100), β-blockers (94.2/100), calcium channel blockers (93.5/100) and diuretics (94.1/100). These patterns were minimally altered in fully adjusted models (all p<0.03).

Conclusions
In this cohort of older Australians without overt cardiovascular disease, use of α-blockers was associated with poorer cognition independent of potential confounders including blood pressure. More work is required to understand whether these associations are seen longitudinally or ultimately lead to increased dementia risk.

Background and Aim
Whether there are sex differences in the management and control of hypertension in older people remains unclear. We aimed to examine sex differences in blood pressure (BP) management and control among older Australians.

Methods
We analysed baseline data from the STAtins in Reducing Events in the Elderly (STAREE) trial, a randomized placebo-controlled trial investigating the effects of atorvastatin on disability-free survival and major cardiovascular events in Australians aged ≥70 years without cardiovascular disease. Descriptive statistics were used to compare self-reported hypertension, measured BP, and the use of BP-lowering medications between men and women.

Results
The study included 9971 participants (52% women, mean±SD age 74.7±4.5years). Women were more likely than men to report a history of hypertension (45% vs. 42%, p=0.001). Women also had lower measured BP than men, both among those with and without a history of hypertension (137/80mmHg vs. 140/82mmHg, p<0.001 and 131/78 vs. 136/81mmHg, p<0.001, respectively). Among those with hypertension, a greater proportion of women than men achieved the target BP of <140/90mmHg (57% vs. 47%, p<0.001). The number of BP-lowering medications was similar between men and women with hypertension, (~65% taking one agent, ~20% taking two agents, and ~5% taking three or more agents, p=0.37). However, women were more likely than men to take β-adrenergic receptor blockers (14% vs. 12%, p<0.001) and diuretics (9% vs. 6%, p<0.001), and less likely to take angiotensin-converting enzyme inhibitors (26% vs. 32%, p<0.001) or other BP-lowering agents such as α-adrenergic receptor blockers (3% vs. 6%, p<0.001).

Conclusions
Older women with hypertension had better BP control than older men, which may be related to underlying physiological factors, differences in awareness, or variations in BP treatment patterns. Further work is required to understand the factors contributing to these sex differences in hypertension management and control among older Australians.

Background and Aim: Direct Fick and bolus thermodilution techniques are endorsed by pulmonary hypertension guidelines to measure cardiac output. However, in contemporary practice, agreement between methods is unknown as are the diagnostic consequences of disagreement. We sought to evaluate the frequency and degree of disagreements between these measurement techniques and to assess their impact on the haemodynamic assessment of pulmonary hypertension.

Methods: This was a single-centre study of 182 patients presenting for right heart catheterisation in the cardiac catheter laboratory who had cardiac output concurrently measured by direct Fick and thermodilution. Bolus thermodilution was taken as the average of at least three measurements using a pulmonary artery catheter. Direct Fick was calculated by measuring oxygen consumption using an indirect calorimeter and collecting arterial and mixed venous blood gases. Agreement between direct Fick and bolus thermodilution cardiac output was assessed using Bland-Altman analysis.

Results: The median direct Fick and thermodilution cardiac outputs were 5.42 L/min [interquartile range 3.90 – 7.41] and 4.10 L/min [interquartile range 3.47 – 5.10], respectively. Significant disagreement and proportional bias were observed, with direct Fick yielding higher cardiac output results than thermodilution. The mean error was proportional to cardiac output (-3.75% at 3 L/min to +44.5% at 7 L/min) and limits of agreement were wide (standard deviation=38.5%). Disagreement was increased by 19.2% in the presence of least moderate tricuspid regurgitation (p=0.001) and by 16.0% in patients with atrial fibrillation (p=0.01). Among 152 patients with pulmonary hypertension, haemodynamic classification discordance occurred in 18 (11.8%) patients. Bolus thermodilution tended to over-classify pre-capillary pulmonary hypertension compared to direct Fick. Disagreement was greatest in patients with less severe pulmonary hypertension (p<0.001).

Conclusions: Significant disagreement between direct Fick and thermodilution cardiac output was observed in the cardiac catheter laboratory, which resulted in discrepant haemodynamic classification in approximately 12% of patients. These techniques should therefore not be used interchangeably, especially in patients presenting for serial surveillance. In the absence of a clinical gold standard measure of cardiac output, a rationale exists for utilising both methods concurrently in selected patients.

Background: Observational studies have demonstrated inverse associations between intake of cruciferous vegetables and cardiovascular disease (CVD) risk. Limited evidence exists from clinical trials exploring causal effects of these vegetables with established CVD risk factors such as elevated blood pressure.
Aim: To determine whether short-term daily intake of cruciferous vegetables (broccoli, cabbage, kale, cauliflower), in comparison to root/squash vegetables (potato, sweet potato, carrot, pumpkin), resulted in lower blood pressure in middle-aged and older adults with mildly elevated blood pressure.
Methods: In this randomised, controlled, crossover trial, participants completed two 2-week dietary interventions, separated by a 2-week washout period. Participants consumed macronutrient-matched soups containing ~300g/day cruciferous (active) or root/squash (control) vegetables with standardised meals twice daily. The primary outcome was 24-hour ambulatory brachial systolic blood pressure (SBP). Secondary outcomes included 24-hour ambulatory brachial diastolic blood pressure (DBP), daytime and night-time ambulatory brachial SBP and DBP, and 24-hour, daytime, and night-time ambulatory aortic SBP and DBP. Adherence measures included self-reported food diaries (subjective) and biomarkers of intake (objective) including S-methyl cysteine sulfoxide (SMCSO, active) and carotenoids (control). Differences were tested using linear mixed effects regression.
Results: Eighteen participants were recruited [median (IQR) age: 68 (66-70); female: n=16/18; mean±SD clinic SBP: 135.9±10.0 mmHg]. For both interventions, 72% of participants had 100% self-reported adherence (IQR: 96.4-100%). SMCSO and carotenoid biomarkers were significantly different between interventions (both P<0.001). 24-hour ambulatory brachial SBP was reduced following the active vs. control (mean difference -2.5mmHg, 95%CI -4.2, -0.9, P=0.002). This result was driven by daytime SBP (mean difference -3.6mmHg, 95%CI -5.4, -1.7, P<0.001). Similar findings were observed for 24-hour ambulatory aortic SBP (mean difference active vs. control: -2.1mmHg, 95% CI -3.7, -0.5, P=0.010) and daytime aortic SBP (mean difference active vs. control: -3.2mmHg, 95% CI -5.0, -1.4, P=0.001). No significant differences were observed for 24-hour ambulatory brachial or aortic DBP.
Conclusions: Daily consumption of cruciferous vegetables, in comparison to root/squash vegetables, resulted in reduced SBP in middle-aged and older adults with mildly elevated blood pressure. Future research is needed to inform whether targeted recommendations to increase population intakes of cruciferous vegetables will reduce hypertension prevalence within Australia.

Background and Aim: Dietary interventions are first line treatment strategies for blood pressure (BP) management. While further research into mechanisms involved in diet related BP management are needed, nutritional metabolomics are under-explored. Therefore, the aim was to evaluate relationships between diet-related metabolites and change in BP in response to a healthy and unhealthy diet.
Methods: An 8-week randomised cross-over feeding intervention with participants completing a 2-week run-in period before random assignment to sequentially receive two feeding interventions, with a 2-week washout period in-between. Participants were fed a Healthy Australian Diet (HAD) that met current Australian Dietary Guidelines and a Typical Australian Diet (TAD) reflecting current “unhealthy” consumption patterns. Pre-post each feeding period in clinic BP, spot urine and blood samples were collected. Metabolomics analysis was conducted using Ultra-high Performance Liquid Chromatography-Tandem Mass Spectrometry. Spearman correlations assessed change in systolic (SBP) or diastolic BP (DBP) and metabolites for each feeding period.
Results: Participants (n=34, 38±18years, 53% females) completed all study measures. Mean baseline SBP 125±13mmHg and DBP 78 ±9mmHg. In total, 44 metabolites were significantly different in response to the feeding interventions.
During the HAD no urinary or plasma metabolites were correlated with change in SBP, with three urinary metabolites significantly, positively correlated with DBP and one negatively correlated. Seven plasma metabolites were significantly, negatively correlated with DBP. Of these metabolites only one, paraxanthine, a product of caffeine metabolism, displayed the same relationship in plasma (ρ= -0.38) and urine (ρ= -0.41).
During the TAD, significant, negative correlations were observed for four urinary metabolites with SBP change and two (one negative) with change in DBP, with three plasma metabolites (two negative) having a significant, correlation with SBP and four had a positive correlation with DBP change. No metabolites were the same across urine and plasma. However, three metabolites were associated with caffeine metabolism, urinary paraxanthine (ρ= 0.35), plasma caffeine (ρ= 0.37) and plasma 1,3,7-trimethylurate (ρ= 0.35).
Conclusions: Several dietary metabolites were correlated with BP change in response to healthy and unhealthy diets. Primarily, metabolites related with caffeine metabolism were correlated with BP change. Further research is required to further assess these relationships.

Background and aim: Cardiometabolic disease poses a significant health burden worldwide. A major goal of the United Nations in achieving its sustainable development target is ensuring the health and well-being of all by 2030. Approximately 60% of adult Australians have low individual health literacy, which may affect their ability to effectively exercise their choice or voice when making healthcare decisions. We aimed to examine the association between health literacy and cardiovascular risk factors among Australian adults and their children.

Methods: We will use data from the 2017-2018 National Health Survey that recruited one adult (aged 18 years or over) and one child (0–17 years, where applicable) for each sampled dwelling. The study collected data using a health literacy questionnaire and outcomes were lifestyle and health factors. Another covariate measurement was stress levels. Hierarchical adjusted regression models will be used to examine the relationship between (1) health literacy and cardiometabolic disease in Australian adults and (2) the health literacy of the adult from the household and the child’s risk factors.

Results: The study is ongoing. There were 5,790 fully responding adults to the HLQ in 2018. Some participants will be lost due to missing cardiometabolic data or confounding data. It is expected the study population will be approximately 5000 people. Households were classified as either a couple family with no children or a couple family with children. The study will provide insight into the risk profile of Australian Adults and their families, particularly children. Further, the study is expected to identify specific health literacy domains posing challenges for individuals with cardiometabolic disease, including understanding from healthcare providers and navigating the healthcare system.

Conclusion: Understanding the level of health literacy in Australian adults with cardiometabolic disease, may provide insights into why these individuals and or their children are more likely to develop such diseases. It may also help to identify other barriers to the prevention of cardiometabolic disease in Australia. Recent policy in Australia explicitly supports shared decision-making and addressing health literacy challenges to facilitate public health improvements. This will lead to more targeted preventive strategies for cardiovascular disease in Australia.