ESH 2016 Abstract Book Posters June 13

Transcription

e286 Abstracts
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POSTERS’ SESSION PS27:
BLOOD PRESSURE MEASUREMENT
PP.27.01
COMPARISON OF TWO BLOOD PRESSURE
MONITORS USED FOR TELEMEDICAL HOME
N. Hoffmann-Petersen, E.B. Pedersen. 1University clinic of hypertension and
nephrology, Department of medical research, Holstebro Hospital, Denmark,
Holstebro, DENMARK
Objective: Accurate and precise blood pressure measurements are a basic necessity in the diagnosis and treatment of hypertension. Even though blood pressure
monitors have been clinically validated according to the ESH guidelines, evidence
is increasing that there may be clinically relevant differences between devices. The
accuracy limit set by the manufacturers is ± 3 mmHg.
Design and method: Due to a planned IT integration, we had to change telemedical equipment as well as blood pressure monitors halfway through a large
telemedical home blood pressure study (NCT 02355392). Consequently we
asked 108 participants to do the home blood pressure measurements (three measurements three times daily for three days) on two devices, A&D 767PlusBT and
Omron 705IT.
Results: Two patients had atrial fibrillation and 15 patients did not do one or both
HBP measurements sufficiently (at least measurements on day 2 and 3). When
measuring the blood pressure at home, 60 patients used the A&D 767PlusBT
monitor first and then the Omron 705IT, 31 patients in the opposite sequence.
Measuring telemedical HBP using 2 different blood pressure monitors revealed
a highly significant difference between them. Mean difference between A&D
767Plus BT and Omron 705IT was systolic –4.8 mmHg (95% CI –5.8: –3.6) and
diastolic 2.4 (95% CI 1.6:3.2).
Conclusions: We found a significant and clinically relevant difference between the
two devices. In accordance to our findings in this study, a difference exceeding the
accuracy limits of ± 3 mmHg was found in a previous study testing the same two
monitors on three different oscillometric waveform simulators. We believe that the
difference between the A&D 767PulsBT and the Omron 705IT can most likely
be attributed to differences in the algorithms used to estimate the blood pressure.
PP.27.02
SCREENING FOR HYPERTENSION DURING
CONSULTATION IN A WALK-IN SERVICE;
LITERATURE REVIEW AND PROPOSED
ALGORITHM
A. Michaud1, M. Lamarre-Cliche2, L. Cloutier1. 1Université du Québec à TroisRivières, Trois-Rivières, CANADA, 2Institut de recherches cliniques de Montréal,
Montréal, CANADA
Objective: In Canada, 17% of people with high blood pressure (BP) are unaware
of their status and another 17% has high blood pressure but is not getting treated
which represents close to 2.5 million individual that could benefit from proper BP
screening and treatment. Walk-in clinics present a definite appeal for hypertension
screening. A large number of patients are seen there every day and blood pressure
(BP) is measured routinely. However, these routine measures are often not standardised and the patient could have pain or other factors that temporarily affect the
BP. Moreover, there seems to be no valid algorithm available on how to integrate
BP screening in a valid and reproducible way in order to diagnose HTN. A literature review was undertaken to identify all studies that addressed BP screening for
HTN in a walk-in or emergency services.
Design and method: MEDLINE and CINHAL Databases were searched for this
review. Primary studies and reviews either in French and English were included
from start date to November 2015. Additional citations from reference lists were
retrieved.
Results: A total of 600 articles were identified and further analysis resulted in the
decision to include 7 papers that corresponded to the criteria. Results show that
between 22 and 76% of patient with an elevated BP in the emergency were diagnosed with hypertension on follow-up. Many patients were lost after the initial
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved
visit and having an immediate reference for ambulatory measurements was more
effective (87%) than other type of follow-up (54%).
Conclusions: Weak predictive value were found between emergency BP measurements and further evaluation for hypertension when routine or poorly standardised
BP measurement was used. Having patient return for follow-up presented a challenge
and a way to improve this was to be able to make an immediate reference for ambulatory BP monitoring. A protocol is now proposed to include a formal algorithm for BP
screening in the emergency including automated blood pressure measurement and
ambulatory measurements. Characteristic of the patient and the impact of the health
care system when implementing this algorithm will also be analysed.
PP.27.03
VALIDATION OF BLOOD PRESSURE MONITORS
USING THE AAMI AND ISO PROTOCOLS: AN
OVERVIEW OF THEIR RECENT APPLICATION
N. Boubouchairopoulou1, A. Kollias1, N. Atkins2, E. O’ Brien3, G.S. Stergiou1.
1Hypertension Center STRIDE-7, University of Athens, Third Department of Medicine, Sotiria Hospital, Athens, GREECE, 2Medaval, Dublin, IRELAND, 3Conway
Institute, University College Dublin, Dublin, IRELAND
Objective: Since 1987 the US Association for the Advancement of Medical Instrumentation (AAMI) has published protocols for blood pressure (BP) monitor validation, and recently in collaboration with the International Organization for Standardization (ISO). A review of published validation studies using these protocols
was performed, to evaluate the level of adherence with the protocol requirements.
Design and method: Published validation studies using the AAMI, ISO, or ANSI/
AAMI/ISO protocols from 2010 until Dec. 2015 were identified. All the protocol
procedures were scrutinized using a standard checklist adjusted according to the
protocol used.
Results: Twenty-six studies were identified. The number of publications per year
were 4/5/2/1/2/12 for years 2010/11/12/13/14/15 respectively. Six different revisions of the protocols were applied. The most used protocol was the ANSI/AAMI/
ISO-2009 (9 studies), whereas the ANSI/AAMI/ISO-2013, ANSI/AAMI/ISO2006, ANSI/AAMI-2003, ANSI/AAMI-2002 and ANSI/AAMI-1996 were used
in 6/2/1/5/1 studies respectively (2 studies did not report the protocol version). 20
studies tested oscillometric devices, 21 upper-arm devices, 16 clinic, 2 ambulatory, 5 home, and 3 hospital monitors. 23 studies reported a ‘pass’ result. 17 used
same-arm sequential method, and 8 opposite-arm simultaneous method (one did
not report the method used). Samples ranging from 30 (specific population) to
509 subjects (epidemiological study) were included. Seven studies included special populations (obese, pregnant, pre-eclampsia, neonatal/infant, intensive care
unit, arrhythmia,cardiac catheterization), while 8 included mixed populations (i.e.
adults and children and/or obese). Several protocol violations were identified in
9 studies, involving failure to assess devices according to stipulated criteria, BP
ranges, cuff size distribution, sample size, and number of test measurements per
participant. Information on cuffs used, precise BP measurement procedure and BP
ranges was omitted in 11 studies.
Conclusions: The AAMI/ISO protocols are mainly used in special or mixed populations, probably because, compared to other protocols, this is permitted by the
large sample required and specific relevant recommendations are provided. The
peer review process of scientific journals often misses important deficiencies of
validation studies. The large number of AAMI/ISO revisions makes peer review
and comparison among devices difficult.
PP.27.04
BLOOD PRESSURE CONTROL IN RELATION TO
THE SEX OF THE PATIENT AND THE PHYSICIAN:
RESULTS FROM THE SWEDISH PRIMARY CARE
CARDIOVASCULAR DATABASE (SPCCD)
C. Ljungman1, K. Manhem1, L. Schiöler1, B. Wettermark2,3, K.B. Boström4,
J. Hasselström5, T. Kahan6. 1Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SWEDEN,
2Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, SWEDEN,
3Public Healthcare Services Committee, Stockholm county council, Stockholm,
SWEDEN, 4Närhälsan R & D Primary Care, R&D-Centre Skaraborg, Skövde,
SWEDEN, 5Karolinska Institutet, Department of Neurobiology, Care Sciences and
Society, Stockholm, SWEDEN, 6Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, SWEDEN
Abstracts e287
Objective: Earlier studies have proposed that the sex of the patient and the physician may influence if target blood pressure is reached. We investigated the associations between the sex of the patient and the physician, and achieved target blood
pressure in a large unselected cohort of hypertensive patients.
Objective: Ambulatory blood pressure monitoring (ABPM) is considered the
gold-standard for the diagnosis of hypertension and assessment of cardiovascular risk. This study aimed to compare the reliability of a cuff-less blood
pressure (BP) method based on pulse transit time (PTT) versus oscillometric
ABPM considering limitations of cuff based BP measurement such as movement artefacts, arrhythmia and arousals during sleep caused by inflation of
the cuff.
Design and method: Systolic (SBP) and diastolic (DBP) blood pressure were
measured in 30 adults (9 women, mean age 65.5 ± 9.3 years) using an oscillometric 24 hour ABPM (boso TM-2430 PC2). Measurement intervals were 15 min
during daytime (6–22 h) and 30 min during night-time (22–6 h). Simultaneously,
BP was recorded beat-to-beat and non-invasively based on PTT (SOMNOtouch
NIBP, SOMNOmedics GmbH) on the contralateral arm. In addition we recorded
a 3-channel ECG, motoric activity, finger plethysmogram, oxygen saturation and
cuff pressure.
Results: In total 1293 measurements were analysed. The correlation coefficient for SBP was r = 0.77 (DBP: r = 0.53). The limits of agreement in
Bland-Altman plot were +28 and –25 mmHg, with a mean difference of
1.6 mmHg for SBP (DBP: +30 and –26 mmHg; mean difference of
1.9 mmHg). 29% of all measurements were affected by the following artefacts: movement (18%), arrhythmia (5%) and arousal reactions (6%, corresponding to 18% of all nocturnal BP measurements). After elimination of all
measurements influenced by cuff related artefacts the correlation of the remaining values improved significantly (n = 921; SBP: r = 0.89; DBP: r = 0.7).
The limits of agreement in Bland-Altman plot were +18 and –15 mmHg with
a mean difference of 1.4 mmHg for SBP (DBP: +14 and –13 mmHg; mean
difference of 0.3 mmHg).
Conclusions: Our results imply that the cuff method is highly affected by movement artefacts, arrhythmia and arousal reactions during sleep. By exclusion
of these artefact related measurements the correlation and agreement between
ABPM and PTT method increased considerably (SBP: r = 0.89; DBP: r = 0.7).
This indicates that oscillometric ABPM is affected by various artefacts which
limit the reliability of cuff based BP measurement.
PP.27.06
Design and method: This cross-sectional cohort study in the Swedish primary
Care Cardiovascular Database (SPCCD) includes 16 248 patients with hypertension treated in primary health care in Stockholm in 2006–2008. The three last
blood pressure measurements during the time period was analyzed and the patients were grouped female/male with all female physician visits, all male physician visits, and visits including both female and male physician visits (mixed
physicians). The blood pressure measurement of the last visit was used for analysis and was < 140/90 mmHg. The regression model and odds ratio for achieved
target blood pressure was adjusted for age, diabetes mellitus, and cardiovascular
comorbidities.
Results: In 15 465 patients (8994 female and 6471 male) the sex of the physician
was known. Female patients were older and had less diabetes mellitus, ischemic
heart disease, and cerebrovascular disease than males (table). Target blood pressure was achieved in 36.9% of the patients visiting male physicians, 33.5% of
the patients visiting female physicians, and 31.6% of the patients visiting mixed
physicians (p < 0.0001 for all difference between groups). Male patients visiting
a female, compared to a male physician, had a lower likelihood of reaching target
blood pressure. Male patients visiting a male physician, compared to mixed physicians visits, had a higher likelihood of reaching target blood pressure (figure).
In female patients the sex of the physician and the probability of reaching target
blood pressure were not associated.
Conclusions: The probability of reaching target blood pressure was associated
with the sex of the physician in male but not in female hypertensive patients.
Best results were observed in male patients with male physicians while the worst
results were seen with mixed physicians.
PP.27.05
CONTINUOUS AND NON-INVASIVE BLOOD
PRESSURE MEASUREMENT BASED ON PULSE
TRANSIT TIME COMPARED TO AMBULATORY
R. Haberl1, M. Wesely1, K. Thimel1, J. Gehring2, G. Küchler2. 1Kardiologische
Praxis Herz im Blick, München, GERMANY, 2SOMNOmedics GmbH, Randersacker, GERMANY
FREQUENCY OF MASKED HYPERTENSION
AND WHITE COAT EFFECT IN UNCONTROLLED
HYPERTENSIVE PATIENTS TREATED WITH MONO
OR DUAL THERAPY
B. Kichou, N. Henine, L. Kichou, A. Hamouche, A. Mazeghrane, L. Chaibi,
M. Khati. University hospital of Tizi-ouzou- Department of Cardiology, Tizi-ouzou,
ALGERIA
Objective: Estimate in a real life setting, the frequency of masked hypertension
(MH) and white coat effect (WCE) in hypertensive patients treated with one or
two drugs, in whom the treating physician decided to intensify the treatment due
to target blood pressure not reached.
Design and method: The study was prospective and observational, carried out
among 174 physicians randomly selected in Tizi-ouzou city (Algeria). Each doctor included between December 2013 and March 2014, 10 consecutive patients
with office blood pressure (OBP) superior or equal to 140/90 mmHg despite 1 or
2 medications and in whom he decided to escalate treatment, left on his discretion. After 6 months follow-up, we recorded OBP and 24-hour ambulatory blood
pressure (ABP). The MH was defined as OBP inferior to140/90 mmHg and ABP
superior or equal to 130/80 mmHg, and the WCE as OBP superior or equal to
140/90 mmHg and ABP inferior to 130/80 mmHg. To estimate the prevalence of
MH and WCE with 2% accuracy and 95% confidence, we should include at least
1225 subjects.
Results: After 6 months follow-up, OBP and ABP were available in 1426 patients.
The characteristics of the population were: mean age: 57.2 ± 12.3 years; men:
61.4%; diabetes: 37.8%; BMI: 28.7 ± 3.9; dyslipidemia: 40.7%; prior major cardiovascular event: 14.2%; number of drugs per patient: 2.9 ± 1.1. The mean OBP
and ABP at 6 months were 149.8 ± 19.6/ 89.4 ± 12.8 mmHg and 138.9 ± 13.7/
84.7 ± 12.4 mmHg respectively. The prevalence of MH and WCE were 25.3% (CI
95%: 23% – 27.6%) and 8.8% (CI 95%: 7.3% – 10.3%) respectively. In the 579
apparently controlled patients (OBP inferior to 140/90 mmHg), 62.3% had ABP
superior or equal to 130/80 mmHg and require in fact a further treatment intensification. In the 847 patients with seemingly uncontrolled hypertension (OBP
superior or equal to 140/90 mmHg), 14.3% had ABP inferior to 130/80 mmHg
and no therapeutic changes are actually useful.
Conclusions: Our study suggests the need for a systematic use of ABP measurement in the management of uncontrolled hypertension.
e288 Journal of Hypertension Vol 34, e-Supplement 2, September 2016
PP.27.07
SUCCESSIVE BLOOD PRESSURE MEASUREMENT
LOSES ACCURACY IN BORDERLINE VALUES OF
BLOOD PRESSURE
M. Vieira Da Silva1, A. Mendes Da Silva2, D. Artigas Giorgi3, F. Ganem4,
L.P. Rodriges De Resende2. 1Cardiac Diagnostic Center, Uberaba, BRAZIL,
2Triângulo Mineiro Federal University, Uberaba, BRAZIL, 3Heart Institute of the
University of São Paulo Faculty of Medicine, Sao Paulo, BRAZIL, 4Sírio-Libanês
Hospital, Sao Paulo, BRAZIL
Objective: To compare the diagnostic performance of successive blood pressure
(BP) measurements in borderline and not borderline blood pressure levels.
Design and method: 834 hypertense patients or suspected of hypertension have had
their BP measured: 7 successive nurse measures using automated equipment, and 24hour ambulatory blood pressure monitoring (ABPM), both were made following protocols of European Guidelines. For all patients were calculated the average of third to
seven nurse readings (3–7BPa). Also, we classified each blood pressure value using
the definitions of 2013 European Society of Hypertension and of the European Society of Cardiology Guidelines for the management of arterial hypertension. Awake
blood pressure average (ABPa) was used as gold standard. We calculated for systolic
and diastolic 3–7BPa, the concordance correlation coefficient (Pc) and area under
the curve (AUC), firstly in the full sample, and after in borderline grades of BP (high
normal and grade 1) and not borderline grades (optimal, normal, grade 2 and 3). The
confidence interval of variables was calculated for comparison between the groups.
Results: Data from 834 patients were analyzed. The results are demonstrated in
table 1. At full sample. 3–7 BPa shows a good concordance with ABPa, 0,63 and
0,72, for systolic and diastolic Pc respectively. The AUC results (0,82 and 0,85
systolic and diastolic) show, that it separates well hypertense from normotensive patients. However, in comparison between borderline against not borderline
group, 3-BPa shows a significant differences in Pc systolic (0,31 vs 0,73), diastolic Pc (0,53 vs 0,78), AUC systolic (0,68 vs 0,91) and AUC diastolic (0,77 vs
0,89). When the results of borderline group were compared with all sample the
same difference were found, Pc systolic (0,31 vs 0,63), diastolic Pc (0,53 vs 0,72),
systolic AUC (0,68 vs 0,82) and diastolic AUC (0,77 vs 0,85). There is a significant difference between not borderline group and all sample for systolic values of
Pc (0,73 vs 0,63) and systolic AUC (0,91 vs 0,82).
Conclusions: 3–7BPa demonstrated good precision and correlation with awake
blood pressure. But, loses significantly this performance in patients with high normal and grade 1 of hypertension.
PP.27.08
UTILISATION OF THE ARTERIAL STIFFNESS
ASSESSMENT IN THE EVERYDAY CLINICAL
PRACTICE
A. Reshetnik, C. Gohlisch, M. Toelle, W. Zidek, M. Van Der Giet. Charité Berlin,
Campus Benjamin Franklin, Berlin, GERMANY
Objective: There is emerging evidence pointing out the arterial stiffness (AS)
as an important independent predictor of cardiovascular events. Carotid-femoral
pulse wave velocity (cfPWV) is a best-established surrogate parameter for assessment of AS. Measurement of cfPWV is considered to be gold standard for
evaluating AS. Though it has been widely used in clinical and observational
studies, its utilisation in the everyday clinical practice is scarce due to technical
challenges and procedural pitfalls of the available non-invasive assessment techniques. Emerging oscillometric techniques seem to simplify assessment procedure. We thus aimed to evaluate the accuracy of performance and reproducibility with a new oscillometric device Tel-O-GRAPH® for measurement of PWV.
Design and method: 89 patients were prospectively included in the study. Oscillometric calculation of cfPWV was performed with Tel-O-GRAPH® (I.E.M., Stolberg, Germany) and tonometric calculation with Sphygmocorâ (AtCor Medical,
West Ryde, NSW, Australia). The accuracy assessment was performed according
to the requirements of ARTERY Society. Coefficients of variation and intraclass
correlation coefficients were used to evaluate the reproducibility.
Results: Mean study population age was 48.8 ± 19.1 years. 59.6% of the patients
were male and 15.1% were smoker. The mean PWV measured with Tel-O-GRAPH®
was 7.8 ± 2.3 m/s, the mean PWV measured with Sphygmocorâ was 7.3 ± 1.7 m/s.
The mean difference of PWV between devices was 0.49 ± 1.26 m/s (p < 0.0001)
and Pearson correlation index was 0.86 (p < 0.0001). The coefficient of variation
and intraclass correlation coefficients between single measured PWV values with
Tel-O-GRAPH® and Sphygmocor® were 2.38 ± 6.13% vs. 6.3 ± 4.33% (p < 0.05)
and 0.99;0.99;0.99 vs. 0,78;0.84;0.71 respectively.
Conclusions: We observed that oscillometric calculation of cfPWV with Tel-OGRAPH® can be done quickly and easy, with very high reproducibility of the
values and adequate measurement accuracy compared to Sphygmocor®. Reported
data suggest that oscillometry might evolve to a favoured method for assessment
of the PWV in the everyday clinical practice and clinical studies due to its easiness
of performance with concurrently remained reliability and accuracy.
PP.27.09
INFLUENCE OF SINGLE-PILL COMBINATION
ANTIHYPERTENSIVE TREATMENT ON THE RISK
OF CARDIOVASCULAR COMPLICATIONS AND
VASCULAR AGE: RESULTS OF THE MULTICENTER
OPEN-LABEL STUDY ADVANT’AGE
Y. Karpov. FSBI Russian cardiological scientific-production complex Ministry of
Health of Russian Federation, Moscow, RUSSIA
Objective: 1) to evaluate the efficacy of a 3-month treatment with single-pill combination (SPC) perindopril arginine/amlodipine;
2) to correlate the predicted cardiovascular risk based on ASCORE, a hypertensive patient–specific risk score, with the vascular age based on SCORE, an indicator that is readily understandable by patients;
3) to assess the influence of blood pressure control with SPC on vascular age
between baseline and month 3 after introduction of SPC perindopril arginine/
amlodipine treatment;
4) to evaluate the adherence to treatment.
Design and method: The patients taking part in the program (n = 1340, 560 men
[42%], 780 women [58%] were followed by physicians in the Russian Federation.
The duration of treatment was 3 months. The parameters recorded were: systolic
and diastolic arterial blood pressure, rate of achievement of BP < 140/90 mmHg,
vascular age, cardiovascular risk assessed using the ASCORE scale, adherence to
treatment assessed by the adherence scale, and biochemical parameters.
Results: After 3 months, BP was decreased by 34.9/16.7 mmHg on average (from
164.4 ± 13.1/96.0 ± 8.9 mmHg to 129.5 ± 9.2/79.3 ± 6.8 mmHg) (P < 0.00001).
Target BP was achieved in 79.51% of patients. There was a significant decrease in
vascular age from 66.6 ± 12.1 to 58.2 ± 10.0 years (P < 0.00001). Cardiovascular
risk also decreased from 6.5 ± 4.3% to 4.0 ± 2.6% (P < 0.00001). This was due
to improved patient adherence to treatment (the percentage of patients with high
adherence increased from 23.8% to 62.1%). During the study, significant (P <
0.00001) reductions were recorded for total cholesterol, from 6.1 ± 1.1 mmol/l to
5.1 ± 0.8 mmol/l; glucose, from 5.55 ± 1.2 to 5.2 ± 0.8 mmol/l; creatinine, from
89.9 ± 18.2 mmol/l to 85.5 ± 15,4 mmol/l; and there was an increase in HDLcholesterol from 1.5 ± 0.6 mmol/l to 1.6 ± 0.6 mmol/l.
Conclusions: This study demonstrated that treatment with SPC perindopril arginine/amlodipine effectively lowers BP at 3 months, with an associated decrease in
vascular age and cardiovascular risk. Vascular age is an easy-to-use concept that
improves patients’ understanding of cardiovascular risk, which, as a result, leads
to improved patient adherence to treatment. A significant decrease in vascular age
could be an important factor to improve doctor-patient communication.
PP.27.10
CAN THE ARTERIAL COLLAPSE PRESSURE BE
ESTIMATED USING PULSE WAVE VELOCITY
MEASUREMENTS?
B. Gavish1, G. Pucci2, F. Battista2, M. D’Abbondanza2, G. Schillaci2. 1Yazmonit
Ltd., Eshtaol, ISRAEL, 2Department of Medicine, University of Perugia and Terni
University Hospital, Terni, ITALY
Objective: Arterial stiffness increases with pressure at the normal and high-pressure range. Theoretically, the extrapolation of this behavior to lower pressures
reaches a pressure level a, at which stiffness becomes zero and the artery is expected to collapse (like a ‘flat tire’). In this work we determined a using pulsewave-velocity (PWV) measurement at variable pressure.
Design and method: A previously reported model predicted that stiffness equals
to b*(Pressure-a), where b is the ‘stiffness parameter’, usually estimated by echotracking or CAVI. Stiffness equals also to constant*PWV2. In 68 healthy subjects
(59% men, age 54 ± 17 years, BP 133 ± 20/76 ± 11 mmHg), we measured brachial
BP and carotid-radial PWV using foot-to-foot method at the diastolic BP (DBP)
in supine position with arm supported at 3 postures: below-, at- and above the
heart level. b and a were best-fitted to the model using symmetric regression.
Abstracts e289
Results: Mean ± SD ‘below’-to-‘above’ DBP and PWV differences were 19.5 ±
4.8 mmHg and 1.5 ± 0.9 m/s (P < 10–6) and the mean correlation between PWV2
and DBP was 0.95. Mean ± SD[range] of b and a were 9.7 ± 5.5[2.1,23.7] and -6 ±
43[-64,107) mmHg, respectively. a decreased exponentially with increasing b (see
figure). Both b and a depended on the age tertile (P < 0.0005 and P < 0.005): 7.1,
9.0 and 13.4 and 10, 1 and -31 mmHg for age ranges 20–45, 47–54 and 65–90 yrs.
ART time and drugs) to normal dipping patients. On the contrary, they showed a
lower QKD (219.9 ± 22.8 vs 203.7 ± 21.3 ms for dippers and non-dippers respectively, p = 0.02). QKd correlates with age (r = –0.57, p < 0.001), 24hDBP (r =
0.32, p = 0.04) and glucose (r = –0.36, p = 0.03) but not with HIV charactheristics
and CV risk factors. The independent predictors of QKd at multivariate analysis
were age (b = 0.54, p = 0.001) and 24hDBP (b = 0.34, p = 0.01).
Conclusions: a estimates the pressure below which the artery ‘collapse’ (or practically becomes ‘soft’) and establishes a natural pressure reference, above which the
artery stiffen with pressure. Results may be important in explaining the interrelation
between age, stiffness and BP. a is likely to have clinical potential since b, with which
a is highly correlated, has already been demonstrated to have both diagnostic and prognostic power when estimated by other methods. The capability of the present method
to determine by the same method both a and b is attractive and deserves further study.
Conclusions: Our results suggest that non-dipping BP is a frequent pattern in
HIV-patients and is associated with impairment of arterial distensibility. Nor HIVinfection status parameters nor ART seems to be directly responsible for nondipping pattern; on the contrary age and 24 hour DBP seem to be strictly related
both with dipping and distensibility.
PP.27.12
VISCERAL ADIPOSITY INDEX IS ASSOCIATED WITH
NOCTURNAL HYPERTENSION BUT NOT NONDIPPING PATTERN IN UNTREATED HYPERTENSIVE
PATIENTS
K. Manousopoulos, E. Manios, V. Chouzouri, F. Michas, A. Lykka,
C. Papageorgiou, C. Vettou, N. Zakopoulos. Department of Clinical Therapeutics,
Medical School, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, GREECE
Objective: The visceral adiposity index (VAI) is a sex-specific scoring system
that can be used as a marker for both visceral fat dysfunction and individual’s
subsequent cardiometabolic risk. A recent study demonstrated that a higher VAI
was associated with arterial hypertension. However, it remains unclear whether
non-dipping status or nocturnal hypertension is associated with VAI. Aim of our
study was to evaluate the impact of non-dipping status and nocturnal hypertension
on VAI in untreated hypertensive patients.
Design and method: A total of 176 consecutive never treated subjects referred for
evaluation to the Hypertension Unit of our department, underwent 24-h ambulatory
BP monitoring and biochemical blood tests. The VAI was calculated as follows:
for male (waist/(39.68+(1.88*BMI)))*(Tg/1.03)*(1.31/HDL) and female (waist/
(36.58+(1.89*BMI))) *(Tg/0.81)*(1.52/HDL). The degree of nocturnal systolic BP
(SBP) dipping (%) was calculated as 100[1 – nighttime SBP/daytime SBP]. Dippers
were defined as subjects with nocturnal SBP fall > 10% and non-dippers as patients
with nocturnal SBP fall < 10%. Nocturnal hypertension was defined as nighttime
SBP > = 120mmHg or DBP > = 70mmHg. Statistical analysis was performed by
means of independent-samples T test, x-square and ANCOVA.
PP.27.11
24 HOUR ARTERIAL DISTENSIBILITY IS RELATED
WITH ABPM NON-DIPPING PATTERN IN HIVPOSITIVE PATIENTS
M. Varrenti1, A. Maloberti1, P. Vallerio2, F. Panzeri2, L. Pessina1,2, F. Casadei2,
D. Lucente1,2, I. D’Alessio1,2, G.M. Mondellini2,5, D. Motta3, C. Moioli3, G. Parati1,4,
M. Puoti3, C. Giannattasio1,2. 1Health Science Department, Milano-Bicocca University, Milan, ITALY, 2Cardiology IV Unit, A. De Gasperis Department, Ospedale
Niguarda Ca Granda, Milan, ITALY, 3Infectious Disease Unit, Ospedale Niguarda
Ca Granda, Milan, ITALY, 4Cardiologic Department, Ospedale S. Luca, Milan,
ITALY, 5Università degli Studi di Milano, Milan, ITALY
Objective: The use of Anti-Retroviral Therapy (ART) has decreased AIDS–related mortality. However, ART treated HIV-patients have higher cardiovascular
(CV) morbidity and mortality than general population. Although hypertension is a
frequent risk factor in HIV-patients (both due to HIV inflammatory activation and
ART drugs), existing data on Ambulatory Blood Pressure Monitoring (ABPM)
phenotypes in this setting are limited, but suggest an increased prevalence of a
non-dipping Blood Pressure (BP) pattern. The present study is aimed at determining the prevalence of non-dipping pattern in a population of unselected HIVpatients and it’s association with arterial stiffness over 24 hour.
Design and method: We studied 40 patients (72% man; 53.4 ± 8.8years). We
measured office and 24 hour systolic (S) and diastolic (D) BP, the QKd interval
during the ABPM evaluation (Dyasis Integra-Novacor, France). QKd represents
an index of arterial stiffness and is calculated as the time (measured in ms) between the onset of the depolarization on the electrocardiogram (Q) and the detection of the last Korotkoff sound (K) during cuff deflation. We also obtained
information on blood glucose and lipid values.
Results: Our HIV positive patients showed normal mean office (127.8/76.5 ±
16.1/7.1mmHg) and 24 h ABPM (121.1/79.8 ± 13.1/10.7mmHg) BP values. Regarding CV risk factors 30% of them were smokers, 25% took antihypertensive
and 17.5% lipid-lowering drugs. Seventeen patients (42.5%) showed non-dipping
pattern at ABPM. Non-dipping patients were superimposable for age, office BP, 24
h and day ABPM, glucose and lipids values and HIV characteristics (infection time,
Results: The study population consisted of 176 subjects with mean age (54y ±
10). The percentage of patients with nocturnal hypertension was 62%, whereas
the percentage of non-dippers was 35%. VAI did not differ significantly between
non-dippers (3.97) and dippers (3.88). In contrast, patients with nocturnal hypertension presented significantly (p = 0.012) higher VAI (4.31) than patients with
nocturnal normotension (3.26), even after adjustment for demographic characteristics and baseline risk factors.
Conclusions: A higher VAI was associated with nocturnal hypertension but not
non-dipping pattern in untreated hypertensive patients.
PP.27.13
USE OF 15-MINUTE AUTOMATED OFFICE BLOOD
PRESSURE MEASUREMENT TO REDUCE WHITE
COAT EFFECT: 24 HOUR AMBULATORY BLOOD
PRESSURE MONITORING STUDY
S. Choi, J. Youn, S. Han, K. Ryu. Hallym University Dongtan Sacred Heart Hospital, Hwaseong, SOUTH KOREA
Objective: Repeated, automated OBPM has showed a possible alternative to 24
h ambulatory blood pressure (ABP) monitoring. We aimed to compare 15-minute
blood pressure (BP) readings with the mean awake ABP.
Design and method: A total of 298 never-treated patients with high BP were enrolled. After consultation with a physician, BP was measured automatically every
3 minutes for 15 minutes, with the patient resting alone in a quiet room. Routine
office BP, mean BP for 15 minutes after consultation, and BP measured at 15-minute was compared with mean awake ABP.
Results: Systolic BP measured at 15 minute after consultation (144 ± 15 mmHg,
p = 0.008) was approximately 2 mmHg higher than mean awake ABP. (142 ±
12 mmHg) Other BP parameters such as mean BP for 15 minutes (146 ± 15,
p < 0.001) and routine office BP (152 ± 18, p < 0.001), were 4 to 10 mmHg higher
than mean awake ABP. Pearson R value was highest in 15-minute SBP (r = 0.451).
Especially, when systolic BP measured at 15-minute after consultation was less
160 mmHg, the difference with mean awake ABP was almost negligible. (139 vs.
140 mmHg, p = 0.207)
Conclusions: In never-treated Korean hypertensives, automated office BP measured at 15-minute after consultation was well correlated with mean awake ABP.
When systolic BP measured at 15 minute after consultation was less than 160
mmHg, white coat effect could virtually be prevented.
PP.27.14
VALUE OF ROUTINE BLOOD PRESSURE
MEASUREMENTS, PERFORMED IN AN
OUTPATIENT HOSPITAL CLINIC
M. Reinhard1,4, P. Poulsen2, K.L. Christensen3. 1Centre of Hypertension, Aarhus,
DENMARK, 2Dept. of Renal Medicine, Aarhus, DENMARK, 3Dept. of Cardiology, Aarhus, DENMARK, 4Dept. of Endocrinology, Aarhus, DENMARK
Objective: Treating hypertension is an important issue in most patients in cardiology, nephrology, endocrinology and geriatrics. Many patients with hypertension
are not properly regulated but some patients are being overdosed. There is a relation between antihypertensive therapy and risk of falls and fractures.
Routinely, BP is measured in all patients in hospital outpatient clinics. Usually, this
is done by and during presence of a nurse or a physician just before or after taking
an ECG. Clinical decisions are usually based on such measurements. 7 different
Danish departments confirmed that this was their procedure in most outpatients.
Design and method: We did an audit of consecutive patients referred from our
own cardiology outpatient clinic over a period of 18 months for ambulatory
monitoring of blood pressure (AMBP). Nineteen were within the age group from
30–45 yr and fourtyfive were older than 75 yr.
Design and method: Cross-sectional, observational, descriptive, non-interventional study in 32 communal pharmacies of the Valencian Community, belonging
to SEFAC (Spanish Society of Communal Pharmacies), between November 2015
and April 2016. BP variables were measured with a validated device (MOBIL-OGRAPH, IEMâ), according to ESH-recommendations, followed by a 10 itemscontaining questionnaire and measurement of the waist circumference.
Results: During the first month, 638 consecutive patients were recruited. Mean age
was 56,5 ± 14,1 years, the percentage of men was 38,6 %, with a global BMI of
28,5 kg/m2. We found significant differences between women and men in systolic BP
(126 vs. 129, p = 0.019), diastolic BP (78 vs. 83, p < 0.001) and waist circumference
(88 vs.100, p < 0.001). Prevalence of HTN (35,5 vs. 47,0%; OR = 1,6; IC: 1,12–
2,30, p < 0.009) was lower in women, but not obesity (41,9 vs. 49,1%; OR = 0,75;
IC: 0,54–1,04, p = 0,08) or smoking (14,8% vs. 19,9%; OR = 1,4; IC: 0,94–2,18,
p = 0,09). Visits directly related to BP made up to 35,4% of the total count. 28,7% of
the participants stood under antihypertensive and 26,8% under lipid-lowering treatment, 7,7% of patients were known diabetics. The prevalence of diagnosed ischemic
heart disease was 6,0%, that of stroke 4,2%. Only 45,7% of participants considered
their BP was adequately controlled. Noteworthy, under participants without known
HTN, prevalence of elevated BP was 25,3%, whereas among already treated patients we found increased values in 29,2%.
Conclusions: This pioneering large scale study involving communal pharmacies
shows their capability to determine adequately BP, risk factors and associated
clinical diseases, identifying a significant percentage of uncontrolled, already
treated patients, as well as a group of de novo, naïve participants with elevated BP.
Future studies shall clear if a pharmacy-based strategy is able to improve adherence and control of HTN on the long run.
PP.27.16
IN HOSPITAL ASSESSMENT OF ARTERIAL
BLOOD PRESSURE IN PATIENTS UNDERGOING
ORTHOPAEDIC SURGERY
M. Koutsaki, M.S. Kallistratos, E. Soulioti, A. Skyrlas, A. Koukouzeli,
A. Daskalaki, K. Vergis, O. Diakoumakou, O. Mascha, A. Mela, A.J. Manolis.
Asklepeion General Hospital, Athens, GREECE
Objective: The presence of hypertension is a common reason for postponing a
scheduled surgery and is based on in hospital blood pressure (BP) measurements
(mainly shortly before surgery). The majority of patients are apprehensive and
anxious of surgery regardless of the severity of the surgical operation, factor that
can influence the assessment of BP and therefore the assessment of hypertensive
burden. This study had the purpose to confront office BP levels in the perioperative clinic with ambulatory BP (ABPM) measurement as well as cortisol levels,
in order to evaluate the influence of stress and anxiety on BP levels, as well as to
assess the variability of BP during surgery.
Results: In the young age group, BP was 156/99 mmHg in the outpatient clinic
but 141/89 mmHg during AMBP in the daytime. SBP measured by these two techniques showed poor aggrement (Lin concordance correlation coefficient 0,38).
Mean difference was 15 mmHg.
In the old age group, clinic BP was average 171/87 mmHg but only 132/73 mmHg
during AMBP in the daytime. In 7 patients, the antihypertensive medication was
intensified before the AMBP, but 5 were reduced after AMBP due to low BP. SBP
measured by these two techniques showed no agreement (evt. Lin concordance
correlation coefficient 0.04). Mean difference was 38 mmHg. Using daytime ambulatory BP as reference, we found these values for clinic BP: sensitivity 92%,
specificity 13%, positive pred value 30% and neg. predictive value 80%.
Design and method: We present the preliminary results of a prospective observational study that will enroll 100 subjects undergoing scheduled knee surgery. In
all patients’ office BP (1 day before and 1 hour before surgery(surgery lounge)),
ABMP (12 hours before and 12 hours after surgery as well as plasma cortisol
levels (1 hour before and 24 hours after surgery) were measured.
Conclusions: Clinic BP is not a useful tool in older patients. Average error in our
database was 39 mmHg systolic, and clinical decisions made were often wrong.
Older patients who had high BP measured, mostly had normal or low BP in the
home. In our outpatient clinic, 60% of clinic BP were above 140/90 mmHg. Clinic
BP in outpatient clinics should be abandoned and replaced by better methods in
order to improve management of hypertension.
Results: We present data of the perioperative period (before and after surgery), of a
total 35 patients with mean age 73 ± 7 years. Mean ABPM levels (131 ± 15 mmHg) as
well as mean office BP levels (138 ± 18 mmHg) were significantly lower compared to
the measurement 1 h before surgery (156 ± 24 mmHg) (p < 0.001 and p < 0.005 respectively). In addition, cortisol levels 1 h before surgery (14.24 mcg/dL) were significantly
higher compared to cortisol levels 24 h after surgery (10.18 mcg/dL) (p < 0.005).
PP.27.15
PREVALENCE OF HYPERTENSION DETERMINED
IN COMMUNAL PHARMACIES OF THE VALENCIAN
COMMUNITY (RIVALFAR-STUDY)
V. Giner1, S. Alcázar2, V. Baixauli3, M. Cano4, E. Ferrer5, M.E. García6,
R.M. Prats7, E. Rodilla Sala8. 1Unidad HTA y Riesgo Cardiometabólico, Hospital
Virgen del los Lirios, Alcoi, SPAIN, 2Farmacia Comunitaria Salvadro Alcázar, Alcudia de Crespins, SPAIN, 3Farmacia Comunitaria Vicente Baixauli, Mislata, SPAIN,
4Farmacia Comunitaria Miguel Cano, La Nucia, SPAIN, 5Farmacia Comunitaria Estrela Ferrer, Mislata, SPAIN, 6Farmacia Comunitaria María Eugenia García, LÁlfàs
del Pi, SPAIN, 7Farmacia Comunitaria Rosa María Prats, Denis, SPAIN, 8Universidad Ceu Cardenal Herrera, Área Ciencias de la Salud, Moncada, SPAIN
Objective: Hypertension represents an underdiagnosed disease, its real prevalence is difficult to determine in population-based inquiries but also in observational studies. This study aims to measure the prevalence of HTN, associated risk
factors and associated clinical diseases in a sanitary environment like communal
pharmacies.
Conclusions: There is a significant difference between office BP, ABPM and BP
measurement in the surgery lounge. This gap can be explained from anxiety as
expressed by the increased cortisol levels. Physicians must take into consideration
this gap before proceed to the therapeutic handling (and eventually postpone the
surgery) in patients with increased BP levels.
PP.27.17
HIGH DAYTIME AND NIGHTTIME BLOOD PRESSURE
LOAD IS ASSOCIATED WITH THE DEVELOPMENT
OF PAROXYSMAL ATRIAL FIBRLLATION IN
HYPERTENSIVES: A PRELIMINARY REPORT
E.A. Andreadis1, C.V. Geladari1, G.N. Kolyvas1, A.I. Georgantoni1,
E.N. Pantikidi1, N.D. Karamichalakis2, S.E. Liapis2, E.T. Angelopoulos1. 1Fourth
Department of Medicine and Hypertension Center, Evangelismos General Hospital, Athens, GREECE, 2Department of Cardiology, Evangelismos General Hospital, Athens, GREECE
Objective: Hypertension (HTN) is a leading risk factor for heart disease and
stroke. Ambulatory blood pressure (ABP) monitoring has been used in the
Abstracts e291
management of HTN, but some limitations have been reported, especially
when mean 24-hour ABP is within normal range. It is suggested that BP
load is a better predictor of the detection of cardiovascular consequences associated with HTN. Links between HTN and atrial fibrillation (AF) further
raise the stroke risk. We aim to investigate whether BP load is associated
with the development of paroxysmal atrial fibrillation (PAF) episodes in
hypertensives.
Design and method: Subjects with office BP > 140/90 mmHg, with or without
antihypertensive medications attending our Hypertension Center participated in
the study. Exclusion criteria were severe renal, cardiac or other systemic disease,
stable arrhythmia, including AF, and evidence of secondary HTN. A complete
medical history was obtained from all participants. Office and ABP measurements
were taken on the same non-dominant arm. Office BP was measured in 3 visits
performed before ABP monitoring, using a validated oscillometric arm device
(Microlife WatchBP Office). ABP was monitored on a routine working day using validated oscillometric arm devices (Microlife WatchBPO3Afib). Daytime
and nighttime periods were defined according to the patients’ diaries (awake and
asleep periods). BP load was defined as the percentage of daytime and nighttime
systolic BP/diastolic BP (SBP/DBP) readings at least 135/85 and at least 120/70
mmHg, respectively.
Results: Thirty-seven hypertensives (age 60 ± 14 years, 22 men) were studied. An
association between daytime and nighttime BP load and the development of PAF
episodes was noted, with a daytime load of 65% and a nighttime load of 85% in
patients with recorded episodes of AF versus a daytime load of 40% (p = 0.01)
and a nighttime load of 54% (p = 0.03) in those hypertensive patients with no
episodes of AF.
Conclusions: BP load was associated with the development of PAF. Thus, BP
load may be a powerful determinant for the improvement of PAF detection in
hypertensives. This highlights that increases in BP load may be responsible for
raised cardiovascular disease risk and increased morbidity and mortality in highrisk individuals.
PP.27.18
THE INDEPENDENT RELATIONSHIP OF BLOOD
PRESSURE LOAD WITH TARGET ORGAN DAMAGE
IN UNTREATED HYPERTENSIVE PATIENTS. THE
ROLE OF DIPPING STATUS
H. Triantafyllidi, I. Xenogiannis, I. Ikonomidis, G. Pavlidis, A. Schoinas,
L. Palaiodimos, S. Vlachos, J. Lekakis. 2nd Department of Cardiology, Medical
School, University of Athens, ATTIKON Hospital, Athens, GREECE
Objective: Blood pressure (BP) load, defined as the percentage of abnormally
elevated BP readings, is provided on the report of ambulatory BP monitoring. The
relationship between BP load, independently from BP level, and target organ damage (TOD) in hypertension disease is under investigation. We aimed to explore the
relationship between BP load and TOD in patients with newly diagnosed essential
hypertension as well as the role of dipping status.
Design and method: We studied 300 patients with newly diagnosed and never
treated essential hypertension (mean age 50+11 years, 187 males, 202 dippers). We performed: a. 24 h ambulatory BP measurement (ABPM) in order
to measure BP load and estimate dipping status and b. we evaluated carotidfemoral artery pulse wave velocity (PWV), carotid intima-media thickness
(IMT), microalbuminouria (MAU), LV remodeling (LVMI), and coronary flow
reserve (CFR).
Results: Dipper hypertensive patients (n = 202) were younger, mostly males with
reduced 24 h SBP, 24 h PP, cIMT and LVMI compared to non-dippers (n = 98).
In the whole hypertensive population, BP load parameters were, independently
of 24 h mean BP, related with PWV (daytime and night-time SBP load) and IMT
(daytime SBP load). In dipper hypertensive population, only daytime SBP load
was independently of 24 h mean BP, related with PWV.
Conclusions: Daytime and night-time SBP load are independently related with
PWV and IMT, respectively, in middle-aged untreated hypertensives. Our results
add new data regarding the role of daytime SBP load since its independent association with PWV was evident only in dipper hypertensives.
PP.27.19
Prati1,
MORE SPEED AND NOISE FOR HBPM ADHERENCE
IMPROVEMENT: INFLATION VS DEFLATION
TECHNOLOGY
Pecchioli1,
Germanò2,
Fedele2. 1Asl
L.
V.
G.
F.
Frosinone, Frosinone, ITALY, 2Università La Sapienza- Policlinico Umberto I, Rome, ITALY
Objective: The most common automatic oscillometric devices, clinically validated, use the deflation technology to measure the blood pressure. However,
we have the inflation technology too has most widely used in settings where
the time factor is fundamental as in emergency. aim of our study was to assess
the degree of satisfaction from the use of inflation technology vs deflation for
HBPM.
Design and method: 70 hypertensive patients were enrolled, 35 used to HBPM
(group A) and 35 naive (group B).
All were subjected to pressure measurement in office without doctor presence
in dedicated room and after training in the naive group with both devices inflation (ClearRapid Pic Solution) and deflation (Daily Check Pic Solution); everyone answered to a questionnaire in order to detect a difference between the two
technologies.
Results: Patients in group A had mean age 58.5 ± 3.53, 19 M 16F. Patients in
group B had a mean age of 49.9 ± 9.69 20 M 15F.
Group A: PAS mean (139.5 ± 15.61) PAD mean (78 ± 9.13) with Inflation device
(clearRapid Pic S)
Group B: PAS mean (140 ± 15.55), PAD mean (83 ± 9.75) with Inflation device
(ClearRapid Pic S)
Group A: PAS mean (143 ± 17.56) PAD mean 84 ± 7.17 with Deflation device
(DailyCheck Pic S)
Group B: PAS mean (137 ± 18.16) PAD mean83.5 ± 10.41 with Deflation device
(DailyCheck Pic S)
In group A the inflation device was faster and much more silent and certainly the
measure was more comfortable.
In the group of subjects ‘naïve’ the device at inflation was considered faster and
quieter than other resulting overall much more acceptable than the other.
Conclusions: new oscillometric devices to inflation as the ClearRapid can be proposed to the hypertensive population for HBPM with purpose to increase HBPM
compliance, since the timing of measurement is significantly lower, as accurate
and less troublesome than deflation technology. In fact, to measure blood pressure
during cuff inflation is faster than during cuff deflation. This fact could increase
the likelihood that patients repeat at home measuring more than once, as required
by the Protocol ESH and helping us to better monitoring pressure load real. Enrollment is continuing.
PP.27.20
EFFECTIVENESS AND SAFETY OF VALSARTAN/
AMLODIPINE/ HYDROCHLOROTHIAZIDE IN
EGYPTIAN PATIENTS WITH HYPERTENSION
UNCONTROLLED ON ANY DUAL THERAPY: AN
OBSERVATIONAL STUDY
A.E. Etriby1, S. Rakha2. 1Ain Shams University, Cairo, EGYPT, 2Novartis
Pharma S. A. E, Cairo, EGYPT
Objective: To assess the effectiveness, safety and tolerability of amlodipine/
valsartan/hydrochlorothiazide (Aml/Val/HCT) single pill combination (SPC)
in Egyptian patients with hypertension who were not controlled on any dual
therapy.
Design and method: Prospective, open label, multicenter, observational, cohort
study conducted in patients with hypertension from Egypt, who were uncontrolled
on any dual antihypertensive therapy and to whom Aml/Val/HCT SPC was indicated. Patients were treated with Aml/Val/HCT (5/160/12.5 mg or 10/160/25 mg;
the only two available forms in Egypt) for 12 weeks. The primary endpoint was
mean change in systolic and diastolic blood pressure (SBP and DBP) at week 12.
Secondary endpoints included mean change in SBP and DBP at week 2, BP goal
(< 140/90 mmHg), safety and tolerability, change in heart rate, and compliance
with SPC at week 12.
Results: A total of 1080 patients completed the study. The mean baseline BP was
165.5/100.8 mmHg. Significant reduction in SBP/DBP -35.9/–20.3 mmHg (P <
0.0001) from baseline was observed at week 12. Similarly, the reduction in SBP/
DBP -28.0/–15.7 mmHg (P < 0.0001) was significant after 2 weeks of treatment.
Majority of patients (76.85%) reached the BP goal of < 140/90 mmHg. The most
common adverse events were ankle edema (10.92%), lower limb edema (5.88%),
and palpitation (5.88%). Physician’s evaluation showed that 61.76% (667/1080)
of the patients had excellent tolerability to study medication. The sitting pulse
significantly reduced from 80.3 bpm at baseline to 77.2 bpm (P < 0.0001). Compliance was better for patients taking Aml/Val/HCT 5/160/12.5 mg as compared
to 10/160/25 mg (60.56% vs 39.35%).
Conclusions: In this observational study conducted in Egypt, Aml/Val/HCT
(5/160/12.5 mg or 10/160/25 mg) SPC significantly reduced BP in patients not
controlled on any previous dual therapy. It also showed significant improvement
in BP control and good safety profile.
PP.27.21
CLINIC BASED MEASUREMENT OF CENTRAL
AORTIC SYSTOLIC PRESSURE – PRACTICAL
UTILITY AND ADVANTAGES: AN INDIAN STUDY
increase gradually from BP1 (71 and 70.9, respectively) until BP5 (46 and
81.1, respectively). Both, stabilize between BP5 and BP7 (45 and 81.6, respectively). There isn’t any difference of all results from BP5 and 3–7BPa.
T. Dhakate, H. Shah, D. Kirpalani, S. Devikar, A. Kirpalani. Bombay Hospital
Institute of Medical Sciences And Research Centre, Department of Nephrology,
Mumbai, INDIA
Objective: 1.To measure CASP across a cross-section of our patient (pt) population and assess the demographic profile using A-Pulse CASP device.
2. To compare and analyse CASP measurements vs brachial blood pressure(BBP)
measurements in pts with Hypertension(HTN) and CKD.
Design and method: BBP was measured by oscillometric method using A-Pulse
device .CASP was then measured by applanation tonometry and radial transfer
function technique by placing the sensor of the A-Pulse CASP device over the
ipsilateral radial artery.
Results: • 90 consecutive pts (males-60;females-30) were included.
• Subgroups : Group (Gp) A- Normal subjects (n = 25); Gp B – pts with HTN (n
= 16); Gp C – pts with CKD,not on dialysis (n = 27) & Gp D –pts with CKD on
dialysis (n = 22).
• In Gp A,mean CASP (114.92 ± 10.8) values across all age gps corresponded to
the worldwide reference range. In this gp,subjects (n = 14) with BMI > 25 kg/m2
had significantly higher CASP (119.14 ± 8.66 vs 109 ± 11.21) as compared to
subjects (n = 11) with BMI < 25 kg/m2.
• In Gps B, C & D (n = 65),the mean BASP was 143.09 ± 17.35 and mean CASP
was 132.78 ± 16.53 which was higher than the corresponding readings in Gp A.
Amongst these pts, the younger sub-gp (n = 29; age < 50 years) had significantly
higher CASP (131.76 ± 16.68) comparable with the older sub gp (133.9 ± 16.57)
(n = 36; age > 50 years) even as the two groups had similar & “within target” BASP readings (142 ± 17.85 vs 144.10 ± 17.02).Mean difference between
CASP and BASP was similar in both these subgroups,thus emphasizing that
younger pts with HTN & CKD exhibit accelerated vascular ageing
Conclusions: In healthy individuals,CASP & not BBP,can predict cardiovascular
risk much earlier in those with higher BMI.
In younger pts with HTN & CKD, Cardiovascular risk is better predicted by CASP
and not by BBP measurements.
Office based measurement of CASP is a necessary additional tool for thorough
cardiovascular risk assessment,especially in pts with CKD.
PP.27.22
WHAT IS THE OPTIMAL NUMBERS OF SEQUENTIAL
MEASUREMENTS TO IMPROVE THE ACCURACY
OF OFFICE BLOOD PRESSURE?
M. Vieira Da Silva1, A. Mendes Da Silva2, D. Artigas Giorgi3, F. Ganem4,
L.P. Rodriges De Resende2, E.M. Rodrigues De Resende2. 1Cardiac Diagnostic Center, Uberaba, BRAZIL, 2Triângulo Mineiro Federal University, Uberaba,
BRAZIL, 3Heart Institute of the University of São Paulo Faculty of Medicine, Sao
Paulo, BRAZIL, 4Sírio-Libanês Hospital, Sao Paulo, BRAZIL
Objective: To evaluate the optimal amount of sequential blood pressure (BP)
readings to improve the diagnostic performance of office BP, using as gold standard awake blood pressure average (ABPa).
Design and method: 426 patients have had their weight, height and waist
circumference measured by a nurse. Also, their BP was measured: 7 successive nurses BP measures (BP1 to BP7), each two minutes, using an automated
equipment, and recorded a 24-hour ambulatory blood pressure monitoring
(ABPM). Both were made second the protocols of European Guidelines. They
have had their BP measured in doctor’s office and were referred to ABPM because of a newly diagnosed high blood pressure. All of them answered questions about personal data and clinical features. It was compared with ABPa,
doctors readings BP average (OBPa), the seven nurse measurement, and the
average of third to seven BP nurse measurements (3–7BPa). We calculated concordance correlation coefficient (PC), specificity, the area under the ROC curve
(AUC), and the false positive
Results: The demographics and clinical features are listed in table 1. At table 2, are demonstrated the results of performance of each BP measurement
analyzed. OBPa showed the worst results for all measures analyzed and significantly different of nurse measurements. The systolic PC of BP1 (0.48) is
significantly smaller them BP5 (0.56), BP6 (0.59), BP7 (0.58) and 3–7BPa
(0.61). There wasn’t found any difference for systolic PC to others comparisons. Also. there wasn’t any difference for diastolic PC, systolic and diastolic
AUC for comparisons between nurse measurements. The specificity of BP5
5 (81.1), BP6 (81.1), BP7 (81.6) and 3–7 BPa (81.1) are significantly higher than BP1 (70.9) and BP2 (71.9). Falsies positive numbers and specificity
Conclusions: Taking account all results, at least, five measurements are necessary to improve OBPa performance and find the best results for positive falsies
and specificity.
PP.27.23
IN PATIENTS WITH WHITE-COAT EFFECT DURING
AMBULATORY BLOOD PRESSURE MONITORING
THE THIRD HOUR VALUES PARTIALLY REFLECT
MEAN DIURNAL BLOOD PRESSURE VALUES
F. Salvo1, C. Lonati2, A.R. Errani1, M. Berardi1, P. Fogliacco1, C. Vallo1, M. Albano1,
V. Meinero1, C.L. Muzzulini1, A. Morganti3. 1Division of Internal Medicine,
Poveri Infermi Hospital, Ceva, ITALY, 2Department of Internal Medicine and
Hypertension Center, S. Giuseppe Hospital, Milan, ITALY, 3Center of Clinical
Physiology and Hypertension, Policlinico Hospital, University of Milan, Milan,
ITALY
Objective: In previous studies we found that the increase in blood pressure (BP)
induced by clinical measurement, the so called white coat effect (WCE), is frequently observed also during ambulatory blood pressure monitoring (ABPM). As
in these hyperreactive patients performing a full 24-hours examination can be
cumbersome, we examined to what extent the mean values of systolic BP collected at the third hour (3hSBP), when WCE tends to wear off, are representative
of the mean diurnal systolic BP values (mDSBP).
Design and method: In 429 ABPM (M/F 144/285) in which WCE was detected
when the first systolic recorded value was at least 10 mmHg higher than mDSBP,
we compared 3hSBP and mDSBP assuming a mean value of 135 mmHg as the
upper limit of normotension.
Results: As expected considering all ABPM there was a progressive decrease
of mean values from the first to the third hour of recording (respectively
153, 139 and 134 mmHg) whereas mDSBP was 135 mmHg. Out of the 429
ABPM, 190 (44%) were above this limit with 3hSBP and 206 (48%) for
mDSBP. However only 147 (34%) and 180 (42%) were diagnosed respectively as hypertensive or normotensive with both measurements, whereas 43
(10%) of those found hypertensive with 3hSBP were not so with mDSBP and
59 (14%) normotensive with 3hSBP were diagnosed as hypertensive with
mDSBP. Thus inspite of the fact that overall there was a significant correlation between 3hSBP and mDSBP (r = 0.72; p < 0.01), 102 (24%) patients had
a discordant diagnosis.
Conclusions: Although 3hSBP provides some insight on DSBP in patients with
WCE, the percent of incorrect diagnoses with 3hSBP is too high to justify the use
of 3hSBP as a surrogate of conventional DSBP.
Abstracts e293
PP.27.24
EFFECTS OF ASTHMA SEVERITY ON LEFT
VENTRICLE OF CARDIAC REMODELING IN
PATIENTS WITH ARTERIAL HYPERTENSION
E. Tarlovskaya1, A. Odegova2, T. Chudinovskikh2. 1Nizhny Novgorod State Medical Academy, Department of Internal Medicine, Nizhny Novgorod, RUSSIA,
2Kirov State Medical Academy, Department of Internal Medicine, Kirov, RUSSIA
Objective: To reveal the characteristics of left ventricle of cardiac remodeling
at different severity degrees of bronchial asthma (BA) on the background of hypertension.
Design and method: 91 patients were involved with varying BA severity in
the step of controllability associated with arterial hypertension (AH) 1, 2 severity. Of these, 26 patients (29%) with mild BA, 34 (37%) with an average
severity of BA, 31 (34%) - severity of severe BA. A group of 30 patients
with AH 1,2 degrees and a group of 32 people with BA were taken for a
comparative analysis. All examined patients were outpatients and were taken
adequately matched basic therapy on BA with inhaled corticosteroids (ICS).
The patients used a beta2-agonists short action on demand. Group of patients
with AH 1,2 degrees, n = 30, and a group with different degrees of BA in the
stage of control n = 32, were taken for comparative analysis. The diagnosis of
AH and extent of increase the blood pressure (BP) - on the basis of criteria
of WHO 2013. In groups of comparison there were no statistically significant
distinctions of an average the BP, groups were comparable on age, sex and an
experience of AH (p > 0,05). All patients were performed the echocardioscopy
on Acuson 128XP /10c (USA).
Results: The Index of weight of myocardium of left ventricle (IWMLV) and
the thickness of a back wall of the LV (TBWLV) were more in groups with AH.
IWMLV in group BA-87,55 ± 2,65 g/m2, AH-112,1 ± 1,97 g/m2, BAMAH-109,18
± 1,16 g/m2, p = 0,004, BAAAH-123,1 ± 1,42 g/m2, p = 0,001, p = 0,0015, BASAH-128,45 ± 1,91 g/m2, p = 0,001, p = 0,0001. TBWLV in BA group-0,93 ±
0,02 cm, AH-1,08 ± 0,03 cm, BAMAH-0,98 ± 0,01 cm, BAAAH-1,13 ± 0,03 cm,
p = 0,004, p = 0,001, BASAH-1,27 ± 0,03 cm, p = 0,001, p = 0,0001. Results the
following are received during studying of the final diastolic size (FDS): BA-4,90
± 0,06 cm, AH-5,01 ± 0,06 cm, BAMAH-5,01 ± 0,06 cm, BAAAH-5,19 ± 0,06
cm, BASAH-5,65 ± 0,06 cm.
Conclusions: The seasonal variability of CBP/ABP parameters in patients with
AH and HNBP corresponds to the general trend - BP is higher in W than in S.
The ambient temperature is not influence on CBP/ABP of patients from two investigated cohort.
PP.27.26
FIRST MEDICAL WARNING.A REAL HARAKIRI.
HYPERTENSIONOLOGIST’S HYPERTENSION.
SAGLIKER EFFECT. CLASSICAL MANUAL
BP MEASUREMENTS MUST BE BANNED BY
LEGISLATIONS AND ESH AND WHO
H.S. Sagliker1, Y. Sagliker2, N. Paylar2, C. Sagliker2, P. Sagliker Ozkaynak2,
F. Ocal3, T Inal4, P. Kolasin5, M. Balal4. 1State Hospital, Konya, TURKEY,
2Sagliker Hypertension Unit, Adana, TURKEY, 3Sutcu Imam University, Kahramanmaras, TURKEY, 4Cukurova University, Adana, TURKEY, 5Duzen Laboratories, Adana, TURKEY
Objective: It is known some normals and hypertensives get higher BP when facing medical environments or devices. Effect called WCE, WCH,stress hypertension or office hypertension. We examined if same be also found in medical staff
in outpatient clinics. This is first medical definite findings in medicine on subject.
Conclusions: Patients with the combined pathology had IWMLV and TBWLV
more, since BAAAH group, than similar indicators of groups with the isolated
BA and AH. FDS didn’t differ at investigated with the combined pathology from a
similar indicator at groups of BA and AH, then is higher the severity of bronchial
obstruction, we see a tendency to its increase.
PP.27.25
SEASONAL DIFFERENCES OF BLOOD PRESSURE
IN PATIENTS WITH ARTERIAL HYPERTENSION AND
HIGH NORMAL BLOOD PRESSURE
D. Volkov, M. Smirnova, V. Gorbunov, S. Boytsov, M. Loukianov, A. Deev,
Y. Koshelyaevskaya. National Research Center for Preventive Medicine, Moscow,
RUSSIA
Objective: Blood pressure (BP) levels have tendency to seasonal (winter [W]
vs. summer [S]) variability but some aspects of this problem are not studied yet.
The aim of our study was to evaluate seasonal and monthly variability of clinical
and ambulatory BP (ABP) in patients with arterial hypertension (AH) and high
normal BP (HNBP) in S and W in two regions of the Russian Federation with
different climate.
Design and method: We included patients from the general population who
visited ambulatory clinics in Ivanovo (I) and Saratov (S) for various reasons.
The main inclusion criteria were clinical BP (CBP) < 160/100 mmHg without
or on regular antihypertensive drugs intake (ADI) or CBP = 130/85–139/89
mmHg without ADI. The CBP measurements was performed by automatic tonometer (OMRON 705 IT). The ABP monitoring (ABPM) was performed with
the BPLab device (Nizny Novgorod, Russia) twice in each patient: in W (DecFeb 2012–2014) and in S (Jun-Aug 2012–2014). The interval between ABPMs
was 6 months ± 10 days. The selection criteria for ABPM records were the quality adequate for sophisticated analyses: duration > 24 h, absence of data gaps >
1 h, > 55 readings per 24 h.
Results: In total, 1630 patients were included: 720 in I and 910 in S. The patients
of I (the region with lower average ambient temperature compared to S) had higher
mean systolic CBP (CSBP) in W than in S (134.4 ± 13.2 mmHg and 129.7 ± 12.6
mmHg, respectively, p < 0.0001). The CSBP in patients of S was also higher in W
(128.9 ± 14.3 mmHg) than in S (125.0 ± 16.0 mmHg, p < 0.0001). Monthly averages of CBP/ABP and ambient temperature were not related in S and W.
Design and method: 58 doctors examined 12 hypertensives by measuring BP in
person,per se with classical manual recorders, every 10 minutes for two hours first
day, then relaxed consecutive day, similarly two hours. SBP, DBP, MAP, HR, two
hours NE, E, VMA, metanephrine in urines and plasma NE,E,PRA, A and A II
examined. Additionally plasma AT II levels examined just before BP recordings
in first stress day.
Results: SBP, DBP, MAP,HR, cathecolamins in two-hours urines, blood cathecolamins PRA,A decreased from first day to second .Interestingly plasma AII
decreased from time of prerecordings to time of postrecordings in first stres day.
P values for differences were less than 0,001.
Conclusions: Personels had higher SBP, DBP, MAP, HR, PRA and A, cathecolamins in urines and plasma after examinations. Reduction of AII at time of postrecordings be explained by AII’s short half life. If AII be examined continously
during measurements, could be found higher at first but decreasing tremendously
by time till end-point. Staff could face complications such as cerebrovascular attacks, myocardial infarctions, blindness if they have hypertension or prone to it
due to some present abnormalities in the body. Manual recordings for personel
was a reverse white coat effect plus hand grip exercise test and dangerous.In developping countries as Turkey, India, Pakistan, Bengladesh, China, Endonesia,
Maleysia where 150–200 patients examined and BP recorded daily only by one
doctor, manual recorders be banned by legistlations and started first in history via
ESHand WHO.This is a sine qua non humanity task.
PP.27.27
CHARACTERS OF HEART REMODELING IN
PATIENTS WITH BRONCHIAL ASTHMA COMBINED
WITH ARTERIAL HYPERTENSION
A. Odegova1, E. Tarlovskaya2, T. Chudinovskikh1. 1Kirov State Medical Academy,
Kirov, RUSSIA, 2Nizhny Novgorod State Medical Academy, Nizhny Novgorod,
RUSSIA
Objective: Bronchial asthma (BA) is a serious global problem. It was found that
the frequency of arterial hypertension (AH) detection in patients with asthma is
about 30 %. Aim. To compare of heart remodeling in patients with a combination
of AH and BA, and with isolated AH and BA
Design and method: 35 patients with controlled BA and combined with AH
1,2 degrees (group I). The group II of 30 patients with AH 1,2 degrees and
the group III of 31 patients with BA were taken for a comparative analysis.
The diagnosis is BA exposed by criteria of GINA 2014. The diagnosis of AH
and extent of increase the blood pressure (BP) - on the basis of criteria of
WHO 2013. In groups of comparison there were no statistically significant
distinctions of an average the BP, groups were comparable on age, sex and an
experience of AH (p > 0,05). All patients were performed the echocardioscopy
on Acuson 128XP/10c (USA). The obtained data were processed by method
of variation statistics.
Results: The Index of weight of myocardium of left ventricle (IWMLV) in group
I - 121,1 ± 1,62 g/m2,p = 0,01, exceeded similar indicators of groups II and III 87,55 ± 2,65 g/m2 and 112,1 ± 1,97 g/m2. The thickness of a back wall of the LV
(TBWLV) in group I - 1,16 ± 0,03 cm, p = 0,045. I exceeded indicators of group
II and III - 0,93 ± 0,02 cm and 1,08 ± 0,03 cm. Prevalence of the maximum speed
of active filling (A) over the maximum speed of fast filling (E) was noted in all
groups. Relation E/A - 0,88 ± 0,05, p = 0,045 was reliable less in group I, than
in groups II and III respectively-1,04 ± 0,07, 0,98 ± 0,03. Values of fraction of
emission according to Simpson at patients of group I - 62,7 ± 1,8%, groups II and
III - 65,3 ± 2,4%; 64,5 ± 1,6%, didn’t differ authentically, p > 0,05.
Conclusions: Patients with confirmed myocardial hypertrophy and diastolic heart
dysfunction occurred in all groups, but the number of them was greater in the
group with combined pathology. Systolic dysfunction was not registered significantly in any of the groups in this study.
Abstracts e295
POSTER SESSION
BLOOD PRESSURE VARIABILITY
PP.28.01
AMBULATORY BLOOD PRESSURE MONITORING IN
DIALYSIS PATIENTS
D. Klaric, K. Artukovic, M. Razov Radas. Zadar General Hospital, Zadar,
CROATIA
Objective: Hypertension is a common illness among hemodialysis (HD) patients.
It is frequently accompanied by other conditions such as hypertrophy of the left
ventricle, increased parathyroid hormone, overhydration and disorders of the renin-angiotensin system and the sympathetic nervous system, which contribute to
higher mortality.
Design and method: We retrospectively analyzed 89 patients on HD, 42.7% of
which had diabetes. Ambulatory blood pressure was monitored on the day before
dialysis. Hypertension was defined as blood pressure above 140/90 mmHg. Daily
rhythms of blood pressure, mean arterial pressure and pulse pressure were also
measured. The control group consisted of 89 patients from the hypertension clinic
who weren’t undergoing dialysis, among which 39.1% had diabetes.
Results: All HD patients median blood pressure was 150/88 mmHg. Dip per
day was –0.5%, while dip per night was –2.0%. Mean arterial pressure was 109
mmHg. Average pulse pressure was 62 mmHg. Among HD patients with diabetes
1 (3%) was a dipper, 10% were non-dippers and 71% were inverse dippers. Control group patients median blood pressure was 140/86. Dip per day was –6.2%, dip
per night was –10.3%, mean arterial pressure was 104 mmHg and pulse pressure
was 53 mmHg. 17% were dippers, 58% were non-dippers, and 25% were inverse
dippers. Pulse pressure was significantly higher among HD patients which could
have had an effect on increased afterload and decreased coronary perfusion pressure. Besides diabetes, other factors have an impact on inverse blood pressure
during night time among HD patients, such as retention of extracellular fluid.
Conclusions: Hypertension is a major risk factor of morbidity and mortality
among HD patients. Causes of hypertension differ. Target blood pressure is similar to that of the general population, and lower values of blood pressure is associated with higher mortality. HD patients have a smaller decline in blood pressure
during night time. Inverse values of blood pressure during the night wasn’t only
among patients with diabetes.
PP.28.02
CLINICAL PATHOGENIC ASPECTS OF BLOOD
PRESSURE CHRONOSTRUCTURE IN THE
CONDITIONS OF SHIFTWORK IN THE ARCTIC
N. Shurkevich1, A. Vetoshkin2, L. Gapon1, N. Shipitsyna1, D. Gubin3,
F. Poshinov2. 1Tyumen Cardiology Center, Branch of Research Institute of Cardiology, Siberian Branch of the Russian Academy of Medical, Tyumen, RUSSIA,
2Medical Unit GAZPROM DOBYCHA YAMBURG LLC, Yamburg, RUSSIA, 3Tyumen State Medical Academy, Tyumen, RUSSIA
Objective: To study clinical differences of arterial hypertension, to conduct standard and cosinor-analysis of 24-hour blood pressure (BP) monitoring for chronobiological assessment of AH circadian rhythms in shift workers of the Arctic polar
region and native residents of Tyumen city
Design and method: 373 patients with AH stage I-II in the control group and
144 patients with AH stage I-II in the comparative group were examined and underwent 24-hour BP monitoring, echocardiography, brachiocephalic artery ultrasound, treadmill ergometer test, 24-hour ECG holter monitoring and biochemical
blood test
Results: In the conditions of shiftwork in the Arctic clinical implications of AH
were more evident and associated with structural heart alterations, high frequency
of atherosclerosis in brachiocephalic arteries, dislipidemy, low exercise tolerance
and level of adaptive potential. Being influenced by exogenic factors, BP neurohumoral regulation mechanisms undergo circadian reliant changes modulating BP
daily rhythm. In northern citizens with AH circadian BP profile was associated
with low circadian rhythm indices, high BP variability, mainly night hyperbaric
overload that explains high frequency of AH circadian BP profile «non dipper» and
«night peaker». Reduction of stability and rate of BP daily rhythms with significant
differences of acrophases location shifted to the later hours was revealed. Results
of Fourier spectral analysis confirm “decay” of BP circadian structure in the conditions of changed photoperiodism of the Extreme North to a wide range of ultradian
rhythms and disturbances in the spectrum of daily systolic BP and diastolic BP.
Conclusions: Chronobiological disturbances in AH circadian rhythm in the conditions of shiftwork was caused by the malfunction of correspondence in internal
and external cueing of physiological processes (desynchronosis) influenced by the
conditions of shiftwork
PP.28.03
EFFECT OF CHOLECALCIFEROL ON BLOOD
PRESSURE VARIABILITY IN WOMEN WITH
ARTERIAL HYPERTENSION IN PREMENOPAUSAL
AND EARLY POSTMENOPAUSAL PERIODS
L. Kezhun, L. Yankouskaya. Educational Establishment «Grodno State Medical
University», Grodno, BELARUS
Objective: To assess effect of cholecalciferol on blood pressure (BP) variability
in women with arterial hypertension (AH) in premenopausal and early postmenopausal periods who received 25(OH)D supplementation.
Design and method: We investigated 102 women with AH stage II risk 3 aged
50(48;53) years: 50 females in premenopausal period – group I and 52 females in
early postmenopausal period – group II. Serum level of 25(OH)D was determined
by the immunoenzymatic assay. In groups I and II we identified subgroups with
the level of 25(OH)D < 30ng/ml: subgroup IB (n = 25) and subgroup IIB (n =
21) respectively, in which antihypertensive therapy was supplemented with cholecalciferol 2,000 IU/day for 3 months. In subgroups IA (n = 25) and IIA (n = 31)
cholecalciferol was not administered. BP variability were calculated as the mean
root square deviation from average values of systolic and diastolic BP (SBP/DBP)
during day/night while conducting 24-hour BP monitoring.
Results: At baseline the level of 25(OH)D was lower (p < 0,05) in subgroups IB
(19,3 ± 8,5 ng/ml) and IIB (18,2 ± 9,5 ng/ml) than in the comparable subgroups
IA (26,7 ± 11,5 ng/ml) and IIA (27,4 ± 10,5 ng/ml). After supplementation the
level of 25(OH)D increased (p < 0,001) in subgroup IB (37,28 ± 11,97 ng/ml)
and in subgroup IIB (36,4 ± 10,0 ng/ml), and became higher (p < 0,001) than
in the comparable subgroups IA and IIA. At baseline subgroups IA and IB did
not differ (p > 0,05) by SBP/DBP variability during day/night. After the therapy
SBP variability at nighttime became lower (p < 0,02) in group IB as compared to
group IA (12(10;14) mmHg and 15(11;18) mmHg). In subgroup IIB indices of
SPB variability at daytime were higher (p = 0,04) at baseline than in group IIA
(36,0(29,0;43,0) mmHg versus 25,0(22,0;38,0) mmHg). Following the therapy
dynamics of SBP variability at daytime was highest (p < 0,05) in subgroup IIB
(–17,61 ± 13,15 mmHg) as compared to the comparable subgroup IIA (–8,17 ±
9,06 mmHg), as well as to subgroups IB (–9,32 ± 15,85 mmHg) and IA (–7,85 ±
8,35 mmHg) correspondingly. We established significant contribution of cholecalciferol to dynamics of SBP variability at daytime: F = 3,95, p = 0,05.
Conclusions: Correction of 25(OH)D level by intake of cholecalciferol 2000 IU/
day for 3 months leads to reduction of BP variability in women with AH.
PP.28.04
DYNAMICS AND VARIABILITY OF BLOOD
PRESSURE IN PATIENTS WITH ACUTE STROKE
AND HYPERTENSIVE CRISIS
L. Baurenski1, E. Trendafilova1, L. Haralanov2. 1National Heart Hospital Department of Cardiology, Sofia, BULGARIA, 2National Heart Hospital - Department of Neurology, Sofia, BULGARIA
Objective: Blood pressure variability (BPV) is considered an independent poor
prognostic factor in acute stroke. The aim of the study was to analyze the blood
pressure (BP) dynamics and variability in patients with hypertensive crisis and
acute ischemic (IS) or hemorrhagic stroke (HS).
Design and method: The study included 108 randomly selected in-hospital patients (54 men and 54 women) with acute stroke (70 patients with IS and 38 with
HS), accompanied by hypertensive crisis at admission (systolic blood pressure /
SBP/ > 180 mmHg and /or diastolic blood pressure (DBP) > 120 mmHg). Dynamics of BP and neurological status were analyzed. Some indices of BP variability
and their potential association with the outcome of stroke were studied too.
M
O
N
D
A
Y
P
O
S
T
E
R
S
Results: Patients with IS were older than those with HS (69 vs 60,6 years /p <
0,001/). Some differences in BP dynamics and BPV between the two types of stroke
were found. Patients with HS were with significantly higher initial levels of SBP,
pulse pressure and mean BP. The BP drop was steeper in the first 24 hours (SBP with
about 26% for IS and 32% for HS) and then smoother. We observed more gradual
fall in SBP and DBP in persons with clinical improvement. Those who did not improve or deteriorated demonstrated steep reduction of SBP in the first 24 hours, then
more fluctuations and a trend for slight increase > 160 mmHg after the 24th hour.
Significantly greater BPV was established in patients with HS. The indices of BPV
significantly associated with the outcome at hospital dissmission in patients with
IS were the maximal variations of SBP and in patients with HS - the mean standart
deviation of SBP and the maximal variations of SBP > 50 mmHg.
Conclusions: BP dynamics and BPV might be of definite importance for the outcome of acute stroke. In our study we observed significantly higher initial BP
values and more variations in the group with HS, which correlated with worse
prognosis.High BP in the acute phase of stroke should be reduced carefully using
therapeutic strategies associated with stable BP levels and low BPV.
PP.28.05
CHARACTERISTICS OF BLOOD PRESSURE
IN PATIENTS UNDERGOING CHRONIC
HEMODIALYISIS
E. Ivandic, V. Ivkovic, V. Premuzic, I. Barisic, R. Smalcelj, N Basic Jukic,
L. Bubic Filipi, I. Mesar, I. Juric, I. Kovacevic Vojtusek, L. Katalinic,
A. Vrdoljak, S. Karanovic, I. Vukovic, L. Gellineo, M. Laganovic, B. Jelakovic.
University of Zagreb School of Medicine, Department of Nephrology, Hypertension, Dialysis and Transplantation, UHC Zag, Zagreb, CROATIA
Objective: Cardiovascular (CV) disease is the most important cause of morbidity
and mortality among patients with chronic kidney disease particularly in those undergoing chronic hemodialysis (HD). Hypertension (HT), the most important CV
risk factor is frequently present and has several particular characteristics. Our aim
was to analyze characteristics of HT in our group 194 patients undergoing HD.
Design and method: In this study we have analyzed characteristics of HT and arterial stiffness (i.e. PWV) in 194 patients (118 m, 83 w; mean age 63+/–15 y). All
patients were dialyzed three times a week with standard bicarbonate hemodialysis
solutions and synthetic dialyzers according to the recent international guidelines.
All measurements were done mid week day. Blood pressure (BP) was measured
with Omron M6 (after dialysis session), ABPM using Spacelab 90207 (24 h) and
PWV (before dialysis session) was determined with Arteriograph.
Results: Significant difference in BP values measured after dialysis and ABPM
were found (day, night, for both systolic and diastolic BP). Only 6.6% patients
were normotensive, 63.3% hypertensive, while white coat (WCH) and masked
hypertension (MH) were diagnosed in 26.4% and 3.7%, respectively (no gender
differences). There were no differences in BP values between men and women,
but PWV > 10m/s were found more frequently in men than in women in (m vs. w
56.5% vs.39.7%;p = 0.049; 48.3% in total; 10.4+/–1.9 vs.9.7+/–1.7;p < 0.01). In
logistic regression age was the most important predictor for pathologic values of
PWV. WCH had slightly higher values of PWV than normotensives (9.7 +/–2.0
vs.8.5+/–1.3; p = 0.09). PWV in MH was not different compared to the sustained
HT (10.2+/–1.7). Non-dipping status was established in 45.3%, extreme dipping
in 18.8%, and only 21.6% were dippers.
Conclusions: Our results confirmed significant clinical value of ABPM in patients undergoing dialysis. Determination of WCH subjects and non-dippers is of
utmost importance for everyday tailoring of therapy. Increased arterial stiffness
should be considered as well.
PP.28.06
DAY AND NIGHT PULSE PRESSURE
AMPLIFICATION IN NORMOTENSIVE,
HYPERTENSIVE DIPPER AND HYPERTENSIVE
NON-DIPPER PATIENTS
Y. Kotovskaya1, S. Millasseau2, J. Topouchian3, I. Posokhov4. 1Russian Peoples
Friendship University, Moscow, RUSSIA, 2Pulse Wave Consulting, Saint Leu la
Foret, FRANCE, 3Diagnostic and Therapeutic Center, Hotel Dieu Hospital, Paris,
FRANCE, 4Hemodynamic Laboratory Ltd, Nizhny Novgorod, RUSSIA
Objective: Several studies have shown that office central blood pressure (cBP)
might better predict cardiovascular events than standard peripheral pressure. Recent ambulatory monitoring technologies such as the BPLab monitor equipped
with Vasotens software (OOO Petr Telegin, Russia) allows to estimate cBP over
24 h. However to date, it is unknown if 24 h monitoring of cBP have added value
to office cBP measurements.
Design and method: We looked at the average day and night pulse pressure
amplification (PPamp = peripheral pulse pressure/ central pulse pressure),
cBP and pulse wave velocity (PWV) in 120(60 M/60F) normotensives (NT),
120(60 M/60F) hypertensive dippers (DI) and 120(60 M/60F) hypertensive nondippers(ND) matched for age, sex and day brachial SBP for the hypertensive
subjects.
Results: Between day and night, peripheral systolic blood pressure fell from 122
± 8 to 103 ± 7 mmHg in NT, from 140 ± 11 to 117 ± 11 mmHg in DI and from 140
± 12 to 137 ± 14 mmHg in ND. Heart rate fell from 70 ± 8 to 59 ± 7 bpm, 77 ± 10
to 63 ± 8 bpm and from 73 ± 12 to 65 ± 11bpm in NT, DI and ND respectively. DI
patients tended to have higher day PPamp value than other groups (132 ± 7%, 135
± 8%, 131 ± 9% in NT, DI and ND respectively, p < 0.001 ANOVA). Night PPamp
was similar in each group and lower than day PPamp (123 ± 7%, 124 ± 6% and
123 ± 7%, p = 0,11). However PPamp was correlated with heart rate (R2 = 0,36,
p < 0.001). After adjustement for heart rate changes, PPamp did not differ during
day and night in the 3 groups.
Conclusions: After heart rate correction, cBP seems to vary in parallel to peripheral blood pressure during the day in normotensive, dipper hypertensive and
non-dipper hypertensive.
PP.28.07
PREVALENCE AND DETERMINANTS OF
EXAGGERATED MORNING SURGE AND MORNING
HYPERTENSION IN CHINESE: THE CHINA
AMBULATORY AND HOME BLOOD PRESSURE
REGISTRY (ABPR)
Q.H. Guo, Y.Y. Kang, J. Song, Q. Chen, C.Y. Liu, S.K. Xu, Y.B. Cheng, Y. Li,
J.G. Wang. The Shanghai Institute of Hypertension, Shanghai Jiaotong University
School of Medicine, Shanghai, CHINA
Objective: Prognosis of exaggerated morning surge (MS) of blood pressure (BP)
remains controversial, possibly due to the ethnic difference in the size of MS.
Compared to MS, evidence on morning hypertension (MH) is more consistent.
With the use of a national BP registry database, we studied the size of MS and the
prevalence and determinants of exaggerated MS and MH in Chinese.
Design and method: In the 3547 patients (mean age, 56.8 years; women, 49.1%;
hypertension, 79.0%) enrolled in the China Ambulatory and Home BP Registry (ABPR), we performed both 24-h ambulatory and 7-day self-measured home
BP monitoring. Exaggerated MS was a sleep-trough MS great and equal than 35
mmHg as recommended by the Chinese guidelines. Morning hypertension was a
mean BP of at least 135/85 mmHg either self-measured at home in the morning
or recorded by ambulatory monitors during 6:00-10:00 (8:00-12:00 for patients
from Xinjiang Province).
Results: In all registered patients, sleep-trough systolic MS averaged (SD) 20.6
(13.5) mmHg, and 457 (12.9%) had an exaggerated MS. Multivariate regression
analysis showed that the size of MS was greater in women (b = 1.26 mmHg; P =
0.02), increased with age (0.04 mmHg, P = 0.03), body-mass index (0.16 mmHg,
P = 0.03) and 24-h systolic BP (0.05 mmHg, P = 0.006). Totally, 1796 (50.6%) and
1874 (52.8%) patients had MH on home and ambulatory BP monitoring, respectively. In treated hypertensive patients with office BP < 140/90 mmHg (n = 1230),
the corresponding values were 32.6% and 37.5%, respectively. Overall, MH was
significantly (P < 0.01) associated with male sex (standardized OR [95% CI], 1.17
[1.04–1.28]), older age (1.27 [1.18–1.37]), body mass index (1.20 [1.12–1.28]),
alcohol intake (1.42 [1.16–1.73]), and home heart rate (1.19 [1.11–1.28]).
Conclusions: The size of the sleep-trough MS in Chinese is modest, but similar
to that reported in Europeans. However, MH is prevalent in Chinese patients, especially in those with cardiovascular risk factors.
PP.28.08
LONG- AND SHORT-TERM BLOOD PRESSURE
VARIABILITIES IN PATIENTS WITH CONTROLLED
ARTERIAL HYPERTENSION ARE NOT
INTERCHANGEABLE
E. Troitskaya, N. Kotovskaya, Y. Kotovskaya, Z. Kobalava. Peoples’ Friendship
University of Russia, Moscow, RUSSIA
Objective: Visit-to-visit blood pressure variability (BPV) is associated with cardiovascular disease risk. In view of the inconvenience of obtaining blood pressure at multiple visits to calculate visit-to-visit BPV, substituting BP variability
from calculating short-term variability (intravisit and 24-hours) may be a practical
alternative. The aim of the study was to evaluate the associations between longterm (visit-to-visit) and short-term (intravisit and 24-hours) BPV in patients with
uncomplicated controlled arterial hypertension (AH).
Design and method: 52 pts (20 men, age 58,9 ± 9,0 yrs; 4 smokers; 6 diabetics)
with AH without HF were treated to target BP < 140/90 mmHg with combination
of RAAS-inhibitor and amlodipine for 14mo. Visit-to-visit BPV was calculated as
Abstracts e297
SD for 5 visits during 8 months after target BP achievement. Intravisit BPV was
calculated as SD of 3 BP values at each visit. ABPM was performed before treatment and at the end of the study.p < 0,05 was considered significant.
Results: Baseline BP was 163,4 ± 8,1/100,9 ± 4,2 mmHg; achieved-123,7
± 9,7/76,8 ± 6,7 mmHg. Intravisit SBPV varied from 0,8 to 7,0 mmHg (mean
3,1 ± 1,1 mmHg), DBPV – from 0,8 to 4,2 mmHg (mean 2,3 ± 0,7 mmHg).
Daytime SBPV varied from 6 to 29 mmHg, daytime DBPV varied from 5 to 31
mmHg. Nighttime SBPV varied from 5 to 18 mmHg, nighttime DBPV – from
4 to 23 mmHg. Visit-to-visit SBPV after achievement of target BP varied from
1,79 mmHg to 16,79 mmHg (mean 7,2 ± 3,6 mmHg); (tertile I < 5,38;II 5,38
–7,78;III > 7,78 mmHg). The groups were similar by age (I 56,6 ± 8,94, II 59,4
± 9, III 60,7 ± 9,1 yrs, p > 0,05), gender, metabolic risk factors, baseline and
achieved BP. Groups were also similar by intravisit SBPV (3,0 ± 1,0 vs 3,4 ±
1,2 vs 3,0 ± 1,2 mmHg, respectively), intravisit DBPV (2,1 ± 0,8 vs 2,1 ± 0,4 vs
2,5 ± 0,9 mmHg, respectively); daytime SBPV (13,5 ± 3,8 vs 15,6 ± 2,9 vs 14,9 ±
5,1 mmHg), daytime DBPV (14,0 ± 6,1 vs 13,6 ± 3,3 vs 12,3 ± 4,7 mmHg), nighttime SBPV (10,7 ± 2,9 vs 11,6 ± 3,1 vs 11,4 ± 3,1 mmHg) and nighttime DBPV
(8,2 ± 2,5 vs 10,2 ± 3,5vs 9,9 ± 4,0 mmHg). No correlation was found between
visit-to-visit BPV and short-term variability.
Conclusions: Absence of association between visit-to-visit blood pressure variability and short-term variability underlines the importance of its separate calculation in patients with uncomplicated controlled AH without HF.
PP.28.09
VISIT-TO-VISIT VARIABILITY OF BLOOD PRESSURE
AND END-STAGE RENAL DISEASE, LEFT
VENTRICULAR HYPERTROPHY IN HYPERTENSIVE
PATIENTS WITH CHRONIC KIDNEY DISEASE
L. Minushkina1, A. Kazakova2, S. Nokitina2. 1Central State Medical Academy of
Department of Presidential Affairs, Moscow, RUSSIA, 2Clinic N. 2 of Department
of Presidential Affairs, Moscow, RUSSIA
Objective: Visit-to-visit long term variability of blood pressure (BP) is an important independent risk factor for premature death and cardiovascular events,
but relatively little is known about this parameter in patients with chronic kidney
disease (CKD). The aim of the study was to clarify the influence of BP long-term
variability on the progression of CKD in hypertensive patients.
Design and method: 34 patients (16 men and 18 woman) with essential hypertension
and CKD included in the study. Mean age was 68,8 ± 13,6 years. 7 pts had impaired
glucose tolerance and 9 diabetes mellitus 64% of patients had left ventricular hypertrophy (LVH) by Echocardiography. 34% of patients had carotid atherosclerosis. 10
pts had 2 st of CKD at the beginning of the study, 24 – 3 st CKD. All patients receive
antihypertensive treatment: 56% ACE inhibitors, 30% – ARB, 43% - calcium antagonists, 61% - beta-blocker and 30% - diuretics. 86% of patients achieved BP goal. The
participants had their office BP measured during the 12-month follow-up We defined
systolic and diastolic visit-to-visit variability of BP using three metrics: coefficient of
variation, standard deviation of the mean SBP, and average real variability.
Results: Glomerular filtration rate correlate significantly with systolic BP variability, but not with BP level. After the 1 year of follow up 6 patients had end-stage
renal disease End-stage renal disease in multiple regression analysis was independently associated with systolic BP variability (OR 1,84 CI 95%[1,22–2,46], p =
0,031) and patients age (OR 2,89CI 95%[1,47–10,71], p = 0,034). Left ventricular
mass index also significantly correlate with systolic BP variability (r = 0,456;
p = 0,050) The correlation was more significant in patients with diabetes mellitus
(r = 0,635; p = 0,036). Multiple regression analysis indicated that only mean visitto-visit systolic BP remained independently associated with LVH after adjustment
for age, sex, hypertension, diabetes mellitus, and glomerular filtration rate (p =
0.047). In patients with carotid atherosclerosis diastolic BP variability was higher,
then in patients without it (p = 0,05).
Conclusions: Thus, the variability of blood pressure may be more significant determinant of CKD progression and development of LVH in patients with hypertension than the achieved BP level.
investigation of BP variability (BPV) is important due to its independent prognostic role and association with neural and humoral mechanisms of BP regulation. The aim of the study was to assess the dynamics of 24-hour BPV (winter
vs. summer) in two sites of the Russian Federation – Ivanovo (relative north) and
Saratov (relative south).
Design and method: We included patients from the general population who visited ambulatory clinics for various reasons. The main inclusion criterion was office
BP 130/85–139/89 mmHg or long-term antihypertensive therapy. The ambulatory
blood pressure monitoring (ABPM) was performed with the BPLab device twice
in each patient: in winter (December-February 2012–2014) and in summer (JuneAugust 2012–2014). The interval between ABPMs was 6 months ± 7 days. The
selection criterion for ABPM records was the quality adequate for sophisticated
analyses: duration>23.5 hours, absence of data gaps>1 hour, > 55 readings per 24
hours. BPV was calculated as day and night SD and ARV24. The data analysis was
adjusted for age, sex, treatment status and average BP.
Results: 1766 patients were enrolled, and 782 of them completed both visits - 513
from Ivanovo (mean age 52 ± 10 years, 185 men), and 269 from Saratov (mean
age 54 ± 11 years, 151 men). We found no seasonal changes of BPV in Saratov.
BPV in Ivanovo was higher in winter than in summer (mean ARV24 of systolic
BP (SBP) 10.0 ± 1.3 vs. 9.8 ± 1.3 respectively, p < 0.05). We found a substantial
difference in BPV between sites: mean ARV24 of SBP in winter was 9.8 ± 1.3 in
Ivanovo and 10.6 ± 1.4 in Saratov, in summer – 9.6 ± 1.3 and 10.5 ± 1.4 respectively, p < 0.0001.
Conclusions: The higher BPV levels in winter in Ivanovo could reflect insufficient BP control in the cohort with tendency to masked hypertension. The difference in BPV between sites may be explained, among other reasons, by specific
kind of continental climate in Saratov. ARV24 appears to be a promising method
of BPV assessment.
PP.28.11
S Feki1, S. Mssead2, H. Mahfoudh1, Y. Chaabouni1, K. Mnif1, F. Jarraya1,
K. Kammoun1, S. Kammoun2, J. Hachicha1. 1CHU Hedi Chaker- Department of
Nephrology, Sfax, TUNISIA, 2CHU Hedi Chaker- Department of Pneumology,
Sfax, TUNISIA
Objective: OSAS is a recognized as a risk factor for development of cardiovascular diseases and hypertension. Hypertension is observed in 1/3 of OSAS. This
last is recognized cause of secondary resistant hypertension. The objective of this
study is to assess the prevalence of masked hypertension in patients with OSAS.
Design and method: We carried out a prospective study of consecutive patients
with OSAS confirmed by polysomnography. All patients underwent blood pressure (BP) measurement and 24 h blood pressure monitoring (ABPM).
Masked hypertension is defined as office blood pressure < 140/90 while outside
daytime ambulatory blood pressure averages are > 135/85.
Results: We enrolled 19 patients with sex ratio of 1.7. Average age was 50 ± 14
years. Cardiovascular factors were: diabetes (21%) dyslipidemia (16%), tobacco
(31%), and treated hypertension 9 cases (47%).
OSAS was severe in 18 cases. Mean average daytime and nighttime BP were
respectively 147.8/94.75 mmHg and 137/77 mmHg. Thirteen patients had masked
hypertension. All patients had a non dipper profile (nighttime fall of mean nighttime BP < 10%).
Conclusions: To our knowledge only a limited number of studies investigating the
prevalence of MH in patients with OSAS exist. This study highlights that masked
hypertension is frequent in OSAS population. In literature MH is observed in
50–60% of OSAS. ESH guidelines for management of patients with OSAS and
hypertension recommend using ABPM or home monitoring usage to diagnosis
MH or nighttime HT.
PP.28.12
PP.28.10
SEASONAL CHANGES OF 24-HOUR BLOOD
PRESSURE VARIABILITY IN HYPERTENSIVE
PATIENTS
V. Gorbunov, M. Smirnova, M. Loukianov, A. Deev, Y. Koshelyaevskaya,
S. Boytsov. National Research Center for Preventive Medicine, Moscow,
RUSSIA
Objective: The seasonal changes of office and ambulatory blood pressure (BP)
in hypertensive patients are well-known. At the same time, the information concerning seasonal changes of 24-hour characteristics of BP profile is limited. The
MASKED HYPERTENSION IN OBSTRUCTIVE SLEEP
APNOEA SYNDROME (OSAS) PATIENTS: NOT SUCH
A RARE CIRCUMSTANCE
24-HOUR PATTERNS OF CENTRAL AORTIC AND
BRACHIAL SYSTOLIC BLOOD PRESSURE IN THE
VERY ELDERLY
N. Ezhova1, A. Alam2, Y. Kotovskaya2, Z. Kobalava2. 1Moscow State University,
Moscow, RUSSIA, 2Peoples’ Friendship University of Russia, Moscow, RUSSIA
Objective: The aim of current study was to investigate and compare 24-hour profiles of central and peripheral blood pressures in the very elderly via their simultaneous ambulatory monitoring
Design and method: Parallel 24-h ambulatory aortic and brachial blood pressure
monitoring was performed in 67 treated hypertensive subjects older than 80 years
(mean age 84,1 ± 3,1 years, 25,5% male, mean clinic brachial SBP 134,8 ± 23,2
mmHg) with an oscillometric cuff-based device BPLab Vasotens («Petr Telegin»,
Russia). Patients with ejection fraction < 40%, atrial fibrillation and severe comorbidities were not included. 24-h, awake and sleep-time systolic, diastolic and
pulse blood pressure in aorta and brachial artery were compared in subgroups
divided according to the diurnal pattern of brachial systolic blood pressure (SBP).
X ~ 25.98 SD ± 8.2; BRS at rest 10.1, ± SD 6.18. In the group with type 2 diabetes
LF HF at rest X ~ 4.01 The SD ± 7.02, LF / HF orthostasis X 4.7 ± 8.9, LF DBP
at rest X ~ 37.17 ± 14.85, LF DBP orthostasis X ~ 37.32 ± 10.89, HF RRI at rest
43.51, SD ± 17:48, HF RRI orthostasis X 43.51 ± 23:30, BRS at rest SD 9.78 ±
6.50. Correlation between the groups showed highly significant difference for LF
DBP in orthostasis (p < 0.00067).
Results: The diurnal profiles of central systolic and pulse BPs run in parallel
with those of peripheral BPs in patients with all types of diurnal pattern and SBP
amplification at night did not change significantly comparing to day-time values.
Non-dipping or reverse-dipping SBP patterns appeared to be typical and were
observed in 82,1% patients, while 50,7% participants had inadequate DBP dip
< 10%. The proportionality of night-time SBP and DBP changes varied in different types of SBP diurnal profile. SBP and DBP decreased proportionally in
dippers (ratio of DBP/SBP night-time reduction was 1,18) and disproportionately
in non-dippers (the ratio was 2,6). In those patients with reverse-dipping pattern
SBP and DBP changed in opposite directions at night. This disproportion in SBP
and DBP night-time changes resulted in different intensity of PP night-time rise
that was most evident in reverse-dippers. Relative nocturnal reduction of PP was
9,3 ± 4,72% in dippers, whereas non-dippers and reverse-dippers had relative PP
increase of 6,2 ± 8,6 and 22,9 ± 12,3 %, respectively
Conclusions: Conclusion: Significantly lower values of LF DBP were registered
in the group with type 2 diabetes, which represents the FAILURE of SYMPHATETIC in orthostasis. Orthostasis has been shown in ABPM analysis as
well. It is common that patients with diabetes have a dominant parasympathetic
dysfunction.
Conclusions: The diurnal patterns of central and brachial BPs observed in very
elderly treated hypertensives were almost parallel. PP amplification is similar in
the day- and nighttime and this finding is different from previously described diurnal PP amplification behavior in younger subjects. Proportionality of SBP and
DBP sleep-time changes depends on dipping status and results in nocturnal PP
increase in non- and reverse-dippers
PP.28.13
DIFFERENCES IN THE MONITORING AND
DYSFUNCTION OF THE AUTONOMIC NERVOUS
SYSTEM IN PATIENTS WITH TYPE 1 AND TYPE 2
DIABETES
M. Stojanovic1, T. Nisic1, T. Lalic1, M. Stojkovic1, B. Beleslin1, J. Ciric1, S. Savic1,
M. Zarkovic1, M. Barac1, S. Vujovic1, V. Stojanov2. 1Endocrinology Department
KCS, Belgrade, SERBIA, 2Blood Pressure Excellence Center, Belgrade, SERBIA
Objective: Dysfunction of the autonomic nervous system can be diagnosed by
spectral analysis of variability of cardiac frequencies of consecutive RR interval
using TASK FORCE monitor.
Design and method: Methodology and results: Study was done using TASK
FORCE monitor and software analysis of HRV Fourier transform algorithm. Testing at rest (20 min) and passive orthostasis (tilt table 90° for 6 minutes and parameters from ambulatory blood pressure monitoring (ABPM) device Meditech
ABPM 05. Diagnostic procedures were done in 110 patients, of which 48 treated
for type 1 diabetes, average age 37 years, of which 28 men and 20 women. The
second group contained 62 patients with type 2 diabetes, average age 62 years of
which 35 men and 27 women.
Results: In groups with type 1 diabetes LF HF at rest X ~ 1.745 ± 0.91 SD; LF HF
orthostasis X ~ 3.08 ± 2.65 SD; LF-DBP at rest 44.79 SD ± 16:52; LF DBP orthostasis X ~ 51.91SD ± 11:41, HF RRI at rest 36.01 SD ± 14.65, HF RRI orthostasis
PP.28.14
BENEFIT OF FORTY-EIGHT-HOUR AMBULATORY
BLOOD PRESSURE MONITORING IN
HEMODIALYSIS POPULATION
K. Mnif1, F. Jarraya1, H. Chaker1, H. Mahfoudh1, S. Feki1, S. Charfeddine2,
L. Abid2, S. Kammoun2, K. Kammoun1, J. Hachicha1. 1CHU Hedi Chaker- Department of Nephrology, Sfax, TUNISIA, 2CHU Hedi Chaker- Department of Cardiology, Sfax, TUNISIA
Objective: Data derived from ambulatory BP (blood pressure) monitoring
(ABPM) allow better characterization of BP during everyday activities and sleep,
and, most importantly, better correlate with target organ damage, cardiovascular
disease (CVD) risk, and long-term patient prognosis than clinic BP.The aim of our
work is to define the role of ABPM in hemodialysis (HD) patients and assess the
correlation of its results with the echocardiographic data.
Design and method: The study has a cross-sectional design. We enrolled 17 patients. We performed ABPM for 48 hours (day of dialysis (D1), day following dialysis (D2)) in all patients. ABPM was recorded every 20 min during the day and
every 30 min during the night. Dialysis unit BP recordings measured before and
after dialysis were collected prospectively at the time of the patient visit. Two-dimensional- guided M-mode echocardiograms were performed before and after HD.
Results: According to the collected BP before HD, 4 (23.5%) patients had HTN,
against 10 (58.8%) according to the measures taken after HD. According to ABPM,
we defined 4 categories of BP: 5 (29.4%) patients were normotensive, 4 (23.5%)
with sustained HTN, 4 (23.5%) with masked HTN and 4 (23.5%) with white- coat
HTN. Systolic BP of 48 H correlated significantly with pre and post dialysis BP (p <
0.05). Pulse pressure (PP) of 48 H correlated significantly with pre and post dialysis
PP (p < 0.01). The study of the variation of nocturnal BP objectified a dipper profile in 3 cases (17.6%), non-dipper in 12 cases (70.6%), inverted-dipper in 2 cases
(11.8%). Three patients (17.6%) had echocardiographic left ventricular hypertrophy.
We found a significant decrease in the mass of the left ventricle after HD from
318.41 g / m2 ± 71.21 to 261.95 g / m2 ± 86.56 (p = 0.002).
Conclusions: Our study confirms the high prevalence of BP abnormalities at the
ABPM in HD population. Not only ABPM helps in the diagnosis and categorization of HTN, but can also provide prognostic. We suggest that ABPM should
become the norm for the diagnosis of HTN and prognostic evaluation in chronic
HD population.
Abstracts e299
POSTER SESSION
OBESITY AND METABOLIC SYNDROME
PP.29.01
FEATURES OF METABOLIC HOMEOSTASIS
DEPENDING ON GENETIC POLYMORPHISM OF
INSULIN RECEPTOR SUBSTRATE-1 GENE IN
PATIENTS WITH ESSENTIAL HYPERTENSION
UNDER COMORBIDITY
A. Shalimova1, M. Kochueva1, V. Psareva2, N. Kirichenko2. 1Kharkiv Medical
Academy of Postgraduate Education - Therapy and Nephrology Department,
Kharkiv, UKRAINE, 2Sumy State University - Department of Internal Medicine of
Postgraduate Education, Sumy, UKRAINE
Objective: to investigate the features of metabolic homeostasis in various polymorphism of insulin receptor substrate-1 (IRS-1) gene in patients with essential
hypertension (EH), obesity and type 2 diabetes (DM2).
Design and method: The main group consisted of 215 patients with EH, obesity
and DM2. The comparison group consisted of 50 patients with EH and obesity
without DM2. The control group consisted of 31 healthy individuals.
We determined carbohydrate and lipid profiles, HOMA-IR, levels of leptin, malondialdehyde (MDA), catalase, conducted genotyping of polymorphic marker
Gly972Arg of IRS-1 gene.
Results: It was established that in patients with EH and obesity both as in presence and absence of DM2, the frequency of Gly/Arg and Arg/Arg genotypes was
significantly higher than in control group (p < 0.001).
The presence of Gly/Arg and Arg/Arg genotypes of IRS-1 gene in patients of
the main group was associated with higher levels of atherogenic lipoproteins
(p < 0,001). The association of Gly972Arg polymorphism with the development
of insulin resistance (IR) was also confirmed significant higher levels of insulin,
HOMA-IR, glucose (p < 0,001), HbA1c (p < 0,05) in presence of Gly/Arg and
Arg/Arg genotypes. In these genotypes patients of the main group had significantly higher levels of leptin, of oxidative stress indicator MDA and significantly
lower levels of antioxidant system indicator catalase (p < 0,05) as compared to
Gly/Gly genotype.
Patients with EH and obesity without DM2 in presence of Gly/Arg and Arg/
Arg genotypes had significantly higher levels of atherogenic lipoproteins, insulin and HOMA-IR (p < 0,01), than patients with Gly/Gly genotype, however,
unlike patients with DM2, they had no significant difference of leptin, MDA
and catalase.
Conclusions: It was established that IRS-1 gene polymorphism was associated
with the development of comorbidity EH, obesity and DM2. Arg/Arg and Gly/Arg
genotypes of IRS-1 gene in patients with EH and obesity both as in presence and
absence of DM2 were associated with more pronounced disorders of blood lipid
spectrum, more pronounced IR as compared to Gly/Gly genotype. Significant differences of leptin levels and indicators of oxidative stress - antioxidant protection
depending on IRS-1 gene polymorphism were established only in presence of
DM2 in patients with EH and obesity.
PP.29.02
METFORMIN REDUCES HIGH-FAT DIET EFFECTS
ON BLOOD PRESSURE, METABOLIC PARAMETERS
AND VASCULAR PROSTANOIDS IN RATS
A. Puyó, H.J. Lee, N.M. Sánchez Eluchans, S.M. Cantú, M.R. Choi,
A.S. Donoso, H.A. Peredo. Cátedra de Anatomía e Histología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, ARGENTINA
Objective: Metformin (Mf) is an antidiabetic drug used in type 2 diabetes and
metabolic syndrome treatment. A high-fat (HF) diet produces insulin resistance
in the rat which is related to cardiovascular alterations such as hypertension.
Prostanoids (PR), cyclooxygenase-derived arachidonic acid metabolites, have
vasoactive properties and mediate inflammation. The aim of this study was to
analyze the effect of Mf on blood pressure (BP), metabolic parameters, and
mesenteric vascular bed (MVB) PR production in male Sprague-Dawley rats
under a HF diet.
Design and method: Four groups were studied during 12 weeks (n = 4 each):
Control (C), standard diet (SD) and tap water to drink; HF diet (HF), 50% (w/w)
bovine fat added to SD and tap water; C + metformin (CMf), SD + 500 mg/Kg/
day Mf in the drinking water; and HF + Mf (HFMf) 50% (w/w) bovine fat added
to SD + 500 mg/Kg/day Mf. PR were determined by HPLC.
Results: HF diet increased body weight (BW: g, HF, 478 ± 10 vs. C, 421 ± 15 p
= 0.01) % MVB/BW ratio (HF, 1.72 ± 0.8 vs. C, 0.8 ± 0.1, p < 0.001); glycemia
(mg/dl, HF, 144 ± 4 vs. C, 127 ± 4, p = 0.01); triglyceridemia (mg/dl, HF, 166 ±
21 vs. C, 86 ± 9, p < 0,01) and systolic BP (mmHg, HF, 151 ± 2 vs. C, 127 ± 2,
p < 0,001). In the HFMf group, Mf decreased MVB/BW ratio (1.38 ± 0.6, p <
0.05); glycemia, triglyceridemia, (mg/dl, 110 ± 11 vs. HF, p = 0.01; 65 ± 13 vs.
HF, p = 0.01) and systolic BP (mmHg, 141 ± 1 vs. HF, p < 0.01). Moreover, HF
diet increased the release of PR thromboxane (TX) B2, stable metabolite of the
vasoconstrictor TXA2, (ng PR/mg tissue, HF, 121 ± 8 vs. C, 71 ± 6, p < 0,05);
and prostaglandin (PG) F2alpha (ng/mg, HF, 166 ± 11 vs. C, 87 ± 9, p < 0,05).
Mf decreased the release of (PG) F2alpha in the HFMf group (ng/mg, 81 ± 12
vs. HF, p < 0,01).
Conclusions: In conclusion, metformin treatment reduces abdominal fat which
plays a role in the pathogenesis of hypertension. A possible mechanism by
which metformin lowers systolic BP in this experimental model could be the
reduction of vasoconstrictor prostanoid release in the MVB, reducing peripheral resistance.
PP.29.03
METABOLIC SYNDROME EXACERBATES ISCHEMIA
AND REPERFUSION INJURY ON THE BRAIN
MICROCIRCULATION OF RATS
N. Obadia Pereira, M.A. Lessa, E. Tibiriçá, V. Estato. Laboratory of Cardiovascular Investigation, Oswaldo Cruz Foundation, Rio de Janeiro, BRAZIL
Objective: Metabolic Syndrome (MS) is characterized by a cluster of risk
factors for cardiovascular diseases and is an independent risk factor for ischemic stroke. In this study we investigated the impact of the MS of brain
ischemia and reperfusion (IR) outcomes on brain microcirculation of dietinduced MS in rats.
Design and method: Forty-eighth Wistar Kyoto rats were fed with high-fat diet
(HFD) submitted or not to 30 minutes of ischemia, through bilateral carotid occlusion, followed by 1 hour of reperfusion IR (HFD-IR or HFD-sham, respectively)
or standard chow submitted or not to IR (CONT-IR or CONT-sham) for 20 weeks.
Cerebral microcirculation flow was evaluated by Laser Speckle Contrast Imaging
and the brain functional capillary density, endothelial-leukocyte interactions and
endothelial function were evaluated by intravital microscopy.
Results: The HFD group presented increases of systolic blood pressure (142
± 7 mmHg p < 0.001), heart rate (431 ± 18bpm p < 0.001), fasting plasma
glucose (224 ± 11 mg/dL p < 0.001) and insulin (6.5 ± 1.1 ng/ml p < 0.01 when
compared to the CONT group (117 ± 8 mmHg, 349 ± 30 bpm, 97 ± 11 mg/dl
and 24 ± 0.5 ng/ml, respectively). These effects were accompanied by decreases
on blood perfusion in the brain (176 arbitrary perfusion units, APU) compared
to control group (230 APU). HFD-IR group showed an exacerbated decrease
in brain perfusion during the ischemia period and not returning to basal values
after reperfusion period (basal 186 APU, ischemia 128 APU and reperfusion
206 APU). HFD group also presented a marked functional and structural capillary rarefaction, HFD Sham (182 ± 21 capillaries/mm2 p < 0.001) and HFD-IR
(111 ± 19 capillaries/mm2 p < 0.001) vs. CONT-sham (325 ± 20capillaries/
mm2). The number of rolling leukocytes was increased in HFD-sham (11 ± 0.4
cells/min p < 0.001), HFD-IR (11 ± 1 cells/min p < 0.001) and in CONT-IR
(10 ± 1 cells/min p < 0.001) vs. CONT-sham (1 ± 0.6 cells/min). Endothelialdependent vasodilation response to Ach was abolished in HFD-IR group when
compared to CONT-sham (–17% vs 30% from baseline; respectively, p < 0.001).
The malondialdehyde levels showed an increase of oxidative stress in all groups
compared to CONT-sham.
Conclusions: Our results demonstrated that animals with metabolic syndrome
have functional, structural and inflammatory changes in the cerebral microcirculation resulting on defective recovery blood flow during brain IR.
M
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PP.29.04
IVABRADINE THERAPY FAVORABLY MODULATES
SYMPATHETIC OVERDRIVE AND ARTERIAL
STIFFENING IN HYPERTENSIVE PATIENTS WITH
METABOLIC SYNDROME
K. Dimitriadis, C. Tsioufis, E. Andrikou, D. Konstantinidis, T. Kalos,
I. Liatakis, E. Koutra, D. Tousoulis. First Cardiology Clinic, University of Athens,
Hippokration Hospital, Athens, GREECE
Objective: Hypertension and metabolic syndrome are related to sympathetic overdrive and arterial stiffening, while there are no data whether ivabradine modulates
sympathetic activity and vascular abnormalities in this setting. The aim of this
study was to assess the effect of ivabradine on muscle sympathetic nerve activity
(MSNA) and arterial stiffness in hypertensive patients with metabolic syndrome.
Design and method: We studied 36 patients with essential hypertension [age:
56 ± 10 years, 30 males, office blood pressure (BP): 148/92 ± 14/11 mmHg]
on antihypertensive therapy with a fixed combination of perindopril/amlodipine.
Patients were randomized with a ratio 2:1 to ivabradine (5 mg twice daily) or
no ivabradine (control group). Metabolic syndrome was defined according to the
Adult Treatment Panel III criteria. In all participants at baseline and at 6 months
follow-up arterial stiffness was evaluated on the basis of carotid to femoral pulse
wave velocity (PWV), while sympathetic drive was assessed by MSNA estimations based on established methodology (microneurography).
Results: Patients on ivabradine (n = 24) compared to controls (n = 12) did not
differ regarding baseline BP, creatinine, glucose and lipid profile (p = NS or all).
There was no significant difference in the reduction of office BP between the two
study groups (p = NS). However, hypertensive patients in the ivabradine group
were characterized by a reduction in carotid to femoral PWV from 11.5 ± 0.9
m/sec to 9.8 ± 1.2 m/sec (p < 0.001) and sympathetic nerve traffic as reflected
by MSNA levels from 86.2 ± 2.5 bursts per 100 heart beats to 74.8 ± 2.4 bursts
per 100 heart beats (p < 0.001) at 6 months. No significant changes in PWV and
MSNA were observed in the control group (p = NS).
Conclusions: Our data suggest that in abdominally obese, but otherwise healthy
men, aldosterone does not contribute to the development of muscle microvascular
dysfunction and insulin resistance. Possibly, the role of aldosterone becomes more
prominent with increasing severity of obesity.
PP.29.06
WHICH TARGET ORGAN IS MORE VULNERABLE
FOR METABOLIC SYNDROME?
O. Rotar, M. Boyarinova, E. Moguchaya, E. Kolesova, V. Solntsev,
A. Konradi, E. Shlyakhto. Federal Almazov Medical Research Centre, SaintPetersburg, RUSSIA
Objective: Different components of metabolic syndrome (MS) and risk factors
can play important role in the development of cardiovascular changes. The aim of
the study was to assess association of MS and its components with target organ
damage (TOD) in a cross-sectional study of relatively healthy bank employers.
Design and method: Out of 1,600 random sample of office workers, a group of
383 participants with at least one component of MS and without cardiovascular
complications was selected (mean age 46.6 ± 9.0 years, 214 females (64.6%)).
TOD was assessed by echocardiography (left ventricular hypertrophy (LVH)),
carotid ultrasound, applanational tonometry (pulse wave velocity (PWV)), ankle-brachial index (ABI) by linear Doppler, and urine albumin excretion (UAE)
measurements. Anthropometry, vital sign assessment, and biochemistry were performed according to standard protocols.
Results: Prevalence of TOD according to number of MS components is presented
in Table.
Patients with the 3 and more MS components are at risk of TOD, but significant
association was documented only for atherosclerotic plaques. Multiple linear regression revealed association of age with all subclinical markers of TOD.
Conclusions: In hypertensive patients with metabolic syndrome, treatment with
ivabradine reduces sympathetic activation and arterial stiffening as reflected by
lower MSNA and PWV levels at 6 months follow-up. These findings suggest that
ivabradine could exhibit additional therapeutic properties in the setting of dysmetabolic hypertension.
PP.29.05
ALDOSTERONE IS NOT ASSOCIATED WITH INSULINMEDIATED MICROVASCULAR RECRUITMENT AND
INSULIN SENSITIVITY IN ABDOMINALLY OBESE,
BUT OTHERWISE HEALTY MEN
M. Schütten1, Y. Kusters1, A. Houben1, C. Schalkwijk1, P. Joris2, J. Plat2,
R. Mensink2, P.W. de Leeuw1, C. Stehouwer1. 1Maastricht University - Department of Internal Medicine, Maastricht, NETHERLANDS, 2Maastricht University
- Department of Human Biology, Maastricht, NETHERLANDS
Objective: Increased aldosterone levels have been implicated in the pathogenesis of obesity-associated insulin resistance, which may be partly attributable to
aldosterone synthesis in adipocytes. We hypothesized that aldosterone-induced
impairment of insulin-mediated microvascular recruitment in skeletal muscle
contributes to the insulin resistant state as observed in obesity. We therefore investigated whether aldosterone levels are related to insulin-mediated muscle microvascular recruitment and insulin sensitivity in lean and abdominally obese men,
and whether improvement of muscle microvascular function and insulin sensitivity following weight loss might be explained by reduced aldosterone levels.
Design and method: In 25 lean (age (mean ± SD) 47 ± 18 years, waist circumference 85 ± 6 cm) and 53 abdominally obese (age 50 ± 13 years, waist circumference 106 ± 4 cm) otherwise healthy men, renin and aldosterone levels were
measured with ELISA. Insulin-mediated microvascular recruitment (IMMR) in
forearm skeletal muscle and glucose infusion rate (GIR; measure of insulin sensitivity) were assessed by means of contrast-enhanced ultrasound before and during
a hyperinsulinaemic clamp. The abdominally obese men were randomized to an
8-week weight loss intervention or their habitual diet. Thereafter, measurements
of renin, aldosterone, IMMR, and GIR were repeated.
Results: IMMR and GIR were lower in the abdominally obese as compared to the
lean men (IMMR: lean 44 ± 41%, obese –3.9 ± 27%, p < 0.01; GIR: lean 6.8 ± 1.8
mg/kg/min, obese: 4.0 ± 1.3 mg/kg/min, p < 0.01). Aldosterone and renin levels
were not different between both groups (aldosterone (median [IQR]): lean 225
[176–316] pg/mL, obese 234 [170–315] pg/mL, p = 0.71; renin: lean 671 [519–
872] pg/mL, obese 615 [535–786] pg/mL, p = 0.30). Aldosterone levels did not
correlate with IMMR or insulin sensitivity. In the weight loss group, waist circumference decreased, and IMMR and GIR improved significantly compared to the
weight stable group. Aldosterone and renin levels, however, remained unchanged.
Conclusions: MS components number accumulation is associated with acceleration of TOD signs. Carotid atherosclerosis is the most vulnerable marker associated with MS components.
PP.29.07
WORLDWIDE PREVALENCE OF METABOLIC
SYNDROME IN PEOPLE LIVING WITH HUMAN
IMMUNODEFICIENCY VIRUS INFECTION: A
SYSTEMATIC REVIEW AND META-ANALYSIS
A. Kengne1, K.A. Nguyen2, N. Peer1, E.J. Mills3. 1South African Research Council, Cape Town, SOUTH AFRICA, 2University of Cape Town, Cape Town, SOUTH
AFRICA, 3Global Evaluation Science, Vancouver, CANADA
Objective: Abnormal cardio-metabolic risk profile is increasingly of concern in
people living with human immunodeficiency virus (HIV) infection. However, the
burden and differential contribution, if any, of HIV specific factors, are poorly
understood. We conducted a systematic review and meta-analysis to estimate
the global prevalence of metabolic syndrome (MS) in people with HIV, and the
variation by HIV severity, treatment, definition criteria and other major predictive
characteristics.
Design and method: We performed a comprehensive search on major databases
for original research articles published between 1998–2015. Pooled prevalence
estimates overall and by specific groups and subgroups were computed using random effects models, with variance stabilisation via arc-sine transformations.
Results: In all 65 studies across five continents comprising 55094 HIV-infected
participants aged 17–73 years (median age 41 years) were included. The overall
prevalence of MS according to the following criteria was: ATPIII-2001:16.7%
(95% CI: 14.6–18.8), IDF-2005: 18% (14.0–22.4), ATPIII-2004–2005: 24.6%
(20.6–28.8), Modified ATPIII-2005: 27.9% (6.7–56.5), JIS-2009: 29.6% (22.9–
36.8), and EGIR: 31.3% (26.8–36.0). Within some criteria of MS, the prevalence
was significantly higher in women than in men (IDF-2005: 23.2% vs. 13.4, p =
0.030), in ART compared to non-ART users (ATPIII-2001: 18.4% vs. 11.8%, p =
0.001), and significantly varied by time-period of study publication, participants
age, severity and diagnosed duration of HIV infection, and non-nucleoside reverse
transcriptase inhibitors (NNRTIs) use. Across criteria, there were significant differences in MS prevalence by sub-group categories such as in men, the Americas,
Abstracts e301
older publications, regional studies, younger adults, smokers, ART-naïve participants, NNRTIs users, participants with shorter duration of diagnosed infection
and across the spectrum of HIV severity. Substantial heterogeneities across and
within criteria were not fully explained by major study characteristics, while evidence of publication bias was marginal.
Conclusions: The prevalence of MS in people with HIV is within the range of reports from the general population, highlighting the commonality of drivers of the
condition. This emphasises the need for holistic management of the HIV-infected
individual with the inclusion of cardio-metabolic assessments. Approaches for
screening and mitigating disease risk associated with MS in the general population will likely provide similar benefits in people with HIV.
PP.29.08
A PROSPECTIVE STUDY OF SERUM GAMMAGLUTAMYLTRANSFERASE LEVELS AND INCIDENT
METABOLIC SYNDROME: THE ARIRANG STUDY
1599.1 ± 387.2 mm·ms in the 1st vs. 2188.5 ± 551.3 mm·ms in the 4th quartile,
P < 0.001; mean systolic ambulatory blood pressure ± standard deviation: 114.5
± 4.2 mmHg in the 1st vs. 149.0 ± 7.7 mmHg in the 4th quartile, P < 0.001). Ageadjusted, mean systolic ambulatory blood pressure was robustly associated with
left ventricular mass (b = 0.48, P < 0.001). Despite evidence of blood pressurerelated increases in left ventricular mass, serum midregional proatrial natriuretic
peptide concentrations were negatively associated with mean systolic ambulatory
blood pressure (b = –0.32, P = 0.004). Serum midregional proatrial natriuretic
peptide concentrations were also negatively associated with mean diastolic ambulatory blood pressure (b = –0.45, P < 0.001).
Conclusions: Contrary to known physiological natriuretic peptide responses to
increases in blood pressure, serum midregional proatrial natriuretic peptide concentrations were not positively but negatively associated with 24-hour ambulatory
blood pressures in our study. Nevertheless, this adds further to the notion that a
low amount of circulating natriuretic peptides could play an important role in the
early stage of obesity-related hypertension.
J. Kim, B.S. Yoo, S.W. Park, J.W. Lee, Y.J. Youn, M.S. Ahn, S.H. Lee, J. Yoon.
College of Medicine, Yonsei University, Wonju, SOUTH KOREA
Objective: Although gamma-glutamyltransferase (GGT) is well known to be associated with metabolic syndrome, prospective data on longitudinal changes in
GGT levels and incident cases of metabolic syndrome are limited. Therefore, we
examined the association between changes in GGT levels over time and incident
metabolic syndrome.
Design and method: A total of 2,579 Korean adults (913 men and 1,666 women;
age range 40–70 years) free of metabolic syndrome were followed up for 2.6
years. Data were collected in 2005–2008 (baseline) and in 2008–2011 (followup). Serum GGT concentrations were determined by enzymatic methods.
PP.29.10
EFFECTS OF AMLODIPINE AND ATORVASTATIN
ON ENDOTHELIAL VASOACTIVE MEDIATORS IN
PATIENTS WITH METABOLIC SYNDROME
N. Blinova, V. Masenko, I. Chazova. Russian Research Cardiology Complex,
Moscow, RUSSIA
Objective: To study the effects of the amlodipine and atorvastatin on the blood levels of endothelial vasoactive mediators in patients with metabolic syndrome (MS).
Results: During an average of 2.6 years of follow-up, 558 participants
(21.6%) developed metabolic syndrome. A gradual increase in the incidence
of metabolic syndrome was observed across the GGT quartiles. In multivariate adjusted models, the odds ratio (95% confidence interval) for incident
metabolic syndrome comparing the highest to lowest quartile of baseline
GGT was 2.07 (1.52–2.80). The corresponding odds ratio for the highest
GGT changes (>4 IU/L increase) with the lowest GGT changes (< -5 IU/L
decrease) were 1.75 (1.32–2.33). The strength of this association was higher
in participants with GGTs above the median compared with those with GGTs
below the median.
Conclusions: Both longitudinal increases in GGT and high baseline GGT, even
levels within the reference range, are independent predictors of incident metabolic
syndrome.
PP.29.09
SERUM MIDREGIONAL PROATRAIL NATRIURETIC
PEPTIDE CONCENTRATIONS DO NOT INCREASE
WITH HIGHER 24-HR AMBULATORY SYSTOLIC
BLOOD PRESSURE AND GREATER LEFT
VENTRICULAR MASS IN OBESE MEN
J. Jeppesen1, C. Asferg2, U. Andersen2, J. Goetze3, A. Linneberg4. 1Hvidovre Hospital Glostrup, University of Copenhagen, Glostrup, DENMARK, 2Rigshospitalet
Glostrup, University of Copenhagen, Glostrup, DENMARK, 3Rigshospitalet Blegdamsvej, University of Copenhagen, Copenhagen, DENMARK, 4Department of
Clinical Experimental Research, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, DENMARK
Objective: Obese persons have low circulating natriuretic peptide concentrations. It has been proposed that this natriuretic handicap could play an important role in the early stage of obesity-related hypertension. The normal
physiological response of the natriuretic peptide system to an increase in blood
pressure is an increase in natriuretic peptide secretion with concomitant higher
circulating natriuretic peptide concentrations. The objective of this study was
to investigate whether higher blood pressure would also be related to higher circulating natriuretic peptide concentrations in obese men. To verify that blood
pressure had affected the hearts of our study participants, left ventricular mass
was estimated.
Design and method: The present study is a cross-sectional study of 103 obese
healthy medication-free men. Blood pressure was measured using 24-hour ambulatory blood pressure recordings. Left ventricular mass was calculated using
the Cornell voltage-duration product method. Fasting serum concentrations of
midregional proatrial natriuretic peptide, a stable serum marker for active atrial
natriuretic peptide, were measured. Linear regression analysis was used to calculate age-adjusted standardized regression coefficients (b)
Results: Left ventricular mass and blood pressure increased across systolic ambulatory blood pressure quartiles (mean left ventricular mass ± standard deviation:
Design and method: In our study we included 60 patients with MS and mild
arterial hypertension. Patients were randomized into three treatment groups:
monotherapy with amlodipine, monotherapy with atorvastatin and a combination therapy with amlodipine and atorvastatin. Office blood pressure (BP),
NO metabolite levels («Shimadzu», Japan), endothelin-1 (ET-1) («Biomedica
Gruppe», Austria), thromboxane B2 (TxB2) and 6-keto-prostaglandin F1a
(6-ketoPG F1.a) (Assay designs) were performed at baseline and after 24
weeks of the therapy. In the control group was had 20 healthy volunteers.
Data were represented as median (Med) and 25%–75% interquartile range or
mean and standard deviation. p-value < 0,05 was considered as statistically
significant
Results: Monotherapy with amlodipine and combination therapy with amlodipine and atorvastatin were associated with the significant decreased office
BP. Initially TxB2, 6-ketoPG F1a, ET-1 levels were significantly higher at
patients with MS then in control group. Difference in NO metabolite level didn’t reach statistical significance. Monotherapy with amlodipine and
atorvastatin or in a combination showed significant improvements in several studied parameters of endothelial vasoactive mediators. The results are
shown in table 1.
Conclusions: Amlodipine and atorvastatin treatment was showed positive effects
on the levels of vasoactive mediators thereby leading to the improvement of endothelial function in patients with MS.
PP.29.11
METABOLIC SYNDROME AS THE PREDICTOR OF
NEW CARDIOVASCULAR EVENTS IN PATIENTS
WITH MYOCARDIAL INFARCTION TREATED
WITH PRIMARY PERCUTANEOUS CORONARY
INTERVENTION
M. Lovic1, L. Savic2, D. Matic2, D. Djordjevic1, D. Lovic3, I. Tasic1, M. Ostojic2.
1Institute for prevention and cardiovascular rehabilitation Niska Banja, Nis,
SERBIA, 2Clinical Centre of Serbia, Belgrade, SERBIA, 3Intermedica Dr. Lovic,
SERBIA
Objective: The presence of Metabolic syndrome (MetS) promotes the development of atherosclerotic cardiovascular disease as well as the appearance of its
complications and is a sole indicator of the elevated risk for new cardiovascular
events. The aim of this study is to determine the prevalence and the impact of
MetS on the appearance of new unwanted cardiovascular events in patients with
STEMI treated with primary percutaneous coronary intervention.
Design and method: The study group consisted of 507 consecutive STEMI patients treated with primary percutaneous coronary intervention (pPCI) in Clinical
Centre of Serbia. During the 36 month-follow up, a telephone visit was conducted
in all patients after 1, 3, 6, 12, 24 and 36 months. All the patient who reported new
cardiovascular events were called up for events evaluation. For patients who died
during the follow up, hospital records and necrophy data were reviewed. AHA/
NHLBI (American Heart Association and national Heart, Lung and Blood Institute) criteria were used for diagnosing the patients.
Results: The prevalence of MetS in our study was 42.80% (217 patients). During the three-year follow-up, a significant increase of unwanted cardiovascular
events (p = 0.0063) was detected in the group of patients with MetS. The presence of MetS in our patients was associated with relative risk for new myocardial infarctions 3.77 (95% CI(1.45–9.80);p = 0.001) and with relative risk for
the occurrence of congestive heart failure 1.43 (95% CI (1.07–2.64);p = 0.027).
Among the risk factors for MetS, hyperglycemia solely had to be independently
associated with cardiovascular death (OR 3.39 95% CI (1.70–6.77) (p = 0.001)),
whereas it did not have a significant influence on the appearance of new myocardial infarctions and congestive heart failure. Elevated blood pressure turned
out to be a moderate risk for the appearance of new unwanted cardiovascular
events while elevated triglyceride level, low HDL cholesterol and obesity did not
significantly influenced the appearance of new cardiovascular events and did not
present a significant risk.
Conclusions: MetS is significantly associated with new myocardial infarction and
the occurrence of heart failure, among patients with STEMI regardless of the fully
conducted secondary prevention in these patients.
PP.29.12
LINKING ULTRASOUND ASSESSMENT OF
EXTRACRANIAL CEREBRAL CIRCULATION TO
THE CARDIOVASCULAR AND RENAL EVENTS AT
HYPERTENSIVE PATIENTS WITH OR WITHOUT
METABOLIC SYNDROME
A. Gavrila, M. Florea, M. Ciobanu, C. Pritulescu, M. Rusu, I. Sosea, R. Persu,
A. Rosu. University Hospital CF, Craiova, ROMANIA
Objective: The objective of the study was to estimate how the ultrasound parameters of the carotid arteries correlate with prognostic of hypertensive patients (pts)
with or without metabolic syndrome (MS).
Design and method: 40 hypertensive pts (mean age = 57.3 ± 7.5 years, 52.5%
males)-group1 and 40 hypertensive pts with MS, matched for age and sex
(mean age = 58.6 ± 7.4 years, 55% males)-group2. Vascular ultrasound parameters performed were: thickness of intima-media layer(IMT) in common carotid
arteries(CCA), peak systolic velocity (PSV) in internal carotid arteries(ICA), end
diastolic velocity(EDV) in ICA, resistance index (RI) in ICA, peak systolic velocity ratio(PSVR) in ICA and CCA. All pts were evaluated during one year in order
to detect the following complications: unstable angina (UA), non-ST-segmentelevation myocardial infarction (NSTEMI), transient ischemic stroke (TIS), ischemic stroke (IS), renal dysfunction (RD): microalbuminuria, proteinuria, chronic
kidney disease.
Results: In group1, UA was significantly associate with higher EDV in ICA (29.3
± 2.9 cm/s vs 16.5 ± 1.8 cm/s, p = 0.03). In the same group, TIS was found in a
significantly higher proportion at pts with greater IMT in CCA (1 ± 0.2 mm vs 0.4
± 0.3 mm, p = 0.01). In group2, UA was significantly associated with a greater RI
in ICA (0.75 ± 0.08 vs 0.57 ± 0.12, p = 0.02). NSTEMI was significantly more
frequent in group2 pts with greater RI in ICA (0.76 ± 0.11 vs 0.56 ± 0.13, p =
0.03) and with higher PSVR in ICA and CCA (2.61 ± 0.12 vs 1.25 ± 0.2, p =
0.008). In the same group, TIS was found in a significantly greater proportion at
pts with higher EDV in ICA (28.7 ± 2.6 cm/s vs 17.3 ± 2.2 cm/s, p = 0.03). RD
was significantly associated with greater PSVR in ICA and CCA at hypertensive
pts with MS (2.58 ± 0.19 vs 1.14 ± 0.21, p = 0.001).
Conclusions: Greater IMT in CCA and higher level of EDV in ICA seem to predict a worse mid term outcome (one year) concerning cardiovascular and cerebrovascular events at hypertensive pts, especially with MS. Moreover, higher RI in
ICA and greater PSVR in ICA and CCA appears to have more powerful mid term
prognostic value (one year) for incidence of acute coronary syndromes without
ST-segment elevation at hypertensive pts with MS. In this group, higher PSVR in
ICA and CCA reflects unfavorable evolution of renal function.
PP.29.13
LEFT VENTRICLE HYPERTROPHY AND DIASTOLIC
DYSFUNCTION ARE ASSOCIATED WITH
ABDOMINAL OBESITY IN HYPERTENSIVE WOMEN
A. Cunha, T. Isbele, J. DÉl-Rei, M. Casanova, M. Trindade, W. Oigman,
M. Neves. Universidade Do Estado Do Rio de Janeiro, Rio de Janeiro, BRAZIL
Objective: Observational studies have demonstrated that increased abdominal
circumference is an important marker of high cardiovascular risk. The purpose of
this study was to identify structural and functional cardiac changes in non-diabetic
hypertensive women with abdominal obesity (AO).
Design and method: Cross-sectional study with 120 hypertensive women, aged
40–65 years, were divided into two groups: without (AO-, n = 42) and with (AO+,
n = 78) abdominal obesity according to abdominal circumference < or > = 88
cm, respectively. After clinical evaluation, all the patients carried out biochemical
tests, echocardiography, and carotid ultrasound.
Results: The mean age was 53 years in both groups. The diastolic blood pressure was significantly higher in the group AO+ (90 ± 1 vs 85 ± 1 mmHg, p <
0.05). On the other hand, the systolic blood pressure, although higher among
women AO+, did not reach statistical significance (145 ± 2 vs 140 ± 2 mmHg,
p = 0.098). The group AO+ presented greater number of criteria (3.1 ± 0.1 vs
1.4 ± 0.1, p < 0.001) and greater prevalence (62.8 vs 11.9%, p < 0.001) of
metabolic syndrome. Despite normal and similar serum glucose levels in both
groups, patients AO+ presented HOMA-IR (2.62 ± 0.22 vs 1.61 ± 0.17, p <
0.01) and HOMA-beta (358 ± 57 vs 200 ± 22, p < 0.05) significantly higher
than in patients AO-. In echocardiography, the systolic function was comparable
between the two groups, but the patients AO+ presented evidences of diastolic
dysfunction by tissue Doppler and a higher prevalence of left ventricle hypertrophy (29.2 vs 2.4%). There was no difference in carotid intima-media thickness
between the two groups.
Conclusions: In this sample of middle-age non-diabetic hypertensive women,
abdominal obesity was associated with left ventricle hypertrophy and diastolic
dysfunction with no evidence of atherosclerotic process.
PP.29.14
BIOCHEMICAL PREDICTORS OF VIOLATION
ELASTIC PROPERTIES IN THE VASCULAR WALL
IN HYPERTENSIVE PATIENTS WITH ABDOMINAL
OBESITY
T. Petelina, L. Gapon, N. Musikhina, K. Avdeeva, T. Petrashevskaya,
N. Tretyakova. Tyumen Cardiology Centre- Department of Arterial Hypertension,
Tyumen, RUSSIA
Objective: To identify predictors of biochemical showing increasing vascular
wall stiffness in patients with hypertension
Design and method: The study involved 130 patients with mild-to moderate
hypertension, hyperlipidemia, and mild abdominal obesity. Group 1 included 53
patients with hypertension, the second group - 77 patients with arterial hypertension and abdominal obesity. Both groups were comparable in age, duration of
hypertension, office blood pressure. The study of elastic properties of the vascular
wall was performed by sphygmography on the unit Vasera VS- 1000 Series (Japan), with a performance rating: PWV-R, PWV-L - pulse wave velocity by elastic
arteries. Biochemical lipid parameters were assessed - TC, LDL-C, HDLC, TG;
inflammatory and endothelial markers – hs CRP, homocysteine, tumor necrosis
factor, nitrites, endothelin 1.
Results: Binary regression method identified biochemical predictors: from lipid
profile-patients 1 and 2 groups in terms of increased levels of TC > 5.0 mmol / l
at its further increase of 1 mmol / l increase the likelihood of PWV -L increases
to 14.7 times (p = 0.05) in group 1 and 2 groups in terms of reduced HDL values
< 1.2 mmol / l at its further decline of 1 mmol / l increase the likelihood of PWVL increases by 72% (p = 0.026). Parameters of endothelial dysfunction - the 2
groups of patients with a decrease in the initial level of nitrite to 1 nmol / ml increase the likelihood of PWV-L increases by 46% (p = 0.035). Method of artificial
neural networks used to confirm that the vascular wall stiffness is directly related
Abstracts e303
to biochemical markers such as the level of TC, HDL, hs-CRP, homocystein and
endothelin-1.
Conclusions: Predictors of biochemical control, in particular, total cholesterol,
HDL cholesterol, hs CRP, homocysteine and endothelin -1 affects the rigidity of
the vascular wall of hypertensive patients with abdominal obesity.
PP.29.15
OBESITY INCREASES THE CENTRAL SYSTOLIC
AND DIASTOLIC BLOOD PRESSURE DESPITE
HAVING PROPER TREATMENT IN HYPERTENSIVE
PATIENTS
R. Cabrera Sole, C. Turpin Lucas, L. Urrego Rivera, D. Calle Salazar,
M. Aguilera Saldaña. University General Hospital, Albacete, SPAIN
Objective: It is well known that obesity is a controllable cardiovascular risk factor
and has effects on other risk factors, including high blood pressure (HTA) .It is
also known to be more difficult to control hypertension in these patients with obesity (POB), requiring more treatment settings to maintain blood pressures (BP)
below 140/90 .In according to these data, we performed an assessment of the
central pressures in obese patients with controlled BP in the office.
The aim of this study is to evalue central systolic and diastolic blood pressures
(CSBP,CDBP) in obese patients whose peripheral blood pressure was apparently
controlled at office.
Design and method: We studied, 68 POB (67 ± 7 average years old,45 women
and 23 men, BMI > 30) and compared to 150 hypertensive patients (66 ± 9 average years old, 90 women and 60 men, BMI < = 25), non obese (P no OB), who
received treatment to maintain BP below 140/90 mmHg in office. All of them
submitted to a study to measure CSBP,CDBP, augmentation index (AI) and pulse
wave velocity (PWV) in a observational and prospective study
Results: Results of these groups were compared and shown in the following table:
Conclusions: According to our data, obesity significantly increases systolic and
diastolic central pressures and also, arterial stiffness, setting these patients in a
high risk group, despite apparently having good peripheral blood pressure control.
We have to take into account these data to increase our control on these kind of
patients.
PP.29.16
EFFECT OF VERY SHORT-TERM WEIGHT
REDUCTION ON BLOOD PRESSURE IN EXTREME
OBESE WELL TREATED HYPERTENSIVE PATIENTS
G. Csitári1, R. Kollár1, T. Ferenci2, G. Simonyi1. 1St. Imre University Teaching
Hospital, Metabolic Center, Budapest, HUNGARY, 2University of Óbuda, Group
of Physiological Regulations, János Neumann Faculty of Informatics, Budapest,
HUNGARY
Objective: Hypertension is a well-known modifiable cardiovascular risk factor.
Extreme obesity also enhance cardiovascular risk. Hypertension and obesity are
often present together.Our aim was to investigate the effect of very short-time
weight loss on blood pressure in extreme obese patients.
Design and method: In our retrospective investigation, we included extreme
obese (BMI > = 40 kg/m2), well treated hypertensive patients (< 140/90 mmHg),
who participated in our one-week long, hospitalized weight reduction program
with dietary intervention. At admission and emission, we measured anthropometric parameters, lipid profile, fasting glucose, systolic and diastolic blood pressure
(SBP, DBP), heart rate; and we calculated pulse pressure (PP) and mean arterial
pressure (MAP). Antihypertensive therapy was not changed during the weight loss
course.
Results: We involved 72 patients all together (46 women, 26 men). Their age was
51.88 ± 12.39 years. Their body weight was 130.36 ± 25.30 kg, and the BMI was
46.96 ± 6.87 kg/m2 at admission. The patient’s SBP was 128.53 ± 12.40 mmHg
and diastolic blood pressure was 75.36 ± 9.79 mmHg at the beginning. The PP
was 53.17 ± 12.51 mmHg, while MAP was 93.08 ± 8.96 mmHg. The heart rate
of them was 71.61 ± 10.14 beat/min. The patients were on an average of 675 ±
172.59 kcal/day diet. As an effect of the one week long low calorie diet, the body
weight was decreased to 126.56 ± 24.20 kg, the BMI diminished to 45.62 ± 6.68
kg/m2 (p < 0.0001). The SBP decreased to 124.49 ± 12.97 mmHg (–4.04 ± 13.09
mmHg p < 0.0001), and DBP reduced to 73.65 ± 10.33 mmHg (–1.71 ± 10.51
mmHg, NS). PP diminished to 50.83 ± 13.87 mmHg (NS), MAP decreased to
90.60 ± 9.6 mmHg (p < 0.05) accompanied by a slight (–1,48 beat/min) not significant (p < 0.0001) reduction of heart rate.
Conclusions: In our study a short-term, approx. 3.80 kg (–2.91%) weight reduction was associated with a significant systolic and a not significant diastolic blood
pressure reduction. According to literature data - on population level - only a
slight (2–3 mmHg) SBP difference may cause 6–9% reduction in stroke mortality
and 4–6 % decrease in coronary mortality risk among obese patients. We would
like expand our investigation in a future to assess the duration and long term effect
of weight loss on blood pressure in extreme obese hypertensive patients.
PP.29.17
THE INFLUENCE OF HORMONAL REPLACEMENT
THERAPY ON CARDIOVASCULAR SYSTEM IN
POSTMENOPAUSAL WOMEN WITH CLIMACTERIC
SYNDROME
J. Prokhorova1, S. Tolstov2, V. Mychka1. 1Moscow State University of Medicine
and Dentistry named after A. I. Yevdokimov, Moscow, RUSSIA, 2Saratov State
Medical University named after V. I. Razumovsky, Saratov, RUSSIA
Objective: To define the influence of hormonal replacement therapy (HRT) on 24hour dynamics of blood pressure and vascular stiffness in postmenopausal women
with climacteric syndrome.
Design and method: The research included 28 postmenopausal women with climacteric syndrome, average age was 52.5 years, average menopause length was
not more then 5 years. The incidence of tobacco consumption was 28.6%; 64.3%
had stage 1 and 2 arterial hypertension, length was 3 years (antihypertensive therapy was presented as Nifedipine 30–60 mg., in several cases in combination with
Indapamide 1,5 mg, duration of therapy at the begining of study reached from 6 to
28 months, it was not changed during the study); 57.1% had metabolic syndrome
and 14.3% had contravention of carbohydrate metabolism. At the study entry all
women were underwent both clinical and gynecological examination (no contraindications for HRT), 24-hour blood pressure monitoring and examination of vascular stiffness by oscillometric method using MnSDP-2 with BPlab Vasotens. All
women were prescribed HRT, containing 1 mg estradiol and 2 mg drospirenone
per tablet. The study lasted 16 weeks.
Results: After 16 weeks of therapy we identified that mean daily systolic blood
pressure (SBP)/diastolic blood pressure (DBP) reduced from 130.1 ± 12.7 to
121.4 ± 7.8/from 82.6 ± 6.7 to 75.7 ± 4.1 mmHg (p < 0.001); average daytime
SBP decreased from 135.8 ± 10.3 to 124.0 ± 7.5 mmHg; average daytime DBP
decreased from 84.8 ± 5.7 to 78.2 ± 4.8 mmHg (p < 0.001); average SBP at night
period decreased from 125.3 ± 17.0 to 116.4 ± 13.3 mmHg (p < 0.05). Studing vascular stiffness we found out significant reducing of Ambulatory arterial
stiffness index (AASI) from 0.460 to 0.425 (p < 0.05), pulse pressure decreased
from 49.4 to 45.6 mmHg (p < 0.01) and Augmentation index (AIx/AIx-75) from
–14.7% to –13.5%/ from -15.5% to -24% (p < 0.05).
Conclusions: Hormonal replacement therapy, containing 1 mg estradiol and 2
mg drospirenone has beneficial effects on daily blood pressure level and vascular stiffness in postmenopausal women with climacteric syndrome after 16
weeks.
PP.29.18
ABDOMINAL OBESITY AND DEPRESSION AMONG
OBESE HEALTHCARE WORKERS
A. Wisetborisut1, H. Klibngern1, W. Jirapornjaroen1, S. Likhitsathian2,
C. Angkurawaranon1. 1Faculty of Medicine, Chiang Mai University - Department
of Family Medicine, Chiang Mai, THAILAND, 2Faculty of Medicine, Chiang Mai
University - Department of Psychiatry, Chiang Mai, THAILAND
Objective: To determine the association between abdominal obesity and depression among obese people.
Design and method: We conducted a cross-sectional study of healthcare workers form Chiang Mai University hospital. Questionnaires, interviews and physical
examination were used to collect the data. Multiple logistic regression analyses,
adjusted for possible confounders including demographic characteristics, socioeconomic status and underlying disease were performed to identify the association between abdominal obesity and depression.
Results: From 3204 participants, 602, 732 and 211 of them were overweight,
obese class I and II, respectively. After adjusted for confounders, the odds ratio
(aOR) of having depression in participants with abdominal obesity was 1.57 (95%
CI, 1.03–2.39) among obese group. For the overweight group, having abdominal
obesity was not associated with depression (aOR 1.13, 95% CI 0.44–2.92). In
contrast, the individuals who were obese class I with abdominal obesity had higher odds of having depression (aOR1.82, 95% CI 1.05–3.14) compared to those
without abdominal obesity.
Conclusions: The abdominal obesity was associated with depression among
obese individuals. However, this association was not found among overweight individuals. For the obese workers, target interventions to reduce abdominal obesity
in order to prevent depression are recommended.
PP.29.19
VISFATIN SERUM LEVEL AND EXPRESSION IN
SUBCUTANEOUS AND VISCERAL ADIPOSE TISSUE
IN PREPUBERTERTAL BOYS: RELATION TO BLOOD
PRESSURE AND METABOLIC PARAMETARS
K. Selthofer Relatic1, S. Novak2, D. Divkovic3, I. Drenjancevic2, A. Cosic2.
1Department for Cardiovascular Diseases, Osijek University Hospital; Department of Internal Medicine, Faculty of Medicine, Osijek, CROATIA, 2Department
of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer
University of Osijek, Osijek, CROATIA, 3Department for Childhood Surgery,
Osijek University Hospital, Osijek, CROATIA
Objective: Childhood obesity presents a risk factor for adult atherosclerosis, hypertension and cardiometabolic diseases. Visfatin, an adipocytokine with inflammatory/enzymatic properties, is involved in atherogenesis and adipose tissue angiogenesis. Predominantly produced in visceral adipose tissue (VAT), less in subcoutaneous
adipose tissue (SAT), muscles, liver, cardiac cells, peripheral blood neutrophils. In
adolescents and adults is a part of metabolic syndrome and could present a marker
of visceral adiposity. The aims of study were to determine the physiological values
of serum visfatin concentrations, visfatin mRNA expression in SAT and VAT in
childhood and its relation to anthropometric/metabolic/blood pressure (BP) level.
Design and method: The study included 59 healthy boys, hospitalized for elective surgery, divided according to age into group I (1–3 years old), group II (3–7
years old) and group III (7–10 years old). Anthropometric, biochemical and BP
measurements were done to all patients. The total visfatin serum were determined
by ELISA immunoassay test, and mRNA level in SAT and VAT by real-time PCR.
Results: Body weight and height were significantly different in all age groups,
where body mass index was statistically higher in the third age group (p = 0.011).
All groups statistically differ from each other in waist circumference (p < 0.001),
but without difference in waist-to-hip ratio (p = 0.099). Group III had statistically
higher systolic BP compared with groups I and II (p = 0.003), but the diastolic
BP was statistically higher only in group III compared with group I (p = 0.009),
all in the normal range values. Fasting morning glucose level, CRP, triglycerides,
cholesterol, LDL and HDL levels did not significantly differ between groups, also
as serum visfatin concentrations. Visfatin mRNA expression was higher in SAT
compared with VAT in all three groups.
Conclusions: The included subjects were metabolically healthy with normal
glucose level, lipidogram and systolic/diastolic BP. Lack of correlation of visfatin serum level and mRNA expression in SAT and VAT with BP and metabolic
parametars can be explained by the underdeveloped inflammation of adipose tissue, indicating that the maturation physiology and ageing process have an important part in the development of pathophysiological processes.
PP.29.20
CIRCADIAN BLOOD PRESSURE PATTERN AND
METABOLIC SYNDROME
A. Hermida Ameijeiras, J.E. Lopez Paz, M.J. Alende, A. Pascual Montes,
V. Martínez Durán, G. Calvo González, A. Pose Reino, C. Calvo Gomez.
Hypertension and Vascular Risk Unit, Santiago de Compostela, SPAIN
Objective: The metabolic syndrome (MS) is associated with a 2-fold increase
in cardiovascular outcomes and a 1.5-fold increase in all-cause mortality. On the
other hand, impaired nocturnal blood pressure decline associates to higher incidence on stroke, chronic kidney disease, and other cardiovascular diseases when
compares to patients with normal dipper pattern. The aim of this study was to assess the five criteria distribution of MS according to circadian BP pattern.
Design and method: A cross sectional study was conducted among 514 hypertensive subjects and MS (age: 53.3 years; 52,7% male. BP was measured by ambulatory monitoring (ABPM) every 20 min between 07:00 am and 23:00 pm and
every 30 min at night, along 48 hours with a Spacelabs 90207 device. We analyzed
48h-systolic and 48h-dyastolic mean ambulatory blood pressure (48h-SBP and
48h-DBP), 48 h nocturnal systolic and diastolic blood pressure falling. Clinical
and biological assessments were performed in all subjects.
Results: The overall prevalence rates of circadian BP pattern were as follows:
9.7% riser; 34.4% no dipper, 48.4% with normal BP falling and only 7.4% with
very dipper pattern. There were no significant differences between groups regarding systolic BP, weight or BMI but on waist circumference (103.4 Vs 100.4 Vs
98.6 Vs 101.2 cms, respectively). When analyzing different criteria of MS we
only found differences when comparing diastolic BP (77.2 Vs 84.7 Vs 86.0 Vs
86.9 mmHg, respectively) or fasting glucose (121.9 Vs 111.6 Vs 107.1 Vs 113.8
mmHg). Neither fasting trygliceride nor HDL cholesterol showed differences.
Waist circumference and fasting glucose poorly and inversely correlated with
systolic blood pressure falling (r: -0.154; p = 0.001 and r: -0.151; p = 0.001) and
dyastolic BP falling (r: -0.166; p = 0.000 and r: -0.198; p = 0.000).
Conclusions: In our cohort abnormal circadian BP pattern (“riser”, “non dipper”
and “very dipper”) associate with higher waist circumference as well as higher
fasting glucose levels These results may help us to understand the underlying
process of increased cardiovascular risk in hypertensive subjects with impaired
nocturnal BP falling.
PP.29.21
LISINOPRIL EFFICIENCY IN OBESE
HYPERTENSIVE MEN
V. Stojanov1, N. Radivojevic1, M. Marjanovic1, B. Jakovljevic2, D. Lovic3. 1Multidisciplinary Center for Polyclinic Diagnostics, Assessment and Treatment of
Blood Pressure Disorders, Belgrade, SERBIA, 2Institute of Hygiene and Medical
Ecology, Faculty of Medicine, Belgrade, SERBIA, 3Clinic for Internal Diseases
InterMedica, Nis, SERBIA
Objective: The aim was to assess the effects of lisinopril combined with hydrochlorthiazide on blood pressure of hypertensive men with normal weight, overweight and obesity.
Design and method: The study comprised 266 hypertensive men, aged 60.56 ±
11.50 years. All patients were treated with fixed combination of 20 mg lisinopril
and 12.5 mg hydrochlorthiazide. Body mass index (BMI) was calculated from
body weight divided by squared body height. Normal weight was defined as
BMI from 18.5 to 24.9 kg/m2, overweight as BMI from 25.0 to 29.9 kg/m2 and
obesity as BMI exceeding 30 kg/m2. Blood pressure (BP) was measured by an
oscillometric device at the beginning of the study, and after three months of
therapy. The differences between the groups were tested with one-way ANOVA.
The differences from baseline values were tested with Student’s t test for paired
samples.
Results: At the beginning of the study 39 men (14.7%) had normal weight, 163
men (61.3%) were overweight, and 64 (24.1%) were obese. All three groups of
men had similar systolic (SBP) and diastolic pressures (DBP) at the beginning
of the study as well as at the end of the study. Mean BMI remained stable during three months of antihypertensive therapy. Mean SBP for all patients at the
beginning of the study was 162.52 ± 13.24 mmHg, mean DBP was 97.38 ± 8.62
mmHg. After three months of therapy, all men reduced their SBP significantly
(mean decrease from baseline = 28.34 ± 13.45 mmHg), as well as their DBP
(mean decrease from baseline = 15.04 ± 8.68 mmHg). The average decrease
in SBP and DBP during therapy was similar among men with normal weight,
overweight and obesity. Men with normal weight reduced their SBP by 30.19
± 12.08 mmHg, in comparison to overweight men (27.70 ± 13.86 mmHg), and
to obese men (28.35 ± 13.13 mmHg), but the difference was not statistically
significant.
Conclusions: Three-month therapy with lisinopril and hydrochlorthiazide is
equally effective in hypertensive men with normal weight, overweight and obesity.
PP.29.22
OVERWEIGHT AND OBESITY IN THE RISK PROFILE
OF HIGH RISK PATIENTS WITH HYPERTENSION
B. Georgiev1, N. Gotcheva1, V. Baytcheva1, D. Gotchev2. 1National Heart Hospital, Sofia, BULGARIA, 2Military Medical Academy, Sofia, BULGARIA
Objective: The aim of this study is to analyse the prevalence of overweight and
obesity in Bulgarian high risk patients during the period 2007–2014.
Design and method: We analyse the data from Bulgarian cohorts of high risk
patients included in both surveys EUROASPIRE (European Action on Secondary
and Primary Prevention by Intervention to Reduce Events) III and IV, held in 2007
and 2014. The protocols of EUROASPIRE III and IV trials comprise standard
questionnaires used by all countries to determine the patient health status.
Results: 88.1% of the patients in EUROASPIRE III are with hypertension (SBP/
DBP > 140/90 mmHg or > 130/80 mmHg for diabetics, or are on therapy). The
mean Body Mass Index (BMI) in EUROASPIRE III is 28.4 kg/m2 and the mean
waist circumference in men is 99.2 cm and in women 95.8 cm. The prevalence
of overweight, defined as BMI > 25 kg/m2, is 93%. The prevalence of obesity,
Abstracts e305
defined as BMI > 30 kg/m2, is 65%. The prevalence of central obesity (waist circumference > 102 cm for men or > 88 cm for women) is 81%. All of the patients
in EUROASPIRE IV are with hypertension. The prevalence of overweight is 88%.
The prevalence of obesity is 50%. The prevalence of central obesity is 86%.
Results: The office BP and ABPM BP control was absolutely equivalent in all
groups. At the end of the study decreased ABPM BP on 16,86, 16,26, 15,40, 17,00
mmHg respectively in groups, (p > 0,05 between all groups). We analyzed glycemic control in the subgroup of patients depended of HOMA level (see table).
Conclusions: We found a very high prevalence of overweight and obesity among
Bulgarian high risk patients with a small decrease of the overweight and obesity
during the last 7 years.
PP.29.23
PREVALENCE OF METABOLICALLY HEALTHY
OBESE PHENOTYPE IN SAINT-PETERSBURG
INHABITANTS ACCORDING TO DIFFERENT
CRITERIA
M. Boyarinova, A. Orlov, O. Rotar, A. Alieva, E. Moguchaya, E. Vasilieva,
V. Yudina, V. Solntsev, E Baranova, A Konradi. Federal Almazov North-West Medical Research Centre, Saint Petersburg, RUSSIA
Objective: Metabolically healthy obese (MHO) phenotype is associated with lower cardiovascular risk, but there is no standard criteria for MHO diagnostic. The
aim of our study was to compare MHO prevalence according to different criteria
in sample of Saint-Petersburg inhabitants.
Design and method: As a part of all-Russian epidemiology survey ESSE-RF
random sampling of 1600 Saint-Petersburg inhabitants (25–65 years) was involved. Anthropometry (weight, height with body-mass index (BMI) calculation), waist circumference (WC)), blood pressure (BP) measurement and fasting blood-tests: glucose, lipids, CRP, insulin (Abbott Architect 8000 (USA))
and HOMA IR were performed. MHO criteria were used in subjects with obesity (BMI > = 30 kg/m2):
1. Meigs (USA, 2006): less than 3 of the following criteria: HDL < 1.30(F)/1.04(M)
mmol/l; triglycerides > = 1.7 mmol/l; glucose > = 5.6 mmol/l or treatment; BP >
= 130/85 mmHg or therapy and WC>102(M)/88(F) cm.
2. Wildman (USA, 2008): less than 2 of the following criteria: HDL <
1.30(F)/1.04(M) mmol/l or therapy; triglycerides > = 1.7 mmol/l; glucose > =
5.55 mmol/l or treatment; BP > = 130/85 mmHg or therapy; CRP>90th percentile;
HOMA IR>90th percentile.
We’ve assumed to use 3 types of CRP and HOMA IR cut-offs in Wildman criteria:
90th percentile in normal-weight (BMI < 25 kg/m2) subjects (variant 1), in whole
cohort (variant 2) and used criteria from Oliveros et al. study (variant 3 criteria)
Results: Obesity was revealed in 430 subjects.
Table 1. MHO prevalence according to different criteria
* - p < 0,05 between before and after treatment in atenolol subgroup
# - p < 0,05 between before and after treatment in carvedilol subgroup
$ - p < 0,05 between before and after treatment in bisoprolol subgroup
£ - p < 0,05 between before and after treatment in nebivolol subgroup
¥ - p < 0,05 between nebivolol and atenolol subgroup (HOMA < 3) after treatment
A – p < 0,05 between carvedilol and atenolol subgroup (HOMA < 3) after treatment
^ – p < 0,05 between bisoprolol and atenolol subgroup (HOMA < 3) after treatment
Q – p < 0,05 between nebivolol and carvedilol subgroup (HOMA < 3) after treatment
m - p < 0,05 between carvedilol and bisoprolol subgroup(HOMA < 3) after treatment
© - p < 0,05 between carvedilol and bisoprolol subgroup (HOMA>3) after treatment
W - p < 0,05 between nebivolol and atenolol subgroup (HOMA>3) after treatment
R - p < 0,05 between carvedilol and atenolol subgroup (HOMA>3) after treatment
N – p < 0,05 between bisoprolol and atenolol subgroup (HOMA>3) after treatment
Conclusions: The 6-month therapy in patients with AH and MS with insulinresistance (HOMA>3) by atenolol can significantly worse HOMA, fasting insulin;
patients with insulinresistance treated by bisoprolol, carvedilol and nebivolol
decreased HOMA, fasting insulin. Different beta-blockers had different
metabolic effects.
Kappa index was maximal between variant 2 and Meigs criteria (kappa = 0,7,
p < 0,001) and minimal between variant 1 and Meigs criteria (kappa = 0,4,
p < 0,001).
Conclusions: MHO prevalence was decreased up to 3 times including CRP and
HOMA IR to MHO criteria. Gender differences in MHO phenotype prevalence
were found only with applying of the strictest cut-off for CRP and HOMA IR. Using of cut-off of whole cohort data for additional components of metabolic health
(CRP and HOMA IR) was associated with best agreement with Meigs criteria.
PP.29.24
METABOLIC EFFECTS DIFFERENT BETA
BLOCKERS DEPENDS ON PRESENTS INSULIN
RESISTANCE IN PATIENTS WITH ARTERIAL
HYPERTENSION AND METABOLIC SYNDROME
O. Rekovets, Y. Sirenko, O. Torbas, G. Primak, A. Vaschylko, E. Pavlyuk,
S. Savitskiy, P. Sidorenko, S. Polischuk, V. Granich, S. Kushnir,
A. Dobrokhod. Institute of Cardiology, Kiev, UKRAINE
Objective: To evaluate the changes of glucose, insulin, HOMA in patients with
AH and MS during 6-month course of antihypertensive treatment with different
beta blockers.
Design and method: Observed 131 patients with mild to moderate AH and MS
(according ATP III criteria). Patients with diabetes mellitus were excluded. In 32
patients (1st group) treated by atenolol, 32 patients (2nd group) - bisoprolol, 32
patients (3rd group) - by carvedilol, 35 patients (4th group) – by nebivolol. In all
patients before and after 6 month of therapy performed ABMP and OGTT estimation of HOMA. We divided patients in groups depends on presents or absents
insulinresistance (HOMA>3 or HOMA < 3).
PP.29.25
ASSOCIATION OF PHERIPHERAL AND CENTRAL
BLOOD PRESSURE WITH THE COMPONENTS OF
METABOLIC SYNDROME IN A MEXICAN SAMPLE
P. Quezada, F. Grover, C. Ramos, S. Pascoe, E. Cardona, S. Hernandez.
Instituto de Terapéutica Experimental y Clínica, Centro Universitario de Ciencias
de la Salud, Universidad de Guadalajara, Guadalajara, MEXICO
Objective: The aim of this study is to associate peripheral and central blood pressure with the components if metabolic syndrome in a mexican sample.
Design and method: 82 Mexican subjects were evaluated in this cross-sectional
study to investigate the distribution of central systolic blood pressure values estimated by the Omron HEM-9000AI device, with at least 1 of the 5 cluster components in accordance with NCEP ATPIII criteria as the simultaneous alteration in
equal or more than 3 of the 5 components: abdominal obesity (W), high triglycerides (T), low HDL cholesterol (H), elevated blood pressure (B), and elevated
fasting glucose (G).
Results: We catalogue the sample in four groups and were used for the present
analysis. Estimated central systolic blood pressure was higher than braquial systolic blood pressure and was significantly correlated with the presence of B in the
groups (p = 0.000). The central blood pressure values obtained from subject with
MetS in presence of B were 144.9 ± 18.2 (n = 24) mmHg. The values obtained
from subject with MetS whitout including blood pressure were 122.8 ± 12.4 (n =
16) mmHg; from subjects with less than 3 cluster but with the presence of B were
142.9 ± 16.7 (n = 18) mmHg and 124.7 ± 9.9 mmHg for normal blood pressure
categories with less than 3 components cluster criteria (n = 23).
Conclusions: In conclusion, beside different component clusters of MetS showed
varying associations with central blood pressure, the single presence of elevated
blood pressure, is sufficient to increase that value than having more cluster components of MetS as a whole.
PP.29.26
AMBULATORY ARTERIAL STIFFNESS INDEX IN
PATIENTS WITH METABOLIC SYNDROME AND
NEWLY DIAGNOSED HYPERTENSION BEFORE
AND AFTER ONE YEAR OF TREATMENT WITH
LOSARTANE AND TELMISARTANE
I. Rihacek, M. Soucek, B. Kianicka, P. Frana, M. Plachy, J. Spac. Masaryk University and St. Anna Hospital, Brno, CZECH REPUBLIC
Objective: To measure the ambulatory arterial stiffness index (AASI) and pulse
pressure (PP) in patients with newly diagnosed hypertension and metabolic syndrome before and after 1 year of treatment with losartane or telmisartane once daily.
Design and method: Blood pressure (BP) measurement using 24-hour ambulatory BP monitoring (ABPM, SpaceLabs 90207) according to the ESH criteria.
Metabolic syndrome and hypertension defined by ATP III criteria. Fifty seven
patients in two groups; 30 patients treated with telmisartane and 27 patients with
losartane. PP pressure calculated as systolic minus diastolic BP, AASI defined
as 1-regression slope of diastolic on systolic BP computed from 24-hour recording for each patient. Statistic evaluation before and after treatment using paired
Students T-test.
Results: Telmisartane (N = 30), before treatment: mean 24-hour ABPM 135/84
mmHg, PP 50,8 ± 8,7 mmHg, AASI 0,37 ± 0,01, after treatment: mean 24-hour
ABPM 126/79 mmHg, difference -9/5 mmHg, P < 0,01, PP 47,4 ± 6,0 mmHg,
difference -3,4 mmHg, P < 0,01, AASI 0,38 ± 0,04, difference + 0,01, P = 0,642.
Losartane (N = 27), before treatment: mean 24-hour ABPM 135/84 mmHg, PP
51,2 ± 7 mmHg, AASI 0,38 ± 0,05, after treatment: mean 24-hour ABPM 124/77
mmHg, difference 11/7 mmHg, P < 0,01, PP 46,9 ± 5,8 mmHg, difference -4,3
mmHg, P < 0,01, AASI 0,38 ± 0,04, difference 0, P = 0,68.
Conclusions: After treatment significantly decreased the value of 24-hour ABPM,
and PP, AASI values were not significantly affected.
Abstracts e307
POSTER SESSION
LIFESTYLE CHANGES, LIPIDS, SALT
PP.30.01
ESTIMATION OF POPULATIONAL 24-H URINARY
SODIUM AND POTASSIUM EXCRETION FROM
SPOT URINE SAMPLES. EVALUATION OF
FOUR FORMULAS IN A LARGE NATIONAL
REPRESENTATIVE POPULATION
J. Polonia1, M.F. Lobo2, L. Martins1, F. Pinto1, J. Nazaré1. 1Portuguese Society
of Hypertension, Lisbon, PORTUGAL, 2CINTESIS, Fac. Medicine Porto, Porto,
PORTUGAL
Objective: To assess the validity of the estimation of 24-h urinary sodium (UNa)
and potassium (UK) excretion obtained through 4 formulae based on occasional
urine samples.
Design and method: We analyzed 2460 individuals (50.2% females) aged 18 – 96
years representatives of Portuguese population (PP). Tanaka, Kawasaki, INTERSALT and NHANES formulae were used to predict 24-h UNa and UK excretions
from occasional urinary samples (OUrS) and we compared it with validated real
24-h urine samples (VUrS) (average 24 h UNa = 4073 mg/d). We also derive
formulas specific to the PP using Tanaka and Kawasaki’s formulae with adjusted
parameters, obtained through the method of least squares. All formulas were then
used on data collected from 24-h urine samples to compute predictions. We compared observed vs estimated measurements by examining bias (observed minus
predicted UNa/UK), the intra-class correlation (ICC) coefficients between measurements, and Bland-Altman plots categorized by hypertension and normotension diagnosis.
Results: The degree of bias of estimations based on OUrS relative to VUrS measurements ranged from -31 mg/day of sodium in Tanaka, to 1969 mg/day of UNa
in Kawasaki and from -259 mg/day to 736 mg/day of UK in Tanaka. The only formula for which bias was not significant was Tanaka’s for UNa prediction. All ICC
were lower than 0,470 for both UNa and UK excretion estimations. The BlandAltman plots indicated a high dispersion of the estimates biases regardless of the
formulae used and the diagnosis of normotension/hypertension. Most formulas’
estimations showed a positive relationship between bias and the magnitude of
the average between observed and predicted measurements. All formulas lead to
a wide range of overestimation and underestimation of both 24 h UNa and UK
excretion even when applied to the 24-h real samples.
Conclusions: We found a poor agreement between estimated and observed measurements of UNa and UK in our large population exhibiting a high salt intake.
That suggests that any of these formulas may incur in over- or under-estimations
of UNa and UK excretion that may be unreliable for clinical evaluation of individual’s daily UNa and UK+ excretion.
PP.30.02
IMPACT OF STRESS REDUCTION ON BLOOD
PRESSURE CONTROL IN PATIENTS TREATED WITH
PERINDOPRIL; SHAKE THE HABIT II
M. Vasilevski1, R. Hamel1, E. Rampakakis2, J. Sampalis2. 1Servier Canada Inc.,
Laval, CANADA, 2JSS Medical Research, Montreal, CANADA
Objective: Stress management has been recognized by the Canadian Hypertension Educational Program (CHEP) as an essential lifestyle modification for hypertension. The study assessed the effectiveness of a patient – centric stress management tool on perceived stress and evaluated the effect of stress reduction on BP
control of patients treated with perindopril.
Design and method: This was an open label, prospective, randomized phaseIV study. Patients for whom the treating physician had prescribed perindopril
independently of the study were enrolled from 74 community physicians across
Canada and were randomized to a stress education group (SE) or a control group
(CTRL). All patients received motivational letters encouraging them to adhere to
the CHEP recommendations. The SE group also received educational material
regarding the impact of stress on BP and suggestions on stress management with a
CD of autogenic and progressive muscle stress reduction exercises. Main outcome
measures were BP and Cohen’s Perceived Stress Scale (PSS). Follow up was at
weeks 4 and 16 after baseline.
Results: A total of 5963 (CTRL: 2,966; SE: 2,997) completed the study. Mean
(SD) age was 62 (13) years, 47% were female and 75% were Caucasian. Baseline mean (SD) SBP/DBP was 151 (9.75)/89 (8.61) mmHg. Demographics and
baseline BP were similar for the two patient groups. The proportion of patients
treated with perindopril 4 and 8 mg/day respectively was 61% and 16% at baseline and 38% and 37% at 16 weeks. By 16 weeks significant (P < 0.001) mean
(SD) reductions in SBP/DBP of -20(13)/–10(9) mmHg were observed and 64%
had achieved target BP. There was no between group difference with respect to
change in BP, target BP and PSS at 16 weeks. After adjusting for relevant covariates improved stress management was associated with a significant reduction in
SBP (–1.8 mmHg, P = 0.002) and DBP (–0.5, P = 0.213) and increased odds of
target BP (OR = 1.4; P = 0.006).
Conclusions: Perindopril was effective in reducing BP after 16 weeks of treatment. Improved stress management is associated with better BP control, Identification of effective stress management interventions must be a priority in BP
management.
PP.30.03
RELATIONSHIP BETWEEN URINE SODIUM/
POTASSIUM EXCRETION AND CENTRAL AORTIC
SYSTOLIC BLOOD PRESSURE IN KOREAN
PATIENTS WITH HYPERTENSION
M. Rhee1, J.H. Kim1, S.J. Shin2, D.Y. Nah3, K.C. Sung4, E.J. Cho5, K.S. Hong6,
S.H. Jo7, K.I. Kim8, S.H. Lee9. 1Cardiovascular Center, Dongguk University Ilsan
Hospital, Goyang, SOUTH KOREA, 2Division of Nephrology, Dongguk University Ilsan Hospital, Goyang, SOUTH KOREA, 3Cardiovascular Center, Dongguk
University Gyeongju Hospital, Gyeongju, SOUTH KOREA, 4Department of Internal Medicine, Kangbuk Samsung Hospital, Seoul, SOUTH KOREA, 5Division of
Cardiology, St. Paul’s Hospital, Seoul, SOUTH KOREA, 6Department of Internal
Medicine, Hallym University College of Medicine, Chuncheon, SOUTH KOREA,
7Department of Internal Medicine, Hallym University Sacred Heart Hospital,
Anyang, SOUTH KOREA, 8Deparment of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, SOUTH KOREA, 9Wonju Medical College,
Yonsei University, Wonju, SOUTH KOREA
Objective: Although several studies showed the association of urinary salt excretion with central hemodynamics, the relationship between 24-hour urine sodium
(24HUNa) and potassium (24HUK), and aortic blood pressure (BP) is uncertain
in Asian.
Design and method: From 707 randomly recruited participants, the relationship
between 24HUNa and 24HUK, and casual BP, 24-hour ambulatory BP, and aortic
BP were analyzed in 524 participants with valid 24-hour urine collection, 24-hour
ambulatory BP and central BP measurement (age 48.1 ± 9.8 years, 193 men). Hypertension was defined by 24-hour ambulatory BP > = 130/80 mmHg, or current
treatment of hypertension (n = 219).
Results: Participants with hypertension and high 24HUNa (mean 214.7 ± 51.4
mmol/day, range 155.0–432.0) showed higher 24-hour systolic (p = 0.021) and
diastolic BP (p = 0.036) and aortic systolic BP (AoSBP, p = 0.032) than participants with hypertension and low 24-HUNa (mean 118.4 ± 25.9 mmol/day,
range 45.6–154.8) with adjustment for confounders. Participants with hypertension and high 24HUNa/24HUK ratio (mean 4.08 ± 1.00, range 3.00–7.95) had
higher AoSBP than participants with hypertension and low 24HUNa/24HUK
ratio (mean 2.17 ± 0.56, range 0.53–3.00) with adjustment for confounders (p =
0.038). Participants with hypertension showed a significant linear relationship between AoSBP and 24HUNa/24HUK ratio in multiple regression analysis, which
was independent to 24HUNa (p = 0.047). In participants without hypertension,
24HUNa and 24HUNa/24HUK ratio were not associated with casual BP, 24-hour
ambulatory BP and AoSBP.
Conclusions: In Korean patients with hypertension, 24HUNa/24HUK ratio is independently related to AoSBP.
PP.30.04
ROLE OF EDUCATION IN PREVENTION OF
ARTERIAL HYPERTENSION IN ST.PETERSBURG
N. Paskar, A. Nedoshivin. Federal Almazov North-West Medical Research
Centre, St. Petersburg, RUSSIA
Objective: Screening of healthy subjects and prevention programs are considered
the best instruments effectively improving hypertension awareness and control
M
O
N
D
A
Y
P
O
S
T
E
R
S
worldwide. Education is an important part of hypertension management. The aim
of the present study was to assess efficacy of special schools for hypertensive
subjects and preventive out-patients departments.
Design and method: The analysis of the results of testing 296871 patients with
arterial hypertension according to the information of medical analytical centre,
27 offices of prevention of arterial hypertension and 74 schools of health were
organized since 2006 in out-patient polyclinic network. Since 2009 68000 patients
passed training in the arterial hypertension schools.
Results: The cardiovascular events was decreased from 440.9 per 1000 in 2009
to 406.4 in 2011 and 336.0 in 2012. The incidence of arterial hypertension has
declined to 108.5 in 2012, compared to 126.5 in 2011 and 142.7 in 2009. In
2011–2013 the blood pressure targets was achieved in 25.5% of patients with
arterial hypertension against 14.8% in 2009–2011 years. The prevalence of main
cardiovascular risk factors decreased as well: hyperglycemia by 8.1% (2011–
2013) against 2.5% (2009–2011), dyslipidaemia by 4.9% (2011–2013) against
2.5% (2009–2011, smoking by 9.1% (2011–2013) against 4.1% (2009–2011)
respectively. The physical activity was not changed. Every year about 5000 of
newly detected patients with arterial hypertension were included in educational
programs.
Conclusions: The lifestyle changes safely and effectively delay or prevent hypertension in non-hypertensive subjects, contribute to reductions blood pressure to
the target level in hypertensive individuals already on medical therapy and control
of cardiovascular risk factors in real clinical practice.
PP.30.05
BLOOD PRESSURE IN RELATION TO 24-HOUR
URINARY SODIUM EXCRETION AND RENAL
SODIUM HANDLING
K. Stolarz-Skrzypek1, A. Bednarski1, A. Franczyk2, M. Folta3, H. Barton3,
A. Olszanecka1, M. Kloch-Badelek1, G. Kielbasa1, K. Kawecka-Jaszcz1,
D. Czarnecka1. 1First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical Coll., Krakow, POLAND, 2Department of Clinical Pharmacy, Jagiellonian University Medical
College, Krakow, POLAND, 3Trace Element Research Laboratory, Department
of Food Chemistry and Nutrition, Jagiellonian University Medical College, Krakow, POLAND
Objective: There is abundant evidence that sodium intake is related to blood pressure (BP). However, the relationship varies between individuals and is probably
determined by renal sodium handling. We investigated ambulatory BP in relation
to interactions between sodium dietary intake and renal handling, as assessed by
24-hour urinary sodium excretion (24hUVNa) and endogenous lithium clearance,
respectively.
Design and method: We recruited from general population 192 individuals,
never treated with antihypertensive medications. We administered standardized
questionnaires to obtain information on subjects’ medical history and life style.
SpaceLab 90207 monitors were programmed to measure blood pressure each 15
min during daytime (6:00–22:00) and each 30 min night-time. Blood and 24-hour
urine samples were collected. We measured urine and plasma lithium and calculated fractional excretion of lithium (FELi) as the marker of proximal sodium
handling. A higher FELi indicates that less sodium and water is reabsorbed in the
proximal tubule.
PP.30.06
DIETARY SODIUM AND POTASSIUM WERE
ASSOCIATED WITH BLOOD PRESSURE IN MIDDLE
AGED ADULT AND OLDER BUT NO ASSOCIATION
WERE SHOWN IN YOUNGER ADULTS; A
NATIONWIDE SURVEY (KNHANES V)
S. Kim, S.J. Chung, M.H. Park. Department of Foods and Nutrition Kookmin
University, Seoul, SOUTH KOREA
Objective: We examined how age affects the association between sodium/potassium intakes and blood pressure.
Design and method: A total of 12,286 adults aged over 19 years without antihypertensive drugs were selected from data KNHANES, a nationally representative
cross-sectional survey in Korea, 2010–2012. To evaluate how age affects the association between sodium/potassium intakes and blood pressure, we categorized
the subjects into three age groups: 19–39 years, 40–59 years and over 60 years.
We used a 24-hour dietary recall method to assess the sodium and potassium intakes. SUDAAN was used to analyze data while considering the sampling design.
Multiple regression models included sodium and potassium intakes as well as
energy intakes, body mass index, drinking status, smoking status, physical activity, income and age to control the confounding factors.
Results: There was no association between dietary sodium/potassium and blood
pressure in younger Korean adults at 19–39 years olds after adjusting the confounding factors. However, the sodium intake was positively associated with systolic and diastolic blood pressure in 40–59 years old adults and was positively
associated with diastolic blood pressure in over 60 years old adults. Potassium
intakes was negatively associated with systolic blood pressure in 40–59 years old
adults and was negatively associated with systolic and diastolic blood pressure in
over 60 years old adults. Sodium to Potassium ratio was also positively associated
with both systolic and diastolic blood pressure in adults over 40 years of age.
Conclusions: Low sodium and high potassium intakes were associated with low
blood pressure in Korean adults over 40 years old but had no association in younger adults at 19–39 years old. Therefore, low sodium and high potassium diet might
be more beneficial for the middle aged and older adults.
PP.30.07
DIURNAL PATTERN OF URINARY SODIUM/
POTASSIUM RATIO IN FREE LIVING JAPANESE IN
DIVIDUALS
T. Iwahori1,2, H. Ueshima1, S. Torii1, Y. Saito1, K. Kondo1, N. Miyagawa1,
H. Arima1, K. Miura1. 1Shiga University of Medical Science, Otsu, JAPAN,
2OMRON Healthcare Co. Ltd., Muko, JAPAN
Objective: High dietary sodium (Na), low dietary potassium (K) intakes and high
Na/K ratio are associated with adverse blood pressure levels and excess risks of
cardiovascular diseases. Handy urinary Na/K ratio measurement device provides
feedback in several ten seconds with far lower patient burden as compared to conventional methods. Since there is no report on diurnal variation of casual urinary
Na/K ratio, we clarified it under free living conditions in Japanese participants.
Results: The study group included 87 men and 105 women, mean age 40.5 years,
office BP 124.7/84.3 mmHg, 24hUVNa 171 mmol/24 h. In adjusted analyses,
FELi was negatively related to night-time systolic BP (r = –0.0095, P = 0.035)
and 24hUVNa showed tendency towards a positive relation to night-time systolic
BP (r = 0.022, P = 0.06). However, a significant association between 24hUVNa
and night-time BP was present only in the subgroup with upper than median FELi
( > = 17.3%). We observed a tendency (P = 0.09) towards more steeper slope of
the regression line of systolic night-time BP over 24hUVNa in individuals with
upper then median FELi as compared to subjects with lower than median FELi.
Moreover, day-night systolic BP difference decreased with decreasing FELi (r =
0.067, P = 0.024).
Conclusions: In our high-salt intake population sample, sodium dietary
intake and proximal tubular sodium handling both showed association with
night-time systolic BP. This relation was observed only in individuals with
lower proximal sodium reabsorption, that might suggest the importance of
extrarenal mechanisms of sodium homeostasis in BP regulation. Moreover,
higher proximal sodium reabsorption, as measured by lower fractional
lithium excretion, is related to lower day-night systolic BP difference, and
might be postulated as one of the mechanisms responsible for blunted diurnal BP profile.
Design and method: This study is a cross sectional study. A total of 122 normotensve and hypertensive individuals (ages 25–69 years) were recruited. Participants were instructed to collect all casual urine samples in aliquot tubes (10 mL),
and to report urine volume and the time at each voiding under free living conditions for 10 to 22 days. Urinary sodium and potassium concentration was measured by ion-specific electrodes, and Na/K ratio was calculated. 13,277 specimens
were collected and classified into hourly data from 00:00 hours to 23:00 hours on
the hour. Diurnal pattern of urinary Na/K ratio, urinary concentrations and excretions of sodium and potassium, and urine volume were evaluated.
Abstracts e309
Results: Mean value of 24-hr urinary Na/K ratio were 4.37 and 3.43 in normotensive and hypertensive individuals, respectively. Of the individuals on anti-hypertensive medications, 14 participants, 9 participants, 15 participants and 5 participants were taking calcium channel blockers (CCB), angiotensin 2 receptor blockers
(ARB), both CCB and ARB, and other drugs, respectively. Overall mean value of
urinary Na/K ratio was highest (4.1–5.0) in the early morning, lower (3.3–3.8) in
daytime and higher (4.0–4.4) toward evening hours. Mean urinary sodium and potassium concentration was lowest (90–110mmol/L, 24–32mmol/L, respectively) in
the early morning, and higher (110–140mmol/L, 35–43mmol/L, respectively) after second voiding. Diurnal variability ratio of potassium concentration was larger
than sodium concentration. In subgroup analysis, diurnal patterns of mean urinary
Na/K ratio were comparable between normotensive and hypertensive individuals.
Conclusions: We identified a diurnal pattern in urinary Na/K ratio under free
living conditions. This fluctuation of urinary Na/K ratio was 1 to 1.5, and its variation is not likely to be explained by postprandial surges.
PP.30.08
THE ECONOMICS OF OBESITY: FOOD PRICE
POLICIES IMPROVE DIET QUALITY WHILE
INCREASING SOCIOECONOMIC INEQUALITIES IN
NUTRITION
Results: Salt intake was 8.9 ± 2.0 g/day in male and 8.6 ± 1.9 g/day in female subjects. eGFR was 80.1 ± 12.7 ml/min/1.73 m2 at baseline, and during the follow-up
period, CKD developed in 706 subjects (29.9 per 1000 person-year), with the incidence being more frequent in male than female subjects (31.1 vs. 27.8 per 1000
person-year). Non-adjusted hazard ratio (HR) (95% confidence interval [CI]) of salt
intake for the new CKD was 1.071 (1.034–1.109). Multivariate Cox-hazard analysis adjusted for body mass index, systolic blood pressure, heart rate, uric acid, fasting plasma glucose, low-density lipoprotein cholesterol, triglyceride, hemoglobin,
smoking status and eGFR at baseline demonstrated that salt intake was a significant
predictor of new onset CKD (HR = 1.077, 95% CI = 1.037–1.119). Univariate and
adjusted multivariate liner regression analyses indicated the significant correlation
between salt intake at baseline and yearly changes in eGFR (r = –0.081, p < 0.001 and
r = –0.069, p < 0.001, respectively). Similar results were obtained in a sub-analysis
performed in subjects with normal blood pressure (n = 5,863).
Conclusions: Dietary salt intake is significantly associated with the development
of CKD and decrease in eGFR in the general population, even in normotensive
subjects. These results suggest that salt restriction is beneficial for the prevention
of the impairment of kidney function and the development of CKD.
PP.30.10
M. De Rosa1, A. Mancini1, A. Lombardi1, L. Cerini2, D. Leosco2, N. Ferrara2. 1University
Federico II Geriatric Unit, Naples, ITALY, 2Bocconi University, Milan, ITALY
Objective: Observed links between obesity and socioeconomic position may be
related to dietary energy(DE) density (ED) and energy cost(EC). An inverse relationship between ED of foods (F) and their EC means that more DE are associated
with lower daily F consumption costs and may be effective saving money.
Design and method: Experimental economics was used to examine 2 price (P)
manipulations: a) a fruit and vegetable P subsidy named “fruit and vegetables
condition”; b) a healthy-product subsidy coupled with an unhealthy-product tax
named “nutrient profile condition”. We used SAIN,LIM,nutrient profiling system,
which classifies each individual F according to its overall nutritional quality which
then allows for a F item to be taxed or subsidized. Women (W) from low (N =
85) and medium-incomes (N = 43) selected a daily F basket, first, at current P
and then at manipulated P. Redistributive effects of experimental conditions were
assessed by comparing the extent of savings induced by subsidies and of costs
generated by the tax on the 2 income groups. ED (kcal/100 g), free sugars (%E)
and the mean adequacy ratio (MAR) were used as nutritional quality indicators.
Results: DE was independently and significantly associated with higher BMI in
W (b = 0.45 (95% CI 0.13–0.83)) and trended toward a significant association in
men (b = 0.38 (– 0.008 to 0.64), P = 0.054). DE was associated with higher waist
circumference in W (b = 1.21 (0.32–1.90)) and men (b = 1.42 (0.56–2.10)). DE
was also independently associated with elevated fasting insulin (b = 0.67 (0.19 1.22)) and the metabolic syndrome (prevalence ratio = 1.12 (95% CI 1.04–1.18)).
Conclusions: F P policies may improve diet quality while increasing socio-economic inequalities in nutrition. Epidemiologic analyses suggest that the low-cost
DE also tend to be nutrient poor. Limiting access to inexpensive F through taxes on
frowned upon fats and sweets is a regressive measure. The broader problem may lie
with growing disparities in incomes and wealth, declining value of the minimum
wage, F imports, tariffs, and trade. Obesity in the world is a largely economic issue.
PP.30.09
DOSE SALT INTAKE PREDICT THE NEW ONSET OF
CHRONIC KIDNEY DISEASE?
H. Takase1, T. Tanaka1, D. Nonaka1, S. Takayama1, H. Hayashi2, T. Sugiura3,
N. Ohte3, Y. Dohi4. 1Enshu Hospital - Department of Internal Medicine, Hamamatsu, JAPAN, 2Hamamatsu University School of Medicine - Third Department
of Internal Medicine, Hamamatsu, JAPAN, 3Nagoya City University Graduate
School of Medical Sciences - Department of Cardio-Renal Medicine and Hypertension, Nagoya, JAPAN, 4Nagoya Gakuin University - Division of Internal Medicine, Faculty of Rehabilitation Science, Seto, JAPAN
Objective: Dietary salt, which is one of the most important modifiable factors
in our life style, is associated not only with blood pressure but also with several
cardiovascular diseases in a blood pressure–independent manner. We investigated
if salt intake predicts new onset of chronic kidney disease (CKD) in the general
population.
Design and method: Consecutive 8,161 participants (male = 5,168, 55.8 ± 11.3
year-old) with normal estimated glomerular filtration rate (eGFR; > = 60 ml/
min/1.73m2) in our physical health check-up program were enrolled in this study.
After baseline examination, participants were followed up (median 1,098 day) with
the endpoint being the development of CKD (eGFR < 60 ml/min/1.73 m2). Individual salt intake was estimated using spot urine by a previously reported method
and GFR was estimated using the Japanese Society of Nephrology formula.
INFLUENCE OF URINARY SODIUM AND
POTASSIUM EXCRETION ON BLOOD PRESSURE IN
CAMEROONIAN PYGMIES AND BANTUS
D. Lemogoum1, C. Bika Lele2, C. Okalla3, F. Akono4, J. Dissongo3, M. Lememan1,
J.P. Degaute1, P. Van de Borne1. 1ULB-Erasme Hospital, Department of Cardiology, Free Brussels University, Brussels, BELGIUM, 2Douala School of Medecine and Pharmaceutic Sciences, Department of Clinical sciences, University of
Douala, Douala, CAMEROON, 3Faculty of sciences, Department of Physiology,
Douala University, Douala, CAMEROON, 4Cameroon Heart Institute, Cameroon
Heart Foundation, Douala, CAMEROON
Objective: High dietary salt increases blood pressure (BP) and is a leading cause
of hypertension. This study aimed to examine association between urinary sodium
and potassium excretion with BP among Cameroonian pygmies under hunter-gatherer subsistence mode and Bantus, living in urban area under westernized lifestyle.
Design and method: We randomly enrolled 150 Pygmies living in the Lolodorf
municipality (rural area) and 150 Bantus living in Douala (urban area). Height,
weight, body mass index (BMI), waist circumference (WC), BP and single overnight spot urine samples were obtained. Brachial systolic BP (SBP) and diastolic
BP (DBP) were measured in triplicate using an automatic device (Omron 705 CP).
Urinary sodium and potassium concentration was determined by flame photometry and was used as surrogates for salt intake.
Results: As Compared to Bantus, Pygmies were shorter with a lower body weight
(all P < 0001) and had a lower age-standardized prevalence of hypertension (3.3
% vs 28 %) (all P < 0.0001).
Age-adjusted SBP and DBP were lower in Pygmies than in Bantus (all P < 0.001).
Both SBP and DBP increased with age but to a lesser extent in Pygmies (both P <
0.01). Urinary sodium excretion was lower in Pygmies than in Bantus (46.9 ± 32.4
vs 121.5 ± 61.0 mmol/L, P < 0.0001). Age-adjusted SBP and DBP were positively
associated with urinary sodium concentration in Bantus (all p < 0.05), but not in
Pygmies. In the two groups, urinary potassium concentration was similar, and was
not related to BP (all > 0.05). In the whole study population and in Bantus taken
separately, urinary sodium excretion was higher in hypertensive than in normotensive subjects (P < 0.0001). Multivariate logistic regression analysis showed that
urinary sodium excretion, Bantu status and age are independent determinants of
hypertension in the whole study population (P < 0.0001).
Conclusions: The present study demonstrates that hunter-gatherer living is associated with low level of urinary sodium concentration which likely explains
the low rates of hypertension and slower increase of BP with age in traditional
pygmies. Hypertension is more common and urinary sodium concentration is
higher in Bantus. Urinary salt excretion emerged as an independent predictor of
hypertension in this Cameroonian population.
PP.30.11
DEFICITS AMONG PHYSICIANS ON SELFREPORTED AWARENESS AND IMPLEMENTATION
OF EVIDENCE BASED RECOMMENDATIONS ON
LIFESTYLE CHANGES FOR MANAGEMENT OF
HYPERTENSION
R. Kreutz1, J. Bolbrinker1, H. Gohlke2, B. Weisser3. 1Charite-Universitätsmedizin,
Berlin, GERMANY, 2Ballrechten-Dottingen, GERMANY, 3Christian-AlbrechtsUniversität zu Kiel, Kiel, GERMANY
Objective: Appropriate lifestyle changes are the cornerstone for prevention
and treatment of hypertension. In the recent 2013 ESH/ESC hypertension
guidelines 6 lifestyle changes are recommended for the treatment of hypertensive patients with class I evidence level A, based on their proven impact
on blood pressure control and cardiovascular risk. We therefore initiated a
survey among physicians involved in the treatment of hypertension to explore
their awareness and consideration of lifestyle factors in the management of
hypertension.
Design and method: The survey included a total of 16 questions covering
physicians´ demographic information and the 2013 ESH/ESC guidelines recommendations on lifestyle changes. It was designed to take less than 5 minutes
to complete and included 6 questions explicitly related to alcohol intake. The
survey was conducted at two national meetings in Germany and at two European meetings (ESH meeting in Milan 2016 and ESC meeting in London 2016,
respectively).
Results: Overall 1084 (37% female) physicians (258 and 826 at the German and
European meetings, respectively) participated. They were predominantly cardiologists (50%) and internists (28%), while 9% were general physicians; 77% were
hospital based and overall 22% were members of the German and/or European
Hypertension Society, respectively. The results of the awareness on the lifestyle
changes included in the guidelines and the corresponding recommendations of
physicians implemented in their own management of hypertension are summarized in the figure.
Also at 5 weeks, clinic systolic BP reduced from 116 to 113 mmHg (p = 0.014),
and urinary thromboxane (measure of platelet turnover) reduced from 1435 to
1024 pg/mg creatinine (p = 0.037).
Conclusions: This study suggests that regular consumption of omega-3-PUFAenriched chicken-meat increases plasma omega-3-PUFA levels, and that this
increase is paralleled by improved cardiovascular health biomarkers. As levels
appeared to be continuing to rise at 5 weeks, further increments in plasma levels
of omega-3-PUFAs, and greater heart, brain and cancer benefits may be achieved
with more prolonged eating of omega-3 enriched chicken-meat. Omega-3-PUFAenriched chicken-meat may offer an attractive alternative to eating oily fish or
taking supplements for many consumers.
Conclusions: These results indicate a close correlation between self-reported
awareness of guideline recommendations and implementation of these recommendations in clinical practice. European cardiologists and internists emphasize regular exercise and weight reduction stronger than the other four life style
factors. Moderation of alcohol consumption is the least emphasized life style
factor.
PP.30.12
Brennan1,
BIOAVAILABILITY AND BENEFICIAL EFFECTS OF
OMEGA-3-PUFA-ENRICHED CHICKEN-MEAT: A
PILOT STUDY
Allen2,
Buskandar2,
Shortall2,
Hayes3,
Williams2,
M.
S.
F.
K.
H.
D.
N. Moran2, A. Stanton2. 1National University of Ireland Galway, Galway,
IRELAND, 2Royal College of Surgeons in Ireland, Dublin, IRELAND, 3Devenish
Nutrition, Belfast, UNITED KINGDOM
Objective: Greater consumption of oily fish, and elevated plasma levels of
the long-chain marine-derived omega-3 polyunsaturated fatty acids (omega3-PUFAs), have been strongly and consistently associated with reduced incidences of heart attacks, strokes, cognitive decline and cancers. Despite international guidelines recommending 2 servings per week of oily fish (>250 mg/day
omega-3-PUFAs), many people do not eat fish at all, and therefore worldwide,
deficiencies are common. Omega-3-PUFAs supplements have not consistently
provided the same beneficial protection – possible explanations include differences in bioavailability, poor adherence, and/or too late commencement
of supplements. In this project, we studied a recently developed alternative
to oily fish or supplementation, namely chicken-meat naturally enriched with
algae-sourced omega-3-PUFAs. The primary objective was to test if regular
consumption of omega-3-PUFA-enriched chicken-meat resulted in measurably
higher plasma levels of omega-3-PUFAs.
Design and method: In an open sequential study in 30 healthy participants, blood
and urine sampling, BP and heart rate measurements, occurred at baseline, and
after 1, 3 and 5 weeks of eating 3 servings/week of omega-3-PUFA-enriched
chicken-meat.
Results: Plasma omega-3-PUFAs levels increased from 82 mg/g at baseline to 93
mg/g at five weeks (12% increment, p = 0.006, Figure).
PP.30.13
GENDER DIET PREFERENCES AND
CARDIOVASCULAR RISK IN RUSSIAN POPULATION
A. Orlov, M. Boyarinova, O. Rotar, A. Alieva, E. Moguchaya, E. Vasilieva,
V. Yudina, V. Solntsev, E. Baranova, A. Konradi. Almazov Federal North-West
Medical Research Centre, Saint-Petersburg, RUSSIA
Objective: The aim of our study is to estimate association of gender diet preferences with prevalence of hypertension and obesity in general population in
St.Petersburg, Russia
Design and method: As a part of all-Russian epidemiology survey ESSE-RF
random sampling of 1600 Saint-Petersburg inhabitants stratified by age and sex
was selected. All subjects signed informed consent and filled in questionnaire
regarding physical activity, smoking, education, sugar and salt consuming. Anthropometry (weight, height with body-mass index (BMI) calculation, waist
circumference (WC)) and blood pressure (BP) measurement (two times on right
hand in sitting position with calculation of average level) were performed. Hypertension was diagnosed in case of antihypertensive therapy and/or BP > =
140/90 mmHg.
Results: Males more often than females had hypertension (45,2% vs 35,9%, 2 =
5,3, p < 0,05). Also males had higher systolic BP level (133,7+18,4 vs 126,7+20,5
mmHg, p < 0,05) and comparable diastolic BP (82,5+11,6 vs 78,0+11,7 mmHg,
p > 0,05) than females. High salt intake was significantly more frequent in males
(44%) compared to females (37,5%) (chi-square = 7,8, p < 0,05).
No difference in overweight according to BMI criteria was revealed: BMI>29 kg/
m2 had 31% of men and 34% of women (p > 0,05), but according to different
WC criteria significant difference was found: 51% of men and 65% of women
(chi-square = 30,7, p < 0,01) according to IDF2005 criteria (WC > = 94 for males
and 80 cm for females) and 30% of men and 46% of women (chi-square = 41,4,
p < 0,01) according to ATP2003 (WC > = 102 for males and 88 cm for females),
respectively. Average sugar intake was 4,1 ± 1,8 for men and 6,2+2,0 pieces/day
for women (p < 0,01). Educational level and age was not associated with dietary
habits.
Conclusions: Hypertension was registered more often in males and can be
associated with higher salt intake. Females with abdominal obesity consumed
more sugar.
Abstracts e311
PP.30.14
SALT CONSUMPTION IN CROATIAN CONTINENTAL
RURAL POPULATION: ENAH STUDY
S. Karanovic1, A. Vrdoljak1, V. Ivkovic1, Z. Dika1, V. Domislovic1, K. Dapic1,
L. Gallineo1, E. Ivandic1, J. Josipovic2, I. Vukovic1, J. Kos1, M. Laganovic1,
T. Zeljkovic Vrkic1, Lj. Fodor1, V. Matijevic3, M. Fucek4, J. Culig5, R. Stevanovic6,
B. Jelakovic1. 1University of Zagreb School of Medicine, Department for Nephrology, Hypertension, Dialysis and Transplantation, UHC Zagreb, Zagreb, CROATIA, 2Department of Nephrology and Dialysis, UHC Sestre MIlosrdnice, Zagreb,
CROATIA, 3Outpatient clinic for general medicine Slavonski Kobas, Slavonski
Kobas, CROATIA, 4Department for Clinical Laboratory Diagnosis, UHC Zagreb,
School of Medicine University of Zagreb, Zagreb, CROATIA, 5Zagreb Institute of
Public Health, Zagreb, CROATIA, 6Croatian Institute of Public Health, Zagreb,
CROATIA
Objective: Results from our previous survey confirmed that salt consumption (24
h mapping) in Croatia is above 11 g/day. Salt intake was higher in rural than in
urban area. Croatian national campaign started in 2008 and our aim was to analyze
trends in salt consumption in rural area in the past period.
Design and method: Out of 3056 subjects enrolled in ENAH study, 2259 (868m,
1391w) were eligible for further analysis. All inhabitants older than 18 years of
age from this rural area were invited to participate and were examined on a doorto-door basis. Pregnant women, patients with terminal illness who were bed-ridden, patients with severe disability or those who have had at least one limb amputated or immobilized and mentally ill or suffering from dementia were considered
ineligible. Participation rate was > 70%. Salt intake (g/day) was estimated from
the first morning spot urine using Intersalt equation. Blood pressure (BP) was
measured using Omron 6 device following the ESH guidelines. Villagers were examined in 2008, 2010 and 2015 and trends in salt intake and association with BP
were analyzed. There were no differences in age and gender between survey years.
Results: In 2008, 2010, 2015 salt intake in the whole group was 10.5(8.7–12.2);
10.2(8.4–12.1); 10.9 (9.5–12.2), respectively; in men 10.4(8.8–12.2); 10.1(8.5–
12.1);10.9 (9.3–12.3), respectively; in women 10.6 (8.6–12.3); 10.4(8.4–12.1);
10.9 (9.6–12.1), respectively. We failed to observe trend in decreasing salt intake,
without gender difference. Significant correlation between salt intake and systolic
and diastolic BP was found in the whole group (r = 0.32; r = 0.18, respectively,
both p < 0.001), in men (r = 0.29; r = 0.134, respectively, both p = 0.01) and in
women (r = 0.35; r = 0.21, respectively, both p < 0.001).
Conclusions: We are fully aware of many drawbacks related to the spot urine sampling. However, using the same method and the same equation in the same population we believe that we can consider our results reliable to estimate the trend
of salt consumption in rural area. Significant correlation with BP was observed
which confirms prior results. Despite of the Croatian National Program launched
10 years ago, salt consumption in rural area is very high and remains unchanged
and further efforts in this field are needed.
PP.30.15
KNOWLEDGE OF SALT INTAKE AND BLOOD
PRESSURE IN A SAMPLE OF MEDITERRANEAN
HYPERTENSIVE PATIENTS
C. Gonçalves1,2, N. Campos3, F. Ribeiro4, J.M. Bastos4,5,6. 1Faculty of Nutrition and Food Sciences, University of Porto, Porto, PORTUGAL, 2School of
Technology and Management, Polytechnic Institute of Viana do Castelo, Viana
do Castelo, PORTUGAL, 3School of Health Sciences, University of Minho,
Braga, PORTUGAL, 4School of Health Sciences, University of Aveiro, Aveiro,
PORTUGAL, 5Centro Hospitalar do Baixo Vouga, EPE, Aveiro, PORTUGAL,
6Portuguese Society of Hypertension, Lisbon, PORTUGAL
(p = 0.102) and with a positive association with BMI (r = 0.240, p = 0.035). Besides 97.4% of the subjects knew that excessive salt intake can result in hypertension, only 2.5% knew the daily recommended salt intake and 97.3% consider that
daily ingest little or the right amount of salt. Also, 94.8% of patients recognize
that try to reduce salt intake and the strategies adopted include reduce salt added
during cooking (67.5%), avoid consume high salt products (13.0%), use herbs and
spices to substitute salt during cooking (5.2%).
Conclusions: This study shows low rate of blood pressure control in a Mediterranean sample of hypertensive patients. Although patients were knowledgeable
about the adverse effects of salt, low rate knew the daily intake recommended
value and the majority of subjects present a misleading perception of actual salt
intake. Increased knowledge about recommended salt intake and individual guidance including information about sodium excretion could be important for reducing salt intake in hypertensive patients.
PP.30.16
RELATIONSHIP BETWEEN SALT INTAKE AND
LIFESTYLE INCLUDING DIET IN HYPERTENSIVE
OUTPATIENTS TREATED AT A GENERAL HOSPITAL
Y. Ohta1, Y. Kimura1, C. Kitaoka1, I. Abe1, Y. Kawano2. 1Department of Internal
Medicine, Japan Seafares Relief Association, Moji Ekisaikai, Kitakyushu, JAPAN,
2Department of Medical Technology, Teikyo University Fukuoka, Fukuoka, JAPAN
Objective: To investigate the salt intake in hypertensive outpatients treated at a
general hospital and to examine the relationship between their lifestyle and the
amount of salt intake
Design and method: Subjects were 429 hypertensive patients (206 males,
223 females, average age 71 ± 11 years). We estimated 24-hour salt excretion
using spot urine samples and checked their lifestyle using a self-description
questionnaire.
Results: Average clinic blood pressure (BP) and the number of antihypertensive
drug were 132 ± 11/73 ± 8 mmHg and 1.8 ± 0.9 and the achievement rate of BP
control defined as < 140/90 mmHg was 73.4%. In all subjects, average estimated
salt intake and the rate of achievement of estimated salt intake < 6 g/day were 9.2
± 2.8 g/day and 11.1%. Those of patients with chronic kidney disease (CKD) or
cardiovascular disease were 8.6 ± 2.6 g/day, 15.5%, and 9.1 ± 3.3 g/day, 18.2%,
respectively. There was no significant difference in estimated salt intake between
the patients with and without consciousness of salt reduction. Patients with living
alone showed less estimated salt intake compared to those with a family. In the
multivariate analysis, the estimated salt intake correlated positively with BMI, and
negatively with age. Among patients with excessive salt intake (10 g/day < = ),
75.2% of patients answered that they made an effort to reduce salt intake. A multivariate analysis revealed that the amount of food and processed food consumption
correlated with estimated salt intake.
Conclusions: The rate of achievement of estimated salt intake < 6 g/day was low
in hypertensive patients treated at a general hospital. It seemed to be important to
provide feedback of data on actual salt intake and guide individually salt restriction in the hypertensive patient.
PP.30.17
KRILL OIL PHOSPHOLIPIDS IMPROVE LIPID
PROFILE IN HYPERTENSIVE PERSONS
V. Stojanov1, N. Radivojevic1, M. Marjanovic1, D. Lovic2. 1Multidisciplinary Center for Polyclinic Diagnostics, Assessment and Treatment of Blood Pressure Disorders, Belgrade, SERBIA, 2Clinic for Internal Diseases InterMedica, Nis, SERBIA
Objective: This study aims to explore the association between salt intake, knowledge of salt intake and blood pressure in Portuguese hypertensive patients.
Objective: The aim of this study was to assess the effectiveness of three-month
treatment with krill oil phospholipids on lipid profile of persons with arterial hypertension.
Design and method: Data were collected from a cross-sectional sample involving
112 patients that were followed at a hypertension consultation at hospital. Data
collection comprised interviewer-administered questionnaires about demographics and knowledge, attitudes and behaviors related to salt, followed by a physical
examination (weight, height and blood pressure) and a single 24-hour urine collection. The 24-hour urine collection was analyzed for volume (ml/d), urinary
creatinine (mg/day) and urinary sodium (mEq/day). For 24-hour urine collection
validation, quality control was used calculating the coefficient of creatinine excretion in relation to body weight according to age group.
Design and method: The study comprised 159 persons with arterial hypertension (69 men and 90 women), aged 55.63 ± 10.84 years. All participants were
given Krill Oil (500 mg capsules containing 225 mg krill phospholipids) for three
months. Lipid status (total cholesterol, LDL-cholesterol, HDL-cholesterol and total triglycerides) was assessed with standard biochemical analysis at the beginning
of the study and after three months of krill oil phospholipids therapy. Blood pressure was measured with standard oscillometric device. Regular antihypertensive
therapy was not changed during the treatment.
Results: Hypertensive patients with valid urine collections were 77 (38 males)
with mean age 58.2 ± 14.7 years old, without gender differences (p = 0.575). The
blood pressure control rate was 32.5% (mean systolic blood pressure was 147.5 ±
21.1 mmHg and diastolic blood pressure was 83.8 ± 11.4 mmHg). Of the subjects,
93.5% had salt intake higher than the 5 g/d recommended by World Health Organization. Mean salt intake was 10.2 ± 3.7 g/d, without differences between sex
Results: Mean systolic blood pressure (SPB) at the beginning of the study was
134.12 ± 16.62 mmHg; mean diastolic blood pressure (DBP) was 81.49 ± 9.58
mmHg. After three months of therapy, mean SBP was similar 135.38 ± 16.86
mmHg, and DBP was similar 82.23 ± 9.56 mmHg. After krill oil phospholipids therapy, total cholesterol decreased from 6.43 to 6.02 mmol/L; the average
LDL-cholesterol decreased from 4.09 to 3.76 mmol/L; the average triglycerides
decreased from 2.56 to 2.15 mmol/L, whereas the average HDL-cholesterol
significantly increased from 1.21 to 1.29 mmol/L. All changes were highly statistically significant.
Conclusions: Three-month therapy with krill oil phospholipids significantly improves lipid profile in hypertensive persons.
PP.30.18
EFFECTS OF A COMBINED BLOOD PRESSURE AND
LIPID-LOWERING NUTRACEUTICAL ON MILDLY
HYPERTENSIVE HYPERCHOLESTEROLEMIC
SUBJECTS: A PILOT, DOUBLE-BLIND, PLACEBOCONTROLLED, RCT
A.F.G. Cicero, M. Rosticci, S. D’Addato, F. Fogacci, R. Urso, C. Borghi. University of Bologna, Bologna, ITALY
Objective: A number of nutraceuticals have demonstrated to significantly lower
blood pressure or lipid levels in humans. Our aim was to evaluate the effect of a
combination of both blood pressure and lipid lowering nutraceuticals in mildly
hypertensive hypercholesterolemic subjects.
how to reduce the sodium on cooking. The chef and the registered dietitians explained how to reduce the sodium when cooking the miso soup. We can reduce the
salt by using the dried bonito.
Results: Total number of the participant to the dinner event was 344 (male39,
female305). Mean age was 68.7 years old (male), and 60.6 years old (female). 26%
of participants were patients with hypertension, and 12.8% with diabetes, 11.0%
with dyslipidemia, other disease 12.8%, No disease 31.8%. The questionnaire from
the participants says cooking live demonstration is useful to understand how to reduce the salt intake. The event gave me a chance to change daily cooking at home.
Conclusions: Healthy dinner event with cooking live demonstration at the Doctor’s restaurant can help to understand how to reduce the sodium intake. The
healthy menus and healthy Cooking Live demonstration at the Doctor’s restaurant
help to understand the appropriate seasoning for low calorie and low salt diet.
PP.30.20
NUTRITION PATTERN AND CARDIOVASCULAR
RISK FACTORS IN SURVIVORS OF THE SIEGE OF
LENINGRAD
E. Moguchaia, A. Orlov, O. Rotar, E. Kolesova, A. Erina, M. Boyarinova,
V. Solntsev, A. Konradi, V. Shlykhto. Federal Almazov North-West Medical Research Centre, Saint-Petersburg, RUSSIA
Objective: Impairment of perinatal nutrition in survivors of the Siege of Leningrad during Second World War could promote to development of cardiometabolic
disorders in the adult life. Besides, early life famine can determine future lifestyle.
The aim of our study was to assess the cardiovascular, socioeconomic (including
nutrition) factors of survivors of the Siege of Leningrad comparing with control
group.
Design and method: This is a pilot, double-blind, randomized, placebo-controlled, clinical trial carried out on 30 mildly hypertensive hypercholesterolemic
subjects in primary prevention for cardiovascular disease, randomized to active
treatment or placebo for 2 months. Active treatment contained red yeast rice extract (with 10 mg monacolin per dose), an NO-donor, magnesium, and vitamins.
Results: The tested product was well-tolerated by all patients. Subjects in active treatment experienced a significant improvement in morning SBP, DBP, MAP,
evening SBP, LDL-C and estimated CV risk vs. placebo (see table).
Conclusions: Conclusion: A combined blood pressure and lipid lowering nutraceutical improved morning SBP, DBP, MAP, evening SBP, LDL-C and estimated
CV risk vs. placebo in mildly hypertensive hypercholesterolemic subjects.
PP.30.19
Design and method: 309 survivors of Leningrad Siege and 54 participants of
control group were examined. Controls of the same age were born in other regions
of the Soviet Union (Russia), but not in Leningrad, and after war were constantly
living in Leningrad (St. Petersburg). All participants were interviewed by special
questionnaire regarding lifestyle, socioeconomic risk factors, cardiovascular disease, comorbidities and medication. An average frequency of fruit and vegetable
consumption (portions per week), fish (days a week) were calculated. We also estimated kind of fat used for cooking. Blood pressure was measured twice on right
arm in the sitting position after 5 minute of rest. Anthropometry were performed
according to standard procedures. Fasting serum lipids and plasma glucose were
measured on Hitachi-902. Informed consent was obtained from all participants.
Results: The groups were matched by age, body mass index and waist circumference. There were no significant differences in the level of glucose, lipid profile,
prevalence of hypertension and diabetes type 2. Survivors have significantly higher income compared to the control group (16710 ± 896 vs 13140 ± 800 rubles,
p = 0,06). Survivors spend significantly more money to buy food: 78 survivors
(31.2%) vs 6 (13.3%) of controls, p = 0,009, were spending more than 2/3 of
income on food. The frequency of food consumption in these two groups did not
differ (table 1).
A NEW METHOD FOR EDUCATING LOW
SALT DIET AND LOW CALORIE DIET, USING
DOCTOR’S RESTAURANT WITH COOKING LIVE
DEMONSTRATION
A. Oikawa1, M. Obara1, H. Takahashi1, K. Sugawara1, R. Takahashi1, H. Tamura1,
S. Fujine2. 1Hiroshi Tamura’s Hilltop Clinic, Kitakami City, JAPAN, 2Doctor’s
Restaurant Ichigeya, Kitakami City, JAPAN
Objective: The Iwate Prefecture is known as the highest salt intake and the highest mortality of cerebrovascular disorder in Japan. So it is difficult to eat healthy
foods when eating out for hypertension patient. So we opened Doctor’s restaurant
Ichigeya in front of our clinic. The doctor and registered dietitians supervised the
healthy menu of the restaurant.
The objective is to give more effective education for low calorie and low salt diet
for hypertension patient by using Dr.’s restaurant which can demonstrate the cooking live from the kitchen.
Design and method: We have held low calorie and low salt diet dinner event
with cooking live demonstration at the Dr.’s restaurant ten times in total (3/2014–
11/2015). The concept of the healthy menu in the restaurant are as follows; 1.Total
calorie is less than 600 kilocalorie, 2.The total salt 2.5 g, 3.Total amount of the
vegetables is over 120 g. In the dinner event, our clinic staff broadcasts the healthy
cooking methods by chef from the kitchen of the restaurant to the TV display at
the main hall, by using handy video camera. The theme of the dinner event was
Conclusions: No significant differences in the prevalence of cardiovascular risk factors and nutritional habits were revealed between controls and survivors. Possibly,
survivors represent selection of subjects who keep alive due to moderation in eating
in spite of special psychological pattern after starvation – to make food as a priority.
PP.30.21
SALT INTAKE AND BLOOD PRESSURE CONTROL
IN PORTUGUESE HYPERTENSIVE PATIENTS
C. Gonçalves1,2, N. Campos3, F. Ribeiro4, J.M. Bastos4,5,6. 1Faculty of Nutrition
and Food Sciences, University of Porto, Porto, PORTUGAL, 2School of Technology and Management, Polytechnic Institute of Viana do Castelo, Viana do Castelo,
PORTUGAL, 3School of Health Sciences, University of Minho, Braga, PORTUGAL, 4School of Health Sciences, University of Aveiro, Aveiro, PORTUGAL, 5Centro Hospitalar do Baixo Vouga, EPE, Aveiro, PORTUGAL, 6Portuguese Society of
Hypertension, Lisbon, PORTUGAL
Objective: This study aims to evaluate salt intake and blood pressure in Portuguese hypertensive patients.
Abstracts e313
Design and method: Data were collected from a cross-sectional sample involving
112 patients that were followed at a hypertension consultation at hospital. Data
collection comprised a physical examination (weight, height and blood pressure)
according to standard procedures and a single 24-hour urine collection. The 24hour urine collection was sent to hospital laboratory to be analyzed for volume
(ml/d), urinary creatinine (mg/day) and urinary sodium (mEq/day). For 24-hour
urine collection validation, quality control was used calculating the coefficient of
creatinine excretion in relation to body weight according to age group.
Design and method: We studied 145 subjects with newly diagnosed stage I-II untreated EH (aged 56 ± 7 years, 47 = dyslipidemic, office blood pressure = 156/92
mmHg). Venous sampling was performed for estimation of lipidemic profile.
The validated Greek version of Short Form 36 (SF-36) General Health Survey
questionnaire was administered. The 8 subscales of SF-36 were further grouped
into two summary scales: the physical component summary scale (PCS) and the
mental component summary scale (MCS). Non-parametric Mann-Whitney and
Spearmann rho tests were performed.
Results: Valid urine collections were provided by 77 hypertensive patients (38
males) with mean age 58.2 ± 14.7 years, without gender differences (p = 0.575).
Of the patients, 93.5% had salt intake higher than the 5 g/d recommended by
World Health Organization (mean 10.2 ± 3.7 g/d). The blood pressure control rate
was 32.5% among the subjects (mean systolic blood pressure was 147.5 ± 21.1
mmHg and diastolic blood pressure was 83.8 ± 11.4). Patients who consumed
salt according to recommendations had higher control rate of blood pressure than
those who consumed salt above recommendations (62.3% vs. 31.2%; OR = 0.5,
CI: 0.053–4.722).
Results: Dyslipidemic hypertensives demonstrated significantly lower scores in
all SF-36 dimensions compared to non dyslipidemic (Table). There was a negative
correlation between scores in general health and the total SF-36 score with serum
triglycerides level (r = –0.284 p = 0.009, r = –0.287 p = 0.014, respectively).
Conclusions: In this sample, patients had salt ingestion well far away from recommendations and low blood pressure control rate. Our results suggest that on this
sample of hypertensive patients, those who ingest salt according to the recommendations had better blood pressure control rate.
PP.30.22
DYSLIPIDEMIA AND AGGRAVATED QUALITY OF
LIFE IN HYPERTENSIVES
V. Katsi1, G. Vamvakou2, T. Makris2, I. Kallikazaros1, D. Tousoulis3. 1Hippokration General Hospital, Athens, GREECE, 2Elena Venizelou General and Maternity
Hospital, Athens, GREECE, 3Hippokration University Hospital, Athens, GREECE
Objective: Essential hypertension (EH) has a negative impact on health-related
quality of life (H-rQoL) while dyslipidemia very often accompanies the hypertensive sequelae. We assesed the hypothesis that the combination of EH and dyslipidemia may have an additive effect on H-rQoL.
Conclusions: Dyslipidemia exerts an additive detrimental effect on quality of life
in the setting of essential hypertension. Whether the above mentioned association
contributes to the high cardiovascular risk observed in those patients remains to
be determined in future studies.
e314 Abstracts
POSTER SESSION
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EXPERIMENTAL HYPERTENSION AND
PHARMACOLOGY
PP.31.01
CIRCULATING PROGENITOR CELLS IN
HYPERTENSION: EFFECTIVENESS OF A
TREATMENT WITH OLMESARTAN IN IMPROVING
CELL NUMBER AND MIRS PROFILE BESIDES
EXPECTED PHARMACOLOGICAL EFFECTS
G. Mandraffino, C.O. Aragona, S. Quartuccio, V. Cairo, F. Mamone, M.A. Sardo,
A. Saitta, E. Imbalzano. Department of Clinical and Experimental Medicine, University of Messina, Messina, ITALY
Objective: CD34+ circulating progenitor cells (CD34+CPCs) are a population of
multipotent spare cells able to delay the development of atherosclerosis and cardiovascular disease (CVD) in conditions of increased CV risk. Increased reactive
oxygen species (ROS), a common feature of CV risk factors including hypertension, may be toxic for cells. MicroRNAs (miRs) 221 and 222 have been shown to
participate in differentiation and proliferation of CD34+CPCs, inhibiting cell migration and homing; miR221/222 are increased and associated with cell number
and ROS in CD34+CPCs from hypertensive patients without additional risk for
CAD. Moreover, miR221/222 modulate different genes regulating angiogenesis
and inflammation.The aim of the present study was to evaluate whether in hypertensives a treatment with olmesartan may modify the number of CD34+CPCs and
the levels of miR221/222 and ROS.
Design and method: We evaluated CD34+CPC number, intracellular miR221/222
and ROS levels, arterial stiffness and echocardiographic indices at baseline (T0)
and after a six-months treatment with olmesartan, 20 mg/die (T1) in 57 hypertensives with no additional risk factor for CAD, and in 29 healthy controls (baseline);
fibrinogen, CRP, glucose and lipid profile were also evaluated.
Results: At T1, systolic and diastolic blood pressure, ROS and miR221/222 were
significantly decreased (all p < 0.001) with respect to T0, and cell number was
increased (p < 0.001). CRP and fibrinogen levels also were reduced (p < 0.001),
as were arterial stiffness indices.
Conclusions: Olmesartan is effective in reducing miRs and ROS levels in
CD34+CPCs from hypertensives, as well as in increasing CD34+CPC number,
besides its expected pharmacological effects.
PP.31.02
ASTRAGALOSIDE IV AMELIORATED
MITOCHONDRIAL OXIDATIVE STRESS IN
HYPERTENSIVE MICE WITH CARDIOMYOPATHY BY
REGULATING MITOCHONDRIAL CA2+ FLUX
Q. Wang1, A. Xie2, H. Xu1, J. Yu1. 1Lanzhou University Second Hospital,
Lanzhou, CHINA, 2The Warren Alpert Medical School of Brown University,
Providence, USA
Objective: Abnormal Ca2+ handling is thought to be related with triggered activity and mitochondria participate in Ca2+ homeostasis. We evaluated the contribution of ASI for mitochondrial ROS and Ca2+ Flux to cardiac function by using
DOCA-salt hypertensive mice.
decreased total K+ currents. Treatment of myocytes with ASI restored AP duration at 90% repolarization cardiomyopathic mice (197.47 ± 85.85). Compared with the sham cells, the peak amplitudes (F/F0) of cytoplasmic Ca2+
transients were reduced by 33% (3.82 ± 0.35 vs. 2.56 ± 0.38, p < 0.05) in myopathic ventricular cells. After external application of ASI to cardiomyopathic
cells, the peak amplitudes of cytoplasmic Ca2+ transients enhanced from 2.56
± 0.38 to 6.10 ± 0.85 (p < 0.01). The mitochondrial ROS overproduction was
observed (2.9 ± 0.3 fold of sham, P < 0.01) in myocytes of cardiomyopathic
mice vs. sham. Treatment of myocytes with ASI reduced the mitochondrial
ROS level of cardiomyopathic mice. The level of NCX was decreased in the
cardiomyopathic mice compared with the sham mice (p = 0.016), however,
ASI improved the NCX level.
Conclusions: Mitochondrial Ca2+ handling and ROS play an important role in
cardiomyopathy. The scavenging mitochondrial ROS by ASI might be beneficial
in the setting of hypertensive cardiomyopathy. The antioxidantive effects of ASI in
heart failure may be related to regulate the mitochondrial Ca2+ Flux.
PP.31.03
PHARMACEUTICAL TREATMENT OF NEWLY
DIAGNOSED PATIENTS WITH ARTERIAL
HYPERTENSION: 5 YEARS DESCRIPTIVE ANALYSIS
OF A LARGE COHORT FROM A BELGIAN HEALTH
INSURER (2008–2012)
G. Karakaya1, R. Van Tielen2, I. Umbach2. 1Union Nationale des Mutualités Libres - Université Libres de Bruxelles, Brussels, BELGIUM, 2Union Nationale des
Mutualités Libres, Brussels, BELGIUM
Objective: To provide a rigorous descriptive analysis of a cohort of newly diagnosed patients with hypertension concerning the population characteristics,
pharmacological choices by physicians and patients’ behavior related to the prescribed treatment.
Design and method: A detailed descriptive analysis was performed for pharmacological and behavioral features of 18706 new patients using for the first time at
least one antihypertensive agent (ATC Classes: C02 antiadrenergic agents, C03
diuretics, C07 beta blocking agents, C08 calcium channel blockers, C09 agents
acting on the renin-angiotensin system) in a retrospectively collected database
from a Belgian health insurer (2008–2012).
Results: Hypertension treatment started at 59 year on average without statistical
difference by gender. About 1/3 of patients aged 75 and above deceased during the
5 years follow up. The majority of patients (62% the first year and 65% the fifth
year) only received one ATC class to treat hypertension; the first year, proportions
are the following: 20.8% for C07, 20.5% for C09, 11.8% for C03, 8.5% for C08,
27.9% for two combined (or sequential) ATC classes and 10.1% for multi ATC
classes and the fifth year: 23.1% for C07, 28.4% for C09, 6.1% for C03, 7.1%
for C08, 27.0% for two combined (or sequential) ATC classes and 8.1% for multi
ATC classes. 62.8% of patients followed their treatment each year (37.2% stopped
the treatment at least once and 69.9% of them permanently). Nearly 50% of these
treatment discontinuations occurred after the first year (mainly after diuretic or
beta-blocker utilization). About 30% of the cohort followed an unchanged treatment during the 5 years.
Conclusions: The use of administrative databases provides interesting findings
about the pharmaceutical intake in real world. The study highlights the necessity
of the prescribing physician to rapidly choose the right molecule to insure afterwards a good persistence (and adherence) of treatment.
Design and method: We used the deoxycorticosterone acetate (DOCA)-salt
mouse model. The ventricular myocytes isolated from mice was utilized for action
potentials (APs) recording, potassium and L-type Ca2+ currents. While we measured mitochondrial ROS monitoring with confocal microscopy and the changes
in cytoplasmic and mitochondrial Ca2+ by fluorescent imaging using Fluo-4 and
Rhod-2.The heart tissue was used for the level of Na+-Ca2+ exchange (NCX)
protein measurements by western blotting.
E. Malikova, K. Galkova, P. Vavrinec, D. Vavrincova-Yaghi, P. Krenek,
J. Klimas. Faculty of Pharmacy, Comenius University, Bratislava, SLOVAK
REPUBLIC
Results: The left ventricular volume was significantly enlarged, and the ejection fraction was reduced (40.8 ± 5.2% vs. 55.6 ± 74%, p < 0.05) in cardiomyopathic mice of hypertension. Myocytes showed a decreased Ca2+ transients
and a significant increase in the AP duration at 90% repolarization from 83.4
± 21.1 to 242.3 ± 43.3ms, explained by augmented L-type Ca2+ current and
Objective: Pulmonary arterial hypertension (PAH) is a rare and complex disease,
where renin-angiotensin system (RAS) is known to be activated. Monocrotaline
induced PAH is well known experimental animal model. We aimed to measure
RAS components, including angiotensin converting enzyme (ACE) and its receptors in various tissues. Additionally, we hypothesized, that kidneys might pose as
PP.31.04
INVOLVEMENT OF RENIN-ANGIOTENSIN SYSTEM
IN MONOCROTALINE INDUCED PULMONARY
HYPERTENSION
Abstracts e315
a source of RAS activation, as they excrete renin, which is a rate limiting step of
angiotensin II formation.
Design and method: Group of 15 male Wistar rats was injected with monocrotaline (60 mg/kg) and 7 control rats (CON) received vehicle. Separate group of
20 (MCT) and 10 (CON) rats was used for hemodynamic measurements. Animals were weighted frequently and vital functions were measured using MouseOx
meter. Rats were sacrificed after 4 weeks or immediately if showing dyspnea,
lethargy and significant weight loss.
Results: MCT-treated rats exhibited significant increase in the right ventricular
systolic pressure (MCT: 50.65 ± 6.28 vs. CON: 21.52 ± 2.49, P < 0.01). Right
ventricular (RV) weight was significantly increased (MCT: 0.29 ± 0.02 vs. CON:
0.17 ± 0.01, P < 0.05), whereas left ventricular (LV) weight was not significantly
changed (MCT: 0.69 ± 0.03 vs. CON: 0.70 ± 0.05). Expression of ACE mRNA
was significantly increased in the RV (MCT: 2.31 ± 0.41 vs. CON: 1.00 ± 0.16,
P < 0.05), also in the LV (MCT: 2.37 ± 0.26 vs. CON: 1.00 ± 0.06, P < 0.01),
as was in the kidney (MCT: 1.66 ± 0.25 vs. CON: 1.00 ± 0.15, P < 0.05), but in
lungs was significantly decreased (MCT: 0.47 ± 0.03 vs. CON: 1.00 ± 0.06, P <
0.01). Expression of angiotensin II receptor type 1 was significantly increased
in the RV (MCT: 2.1 ± 0.21 vs. CON: 1.00 ± 0.13, P < 0.05), while in the left
ventricle, lungs and kidney was unchanged. There was no significant alteration in
the mRNA of angiotensin II receptor type 2 in the heart, lungs or kidney. Renin
mRNA expression was significantly increased in the kidney (MCT: 2.46 ± 0.69
vs. CON: 1.00 ± 0.13, P < 0.01).
Conclusions: Renin-angiotensin system is activated in the heart and kidneys, for
which the increased kidney renin might be responsible. Interestingly, the opposite
effect is present in lungs, where ACE is decreased.
PP.31.05
ALTERED CALCIUM SENSITIZATION IN
HYPERTENSIVE REN-2 TRANSGENIC RATS
Objective: To compare the effects of an angiotensin receptor blockers-based regimen with valsartan, eprosartan or losartan on LVH and NT-proBNP levels in hypertensives with preserved LV systolic function.
Design and method: Clinical study/design: 154 hypertensive patients
(56,5% of men; mean age 53,6 ± 0,5 years) with concentric LVH, DD
and preserved ejection fraction (EF > 50%) and symptomatic HF II-III
NYHA. Functional class of HF was evaluated on the basis of a six minute
walk test (6MWT). All patients were randomly assigned to treatment with
Losartan (L-gr; n = 54, mean dose = 125,7 ± 0,8 mg ± mg/daily), Valsartan
(V-gr; n = 48, mean dose = 240 ± 0,7 mg/daily) or Eprosartan (E-gr; n =
52, mean dose = 900 ± 0.9 mg/daily). Ambulatory blood pressure monitoring (ABPM), transthoracic echocardiography (TE), 6MWT, and serum NTproBNP activity were performed at baseline and after 12-, and 24- months
period of treatment. The normal cut-off value for NT-pro BNP level in
patients < 75 yrs old was considered < 125 pg/ml. LV mass index (LVMI)
> 95 g/m2 in women and > 115 g/m2 in men identified LV hypertrophy.
Relative wall thickness (RWT > 0.42) help to categorize geometry of LV
remodeling to concentric LVH. Parameters used in assessment of diastolic
function and LV filling pressure were: left atrium (LA) volum index, isovolumetric relaxation time (IRVT), deceleration time (DT), E/A ratio, E/e’
(averaged) ratio.
Results: At baseline, group did not differ statistically with respect to age, clinic
and hemodynamic status (Table1).The baseline ambulatory blood pressure levels
were similar among the groups and reductions were as well comparable (Table
2). At the running-up, the LVMI were comparable in all groups but during the
follow-up period, this reduction was more significant in group randomized to
eprosartan (–35 g/m2, p < 0,001) (Tabel 3). Also, the NT-proBNP levels have
decreased greater in the eprosartan group (–45,6%, p < 0,001), while in the valsartan and losartan group the reduction was comparable ((–39,06% and 40,46%,
respectively, p < 0,01) (Table 4).
J. Zicha, M. Behuliak, I. Vaneckova. Institute of Physiology, Czech Academy of
Sciences, Prague, CZECH REPUBLIC
Objective: A comparison of BP response to Ca channel opener BAY K8644
prior and after Rho kinase inhibition indicated decreased calcium sensitization
in spontaneously hypertensive rats (SHR), although blood pressure (BP) response
of intact SHR to Rho kinase inhibitor fasudil was enhanced (Behuliak et al.
J Hypertens 31: 2025, 2013). The aim of the present study was to evaluate calcium sensitization in hypertensive transgenic rats with murine Ren-2 gene (TGR)
and their normotensive HanSD controls using the same methods. We also tried
to elucidate the interference of baroreflex-activated sympathetic activity with BP
response to fasudil.
Design and method: Blood pressure and heart rate responses to increasing doses
BAY K8644 (opener of L type voltage-dependent calcium channels) was determined in conscious rats (subjected to acute RAS and SNS blockade). BP response
was recorded prior and after Rho kinase inhibition by fasudil and calcium sensitization was estimated from the difference between both BP response curves. Furthermore, BP-lowering effects of acute administration of increasing fasudil doses
were measured in conscious intact rats as well as in rats subjected to combined
blockade of RAS, SNS and NOS in which baroreflex efficiency was suppressed.
Results: Using the above BAY K8644-based approach we demonstrated moderate
attenuation of calcium sensitization in hypertensive TGR. We also observed enhanced acute BP response to fasudil in intact TGR compared to HanSD rats. This
different BP response was accompanied by more pronounced heart rate increase
in HanSD than in TGR, indicating attenuated baroreflex efficiency in hypertensive TGR. If baroreflex operation was minimized by ganglionic blockade in rats
subjected to combined RAS, SNS and NO synthase blockade, fasudil-induced
BP fall was manifold augmented in HanSD but unchanged in TGR, suggesting
the importance of baroreflex-activated sympathetic activity in compensation of
fasudil-induced BP changes.
Conclusions: Calcium sensitization is attenuated in hypertensive TGR compared to
normotensive controls, but this difference can be seen only in the absence of operating sympathetic nervous system which compensates BP changes elicited by acute
Rho kinase inhibition much better in normotensive than in hypertensive animals.
Partially supported by grant AZV 15–25396A (MH CR)
PP.31.06
EVOLUTION OF NT-PROBNP ACTIVITY AND LEFT
VENTRICULAR HYPERTROPHY DURING LONGTERM THERAPY WITH LOSARTAN, VALSARTAN
AND EPROSARTAN IN ESSENTIAL HYPERTENSION
N. Sapojnic, A Caraus, L Popescu. Institute of Cardiology, Chisinau, REPUBLIC
OF MOLDOVA
Conclusions: The findings of the study showed that all three agents progressively
reduced LVH, but this reduction was significantly greater in the eprosartan group.
Additionally, eprosartan was associated with a greater reduction of NT-proBNP
levels.
PP.31.07
CARDIAC UPREGULATION OF ATRIAL
NATRIURETIC PEPTIDE IN METABOLIC SYNDROME
INDUCED BY CONSUMPTION OF COLA BEVERAGE
IN WISTAR RATS
K. Galkova, E. Malikova, E. Kralova, P. Vavrinec, P. Krenek, J. Klimas.
Comenius University-Department of Pharmacology and Toxicology, Faculty of
Pharmacy, Bratislava, SLOVAK REPUBLIC
Objective: The present study was designed to investigate the influence of longterm consumption of cola beverage on expression of cardiac atrial natriuretic
peptide (ANP) gene. Natriuretic peptides, aside from their classic hemodynamic
effects, have been associated with regulation of numerous physiological functions
controlling energy metabolism. In rat, the effects of the consumption of cola beverage on cardiac ANP expression have not been described yet.
Design and method: Male Wistar rats received a standard diet. Additionally, a
group of rats received a commercially available cola beverage to induce experimental metabolic syndrome conditions (MetS, n = 12) while controls (CON, n
= 7) received standard drinking water. We measured weight gain weekly. After
six months of administration, blood glucose was determined by conventional oral
glucose tolerance test (oGTT). In addition, heart rate (HR), systolic and diastolic
blood pressures (sBP and dBP) were measured by using tail-cuff method. Cardiac
gene expression was determined by quantitative real-time polymerase chain reaction (RT-PCR) in left ventricles.
of acetylcholine-evoked vasorelaxation proving a well-preserved production of
NO in all followed groups.
Conclusions: Results confirmed the specificity of nNOS a eNOS signalization in
prehypertensive SHR as well heterogenity in vasoactive responses of elastic (HA)
and muscular (MA) types of arteries. HA disposes of compensatory mechanisms
in condition of non-specific NO deficiency: adaptive contractile abilities assosiated with activation of NO-derived vasorelaxation which could later compensate
effect of sympatic nervous system. Supported by VEGA-2/0074/14; VEGA2/0067/14; MZ-2012/51-SAV-1.
PP.31.09
URTICA DIOICA L. LEAF EXTRACT REDUCES
BLOOD PRESSURE AND IMPROVES
ANTIOXIDATIVE DEFENCE IN SPONTANEOUSLY
HYPERTENSIVE RATS
U. Vajic, J. Grujic-Milanovic, Z. Miloradovic, D. Jovovic, M. Ivanov,
D. Karanovic, N. Mihailovic-Stanojevic. Institute for Medical Research, University of Belgrade, Belgrade, SERBIA
Objective: Stinging nettle (Urtica dioica L.) has been traditionally used in treatment numerous health problems, including hypertension and hyperlipidemia. The
aim of this study was to evaluate potential antihypertensive and antioxidant effects
of chronic intake of stinging nettle leaf extract (UE) in spontaneously hypertensive rats (SHR).
Results: We observed a significantly increased body weight in MetS rats (541 ±
12 g; P < 0.01) when compared to controls (443 ± 23 g). This was accompanied
with significantly increased HR (CC: 383 ± 9 mmHg vs. CON: 312 ± 15 mmHg;
P < 0.01), significantly increased sBP (MetS: 135 ± 3 mmHg vs. CON: 120 ±
4 mmHg; P < 0.01) but unaltered dBP (MetS: 86 ± 1 mmHg vs. CON: 85 ± 1
mmHg; NS). Postprandial glycaemia was significantly increased after 60 minutes
(MetS: 9.3 ± 0.5 mmol/L vs. CON: 6.6 ± 0.6 mmol/L; P < 0.01) as well as after 90
minutes following oGTT induction (MetS: 8.3 ± 0.4 mmol/L vs. CON: 6.6 ± 0.5
mmol/L; P < 0.01). Left ventricles from MetS rats exhibited significant upregulation of ANP (MetS: 244 ± 0.5 % vs. CON: 100 ± 0.2 %; P < 0.01).
Design and method: SHR were divided into 5 experimental groups. Throughout 4 weeks long study, control group (SHRC) received tap water, positive antihypertensive control group (SHR+L) received 10 mg/kg/day of losartan, while
SHR+UE10, SHR+UE50 and SHR+UE200 groups were treated with 10, 50, and
200 mg/kg/day of dry aqueous-methanolic UE. Losartan and UE were dissolved
in 0.5 ml of water, and given to the animals by gavage. At the end of the treatment
mean arterial pressure (MAP) was measured directly in anesthetized animals, and
blood samples were collected for erythrocyte superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) activities. Serum lipid peroxidation level was assessed by total thiobarbituric acid-reactive substances assay (TBARS).
Conclusions: Experimental metabolic syndrome induced by cola beverage administration is characterised by increased sBP and impaired glucose utilisation
and is accompanied by upregulation of cardiac expression of ANP. The data indicate that the altered expression profile in the heart could contribute to the increased incidence of hypertension, cardiovascular and also metabolic alterations
observed in this animal model.
Results: MBP dropped significantly in SHR+L, SHR+UE50, and SHR+UE200
group. Furthermore, all three UE doses significantly increased SOD and CAT
activities, but not the GPx activity. Antioxidant enzyme activities remained unchained in SHR+L group. Serum lipid peroxidation level was decreased in all
three tested UE doses while it remained unchanged in SHR+L group.
PP.31.08
CHRONIC INHIBITION OF TWO CONSTITUTIVE NOSYNTHASE ISOFORMS DURING DEVELOPMENTAL
STAGE OF HYPERTENSION
A. Berényiová, M. Drobná, F. Kristek, I. Dovinová, M. Kvandová, S. Cacányiová.
Institute of Normal and Pathological Physiology, Laboratory of Vascular Disorders Etiopathogenesis, SAS, Bratislava, SLOVAK REPUBLIC
Objective: The specific effect of endothelial (eNOS) and neuronal (nNOS) NOsynthase on cardiovascular system was confirmed in young and adult normotensive rats. During the prehypertensive period, information related to a long-term
nitric oxide (NO) inhibiton is incomplete (eNOS) or completely missing (nNOS).
The aim of this study was to investigate the effect of chronic inhibition of constitutive NO-synthase isoforms on cardiovascular system of 4-weeks-old spontaneously hypertensive rats (SHR).
Design and method: 4-weeks-old SHR were treated by 7-nitroindazole (7-NI,
specific inhibitor of nNOS, 10 mg/kg/day) or NG-nitro-L-argine methylester
(L-NAME; non-specific inhibitor of NOS, 50 mg/kg/day, p.o.) during 6 weeks.
Systolic blood pressure (sBP) was measured by the plethysmographic method.
The vasoactive responses of thoracic aorta (TA) and mesenteric artery (MA) were
measured as changes in isomentric tension. NOS activity was measured in TA
using radioactive assay.
Results: After treatment with 7-NI the sBP was unchanged, the treatment with
L-NAME initiated an increase of sBP in the 4th week of the experiment. The
contractile responses were signifcantly increased in both experimental groups.
Regarding the L-NAME group the increased contractility was associated with
increased sensitivity of adrenergic receptors whereby in 7-NI group an increase
of absolute contration was observed. After treatment of L-NAME the contractile
responses of MA were decreased as the result of the collapse of the contractile apparatus, the treatment with 7-NI did not affect these responses. The long-term NO
inhibition induced no (7-NI) or only a slight (L-NAME) inhibitory effect on endothel-depentent relaxation to acetylcholine (ACh). NOS acitivity was decreased by
50% in both experimental groups. However, an acute administration of L-NAME
induced not only an increased adrenergic vasoconstriction but also an inhibition
Conclusions: Our results indicate that all three UE doses improve antioxidant
enzymes activity and reduce serum lipid peroxidation level in SHR. Furthermore,
MAP reduction in SHR+UE50 and SHR+UE200 is similar to losartan therapy.
Therefore, UE expresses beneficial effects in genetically induced hypertension.
PP.31.10
ENDOTHELIAL CELL GROWTH SUPPLEMENT
IMPROVES CARDIAC FUNCTION FOLLOWING
MOUSE MYOCARDIAL INFARCTION
X. Fan, H. Shi, C.A. Drummond, J. Xie, S. Haller, D. Kennedy, C.J. Cooper,
J. Tian. University of Toledo College of Medicine, Toledo, USA
Objective: Myocardial infarction (MI) and subsequent heart failure is a leading
cause of death in high or middle income countries. Development of treatments
that stimulate heart tissue regeneration and revascularization/angiogenesis is important to improve the prognosis of these patients. Our recent work demonstrated
that endothelial cell growth supplement (ECGS)-containing medium stimulates
endothelial differentiation of c-kit positive cardiac progenitor cells in vitro. The
objective of the current work was to test whether ECGS can activate endogenous
cardiac progenitor cells and improve cardiac function in a mouse MI model.
Design and method: Ligation of the left anterior descending (LAD) artery was
performed on mice at 2 months of age under anesthetization and intubation. After
displacing the pericardium, a 7-0 silk suture was passed under the LAD artery 2
mm below the left atrium and permanently tied, to eliminate blood flow to the area
distal to the suture. ECGS or saline (as control) were injected intramyocardially
to the ligation area through a sterile Hamilton syringe with a 30 gauge needle immediately after the ligation. Mice that survived the procedure were maintained for
Abstracts e317
3 weeks. Echocardiography was performed to monitor the cardiac function prior
to organ collection.
Results: The results showed that MI increased c-kit positive cells and blood vessel
formation as well as massive fibrosis in the infarcted area 3 weeks post-surgery.
ECGS treatment significantly reduced cardiac fibrosis, especially in the non-infarcted area and border zone (1.96 ± 0.28 % in ECGS treated group vs 4.54 ±
1.08 % in saline treated control group, p < 0.05). ECGS also improved ejection
fraction in these animals compared to the saline treated control group (49.9 ± 2.9
% ECGS treated vs 37.4 ± 4.6 % saline treated, p < 0.05). However, ECGS had no
significant effect on infarct size in these animals.
Conclusions: The current study demonstrates a reduction in cardiac fibrosis and
improvement of cardiac function with ECGS in a mouse MI model, which may
link to our in vitro observation that ECGS can activate endothelial differentiation
of cardiac progenitor cells.
PP.31.11
OBSERVATIONAL STUDY ON NACL + CHITOSAN
3% CONFIRMS THE LOWERING OF THE
HYPERTENSIVE TOXICITY OF NACL SALT
F. Allaert. Chaire évaluation médicale, Dijon, FRANCE
Objective: to confirm in daily practice the results of a previous double blind cross
over clinical trial which demonstrated that the replacement of NaCl by NaCl +
chitosan 3% (according a specific patent process) significantly decreases the hypertensive power of the salt. Previous work has shown that the involved mechanism could be a chelation of Cl ion which is involved in the renine angiotensine
system.
Design and method: an observational study was conducted in a rehabilitation
centre for elderly in which all foods (bread, meat, fish, vegetable, desert) are produced by the local kitchen and all the salt NaCl traditionally used was replaced by
the Symbiosal salt ie a combination of NaCl + 3% chitosan according a specific
Korean patent. All patients, hypertensive or not, were followed at inclusion and
every three months for their hypertension by the medical practitioner in charge of
their medical follow up. The cook was asked not to change his cooking habits and
especially concerning the salt during all the study period.
Results: The study covers 79 patients, 75.2 ± 8.0 years old, among whom 72.2%
are women. Among them 20.3% were hypertensives. In the total population SBP
(mmHg) decreases from 130 ± 17 at inclusion to 129 ± 14 at one month (M), 125
± 12 at 2 months (M2) and 123 ± 10 at 3 months (p < 0.0001). In the hypertensive
sample the results are M0: 156 ± 18; M1: 148 ± 14, M2: 140 ± 12, M3 136 ± 12
(p < 0.0001). In the non hypertensive patients they were M0: 124 ± 9; M1: 124 ±
10, M2: 121 ± 8, M3 119 ± 6 (p < 0.0001).
Conclusions: The replacement of the traditional salt NaCl by the NaCl + chitosan
3% appears to reduce significantly the blood pressure and contribute to demonstrate that a decrease of the hypertensive toxicity of the salt may be obtained. This
suggest that it could be used either in the field of a low salt diet in hypertensive
patient but also in general population in addition to the recommendation of a salt
reduction. These results confirm the outcomes of the previous clinical trial.
PP.31.12
Design and method: Control SHRC group (n = 8), received tap water, SHR+RW
(n = 8) received red wine (Prokupac wine, Cellar Braca Rajkovic, Serbia) and
SHR+AFRW (n = 8) received alcohol-free red wine by gavage throughout the
4-week experimental period. Systolic (SBP), diastolic (DBP), mean blood pressure (MBP), heart rate (HR), cardiac index (CI) and total vascular resistance
(TVR) were measured in anesthetized rats. Blood samples were collected for
total cholesterol, triglycerides, high-density lipoproteins (HDL) cholesterol, lowdensity lipoproteins (LDL) cholesterol, bilirubin, uric acid and plasma TBARS
(p-thiobarbituric acid reactive substances).
Results: SBP was found to be lower in SHR+AFRW and SHR+RW groups compared to control. Chronic consumption of AFRW resulted in a significant decrease
of DBP and MAP (p < 0.05), while chronic RW application significantly reduced
only the DBP. None of the two types of wine had significant effect on HR, CI and
TVR of SHRs. The lipid profile was significantly changed in SHR after RW but
not after AFRW consumption. RW raise the level of total cholesterol (p < 0.05)
relative to control, and the triglycerides were increased compared to the control
as well as the AFRW group (p < 0.001). Although, HDL was slightly higher and
LDL cholesterol was mildly to moderately lower in both wine groups compared
to control. AFRW doubles the production of endogenous antioxidant bilirubin in
the SHRs, while RW cause a significant increase of plasma uric acid (p < 0.05)
compared to control. Both, RW and AFRW, significantly reduced p-TBARS.
Conclusions: Chronic intake of AFRW has a better effect on blood pressure
and lipid proifile of SHR than consumption of RW. Both, RW and AFRW, can
increased antioxidant capacity and reduce susceptibility of SHR plasma to lipid
peroxidation.
PP.31.13
HAEMODYNAMIC DOSE-DEPENDENT RESPONSE
TO OLIVE LEAF EXTRACTS IN SPONTANEOUSLY
HYPERTENSIVE RATS
M. Ivanov, Z. Miloradovic, N. Mihailovic-Stanojevic, J. Grujic-Milanovic,
U. Vajic, D. Karanovic, D. Jovovic. Institute for Medical Research, Department of
cardiovascular physiology, University of Belgrade, Belgrade, SERBIA
Objective: Numerous studies demonstrate that a Mediterranean diet leads to significant drops in elevated blood pressure. It is well known that different products
of Olea europea L. are very important part of this diet. The aim of our study was
to investigate the dose-dependent response of haemodynamic parameters to olive
leaf extracts in SHR
Design and method: Experiment was performed in anesthetized, six-month-old
male spontaneously hypertensive rats (SHR). SHR were divided into 3 experimental groups: the group treated with 5 mg/kg of olive leaf extract (OE5; n = 8);
the group treated with 25 mg/kg of olive leaf extract (OE25; n = 8); and the group
treated with 50 mg/kg of olive leaf extract (OE50; n = 7). Different dosage of olive
leaf extract was given by bolus, through the jugular vain. Mean arterial pressure
(MAP), cardiac output (CO), heart rate (HR) were measured, and total peripheral
vascular resistance (TPVR) was calculated before and after bolus.
Results:
EFFECTS OF REGULAR CONSUMPTION OF
RED WINE AND ALCOHOL-FREE RED WINE ON
SYSTEMIC HAEMODYNAMICS, LIPID PROFILE
AND OXIDATIVE STRESS IN SPONTANEOUSLY
HYPERTENSIVE RATS
N. Mihailovic-Stanojevic1, K. Savikin2, Z. Miloradovic1, M. Ivanov1,
D. Karanovic1, U.J. Vajic1, D. Jovovic1, J. Grujic-Milanovic1. 1University of Belgrade, Institute for Medical Research, Belgrade, SERBIA, 2Institute for Medicinal
Plant Research Dr. Josif Pancic, Belgrade, SERBIA
Objective: Numerous studies have shown that moderate wine consumption is associated with decreased incidence of cardiovascular disease, including hypertension. Other studies have observed that moderate alcohol consumption lowers the
risk of cardiovascular events. The aim of the present study was to compare the
effects of regular red wine (RW) and alcohol-free red wine (AFRW) consumption
(1 ml/day) on systemic haemodynamics, lipid profile and oxidative stress in adult
male spontaneously hypertensive rats (SHR).
Conclusions: Our results suggest that dosages of 25 mg/kg and 50 mg/kg olive
leaf extract lower blood pressure in SHR, but in two different ways. Lower dosage
decreases MAP due to vascular response (decreases TPVR), and higher dosage
decreases MAP because of cardiac response due to decrease of CO.
e318 Abstracts
POSTER SESSION
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EPIDEMIOLOGY OF HYPERTENSION AND
METABOLIC DISORDERS
PP.32.01
MORTALITY FROM BLOOD-PRESSURE-RELATED
DISEASES IN BRAZIL FROM 1980–2010
H. Moreira, A. Reis, R. Rodrigues, A. Sousa, C. Barros, Y. Araujo,
T. Jardim, A. Sousa, W. Souza, P. Jardim. Hypertension League - Federal University of Goias, Goiania, BRAZIL
Objective: To estimate the mortality attributable to Hypertension in Brazil from
1980 to 2010
Design and method: Data about deaths from cardiovascular diseases in Brazil
from 1980 to 2010 were obtained from the Ministry of Health/DATASUS. Besides
the specific mortality from hypertensive diseases (ICD10 I10-I13 and corresponding ICD9 codes), cardiovascular mortality attributable to HTN was calculated using 2000 s Global Burden of Disease study estimation (Lancet 2008;371:1513–
18). According to this study, mortality attributable to high blood pressure ( > or
= 115 mmHg systolic) was estimated by 54% of all deaths from CeVD (ICD10
I60–69 and corresponding ICD9), 47% of deaths from coronary artery disease
(CAD) (ICD10 I20-I25 and corresponding ICD9), and 25% of deaths from other
cardiovascular diseases (ICD10 I26–28, I34–37, I44–51, I70–99, and corresponding ICD9) can be attributed to HTN. Mortality rates (deaths/100,000 people) were
adjusted by gender and age group using the direct method. For trend analysis data
were adjusted by Poisson regression model.
Results: Approximately 3,660,313 deaths could be attributed to HTN over the
analyzed period. Those deaths accounted for 11.4% of all deaths recorded in 1980,
increasing proportionally to 14.5% of all deaths in 2010. Cerebrovascular diseases
were the main cause of those deaths (37.4%), followed by CAD (29.0%). There
was an increase of mortality rates attributed to HTN in this period: adjusted mortality raised from 74.7 to 89.8/100,000 people (P-value < 0.01), which was more
pronounced among women (66.8 to 81.8/100,000, R2 = 0.627).
Conclusions: Between 1980 and 2010, there was an increase in mortality rates for
causes directly attributable to high blood pressure in Brazil. Despite the limitations of risk estimate studies, there are evidences that the hypertension control is
still not ideal in Brazil, with significant impact on related mortality.
PP.32.02
IMPROVED TREATMENT AND CONTROL OF
HYPERTENSION IN SWEDISH PRIMARY CARE:
RESULTS FROM THE SWEDISH PRIMARY CARE
CARDIOVASCULAR DATABASE (SPCCD)
C. Holmquist1, J. Hasselström1, K. Bengtsson Boström2, P. Hjerpe2,
B. Wettermark3, K. Manhem4, T. Kahan5. 1Karolinska Institutet, Division of
Family Medicine, Department of Neurobiology, Care Sciences and Society,
Stockholm, SWEDEN, 2Närhälsan R&D Primary Health Care, R&D Center
Skaraborg, Skövde, SWEDEN, 3Karolinska Institutet, Centre for Pharmacoepidemiology and Clinical Epidemiology Unit, Department of Medicine, Karolin,
Stockholm, SWEDEN, 4Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital, Sahlg, Göteborg,
SWEDEN, 5Karolinska Institutet, Department of Clinical Sciences, Danderyd
Hospital, Division of Cardiovascular Medicine, Stockholm, SWEDEN
Objective: To study changes in hypertension control and antihypertensive treatment in patients treated in primary care from 2001–02 to 2007–08.
Design and method: The SPCCD includes extractions from computerized
medical records of 74,751 hypertensive patients treated in Swedish primary care
2001–08. The main outcome measures of this retrospective analysis were blood
pressures in relation to clinical characteristics, comorbidity and pharmacotherapy.
Results: The mean age of women and men in 2001–02 was 69 ± 12 and 66 ± 12
years respectively. This increased to 70 ± 13 and 67 ± 12 years. In 2001–02 72%
of women and 64% of men had cardiovascular (stroke, IHD, CHF, AF) and/or
diabetic comorbidity while in 2007–08 this proportion was 60% and 50% respectively. Mean blood pressure (BP) was 152 ± 19/82 ± 10 mmHg in women and 150
± 18/84 ± 10 mmHg in men in 2001–02. In 2007–08 mean BP was 143 ± 18/79 ±
10 mmHg and 142 ± 17/81 ± 11 mmHg respectively. The proportion of all patients
with BP < 140/90 mmHg increased from 2001–02 to 2007–08 (22% vs 41%,
p < 0.001) with the gretest improvement amongst patients with comorbidities. In
patients with diabetes and cardiovascular comorbidity, BP in women decreased
151 ± 21/78 ± 11 mmHg to 141 ± 19/75 ± 11 mmHg and in men from 148
± 19/80 ± 10 mmHg to 139 ± 18/76 ± 11 mmHg and the proportion with BP
< 140/90 mmHg increased from 22% to 43% and from 25% to 49% respectively
(all p < 0.001). Main drug classes used in 2001–02 and 2007–08 were ACEI
(17% and 28%), ARB (9% and 16%), beta-blockers (48% and 41%), calcium antagonists (23% and 22%), and diuretics (34% and 42%), respectively. The mean
number of drugs used to treat was 1.5 in both genders in 2001–02 and 1.7 in
women and 1.8 in men in 2007–08 (p < 0.001). The mean number of drugs used
to treat patients who reached BP < 140/ < 90 mmHg was 1.5 in women and 1.6 in
men in 2001–02 and 1.7 and 1.8 respectively in 2007–08 (p < 0.001).
Conclusions: Blood pressure control in Swedish primary care has improved as
did the use of ACEI and ARBS. However, the combination of several drug classes
in patients with insufficient blood pressure control remains underused. There is
room for further improvement.
PP.32.03
CLINICAL CHARACTERISTICS AND BLOOD
PRESSURE BEHAVIOR OF PATIENTS YOUNGER
THAN 30 YEARS WITH APPARENT HYPERTENSION
A. Kasiakogias, D. Konstantinidis, C. Tsioufis, K. Dimitriadis, K. Kintis,
A. Kalos, E. Nikolakopoulos, G. Bazoukis, D. Chatzis, I. Kallikazaros,
D. Tousoulis. First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, GREECE
Objective: Rates of hypertension (HT) increase with advancing age, but there
is little data about young hypertensive patients. We investigated clinical, blood
pressure (BP) and laboratory data of adults less than 30 years of age visiting a
specialized HT unit.
Design and method: We studied 139 individuals aged 18–30 years that visited
our clinic for evaluation of high BP. Clinical history and demographics were collected and 24-hour BP monitoring, echocardiography and routine blood testing
was performed in all participants. Further testing for secondary causes of HT
was run where appropriate. Based on uncontrolled office BP (>140/90mmHg) and
ambulatory BP (>130/80mmHg), participants with sustained HT, white-coat HT,
masked HT and normal BP were identified. A fall of BP by < 10% at night-time
was defined as non-dipping. Left ventricular hypertrophy was defined as a left
ventricular mass index greater than 115gr/m2 for men and 95gr/m2 for women.
Results: Participants had a mean age of 23 ± 5 years and were mostly male (80%).
Prevalence of a BMI over 30Kg/m2 and abdominal obesity was 30% and 31%
respectively, while 37% of patients were smokers. A family history of HT was reported by 38% of participants. Mean office systolic/diastolic BP was 139 ± 17/87
± 13mmHg and mean ambulatory BP was 129 ± 13/76 ± 11mmHg. Fourteen
patients (10%) were under antihypertensive treatment and 8 patients (5.8%) were
diagnosed with a secondary cause of HT. Out of the untreated patients, 39 patients
(31%) had sustained HT, 36 patients (29%) had white-coat HT, 15 patients (12%)
had masked HT and 35 individuals (28%) were normotensive. Prevalence of nondipping was 52%. Left ventricular mass index was 75 ± 16 gr/m2 and only 2% of
patients had left ventricular hypertrophy.
Conclusions: Young adults visiting a specialized HT unit have multiple risk factors
and are often non-dippers, while secondary HT remains a rare cause. Ambulatory
BP monitoring is important for the diagnosis of sustained HT in such a population.
PP.32.04
PREDICTORS OF PWV PROGRESSION OVER
A THREE YEARS FOLLOW UP: FOCUS ON
PSYCHOLOGICAL CHARACTERISTICS
P. Sormani1, G. Colombo1,2, A. Greco3, A. Maloberti1, C. Franzosi1, P. Meani1,2,
M. Varrenti1,2, P. Vallerio2, B. De Chiara2, F. Casadei2, A. Moreo2, M. D’Addario3,
M.E. Magrin3, M. Miglioretti3, M. Sarini3, L. Vecchio3, P. Steca3, G. Grassi1,
G. Mancia1, C. Giannattasio1,2. 1Health Science Department, Milano-Bicocca
University, Milan, ITALY, 2Cardiology IV Unit, A. De Gasperis Department, Ospedale Niguarda Ca Granda, Milan, ITALY, 3Department of Psychology, MilanoBicocca University, Milan, ITALY
Abstracts e319
Objective: Abnormal large artery function plays an important role in the
pathogenesis of cardiovascular (CV) diseases. Prior studies have suggested
that the principal determinants of arterial stiffening are age, Blood Pressure
(BP) and others CV risk factors such as dyslipidemia and diabetes. However the role of psychological characteristics on the long-term progression
of arterial stiffness has not yet been evaluated. The aim of the current longitudinal study was to evaluate the psychological determinants of the Pulse
Wave Velocity (PWV) progression over a 3 years follow-up period in treated
hypertensives subjects.
Design and method: We enrolled 350 consecutive 18–80 aged outpatients,
followed by the Hypertension Unit of S. Gerardo Hospital (Monza, Italy) affected by essential hypertension. At baseline (T0) anamnestic data, clinical BP,
laboratory data and PWV were evaluated; also psychological tests were performed. In a subgroup of 50 subjects, after a median follow-up time of 2.96
± 0.33 years, we performed again psychological tests and PWV examination
(T1). Psychological tests were administered by trained researchers for measuring perceived stress, resiliency factors (self-esteem, sense of coherence), and
perceived social support.
Conclusions: The limited information available on Chinese communities living in
Europe highlights the strength of the present study. The high prevalence of main
risk factors observed among first-generation Chinese migrants living in the South
of Europe far from being a threat can be a turning point for implementation of
specific health promotion programs.
PP.32.06
CARDIOVASCULAR RISK MANAGEMENT IN THE
FRENCH WEST INDIES: BETTER COORDINATION
NEEDED
Results: At T0 the mean age was 55.9 ± 10.1years, SBP and DBP were 135.6
± 17.7 and 82.5 ± 9.1 mmHg and PWV was 8.6 ± 2.1 m/s. Despite a significant
improvement in the blood pressure control (from 72 to 84%; PAS from 135.6 ±
17.7 to 130.1 ± 14.2, p = 0.08; PAD from 82.5 ± 9.1 to 77.5 ± 9.4, p < 0.05), at
follow-up examination PWV didn’t showed significant changes (from 8.6 ± 2.1 to
8.6 ± 2.4, p = 0.87) with a mean deltaPWV of –0.05 ± 2.8 m/s. Focusing on PWV
changes over the follow-up period and on psychological test, subjects where then
divided accordingly to their delta PWV in those in which an increase was showed
and those in which the values decrease. For similar baseline values, subjects with
positive deltaPWV showed higher T1 values of stress (37.4 ± 1.1 vs 36.8 ± 0.8,
p = 0.02) and lower values of self-esteem (2.9 ± 0.5vs3.3 ± 0.4, p = 0.02), sense
of coherence (4.4 ± 0.7 vs 4.9 ± 0.8, p = 0.02), and a worse family climate (3.5 ±
0.9vs4.1 ± 0.8, p = 0.02). No significant differences were showed regarding BP
values and CV risk factors.
P. Carrère1,2,3,4, M. Hérin1, J. Hélène-Pelage1, J. Inamo4,5, A. Atallah3, T. Lang4.
1Department of General Medicine, University of the French West Indies and Guiana, Pointe-à-Pitre, FRANCE, 2Guadeloupean Association for the Management
and Realization of Health Examinations and the Promotion of Health, Pointeà-Pitre, FRANCE, 3HTA-Gwad network, Basse-Terre, FRANCE, 4UMR 1027,
INSERM, Paul Sabatier University, Toulouse, FRANCE, 5Department of Cardiology, University of the French West Indies and Guiana, Fort-de-France, FRANCE
Conclusions: The current longitudinal study shows that arterial stiffness didn’t
shown any significant changes despite BP improvement. PWV increase is related
to higher stress and lower self-esteem and familiar support.
Design and method: A multicenter cross-sectional study was conducted in
Guadeloupe between July and December 2014, including all patients aged
18–74 receiving a systematic periodic health examination funded by social security (2255 subjects). Diabetes was defined by antidiabetic treatment or fasting plasma glucose > = 7 mmol/L and glycated hemoglobin > = 6.5%, and
controlled diabetes by glycated hemoglobin < 7%. Hypertension was defined
by antihypertensive treatment or mean of 3 measurements of blood pressure >
= 140/90 mmHg. Access to a referring physician, cardiologist or endocrinologist and social workers were evaluated by questionnaire. Food insecurity was
defined as self-reported difficulty in meeting basic needs. Multilevel logistic
regression was used for analysis.
PP.32.05
HYPERTENSION AND TYPE II DIABETES IN FIRST
GENERATION CHINESE MIGRANTS SETTLED IN
THE SOUTH OF EUROPE: THE CHINESE IN PRATO
CROSS-SECTIONAL SURVEY
P.A. Modesti1, E. Perruolo1, M. Calabrese2, M. Boddi1, S. Castellani1, G. Galanti3,
D. Zhao4. 1Dept. of Experimental and Clinical Medicine, University of Florence,
Florence, ITALY, 2Diabetology Unit, Ospedale Misericordia e Dolce, Prato,
ITALY, 3Sports Medicine Center, University of Florence, Florence, ITALY, 4Dept.
of Epidemiology, Capital Medical University Beijing Anzhen Hospital, Beijing,
CHINA
Objective: Despite concern about the epidemic of hypertension and type 2 diabetes mellitus in China, no data is available on health care needs of Chinese
migrants settled in the South of Europe. In the last decades migration flows
from China to Europe have been mainly directed towards Italy and Spain, and
Chinese are now the third largest overseas-born population in Italy. Health needs
of Chinese communities, are of special interest for health policies, strategies and
plans. The objective of this study was to estimate prevalence of main risk factors
among first-generation Chinese migrants living in Prato (Italy) in the age group
35 to 59 years.
Design and method: Cross-sectional study. Population based samples of Chinese
first-generation migrants living in Prato (n = 1200) and Italian adults (n = 291)
were recruited. Measurements were performed by Chinese and Italian staff personnel. Primary outcome measure was hypertension, secondary measure being
type 2 diabetes. Prevalence were based on direct standardization using the 2001
WHO World Standard Population. Associations with exposures (including age,
gender, BMI, waist-to-hip ratio, education level, total cholesterol, triglycerides)
were examined using logistic regression.
Results: The prevalence of hypertension age-standardized according to the
2001 WHO population in the age range 35 to 59 years was 25.3% (95% Cl 24.3
to 26.4) among Chinese with 19.9% (95% Cl 18.0 to 21.8) among Italian participants (age- and sex-adjusted OR 1.57; 95 % Cl 1.10 to 2.2). Age standardized
prevalence of type 2 diabetes was 12.9% (95% Cl 12.1 to 13.7) among Chinese
and 6.6% (95% Cl 5.4 to 7.8) among Italian participants (age- and gender-adjusted OR 2.51; 95% Cl 1.55 to 4.08). In both Chinese and Italian adults, higher
BMI was associated with hypertension, higher waist-hip ratio being associated
with type 2 diabetes.
Objective: Since 2004, the implementation of coordinated care pathways in
France has made the referring physician, usually a general practitioner, responsible for coordinating care of outpatients. Nevertheless, considerable social inequalities in health remain. This is particularly true in the French overseas departments, which present highly unequal health outcomes. Our objectives were to
evaluate secondary access to medical care and social services in a population at
risk for cardiovascular disease in the French West Indies.
Results: Among participants, 35.1% had hypertension and/or diabetes. That proportion fell to 25.3% for subjects with at least a middle school diploma and rose
to 48.8% for those with less education (center-, sex- and age-adjusted OR = 1.72;
p < 0.001). Among the 76.7% of subjects with hypertension and/or diabetes who
had seen their referring physician during the past year, 62.9% had uncontrolled
hypertension and/or diabetes. Among this last group, 58% had consulted neither
a cardiologist nor an endocrinologist. That proportion rose to 66.7% for subjects
with income limited to welfare and fell to 42.4% for those with higher income
(adjusted OR = 2.7;p = 0.004). Among the 56.4% of subjects with uncontrolled
hypertension and/or diabetes who were also food insecure, nine in ten had never
met with a social worker, regardless the number of consultations they had with
their referring physician in the preceding year.
Conclusions: In this at-risk French Caribbean population, secondary access to medical care and social services was deficient. Coordination of care must be improved.
PP.32.07
DISTRIBUTION OF CARDIOVASCULAR RISK
INDICATORS ACCORDING TO BLOOD PRESSURE
STATUS IN THE GERMAN ADULT POPULATION
D. Krupp1, J. Esche1, S. Klenow2, G.B. Mensink2, T. Remer1. 1DONALD Study,
Institute of Nutrition and Food Sciences, Department of Nutritional Epidemiology, University of Bonn, Bonn, GERMANY, 2Department of Epidemiology and
Health Monitoring, Robert Koch Institute, Berlin, GERMANY
Objective: About one third of the German adult population is affected by hypertension, which is often accompanied by other metabolic and lifestyle-related
changes that may act synergistically to increase the risk of cardiovascular and
renal disorders. We thus aimed to describe the distribution of several common cardiovascular risk factors and socio-demographic characteristics according to blood
pressure (BP) levels in a nationally representative sample of the adult German
population 2008–2011.
Design and method: Cross-sectional analyses were performed in 6788 participants aged 18–79 years of the German Health Interview and Examination Survey for Adults (DEGS1) with available urine and blood measurements as well
as information on BP and BMI. Participants were grouped in tertiles according
to their systolic BP (sysBP), stratified by 20-year age groups and sex. Characteristics including serum glucose, cholesterol, uric acid, an urinary estimate of
potassium intake (estK), and proportions of smokers, persons with high socioeconomic status and those without any sports activity were compared between
tertiles. The association of sysBP as a continuous variable adjusted for age, sex
and BMI with several of these cardiovascular risk factors was also evaluated in
linear regression models. Finally, least-squares means of risk factors adjusted for
age, sex and BMI were compared between BP-categories classified according to
the guidelines of the European Society of Hypertension (ESH).
Results: Except for estK and investigated characteristics of physical activity and
socioeconomic status, all risk factors differed significantly (P < = 0.01) between
tertiles of sysBP. Results were also confirmed in linear regression models, with
an additional inverse association emerging between estK and sysBP after BMIadjustment. Least-squares means of serum uric acid, glucose and cholesterol adjusted for age, sex and BMI increased by 0.15 mg/dL, 2.3 mg/dL and 12 mg/dL,
respectively, from those with optimal BP to those with hypertension grade 1–3.
Mean estK was 160 mg/d lower in participants with hypertensive BP-values compared to those with optimal BP.
Conclusions: In the general adult German population, several cardiovascular risk
indicators differ according to BP-status. Further analyses should investigate which
of these (potentially modifiable) factors are independently associated with BP.
PP.32.08
ARTERIAL HYPERTENSION (AHT): AN ACTUAL AND
WORSENING PATHOLOGY
Moreira1,
Alcântara1,
Nicolau2,
Escoval2,
Braz-Nogueira1.
C. Santos
P.
V.
A.
J.
1Medicine I - Faculty of Medicine - University of Lisbon, Lisbon, PORTUGAL,
2Nacional Public Heath School - NOVA University of Lisbon, Lisbon, PORTUGAL
Objective: In Portugal, there are about two million hypertensives. Of these, only
half are aware of the fact that they suffer from high blood pressure and only a
quarter is undertaking medication and some mere 16 percent are controlled.
The purpose of this study was to evaluate the impact of AHT in inpatient episodes
over 14 years among the inpatients (DI) in Portugal, studying the association between diabetes mellitus (DM) and obesity (Ob).
group with AHT compared to non AHT(NAHT) and with differences in terms
of sex (Table 2). In relation to Ob, we can see an increase between 2000 and
2013 and was significantly higher in patients with hypertension (G1_AHT:8.2 and
22.7%, G1_NAHT:0.3% and 3.4%, G2_AHT:8.5% and 18.7%, G2_NAHT1.0%
and 4.4%, G3_AHT:4.8 and 13.8% and G3_NAHT:0.7 and 3.9% in G4_AHT:1.4
and 7.8% and G4_NAHT:0.4 and 2.3%, p < 0.01) (Table 3).
Conclusions: AHTC is becoming a more common condition and has been increasing its presence between 2000 and 2013, existing a direct relation with age
and sex groups. Associated with AHT there is an increase in DM and Ob, this
could be the result of an increase of the pathology itself or merely an improvement
in the quality of the records. In any case it must imperatively be deemed a public
health problem. The correlation of this pathology with hypertension, obesity and
DM is hence clearly demonstrated.
PP.32.09
EPISTAXIS: RELATIONSHIP WITH CLINIC BLOOD
PRESSURE
F. Bertacchini1, A. Paini1, M. Salvetti1, A. Bazza1, E. Colonetti1, C. Agabiti Rosei1,
L. Verzeri1, D. Lombardi2, P. Nicolai2, E. Agabiti Rosei1, M.L. Muiesan1.
1Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ITALY, 2ENT Department, University of Brescia, Brescia, ITALY
Objective: Background: Epistaxis and hypertension are frequent diseases in the
adult population. A relationship between the increase of the blood pressure (BP) and
the prevalence and incidence of epistaxis has been suggested (Kikidis et al, 2013).
Design and method: Aim of our study was to analyze blood pressure changes in
patients with active or recent onset epistaxis (<12 hours) from admission to the
emergency department (ED) to discharge.
Patients and methods: 126 consecutive subjects (84 males, age range 15–93
years, mean age 67 ± 17 years) admitted to the ED (April 2014-February 2015)
with primary epistaxis, were prospectively evaluated. BP was measured with an
automatic device (OMRON MT10-E) in accordance to ESH-ESC guidelines
2013; measurements were performed at admission to the ED and 30 minutes after
the ear, nose and throat (ENT) specialist visit (and possible hemostasis).
Results: Results: a diagnosis of hypertension was present in 68% of subjects; 75%
of them were on antihypertensive treatment, 35% of them reported adequate BP
control, 17% had diabetes mellitus and 25% dyslipidemia. A statistically significant
reduction in BP was observed from admission to the ED and to the end of ENT evaluation (from 142 ± 21/84 ± 13 mmHg to 135 ± 21/81 ± 13 mmHg, p = 0.001), while
no significant changes were observed in heart rate (from 76 ± 15 to 72 ± 13 b/min).
Conclusions: Conclusions: results obtained in this group of patients with primary
epistaxis show a prevalence of hypertension similar to that of a general population. An accurate BP measurement shows a significant reduction at the end of the
ENT specialist evaluation compared to baseline measurement, in both hypertensive and normotensive subjects.
PP.32.10
A COMPARATIVE ANALYSIS OF THE
HYPERTENSION TREATMENT DEPENDING ON
COMORBIDITIES: INSIGHTS FROM CLINICAL
PRACTICE
C. Diaconu1, A. Nastasa2, A. Zaki2, B. Istratie2, R. Nazari2, M. Iancu3,
L. Balaceanu4. 1University of Medicine and Pharmacy Carol Davila, Clinical Emergency Hospital of Bucharest, Internal Medicine Clinic, Bucharest,
ROMANIA, 2Clinical Emergency Hospital of Bucharest, Internal Medicine
Clinic, Bucharest, ROMANIA, 3University of Medicine and Pharmacy Carol
Davila, Family Medicine Department, Bucharest, ROMANIA, 4University of
Medicine and Pharmacy Carol Davila, Clinical Emergency Hospital Sf. Ioan,
Internal Medicine Clinic, Bucharest, ROMANIA
Design and method: We used the DRGbase of inpatients. The following variables
were analysed: AHT(yes/no), age groups(G1:19and40; G2:41and65; G3:66and80;
G4:greater than 81years), gender (m-male/f-female), DM (yes/no) and/or Ob (yes/
no). We used the model ANOVA and chi-square, having considered significant
values of p < 0.01
Results: Between 2000 y 2013 there has been an increase in episodes with AHT,
and in older groups we have been watching the doubling of patients admitted with
AHT. Furthermore there is an increase in the number of episodes related to age
classes (G1:1.0 and 2.76%, G2:13.2 and 29.6%, G3:22.3 and 54.1% and G4:20.5
and 57.2%, p < 0.01), with a break-down sex (Table 1). The presence of DM increased between 2000 and 2013 in these patients, being significantly higher in the
Objective: The presence of comorbidities influences the drug treatment of arterial hypertension. The objective of the study was to investigate the antihypertensive treatment according to associated comorbidities in hospitalized hypertensive
patients.
Design and method: The study included 200 patients with arterial hypertension
consecutively hospitalized in the Internal Medicine Clinic of a University Emergency Hospital, in 2015. We retrospectively analyzed data from the hospital record database, using Analyse-IT software.
Results: The mean age of the patients was 66 ± 12.2 years old. The distribution of
main comorbidities in the group of study: dyslipidemia 56%, diastolic dysfunction 54.7%, left ventricle hypertrophy 52%, heart failure 42%, obesity 29.8%,
type 2 diabetes 28%, chronic kidney disease 16.2%, carotid atheromatosis 12.7%,
atrial fibrillation 11.2%, peripheral arterial disease 3.6%, hyperuricemia 1.2%.
We did not find a significant difference regarding the class of antihypertensive
Abstracts e321
drugs in patients with or without coronary heart disease, heart failure, chronic
kidney disease, dyslipidemia, sleep apnea syndrome. More hypertensive patients
with diabetes compared with nondiabetics were treated with ACE inhibitors (85%
versus 59%, p = 0.001); 13.3% of diabetics were treated with ARBs, compared
with 30.8% of non-diabetics (p = 0.02). We did not find any difference regarding
the calcium antagonists, diuretics, central antihypertensives between diabetics and
non-diabetics. 58.7% of patients with left ventricle hypertrophy were treated with
diuretics, compared with 41% of patients without left ventricle hypertrophy (p =
0.052). 77% of obese patients were treated with ACE inhibitors, versus 61% of
nonobese (p = 0.07).
Conclusions: Diabetic hypertensive patients are more likely to receive ACE
inhibitors than nondiabetics; nondiabetics hypertensive patients receive more
ARBs. Similarly, obese hypertensive patients are more likely to receive ACE inhibitors than nonobese ones.
PP.32.11
AUGMENTATION INDEX (AI) AND SMOKING
HABBITS FROM VIEWPOINT OF EPIDEMIOLOGY:
THE TANUSHIMARU STUDY
T. Tsuru1, H. Adachi1,2, M. Enomoto1, A. Fukami1, E. Kumagai1, S. Nakamura1,
Y. Nohara1, E. Nakao1, A. Sakaue1, N. Morikawa1. 1Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, JAPAN, 2Department of Community Medicine, Kurume University
School of Medicine, Kurume, JAPAN
Objective: We investigated the relationship between augmentation index (AI) and
coronary risk factors in community-dwelling Japanese.
Design and method: This cross-sectional study included 1,925 subjects (764
males and 1,161 females) aged 40 to 95 years who underwent a health checkup in a Japanese cohort of the Seven Countries Study, in Tanushimaru, a typical
farming town on Kyushu Island in 2009. The subjects’ medical history, alcohol
intake, smoking habit, and current medications for hypertension, dyslipidemia and
diabetes were ascertained by questionnaire. Radial arterial pressure wave analysis
was used to obtain AI.
Results: Univariate linear regression analysis demonstrated that coronary risk
factors such as age (p < 0.001), female gender (p < 0.001), body mass index
(p < 0.001; inversely), systolic (p < 0.001) and diastolic (p < 0.001) blood pressures, total cholesterol (p < 0.05) and smoking status (p < 0.01) were significantly
associated with AI. A multiple step-wise linear regression analysis showed that
female gender (p < 0.001), systolic blood pressure (p < 0.001), age (p < 0.001),
body mass index (p < 0.001; inversely) and smoking status (p < 0.001) were significantly and independently related to AI. Especially, a linear and significant
trend (p = 0.008) of AI values (%) was demonstrated by ANCOVA adjusted for
age, gender, systolic blood pressure and body mass index.
Conclusions: The present study demonstrated that AI values were strongly related
to coronary risk factors including habitual smoking in a dose-dependent manner
in a Japanese general population.
PP.32.12
GENDER DIFFERENCES IN URIC ACID AND
CARDIOVASCULAR RISK
A. Hermida Ameijeiras, J.E. Lopez Paz, M.J. Alende, G. Calvo Gonzalez,
V. Martínez Durán, A. Pascual Montes, I. Rodriguez Lopez, C. Calvo Gomez.
Hypertension and Vascular Risk Unit, Santiago de Compostela, SPAIN
Objective: The aim of this study was to assess influence of uric acid levels (UA)
and nocturnal BP dipping considering gender differences.
Design and method: A cross sectional study was conducted among 404 subjects
(55% women) with preserved renal function (MDRD > 60 ml/min. without proteinuria). BP was measured by ambulatory monitoring (ABPM) every 20 min
between 07:00 am and 23:00 pm and every 30 min at night, along 48 hours with
a Spacelabs 90207 device. We analyzed 48h-systolic and 48h-dyastolic mean
ambulatory BP (48h-SBP/48h-DBP), 48 h nocturnal SBP/DBP falling. Clinical
and biological assessments were performed in order to detect UA and kydney
function.
Results: The prevalence rates of UA between men were 55.1% (UA < 6 mg/dl) and
44.9% (UA > 6 mg/dL). Women had lower UA (83.8% < 6 mg/dL, compared to
16.2% > 6 mg/dL). Mean value of UA was 5.6 mg/dL among males (Vs 4.8 mg/dL
among females; p: 0.000).
We found gender differences on several clinical aspects between males and females as waist circumference (104.5 Vs 94.5 cms; p: 0.00), weight (88.2 Vs 73.3
kg; p: 0.00), 48 h SBP (129.8 Vs 126.6 mmHg; p: 0.05), diurnal SBP (134.4 Vs
131.3 mmHg; p: 0.01), nocturnal SBP (120.3 Vs 117.1 mmHg; p: 0.01) and nocturnal DBP (69.3 Vs 67.5 mmHg; p: 0.03).
We only found differences in women (not in men) according to UA (lower Vs
higher of 6 mg/dL) on SBP falling (11.1 Vs 8.0 mmHg) and DBP falling (16.4 Vs
13.4 mmHg). 58.6% of non dipper women presented UA over 6 mg/dL.
UA correlated poorly and inversely with nocturnal SBP falling (r: –0.133;
p = 0.039) and DBP falling (r: -0.163; p = 0.011).
Conclusions: In a cohort of renal preserved function subjects. uric acid levels
are higher in men and those with central obesity. No association between UA and
office or ambulatory BP levels was observed independently of gender. Nevertheless, we observed inverse association between nocturnal BP falling and UA only
in women. These results may help us to understand the underlying process of
increased cardiovascular risk in women with high uric acid.
PP.32.13
AN AGE-RELATED COMPARISON BETWEEN
COMORBIDITIES AND TREATMENT OF
C. Diaconu1, B. Istratie2, A. Nastasa2, A Zaki2, L Balaceanu3, M Iancu4. 1University of Medicine and Pharmacy Carol Davila, Clinical Emergency Hospital
of Bucharest, Internal Medicine Clinic, Bucharest, ROMANIA, 2Clinical Emergency Hospital of Bucharest, Internal Medicine Clinic, Bucharest, ROMANIA,
3University of Medicine and Pharmacy Carol Davila, Clinical Emergency
Hospital Sf. Ioan, Internal Medicine Clinic, Bucharest, ROMANIA, 4University of Medicine and Pharmacy Carol Davila, Family Medicine Department,
Bucharest, ROMANIA
Objective: Hypertensive patients with multiple chronic conditions are a priority
population for health research. The objective of the study was to comparatively
analyse age specific comorbidities and treatment of hypertensive patients.
consecutively hospitalized in the Internal Medicine Clinic of a University Emergency Hospital, in 2015. We compared 2 groups of hypertensive patients: younger
than 75 years (group 1) and older than 75 years (group 2). We analyzed data from
the hospital record database, using Analyse-IT software.
Results: The distribution by sex in the group of study: 122 men (61.60%) and 78
women (38.40%). The distribution by age: 154 patients in group 1, 46 patients
in group 2. The majority of hypertensive patients over 75 years were men (p =
0.0002). There were no significant differences in the severity of hypertension,
grade of left ventricle hypertrophy and left ventricular ejection fraction, frequency
of diabetes or chronic kidney disease, between the 2 groups. We have found a significant higher frequency of dyslipidemia in group 1 (p = 0.01). Instead, patients
over 75 years old had a higher frequency of heart failure (p = 0.0001). 33% of
patients from group 2 had coronary heart disease, as compared with 16% from
group 1 (p = 0.04). 35% of patients from group 1 were obese, as compared with
9% of patients from group 2 (p = 0.0008). Regarding the treatment, we did not
find any significant difference in the proportion of patients treated with ARBs, calcium channel blockers, diuretics, central antihypertensives, between the 2 groups.
Instead, ACE inhibitors were prescribed more frequent in group 1 (70%) versus
group 2 (53%).
Conclusions: In our study, elderly hypertensive patients over 75 years old had a higher frequency of coronary heart disease and heart failure. Instead, they had a lower
frequency of dyslipidemia and obesity. The antihypertensive treatment was similar in
both groups, but less patients over 75 years old received ACE inhibitors. Evaluating
the frequency of different comorbidities in hypertensive patients could help in planning appropriate strategies. Medical needs might be specifically addressed.
PP.32.14
CIRCADIAN BLOOD PRESSURE PROFILE AND
TARGET ORGAN DAMAGE IN HYPERTENSIVE
PATIENTS. SINGLE PILOT HYPERTENSION CENTER
STUDY
I. Tilea1, A. Mitre1, C. Carasca2, A. Varga1. University of Medicine and Pharmacy,
Tirgu Mures, ROMANIA, 2Clinical County Hospital, Tirgu Mures, ROMANIA
Objective: Long term proper management of hypertensive patients in family
medicine practice in order to reduce cardiovascular events emphasize the global
interest for active early diagnostic and accurate risk stratification in hypertension.
Increased use of ambulatory blood pressure monitoring (ABPM) by trained family physicians will allow identification of different hypertension subtypes and their
correlations with target organ damage.
Design and method: 60 hypertensive patients from the evidence of a family
medicine practice were evaluated according to a standardized protocol in a single
pilot hypertension center. All patients underwent 24-hour ambulatory BP monitoring (ABPM); rest electrocardiogram (ECG) was performed. Echocardiographic
left ventricular hypertrophy (LVH) was assessed and intima media thickness was
evaluated. Renal organ damage was evaluated.
Results: Circadian blood pressure profile was classified according to the ABPM;
28 (46.66%) dipper hypertensive patients, 24 (40%) patients with a non-dipping
profile (non-dippers), 3 (5%) hypertensive patients with reverse-dipper BP profile
and 5 (8.33%) hypertensive patients with extreme-dipper circadian BP profile.
Left ventricular hypertrophy was present in 48.33% hypertensive patients; in contrast ECG evaluation showed LHV in 23.3% (14) patients. Obesity and smoking
were not associated with LVH, (p < 0.05) in any identified hypertension profiles.
Of all hypertensive patients, 31 (51.66%) were stratified in stage 2 CKD and 10
(6%) patients with severe renal damage (CKD stage 3 and 4).
Non-dipper and reverse dipper hypertensive patients presented significant correlation between renal damage and LVH (p < 0.02).
Conclusions: Real data from family medicine offices are missing. Specific centers involved in long-term monitoring hypertensive patients are needed.
PP.32.15
according to SCORE scale were evaluated. We noted the number of pack-years
in all patients.
Statistical calculations were performed in the StatSoft Statistica 10. The t-student
test was used for the statistical analysis, r Spearmann was taken to analyze the
correlation of statistically significant values.
Results: We revealed following results in both groups: comparison A vs B respectively (SD) [*for p < = 0,05; **for p < 0,001; NS- negligible statistically]:
ABI: 0,94(0,16) and 1,01(0,14) NS; PWV [m/s]: 10,68 (2,29) and 12,54 (3,01) **;
IMT [mm]: 0,73(0,15) and 0,81(0,17) *; number of pack-years: 9,64(11,23) and
15,22(20,47) *; SCORE: 3,16 (2,49) and 7,00 (5,10) **. Women were characterized by a lower IMT, PWV and number of pack-years than men. In this group the
above-mentioned parameters were correlated together.
HYPERTENSIVE WOMEN COMPARED TO
HYPERTENSIVE MEN ARE CHARACTERIZED BY
POORER QUALITY OF LIFE
V. Katsi1, G. Vamvakou2, T. Makris2, I. Kallikazaros1, D. Tousoulis3. 1Hippokration General Hospital, Athens, GREECE, 2Elena Venizelou General and Maternity
Hospital, Athens, GREECE, 3Hippokration University Hospital, Athens, GREECE
Objective: Females and the elderly, demonstrate low scores of health-related
quality of life (H-rQoL) as far as coronary artery disease is concerned.We assessed the hypothesis that age and gender have an influence on H-rQoL in the
setting of essential hypertension (EH).
Design and method: We studied 154 subjects with untreated uncomplicated
stage I-II EH (aged = 54.9 ± 8 years, male = 78 female = 76, office BP = 152/92
mmHg). Both female and male group of patients were matched for age, office BP
and lipid parameters. The validated Greek version of the Short Form 36 (SF-36)
General Health Survey questionnaire was administered to all participants. The
eight subscales were further grouped into two summary scales: the physical component summary (PCS) and the mental component summary (MCS). Nonparametric Mann-Whitney ans Spearmann tests were performed.
Results: scored significantly lower in the physical functioning dimension when
compared to men (Table). This decline in the female group is negatively correlated
to age (r = –0.328, p = 0.002).
In women group there were significant negative correlation between ABI and SCORE
scale and positive correlation between IMT and SCORE scale. In men group there
was positive correlation between number of pack-years and SCORE scale.
Conclusions: 1. Women with hypertension were characterized by minor vascular
damages assessed by PWV and IMT than men. This is probably due to lower
number of pack-years in this group.
2. ABI and IMT in hypertensive women were proportional to the cardiovascular risk.
3. The number of pack-years in hypertensive men were proportional to the
cardiovascular risk.
PP.32.17
THE EPIDEMIOLOGICAL CHARACTERISTIC
OF HYPERHOMOCYSTEINEMIA AND H-TYPE
HYPERTENSION IN THE ELDERLY IN BEIJING,
CHINA
L. Ma, L. Li, Z. Tang, Y. Li. Xuan Wu Hospital, Capital Medical University,
Beijing, CHINA
Objective: Hyperhomocysteinemia (HHcy) is an important risk factor of atherosclerosis-related diseases, and H-type hypertension (HHT) is obviously becoming
a major health care concern in China. The aim of the study was to explore the
prevalence of HHcy and HHT in the elderly in Beijing, China.
Conclusions: Older women may represent a more vulnerable group of hypertensives, as far as their physical functional capacity is concerned. Quality of life has
hitherto been underestimated but should be more intensively considered in parallel to hypertension control.
PP.32.16
RELATIONSHIP BETWEEN SUBCLINICAL
ORGAN DAMAGE, CIGARETTE SMOKING AND
CARDIOVASCULAR RISK IN BOTH GENDERS OF
L. Woznicka-Leskiewicz, A. Posadzy-Malaczynska. Department of Family Medicine, Poznan, POLAND
Objective: Assessment of correlation between subclinical organ damage, cigarette smoking and cardiovascular risk in both genders of hypertensive patients.
Design and method: We divided 50 patients who smoked cigarettes in the past
with arterial hypertension in two groups: A: 25 women; B: 25 men. The average age of them [yrs]: A: 55 and B: 57. Ankle-brachial index (ABI), pulse wave
velocity (PWV), carotid intima-media thickness (IMT) and cardiovascular risk
Design and method: This is a retrospective study. Data for these analyses came
from the Beijing Longitudinal Study of Ageing. This cross-sectional study comprised
1460 elderly people dwelling in an urban district, a suburb, and in mountain country
in the general population in Beijing in 2012, which contained 638 male people and
822 female people. Statistical sampling techniques included cluster, stratification,
and random selection. Basic information and physical examination were collected by
trained staff, and the levels of plasma Homocysteine (Hcy) were measured.
Results: Our results showed that the mean concentration of plasma Hcy was 21.3
umol/L in Beijing elderly population. 74.4% of the subjects were considered to
have HHcy. 50.2% of the subjects were considered to have HHT.
Conclusions: Our study findings indicated that the prevalence of HHcy and HHT
were high in elderly participants in Beijing, China.
PP.32.18
PREVALENCE OF DIABETES AND LIPID
DISORDERS IN HYPERTENSION PATIENTS
REFERRED TO SPECIALIZED CARDIOLOGICAL
CENTRE: FIVE-YEARS TRENDS
N. Zvartau1, A. Krikunov2, A. Semakova2, E. Bolgova2, S. Kovalchuk2,
A. Boukhanovsky2, A. Konradi1. 1Federal Almazov North-West Medical Research
Centre, St. Petersburg, RUSSIA, 2ITMO University, St. Petersburg, RUSSIA
Objective: Diabetes mellitus (DM) and lipid disorders in hypertensive patients
are associated with higher risk of cardiovascular complications and poor outcome
and require more aggressive treatment strategies and follow-up. The main objec-
Abstracts e323
tive of this study was to describe trends in prevalence of DM and lipids disorders
in adult hypertensive patients referred to specialized cardiology clinic during the
period of January 2010 - December 2014.
Design and method: Data included 59268 (21153 males and 38115 females) patients, mean age 58.3 ± 13,8 years, referred to specialized clinic due to uncontrolled
hypertension. Descriptive statistics were used to estimate the means in gender and
age [under 35 years (n = 4079), 35–49 (n = 8566), 50–65 (n = 26381), older than
65 (n = 20242) years] subgroups. Linear regression was employed to determine the
yearly trends. Age and gender-specific results were adjusted to Saint-Petersburg
general population data for 5-years period and every studied year.
Results: The average prevalence of known lipid disorders for the studied period
was 3,7% (2160 patients) without any significant 5-years trends. Increased level of
total cholesterol in combination with increased low density lipoprotein levels was
the most frequent disorder (917 cases; 42,7%). There were no significant changes
in prevalence and characteristics of lipids disorders in gender subgroups. Analysis
of age groups demonstrated increase in lipid disorders frequency in patients over
65 years (R2 = 0,80; p = 0,04). The average prevalence of known diabetes was
14,5% (8592 patients) and impaired glucose tolerance 0,9% (518 cases) without
any significant trends during studied period in overall population and in gender
subgroups. While in subgroup of hypertensive patients over 65 years there was an
increase in prevalence of diabetes and impaired glucose tolerance during the last 5
years (R2 = 0,78, p = 0,05 and R2 = 0,95 p = 0,005, respectively).
Conclusions: During the last 5 years age older than 65 was associated with increase in prevalence of metabolic disorders in difficult to control hypertension.
These trends can be important for the total risk reduction in the elderly and explain poor blood pressure control in this subgroup.
Objective: Hypertension is a global health concern. A better understanding of sex
differences in the comorbidities of patients with arterial hypertension could yield
treatments that are better tailored to the individual. The objective of the study was to
investigate sex differences in the comorbidities of hospitalized hypertensive patients.
consecutively hospitalized in the Internal Medicine Clinic of a University Emergency Hospital, in 2015. We analyzed data from the hospital record database,
using Analyse-IT software.
Results: The distribution by sex: 122 men (61.60%) and 78 women (38.40%).
Women were younger than men (mean age 62.2 ± 11.2 years versus 68.4 ± 12.3
years). The comparative distribution of comorbidities in women and men: dyslipidemia (62.5% vs 55%), left ventricle hypertrophy (54.4% vs 50.5%), diabetes
(37.5% vs 21%), heart failure (34.4% vs 42.6%), obesity (34.4% vs 25%), coronary heart disease (32.8% vs 27.4%), chronic kidney disease (31.8% vs 26.1%),
sleep apnea syndrome (14% vs 1%), hyperuricemia (2.3% vs 1%). We did not find
a significant difference in the severity of hypertension between men and women
(p = 0.49), nor in the grade of obesity, left ventricular hypertrophy, frequency of
heart failure, chronic kidney disease or coronary heart disease. Instead, we have
found a statistically significant higher frequency of diabetes in women (p = 0.03).
Also, the frequency of sleep apnea was higher in women (p = 0.003). The mean
left ventricular ejection fraction was similar in women and men (57.5% vs 56%).
Conclusions: Hypertensive women in our study were younger than men. The severity of hypertension was similar in both genders. Women had a higher frequency
of diabetes and sleep apnea.
PP.32.21
PP.32.19
CARDIOVASCULAR RISK ASSESSMENT AND
SOCIAL FRAMEWORK OF COMMUNITY OF CAPE
VERDEAN UNIVERSITY STUDENTS STUDYING IN
PORTUGAL
L. Tavares, C. Calhau, J. Polonia. Faculty of Medicine of University of Porto,
Porto, PORTUGAL
Objective: Migration of populations of African to Europe poses problems of adaptation and health risk Cardiovascular disease is the leading cause of mortality
and population of African appears to have greater risk We evaluate the cardiovascular risk profile in Cape Verde University population studying in Portugal compared to Cape Verdean population equivalent to live in Cape Verde and Portuguese
equivalent Caucasian population living in Portugal
Design and method: A cross-sectional study comparing 3 University populations aged between 19–25 years: Cape Verde to study in Portugal (CV-EN), Cape
Verde equivalent to live in Cape Verde (CV-CV), Portuguese Caucasian living in
Portugal (PT-PT). Anthropometric assessment was made, blood pressure (media
3 records), the pulse wave velocity (PWV), the mcroalbuminuria (MA micg/mg
creatinine) and urinary excretion of sodium estimated for 12:00 am (Kawasaki)
Results: For similar ages 22.5 + 2.6 years, n = 104, 54% women (CV-EN); 24.9
+ 3.3, n = 100, 62% women (CV-CV), 23.5 + 3.0 years, 67% women (PT-PT), in
the comparison between groups (ANOVA) the IMC in CV-EN (22.9 + 3.5 Kg/m2)
was higher (p = 0.018) than CV-CV (21.9 + 3.8) and PT-PT (21.6 + 3.1), blood
pressure (mmHg) was higher (p = 0.001) in CV-EN (119/73 + 12/7) and CV-CV
(121/73 + 15/9) that in PT-PT (107/69 + 14/8), the PWV (m/s) was higher (p =
0.04) in CV-EN (8.7 + 1.1) and CV-CV (8.8 + 1.8) than in PT-PT (8.0 + 1.2), MA
(micg/mg creatinine) was higher (p = 0.04) in CV-EN (13.0 + 63.2) and CV-CV
(9.2 + 25.1) than in PT-PT (5.8 + 6.4), and excretion of sodium (mmol/24 h) was
higher (p = 0.001) in CV-EN (235 + 91) and CV-CV (197 + 85) that in PT-PT (194
+ 90) while this trend was maintained while comparing genders separately
AN ANALYSIS OF HYPERTENSIVE MALE PATIENTS
ADDRESSED TO A PRIMARY CARE PRACTICE
M. Iancu1, C. Diaconu2, G. Dediu3, L. Balaceanu3, R. Matei4, D. Matei1.
1University of Medicine and Pharmacy Carol Davila, Family Medicine Department, Bucharest, ROMANIA, 2University of Medicine and Pharmacy Carol Davila,
Clinical Emergency Hospital of Bucharest, Internal Medicine Clinic, Bucharest,
ROMANIA, 3University of Medicine and Pharmacy Carol Davila, Clinical Emergency Hospital Sf. Ioan, Internal Medicine Clinic, Bucharest, ROMANIA, 4CMI Dr.
Rodica Steluta Matei, Family Medicine practice, Bucharest, ROMANIA
Objective: The great majority of hypertensive patients are cared for in primary
care. The objective of the study was to investigate the comorbidities of male hypertensive patients addressed to a primary care practice and to create a regression
model with systolic blood pressure as dependent variable and other clinical and
paraclinical factors that could have an influence on the blood pressure values.
Design and method: The prospective study included 51 male patients with diagnosed arterial hypertension consecutively addressed for prescription refilling to a
family medicine practice in 2015. We recorded the family and personal medical
history, performed the clinical exam, laboratory tests (blood sugar, lipids), and
ECG in every patient. The statistical analysis was made using the SAS system.
Results: The epidemiological, clinical and paraclinical characteristics of the patients are described in Table 1. Half of the study group had over 50 years old and
the BMI above 29 Kg/m2. 40% of the patients were smokers, 29% were diagnosed
with type 2 diabetes, 10% had a family history of diabetes, and 27% had a family history of hypertension. All the patients were in sinus rhythm. 82% of the
patients had dyslipidemia. 25% of the hypertensive patients had both diabetes and
dyslipidemia. The Pearson Correlation Matrix showed a relationship between systolic blood pressure with BMI (11%), heart rate (35%), family history of diabetes
(13%) and hypertension (12%), and smoking status (19%).
Conclusions: Cape Verdean student population (with greater tendency for those
resident in Portugal) presents BP values, arterial stiffness, albuminuria and salt
intake higher than the Caucasian counterparts. The increased cardiovascular risk
associated with these particular measures to combat justifies populations the modifiable risk factors and the promotion of hygiene habits.
PP.32.20
GENDER DIFFERENCES OF THE COMORBIDITIES
IN HYPERTENSIVE PATIENTS
C. Diaconu1, A. Nastasa2, A. Zaki2, B. Istratie2, R. Nazari2, M. Iancu3,
L. Balaceanu4. 1University of Medicine and Pharmacy Carol Davila, Clinical Emergency Hospital of Bucharest, Internal Medicine Clinic, Bucharest, ROMANIA, 2Clinical Emergency Hospital of Bucharest, Internal Medicine Clinic, Bucharest, ROMANIA,
3University of Medicine and Pharmacy Carol Davila, Family Medicine Department,
Bucharest, ROMANIA, 4University of Medicine and Pharmacy Carol Davila, Clinical
Emergency Hospital Sf. Ioan, Internal Medicine Clinic, Bucharest, ROMANIA
Conclusions: Almost 1/3 of male hypertensive patients in our study had diabetes.
A large majority of hypertensive patients had dyslipidemia. We have found a significant relationship between systolic blood pressure values and BMI, heart rate,
family history of diabetes and hypertension, and smoking status. The analysis
of every-day practice may offer insights into the comorbidities of hypertensive
patients, that should be addressed for a better control of all the cardiovascular
risk factors.
e324 Abstracts
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HEART AND HAEMODYNAMICS
PP.33.01
EVALUATION OF HYPERTENSIVE PATIENTS: TEN
YEARS PROGNOSTIC SIGNIFICANCE OF NONINVASIVE PARAMETERS
D. Djordjevic1, I. Tasic1, S. Kostic2, B. Stamenkovic1, M. Lovic2, D. Lovic3.
1University of Nis, Medical Faculty, Institute Niska Banja, Nis, SERBIA, 2Institute
Niska Banja, NIs, SERBIA, 3Inter Medica Dr. Lovic, Nis, SERBIA
Objective: In practice, it is of utmost importance to predict the outcome for every
patient at the beginning of the treatment. The aim was to examine the correlation
between non-invasive parameters and outcomes in patients (pts) with essential
arterial hypertension (AH) and left ventricular hypertrophy (LVH) during the ten
years of follow-up.
Design and method: All 124 pts with AH and LVH (57.0 ± 8.0 years; 84 male
and 40 female) were examined by means of echocardiography (two independent
examiners - Acuson-Sequoia), exercise testing, 24-h Holter monitoring, 24-h ambulatory blood pressure monitoring, heart rate variability and QTc interval dispersion. Patients used regular medicament therapy according to currently valid
guidelines during the period of follow-up.
Results: During the ten years period of follow-up in 40 (32.3%) pts occurred
cardiovascular and cerebrovascular adverse events (AE). At the beginning of the
study pts with AE had greater: LVMI (178.9 ± 29.5 g/m2 vs. 165.5 ± 29.5 g/m2;
p < 0.05) and left atrial diameter (41.6 ± 6.1 mm vs. 39.2 ± 4.3 mm; p < 0.05). In
pts with AE QTc dispersion was greater than in pts without AE (64.1 ± 24.7 ms
vs. 54.8 ± 19.4 ms; p < 0.05). In pts with AE Cornell product was more frequently
positive than in pts without AE (35% vs. 22.2%; p < 0.01). Positive Lyon-Sokolow
score for left ventricular hypertrophy did not achieve statistical significance (25%
vs. 11.9%; p = 0.06). Other non/invasive parameters did not achieve statistical
significance. Using multiple linear regression analysis the best predictors of worse
prognosis were Cornell product and QTc dispersion greater than 65 ms (standardized coefficient beta: for left atrial diameter 0.234; p < 0.01 and QTc dispersion
0.184; p < 0.05 and for the model: R = 0.314, R2 = 0.099, adjusted R2 = 0.084
standard error of the estimate = 0.449; p < 0.05).
Conclusions: Patients with positive Cornell product for left ventricular hypertrophy and greater QTc dispersion, especially greater than 65 ms, have worse
outcome during the ten years in spite of regular medical treatment.
PP.33.02
FORWARD AND BACKWARD PRESSURE
WAVEFORM MORPHOLOGY IN HYPERTENSIVE
SUBJECTS
Y. Li, H. Gu, H. Fok, J. Alastruey, P. Chowienczyk. King’s College London,
London, UNITED KINGDOM
Objective: Beyond middle age hypertension results mainly from an increase in
pulse pressure which may be attributed to a forward pressure wave generated by
the interaction of the ventricle with the arterial tree and a backward wave due to
“reflection” of the forward wave. We investigated whether increased pulse pressure in hypertension relates to a proportionally greater backward/forward wave or
is driven by an increase in the forward wave.
Design and method: Non-invasive central pressure and flow were obtained by carotid tonometry and Doppler sonography respectively in 158 hypertensive patients
(mean ± SD age, 46 ± 17 years). Patients were divided into three groups by pulse
pressure (group 1: 29.7 ± 5.3, group 2: 41.5 ± 2.6, group 3: 60.1 ± 12.5 mmHg).
Forward and backward pressure waves were separated using wave intensity analysis. Dimensionless ratios were used to examine how characteristics of the backward wave: maximum amplitude, slope of upstroke, width at 80% maximum and
area compared to the same characteristics of the forward wave.
Results: All the dimensionless ratios were similar across the three groups, with no
statistically significant difference in any ratio. However, the backward wave provided a slightly greater contribution to central pulse pressure in group 3 compared
to group 1 (20.2 ± 1.3% vs. 16.3 ± 1.8%, means ± SE due to earlier time of arrival
of the backward wave: 95 ± 2.8 vs. 107 ± 5.2 ms, P < 0.05).
Conclusions: Increased pulsatile components of blood pressure in hypertension derive predominantly from the interaction of ventricular contraction with
the impedance of the arterial tree. “Reflection” of the backward wave remains
approximately the same across groups with a two-fold difference in pulse pressure. Earlier arrival of the backward wave contributes to a small proportion of the
increase in pulse pressure.
PP.33.03
PREVALENCE AND CORRELATES OF NEW-ONSET
LEFT VENTRICULAR GEOMETRIC ABNORMALITIES
IN A GENERAL POPULATION: THE PAMELA STUDY
G. Seravalle1, C. Cuspidi1, R. Facchetti2, M. Bombelli2, G. Brambilla2,
D. Prata Pizzala2, G. Erba2, R. Dell’Oro2, C. Sala3, M. Tadjc4, G. Mancia1,
G. Grassi2. 1IRCCS Istituto Auxologico Italiano, Milan, ITALY, 2Department of
Health Science, University Milano-Bicocca, Milan, ITALY, 3Department of Clinical Science and Community Health, University of Milan, Milan, ITALY, 4University Clinical Hospital Centre, Belgrade, SERBIA
Objective: We sought to evaluate new-onset abnormal LV patterns and their correlates over a 10-year period in members of the general population enrolled in the
PAMELA study.
Design and method: The study included 817 subjects with normal LV geometry
at baseline evaluation having a readable echocardiogram at the end of follow-up.
Cut-points for abnormal LV geometric patterns were derived from reference values of the healthy fraction of the PAMELA population.
Results: Over a 10-year period 39% of participants progressed to abnormal LV
geometric patterns as follows: LV concentric remodelling (15.2 %), eccentric dilated LVH (8.4%), concentric LVH (7.9%), eccentric non-dilated LVH (6.8%),
and concentric dilated LVH (0.7%). Age (OR: 1.051; 95% CI 1.037–1.066, p <
0.0001), LV mass index (OR : 1.039; 95% CI 1.026–1.052, p < 0.0001), nighttime SBP (OR : 1.031; 95% CI 1.014–1.052, p = 0.0003) and BMI (OR : 1.082;
95% CI 1.032–1.135, p = 0.0001) emerged as key correlates of new-onset abnormal LV geometry. Age and LV mass index turned out to be strong determinants
of all sub-types of LVH; whereas BP, BMI and sex exhibited a different predictive
value across the various LV geometric patterns.
Conclusions: Our study provides the first evidence that long-term changes from
normal cardiac morphology towards to abnormal LV geometry represent a clinically relevant phenomenon at the community level. From a practical perspective
this finding reinforces the concept that life-style changes and pharmacologic treatment aimed to reduce over-weight/obesity and optimize BP are of paramount importance for prevention of subclinical cardiac damage.
PP.33.04
DIFFERENCES IN PREDICTORS OF ONEYEAR MORTALITY BETWEEN PATIENTS WITH
HYPERTENSIVE AND NONHYPERTENSIVE ACUTE
HEART FAILURE: USEFULNESS OF E/E’ IN
HYPERTENSIVE HEART FAILURE
K. Matsushita, T. Minamishima, K. Sakata, T. Satoh, H. Yoshino. Kyorin University School of Medicine, Division of Cardiology, Tokyo, JAPAN
Objective: Although elevated blood pressure (BP) is an important factor causing acute decompensated heart failure (HF), the underlying pathophysiology of
hypertensive HF remains unclear. Here we compared the prognostic factors for
one-year mortality between patients with hypertensive and nonhypertensive acute
decompensated HF.
Design and method: We retrospectively studied 436 consecutive patients with
acute decompensated HF. Hypertensive HF was defined as an elevated BP of
greater than or equal to 140/ mmHg and/or /90 mmHg at admission. Potential risk
factors for one-year mortality were identified by univariate analyses; then multivariate Cox regression analysis with backward stepwise selection was performed
with variables showing a statistical value of P < 0.10 in the univariate analyses.
Results: Of the entire study cohort, 49% had hypertensive and 51% had nonhypertensive HF. One-year mortality was 9.6% (42 deaths). Patients with hypertensive HF exhibited a significantly lower one-year mortality than those with
nonhypertensive HF (log-rank, P = 0.005). In the hypertensive HF group, age
Abstracts e325
[hazard ratio (HR), 1.14; 95% confidence interval (CI), 1.03–1.25; P = 0.007],
lower serum sodium value at admission (serum sodium value: HR, 0.64; 95%
CI, 0.49–0.83; P = 0.001), and higher mitral E/E’ ratio determined by echocardiogram (HR, 1.39; 95% CI, 1.11–1.74; P = 0.004) were independent risk factors
for one-year mortality. In contrast, age (HR, 1.09; 95% CI, 1.03–1.15; P = 0.002),
lower systolic BP at admission (systolic BP: HR, 0.96; 95% CI, 0.93–0.99; P =
0.009), higher serum creatinine level at admission (HR, 1.76; 95% CI, 1.21–2.55;
P = 0.003), and medication without diuretics at discharge (HR, 4.27; 95% CI,
1.80–10.12; P = 0.001) were independent risk factors for one-year mortality in the
nonhypertensive HF group.
Conclusions: There were significant differences in the prognostic factors for oneyear mortality between the hypertensive and nonhypertensive HF groups. Renal
impairment at admission significantly associated with one-year mortality only in
the nonhypertensive HF group. E/E’ was a reliable predictor of mortality only in
the hypertensive HF group. Elucidation of the mechanisms behind these findings
could lead to more effective therapeutic strategies for patients with HF.
PP.33.05
BODY FAT COMPOSITION AFFECTS LEFT
VENTRICULAR MASS IN HYPERTENSIVE WOMEN:
A BIOIMPEDANCE STUDY
C. Catena, G.L. Colussi, M. Novello, F. Pezzutto, A. Palomba, L.A. Sechi.
Hypertension Unit, Internal Medicine, Department of Experimental and Clinical
Medical Sciences, University of Udine, Udine, ITALY
Objective: In addition to the hemodynamic load, other clinical and biochemical
factors could contribute to the development of left ventricular (LV) hypertrophy in
hypertensive patients. It is not clear, however, whether body composition in terms
of fat and muscle mass is related to the LV mass and whether this relationship
differs between genders. The aim of the study was to investigate the possible association between components of the body mass, as estimated by a bioimpedance
analysis (BIA), and LV morphology and function in hypertension.
Design and method: In 146 patients with essential hypertension (age 48 ± 13; 81
males; 49 never treated and 97 studied after drug wash-out of at least 2 weeks)
we measured anthropometric and clinical variables, plasma insulin and fibrinogen
levels, total body fat and free fat mass and body muscle mass by BIA, and performed conventional echocardiography
Results: Men had higher systolic blood pressure and body free fat and muscle
mass and lower total body fat mass than women. LV hypertrophy was detected
according to consensus criteria in 42 (28%) patients who were older, had higher
body mass index, blood pressure, total body fat mass and fibrinogen levels than
patients without LV hypertrophy. In men, LV mass index was significantly and
directly related to age, body mass index, blood pressure, and fibrinogen levels,
whereas no relationship were observed with body fat composition. In women, LV
mass index was directly related to body mass index, blood pressure, duration of
hypertension, total body fat mass, and plasma insulin and fibrinogen levels. At
multivariate regression analysis, LV mass index was related independently with
age and blood pressure in men and with blood pressure, duration of hypertension,
and fibrinogen levels in women
ventricular mass index (LVMI) of 139.2 ± 30.5 g/m2 (63.6% with LVH defined
as LVMI > 125 gm2), carotid intimae-medial thickness (IMT) of 0.94 ± 0.2 mm
(19.6% was > 0,9 mm) and presence of a plaque in 52.4% patients, medium value
estimated GFR 69.3. Diabetes mellitus occurred in 23.1% of patients, impaired
fasting glucose occurred in13.3% of patients, and the rate of hypercholesterolemia (defined as cholesterol > 5 mmol) was 79.7%.
A reduction in the LVMI was achieved by 55.9% patients. At the time of follow-up,
the incidence of non-fatal and fatal cardiovascular events was significantly greater
in patients without a reduction in the left ventricular mass index: 20 (31.7%) vs
11 (13.75%); P < 0.008; higher number of these patients died of cardiovascular
causes 5 (7.9%) vs 2 (2.5%), however, the difference was not significant. Between
these groups, there was no difference in the incidence of disease 5 (7.9%) vs. 8
(10%) and death (1.6% vs. 1.25%) from cancer.
There were only two parameters that differed between the groups at the final follow up: mean LVMI (162.7 gm2 vs. 129.9; p < 0.001) and mean systolic blood
pressure (148 vs. 141; p < 0.048).
Conclusions: Our results suggest that a lack of regression of LVH and poor regulation of systolic blood pressure are stronger indicators of cardiovascular risk than
subclinical damage to other organs and modifiable risk factors.
PP.33.07
CARDIAC ORGAN DAMAGE IN PARKINSONIAN
PATIENTS WITH NOCTURNAL HYPERTENSION AND
AUTONOMIC NEUROPATHY
C. Di Stefano, V. Milazzo, G. Sobrero, F. Vallelonga, A. Milan, F. Veglio,
S. Maule. Autonomic Unit, Department of Medical Sciences, Città della Salute e
della Scienza, University of Turin, Turin, ITALY
Objective: Patients with autonomic neuropathy (AN) in Parkinson’s disease (PD)
often show nocturnal hypertension and reverse dipping pattern on ambulatory
blood pressure (BP) monitoring (ABPM), and orthostatic hypotension. The aim
of this study is the comparison of cardiac organ damage in reverse and non-reverse
dipping PD and hypertensive patients.
Design and method: 19 PD patients with reverse dipping on ABPM and no
previous history of hypertension were compared to 19 non-reverse PD patients,
matched for age and 24-hours mean BP, and 19 essential hypertensive patients
matched for nocturnal mean BP. None of the PD and hypertensive patients suffered from diabetes, dyslipidemia, chronic kidney disease, sleep apnea and previous cardiovascular diseases. None of the patients were treated with antihypertensive
or antihypotensive drugs. Reverse dipping was defined as day-night BP difference <
0% on ABPM; nocturnal hypertension was considered as night systolic and diastolic
BP > = 120/70 mmHg. Left ventricular (LV) hypertrophy was defined as LV mass
index > = 115 g/m2 in males and > = 95 g/m2 in females.
Conclusions: LV mass index is related to body fat mass only in women, a relationship that is not independent and that appears to be mediated by higher plasma
levels of insulin and fibrinogen.
PP.33.06
SUBCLINICAL ORGAN DAMAGE IN HYPERTENSIVE
PATIENTS WITH HIGH CARDIOVASCULAR
RISK: THE IMPORTANCE OF CHANGES IN LEFT
VENTRICULAR MASS - FOLLOW UP
I. Tasic1, S. Kostic2, D. Djordjevic1, M. Lovic2, M. Rihter2, J. Cvetkovic2,
S. Andonov2, D. Lovic3. 1Institute for Treatment and Rehabilitation Niska Banja,
Faculty of Medicine University of Nis, Nis, SERBIA, 2Institute for Treatment and
Rehabilitation Niska Banja, Niska Banja, SERBIA, 3Inter Medica, Nis, SERBIA
Objective: The careful assessment of target organ damage is a vital part of the management of any patient with hypertension, particularly for those who are high risk.
Design and method: We studied 143 hypertensive patients (93 females). Each
participant underwent asymptomatic organ damage: 12-lead electrocardiogram
examinations, two-dimensional and Doppler echocardiographs, Doppler sonography of the carotid arteries, and laboratory investigations were prospectively
followed for total and cardiovascular mortality and disease over a median of 7
years. In this paper, we analyzed the change in LVMI and the relationship with
cardiovascular events and malignant diseases.
Results: In the beginning of the study, the mean age was 63.1 ± 8 years, body
mass index of 28.7 ± 3 kg/m2, office blood pressure of 158 ± 16.5 mmHg, left
Results: 36.8% of PD patients were women and the mean age was 70 years.
84.2% of reverse PD patients suffered from AN and nocturnal hypertension. Reverse PD patients showed similar 24-hours BP but higher nocturnal systolic and
mean BP values than non-reverse PD patients. None of hypertensive patients had a
reverse dipping pattern, but 84.2% revealed nocturnal hypertension. In reverse PD
LV mass index was significantly increased than non-reverse PD patients (respectively 90.21 ± 25.26 vs 77.43 ± 13.32 g/m2, p = 0.04), and was similar to essential
hypertensive patients (91.64 ± 24.78, p = 0.92), although remaining within normal
limits. LV hypertrophy was detected in 5 reverse PD patients and 4 hypertensive
patients, and none non-reverse PD patients (p = 0.046). No other significant differences in systolic and diastolic function were found between PD and hypertensive
groups. Nocturnal mean BP and nocturnal systolic BP load were found to be the
strongest predictors of higher LV mass index (p = 0.04, p = 0.045).
Conclusions: Reverse dipping and nocturnal hypertension are related to higher
LV mass and increased finding of LV hypertrophy in PD patients.
PP.33.08
LONGITUDINAL LEFT VENTRICULAR
CONTRACTILITY AND ISOLATED SYSTOLIC
HYPERTENSION IN THE YOUNG
D. Piskorz, A Tommasi. Cardiovascular Research Center British Sanatorium, Rosario, ARGENTINA
Objective: Background: Increased stroke volume and an unusual elevated amplification of the pulse wave are the main substratum of isolated systolic hypertension in the young.
Objectives: to compare systolic and diastolic function in young isolated systolic
and systolic-diastolic hypertensives to young normotensives.
Design and method: Design and methods: under 40 years old non treated
consecutives isolated systolic hypertensives, systolic-diastolic hypertensives
and normotensives controls were included in a case control design. Left ventricular mass assessed by Devereux method, left ventricular hypertrophy considered > 95 g/m2 in women and > 115 g/m2 in men. Transmitral diastolic
peak early flow to septal/lateral mitral annulus average peak early diastolic
velocities (E/e’ ratio) measured. Systolic function assessed by tissue Doppler
average interventricular septum/lateral wall mitral annulus rate systolic excursion (s wave). Left ventricular end diastolic volume, end systolic volume,
stroke volume, stroke work and systolic stress were measure by volumetric
methods and corrected by body surface. Statistical analysis by ANOVA test,
statistically significant p < 0,05.
Results: Results: 10 controls, 24 systolic – diastolic hypertensives and 14 isolated
systolic hypertensives were included. Data are showed at the table.
Conclusions: In all groups of hypertensive patients LV massand diastolic dysfunction increased in comparison to healthy controls in post-hoc tests. We found
statistically significant correlation between diastolic dysfunction of right and left
chamber including the following parameters E/Am, E/E’m, E’m,E/At, E/E’t,
E’t,except the deceleration time (DcT).
These results suggest that hypertension causes parallel and gradual increase of
diastolic dysfunction in both heart chambers.
PP.33.10
AMBULATORY HEMODYNAMIC TRENDS IN
HYPERTENSION AND AGING
S. Bhura, K. Elango, J.L. Izzo, P.J. Osmond. State University of New York at Buffalo, Buffalo, USA
Objective: To compare 24-hour ambulatory blood pressure monitoring with existing laboratory methods, and to investigate the impact of BP and age on systemic
hemodynamics.
Conclusions: Conclusions: 1) LV end diastolic volume is increased in isolated
systolic hypertension in the young which by Franck Starling law could recruit
myocardial fibers and increased longitudinal LV contractility; 2) exaggerated LV
longitudinal shortening could explain the increased stroke volume in isolated systolic young hypertensives.
PP.33.09
THE RELATIONSHIP BETWEEN RIGHT AND LEFT
VENTRICLES IN PATIENTS WITH HYPERTENSION
AND HEALTHY CONTROLS
J. Krolczyk, O. Siga, A. Dzieza-Grudnik, J. Walczewska, T. Grodzicki.
Jagiellonian University, Medical College, Department of Internal Medicine and
Gerontology, Cracow, POLAND
Objective: The aim of the study was to estimate the diastolic ratio between right
and left ventriclein groups of hypertensive patients and healthy controls.
Design and method: We examined 40 healthy controls and 103 hypertensive
patients (41 treatment naive and 31 with well controlled HT and 31 resistant
controlled HT).Measurements of the RV and LV diastolic function as well as LV
structure were assessed by echocardiography (Toshiba Xario XG) using Tissue
Doppler analyzer. The ANOVA test was used to compare differences between
groups and the Statistica Pearson test was used to compare the correlation between parameters LV to RV.
Results: SBP–systolic blood pressure, DBP–diastolic blood pressure,DcTt – deceleration times, E/A–ratio of the ealry (E) to late (A) ventricular filling velocities
of mitral (m) or tricuspid (t), E’–early diastolic of mitral (m) or tricuspid (t) annular velocity, E/E’m–ratio of the early ventricular filling velocity to early diastolic
of mitral (m) or tricuspid (t) annular velocity, EF -ejection fraction.
Design and method: Cardiac output (CO) and systemic vascular resistance
(SVR) were analyzed in 3 sub studies. Sub study A: 24-hour PWA (MobilOGraph, IEM, Stolberg, DE) was performed in a convenience sample (n = 66)
stratified into 3 groups by systolic BP levels (< 120, 120–139, > 139 mmHg)
and separately stratified by age (< 55, > / = 55 years). Sub study B: Each individual PWA was analyzed for within individual trends in CO and SVR. These
trends were compared to the trends obtained from Sub study A. Sub study C:
supine hemodynamics and echocardiographic parameters measured in a reference population developed in our laboratory (n = 78) were compared to 24-hour
PWA means(Sub study A).
Results: BP was independent of CO in all 3 sub studies, overall and for each
BP subgroup. Thus, there are very strong inverse relationships between 24hour SVR and 24-hour CO for each BP group (p < 0.000 each) in each sub
study, with a parallel upward-rightward shift of the respective SVR-CO isobars
as BP increases. Figure 1 (left panel) shows the SVR-CO isobars for each BP
group in Sub study A. Nearly identical relationships were also found in sub
studies B and C. Figure 1 (right panel) demonstrates respective SVR-CO isobars for younger and older individuals, demonstrating only a rightward shift in
the SVR-CO isobar.
Abstracts e327
Conclusions: 1) Hemodynamic analysis using 24-hour ambulatory PWA is
feasible.
2) Sustained hypertension is associated with an upward-rightward shift of the
SVR-CO isobar in proportion to the degree of BP elevation, indicating that the
underlying hemodynamic abnormality in hypertension at any stage is both inappropriately high CO and inappropriate high SVR.
3) Age effects on hemodynamics are more complex.
PP.33.11
COMPARATIVE EFFECTIVENESS OF ANGIOTENSIN
II RECEPTOR BLOCKERS VERSUS ANGIOTENSIN
CONVERTING ENZYME INHIBITORS IN LEFT
VENTRICULAR STRUCTURE AND FUNCTION
R. Ma, Y. Zhao, Q.Y. Wang, N.Y. Li, H.T. Meng, J. Yu. Lanzhou University Second
Hospital, Lanzhou, CHINA
Objective: Angiotensin converting enzyme inhibitor (ACEI) and angiotensin
receptor 1 antagonists (ARB) ameliorate oxidative stress and fibrosis of myocardium through inhibiting the renin angiotensin system (RAS) in different ways,
but if there is difference between this two kind of agents in protection to organ
damages remains controversial. The purpose of this study is to study if irbesartan
and benazepril alone and in combination would have different protective effects
on left ventricular structure, systolic and diastolic function.
Design and method: Sixteen-weeks old female spontaneously hypertensive rats
(SHR) (n = 8) were treated with irbesartan (Irb,), benazepril (Ben), combination of low irbesartan and benazepril (Irb+Ben) and vehicle for 12 weeks. Wistar
Kyoto (WKY) rats (n = 8) receive vehicle. Echocardiography was performed for
evaluation of left ventricular structure, systolic and diastolic function at 12 weeks.
Results: Systolic blood pressure were significantly lower in Irb+Ben rats than in
untreated SHR, and demonstrated greater improvement than irbesartan or benazepril alone. IVSd was significantly lower in the Irb+Ben rats, Irb rats and Ben rats
than untreated SHR (P = 0.010, P = 0.035, P = 0.028, separately). There was no
difference in the LVEDD, LVEF and FS between SHR in each group and WKY.
E/A showed no statistical difference between groups. E/E’ decreased in Irb+Ben
rats, Irb rats and Ben rats compared with untreated SHR (P = 0.007, P = 0.020, P
= 0.039, separately). E’/A’ increased in Irb+Ben rats, Irb rats and Ben rats compared with untreated SHR (P = 0.019, P = 0.032, P = 0.041, separately). Irb+Ben
combination resulted in better outcomes of IVSd, E/E’ and E’/A’ than irbesartan
or benazepril alone (P < 0.05 for all).
Conclusions: Hypertension associated with diastolic dysfunction. Irbesartan,
benazepril and dual therapy provide therapeutic benefit in the blood pressure
control, as well as improvement of left ventricular hypertrophy and diastolic dysfunction. The combination of these two RAS antagonists significantly attenuating
development of hypertension and reducing left ventricular hypertrophy than monotherapy, however, this result could be related to the better antihypertensive effect of
combination treatment. There was no evidence of differential effects of irbesartan
and benazepril on the outcomes of left ventricular structure and function.
PP.33.12
THE INFLUENCE OF ANTIHYPERTENSIVE
TREATMENT ON THE FUNCTION OF LEFT
VENTRICLE IN PATIENTS WITH PRIMARY,
UNCOMPLICATED HYPERTENSION
T. Pizon1, M. Rajzer2, M. Rojek2, D. Czarnecka2. 1University Hospital, Department of Observation and Internal Medicine, Cracow, POLAND, 2Jagiellonian
University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Cracow, POLAND
Objective: The aim of the study was to check if chosen antihypertensive drugs
can influence the ejection fraction of left ventricle (EF) and to assess possible
factors for this change.
Design and method: 95 never treated patients with HT stage 1 or 2 were randomized to 6 months monotherapy with: quinapril, amlodipine, hydrochlorothiazide,
losartan or bisoprolol. Each therapeuthic group consisted of 19 patients (N = 19).
Before and then after 1, 3 and 6 months of treatment EF in echocardiography,
arterial stiffness indexes: carotid-femoral pulse wave velocity (PWV) by using
COMPLIOR device and aortic pulse pressure (AoPP) from pulse wave in applanation tonometry by using SPHYGMOCOR device were measured.
Results: At baseline no differences between groups were observed in EF. ANOVA
for repeated measurements revealed for all groups significant increase in EF (p =
0.01). No differences appeared between therapeutic groups in mentioned above
effect. PWV and AoPP decreased significantly during observation period in all
examined groups (p value: 0.0007 and 0.0003 respectively), with no betweengroups difference.
Conclusions: Irrespectively of chosen drug we observed similar effect for EF
increase; PWV and AoPP decrease drop. Improvement of left ventricle function
as a result of antihypertensive therapy is strongly connected with arterial stiffness
decrease.
PP.33.13
LEFT VENTRICLE DIASTOLIC FUNCTION IN A
COHORT OF TREATED HYPERTENSIVE PATIENTS
E. Swierblewska, K. Kunicka, J. Wolf, W. Kucharska, M. Hoffmann, K. Polonis,
A. Szyndler, M. Chrostowska, L. Bieniaszewski, K. Narkiewicz. Dept. of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, POLAND
Objective: Diastolic dysfunction (DD) is highly prevalent consequence of hypertension, and its occurrence, among others, relies on both the duration, as well as
the control of blood pressure. Although the presence of clinically silent DD confer
the cardiovascular risk, current ESH guidelines do not include the presence of
DD in the list of subclinical organ damage which delineates patients’ risk profile.
Based on the current echocardiographic recommendations we aimed to assess
both the occurrence and the severity of diastolic dysfunction DD in a cohort of
853 treated hypertensives.
Design and method: We enrolled consecutive 853 hypertensive subjects (45.8%
females). Routine echocardiography was performed (Vivid 7 Pro). Diastolic function was assessed and graded according to the recommendations of the European
Association of Echocardiography. Additionally, clinical history, laboratory tests
and ABPM were recorded. Patients with overt heart and cerebrovascular diseases
were excluded from the analyses.
Results: Patients were characterized as follows: age = 54.5 ± 13.5 y.o.; BMI =
30.0 ± 5 kg/m2; hypertension duration = 15 ± 10 years; blood-lowering treatment duration = 13 ± 9 years. 23% of participants had established type 2 diabetes
mellitus, 76.5% dyslipidaemia, 7.9% chronic kidney disease. 648 (76%) patients
were eligible for echocardiographic analyses. The distribution of diastolic function characteristics was as follows: normal = 26% (18% vs. 33% for females and
males, respectively); grade 1 DD = 45% (45% vs. 45% for F vs. M); grade 2 DD
= 29% (37% vs. 22%). None of the patients were diagnosed with grade 3 DD. Patients required 2.9 ± 1.5 blood-lowering drugs, and the hypertension control over
24 h ABPM was as follows: SBP = 129.2 ± 9.1 mmHg; DBP = 77.0 ± 9.2 mmHg;
24 h HR = 71.5 ± 9.1 bpm.
Conclusions: Mild-to-moderate diastolic dysfunction is highly prevalent in satisfactory controlled, long-lasting hypertensives.
PP.33.14
TEI INDEX AS A TOOL FOR THE DIAGNOSIS
OF LEFT VENTRICULAR DYSFUNCTION
WITH PRESERVED EJECTION FRACTION IN
G. Tissera1, D. Piskorz2, A. Tommasi2. 1Hospital Provincial del Centenario, Rosario,
ARGENTINA, 2Sanatorio Británico SA, Rosario, ARGENTINA
Objective: The frequency of left ventricular dysfunction (LVD) in patients (p)
with hypertension (HBP) and the methodologies used for its detection are controversial issues. The Ventricular Performance Index, known as Tei index, simultaneously evaluates systolic and diastolic function, and could be a useful tool in HBP
p with preserved ejection fraction (PEF).
To determine the frequency of LVD in HBP p with PEF by Tei Index.
Design and method: Case – control study. Patients divided in three groups: 1)
HBP p without left ventricular hypertrophy (LVH); 2) HBP with LVH; 3) nonHBP controls. Volumetric > 54 % was considered PEF. Left ventricular mass index was measured by Devereux method, LVH was considered with values > 95
g/m2 in women and > 115 g/m2 in men. Transmitral diastolic peak early flow to
septal/lateral mitral annulus average peak early diastolic velocities (E/e’ ratio).
Systolic and diastolic functions were assessed by standard echocardiography and
tissue Doppler and measured as the average diastolic excursion rate of the septal and lateral walls at the mitral annulus level in diastole (e’ wave) and systole
(s wave). Left atrial volume index (LAVI) was measured. 2013 ESH / ESC Hypertension Guidelines cutoff values were considered. Tei index was measured at the
lateral and septal walls of the left ventricle in the apical 4-chamber view by tissue Doppler, three measurements of isovolumetric contraction time, ejection time,
and isovolumic relaxation time were averaged and a value > 0.40 was considered
abnormal. Statistical analysis: ANOVA test, p < 0.05 was considered statistically
significant.
Results: The mean sample age was 57.3+14.5 years, 54.2 % p were males. 88
non LVH HBP p; 19 LVH HBP p; and 11 non-HBP controls were included. Table
shows systolic and diastolic left ventricular function results:
Conclusions: In hypertensive patients monotherapy with bisoprolol reduces
initially increased Ees without negative effect on Ea and PAR and switching to
bisoprolol/amlodipine FDC results in additional Ea reduction. Thus the study confirms potential benefits of bisoprolol/amlodipine in arterial hypertension in terms
of cardiovascular functioning.
PP.33.16
Conclusions: 1) abnormal left ventricular function is frequent in HBP p, even in
the absence of LVH; 2) tissue Doppler obtained Tei Index is a useful tool for the
diagnosis of LVD.
PP.33.15
BISOPROLOL/AMLODIPINE FIXED DOSE
COMBINATION EFFECTS ON LEFT VENTRICULARARTERIAL COUPLING IN HYPERTENSIVE PATIENTS
A. Bogomaz, Y. Kotovskaya, Z. Kobalava. Peoples Friendship University of
Russia (PFUR), Moscow, RUSSIA
Objective: To evaluate ventricular-arterial coupling in hypertensive patients after
therapy with a beta-blocker and its fixed dose combination (FDC) with amlodipine.
Design and method: 28 patients (age 53,95 ± 7,2, 20 males, BP 148,7 ±
13,4/96,6 ± 14,1 mmHg, HR 83,2 ± 10,1 bpm) with untreated uncomplicated
hypertension underwent simultaneous EchoCG and blood pressure (BP) acquisition at baseline, after 4 weeks of bisoprolol 5–10 mg monotherapy and after
8 weeks after switching to FDC bisoprolol 5–10/amlodipine 5–10 mg. Doses
were titrated to reach BP < 140/90 mmHg. Arterial elastance (Ea) and LV elastance (Ees) at rest were calculated as end-systolic pressure (ESP)/stroke volume (SV) and ESP/end-systolic volume (ESV). Ventricular-arterial coupling
(VAC) was assessed as Ea/Ees. Mechanical efficiency of left ventricle (ELV)
and peripheral arterial resistance (PAR) were evaluated also. p < 0,05 was considered significant.
Results: After monotherapy with bisoprolol BP was 146,1 ± 15,3/85,3 ± 11,3
mmHg (p > 0,05 vs baseline), HR 59,8 ± 7,7 (p < 0,05 vs baseline), after FDC
132,1 ± 11,3/76,23 ± 11,1 mmHg and 64,54 ± 7,0 bpm, respectively (all p < 0,05
vs baseline). Bisoprolol decreased Ees from 4,45 ± 1,9 to 3,67 ± 0,98 (p < 0,05)
whereas Ea, PAR did not change significantly. Ea/Ees increased significantly from
0,47 ± 0,16 to 0,55 ± 0,14 (p < 0,05). Switching to bisoprolol/amlodipine FDC
resulted in decrease of Ea from 1,88 ± 0,39 at baseline and from 1,92 ± 0,38 after
bisoprolol monotherapy, PAR from 137,1 ± 35,3 at baseline and from 128,9 ±
36, respectively to 105,6 ± 28. Ees did not change from that on bisoprolol, Ea/
Ees (0,45 ± 0,1) returned to baseline values. ELV did not change significantly
throughout a study.
IN RESTRICTIVE CARDIOMYOPATHY CAUSED
BY CARDIAC AL AMYLOIDOSIS A RESTRICTIVE
LV FILLING PATTERN IS ONLY PRESENT IN A
MINORITY OF PATIENTS
R. Mussinelli1, F. Musca2, F. Salinaro1, M. Boldrini1, A. Raimondi1, G. Gioia1,
G. Rizzola1, E. Binot1, T. Perrone3, G. Palladini3, G. Merlini3, S. Perlini1,3.
1Dept. Internal Medicine, IRCCS San Matteo, University of Pavia, Pavia, ITALY,
2Cardiology, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico,
Milano, ITALY, 3Amyloidosis Research and Treatment Center, Dept. Molecular
Medicine, IRCCS Policlinico San Matteo, Pavia, ITALY
Objective: Cardiac amyloidosis is a typical form of restrictive cardiomyopathy,
characterized by severe diastolic dysfunction, associated with preserved ejection
fraction (EF) until the late stage of the disease in the vast majority of patients.
Therefore cardiac amyloidosis patients typically fulfil the definition of heart failure with preserved ejection fraction (HFpEF). A restrictive pattern of transmitral
left ventricular (LV) filling is reported as a typical hallmark of diastolic dysfunction in these patients.
Design and method: To evaluate the extent of diastolic dysfunction in cardiac
light-chain (AL) amyloidosis, 221 consecutive never-treated subjects were evaluated at diagnosis between 2007 and 2010, according to the International Society
of Amyloidosis criteria. Further inclusion criteria were EF > 50%, and the absence
of significant valve disease, previous myocardial infarction, atrial fibrillation, or
chronic obstructive lung disease. The extent of diastolic dysfunction was graded
according to the ESC guidelines. To this aim, transmitral Doppler early (E) and
atrial (A) velocities, E deceleration time, pulmonary venous flow velocity, early
diastolic tissue Doppler peak velocity (E’) and E/E’ ratio were recorded. Survival
was assessed over a median follow-up of 35.8 months (range, 19–60 months).
Results: Unexpectedly, grade III diastolic dysfunction was only present in 82/221
cardiac AL patients (37.1%), grade II and grade I diastolic dysfunction being
evident in 84 (38.0%) and 55 (24.9%) patients, respectively. The extent of amyloid deposit, as assessed by interventricular septal thickness was slightly lower
in grade I than in grade III diastolic dysfunction groups (14.2 ± 2.0 vs.14.7 ±
2.1 mm; p < 0.05). Both left atrial dimensions and estimated systolic pulmonary
pressure progressively increased from grade I to grade III diastolic dysfunction
(p < 0.01 for both). At variance with EF, the grade of diastolic dysfunction was a
significant predictor of survival at a 3-year median follow-up (p < 0.001).
Conclusions: A clear-cut restrictive LV filling is only present in one third of patients with overt cardiac AL amyloidosis, grade I diastolic dysfunction being present in almost one fourth of patients. Despite being an important prognostic factor,
the presence of a restrictive pattern of transmitral LV filling cannot be viewed as a
‘red flag’ diagnostic marker in cardiac AL amyloidosis.
Abstracts e329
POSTER SESSION
SLEEP APNOEA AND NEURAL
MECHANISMS
PP.34.01
NECK CIRCUMFERENCE AND WAIST-HIP RATIO,
INDEPENDENTLY OF BODY MASS INDEX, ARE
MORE RELATED WITH MASKED HYPERTENSION
IN OBESE NORMOTENSIVE INDIVIDUALS WITH
OBSTRUCTIVE SLEEP APNEA
age, BP and BMI (for group 3 and group 4).Cut-off values for detection of vasomotor endothelial dysfunction were: delta PWV < 5,1 (by VaSera), index occlusion amplitude (by Angioscan) < 2,0, the phase shift between the channels before
and after occlusion (by Angioscan) < 10,0.
Results: FMD% (flow-mediated vasodilation) was lower in all groups in comparison with control group, though we didn’t show statistically significant differences
between groups 2, 3 and 4. With delta PWV% were observed just the tendency
for decrease. Index occlusion amplitude was lowest in the group 4, but significant
difference was only in comparison with group 2. The phase shift between the
channels before and after occlusion was lower in groups 3 and 4 in comparison
with group 1; and in group 4 was lower vs group 2.
A. Cunha, R. Gismondi, C. Correa, M. Neves, W. Oigman. Universidade do
Estado Do Rio de Janeiro, Rio de Janeiro, BRAZIL
Objective: Obesity has been associated to development of sleep obstructive apnea
(SOA). At same token, SOA is recognized as secondary cause of arterial hypertension (AH). The aim of this study was to evaluate antropometric parameters and
ambulatory blood pressure associated to SOA in obese normotensive subjects.
Design and method: Obese normotensive (ON) subjects were enrolled in a crosssectional study. Based on apnea-hypopnea index (AHI) obtained with WatchPAT200, a home device for sleep study, patients were divided into the group with
absent/mild OSA (Group 1, AHI < 15) and with moderate/severe OSA (Group 2,
AHI > = 15). All patients were submitted to clinical evaluation and 24-h ambulatory blood pressure monitoring with SpaceLabs 90207.
Results: We studied 81 ON, 21 men and 61 women, mean age 42 ± 6 yo. ON were
divided in 2 groups (G) by apnea-hypopnea index (AHI), G1 < 15/h (n = 55) and
G2 > = 15/h (n = 26). Anthropometrics data: body mass index (BMI) (G1 = 33.9
± 3.2 vs G2 = 33.8 ± 2.9 Kg/m2 p = 0.855), neck circumference (NC) (G1 = 38.0
cm ± 3.3 vs 40.5 ± 3.2 cm p = 0.001) and waist-hip ratio (WHR) (G1 = 0.89 ±
0.01 vs G2 = 0.94 ± 0.01 p = 0.003). Office Systolic (SBP) and Diastolic (DBP)
blood pressure were similar (G1 = 121 ± 8 vs G2 = 123 ± 8 mmHg and G1 = 79
± 8 vs G2 = 77 ± 8 mmHg, p = 0.32). Daytime SBP (G1 = 120 ± 8 vs G2 = 126
± 6 mmHg, p = 0.037), nighttime SBP (110 ± 10 vs 115 ± 7 mmHg, p = 0.036),
daytime DBP (76 ± 7.6 vs 81 ± 8. 5 mmHg p = 0.025) nighttime DBP (66 ± 8
vs 70 ± 7 mmHg p = 0.02) and G2 presented greater nocturne DBP load (45 vs
31%, p = 0.041). In this Obese Normotensive population, AHI presented positive
correlation with NC (r = 0.42, p < 0.001) and with WHR (r = 0.44, p < 0.001).
Conclusions: In this group of obese normotensive individuals, neck circumference and waist-hip ratio were the factors more associated with the presence of
sleep obstructive apnea and masked hypertension, independently of body mass
index. These findings suggest that obese normotensive subjects with increased
neck circumference should be evaluated with ABPM and sleep study.
PP.34.02
ENDOTHELIAL FUNCTION IN MIDDLE-AGED MALE
PATIENTS WITH ARTERIAL HYPERTENSION AND
ADDITIONAL CONFOUNDING FACTORS: OBESITY
AND OBSTRUCTIVE SLEEP APNEA SYNDROME
E. Elfimova, P. Galitsin, M. Tripoten, O. Pogorelova, A. Zairova, A. Litvin,
T. Balakhonova, A. Rogoza, I. Chazova. Russian Cardiology Research and Production Complex, Moscow, RUSSIA
Objective: Arterial hypertension (AH) plays pivotal role in progression of endothelial dysfunction. Obesity and obstructive sleep apnea syndrome (OSAS) are
two conditions also known to decrease endothelial function. The aim of this study
was to explore differences in endothelial function in patients with AH with concomitant obesity and with or without OSAS.
Design and method: In our study we enrolled male patients with AH and 10
healthy volunteers (group 1). Patients were divided into 3 groups: group 2 patients
solely with AH (n = 17) (mean age 32 (28,39–35,61), BP 147,47(145–149,94)/
92,53 (87,72–97,34), BMI 27,06 (23,88–30,24)), group 3 (n = 15) patients with
AH and obesity (mean age 36,67 (31,49–41,85), BP 149,2 (145,31–153,09)/
89,27 (84,49–94,04), BMI 34,84 (32,68–37)), without OSAS (AHI 4,1 (3,58–
4,62)) and group 4 (n = 20) patients with AH, obesity and severe OSAS (mean
age 35,8 (33,01–38,59), BP 149,1 (144,5–153,7)/ 89,5 (85,01–93,99), BMI 35,71
(33,74–37,67), AHI 59,3 (48,66–69,93)). All groups were matched in terms of
Conclusions: In our study we didn’t obtain additional deterioration of endothelial function in patients with AH, obesity and severe OSAS in comparison with
patients with AH and obesity. In terms of microvascular endothelial dysfunction
the presence of severe OSAS led to additional impairment in comparison with
patients solely with AH. Results could be limited to the number of enrolled
patients.
PP.34.03
CIRCADIAN BLOOD PRESSURE PROFILE AND
SLEEP APNEA
M. Rozanska1, P. Talarowska1, A. Segiet1, O. Mozenska1, D.A. Kosior1,2. 1Clinical Department of Cardiology and Hypertension, Central Clinical Hospital of
the Ministry of Interior, Warsaw, POLAND, 2Department of Applied Physiology,
Mossakowski Institute of Experimental and Clinical Medicine, National Academy
of Scien, Warsaw, POLAND
Objective: While asleep, blood pressure (BP) and heart rate (HR) decrease by
approximately 25% from average waking values. The consequent lowering of cardiac load and oxygen demand is substantial for proper cardiac function. Hypertension (HTN) is one of the most common comorbidity in patients with sleep apnea.
Detailed data regarding circadian BP profile (CBPP) and sleep apnea are lacking.
The aim of the study was to characterize the relationship between CBPP and different aspects of sleep apnea.
Design and method: We retrospectively analyzed 1270 patients, treated in our
outpatient sleep apnea clinic. All patients underwent polysomnography. Among
795 patients with diagnosed HTN, 83 patients with detailed data regarding CBPP
obtained from 24-hours arterial BP monitoring were further analysed. We defined
dippers as a 10–20% fall in nocturnal BP, non-dippers as less than 10% and reverse-dippers as 0% at most fall in nocturnal BP. Local ethics committee gave
consent to conduct the study.
Results: In our study population (795 patients) mean age was 60.1 ± 11.4 years,
69.4% were male, 64.9% were smokers, 63% were obese, 65% had hyperlipidemia, 59.9% reported snoring, 83.4% had additional diagnosis of OSA (average
supine AHI 46.8 ± 35.2). Patients with OSA were statistically significantly older
(p = 0.033), were more frequently male (p < 0.001), obese (p < 0.001) and more
often had hyperlipidemia (p < 0.001). In the 83 patients subgroup we further analyzed there were 36,1% dippers, 51,8% non-dippers and 12,0% reverse-dippers.
Those groups did not differ in respect of patients’ general characteristics and
in respect of clinical features of sleep apnea. We found statistically significant:
negative correlations (d-Spearman’s rank correlation coefficient) between average
systolic BP during awake hours and mean duration of obstructive apneas, mixed
apneas and hypopneas (d1 = –0.282, d2 = –0.222, d3 = –0.237; p1 = 0.012, p2 =
0.049 and p3 = 0.036, respectively), positive correlation between average systolic
BP during sleeping hours and supine AHI (d = 0.252; p = 0.024) and positive correlation between average systolic BP during sleeping hours and oxygen distribution on desaturation index/hour (d = 0.222; p = 0.049).
Conclusions: We found significant correlations between different measures of
CBPP and different measures of sleep apnea. Further studies on larger patients’
cohorts are needed to assess the importance of those findings.
M
O
N
D
A
Y
P
O
S
T
E
R
S
PP.34.04
EFFECT OF EPLERENONE ON APNOEAHYPOPNOEA INDEX IN PATIENTS WITH RESISTANT
HYPERTENSION AND OBSTRUCTIVE SLEEP
APNEA
B. Krasinska1, A. Miazga1, S. Cofta2, L. Chichel1, T. Trafas2, Z. Krasinski3,
A. Tykarski1. 1Department of Hypertension, Poznan, POLAND, 2Department of Pulmonology, Poznan, POLAND, 3Department of Vascular Surgery, Poznan, POLAND
Objective: To determine if the addition of eplerenone to the hypotensive treatment reduces the severity of obstructive sleep apnea (OSA) in patients with resistant hypertension and OSA
Design and method: 38 consecutive patients with OSA (25 men and 13 women)
aged 57.76+/–6.16 were referred to Department of Hypertension with diagnosis
of resistant hypertension.Resistant hypertension was defined as uncontrolled hypertension despite the use of at least three hypotensive drugs including diuretics.
Exclusion criteria were: secondary hypertension, myocardial infarction, stroke
within six months before the study, chronic heart failure NYHA III and IV, chronic kidney failure (GFR < 30 ml/min), alcohol or drugs abuse, active cancer.
All subjects underwent following examinations: BP measurement with OMRON
705IT sphygmomanometer – mean value from 3 measurements after 15 min. of
rest was used; 24-hour ambulatory BP monitoring using 2430TM A&D device;
assessment of aortic pulse wave and arterial wall stiffness parameters of the large
conduit arteries measured using applanation tonometry method with SphygmoCorPVx system by a single observer.
In all patients polysomnography was performed using a all-night polysomnographic monitoring system EMBLA S4000, Remlogic with Somnologica studio
3.3.2 software. Apnea was defined as a cessation of airflow lasting for more than
10 sec. After primary evaluation eplerenone 50 mg once daily was added to existing antihypertensive treatment regimen in all subjects. After 3 months all procedures were repeated.
Results: Eplerenone therapy reduced SBP24 h from 144,6+/–9,4 to 135,7+/–4,9
p < 0,05, DBP24 h from 87,8+/–7,9 to 84,1+/–4,9,p < 0,05, MAP24 h from
106,7+/–6,8 to 101,5+/–4,1 p < 0,05, PWV from 15,3+/–1,3 to 12,8+/–2,2 p <
0,05, AoAlx (%) from 31,6+/–4,2 to 27,1+/–4,6 p < 0,05, AlxHR75(%) from
28,4+/–4,2 to 22+/–5,4 p < 0,05, AHI (/h) from 44,5+/–19,9 to 29,5+/–12,9 p <
0,05. There was a significant positive correlation between AHI and SBP24 h 0,487
p = 0,014, AHI and MAP 24 h 0,477p = 0,016 AHI and PWV 0,659 p = 0,003,
AHI and AoAlx 0,436 p = 0,029, AHI and AlxHR75 0,530 p = 0,006.
Conclusions: Treatment with eplerenone reduces severity of obstructive sleep
apnoea in patients with resistant hypertension.
PP.34.05
AMBULATORY SCREENING OF OBSTRUCTIVE
SLEEP APNOEA IN PATIENTS WITH RESISTANT
ARTERIAL HYPERTENSION USING APNEALINK
M. Kamasova1, J. Vaclavik1, T. Vaclavik2, M. Hobzova3, E. Kocianova1.
1Department of Internal Medicine I - Cardiology, Palacky University and University Hospital Olomouc, Olomouc, CZECH REPUBLIC, 2Department of Statistics
and Probability, Faculty of Information Studies, College of economics, Prague,
CZECH REPUBLIC, 3Department of Respiratory Medicine, Palacky University
and University Hospital Olomouc, Olomouc, CZECH REPUBLIC
Objective: Obstructive sleep apnea syndrome (OSAS) is one of the most common
causes of secondary arterial hypertension. In patients with resistant arterial hypertension is important to evaluate patients for presence of OSAS. ApneaLink sleep
study is a simple and economic outpatient method, but its diagnostic yield was not
assessed in patients with resistant arterial hypertension. The aim of this study was
to compare results of ApneaLink sleep study with respiratory polygraphy.
Design and method: Following examinations were performed in patients with
resistant arterial hypertension and OSAS symptoms: physical evaluation, ApneaLink sleep study followed by respiratory polygraphy with assessment of apneahypopnea index (AHI), oxygen desaturation index (ODI), average nocturnal blood
oxygen saturation (SpO2), % of sleep time < 90% SpO2. We have also compared
and correlated severity of OSAS (AHI: mild 5–15, moderate 15–30, severe > 30)
with anthropometric results.
Results: We enrolled 69 patients (43 men) of mean age 58.8 ± 9.3 years. We did
not find any significant difference between AHI values (ApneaLink 30.4 ± 21.7
and polygraphy 37.2 ± 20.9, P = 0.07) and in average nocturnal blood oxygen
saturation (91.3 ± 2.5% vs. 90.9 ± 3.3%, P = 0.22). ODI was significantly lower in
ApneaLink sleep study (32.1 ± 20.2 vs. 43.9 ± 24.8, P = 0.002) and contrary the
% of sleep < 90% SpO2 in ApneaLink was significantly higher (31.8 ± 23.7 vs.
23.3 ± 24.4, P = 0.001). In the evaluation of OSAS severity both methods were in
concordance in 50.7% of patients, in 23.2% ApneaLink underestimated the OSAS
severity and in 26.1% overestimated. We have found a significant correlation be-
tween neck circumference and OSAS severity on polygraphy measured by AHI
(Pearson correlation coefficient r = 0.81), moderate correlation between OSAS severity and Epworth sleepiness scale (r = 0.45) and waist circumference (r = 0.47).
Conclusions: ApneaLink sleep study is a reliable screening method for OSAS in
patients with resistant arterial hypertension, but respiratory polygraphy has to be
perfomed to correctly assess the OSAS severity.
PP.34.06
SEVERE SNORES WITHOUT APNEA AND
UNDERESTIMATED HIGH BLOOD PRESSURE
G. Caruso1, D. Fernandez1, M. Perez1, M. Smurra2, J. Pezzi1. 1Hospital Ramos
Mejia, Buenos Aires, ARGENTINA, 2Hospital Tornu, Buenos Aires, ARGENTINA
Objective: Snoring is the main manifestation of Obstructive Sleep Apnea Syndrome (OSAS) Hypertension (HPB) occurring in this subject is more likely to be
associated with alterations in day to night BP changes. It described an association
between snoring and HBP, but it is known that an important quantity of the snorers does not present apnea. To evaluate ambulatory blood pressure (ABP) pattern
day to night BP changes and their correlation with snoring scale in hypertensive
patients without apnea.
Design and method: 92 male HP were prospectively included (age 52 +- 20 BMI
31+- 5 systolic and diastolic BP 168 +- 23 and 101 +- 8 respectively).
Exclusion criteria: OSAS, antihypertensive or anxiolytic therapy; respiratory
pathologies and smoke or alcohol abuse. All patients were evaluated by Berlin
questionnaires and they were classified according to a scale of snoring in mild,
moderate or severe. All patients underwent ambulatory BP measurement (Space
Labs 90207) and polisomnographic studies (PSG). Pattern dipper was considered
a fall > 10% in medium nocturnal BP (NBP) vs medium diurnal BP (DBP) and
inverse dipper NBP > than DBP. Statistical analysis were performed by Kruskal
Wallis test, chi squared distribution and Spearman correlation. P < 0,05 was considered statistically significant.
Results: ABP pattern showed that 58 HP (63%) had lost the Circadian Rhythm,
and 29 HP, out of these 58 HP, disclosed an inverse dipper pattern. Moreover,
we found a significant diference in 28 severe snoring patients (30.4%) between
nocturnal diastolic BP (NDBP) and office diastolic (ODBP) (P 0.03). A significant correlation was found between severe snoring and nocturnal systolic and
diastolic BP (p 0.01) as well as 24 hour systolic BP (p 0.03). This correlation stays
unaltered even when adjusted by age and BMI. Office BP had no correlation with
severe snoring.
Conclusions: A high incidence of day to night BP changes and a significative
underestimated high NDBP were found in our snoring HT patients without apnea.
We found a significative relationship between severe snoring and ABP, According
to our results, nocturnal blood pressure should be evaluated in non apneic severe
snoring hypertension population.
PP.34.07
DIETARY NITRATE DECREASED BLOOD PRESSURE
PROFILES IN CPAP NAÏVE OBSTRUCTIVE SLEEP
APNOEA SYNDROME: A 2 WEEK, DOUBLEBLIND RANDOMIZED, PLACEBO-CONTROLLED
CROSSOVER TRIAL
C. Kerley, E. Dolan, L. Cormican. Connolly Hospital, Blanchardstown, Dublin,
IRELAND
Objective: To assess the effect of 14d daily nocturnal nitrate (NO3) supplementation compared to matching placebo (PL) among a group of well-characterized, untreated subjects with severe obstructive sleep apnoea syndrome (OSAS) on ambulatory BP, plasma nitrite, exhaled nitric oxide (eNO) and nocturnal pulse oximetry.
Design and method: We recruited 12 with severe OSAS (mean AHI = 74, mean
age = 52y, mean BMI = 31 kg/m2) to this 14d, double-blind, randomized, placebo-controlled, crossover trial. Subjects were tested on three occasions, baseline (day 1), midpoint, (day 15) and endpoint (day 29) – before and after each
intervention period.
Abstracts e331
Results:Conclusions: Daily dietary nitrate for 14d was well-tolerated, safe and
led to increases in plasma nitrite and eNO as ell as decreases in BP profiles, particularly nocturnally.
PP.34.08
PECULIARITIES OF INFLAMMATORY MARKERS IN
MIDDLE-AGED MALE PATIENTS WITH ARTERIAL
HYPERTENSION, OBESITY AND OBSTRUCTIVE
SLEEP APNEA SYNDROME
E. Elfimova, P. Galitsin, A. Rvacheva, A. Litvin, K. Zykov, I. Chazova.
Russian Cardiology Research and Production Complex, Moscow, RUSSIA
Objective: Obesity and obstructive sleep apnea syndrome (OSAS) are the conditions associated with inflammation. The aim of this study was to explore peculiarities in serum levels of inflammation markers in patients with arterial hypertension
(AH) with or without obesity and OSAS.
Design and method: In the study we included 10 healthy volunteers (group 1)
and 52 middle-aged male patients with AH. According to BMI and AHI (apnea/
hypopnea index) patients were divided into 3 groups: group 2 patients solely
with AH (n = 17), group 3 (n = 15) patients with AH and obesity, without OSAS
and group 4 (n = 20) patients with AH, obesity and severe OSAS. Patients were
healthy in terms of chronic heart disease, diabetes mellitus, chronic kidney disease, manifested autoimmune or inflammatory disease. All blood samples were
obtained after initial diagnostics, in the morning, in fasting condition; initially
patients were not on any medication.
Results: Patients were examined for levels of fibrinogen, CRP, hsCRP, IL 6,
sCD40L, IL 1b, IL 2R a, IL 6, TNF a, ICAM and VCAM. Levels of fibrinogen
were higher in group 2 and group 4 vs control group 1. The highest levels of
CRP and hsCRP were detected in group 4: CRP 0,55 (0,26–0,83), hsCRP 4,52
(2,47–6,56), but statistically significant difference was obtained between group 1
and group 2 vs group 4. IL 2R a was the highest in group 3 with high diversity in
levels, and statistically higher in comparison with group 2.
(body-mass index (BMI) of 35,1 [31,8; 37,6] kg/m2) and severe OSA (apneahypopnea index (AHI) - 48,5[40; 60]). Group 2 - included 30 patients with obesity
(BMI of 33,6[32,05; 34,6]) with mild OSAS (AHI of 8[5;12]). And group 3 (normal group) - 20 healthy volunteers without obesity (BMI - 24[22,8;24,85]) and
without OSAS (AHI - 1[0;3]). All patients underwent MRI using 3T scanner with
measurements of the soft palate volume(VSP), tongue volume (VT), fat volume
in the tongue, volume of the lateral walls (VLW) of the RP (retropalatal) and RG
(retroglossal) regions, the area of maximum airway constriction (SmaxCA) at the
level of RP and RG regions.
The pharynx was divided into the following segments: from the hard palate to
the lower edge of the soft palate (level RP - region retropalatal) and from the
lower edge of the soft palate to the bottom of the epiglottis (level RG - region
retroglossal).
Results: Patients with OSAS showed higher values of VT, sm3 - (77,4 [70,9;93,4]
vs. 54,8[48,3;66,2] vs. 44,9[33,9;49,4]), the volume of fat in the tongue,
sm3- (32,8[29,6;36,5] vs. 22,8[20,2;24,5] vs. 13,5[12,2;15,7]),VSP, sm3 –
(8,4[7,4;9,8] vs. 6,4[5,5;7,4] vs. 3,3[2,9;4,1]), VLW RP, sm3 (12,7[10,7;14,8]
vs. 8,3[6,4;10,5] vs. 3,1[2,8;3,7]), VLW RG, sm3 (11,5[9,3;13,7] vs. 7,5[5,8;91]
vs. 2,9[2,4;3,8]), and lower values of SmaxCA at the level of both RP, sm2
(4,6[3,2;6,5] vs. 8,5[6,4;11,4] vs. 12,9[10,4;17,3],) and RG, sm2 (16,9[12,4;2,1]
vs. 21,5[16,9;25,2] vs. 27,3[24,7;30,4].) comparing with the control and normal
groups, p < 0.05 for all comparisons.
Conclusions: Patients with obesity and severe OSA have significantly higher
volumes of soft tissues and lower area of maximum airway constriction in comparison with the patients with mild OSA and obesity. These values can be used
for OSA detection.
PP.34.10
CLINICO-PSYCHOLOGICAL STATUS OF PATIENTS
WITH OBSTRUCTIVE SLEEP APNEA SYNDROME
OF VARYING SEVERITY AND HYPERTENSION
K. Konovalova, A. Litvin, V. Fedorova. Russian Cardiology Research and Production Complex, Hypertension Department, Moscow, RUSSIA
Objective: To determine the clinical and psychological parameters in patients
with obstructive sleep apnea syndrome (OSA) of varying severity and arterial
hypertension (AH).
Conclusions: Obese patients with AH and severe OSAS have elevated levels
of CRP and hsCRP compared to age and BP matched patients with solely AH,
but not with patients with concomitant obesity, suggesting a confounding role of
OSAS together with obesity in promoting inflammation.
PP.34.09
MRI MEASUREMENT OF AIRWAY SOFT TISSUES
PARAMETERS IN PATIENTS WITH OBSTRUCTIVE
SLEEP APNOEA
E. Butorova1, E. Elfimova2, M. Shariya1, A. Litvin2. 1Department of Tomography, A. L. Myasnikov Institute of Clinical Cardiolog Research Center, Moscow,
RUSSIA, 2Department of Hypertension, A. L. Myasnikov Institute of Clinical
Cardiology Research Center, Moscow, RUSSIA
Objective: To compare the size of airway soft tissues parameters measured by
MRI in obese patients with and without obstructive sleep apnea (OSA).
Design and method: We included 74 obese males (mean age 31 to 66 years). All
patients were divided into 3 groups. Group 1 - included 42 patients with obesity
Design and method: The study involved 90 patients with OSA (76 men and 14
women, aged 56 ± 9.5 years) and AH. It included patients of the cardiological
department with high predictive probability of OSA (Stradling questionnaire),
and outpatients. Thus, the following patients were enrolled: 17 patients with mild
OSA (5>apnea/ hypopnea index (AHI) < 15) with a body mass index (BMI) 31.3
± 1.9, 13 patients with moderate of OSA (15>AHI < 30) with a BMI 33.4 ± 2.6,
and 60 patients with severe (AHI>30) and BMI 35.47 ± 2.1. Diagnosis is based
on cardiorespiratory monitoring (Somte Compumedics system, Australia). After
the diagnosis of OSA was confirmed, patients filled questionnaires: WHOQOL,
The Beck Depression Inventory, Spielberger’s State Anxiety Inventory, Epworth
Sleepiness Scale.
Results: A group of overweight or obese patients (14 people) with BMI>25, with
severe daytime sleepiness and high baseline anxiety was singled out during analysis. All 14 people fell into the group of patients with severe OSA. This combination of factors has allowed to split the group with severe OSA into patients with
a combination of these factors (14) and into patients without the combination of
these factors (46). Using the Mann-Whitney test has revealed a statistically significant difference in the distribution of the following symptoms: AHI, desaturation
index, the minimum saturation, anxiety, drowsiness. A group of 14 people had a
higher AHI compared to a group of 46 people (63 ± 20.8 and 46 ± 18.5 resp.; p
< 0.05), a higher index of desaturation (60 ± 19.6 and 45 ± 20.5 resp.; p < 0,05),
a lower minimum saturation index (66 ± 8.5 and 73 ± 9.7 resp.; p < 0.05). Also
higher level of anxiety (49.5 ± 3.4 and 46.1 ± 5.9 resp .; p < 0.05) and higher levels
of sleepiness (12.7 ± 5 and 7 ± 3 7 resp.; p < 0.05) were found.
Conclusions: The presence of a combination of known factors, such as excessive
weight and severe daytime sleepiness, along with high levels of anxiety, suggests
more severe OSA progression.
e332 Abstracts
POSTER SESSION
M
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RENIN-ANGIOTENSIN-ALDOSTERONE
SYSTEM
PP.35.01
ATRAP, A NOVEL INTERACTING MOLECULE
WITH AT1 RECEPTOR, INHIBITS ANG II INDUCED
PROLIFERATIVE ACTIVITY AND OXIDATIVE STRESS
IN RAT SMOOTH MUSCLE CELLS
K. Azuma1, K. Tamura2, T. Taira3, H. Wakui2, K. Uneda2. 1Asamizo jin clinic,
Sagamihara, JAPAN, 2Yokohama city university graduate school of medicine, Yokohama, JAPAN, 3Aobadai jin clinic, Yokohama, JAPAN
Objective: Ang II influenses the structure and function of vascular smooth muscle
cells, and plays an important role in reactive oxygen species production. Superoxide anions are recognized as mediators of intracellular signaling cascades and
are known to participate in cardiovascular diseases such as arteriosclerosis and
hypertension.
Previous studies reported that the production of superoxide is modulated by many
factors including Ang II - AT1 receptor signaling. One of the major sources of
superoxide in the aorta is NADPH oxidase located in the smooth muscle cells.
The NADPH oxidase complex consists of p22phox, Rac1, and Nox1 etc. With
respect to AT1 receptor signaling, the carboxy-terminal cytoplasmic domain of
AT1 receptor is involved in the control of receptor internalization and in linking receptor-mediated signal transduction to the specific biological response. We
cloned a novel molecule interacting with carboxy-terminal domain of AT1 receptor, which we named ATRAP (for AT1 receptor-associated protein), using the
yeast two-hybrid strategy. In this study, we tested the hypothesis that vascular
smooth muscle cells express ATRAP and that ATRAP attenuates Ang II-induced
proliferative activity and oxidative stress in vascular smooth muscle cells.
Design and method: We used rat smooth muscle cells and used adenoviral gene
transfer for ATRAP overexpression. We used real time PCR,ELISA of TGFb,p22phox,Rac1,Nox1 and BrdU incorporation assay for cell proliferation.
Results: We identified that the ATRAP mRNA and protein were endogeneously
expressed in VSMC, and found a colocalization of ATRAP and AT1 receptor in
Ang II-stimulated VSMC. The results of gain-of-function studies by adenoviral
gene transfer demonstrated that overexpression of ATRAP significantly inhibited
Ang II-mediated increases in c-fos gene transcription, BrdU incorpoaration, and
mRNAs expression of NADPH oxidase complex (p < 0.05, n = 6).
Conclusions: These results indicate that ATRAP significantly attenuates Ang
II-mediated proliferative activity and oxidative stress in vascular smooth muscle
cells, and suggests a novel strategy to inhibit cardiovascular disease such as arteriosclerosis and hypertension.
PP.35.02
EFFECT OF ANGIOTENSIN RECEPTOR
STIMULATION IN THE ROSTRAL VENTROLATERAL
MEDULLA ON BLOOD PRESSURE IN
NORMOTENSIVE RATS: INTERACTION WITH
GLUTAMATE AND GAMMA-AMINOBUTYRIC ACID
L. Legat1, S. Brouwers1, I. Smolders2, A.D. Dupont1. 1Vrije Universiteit Brussel
- Department of Pharmacology, Brussel, BELGIUM, 2Vrije Universiteit Brussel Center for Neurosciences (C4N), Brussel, BELGIUM
Objective: There is increasing evidence that glutamate and gamma-aminobutyric
acid (GABA) interact within the rostral ventrolateral medulla (RVLM) modulating the central regulation of blood pressure and sympathetic tone. Angiotensin
II (Ang II) is the most important effector in the renin-angiotensin-aldosterone
system (RAAS) mediating its actions through the angiotensin II type 1 receptor
(AT1R) and angiotensin II type 2 receptor (AT2R). The AT2R is part of the protective arm of the RAAS and mediates opposing effects counterbalancing the AT1R
mediated actions. The selective and specific AT2R agonist Compound 21 (C21) is
a useful research tool to investigate the AT2R mediated effects.
Design and method: In the present study we assess through local stimulation and
blockade of AT1R and AT2R the possible role of the brain RAAS at the level of
the RVLM on the regulation of blood pressure. In vivo microdialysis, for measurement of extracellular glutamate and GABA levels, was carried out in the RVLM
of conscious normotensive Wistar rats while locally infusing C21, Ang II, and
PD123319. Glutamate and GABA levels were quantified by HPLC. Subsequently,
the effect of central administration of C21, Ang II, and PD123319 on mean arterial pressure was assessed with a pressure transducer for continuous monitoring.
Results: Infusion of Ang II into the RVLM significantly increased glutamate
levels (P < 0.05) and significantly decreased GABA levels (P < 0.01). Infusion of the AT2R agonist C21 (0.05 mg/ml/h) tended to decrease glutamate and
increase GABA levels, while absolutely no change was seen when co-infusing
C21 together with the AT2 receptor antagonist PD123319. C21 infusion (0.05
mg/ml/h) significantly lowered blood pressure (P < 0.01). These responses
were abolished by co-administration of C21 and PD123319. No changes in
neurotransmitter levels or effects on blood pressure were seen with PD123319
infusion alone.
Conclusions: These data demonstrate that acute specific stimulation of AT2R in
the RVLM by local C21 infusion reduces blood pressure in normotensive rats, and
suggests that decreases in local glutamate and increases in GABA levels may be
involved in the sympatho-inhibitory action underlying this hypotensive response.
PP.35.03
ALDOSTERONE, RENIN AND THE ALDOSTERONETO-RENIN-RATIO: AGE- AND SEX-SPECIFIC
DISTRIBUTION AND DETERMINATS IN THE
POPULATION
M.I. Hermanns1, S. Matheis1, N. Arnold2, J.H. Prochaska1,2, M. Panova-Noeva1,
A. Schulz3, D. Laubert-Reh3, K.J. Lackner4, T. Münzel2,5, P.S. Wild1,3,5. 1University Medical Center, JGU Mainz, Center for Thrombosis and Hemostasis (CTH),
Mainz, GERMANY, 2University Medical Center, JGU Mainz, Center of Cardiology I, Mainz, GERMANY, 3University Medical Center, JGU Mainz, Preventive
Cardiology and Preventive Medicine, Center of Cardiology, Mainz, GERMANY,
4University Medical Center, JGU Mainz, Institute for Clinical Chemistry and
Laboratory Medicine, Mainz, GERMANY, 5German Center for Cardiovascular
Research (DZHK), Partner Site Rhein-Main, Mainz, GERMANY
Objective: Renin-angiotensin-aldosterone system (RAAS) plays a key role in the
regulation of human blood pressure. Recent investigations have demonstrated that
both a higher aldosterone concentration and a higher aldosterone-to-renin-ratio
serve as markers of increased risk for hypertension. However, the distribution
of the aldosterone-to-renin-ratio in the general population is largely unknown.
We aimed to provide a sex-specific distribution and reference ranges for plasma
aldosterone concentration (PAC), plasma renin concentration (PRC) and its ratio
in a large population-based sample.
Design and method: PAC and PRC were analyzed by chemiluminescent immunoassay (CLIA) (LIAISONâ, DiaSorin) in a sample of 7,474 (50.7%) men
and 7,266 (49.3%) women from the population-based Gutenberg Health Study in
Germany. Multivariable regression analyses for PAC, PRC and the aldosterone-todirect-renin-ratio (ADRR) were performed under adjustment for age, medication,
cardiovascular risk factors (CVRFs) and cardiovascular disease (CVD). Biomarkers and the ratio were log-transformed. Reference subgroups were selected by
excluding hypokalemia, CVRFs, CVD, renal insufficiency, and intake of analyte
modifying drugs. The reference interval was defined as the central 95% range
between the 2.5th and 97.5th percentiles.
Results: Results showed sex differences in PAC, PRC and ADRR with lower PRC
and higher PAC and ADRR in females than in males. PRC decreased with age
in males and females whereas PAC decreased was significant in females only.
The ADRR increased with age (blog(ADRR) per 5y: 0.08 [95% CI: 0.06/0.09])
and 0.06 [0.05/0.08] for men and women, resp.; p < 0.0001). Thus, age- and sexspecific nomograms for PAC, PRC, and ADRR were created by quantile regression. In multivariable analysis, PAC was positively associated with obesity and
dyslipidemia. Both, PAC and PRC were elevated for chronic kidney disease, while
the ADRR showed no association. In a fully adjusted multivariable model, the
strongest correlation observed was found for hypertension with elevated ADRR
in both sexes.
Conclusions: Based on a large population-based data set, the present investigation provides a comprehensive characterization of the distribution and reference
ranges for PAC, PRC and the ADRR in a predominantly Caucasian sample. Ageand sex-related limits of PAC, PRC, and the ADRR could support clinicians in
diagnosis and treatment of hypertension.
Abstracts e333
PP.35.04
MALIGNANT HYPERTENSION: A FRENCH COHORT
STUDY
S. Rubin1, A. Cremer2, P. Gosse2. 1Renal Unit, Pellegrin Hospital, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, FRANCE, 2Hypertension and
Cardiology, Saint André Hospital, Centre Hospitalier Universitaire de Bordeaux,
Bordeaux, FRANCE
Objective: The European Society of Hypertension defines malignant hypertension (MHT) as the «presence of very high blood pressure (BP) associated with
ischemic organ failure (retina, kidney, heart or brain)». The aim of this study was
to describe the biggest French cohort and study prognostic factors for End Stage
Renal Disease (ESRD), major cardiovascular events and deaths.
Design and method: This retrospective study was performed in Bordeaux –
France – from 1995 to 2015.
Results: One hundred and twenty fours patients with MHT (67.7 % males, mean
age 46 years, average baseline BP = 206/118mmHg) were included. Median follow-up was 60 months. All patients were treated using at least a renin-angiotensin
system blocker. Retinal impairment was found in 87% of subject (papilloedema
in 60%). Heart involvement was found in 82%: important left ventricular hypertrophy (average left ventricular mass index was 87 g/m2,7 ± 29,36) and systolic
dysfunction better assessed with global longitudinal strain (GLS) often severely
impaired (mean GLS was 12.99 % ± 4.22). ECG showed abnormal repolarisation
in 60%. Starting 2005, all patients had brain Magnetic Resonance Imaging (MRI);
69% showed a Posterior Regressive Encephalopathy Syndrome, asymptomatic
most of the time. Creatinine level was > 150 mmol/l for 38% of our patients at
admission. Proteinuria was low (mean Proteinuria/Creatinuria 78.1 mg/mmol ±
116.5). Renal function decreased for 17% of them during the follow-up. The incidence of ESRD or death was 12.41 % at 5 years, 27.33 % at 10 years and 43.48 %
at 15 years. Patients without retinal anomalies were not different from the others.
In a cox model, age (HR 1.005; p: 0.027) and creatinine level at discharge (HR:
1.0046; p: 0.01) were significantly associated to primary end-point.
Conclusions: These results show that retinal, cardiac and brain damages are very
frequent in case of MHT. Age and creatinine level at discharge are significant
prognostic factors. Retinal anomalies are not mandatory to the diagnosis of this
acute hypertension with multi organ damage (hypertension-MOD). Brain MRI
and echocardiography should be systematically performed in these patients to better characterize organ dysfunction as MHT is really a systemic disease.
PP.35.05
RENAL DENERVATION ATTENUATES
CARDIOVASCULAR INFLAMMATION AND
REMODELING IN ANGIOTENSIN II-INDUCED
HYPERTENSIVE RATS
M. Hong, X. Li, P. Gao. Shanghai Institute of Hypertension, Ruijin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, CHINA
Objective: Chronic infusion of angiotensin II (AngII) in experimental animals
contributes to hypertension. However, it is uncertain whether the sympathetic nervous system (SNS) plays an important role in this form of hypertension. In this
study, we hypothesized that renal denervation (RDN) inhibits angiotensin II (Ang
II)-induced cardiovascular inflammation and remodeling.
Design and method: Male Sprague-Dawley rats weighing between 300 and 350
g were divided into four groups: SHAM group; RDN group; Ang II group; Ang
II + RDN group. Blood pressure was measured invasively by telemetry and noninvasively by tail cuff method. Cardiac hypertrophy and function were evaluated
by echocardiography. Hearts and aortas were obtained at 14 days to perform western blotting and immunohistochemistry.
Results: Efficacy of RDN was confirmed by reduction of renal tyrosine hydroxylase expression and norepinephrine levels at two weeks after the procedure. RDN
ameliorated the blood pressure elevation and the mesenteric vascular dysfunction
induced by Ang II. Ang II caused vascular and cardiac hypertrophy was significantly blunted by RDN compared with sham-operated group, as shown by histopathology and transthoracic echocardiography, respectively. Ang II induction
of vascular and myocardial fibrosis and inflammation was suppressed by RDN
with concurrent decrease in fibronectin and collagen deposition, macrophage infiltration and MCP-1 expression. Transforming growth factor-b (TGF-b)/Smad
signaling pathway and extracellular signal-regulated kinases (ERK) 1/2 were both
inhibited by RDN especially in hearts. Most importantly, RDN reduced Ang IIinduced aldosterone expression in systemic and local tissues, while tissue levels
of norepinephrine were similar among the four groups.
Conclusions: These results demonstrate that renal denervation attenuates cardiovascular inflammation and remodeling in Ang II-induced hypertensive models,
which is likely mediated by both the systemic and local renin-angiotensin system.
PP.35.06
HYPOVOLEMIC RENIN-ALDOSTERONE AXIS
DEFICIENCY WITHOUT HYPERKALEMIA
FOLLOWING UNILATERAL ADRENALECTOMY FOR
PRIMARY ALDOSTERONISM
M. Vallet2, A. Martin2, E. Huyghe3, J. Amar1, B. Chamontin1, I. Tack2,
B. Bouhanick1. 1Chu Rangueil Service de Medecine Interne et HTA, Toulouse,
FRANCE, 2Chu Rangueil Service d’Explorations Fonctionnelles Physiologiques,
Toulouse, FRANCE, 3Chu Rangueil Service d’Urologie, Toulouse, FRANCE
Objective: Aldosterone-producing adenoma is classically treated by unilateral
adrenalectomy. Severe hyperkalemia, related to hypoaldosteronism, have been
already reported after surgery. We hereby describe six male patients exhibiting
prolonged failure of the renin-aldosterone (RA) axis, in association with normalto-high kalemia or labile blood pressure and, most significantly, decrease in extracellular fluid volume (ECFV).
Design and method: Primary aldosteronism diagnosis was established according
to French recommendations. Unilateral adrenalectomy was performed in all. Postoperative explorations included ECFV measurement using inulin, and RA axis
functionally tests by orthostatic and ACTH stimulation.
Results: A decrease in ECFV with inappropriately low renin level, and insufficient orthostatism-induced aldosterone production were depicted. The ACTH
test demonstrated no glucocorticoid deficiency, along with responsive aldosterone
secretion. The discrepancy in aldosterone response in orthostatic position versus
ACTH stimulation test suggested that hypoaldosteronism primarily results from
the lack of angiotensin 2 stimulation as a result of hyporeninism.
Conclusions: Following unilateral adrenalectomy for primary aldosteronism, the
occurrence of normal-to-high kalemia prompted an evaluation of the RA system
using orthostatic stimulation test rather than simply measuring baseline values
and evaluating the glucocorticoid axis. When confirmed, RA axis depression
causes latent hypovolemia, meaning that all treatment likely to further decrease
plasma volume should be avoided, while this may at times require mineralocorticoid substitution.
PP.35.07
PLASMA RENIN ACTIVITY/PLASMA ALDOSTERONE
CONCENTRATION RATIO: A USEFUL TOOL IN
EVALUATING THE CLINICAL EFFECTIVENESS OF
HIGH BLOOD PRESSURE TREATMENT BASED ON
ACEI OR ARB
F. Giulietti, F. Spannella, E. Borioni, F.E. Lombardi, L. Landi, E. Espinosa,
R. Sarzani. Internal Medicine and Geriatrics, IRCCS-INRCA, Hypertension Excellence Centre of the ESH, UNIVPM, Ancona, ITALY
Objective: ACE inhibitors and angiotensin receptor blockers (ARB) are considered cornerstones of anti-hypertensive therapy. These drugs modulate the reninangiotensin system (RAS) leading to an increase in plasma renin activity (PRA)
together with a reduction of plasma aldosterone concentration (PAC), proportional
to the pharmacological effect. Aim: to evaluate the efficacy of stable therapies
based on ACEI or ARB, using PRA / PAC ratio values in real-life clinical-practice.
Design and method: We studied 184 essential hypertensives (59.2 ± 11.9 years,
63% males) in stable treatment for at least three months with an ACEI or ARB
as part of the treatment. PRA was expressed as ng/ml and PAC as ng/dl, then the
ratio was multiplied by 100. Tertiles of PRA/PAC ratio were considered for the
analysis. ABPM was performed to evaluate the blood pressure (BP) control.
Results: A significant linear correlation was present between the increase of PRA/
PAC ratio and the reduction of BP values. Tertiles of PRA/PAC: 1st 0.2 to 5.7;
2nd 5.9 to 28.4; 3rd 29.4 to 509.8. There was no difference by age, sex, BMI and
eGFR between PRA/PAC tertiles. A significant reduction in 24hour, daytime and
night-time BP values was associated with increasing PRA/PAC tertiles (all p <
0.05). An increase of PRA/PAC tertiles was associated with a higher prevalence
of controlled patients during the night-time period (1st: 14.5%; 2nd: 43.3%; 3rd:
45.9%; p < 0.001 for trend). PRA/PAC ratio was also a predictor of night-time BP
control, as shown by ROC curve (AUC: 0.664, 95% CI: 0.582–0.745; p < 0.001).
Conclusions: An increasing PRA/PAC ratio reflects reduced values of PAC despite
higher values of PRA as expression of a more effective RAS blockade by ACEI or
ARB. These findings are associated with lower BP values and better BP control,
especially in night-time period, highlighting the effectiveness and compliance to
the anti-hypertensive therapy with ACEI or ARB. Therefore, PRA/PAC ratio may
be not only a useful biomarker of effective treatment based on ACEI or ARB, but
also can be used as indirect index of drug intake and therapy compliance.
PP.35.08
CEREBRAL AT2 RECEPTOR-INTERACTING
PROTEIN ENHANCES PROTECTIVE EFFECTS OF
AT2 RECEPTOR STIMULATION ON ISCHEMIC
BRAIN DAMAGE
J. Iwanami, M. Mogi, X.L. Wang, K. Tsukuda, A. Higaki, M. Kukida,
H. Nakaoka, T. Yamauchi, H.Y. Bai, B.S. Shan, L.J. Min, M. Horiuchi. Ehime
University, Graduate School of Medicine, Tohon, Ehime, JAPAN
Objective: We previously reported that the ischemic brain area was significantly larger in angiotensin II type 2 (AT2) receptor-deficient mice after
middle cerebral artery (MCA) occlusion compared to wild-type (WT) mice.
We have cloned ATIP (AT2 receptor interacting protein) as a protein interacting specifically with the C-terminal tail of the AT2 receptor, and suggest that
ATIP might play key roles in diverse mechanisms of AT2 receptor signaling.
We investigated the possibility that ATIP could enhance the protective effects
compound 21 (C21), a selective non-peptidic AT2 receptor agonist, on focal
cerebral ischemia.
Design and method: Ten week-old male ATIP1-transgenic (ATIP1-Tg) and littermate (WT) mice were subjected to (MCA) occlusion with silicon-coated microfilament. C21 (10 mg/kg/day) was administered 2 weeks before MCA occlusion.
Twenty-four hours after MCA occlusion, ischemic area was assessed by triphenylterazolium chloride staining. Neurological deficit after MCA occlusion was
evaluated using a neurological score. Cerebral blood flow (CBF) was measured by
laser speckle flowmetry. Expression of inflammatory cytokines and methyl methanesulfonate sensitive 2 (MMS2) as a neuroprotective factor were measured by
real-time RT-PCR.
Results: Administration of C21 did not influence the blood pressure measured by tail-cuff method. There was no significant difference in ischemic
size without C21 treatment between WT and ATIP-Tg mice. Treatment with
C21 decreased ischemic size and improved neurological deficit in both strains.
These protective effects by C21 were more marked in ATIP-Tg mice compared
with WT mice. Administration of C21 did not affect CBF in the core region
of ischemic area after MCA occlusion in both strains; however, the reduction
of CBF in penumbra region was markedly attenuated in ATIP-Tg mice treated
with C21. MMS2 tended to increase in ATIP1-Tg mice compared with WT
mice. Expression of inflammatory cytokines such as TNF-a and MCP-1 was
increased in ipsilateral hemisphere compared with in contralateral hemisphere.
Treatment of C21 tended to reduce inflammatory cytokine expression in ipsilateral hemisphere.
Conclusions: These results suggested that ATIP1 could enhance the cerebral protective effects of AT2 receptor stimulation at least in part due to the improvement
of CBF.
PP.35.09
THE ENZYMATIC AND ENDOCRINE PATTERN
IN PATIENTS WITH CONTROLED ESSENTIAL
HYPERTENSION
A. Vintila1, V. Vintila2, C. Tudorica3, S. Tudorica4, C. Serbanete3, A. Gurghean1.
Davila University of Medicine and Pharmacy, Coltea Clinical Hospital,
Department of Internal Medicine, Bucharest, ROMANIA, 2Carol Davila University of Medicine and Pharmacy, University Emergency Hospital, Department of
Cardiology, Bucharest, ROMANIA, 3Coltea Clinical Hospital, Department of Internal Medicine, Bucharest, ROMANIA, 4CMI Tudorica Steluta, Bucharest, ROMANIA
1Carol
Objective: To assess the influence of an altered aldosterone, renin, angiotensin
(ARA), cortisol and thyroid hormone pattern on the clinical course of high blood
pressure subjects and the effect of medical treatment on this pattern.
Design and method: We have studied a group of 110 patients with controlled
essential hypertension examined in the last two years; the subjects have been
hypertensive for at least 3 years; the HBP duration ranged from 3 to 33 years
(average duration 9.6 years). We recorded family history of cardiovascular diseases, smoking status, socio-professional stress, comorbidities, clinical course,
medication and blood test results for the endocrine and enzymatic pattern of the
subjects (plasma cortisol, TSH, aldosterone, renin and angiotensin converting
enzyme). All patients have also been explored by standard echocardiography,
ECG and had the usual blood tests performed (e.g. glycaemia, lipid profile, serum creatinine etc.)
Results: Group characteristics: mean age 57.3 +/– 12.7 years, males 56.4%,
smokers 33.6%, obesity 41.8%, dyslipidemia 48.2%, IHD 33.6%, type 2 DM
23.6%, HF 28.2%, cerebrovascular disease 13.6%, atrial fibrillation 8.2%. Main
blood test results: cortisol 19.2 +/– 7.4 mg/dl; TSH 2.8 +/– 1.7 mIU/l; aldosterone
17.5 +/– 7.9 ng/dl; renin 62.7 +/– 31.4 mIU/ml; ACE 30.6 +/– 15.6 IU/l. Cortisol
and TSH pattern were frequently altered in subjects with socio-professional stress
or by medication. Clinical course was mainly influenced by associated cardiovascular pathology and other major comorbidities (e.g. DM). Neither the ARA pattern was significantly influenced by ACEI and ARB treatment, nor did high ARA
pattern change the clinical course of the controlled high blood pressure patients.
We found a relatively important correlation between high ARA values and the
presence of family history for cardiovascular events together with young age at
the moment of hypertension diagnosis.
Conclusions: The enzymatic and endocrine pattern is frequently altered in essential hypertension. Despite this, patients can achieve good blood pressure control
through medical treatment according to guidelines. Family history of cardiovascular events and young age at the diagnosis of hypertension have an impact on ARA
pattern, which might be considered for tailoring treatment.
Abstracts e335
POSTER SESSION
ENDOTHELIUM AND ATHEROSCLEROSIS
PP.36.01
Results: cIMT and aPWV were higher, and eGFR lower, in uppermost SUA-tertile patients when compared to those in the lowest ones (all p < 0.001) (Figure 1).
P
O
S
T
E
R
S
TRADITIONAL CARDIOVASCULAR RISK FACTORS
ARE MAJOR FACTORS IN ACCELERATION OF
ATHEROSCLEROSIS IN ARTHRITIS PATIENTS
A. Dalbeni1, M. Mazzon1, G. Orsolini2, A. Giollo2, G. Cioffi3, F. Ognibeni3,
M. Rossini2, C. Fava1, O. Viapiana2. 1Division of Internal Medicine, Department
of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Ver,
Verona, ITALY, 2Division of Rheumatology, Department of Medicine, University
and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, ITALY, 3Department of Cardiology, Villa Bianca Hospital, Trento, ITALY
Objective: Patients with chronic inflammatory arthropathy have an increased
incidence of cardiovascular events (CV) due to acceleration of atherosclerosis.
The echo-color Doppler examination of the carotid arteries can be useful in
detection of pre-clinical atherosclerosis, such as intimal-medial thickness (IMT)
and carotid segmental distensibility (DC), indices of subclinical atherosclerosis.
As a whole the echo-color Doppler of the carotid arteries could allow a better
stratification of cardiovascular risk in patients with chronic arthritis and may
have immediate clinical utility. The aim of the study was to evaluate in a group
of patients with rheumatoid arthritis prevalence of atherosclerotic plaques, and
the values of carotid DC and IMT, comparing them with a population of healthy
subjects.
Design and method: The series consists of 219 subjects, including 163 patients
with arthritis and 56 healthy volunteers, who did not have a history of CV events.
All subjects were enrolled at the operating unit complex of Rheumatology of Verona in the period from March 2014 to October 2015. The patients were examined
by echo-color Doppler of the carotid arteries to detect atheromatous plaques and
the values of carotid IMT and DC.
Results: Patients with rheumatoid arthritis don’t showed a IMT significantly increased compared to the population of healthy subjects (mean ± SD patients vs.
controls 0,78 ± 0.20 s 0,73 ± 0,19, p = 0.074) but have an increased frequency of
carotid plaques than controls (37% vs 20%; p = 0.020). No differences were found
for DC in the two groups.The association have however shown that the differences
are due primarily to age and traditional cardiovascular risk factors rather than to
inflammation, disease state or anti-inflammatory drugs.
Conclusions: Our study found the association between arthritis and chronic
subclinical atherosclerosis emphasizing that the classic cardiovascular risk factors, potentially present in higher prevalence in this population, are major factors in the acceleration of this process. In patients with chronic arthritis it’s
fundamental to be aggressive in identifying these factors to counteract quickly
and effectively their deleterious effects on the cardiovascular system.
PP.36.02
ASSOCIATION BETWEEN URIC ACID AND RENAL
FUNCTION IN HYPERTENSIVE PATIENTS: WHICH
ROLE FOR SYSTEMIC VASCULAR INVOLVEMENT?
G. Geraci, G. Mulè, M. Morreale, D. Altieri, M.G. Vario, C. Geraci,
M. Mogavero, S. Cottone. Dipartimento di Medicina Interna e Specialistica,
Palermo, ITALY
Objective: The role of systemic vascular involvement in mediating the association between serum uric acid (SUA) and renal function in hypertension and chronic kidney disease (CKD) has not been fully explored. The purposes of our study
were: (1) to investigate the relationship between SUA with both carotid intimamedia thickness (cIMT) and aortic pulse wave velocity (aPWV) in hypertensive
subjects; (2) to assess the influence of renal function on these relationships; (3)
to study whether systemic vascular changes may mediate the association between
SUA and renal function in this population.
Design and method: We enrolled 523 hypertensive subjects with (n = 263) or
without CKD (n = 260). The study was also conducted in the population divided
into tertiles of SUA based on sex-specific cut-off values. cIMT was assessed by
Duplex-Doppler ultrasonography and aPWV through oscillometric device.
M
O
N
D
A
Y
Uricemia strongly correlated with eGFR, cIMT and aPWV at univariate analysis
(p < 0.001) in all subjects, and with eGFR and cIMT after adjustment for confounders (p < 0.001). The relationships between SUA and cIMT were significant
in both patients with or without CKD, in absence of significant differences between groups. Moreover, the adjustment of SUA for cIMT attenuated the relationship between SUA and eGFR (p = 0.019).
Conclusions: Systemic vascular changes related with SUA seem in part to mediate the association between SUA and renal function in hypertensive patients,
regardless of kidney function.
PP.36.03
REFERENCE VALUES FOR LOCAL ONE-POINT
CAROTID STIFFNESS IN A LARGE HEALTHY
POPULATION
S. Favretto1, S. Carerj2, J. Jaroch3, K. Loboz-Grudzien3, F. Antonini-Canterin4,
C. Zito2, E. Bossone5, M. Pirisi1, O. Vriz6. 1University of Eastern Piedmont,
Novara, ITALY, 2University of Messina, Messina, ITALY, 3T. Marciniak Hospital, Wroclaw, POLAND, 4Santa Maria degli Angeli Hospital, Pordenone, ITALY,
5University Hospital Scuola Medica Salernitana, Salerno, ITALY, 6Sant’Antonio
Hospital, San Daniele del Friuli, ITALY
Objective: Echo-tracking derived measures of arterial stiffness, implemented in a
echo-machine, allow the assessment of local arterial stiffness [Beta stiffness (B),
pressure-strain elasticity modulus (EP) and arterial compliance (AC)] deriving
the pressure–diameter curve of the artery and calculating the local pulse wave
velocity (PWV) from the time delay between the two adjacent distension. Clinical
studies have demonstrated that parameters of local arterial stiffness can predict
cardiovascular mortality. The aim of the present study was to evaluate carotid
arterial stiffness obtained by echo-tracking system in a healthy population and to
investigate clinical correlates as there are no reference values available yet.
Results: A significant correlation was found between stiffness parameters and
age in both genders demonstrating an increase in EP, B and PWV and a downward trend in AC with ageing (males: B stiffness r = 0.655; EP r = 0.69; AC r =
–0.59; PWV r = 0.74 p < 0.0001. Females: B stiffness r = 0.66; EP r = 0.71; AC r
= –0.58; PWV r = 0.74, p < 0.0001). Nevertheless we found significantly higher
stiffness values (and lower AC) in females. The subjects were then divided into 9
age groups (ages: 2–11, 12–19, 20–29, 30–39, 40–49, 50–59, 60–69, 70–79 and
over 80) and stratified by gender. Within the single groups, stiffness was not different between gender except AC which was lower in females. In a multivariate
model, carotid stiffness were constantly and independently associated with age,
gender, mean blood pressure, pulse pressure, heart rate and body surface area.
Conclusions: The results of the present study have been used to produce reference
values of carotid stiffness parameters obtained by echo-tracking system in a large
healthy population.
PP.36.04
THE RELATIONSHIP BETWEEN VARIOUS METHODS
OF CARDIOVASCULAR RISK ASSESSMENT
AND NON-INVASIVE ENDOTHELIAL FUNCTION
MEASURES
G. Wilk1, G. Osmenda1, M. Nowak1, D. Rajch2, T. Sliwa1, J. Maciag1,
M. Czesnikiewicz-Guzik3, T. Guzik1. 1Department of Internal and Agricultural
Medicine, Joseph Dietl Hospital, Jagiellonian University Medical College, Cracow, POLAND, 2Department of Cardiology, Edward Szczeklik Hospital, Tarnow,
POLAND, 3Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Cracow, POLAND
Objective: There are several clinical scoring systems for cardiovascular risk. It is
however not clear how individual risk scoring systems are related to endothelial
dysfunction, which is known to underlie the pathogenesis of the disease. Accordingly, we aimed to analyse the relationship between several, independent measures
of vascular dysfunction and various scores of cardiovascular risk in a primary
prevention population.
Design and method: The group of 170 subjects, with a negative history of cardiovascular disease were examined. The mean age was 57.3 ± 6.9; 84 (49.4%) were
men. Cardiovascular risk was independently estimated using the following risk
scales: FRAMINGHAM 2008, SCORE, ASCVD, PROCAM and QRISK. Endothelial function was assessed by: Flow Mediated Dilation (FMD) and Nitroglycerin-Mediated Dilatation (bNMD) of the brachial artery; measurement of reactive
hyperaemia using Peripheral Arterial Tonometry (RH-PAT) with Endo-PAT 2000®
device and by assessment of Pulse Wave Velocity (PWV) using SphygmoCor
EM3. Carotid artery Intima Media Thickness (IMT) was measured as a measure
of sub-clinical atherosclerosis.
Results: Classical risk score calculators were correlated with most endothelial
function measures apart from RH-PAT, which was significantly related only to
FRAMINGAM Score. Classical flow mediated dilatation showed greatest degree
of correlation and FRAMINGHAM and SCORE appear to represent endothelial
function status (Table 1).
Conclusions: Brachial FMD appears to provide greatest degree of relation to cardiovascular risk scales. FRAMINGHAM and SCORE are most related to indices
of vascular function.
PP.36.05
Design and method: 1092 healthy subjects aged 2–92 years (586 male, 506 female) were enrolled from 3 European centers. Local arterial stiffness was evaluated at the level of the left CCA 1 to 2 cm before its bifurcation using a highdefinition echo-tracking ultrasound (Hitachi Aloka Inc). Stiffness indices were
derived from measurement of arterial diameters and brachial artery pressure.
Statistical models were developed to describe relationships with age, and nomograms plotted to obtain median values.
EXPRESSION AND CHANGE IN MIRS 145, 221 AND
222 EXPRESSION IN HYPERTENSIVE SUBJECTS
TREATED WITH ENALAPRIL, LOSARTAN OR
OLMESARTAN
C.O. Aragona1, G. Mandraffino1, V. Cairo1, F. Mamone1, S. Quartuccio2,
A. D’Ascola3, M. Scuruchi3, A. Lo Gullo1, A. Saitta1, E. Imbalzano2. 1Cardiovascular Prevention Center, Clinical and Experimental Medicine, Messina, ITALY,
2Ultrasound Cardiovascular Diagnosis, Clinical and Experimental Medicine,
Abstracts e337
Messina, ITALY, 3Department of Biochemical, Physiological and Nutritional Sciences, Messina, ITALY
Objective: To evaluate whether the anti-hypertensive drugs enalapril, losartan
or olmesartan may have effects on monocyte expression of different microRNAs
(miRs 145, 221 and 222) involved in vasculature homeostasis and damage, in
essential hypertensives.
Design and method: Sixty-four essential hypertensives without organ damage
nor additional risk factor for CVD and 42 controls were included; we evaluated blood pressure (SBP/DBP), lipid profile, fasting glucose, C-reactive protein
(CRP), fibrinogen, arterial stiffness (AS) indices (pulse way velocity: PWV; augmentation index: AIx) and carotid intima-media thickness (cIMT) at baseline (T0)
and after 24-weeks treatment (T1). Subjects with plasma levels of low-density
lipoprotein cholesterol (LDL-C) > 160 mg/dl, triglycerides (TG) > 200 mg/dl,
body mass index (BMI) > 30, alcohol consumption, a personal or familial history
of CVD, diabetes mellitus, or thyroid, liver or kidney diseases were excluded.
Patients were randomly assigned to receive once a day enalapril 20 mg, losartan
100 mg or olmesartan 20 mg. Comparisons were carried out by Wilcoxon test
(T1 vs T0), Kruskall-Wallis (multiple comparisons), and Mann-Whitney (comparisons between paired treatment arms). A two tailed p of 0.05 was considered
for significance.
Results: T1: we found a significant improvement of both SBP/DBP (SBP:
–19.03%, p < 0.001; DBP: –14.41%, p < 0.001), lipid profile (HDL-C: +4.4%,
and LDL-C: –6.4%; both p < 0.001), glucose (–2.5%, p < 0.001), BMI (–3.1%,
p < 0.001), fibrinogen (–6.2%, p < 0.001), CRP (–9.2%, p < 0.005), AIx (–19.1%,
p < 0.001); PWV (–14.4%, p < 0.001), and miR expression (miR221: –29.8%,
miR222: -39.7%, miR145: +41.1%; all p < 0.001).
We compared the effects on different variables by analyzing separately each arm
of treatment: olmesartan appeared the most effective in reducing CRP (–9.48%),
and miRs221/222 (–32.9% and -42.4%, respectively); losartan reduced PWV
(–37.6%) and improved HDL-C (+7.9%) and miR145 (+51.5%) more than olmesartan and enalapril; enalapril appeared more effective on fibrinogen reduction
(–9%); no differences were found as regards BMI, glucose, LDL-C, SBP, DBP,
AIx, and cIMT.
Conclusions: Enalapril, losartan and olmesartan are effective in improving mechanical and humoral factors associated to AS and atherogenesis; these drugs
restored in untreated hypertensives the deregulated connection between miRs
221/222 and miR145, thus contributing to slow the progression of vascular damage already shown in the clinical studies.
PP.36.06
THE IMPACT OF SERUM URIC ACID ON
ASYMPTOMATIC CAROTID ATHEROSCLEROSIS
AND RENAL DISEASE IN HYPERTENSIVE PATIENTS
S. Kostic1, I. Tasic1,2, D. Djordjevic1,2. 1Institute for Therapy and Rehabilitation Niska Banja, Niska Banja, SERBIA, 2University of Nis, Medical Faculty, Nis, SERBIA
Objective: Serum uric acid represents an important risk factor for cardiovascular
(CV) and renal disease in patients with hypertension. Carotid intima-media thickness (C-IMT) is a useful surrogate marker of early carotid atherosclerosis.
Objective: To examine relation between serum uric acid (sUA) and asymptomatic
carotid atherosclerosis and renal disease in patients with hypertension.
Design and method: Study included 315 participants without manifested CV disease,274 with hypertension (mean age 66,75 ± 7.45 years, 108 men), 41 controls
(mean age 56,16 ± 13,37, 15 men). For all patients was determined: presence of
CV risk factors, SCORE risk, laboratory analysis and anthropometric measurements. Hyperuricemia was defined as a sUA value > 420 mmol/L for males or
>360 mmol/L for females. C-IMT and carotid atherosclerotic plaques were evaluated by B-mode ultrasound.
Results: Hypertensive patients were divided into 2 groups according to level sAU.
The first group (I) consisted of subjects with normal sUA, n = 200(73%), the
second (II) group patients with elevated sUA, n = 74(27%). The average value
of sUA was 289,91 ± 62,32 in I group, 443,81 ± 58,83 mmol/L in II group (p <
0,0001). Patients with high sUA had significantly higher average number of risk
factors (p = 0,047), SCORE risk (p = 0,01), body mass index (p = 0,0001), prevalence of diabetes (p = 0,01) and obesity (p = 0,0001). C-IMT were significantly
higher in II group (0.99 ± 0,22vs 0,80 ± 0,17,p < 0,0001). The high C-IMT were
observed in 66% patients in II group vs 22% in I group, p < 0,0001. Patients with
elevated sUA had more frequently one or more carotid plaques (p = 0,001), higher
average number of plaques (p < 0,0001) and percentage of stenosis (p < 0,0001).
In I group plaques were mostly fibrous (28%), in II group fibrocalcified (35%).
Creatinine clearance and glomerular filtration rate were lower in II group(MDRD
p < 0,001). Univariate regression analysis showed that sAU was associated with
C-IMT, number of carotid plaques and percentage of stenosis (p < 0.0001),
creatinine (p < 0.0001), obesity (p < 0.0001), SCORE risk (p < 0.0001), number
of risk factors (p = 0.01) and duration of hypertension (p = 0,001). In multiple
regression analysis sAU was independently related with C-IMT (beta = 0.202;
p < 0.0001), percentage of stenosis (beta = 0.013;p = 0.04), creatinine (beta =
0,308, p < 0.0001) and obesity (beta = 0,219, p < 0.0001).
Conclusions: Our data suggest that elevated uric acid were independently correlated with subclinical carotid atherosclerosis in patients with hypertension.
PP.36.07
MODIFICATION OF HISTONE INDUCED BY
ACROLEIN IN RAT VASCULAR SMOOTH MUSCLE
CELLS
Z. Yousefipour1, M.A. Newaz2, M. Esmaeilli1, K. Ranganna1. 1Texas Southern
University, Houston, USA, 2Chicago State University, Houston, USA
Objective: Modifications of histones due to environmental pollutants have been
reported to affect chromatin structure and ultimately play an important role in the
regulation of gene expression. Several studies have shown that these modifications
are associated with cardiac problems during development and differentiation. Acrolein, an environmental pollutant and a major component of cigarette smoke, has
been implicated in cardiovascular toxicity and several neurological disorders such
as Alzheimer’s disease. N-acetyl cysteine (NAC), an antioxidant, has been reported
to prevent acrolein toxicity. The goal of the present study was to investigate whether or not exposure to sub-toxic levels of acrolein causes epigenetic alterations in
rat’s vascular smooth muscle cells (VSMCs) and if the protection by NAC is related
to these changes.
Design and method: VSMCs were treated with 2 and 3 mg/ml of acrolein for 1, 6
and 18 hours in the present or absent of 10 mM NAC. At the end of the treatment,
cells were checked for viability. Additionally, immunofluorescence staining was
used to analysis H3Lys9 acetylation and H3Ser10 phosphorylation. Western blot
analysis was used to determine H3K4, H3K9, H3K27 and H4K20 tri-methylation
and H3K9 and H3K56 acetylation.
Results: Cells treated with 2 and 3 mg/ml of acrolein did not exhibit any toxicity for the different time points. Acrolein exposed VSMC displayed induction of
histone H3-lysine9 and 56 acetylation (30% & 35% respectively) and reduced
H3-lysine9 tri-methylation (25% respectively). Co-treated VSMCs with acrolein
and N-acetyl cysteine, exhibited reduced H3-lysine9 acetylation, induced H3-Serine10 phosphorylation and di-methylation (26% & 31% respectively) and reduced
H3-Lysine4 di-methylation (22%).
Conclusions: Based on these data we are concluding that exposure to sub-toxic
levels of acrolein results in alterations in DNA methylation and histone lysine
methylation and acetylation which can be prevented with addition of NAC.
PP.36.08
EFFECT OF PROINFLAMMATORY CYTOKINES
LEVEL IN PLASMA ON ENDOTHELIAL FUNCTION IN
PATIENTS WITH CHRONIC HEART FAILURE
A. Marhol, L. Yankovskaya. Grodno State Medical University, Outpatient Therapy
Department, Grodno, BELARUS
Objective: The aim was to assess the impact of interleukin-6 (IL-6) and tumor
necrosis factor alpha (TNF-a) levels in plasma on endothelial function in patients
with chronic heart failure (CHF).
Design and method: The study included 56 patients with CHF functional class II by
NYNA. CHF resulted from the background of ischemic heart disease and/or arterial
hypertension. Group I consisted of 33 patients with endothelial dysfunction (36.4%
men, 63.6% women), group II - 23 patients with normal endothelial function (34.8%
men, 65.2% women). Patients underwent measurement of height and weight. Body
mass index (BMI) was calculated. Assessment of endothelial function was conducted
to determine the endothelium-dependent vasodilation (EDVD) by means of computer impedancometry on the brachial artery during the test with reactive hyperemia.
EDVD was estimated as the maximal rate of blood filling (dz/dt max) as a percentage
of the baseline blood filling. Value of dz/dt < 12% was evaluated as an impairment of
EDVD. The level of IL-6 and TNF-a in plasma was determined by ELISA assay. The
range of normal values for IL-6 is 0–10 pg/mL for TNF-a - 0–6 pg/ml.
Results: Mean age was 67,0 ± 6,5 and 68,2 ± 9,1 years, height - 165,5 ± 9,6 and
165,6 ± 11,0 cm, weight - 81,9 ± 15,5 and 79,5 ± 13,0 kg, BMI - 29,8 ± 3,8 and
29,1 ± 4,5 kg/m2 in group I and II, respectively. The average dz/dt in group I was
–0,8 ± 14% in group II it was 20 ± 14% (p > 0.05). The average level of IL-6 and
TNF-a in plasma in group I was 4,9 ± 3,2 pg/ml and 2,5 ± 6,5 pg/ml, in group
II - 2,9 ± 1,1 pg/ml (p = 0.03) and 0.4 ± 0.5 pg/ml (p = 0.04), respectively. In both
groups of patients we found negative correlation relationship between level of
IL-6 in plasma and dz/dt (R = –0,38; p = 0.008) and between level of TNF-a in
plasma and dz/dt (R = –0.34; p = 0.02).
Conclusions: Patients with chronic heart failure with endothelial dysfunction
have higher levels of inflammatory cytokines in blood plasma than in those with
normal endothelial function. Changes in EDVD at computer impedancometry on
the brachial artery with reactive hyperemia turned to be worse with increasing of
IL-6 and TNF-a levels in plasma.
PP.36.09
MIRNA-REGULATED CARDIOVASCULAR
PATHWAYS IN ESTRADIOL-TREATED HUMAN VEIN
ENDOTHELIAL CELLS
C. Hermenegildo1, D. Perez-Cremades1, X. Vidal-Gomez1, A. Mompeon1,
A.P. Dantas2, S. Novella1. 1Dept. Physiology, University of Valencia and INCLIVA
Biomedical Research Institute, Valencia, SPAIN, 2IDIBAPS and Ins. Clinic Torax,
Barcelona, SPAIN
Objective: Endothelium, as target of estrogens, has a key role in the modulation of vascular physiology. MicroRNAs (miRNAs) are a small non-coding RNAs that modulate
post-transcriptional expression of numerous genes implicated in a wide range of biological processes. Our aim was to determine cardiovascular pathways regulated by miRNA
expression modification induced by estradiol in cultured human endothelial cells.
Design and method: Primary HUVEC were exposed to 1 nM estradiol for 24 hours
and miRNAs were isolated by miRNeasy Mini Kit (Qiagen). miRNAs expression
was performed with GeneChip miRNA 4.0 Array (Affymetrix). Global differences
between samples were measured by Principal Components Analysis (PCA) and
changes in the expression profile were analyzed by Hierarchical Cluster using Partek
Genomic Suite v6.6 software (Partek Inc., ST Louise, MO). Highly predicted and
experimentally observed mRNA targets of differentially expressed miRNAs were
used to canonical pathway analysis using Ingenuity Pathway Analysis software.
PP.36.11
“REVERSE” VASCULAR REACTION AFTER
BRACHIAL ARTERY OCCLUSION (FMD) IS
RELATED TO THE IMPAIRED HEMODYNAMICS IN
HYPERTENSIVES
A. Stanczyk, P. Krzesinski, G. Gielerak, M. Kurpaska, B. Uzieblo - Zyczkowska,
K. Piotrowicz, A. Skrobowski. Military Institute of Medicine, Department of Cardiology and Internal Diseases, Warsaw, POLAND
Objective: The assessment of extension of brachial artery after 5-minute occlusion of the proximal arm (FMD, flow-mediated dilatation) is commonly used in
endothelial evaluation. FMD is an independent predictor of cardiovascular risk,
and may be related with impaired systemic hemodynamics.
The assessment of relationship between FMD and selected clinical and hemodynamic parameters in patients with untreated arterial hypertension (AH).
Design and method: The study (ClinicalTrials.gov, NCT01996085) involved 133
hypertensives (mean age: 44.9 years). FMD was measured at morning hours with
use of linear transducer 12 MHz. The hemodynamic profile was assessed by noninvasive methods (impedance cardiography, applanation tonometry, echocardiography), drawing special attention to: systolic and diastolic blood pressure (SBP, DBP),
systemic vascular resistance index (SVRI), total arterial compliance (TAC), stroke
and cardiac index (SI, CI), velocity index (VI), acceleration index (ACI), Heather
index (HI), augmentation index (AI), central blood pressure (cSBP, cDBP), central
pulse pressure (cPP) and left ventricular diastolic (E/A, e’) and global longitudinal
systolic strain (GLSS). The interquartile analysis in subgroups of FMD: < 0% (Q1),
0–2.28% (Q2), 2.29–6.15% (Q3), > = 6.16% (Q4) was performed.
Results: Global interrelationships among samples studied by PCA analysis shown
differences between samples from control cells and estradiol-treated cells. We identified 120 miRNAs with significant differential expression: 47 up-regulated and 73
down-regulated with estradiol exposure. Bioinformatic analysis revealed significant
canonical pathways important for endothelial function, including ERK/MAPK signalling, integrin signalling and actin cytoskeleton signalling, among other pathways.
Conclusions: This study identifies changes in miRNA expression profile of human endothelial cells by which estradiol regulates different biological processes
implicated in vascular function. Supported by the Spanish MINECO, ISCIII-FEDER-ERDF (grants FIS PI13/00091, PI13/00617, and RD12/0042/0052). DPC is
an ‘Atracció de Talent’ fellow (PREDOC13-110541, UV). A.M. is a ‘Formación
de Profesorado Universitario’ fellow (FPU13/02235 Spanish MECD).
PP.36.10
ENDOTHELIAL GLYCOCALYX DIMENSIONS ARE
SIMILAR IN NORMOTENSIVES AND LOW RISK
UNTREATED HYPERTENSIVE PATIENTS
H. Triantafyllidi, I. Ikonomidis, A. Schoinas, S. Vlachos, M. Varoudi,
D. Vlastos, G. Pavlidis, L. Palaiodimos, J. Lekakis. 2nd Department of Cardiology,
Medical School, University of Athens, ATTIKON Hospital, Athens, GREECE
Objective: The integrity of endothelial glycocalyx (EG) plays a vital role in
vascular permeability, inflammation and elasticity and finally to cardiovascular
disease. Sideview Darkfield imaging allows for non-invasive automated estimation of EG dimensions based on the erythrocyte column distribution. Endothelial
dysfunction is not uncommon in patients with arterial hypertension. We aimed to
investigate any differences regarding EG dimensions between low risk untreated
hypertensive patients and normotensive subjects.
Design and method: We studied 126 patients with newly diagnosed and never treated
essential hypertension (group A, mean age 48+10 years, 44 females). Twenty (20)
normotensive subjects, matched for age, served as control group (group B, mean
age 51+9 years, 17 females). Arterial hypertension was confirmed by 24 h ABPM.
Increased perfusion boundary region (PBR) of the sublingual arterial microvessels
(ranged from 5–25 micrometers) using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non-invasive accurate index of reduced EG thickness.
Results: 24 h mean ABPM was significantly increased in group A (137/85 vs.
119/74 mmHg, p < 0.001) while no significant differences were found regarding
age and BMI. EG dimensions were similar within groups. Indeed, we found that
in groups A and B: a. PBR 5–25 was 2.06 mm vs. 2.06 mm, p = 0.98, b. PBR 5–9
was 1.16 mm vs. 1.23 mm, p = 0.07, c. PBR 10–19 was 2.19 mm vs. 2.19 mm, p
= 0.98 and d. PBR 20–25 was 2.56 mm vs. 2.40 mm, p = 0.16. No correlations
were found between PBR and age, sex and blood pressure levels in both groups.
Conclusions: It seems that EG does not represent a valuable tool regarding cardiovascular risk estimation in low risk hypertensive patients. Future studies in
both high risk hypertensives and in patients under antihypertensive treatment are
needed in order to evaluate the possible role of EG in essential hypertension.
Results: The mean FMD in the total group was 2.84 ± 5.4%. Proper vascular
reaction (FMD > 7%) was observed only in 26 subjects (20%). There were no
differences in FMD with respect to demographic and constitutional data (age,
gender, obesity, smoking). The subjects with reactive constriction after brachial
artery occlusion (FMD < 0%; “reverse FMD reaction”) in comparison to the rest
of the group, presented higher peripheral DBP (92.8 ± 7.5 vs. 87.3 ± 9.2[mmHg],
p = 0.002), central DBP (93.9 ± 7.8 vs. 88.3 ± 9.4[mmHg], p = 0.002) and SVRI
(2371 ± 468 vs. 2242 ± 462[dyn*s*m2/cm5], p = 0.049). Moreover, significantly
lower indicators of LV systolic (GLSS -17.1 ± 2,7 vs. -18.4 ± 2.8[%], p = 0.018;
Abstracts e339
VI 44.0 ± 14.4 vs. 49.4 ± 13.6[1/100/s], p = 0.018; ACI 62.5 ± 27.1 vs. 75.5 ±
30.8[1/1000/s2], p = 0.026; HI 11.8 ± 3.6 vs. 13.6 ± 4.2[Ohm*s2], p = 0.024) and
diastolic function (E/A 0.97 ± 0.31 vs. 1.11 ± 0.34, p = 0.022; e’ 8.77 ± 2.33 vs.
10.0 ± 2.64[cm/s], p = 0.019) were noted in that subgroup.
Conclusions: Flow-mediated constriction (reverse FMD reaction) is related to
impaired afterload and LV systolic and diastolic dysfunction.
PP.36.12
Results: There was a significant correlation between the number of risk factors
and the bFMD value (r = –0.450; p = 0.001), IMT mean (r = 0.305; p = 0.001) and
LnRHI (r = –0.219; p = 0.004) and PWV (r = 0.165; p = 0.031). Statistically significant differences between the average values of the tests performed and atherosclerosis risk factors presented in the table below. There was no statistical differences in
testing for dyslipidemia. All measures apart from LnRHI correlated to IMTmean.
METABOLIC CHANGES, BIOMARKERS OF
ENDOTHELIAL DYSFUNCTION AND COAGULATION
FACTORS ARE PRESENT IN INDIVIDUALS WITH
HYPERTENSIVE CRISIS
D. Oliveira De Andrade1, F. Valente1, S. Oliveira Santos1, M. Gregorio2,
M. Pinhel1, D. Souza1, M. Godoy1, L Cosenso-Martin1, J. Vilela-Martin1. 1Medical School in Sao Jose do Rio Preto, Sao Jose do Rio Preto, BRAZIL, 2Franca
University, Franca, BRAZIL
Objective: Hypertensive crisis (HC), characterized as sudden and symptomatic
elevation in the blood pressure, with or without risk of target organ damage, can
be classified in hypertensive emergency (HE) and hypertensive urgency (HU),
respectively. Evidence shows that endothelial dysfunction and coagulation biomarkers play an important role in the pathophysiology of chronic high blood pressure (BP). However, few studies demonstrate the involvement of these biomarkers
in the pathogenesis of acute BP elevation. Thus, this study had the objectives: to
characterize biochemical profile of HU and HE, and to evaluate the participation
of C-reactive protein (CRP), intercellular adhesion molecule (ICAM-1) and coagulation factors (fibrinogen and PAI-1) in subjects with HC.
Design and method: It was a cross-sectional study with 74 normotensive (NT),
74 controlled hypertensive (CHT), 50 with HU and 78 individuals with HE. It
was used MULTIPLEX technique for evaluating the clotting factors. Analysis of
variance was used for comparative study among the groups, with significant pvalue < 0.05.
Results: The diastolic BP and heart rate were higher in the HC group (120mmHg
and 85bpm, respectively) compared to the CHT group (75mmHg and 68 bpm, respectively). Individuals with HE were older. Glycaemia was significantly higher in
the HE group (113 mg/dL) versus NT and CHT (91 mg/dL and 98 mg/dL, respectively; p < 0.05). It was also higher in the HU group (109 mg/dL) compared to NT.
Potassium was significantly lower in HE group (4,2mEq/l) compared to NT, CHT
and HU groups (4.5, 4.4 and 4.4mEq/L, respectively). CRP, fibrinogen, and PAI-1
were significantly higher in patients with HE (0.75, 0.04 and 2.46, respectively)
in comparison to NT (0.19, 0.01 and 2.1, respectively) and CHT (0.14, 0.01 and
2.25, respectively) groups, except ICAM-1. Logistic regression showed that CRP
and fibrinogen were markers for HC development with odds ratios of 2.6 (1.24 to
5.50) and 8.72 (4.07 to 18.68), respectively.
Conclusions: HC individuals have metabolic abnormalities compared to controls.
Biomarkers of endothelial dysfunction and coagulation factors are higher in HU
and HE groups compared to control groups. This suggests the role of endothelial
dysfunction biomarkers and coagulation factors in the pathogenesis of acute hypertensive event.
PP.36.13
NONINVASIVE METHODS FOR ENDOTHELIAL
FUNCTION ASSESSMENT IN PATIENTS WITH RISK
FACTORS FOR ATHEROSCLEROSIS
G. Wilk1, G. Osmenda1, M. Nowak1, D. Rajch2, T. Sliwa1, T. Mikolajczyk1,
M. Czesnikiewicz-Guzik3, T. Guzik1. 1Department of Internal and Agricultural
Medicine, Joseph Dietl Hospital, Jagiellonian University Medical College,
Cracow, POLAND, 2Department of Cardiology, Edward Szczeklik Hospital,
Tarnow, POLAND, 3Department of Dental Prophylaxis and Experimental
Dentistry, Jagiellonian University Medical College, Cracow, POLAND
Objective: While various methods are available for assessment of endothelial
function in patients with atherosclerosis, some studies suggested that various techniques differ in their ability to detect effects of various risk factors. We aimed to
investigate which risk factors for atherosclerosis have greatest effects on measures
of individual risk factors (hypertension, diabetes, obesity, smoking and male sex).
Design and method: The group of 170 subjects, with a negative history of cardiovascular disease were examined. The mean age was 57.3 ± 6.9; 84 (49.4%)
were men. Risk factors were determined from patient history and conformed by
biochemical/clinical measurements. Endothelial function was assessed by: Flow
Mediated Dilation (FMD) and Nitroglycerin-Mediated Dilatation (bNMD) of the
brachial artery; measurement of reactive hyperaemia using Peripheral Arterial Tonometry (LnRHI) with Endo-PAT 2000 and by assessment of Pulse Wave Velocity
(PWV) using SphygmoCor EM3. Carotid artery Intima Media Thickness (IMTmean) was measured as a measure of sub-clinical atherosclerosis.
Conclusions: The study established that bFMD is most strongly affected by classical risk factors for atherosclerosis, while relative hyperaemia index (LnRHI)
was different only in relation to obesity and diabetes.
PP.36.14
COMPARATIVE CHARACTERISTICS OF LOCAL
STIFFNESS PARAMETERS IN HEALTHY SUBJECTS
AND PATIENTS WITH ARTERIAL HYPERTENSION
OF 1–2 DEGREES
V. Oleyniko, I. Matrosova, E. Melnikova, L. Salyamova. Penza State University,
Penza, RUSSIA
Objective: To conduct a comparative analysis of the local stiffness parameters
of the carotid arteries in healthy subjects and patients with arterial hypertension
(AH) 1–2 degrees.
Design and method: Study involved 56 subjects. Group 1 included 34 healthy
normotensive subjects (mean age 47,1 ± 7,1 years; SBP 117,4 ± 6,9 mmHg, diastolic blood pressure 74 (67,5; 80,0) mmHg). Group 2 consisted of 22 patients with
hypertension of 1-2 degrees (average age 47,5 ± 6,9 years, SBP 146,2 ± 7,1 mmHg,
diastolic blood pressure 93,0 ± 6,7 mmHg). Local arterial stiffness were evaluated
by the ultrasonic device My Lab 90 («Esaote», Italy) using the echotracking software on the following parameters: local systolic (Loc Psys) and diastolic pressure
(Loc Pdia), the coefficient of transverse extensibility (DC), the coefficient of lateral
compliance (CC), stiffness index b, local carotid pulse wave velocity (PWV).
Results: According to echotracking the local pressure values - Loc Psys and
Loc Pdia in group 1 were the following: 102,7 (96,7; 110,4), and 70 (70,0; 80,0)
mmHg.; group 2 - 8,0 and 123,4 ± 90,0 (80,0; 95,0) mmHg (p < 0,05). DC indicator decreased with increasing pressure: in healthy normotensive individuals - 0,02
(0,02; 0,03) 1/kPa, in hypertensive patients - 0,01 (0,01; 0,02) 1/kPa (p < 0,05).
Values of local compliance of the CC in group 1 were 0,81 (0,63; 1,17) mm2/
kPa, group 2 - 0,55 (0,45; 0,73) mm2/kPa (p < 0,05). Stiffness index b prevailed
in patients with hypertension (10,5 (8,1; 12,4)) compared with healthy individuals
(7,5 ± 2,5) (p < 0,05). The subjects in the control group had lower values of PWV
- 6,3 ± 1,0 m/s in individuals with hypertension were 8,8 (8,1; 9,5) m/s (p < 0,05).
Conclusions: According to echotracking an impairment of most parameters of
local rigidity has been revealed in patients with hypertension. Progressive remodeling in conditions of high blood pressure is accompanied by a decrease in the
damping function of the vascular wall, as evidenced by an increase in pulse wave
velocity, stiffness index, and reduced coefficients of compliance and distensibility
of the carotid arteries.
PP.36.15
VENOUS OCCLUSION PLETHYSMOGRAPHY AND
BIOMARKERS AS EVALUATION METHODS OF
ENDOTHELIUM FUNCTION IN PATIENTS WITH
ARTERIAL HYPERTENSION
C. Junqueira, M. Magalhaes, A. Brandao, E. Ferreira, A. Junqueira, J. Neto,
D. Bottino, E. Bouskela. State University of Rio de Janeiro, Rio de Janeiro,
BRAZIL
Objective: The aim of this study was to investigate the correlation between serum
markers of inflammation and microcirculatory parameters observed by Venous
occlusion plethysmography (VOP) in hypertensive patients
Design and method: It is a cross-sectional study. Patients with resistant (RH,
58 [50–63] years, n = 25) or mild to moderate hypertension (MMH, 56[47–64],
n = 25) were compared to normotensive ones (Control Group – CG, 33 [27–52],
n = 25). C-reactive protein (CRP), endothelin, adiponectin, I-CAM and V-CAM
were obtained by laboratorial analysis. Flow rate and resistance in the basal period, post-ischemic 5 minutes on the forearm (endothelium-dependent phase) and
post-use of sublingual nitroglycerin (endothelium-independent phase) were determined by VOP. A sub-analysis was also conducted on hypertensive patients not
taking statins, with controlled/uncontrolled blood pressure.
Results: RH group showed a lower percentage of maximum flow and increased
post-ischemia minimal resistance compared to MMH and CG ones (p < 0,003)
with worse values in patients with uncontrolled blood pressure (p < 0,05). Postnitroglycerin phase (endothelium independent) showed no significant differences
among the three groups, with higher CRP values in RH and MMH groups. An
increase in endothelin was seen only in patients not taking statins in both hypertensive groups. The VOP analyzes were adjusted for confounding factors.
Conclusions: Patients with severe hypertension and uncontrolled blood pressure
levels presented more pronounced impairment of vascular reactivity, when analyzed by VOP, as well as higher serum values for CRP and endothelin. It is possible that the use of statins decrease endothelin release.
Abstracts e341
POSTER SESSION
LARGE ARTERIES
PP.37.01
TIME TO PEAK OF THE AORTIC FORWARD
WAVE DETERMINES THE IMPACT OF AORTIC
BACKWARD WAVE AND PULSE PRESSURES ON
LEFT VENTRICULAR MASS
A. Woodiwiss1, G. Tade1, H.L. Booysen1, M.J. Sibiya1, I. Ballim1, P. Sareli1,
E. Libhaber2, O.H.I. Majane1, G.R. Norton1. 1Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand, Johannesburg, SOUTH AFRICA, 2School of Clinical Medicine, Faculty of
Health Sciences, University of the Witwatersrand, Johannesburg, SOUTH AFRICA
Objective: Although aortic backward waves and hence pulse pressure are wellrecognised determinants of cardiovascular damage beyond brachial pressures,
these effects are inconsistent across studies. We aimed to assess whether an extended time to peak of aortic forward wave (Ft) or early wave reflection time (Rt)
increase the chances of backward wave pressures (Pb) and hence central aortic
pulse pressure (PPc) modifying end-organ effects.
Design and method: In 812 adult participants from a community sample we assessed aortic haemodynamics (SphygmoCor software and wave separation analysis) and left ventricular mass index (LVMI) (echocardiography).
Results: An interaction between Ft and Pb was independently associated with
aortic augmented pressure (Pa) (p < 0.02), PPc (p < 0.005), LVMI (p < 0.0001)
and LV hypertrophy (LVH) (p = 0.001). The Ft-Pb interaction translated into a
stepwise increase in the independent association between Pb and Pa or PPc across
quartiles of Ft (p < 0.02 for comparison of slopes of relations). Furthermore, the
Ft-Pb interaction translated into an increase in the independent association between PPc or Pb and LVMI (p < 0.0001 for comparison of slopes and strength
of relations) or LVH (p < 0.01 for comparisons of Odds ratios), but not between
forward wave pressures and LVMI or LVH across quartiles of Ft. A markedly better ability of Pb and PPc, but not forward wave pressures to detect LVH was noted
in the highest as compared to the first three quartiles of Ft (p < 0.01). In contrast,
Rt failed to influence the impact of Pb or PPc on LVMI.
Conclusions: Time to peak of aortic forward wave, but not early wave reflection
markedly influences the impact of aortic backward wave pressure and hence PP
on LVMI and LVH in adults. Hence, the adverse effects of aortic backward wave
and hence pulse pressures may be strongly determined by forward wave timing.
PP.37.02
ASSOCIATION BETWEEN TWO ANGIOGRAPHIC
SUBTYPES OF RENAL ARTERY FIBROMUSCULAR
DYSPLASIA AND CLINICAL CHARACTERITSIC:
THE PRELIMINARY DATA OF THE REGISTRY FOR
FIBROMUSCULAR DYSPLASIA
E. Florczak1, M. Miadziolko1, E. Warchol-Celinska1, M. Januszewicz2,
I. Michalowska3, K. Hanus1, K. Jozwik-Plebanek1, A. Prejbisz1, P. Talarowska1,
J. Kadziela4, S. Nazarewski5, K. Madej5, K. Grygiel5, M. Litwin6, A. Niemirska6,
M. Skowronska7, A. Witkowski4, P. Odrowaz-Pieniazek8, L. Tekieli8, A. Januszewicz1. 1Institute of Cardiology, Department of Hypertension, Warsaw, POLAND,
2Medical University of Warsaw, 2nd Department of Clinical Radiology, Warsaw,
POLAND, 3Institute of Cardiology, Department of Radiology, Warsaw, POLAND,
4Institute of Cardiology, Department of Interventional Cardiology and Angiology, Warsaw, POLAND, 5Medical University of Warsaw, Department of General,
Vascular and Transplant Surgery, Warsaw, POLAND, 6Child Health Center, Department of Nephrology, Kidney Transplant and Hypertension, Warsaw, POLAND,
7Institute of Psychiatry and Neurology, 2nd Department of Neurology, Warsaw,
POLAND, 8John Paul II Hospital, Dept. of Vascular Surgery and Endovascular
Interventions; Dept. of Interventional Cardiology, Cracow, POLAND
Objective: To compare clinical presentation of two angiographic subtypes of renal fibromuscular dysplasia (FMD) in patients with renal FMD enrolled to ARCADIA-POL registry.
Design and method: From 84 patients with confirmed FMD in any vascular bed
enrolled in the ARCADIA-POL registry in 2015 (instituted on the basis of as
Polish-French collaboration), we analyzed 74 patients (54F, 20 M, mean age:41.7
± 15.2 years, range:18–72) with renal FMD. All patients underwent evaluation including ambulatory blood pressure monitoring, biochemical evaluation, biobanking, duplex Doppler of carotid and abdominal arteries and whole body angio-CT.
In this analysis we divided patients into two groups according to angiographic
subtypes of renal FMD lesions (Savard et al. Circulation 2012). FMD lesions were
classified according to angio-CT as multifocal if there were at least 2 stenoses in
the same arterial segment (Group 1); otherwise as unifocal (Group2).
Results: Of 74 patients with renal FMD, 48 pts (64.9%) were classified as multifocal (Group 1) and 26 pts (35.1%) as unifocal (Group 2). Patients in Group 1
as compared to Group 2 were characterized by non-significantly higher rate of
females (79.2vs.61.5%; p = 0.103). At evaluation there were no differences in
age, frequency of smokers, hypertension rate, median number of antihypertensive
medications, nor in office and 24-hour blood pressure values. Group 1 differed
significantly from Group 2 in mean age at diagnosis of FMD (29.2 ± 14.2vs.41.0
± 15.5 years, p = 0.003) and hypertension (23.4 ± 12.6vs.34.8 ± 14.0 years, p =
0.002). Among 27 patients in whom FMD was diagnosed at age over 40 years
only 4(14.8%) had unifocal and 20(85.2%) had multifocal type. Group 1 were
characterized by non-significantly higher proportion of patients with more than
one vascular bed involved (36% vs. 54.2 %,p = 0.14). Aneurysm of renal artery
was found in 10 pts with multifocal and in 3 patients with unifocal lesions (20.8%
vs.11.5 %,p = 0.316). In two patients with multifocal and none of patients with
unifocal FMD renal artery dissection was observed.
Conclusions: A binary angiographic classification in unifocal and multifocal
FMD discriminated two groups of patients with different age at diagnosis of FMD
and hypertension, as well as tendency towards different proportion of multiple
beds involvement and vascular complications.
PP.37.03
IMPACT OF SEASONALITY AND AIR POLLUTANTS
ON WAVE REFLECTION IN HYPERTENSIVE
PATIENTS
M. Di Pilla1, R.M. Bruno1, L. Ghiadoni1, F. Stea2, L. Massetti3, I. Bertolozzi3,
S. Taddei1, P.A. Modesti3. 1University of Pisa, Pisa, ITALY, 2Institute of Clinical
Physiology, CNR, Pisa, ITALY, 3University of Florence, Florence, ITALY
Objective: Important climate-related variations of clinic and ambulatory blood
pressure (BP) have been repeatedly reported. However, the influence of seasonality and other environmental factors such as air pollutants and outdoor temperature
on wave reflection, a parameter associated with increased risk of cardiovascular
events, has never been investigated. The aim of the present study was to examine
in a cross-sectional survey whether acute variations in these environmental factors
may affect wave reflection, measured as augmentation pressure (AP) and augmentation index normalized at a heart rate of 75bpm (AIx75).
Design and method: This survey included retrospectively 731 hypertensive patients (30–88 years, 417 drug-treated), referring to our Hypertension Center during
a 5-year period (2006–2011). Radial arterial tonometry was performed to all participants in a quiet, temperature-controlled (22–24°C) room, with the calculation of
central BP, Aix75 and AP. The data of the local office of the National Climatic Data
Observatory were used to estimate meteorological conditions and air pollutants
(PM10, O3, CO, N2O) exposure the same day of the vascular evaluation.
Results: Aix75 (mean value 24.1 ± 10.2%) was related to age (r = 0.27, p <
0.001), BMI (r = –0.12, p = 0.002), central systolic BP (r = 0.32, p < 0.001),
diastolic BP (r = 0.14, p < 0.001), total cholesterol (r = 0.16, p < 0.001), LDL (r
= 0.08, p = 0.04), HDL (r = 0.26, p < 0.001),creatinine (r = –0.15, p < 0.001). No
significant correlation was found between AIx75 and environmental factors (daylight hours, mean temperature and air pollutants). The multiple regression analysis
including the above-mentioned variables confirmed an independent association of
AIx75 only with age, central systolic BP, diastolic BP and female sex. This result
was confirmed also in the untreated group. Furthermore, no significant correlation was found between AP (mean value 14.2 ± 7.9 mmHg) and daylight hours,
mean temperature and air pollutants, neither in the univariate analysis, nor in the
multiple regression analysis adjusted for confounders.
Conclusions: This cross-sectional analysis suggests that seasonality, expressed
by the daily number of hours of light, and acute changes in environmental factors
such as outdoor temperature and air pollutants concentration, do not influence
either AP or AIx75.
M
O
N
D
A
Y
P
O
S
T
E
R
S
PP.37.04
EVOLUTION OF ARTERIAL STIFFNESS AFTER
KIDNEY TRANSPLANTATION: A SYSTEMATIC
REVIEW AND META-ANALYSIS
M. Agharazii, A. Sidebe, C. Fortier, M.P. Desjardins, S.A. De Serres,
F. Mac-Way. CHU de Québec Research Center, L’Hôtel-Dieu de Québec, Dept. of
Medicine, Université Laval, Québec, CANADA
Objective: Chronic kidney disease is associated with increased arterial stiffness.
Correction of the uremic milieu by kidney transplantation may be improve arterial
stiffness. However, the results from clinical studies are not uniformly convincing.
This could be related to small sample size of studies, heterogeneity in methods
and timing of assessment of arterial stiffness after transplantation. The objective
of the present study is to measure the impact of renal transplantation on the reduction of arterial stiffness.
Design and method: Observational studies and randomized controlled trials with
measurements of arterial wave velocity (PWV) were extracted from MEDLINE,
EMBASE, COCHRANE LIBRARY, and Web of Science from their inception to
January 2016. Two reviewers independently identified eligible studies comparing
PWV before and after kidney transplantation and extracted data including population characteristics, interventions and outcomes.
Results: 11 studies with 408 subjects were available for comparing pre- to posttransplant PWV. There was a mean change of PWV by –1.28 m/s (95% CI, – 2.01
to – 0.55) post-transplantation (I2 = 72 %). When subgroup analysis was performed only for studies that had assessed aortic PWV (5 studies, 163 patients),
there was a non-significant mean changes of PWV by –0.74 m/s (95% CI, –1.49
to 0.02) post-transplantation (I2 = 61%) (FIGURE). The subgroup analysis of the
studies with brachial-ankle PWV (BA-PWV), which included 4 studies and 168
patients, showed a significant reduction in PWV by –2.48 m/s (95% CI, – 4.36 to
– 0.60) (I2 = 84 %). Limiting analysis to the studies that have measured BA-PWV
after at least 3 months of transplantation (3 studies, 151 patients) showed similar
results but reduced heterogeneity (I2 = 13%).
P < 0.001) and serum PTH (r = 0.06, P = 0.031) remained significantly associated
with carotid-femoral PWV. Indeed, per SD (12 mmHg) increment of 24-h systolic
blood pressure and each double of serum PTH were associated with the increase
in carotid-femoral PWV by 0.45 (0.38–0.52) m/s and by 0.19 (0.049–0.32) m/s,
respectively. The effect size associated with 24-hour systolic blood pressure was
statistically (P < 0.001) larger than that with PTH.
Conclusions: Among the studied mineral metabolism factors, only serum PTH,
was associated with aortic stiffness, and blood pressure might play a more significant role than PTH in arterial stiffening.
PP.37.06
A GENETIC RISK SCORE FOR TYPE 2 DIABETES
IS INDEPENDENTLY ASSOCIATED WITH ARTERIAL
STIFFNESS: THE MALMO DIET CANCER STUDY
M. Gottsäter1, G. Hindy1, M. Orho-Melander1, P.M. Nilsson1,2, O. Melander1,2.
1Department of Clinical Sciences, Lund University, Malmö, SWEDEN, 2Department of Internal Medicine, Skåne University Hospital, Malmö, SWEDEN
Objective: Arterial stiffness (AS) is known to be associated with a number of
clinical conditions including hypertension, diabetes and dyslipidemia, and may
predict cardiovascular events and mortality. However, causal links are hard to establish. Results from Genome Wide Association Studies (GWAS) have identified
some Single Nucleotide Polymorphisms (SNP) associated with AS but the overlap with other clinical conditions has been modest. Our aim was to investigate a
potential shared set of risk SNPs between relevant cardiometabolic conditions
and AS.
Design and method: The study population consists of 3056 individuals (mean
age 72 years, 40% men) from the population-based Malmo Diet Cancer study,
Sweden. Carotid-femoral pulse wave velocity (c-f PWV), a marker of AS, was
measured with Sphygmocor®. Genetic risk scores (GRS) were calculated for eight
cardiometabolic conditions based on previously reported SNPs. Associations
between GRS and AS were calculated with Pearson’s correlation and multiple
regression, adjusting for mean arterial pressure (MAP), heart rate (HR), and ongoing antihypertensive treatment (AHT).
Results: After adjustment, AS was negatively associated with a GRS for blood
pressure but positively associated with GRS for type 2 diabetes. Fasting glucose
and LDL-cholesterol GRS were of borderline significance associated with AS.
Conclusions: There is a significant reduction in overall PWV after kidney transplantation. There was a great heterogeneity in the among studies. Further analysis
is required to examine the importance of changes in different vascular beds taking
into account changes in blood pressure.
PP.37.05
ASSOCIATION OF AORTIC PULSE WAVE VELOCITY
WITH MINERAL METABOLISM FACTORS AND
BLOOD PRESSURE IN UNTREATED CHINESE
PATIENTS
Y.B. Cheng, L.H. Li, Q.H. Guo, C.S. Sheng, Q.F. Huang, F.K. Li,
D.Y. Zhang, J.G. Wang, Y. Li. Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai, CHINA
Objective: Disorders of mineral metabolism predicted incidence of cardiovascular
events in various clinical settings, possibly because that arterial stiffness mediate
this pathway in part. We investigated the interrelationship between mineral metabolism factors and carotid-femoral PWV, and compared the effect sizes of blood
pressure and mineral factors with carotid-femoral PWV in untreated Chinese.
Design and method: Consecutive untreated outpatients referred for ambulatory
blood pressure monitoring were recruited. Serum parathyroid hormone (PTH) and
25-hydroxyvitamin D were measured with electrochemiluminescence immunoassay, and 24-h urinary calcium and phosphate excretion were determined. Carotidfemoral PWV was measured using the SphygmoCor (AtCor, Australia) device.
Pearson’s correlation, single and multiple regressions were applied for analyses.
Results: The 1063 participants (mean age 51 years) included 539 (50.7%) women, 658 (61.9%) patients with ambulatory hypertension, 75 (7.1%) patients with
arterial stiffness defined as a carotid-femoral PWV over 10 m/s. After standardization for sex, age, body mass index, fasting plasma glucose, serum total and HDL
cholesterol, all 24-h blood pressure parameters, including systolic and diastolic
blood pressure, mean and pulse pressures, were significantly (r > 0.21, P < 0.001)
associated with carotid-femoral PWV, and for mineral metabolism factors, none
(P > 0.22) was associated with carotid-femoral PWV, except for serum PTH (r =
0.08, P = 0.008). In fully adjusted model including aforementioned risk factors
and both 24-hour systolic blood pressure and PTH, 24-h blood pressures (r > 0.21,
Conclusions: A GRS (48SNP) for type 2 diabetes is significantly associated with
c-f PWV both before and after adjustment supporting a causal link between type
2 diabetes and arterial stiffness. The inverse relationship between blood pressure
and arterial stiffness after adjustment for MAP and ongoing AHT is surprising. It
could be explained by over-adjustment but needs to be further investigated.
PP.37.07
ASSOCIATION BETWEEN NITRIC OXIDE SYNTHASE
POLYMORPHISMS AND ARTERIAL PROPERTIES IN
GENERAL POPULATION
J. Filipovsky1, J. Seidlerova1, O. Mayer1, A. Kucerova2, M. Pesta2, P. Karnosova1.
University Medical Faculty, Department of Internal Medicine II, Pilsen,
CZECH REPUBLIC, 2Charles University Medical Faculty, Laboratory of Genetics, Pilsen, CZECH REPUBLIC
1Charles
Objective: Nitric oxide plays an important role in vascular biology. Several single
nucleotide polymorphisms (SNP) in the endothelial nitric oxide gene (NOS3)
have been previously associated with arterial hypertension. We investigated
whether these SNPs might be associated with arterial phenotypes in the Czech
general population.
Design and method: We genotyped three NOS3 SNPs in 426 subjects not treated
for arterial hypertension (mean age, 49.1 years; 55.9% women). Arterial properties were measured using applanation tonometry. In multivariate-adjusted analyses, we assessed the gene effects of rs3918226 (665 C > T), rs1799983 (glu298asp
Abstracts e343
G > T) and rs2070744 (786 T > C) on augmentation index (AIx), central augmentation pressure (AP) and aortic pulse wave velocity (PWV).
Results: Carriers of rs3918226 mutated T allele (8% of the sample) had marginally higher AIx (145.3 ± 2.5 vs. 140.2 ± 1.1%; P = 0.064) and significantly
higher AP (12.7 ± 0.7 vs. 11.1 ± 0.3 mmHg; P = 0.033). These associations were
independent of potential confounding factors (sex, age, heart rate and smoking).
Aortic PWV was not different in the two rs39182226 genotypes groups (P = 0.35).
In single gene analyses, we did not observe any association between measured
phenotypes and rs1799983 or rs2070744 (P > 0.11). In haplotype analysis, we
observed trend for higher PWV in haplotypes containing rs3918226 mutated T
allele compared with other allelic combination (P < 0.079).
Conclusions: Mutated T allele of rs3918226 polymorphism in NOS3 gene was
associated with parameters reflecting central arterial stiffness and wave reflection.
We hypothesize that genetic modulation of intermediate arterial phenotypes might
lead to higher blood pressure.
PP.37.08
HEALTHY LIFESTYLE IS ASSOCIATED WITH LOWER
RISK OF EARLY VASCULAR AGEING: THE OPTIMO
STUDY IN LATIN AMERICA
P.M. Nilsson1, A. Scuteri2, F. Botto3, S. Obregon3, P. Forcada3, M. Koretzky3,
A. Di Leva3, E. Huguet3, M. Haehnel3, G. Waisman3, C. Kotliar3. 1Department of
Clinical Sciences, Lund University, Malmö, SWEDEN, 2Department of Medicine,
UOC Hypertension and Nephrology, Policlinico Tor Vergata, Rome, ITALY, 3The
OPTIMO Study Group in Latin America, Buenos Aires, ARGENTINA
Objective: Early Vascular Ageing (EVA), dominated by increased arterial stiffness, is a cardiovascular risk marker. Our aim was to elucidate on lifestyle factors
associated with EVA in diverse populations across Latin America.
Design and method: A total of 1044 city inhabitants (51.3% men, mean age 50.3
± 15.3 years) underwent a health screening examination in 12 countries in Latin
America (Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, Honduras,
México, Nicaragua, Panamá, República Dominicana, Salvador). This included anthropometrics, a questionnaire on lifestyle (WHO STEPS survey), medical history,
and measurement of pulse wave velocity (PWV) for arterial stiffness (Mobil-OGraph device). PWV values were transformed into age-specific z-scores to identify subjects with greater than age-peers PWV values, here defined as EVA. Age
groups were defined based upon age quartiles of the study population (Q1: < 42,
Q2: 42–51, Q3: 52–60, and Q4: 61+ years). Within each age quartile, a z-score was
defined as (individual PWV – age-quartile mean PWV)/ age-quartile SD of PWV).
Results: PWV ranged from 4.1 to 15.0 m/s and correlated with age (r = 0.81, p <
0.0001), as expected. PWV average values (mean, SD) were for age quartiles: Q1:
6.0 ± 1.6; Q2: 6.7 ± 0.7; Q3: 7.9 ± 0.7; and Q4: 9.8 ± 1.5 m/s. A consumption of
fruit greater than 7 servings/week (beta-coefficient –0.118 ± 0.061, p < 0.05) and
physical activity (day per week) (beta-coefficient –0.032 ± 0.013, p < 0.01) were
independent and significant determinants of the PWV z-score treated as a continuous variable, after controlling for age, sex and risk factors. When the likelihood
of having a PWV z-score above the median (indicating EVA) was modelled, fruit
consumption lost significance (odds ratio (OR) 0.99, 95% CI: 0.65–1.50). However, physical activity (OR 0.91, 95% CI: 0.83–0.99, p < 0.05) and a daily intake of
seeds (OR 0.63, 95% CI: 0.41–0.96, p < 0.01) were still associated with reduced
risk of EVA. This corresponded to the equivalent of having a 4 to10 year younger
arterial system in subjects reporting healthy lifestyle.
Conclusions: A healthy lifestyle was associated with lower risk of age- and risk
factor adjusted PWV (arterial stiffness) as the core component of EVA in a diverse
population from across Latin America.
PP.37.09
IMPACT OF INFLAMMATOIRY CYTOKINES ON
AORTIC STIFFNESS IN PATIENTS WITH CHRONIC
KIDNEY DISEASE
M.P. Desjardins, C. Fortier, S. De Serres, R. Lariviere, M. Agharazii. Endocrinology and Nephrology, CHU de Quebec Research Centre, Quebec, CANADA
Objective: Cardiovascular diseases are the primary cause of morbidity and mortality in patients with chronic kidney disease (CKD). Aortic stiffness is a nontraditional risk factor in these patients. Using an animal model of CKD with vascular calcification, we reported that inflammation is involved in the development
of aortic calcification and stiffness. Hence, increased vascular production of IL-1,
IL-6 and TNF was associated with aortic calcification. Therefore, we investigated
the impact of the latter cytokines on aortic stiffness and determined the profile of
inflammatory cytokines in a cohort of CKD patients.ba
Design and method: This is a transversal study involving 196 CKD patients on
dialysis, in which aortic stiffness was determined non-invasively by the assessment
of carotid-femoral pulse wave velocity (cf-PWV). The profile of inflammatory
cytokines (IFN, IL-1, IL-1, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12 and TNF) was
determined in plasma by ELISA using a Multiplex.
Results: Mean cf-PWV of the cohort was 12.8 ± 3.9 m/s. Median plasma levels
of IL-1, IL-6 and TNF were 1.01 pg/ml, 4.26 pg/ml and 3.33 pg/ml, respectively.
IL-6 levels positively correlated with cf-PWV ( = 0.218, P = 0.006, R = 0.129),
suggesting a role in aortic stiffness. In contrast, no correlation between PWV and
plasma levels of IL-1 or TNF was established.
Conclusions: This study reveals a relationship between an inflammatory cytokine, Il-6, and aortic stiffness in patients with CKD. Our results, together with
our previous findings in an experimental animal model, indicate that IL-6 may
represent a novel therapeutic target of cardiovascular diseases in CKD.
PP.37.10
CORRELATION BETWEEN CARDIO ANKLE
VASCULAR STIFFNESS INDEX (CAVI) AND
SUBCLINICAL CARDIOVASCULAR ORGAN
DAMAGE
V. Guida2, L. Lonati1,2, V. Giuli2, G. Seravalle1,2, G. Bilo1,2, C. Vergani2,
G. Parati1,2. 1S. Luca Hospital, IRCCS Istituto Auxologico Italiano, Dept. of Cardiovascular, Neural and Metabolic Sciences, Milan, ITALY, 2University of MilanoBicocca, Dept. of Health Sciences, Milan, ITALY
Objective: Increased arterial stiffness is acknowledged as an early marker of
subclinical organ damage in hypertension. Its use for risk stratification in daily
practice is limited because of relative complexity of its assessment. Cardio Ankle
Vascular stiffness Index(CAVI) is a recently proposed, easy to obtain, blood pressure independent index of arterial stiffness and can be used as a vascular age
marker. Aim of our study was to assess the relationship between CAVI and other
indices of cardiovascular organ damage in hypertension.
Design and method: In 362 consecutive essential hypertensive patients(179
M/183F;age 14–81yrs) referred to our Hypertension Clinic we performed: echocardiography, carotid ultrasound examination (both with Vivid 7,GE), CAVI measurement (VaSera Fukuda Denshi), renal function assessment (eGFR,CKD-EPI
formula).CAVI was used to subdivide our subjects based on age-specific reference
values in three vascular age classes, respectively higher than(HVA), corresponding to(normal, NVA) or lower than(LVA) anagraphic age
Results: CAVI showed a direct correlation with age(R = 0.62, p < 0.001),left
ventricular(LV) mass indexed for body surface area (R = 0.22; p < 0.001),
LV relative wall thickness (RWT: R = 0.17; p < 0.001), carotid intima-media thickness (cIMT; R = 0.40; p < 0.001), eGFR (R = 0.38; p < 0.001) and
E/e’(R = 0.23; p < 0.001).In multiple regression analysis only age (p < 0.001)
was independently associated with CAVI. NVA(N = 149), HVA(N = 124) and
LVA(N = 89) groups had similar clinical characteristics (NVA:77 M/72F, age
54.8yrs, heart rate 65.6 bpm, HVA:59 M/65F, age 55.4 yrs, heart rate 67.5 bpm,
LVA:47 M/42F, age 53.7yrs, heart rate 67. bpm, all differences NS. Significant
differences emerged for office systolic blood pressure between HVA(143.5
mmHg) and LVA(137.3 mmHg), p < 0.01; and for body mass index between LVA
(28.3 kg/m2) and NVA (27 kg/m2), p < 0.05.
HVA group had higher LV mass index, RWT and E/e’ than NVA and LVA
groups(p < 0.05).No differences in aortic dimensions and left atrium diameter
were observed. The three groups showed similar cIMT and prevalence of carotid
plaques (ns). Laboratory tests such as total,LDL and HDL cholesterol, glucose,
microalbuminuria and eGFR were not significantly different between groups
Conclusions: Our data confirm a significant relationship of CAVI with anagraphic age and with predisposition to subclinical cardiovascular damage and indicate a
strong correlation with vascular age even after correcting for all other subclinical
cardiac damage markers. Our study thus supports the suggestion that CAVI may
represent an easy tool for early detection of patient with high cardiovascular risk.
PP.37.11
PROGNOSTIC IMPACT OF ARTERIAL STIFFNESS
ON MORTALITY IN BLACK AFRICAN PATIENTS
WITH ACUTE STROKE
D. Lemogoum1, Y. Mapoure2, F. Kamdem2, C. Djomou3, J. Dissongo2, P.H. Van de
Borne1. 1ULB-Erasme Hospital, Department of Cardiology, Free Brussels University, Brussels, BELGIUM, 2Douala School of Medecine and Pharmaceutic Sciences, Department of Clinical Sciences, University of Douala, Douala, CAMEROON,
3Cameroon Heart Institute, Cameroon Heart Foundation, Douala, CAMEROON
Objective: Increased aortic stiffness(AS), is a determinant of stroke mortality,
especially in Caucasian patients. Whether aortic pulse wave velocty (PWV), a
gold standard measure of AS, and augmentation index (AI), a surrogate measure
of AS are related to mortality in acute stroke in black African patients have been
poorly investigated. This study assessed the pronostic impact of PWV and AI on
mortality in Cameroonian patients with acute stroke.
Design and method: We prospectively enrolled 138 patients who were admitted with acute stroke in the two public hospitals of Douala, Cameroon (53.9 %
females, mean age: 64 ± 13 years). The severity of stroke was assessed on admission with the National Institutes of Health Stroke Scale (NIHSS) score. Heart
rate (HR), AI corrected for HR (AIx) and aortic PWV were measured (SphygmoCor) at one week or lesser following stroke onset. The outcome was evaluated at
discharge with in-hospital mortality and post-charge with community mortality
whitin 30 days following stroke onset.
Results: BP were comparable between died and survied groups (p > 0.05). PWV
was faster in patients with NIHSS score over 14 than in those with NIHSS score of 14
or lesser: 10.7 ± 2.3 m/s vs 9. 7 ± 1.9 m/s, P = 0.012. PWV and AIx were greater in
died than survived group: 10.9 ± 2.2 m/s vs 9.7 ± 1.9 m/s, P = 0.0022 and 31 ± 12%
vs 26 ± 12%, P = 0.023, respectivement. PWV increased markedly with aging to a
larger extend in patients who died as compared to those who survived (P = 0,014).
Aged-adjusted PWVgreater or equal to 10 m/s was strongly associated with early and
high mortality rate compared to participants with PWV < 10 m/s (P = 0,006). AIx
increased significantly with aging to comparable extend in both two groups (P = 0.5).
Multivariate regression analysis reavealed PWV greater or equal to 10 m/s, diabetes
mellitus, Glasgow score of 8 or lesser and NIHSS score over 14, as independant
predictors of mortality during acute stroke in this study population.
Conclusions: PWV is strongly associated with early and high mortality rate in
Cameroonian patients with acute stroke, independenly of other know pronostic
factors.
PP.37.12
INFLUENCE OF WAVE REFLECTION AND
VASCULAR STIFFNESS PARAMETERS ON CARDIAC
STRUCTURE AND FUNCTION IN PATIENTS AT RISK
OR WITH TYPE 2 DIABETES
Macquarie University, Sydney, AUSTRALIA, 2Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University,
Maastricht, NETHERLANDS
Objective: Stiffness index beta (b) and cardio-ankle vascular index (CAVI) are
proposed pressure-independent measures of arterial stiffness that quantify the intrinsic exponent (bo) of the exponential relationship between arterial pressure and
diameter. We aim (i) to demonstrate that b and CAVI do not strictly approximate
the pressure-independent parameter bo, and (ii) to provide a suitable correction
for the inherent pressure dependency of beta and CAVI.
Design and method: The exponential relationship between pressure (P) and diameter (d) (Figure A) is valid when expressed using a reference pressure (Pref)
and corresponding diameter (dref): P = Pref*exp[bo(d/dref-1)]. In practice, diastolic blood pressure (BP) and diastolic diameter are substituted for Pref and dref.
The resulting b (Figure B) is not equal to bo, and can be analytically shown to
depend on BP. This dependence affects both b and CAVI. CAVI calculation also
relies on an approximation of incremental stiffness dP/dd (Figure D), which further increases pressure dependence.
Both effects can be analytically and fundamentally corrected for to obtain clinically usable equations to estimate pressure-independent bo and CAVIo (Figures C,F).
The pressure dependence of CAVI and the proposed corrected parameters were
quantified in a numerical simulation of a hypertensive patient group. Simulation
was done by randomly assigning to each subject a single pressure-independent bo
value (no change in actual P-d relationship), and baseline and treated (lowered)
diastolic and pulse pressures (DBP and PP). Values were drawn from normal distributions (mean ± SD: bo 10 ± 2, baseline DBP 110 ± 10 and PP 50 ± 10 mmHg;
treated DBP 80 ± 10 and PP 40 ± 10 mmHg).
Results: Results of pressure dependence of b and CAVI are shown in Figures B,E.
Corrected measures (Figures C,F) showed no change with BP.
L. Faconti1, C.E. Mills1, V. Govoni1, M.L. Casagrande1, L. Yao1, A. Webb2,
J.K. Cruickshank1. 1Division of Diabetes and Nutritional Sciences, King’s College London, London, UNITED KINGDOM, 2British Heart Foundation Centre,
Cardiovascular Division, Clinical Pharmacology, London, UNITED KINGDOM
Objective: Left ventricular (LV) diastolic dysfunction, LV hypertrophy and increased arterial stiffness are common in type 2 diabetes (T2DM); however, the relation between these pathophysiological factors remains unclear. We investigated
the relationship between arterial function and cardiac structure and function, in
people at risk of or with T2DM.
Design and method: 83 patients (47% non-European) participated in the study. Cardiac indices, arterial elastance (EA) and ventricular elastance (ELV) were estimated by
conventional 2-dimensional echocardiography. Aortic pulse wave velocity (PWV) and
augmentation index (AIx) were measured with an Arteriograph, cardio-ankle vascular
index (CAVI), nominally independent of blood pressure (BP), by a VaSera device.
Results: Mean age was 57y, 75% had T2DM, 84% hypertension, 12 % previous
cardiovascular events; 89% of the population had normal LV filling pressure (E/e’
= 7.7 ± 2.3) and mean LV mass index (LVMI) was 52.5 g/m2.7. PWV (9.4 ± 1.7
m/s) and AIx (27.9 ± 15.8 %) were both related with BP (p < 0.05) while CAVI
(8.3 ± 1.2) was not. Tissue Doppler indices (TDI) of diastolic function (E’ septal
and lateral waves) were inversely related with AIx (b = –0.27 and –0.37) as they
were with CAVI (b = –0.14 and –0.25) and PWV (b = –0.29 and -0.23) (all p <
0.05); instead only regressions for AIx with LVMI and left atrium volume index
(LAVI) were significant (b = 0.28 and 0.42, p < 0.001). In multiple regression
models adjusted for BP, age, gender and BMI, AIx was still significantly associated with cardiac structure: LVMI and LAVI (all p < 0.05), and CAVI with diastolic
function (E’ septal), also independently of LVMI (p < 0.05). PWV was not related
to these indices. Moreover only AIx and arterial elastance (an integrated index of
arterial vascular load), were related with ELV (an index of myocardial contractility and systolic stiffness) after adjusting for age, gender, BP and LVMI (p < 0.05).
Conclusions: In a multi ethnic cohort of patients at risk of or with T2DM, pressure augmentation was related to cardiac remodelling and myocardial systolic
stiffness while a generally pressure-independent index of stiffness of the aorta,
femoral and tibial artery (CAVI) was associated with TDI of diastolic function.
PP.37.13
INHERENT BLOOD PRESSURE DEPENDENCE OF
ARTERIAL STIFFNESS INDEX BETA AND CARDIOANKLE VASCULAR INDEX: ASSESSMENT OF
PROBLEM AND SOLUTION
B. Spronck1,2, A.P. Avolio1, I. Tan1, M. Butlin1, K.D. Reesink2, T. Delhaas2.
1Department of Biomedical Sciences, Faculty of Medicine and Health Sciences,
After power calculation, simulation of n = 154, with systolic/diastolic BP (SBP/
DBP) lowered from 160 ± 15/110 ± 11 to 120 ± 14/79 ± 11 mmHg, resulted in
pulse wave velocity reduction from 8.2 ± 1.1 to 6.9 ± 1.0 m/s (p < 0.001). CAVI
changed significantly from 8.1 ± 2.0 to 7.7 ± 2.1 (p = 0.023), while CAVIo did not
change (9.7 ± 2.3 vs. 9.9 ± 2.6, p = 0.393).
Conclusions: We conclude that b and CAVI as regularly used inherently exhibit
pressure dependence. We derived clinically applicable equations to evaluate intrinsic pressure-independent changes in arterial stiffness.
PP.37.14
RELATIONSHIP OF CAROTID FEMORAL PULSE
WAVE VELOCITY WITH AGE AND TIME OF
EVOLUTION IN PATIENTS WITH RHEUMATOID
ARTHRITIS
C, Ramos Becerra1,2,3, D. Cardona Muller1,2,3, M. Vazquez Del Mercado1,4,5,
E. Gonzalez Bañuelos1,4,5, E. Perez Vazquez1,4,5, J. Valadez Soto1,4,5,
A. Macias Chumacera1,2,3, E. Chavarria Avila1,4,5, F. Grover Paez1,2,3, M. Jimenez
Abstracts e345
Cazarez1,2,3, C. Garcia Aguilar1,2,3, S. Totsuka Sutto1,2,3, E. Cardona Muñoz1,2,3.
1University of Guadalajara, Guadalajara, MEXICO, 2Clinical and Experimental Terapeutic Institute, Guadalajara, MEXICO, 3Arterial Stiffness Laboratory,
Guadalajara, MEXICO, 4Rheumatology and Skeletal Muscle System Research
Institute, Guadalajara, MEXICO, 5Molecular Biology Department, Guadalajara,
MEXICO
Objective: The aim of this study was to evaluate variations in the carotid-femoral
Pulse Wave Velocity (cfPWV) and it’s association to age and time of disease evolution in patients with rheumatoid arthritis.
partment of Radiology, Lodz, POLAND, 9Institute of Cardiology, Department of
Interventional Cardiology and Angiology, Warsaw, POLAND
Objective: To present and compare clinical characteristics of patients with fibromuscular dysplasia (FMD) in one and two or more vascular beds
Design and method: 84 patients (59F, 25 M, mean age:42.5 ± 14.8 years,
range:18–72) with confirmed FMD in any vascular bed were enrolled in 2015
in ARCADIA-POL registry (instituted as Polish-French collaboration). All patients underwent evaluation including ambulatory blood pressure monitoring,
biochemical evaluation, biobanking, duplex Doppler of carotid and abdominal
arteries and whole body angio-CT. In this analysis we divided patients into two
groups according to the number of vascular beds affected – Group 1 (patients
with FMD in one vascular bed) and Group 2 (patients with FMD in two or more
vascular beds)
Results: Of 84 patients with established FMD, 45 pts(53.6%) had one vascular
bed affected (Group 1) and 39pts(46.4%) had two or more vascular bed affected
(Group 2). Patients in group 2 as compared with group 1 were significantly older
(46.1 ± 14.5vs.39.4 ± 14.4, p = 0.037) and were characterized by non-significantly
higher rate of females (79.5vs.62.2%; p = 0.084). At evaluation there were no
difference in frequency of smokers, hypertension rate, median number of antihypertensive medications, nor in office and 24-hour blood pressure values. Patients
in group 2 differed significantly in median age at diagnosis of FMD (41.9 ± 14.8
vs.34.4 ± 15.9 ys, p = 0.038) and hypertension (35.9 ± 14.8 vs.27.9 ± 13.9 ys, p
= 0.024) as compared to group 1. Bilateral renal artery FMD lesions were nonsignificantly higher in patients in group 2 (43.6% vs. 26.7%, p = 0.104). Patients
in group 2 were characterized by significantly higher frequency of aneurysms in
any artery (43.6vs.11.4%, p = 0.001) and non- significantly higher incidence of
artery dissection (21.1%vs.9.1%, p = 0.126) as compared to group 1. There was
no difference in the incidence of dissection of any artery between the groups. In
multiple logistic regression analysis the only predictor of an involvement of two
and more vascular beds was the presence of aneurysm
Conclusions: Patients with FMD confirmed in two or more vascular bed were
older and were characterized by older age at diagnosis of FMD and hypertension
as well as higher incidence of aneurysm as compared to patients with FMD affecting only one vascular bed
PP.37.16
Design and method: RA patients were matched for age and sex with healthy
controls. Subjects with a history of smoking, cardiovascular disease, hypertension, diabetes mellitus, cancer, liver disease, thyroid disease and kidney disease
were excluded. The cfPWV was calculated using the Pulse Pen® (Diatechne,
Italy) device.
Results: We included 76 women with RA and 28 healthy women, mean age (44.3
± 10.92 vs. 43.0 ± 16.26, P = 0.654). cfPWV demonstrated good correlation with
age (r = 0.459, P < 0.01), disease evolution time (r = 0.311, P = 0.008), triglycerides (r = 0.289, P = 0.03), total cholesterol (r = 0.421, P < 0.01) and atherogenic
index (r = 0.320, P = 0.02). No association with disease activity was found. cfPWV was higher in those patients with RA > 10 years evolution compared to
patients with < 10 years of disease evolution and to controls (P < 0.05).
Conclusions: A significant association between cfPWV was seen in patients with
RA, and was also correlated to age and to a disease evolution > 10 years long
without finding a significant association with increased disease activity.
PP.37.15
CLINICAL PRESENTATION OF PATIENTS WITH
FIBROMUSCULAR DYSPLASIA ACCORDING TO
THE NUMBER OF VASCUALR BEDS AFFECTED:
THE PRELIMINARY DATA OF THE POLISH
REGISTRY FOR FIBROMUSCULAR DYSPLASIA
K. Jozwik-Plebanek1, M. Januszewicz2, W. Wojcik1, E. Warchol-Celinska1,
K. Hanus1, I. Michalowska3, E. Florczak1, A. Prejbisz1, M. Kabat1, H. JanaszekSitkowska1, P. Andziak4, L. Stryczynski5, L. Swiatlowski6, P. Odrowaz-Pieniazek7,
L. Tekieli7, L. Stafanczyk8, M. Szczerbo-Trojanowska6, A. Witkowski9, A. Tykarski5,
A. Januszewicz1. 1Institute of Cardiology, Department of Hypertension, Warsaw,
POLAND, 2Medical University of Warsaw, 2nd Department of Clinical Radiology,
Warsaw, POLAND, 3Institute of Cardiology, Department of Radiology, Warsaw,
POLAND, 4Central Clinical Hospital MSW Warsaw, Department of General and
Vascular Surgery, Warsaw, POLAND, 5Clinical Hospital of Transfiguration, Medical University of Poznan, Department of Hypertension, Angiology and Internal M,
Poznan, POLAND, 6Independent Public Central Clinical Hospital4, Department
of Interventional and Neuroradiology, Lublin, POLAND, 7John Paul II Hospital,
Dept. of Vascular Surgery and Endovascular Interventions, Dept. of Interventional Cardiology, Cracow, POLAND, 8University Teaching Hospital in Lodz, De-
THE ASSOCIATION OF FOUR-LIMB BLOOD
PRESSURE DIFFERENCES WITH CARDIOVASCULAR
RISK FACTORS AND TARGET ORGAN DAMAGES IN
COMMUNITY-DWELLING ELDERLY CHINESE: THE
NORTHERN SHANGHAI STUDY
S. Yu, J. Xiong, Y. Lv, B. Bai, C. Chi, K. Wang, J. Teliewubai, Y. Zhou,
X. Fan, H. Ji, L. Wang, Y. Zhang, Y. Xu. Department of Cardiology, Shanghai
Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China,
Shanghai, CHINA
Objective: Four-limb systolic blood pressure differences (SBPDs), including
inter-arm SBPD (IASBPD), inter-leg SBPD (ILSBPD) and ankle-brachial index
(ABI), were significantly associated with mortality. We aimed to investigate the
associations of those parameters with cardiovascular (CV) risk factors and target
organ damages (TODs).
Design and method: 1528 community-dwelling elderly participants with age
72.5 ± 5.9 years were recruited in the northern Shanghai. The four-limb BP was
simultaneously measured by VP1000 (Omron, Japan). Under the framework of
comprehensive cardiovascular examinations, conventional CV risk factors were
assessed in each participant, and hypertensive TODs, namely left ventricular mass
index (LVMI), ratio of transmitral early diastolic peak flow and early diastolic
movement (E/Ea), carotid intima-media thickness (CIMT), carotid-femoral pulse
wave velocity (CF-PWV), estimated glomerular filtration rate (eGFR) and urinary
albumin/creatinine ratio (UACR), were all evaluated.
Results: ABI was significantly correlated with most cardiovascular risk factors,
whereas IASBPD was significantly correlated with several CV risk factors, including male gender (r = 0.05, P = 0.03), BMI (r = 0.20, P < 0.01), triglyceride
(r = 0.07, P = 0.01) and HDL (r = –0.12, P < 0.01). While ILSBPD was only significantly correlated with age (r = 0.09, P < 0.01) and HDL (r = –0.09, P < 0.01).
Multiple linear and logistic regression analyses indicated the similar findings. On
the contrary, after adjustment for potential covariates, those three SBPDs were
only independently and significantly associated with CF-PWV and eGFR (all P <
0.05), but not with other hypertensive TODs. Analysis of variance obtained similar results (Figure1).
Conclusions: It seems that three four-limb SBPDs bear various cardiovascular
burden, while they were mainly and significantly associated with atherosclerosis
and renal dysfunction.
symmetry and determinants of right and left carotid AS. Aim of our study was to
investigate this issue in middle-aged essential hypertensive patients.
Design and method: Thirty outpatients (age 51.7 ± 6.7 [39–63] years, M/F
13/17, BMI 26.9 ± 5.6 kg/m2, 20 on antihypertensive treatment) underwent carotid ultrasonography with AS measurement in radiofrequency (QAS, MyLab
Class C, Esaote, Italy). Associations of AS with conventional and 24 h blood
pressure, as well as with other vascular indices (CCA intima-media thickness in
radiofrequency [IMT], carotid-femoral pulse wave velocity [cfPWV, PulsePen,
DiaTecne, Italy], cardio-ankle vascular index [CAVI; VaSera, Fukuda Denshi,
Japan]) were assessed.
PP.37.17
PREVALENCE OF VARIABLES ASSOCIATED
WITH ARTERIAL STIFFNESS IN COMMUNAL
PHARMACIES OF THE VALENCIAN COMMUNITY
(RIVALFAR-STUDY)
E. Rodilla Sala1, L. Salar2, E. Alonso3, C. Aparicio4, O. Bellver5, M. Climent6,
V. Colomer7, V. Giner8. 1Universidad CEU Cardenal Herrera, Área Ciencias de
la Salud, Moncada, SPAIN, 2Farmacia Comunitaria Luis Salar, Valencia, SPAIN,
3Farmacia Comunitaria Esther Alonso, Castellón, SPAIN, 4Farmacia Comunitaria Cristina Aparicio, Valencia, SPAIN, 5Farmacia Comunitaria Otón Bellver,
Valencia, SPAIN, 6Farmacia Comunitaria Maite Climent, LÓlleria, SPAIN,
7Farmacia Comunitaria Vicente Colomer, Bocairent, SPAIN, 8Unidad HTA y
Riesgo Cardiometabólico, Hospital Virgen de los Lirios, Alcoi, SPAIN
Objective: Although determination of arterial stiffness is included in ESH-Guidelines as subclinical target organ damage for monitoring patients, stiffness- related
variables are rather unknown among medical doctors and pharmacists. This study
aims to measure the prevalence of pulse wave velocity (PWV), central arterial
pressure (BPc) and Augmentation Index (AIx) in persons attending a communal
pharmacy for any reason.
Design and method: Cross-sectional, observational, descriptive, non-interventional study in 32 communal pharmacies of the Valencian Community, belonging to SEFAC (Spanish Society of Communal Pharmacies), between November 2015 and April 2016. Stiffness-related variables were measured with
a validated device (MOBIL-O-GRAPH, IEM®), according to ESH-recommendations, followed by a 10 items-containing questionnaire and measurement of
the waist circumference.
Results: During the first month, mean age of the 638 consecutive recruited
patients was 56,5 years, the percentage of men was 38,6 %, with a global BMI
of 28,5 kg/m2. Brachial and central BP were 127/80 and 116/81 mmHg, PWV
and AI were 8,2 m/seg and 22,5 %, respectively. The proportion of patients
with increased PWV, defined as an absolute value > 10 m/seg, was 19,6 %.
when adjusting to six age-groups, prevalence was 24,1 %, with a concordance
rate of both measurements of 75,9 %. Multivariate lineal regression confirmed
age (beta = 0,13; CI: 0,125/0,130; p < 0.0001), and brachial BP (beta = 0,03;
CI: 0,028/;0,032; p < 0.0001), as the 2 variables with the highest, independent
association with PWV, followed by and obesity. In 69,1 % of the cases elevated
PWV coincided with high BP values, but in 18,8 % of patients PWV was normal in spite of high BP and in 12,1 % of the cases BP was normal but PWV
was pathological, indicating increased CV risk, not recognized by simple BP
measurement.
Results: There was no significant difference in mean carotid pulse wave velocity
(carPWV) between R and L CCA (7.5 ± 1.5 vs 7.7 ± 1.6, p = 0.6), while IMT was
slightly smaller in R than in L CCA (0.61 ± 0.11 vs 0.65 ± 0.09 mm, p < 0.005).
Table shows coefficients of univariate correlation (r) between carPWV in L and
R CCA and the assessed variables. In multiple regression models which included
age, sex, BMI, 24 h SBP, 24 h DBP, CAVI and cfPWV, carPWV in R CCA was
independently associated only with CAVI (beta = 0.38, p = 0.03) while carPWV
in L CCA only with 24 h DBP (beta = 0.60, p = 0.05).
Conclusions: Our data suggest that in middle-aged hypertensive subjects local
stiffness of R and L carotid artery may have different determinants, possibly due
to anatomical differences: R is more closely associated with indices of global vascular aging while L, directly emerging from aortic arch, seems to depend mostly
on blood pressure level. These findings, if confirmed in larger studies, may be
relevant for identification of possible determinants of cerebrovascular complications in hypertensive patients.
PP.37.19
ANTIHYPERTENSIVE TREATMENT AND
PROGRESSION OF VASCULAR AGEING
D. Terentes-Printzios, C. Vlachopoulos, P. Xaplanteris, P. Pietri, N. Ioakeimidis,
A. Aggelis, M. Abdelrasoul, E. Paschalidis, D. Tousoulis. 1st Cardiology Department, Hippokration Hospital, Athens Medical School, Athens, GREECE
Objective: Vascular age, as assessed by structural and functional properties of
the arteries, is an important prognostic risk factor for cardiovascular events.
Antihypertensive treatment has shown beneficial effects on prognosis through
blood reduction. The aim of this study was to investigate the effect of different
classes of antihypertensive drugs on the progression of vascular stiffening.
Design and method: One hundred and forty-two subjects (mean age 51.9
± 10.8 years, 94 men, 61 hypertensives) with no established cardiovascular
disease were investigated in two examinations over a 2-year period (mean
follow-up visit 1.84 years). All hypertensives were under treatment for at
least 1 year and had well-controlled blood pressure. Subjects had at the beginning and end of the study determinations of carotid-femoral pulse wave
velocity (PWV). Based on these measurements the annual absolute changes
were calculated.
G. Bilo1, L.M. Lonati1, G. Lan1, V. Giuli1,2, V. Guida1,2, G. Parati1,2. 1S. Luca
Hospital, IRCCS Istituto Auxologico Italiano, Dept. of Cardiovascular, Neural
and Metabolic Sciences, Milan, ITALY, 2Dept. of Health Sciences, University of
Milano-Bicocca, Milan, ITALY
Results: At baseline PWV was not statistically different between patients with
and without hypertension (7.14m/s vs. 7.26m/s, P = 0.447). Subjects with hypertension had a gradual higher annual progression of PWV compared to subjects without hypertension [0.281 m/s/year (95% CI: 0.183–0.379) vs. 0.102
m/s/year (95% CI: 0.020–0.185), P = 0.013]. Treatment with angiotensin receptor blockers was associated with slower progression of arterial stiffening after
adjustment for relevant confounders [0.03m/s/year (95% CI: -0.12 to 0.18) vs.
0.23m/s/year (95% CI: 0.15 to 0.30), P = 0.032]. Angiotensin converting enzyme inhibitors did not attenuate the hypertension-related progression of aortic
stiffness [0.33m/s/year (95% CI: 0.15 to 0.50) under treatment vs. 0.15m/s/year
(95% CI: 0.09 to 0.22), P = 0.08]. Neither beta-blockers [0.24m/s/year (95%
CI:0.08 to 0.41) under treatment vs. 0.17m/s/year (95% CI:0.10 to 0.23), P =
0.42], calcium channel blockers [0.11m/s/year (95% CI: -0.04 to 0.27) under
treatment vs. 0.20m/s/year (95% CI:0.13 to 0.27), P = 0.35] or thiazide diuretics [0.31m/s/year (95% CI:0.12 to 0.49) under treatment vs. 0.16m/s/year (95%
CI:0.09 to 0.23), P = 0.16] showed beneficial effect on reversing progression of
aortic stiffening.
Objective: Local arterial stiffness (AS) of common carotid arteries (CCA) can be
noninvasively investigated by ultrasonography and was reported to independently
predict incident stroke. Several studies reported on asymmetry between right (R)
and left (L) CCA in terms of intima-media thickness but little is known on AS
Conclusions: Angiotensin receptor blockers may slow down progression of vascular stiffening more effectively compared to other classes of antihypertensive
drugs independently of blood pressure reduction.These results warrant further
confirmation in larger outcome studies.
Conclusions: This pioneering large scale study measuring arterial stiffness in
communal pharmacies shows their capability to contribute to the management of
hypertensive patients by identifying subclinical organ lesions as vascular damage
in almost one fourth of individuals attending a pharmacy for whatever reasons.
Measuring PWV together with BP can therefore be recommended as a strategy to
improve monitoring BP and promote adherence to treatment.
PP.37.18
DIFFERENT CORRELATES OF LEFT AND RIGHT
CAROTID ARTERIAL STIFFNESS IN HYPERTENSIVE
PATIENTS
Abstracts e347
PP.37.20
THE RELATIONSHIP BETWEEN CENTRAL BLOOD
PRESSURE AND LEFT VENTRICULAR MASS
INDEX IN COMPARISON WITH CASUAL AND
AMBULATORY BLOOD PRESSURES
J. Shin1, By Choi2, Y. Yamori3, Y. Lee4, B.K. Kim4, S.Y. Choi2, M. Mori3.
1Department of Internal Medicine Hanyang University College of Medicine,
Seoul, SOUTH KOREA, 2Department of Preventive Medicine Hanyang University
College of Medicine, Seoul, SOUTH KOREA, 3Institute for World Health Development Mukogawa Womens University, Seoul, SOUTH KOREA, 4Division of Cardiology Department of Internal Medicine Sung-Ae General Hospital, Hyogo, JAPAN
Objective: Theoretically, it is postulated that the central blood pressure (BP) is
more directly interact with the left ventricular mass index than casual blood pressure or ambulatory blood pressure which were measured more peripheral site.
In some studies showed that central blood pressure or arterial stiffness iis more
closely associated with left ventricular hypertrophy or function than others. But
there is few study to compare the relationship in the general population in terms
of the representative relation in healthy subjects
Design and method: In the general population study for the middle aged subjects (30~59 years) in the rural area in South Korea, 143 subjects undergone central blood pressure (BP) measurement using (HEM-9000AI: Omron Healthcare,
Kyoto, Japan) and ambulatory blood pressure monitoring using TM2430, A&D in
succession were analyzed. Casual blood pressure was measured six times random
and alternative order using Omron 907 HEM and standard mercury sphygmomanometer. Left ventricular mass index (LVMI) was measured by echocardiography
(Vivid-i, GE, USA)
Results: Age was 47.9 ± 8.3 year and BMI was 25.3 ± 3.3 kg/m2. Casual systolic/
diastolic BP was 123.2 ± 17.3 / 74.6 ± 12.6 mmHg by automated device (AD) and
123.2 ± 18.7/77.2 ± 11.5 mmHg by auscultation method (AM). Daytime BP was
131.5 ± 15.2/82.6 ± 9.7 mmHg and central systolic BP was 129.5 ± 19.9 mmHg.
In simple and partially adjusted correlation coefficients for age sex, BMI, and 24
hour systolic BP, all of the correlation coefficients between LVMI and AD, AM,
and central BPs were statistically significant. But when adjusted additionally for
casual BP measured by AM, casual diastolic BPs by AD or AM and sleep systolic
BP remained significant (beta = –0.15(p = 0.04), beta = –0.24(p = 0.008), beta =
–0.25(p = 0.007), respectively). But central BP or augmentation index were not
independent factor for LVMI in the adjusted model (beta = –0.01, p = 0.68). And
when additionally adjusted for casual systolic BP by AD, casual systolic BP by
AM and nocturnal BPs remained significant.
(OR = 3,3, 95% CI = 1,2–10,6, p = 0,03) in hypertensive patients. Association of
arterial stiffness with age and hyperglycemia was found out only by cfPWV assessment: (OR = 1,13, 95% CI = 1,06–1,19, p < 0,0001) and (OR = 2,5, 95% CI
= 1,1–6,2, p = 0,04) respectively.
Conclusions: Hypertension and hyperglycemia are associated with increased arterial stiffness assessed by applanation tonometry. Applanation tonometry seems
to give the opportunity to reveal increasing of arterial stiffness at earlier stages of
hypertension in comparison with volumetric sphygmography.
PP.37.22
PROTECTIVE VASCULAR FACTORS ACCORDING
TO VASERA EXAMINATION IN RUSSIAN
POPULATION
N. Soldatenkova1, O. Rotar1, A. Orlov1, M. Boyarinova1, A. Alieva1, E. Vasilieva1,
V. Solntsev1, E. Baranova1, A. Rogoza2, A. Konradi1. 1Federal Almazov NorthWest Medical Research Centre, Saint-Petersburg, RUSSIA, 2Russian Cardiology
Research and Production Complex, Moscow, RUSSIA
Objective: Vascular age is the apparent age of the arteries that can be affected by
genetic predisposition and lifestyle risk factors. Subjects whose vascular age is
younger than chronological age might have lower cardiovascular risk. The aim of
our study was estimate protective factors, which can be associated with younger
vascular age in Russian population according to VaSera examination results.
Design and method: 1600 apparently healthy participants aged 25–65 years were
randomly selected from Saint-Petersburg inhabitants (ESSE-RF study). Fasting
lipids, glucose (Abbott Architect 8000 (USA)) and blood pressure (BP) measurement by Omron (Japan) were performed. Cardio-ankle vascular index (CAVI) was
detected by VaSera VS-1500 (Fukuda, Japan).We presumed definition of younger
vascular age - it the biological age exceeded vascular age calculated from pressure
independent stiffness index (CAVI) > 4 years. Hypertension was considered as BP
> = 140/90 mmHg or antihypertensive treatment, diabetes type 2 was considered
as fasting glucose > = 7.0 mmol/l or treatment. Multiple regression analysis was
applied (SPSS Statistics 20).
Results: Data of 1361 subjects were suitable for analysis, 391 patients (28,7%)
had vascular age younger than chronological (281 (71,8%) women and 110
(28,1%) men, ð < 0,001). These subjects were younger than other participants
also according biological age (43,4 ± 10,8 vs 45,8 ± 11,8 years, p < 0.05).
Conclusions: In terms of the relationship with LVMI, in our study done in a general population, central BP did not show additional benefit or superiority to casual
or ambulatory BPs.
PP.37.21
RISK FACTORS OF SUBCLINICAL VASCULAR
DAMAGE DETECTED BY DIFFERENT METHODS
IN POPULATION-BASED SAMPLE OF SAINTPETERSBURG INHABITANTS
A. Alieva1, O. Rotar1, A. Orlov1, M. Boyarinova1, E. Vasilieva1, V. Solntsev1,
E. Baranova1, A. Rogoza2, A. Konradi1, E. Shlyakhto1. 1Federal Almazov NorthWest Medical Research Centre, Saint-Petersburg, RUSSIA, 2Russian Cardiology
Research-and-Production Complex, Moscow, RUSSIA
Objective: Different diagnostic procedures of subclinical vascular damage detection are now suggested but unequal impact of cardiovascular risk factors on
arterial wall is still discussed. The aim of our study was to assess the association
of cardiovascular risk factors with subclinical vascular changes according to different diagnostic methods.
Design and method: 452 apparently healthy participants aged 25–65 years were
randomly selected from 1600 Saint-Petersburg inhabitants (a sample form ESSERF study). All participants signed informed consent and filled in the questionnaire
regarding risk factors, concomitant diseases and therapy. Fasting lipids, glucose
(Abbott Architect 8000 (USA)), anthropometry and BP measurement (OMRON,
Japan) were performed. Cardio-ankle vascular index (CAVI) was measured by
VaSera VS-1500 (Fukuda, Japan), carotid-femoral pulse wave velocity (cfPWV)
was measured by SphygmoCor (Atcor, Australia). Statistical analysis was performed using SPSS Statistics 20.
Results: Most of patients 341 (75,4%) did not have subclinical vascular damage by both methods and only 3 patients (0,7%) had. Increased arterial stiffness
detected by CAVI assessment (33 (7,3%)) was found out significantly more often
(p < 0,005) in comparison with cfPWV assessment (21 (4,6%)). According to
results of multiple logistic regression adjusted by sex and age, probability to reveal increased arterial stiffness by applanation tonometry (OR = 11,2, 95% CI =
3,6–34,9, p < 0,0001) was higher in comparison with volumetric sphygmography
Table 1. Determinants of younger vascular age in general population.
Conclusions: Female gender was associated with higher probability to have a
younger vascular age comparing to chronological age might be through higher
HDL level despite the absence of direct associations. Dyslipidemia and hypertension decreased a probability to have younger vascular age.
PP.37.23
CARDIOVASCULAR REMODELLING IN
HYPERTENSIVE PATIENTS: DOES GENDER
MATTER?
V. Pierobon, L. Tavecchia, M. Agostinis, N. Tandurella, A. Grossi, C. Mongiardi,
L. Robustelli Test, S. Moretti, C. Gadaleta, L. Guasti, A.M. Grandi,
A.M. Maresca. Department of Clinical and Experimental Medicine, University of
Insubria, Varese, ITALY
Objective: To investigate whether common cardiovascular risk factors act differently between genders in the development of organ damage in untreated mild
hypertensive patients. To correlate also any differences in subclinical organ damage to office, 24 h and central blood pressure (BP).
Design and method: We enrolled 60 women and 50 men (without cardiovascular
disease or diabetes, non smokers) aged between 35 and 55 years old with mild
hypertension. For the control group were enrolled 60 normotensive women and 50
normotensive men matched for age and BMI. For each subject, we evaluated office
and 24 h BP. Each patient underwent arterial tonometry (central blood pressure),
echocardiography (left ventricular mass, thoracic aortic diameters), carotid (intima
media thickness, IMT) and abdominal aortic ultrasonography and blood tests.
Results: Using a regression analysis we found an outstanding role of BMI (beta =
0.47, p = 0.0001) and central BP (beta = 0.26, p = 0.002) to predict left ventricular
mass in women. In men, BMI (beta = 0.40, p = 0.001) age (beta = 0.21, p = 0.003)
and 24 h SBP (beta = 0.34, p = 0.0001) seem to play a major role. Regarding
thoracic aorta we found a significant correlation to central BP in both men and
women (beta = 0.23, p = 0.01 and beta = 0.19, p = 0.03), whereas this association
is detectable for abdominal aorta only in women (beta = 0.37, p = 0.01). Finally,
in the prediction model of IMT, age and BMI were significant in both genders. In
women we found a significant correlation with 24 h BP (beta = 0.20, p = 0.007),
while in men with central BP (beta = 0.23, p = 0.007).
(Peter Telegin, Russia). Evaluated such marks as systolic BP aortic, diastolic BP
aortic, index of augmentation in aorta (AIxao), pulse pressure amplification and
others. To determine the contribution of overweight in increasing of aortic stiffness we used conjugation tables and assessed odds ratios and confidence intervals.
To eliminate the influence of BP on the vessel rigidity all people were divided
into 2grupps: 1gr. – hypertension / prehypertension (AH/PH) and 2gr. - normal/
optimal BP. In presence of other RF both groups were quite comparable.
Conclusions: In men target organ damage appears mainly related to age, BMI and
24 h BP. In women the role of age seems lower and CV remodelling appears also
related to central BP.
Results: It found in boys of 1st group with signs AH/PH if they have overweight
chance of detection of increased AIxao is 3.6 times higher than among their peers
with normal BW. In young men from 2nd group with normal/optimal BP probability of detection of cases increased aortic stiffness was 2.7 times higher than among
students with normal BW. Among girls with signs of AH/PH if they have overweight high probability of detecting enlarged IAao increased by 21% compared to
comparison group. For girls with normal/optimal BP risk to indicate of increased
AIxao among those with overweight does not differ from girls with a normal BW.
PP.37.24
IMPACT OF OVERWEIGHT ON PARAMETERS
OF AORTIC AUGMENTATION INDEX IN YOUNG
ADULTS
M. Evsevyeva, N. Konovalova, M. Rostovtseva, I. Prohorenko-Kolomoytseva,
E. Shchetinin. Stavropol State Medical University, Stavropol, RUSSIA
Objective: Evaluation contribution of excess body weight (BW) in increase of
aortic rigidity in young adults.
Design and method: 171 students (105 boys and 66 girls) were screened for profile risk factors (RF) on results of survey, anthropometry, strip diagnosis (lipids
and glucose). Study included people without disorders of glycemic and lipid status.Parameters of CP were determined using diagnostic complex BPLab Vasotens
Conclusions: Sex and belonging to different ranges of BP affect on the value of
contribution of overweight in the increasing of AIxao. A more significant contribution of inlarged index BW in improving aortic rigidity is recorded among
boys compared with girls. Moreover, the presence of AH/PH in boys increase this
contribution to 1.5 times compared to normotensive state. Among girls effect of
overweight on the studied parameters was much weaker. This data is advisable to
take into account formation of groups of CV risk among youthers for realization
of personalized prevention programs among them.
Abstracts e349
POSTER SESSION
SPORT AND EXERCISE
PP.38.01
THE RELATIONSHIP BETWEEN REGULAR
PHYSICAL EXERCISE AND NOCTURNAL BLOOD
PRESSURE IN KOREAN AMBULATORY BLOOD
PRESSURE MONITORING (KORABP) STUDY
B. Kim1, J. Shin2, Y. Lim2, S. Kim2. 1Division of Cardiology, Department of Internal medicine, Sung Ae General Hospital, Seoul, SOUTH KOREA, 2Divison
of Cardiology, Department of Internal medicine, Hanyang University, Seoul,
SOUTH KOREA
Objective: There have been many reports showing that regular physical exercise
can reduce the blood pressure (BP). Thus physical activity is one of the important
component of lifestyle modification of hypertension. It is known that nocturnal
BP is an independent factor for the cardiovascular event but there are few studies
for the relationship between physical exercise and nocturnal BP.
Design and method: Among 4145 subjects whose data for both clinical data and
ambulatory blood pressure monitoring (ABPM) data file from the 5308 Korean
ABPM (KorABP) study subjects, 3689 subjects were analyzed. The exclusion criteria was age less than 20 years (n = 84), missing data for the questionnaire for
physical exercise (n = 372). Physical exercise was defined as regular structured
exercise which intensity was heavier than the fast walking for 30 minutes. The
count was recorded as the number per week.
Results: Age was 55.5 ± 14.1 years and female was 45.9 %. Prevalence of hypertension, antihypertensive medication (AHM), diabetes and cardiovascular diseases were 58.9%, 32.5%, 13.0%, and 21.1%, respectively. Daytime and nighttime
systolic BP was 138.5 ± 17.2 mmHg and 126.3 ± 18.8 mmHg. When adjusted
for age, sex, BMI, and AHM, exercise frequency was independently decreased
daytime systolic BP (beta = –0.52 mmHg per exercise, p = 0.02). For the nighttime systolic BP further adjusted by daytime systolic BP and sleep quality, exercise frequency was an independent factor (beta = –0.26 mmHg per exercise, p =
0.002). The statistical significances were observed even for only for 1 times per
week. When further adjusted by smoking, exercise frequency was independent for
nocturnal dipping (beta = 0.18% per exercise, p = 0.015)
Poitiers, Poitiers, FRANCE, 2Centre de Réahabilitation cardiovasculaire et pulmonaire, Clinique Saint-Orens, Saint-Orens-de-Gameville, FRANCE, 3CHU de
Dijon, Service de Médecine Physique et Réadaptation, Dijon, FRANCE, 4Bibliothèque de Kinésiologie, Université de Montréal, Montréal, CANADA, 5CHU de
Poitiers, Service de Cardiologie, Poitiers, FRANCE
Objective: The effectiveness of regular exercise in decreasing both systolic and
diastolic blood pressure (BP) is well-established. Our purpose was to assess the
impact of both subject and physical activity program characteristics on ambulatory BP through a meta-analysis of the existing literature.
Design and method: Three databases (PubMed, Embase, Web-of-Science) were
searched using relevant terms and strategies. From 637 identified records, 37 studies met inclusion criteria: details about training intervention and participant characteristics, pre- and post-training ambulatory BP measurements, at home (HBPM)
or during 24-h (ABPM).
Results: The weighted mean difference was for 24-h systolic/diastolic ABPM
(n = 847 participants): –4.06/–2.77 mmHg (95% CI: –5.19 to –2.93/ –3.58 to
–1.97; P < 0.001), for daytime (ABPM or HBPM, n = 983): -3.78/–2.73 mmHg
(95% CI: -5.09 to –2.47/ –3.57 to –1.89; P < 0.001) and nighttime ABPM periods (n = 796): –2.35/–1.70 mmHg (95% CI: –3.26 to –1.44/ –2.45 to –0.95; P <
0.001). Characteristics significantly influencing BP improvement were: an initial
office BP > = 130/85 mmHg and diet-induced weight-loss. We found no differences in standardized mean difference (SMD) according to sex, age, or training
characteristics (intensity, number of sessions, training duration) (Fig.1).
Conclusions: Antihypertensive effects of aerobic training assessed by ambulatory BP measurements appear significant and clinically relevant for both daytime and nighttime periods, in particular for participants with an office BP > =
130/85 mmHg.
PP.38.03
THE IMPACT OF EARLY OR LATE EXERCISE
TRAINING ON THE MICROVASCULAR
ALTERATIONS INDUCED BY CEREBRAL
HYPOPERFUSION
M. Pacheco Leardini Tristão, V. Estato, J. Borges, F. Freitas, R. Rangel,
A. Daliry, E. Tibiriçá. Oswaldo Cruz Fundation, Laboratory of Cardiovascular
Investigation, Rio de Janeiro, BRAZIL
Objective: To investigate the impact of early or late exercise training (ET) on
brain microcirculatory and inflammatory parameters after an experimental model
of cerebral hypoperfusion induced by bilateral common carotid artery occlusion
(2VO) in rats.
Conclusions: Regular physical exercise is independently associated with lower
nocturnal BP also lower daytime BP and with increased nocturnal dipping, which
was independent of AHM and sleep quality.
PP.38.02
THE AMBULATORY HYPOTENSIVE EFFECT OF
AEROBIC TRAINING: A REAPPRAISAL THROUGH A
META-ANALYSIS OF SELECTED MODERATORS
P. Sosner1, T. Guiraud2, V. Gremeaux3, D. Arvisais4, D. Herpin5, L. Bosquet1.
1Laboratoire MOVE (EA6314), Faculté des Sciences du Sport, Université de
Design and method: Wistar rats aged 12 weeks were randomly divided into two
groups: Sham and 2VO and then divided into two intervention groups: (1) Early
intervention with physical exercise group, starting the ET three days after 2VO
and (2) Late intervention with physical exercise group, starting the ET ten days
after the 2VO. Finally, each intervention group was divided into three subgroups
of 10 animals: (1) Sham sedentary group (Sham Sed); (2) 2VO sedentary group
(2VO Sed) and (3) 2VO+exercise group (2VO+Ex). The animals of the exercised
group were subjected to the maximum incremental test (MIT) for the adequate
prescription of exercise intensity each training session consisted of seven days,
for 30 minutes at 60 % of maximum speed (MIT). Cerebral blood flow (CBF) was
evaluated by laser speckle contrast imaging; brain functional capillary density and
endothelial-leukocyte interactions were evaluated by intravital video-microscopy
and the gene expression of the NADPH oxidase by real time PCR
M
O
N
D
A
Y
P
O
S
T
E
R
S
Results: The 2VO model was induced a decrease of brain functional capillary
density in 2VO-Sed group compared to Sham Sed (225 ± 28 vs. 337 ± 28 capillaries/mm2, respectively; p < 0.05), a decrease of 19% in cerebral blood flow,
increased leukocyte-endothelial interactions, and although not significant, induced increases of gene expression of NADPH oxidase and IL-6. Both exercise protocols promoted increases in CBF (about 6%) and functional capillary
density (2VO+Ex early 290 ± 29 and 2VO+Ex Late 279 ± 37 capillaries/mm2,
p < 0.05). Only the early intervention group showed a significant effect of exercise
on endothelial-leukocyte interactions (2VO-Sed 5.0 ± 0.6 vs. 2VO+Ex early 1.0
± 0.3 cells/min, p < 0.05). Although not presenting statistical differences, early
intervention reduced the gene expression of NADPH-oxidase (2VO+Ex early: 1.7
± 0.2 vs. 2VO Sed: 3.3 ± 0.9 APU).
Conclusions: Cerebral microcirculatory and inflammatory changes appear to be
triggered in first days after 2VO. Therefore, and early exercise intervention can
be considered a preventive approach for neurodegenerative diseases caused by
chronic cerebral hypoperfusion.
PP.38.04
NET BLOOD PRESSURE REDUCTION FOLLOWING
9-MONTH OF LIFESTYLE AND HIGH-INTENSITY
INTERVAL TRAINING INTERVENTION IN
INDIVIDUALS WITH ABDOMINAL OBESITY
P. Sosner1, L. Bosquet1, D. Herpin2, V. Guilbeault3, E. Latour3,
L. Paquette-Tannir3, M. Juneau3, A. Nigam3, M. Gayda3. 1Laboratoire MOVE
(EA6314), Faculté des Sciences du Sport, Université de Poitiers, Poitiers,
FRANCE, 2CHU de Poitiers, Service de Cardiologie, Poitiers, FRANCE, 3Centre
de Médecine Préventive et d’Activité Physique (Centre ÉPIC) de l’Institut de Cardiologie de Montréal, Montréal, CANADA
Objective: This study aimed to examine the association of maximal aerobic capacity (VO2max) with blood pressure (BP), heart rate (HR), body mass index (BMI) and
waist circumference (WC) in a representative sample of healthy Swiss employees.
Design and method: In this cross-sectional study, 337 healthy and at least 80%
employed adult workers were recruited in the Basel region, Switzerland. Gender,
age and smoking status (yes, no more, never) were recorded. Height, weight and
WC were measured and BMI was calculated. VO2max was determined using the
multistage 20-meter shuttle run test. Subjects were categorized according to the
25th (P25) and 75th percentile (P75) of VO2max. HR, systolic and diastolic BP
were assessed at rest prior to testing and at test termination (maximal HR) respectively two minutes after the end of the test. Group differences between P25 and
P75 were analysed with Student-t test or Mann-Whitney test. Forced-entry multiple linear regression analysis was performed to identify predictors of VO2max.
Results: Complete data were available from 303 subjects aged 18 to 61 years. Descriptive statistics for total subjects, P25 and P75 are presented in Table 1. Compared
to P25, subjects in P75 were mostly male, younger, had lower BMI and WC, higher
resting and recovery systolic BP, lower resting but higher maximal HR and a greater
difference between maximal and resting as well as recovery HR. Multiple linear regressions (Table 2) revealed that a higher VO2max was associated with a greater difference between maximal and resting HR, whereas female gender, increasing age, higher
WC and current smoking contributed to a decrease of VO2max. BMI, ex-smoking,
differences in BP and maximal-to-recovery HR were not related to VO2max.
Objective: We aimed to study the impact of a combined long-term lifestyle and
high-intensity interval training (HIIT) intervention on blood pressure (BP) in individuals with abdominal obesity, taking into account the regression-to-the-mean
(RTM) phenomena (net-change).
Design and method: One hundred fifteen participants (age: 53 ± 9 years; 84
women; waist circumference (WC): 111 ± 13 cm; systolic/diastolic BP (SBP/
DBP): 133 ± 13/82 ± 8 mmHg; 13% diabetics, 12% smokers, 30% under antihypertensive therapy) were retrospectively analyzed before and after a combined
lifestyle (Mediterranean diet nutritional counselling) and HIIT program twice a
week. Anthropometric measurements and resting BP were assessed at baseline
and after 9 months of program.
Results: After 9 months, we observed an improvement in weight (–5.2 ± 5.6 kg),
BMI (–1.87 ± 1.98 kg/m2), WC (–6.3 ± 6.0 cm) and an average SBP/DBP netdecrease of –5.1 ± 13.7/ –2.8 ± 8.7 mmHg (Table 1). These changes were not uniform: 67 participants (58%) decreased their SBP by 2 mmHg or more, reaching
–8.7 ± 12.3/ –4.1 ± 8.0 mmHg (SBP/DBP). The characteristics of responders were
a higher baseline BP than non-responders (SBP/DBP: 137.2 ± 13.7/83.1 ± 7.3 vs.
127.0 ± 10.3/80.0 ± 7.3 mmHg, P < 0.05) and a higher proportion of participants
with a baseline BP > = 130/85 mmHg (81% vs. 52%, P = 0.001) or with a metabolic syndrome (75% vs. 54%, P = 0.02).
Conclusions: A combined long-term lifestyle and HIIT intervention has a beneficial effect on net-BP-change in patients with abdominal obesity and a baseline
BP > = 130/85 mmHg.
PP.38.05
THE ASSOCIATION OF BLOOD PRESSURE AND
BODY COMPOSITION MEASURES WITH MAXIMAL
AEROBIC CAPACITY IN A SWISS WORKING
POPULATION
U. Schuepbach1, J. Mundwiler1, T. Dieterle1,2, J.D. Leuppi1,2, D. Miedinger2,3,
S. Zogg1,4. 1Cantonal Hospital Baselland - University Clinic of Medicine, Liestal,
SWITZERLAND, 2University of Basel - Faculty of Medicine, Basel, SWITZERLAND, 3Swiss National Accident Insurance Fund - Department of Occupational
Medicine, Lucerne, SWITZERLAND, 4ETH Zurich - Institute of Human Movement
Sciences and Sport, Zurich, SWITZERLAND
Conclusions: This study provides evidence that diastolic BP is not affected by
aerobic exercise, while systolic BP was increased in the fittest category. The present findings suggest that maximal aerobic capacity is associated with maximal
and resting HR, but not with recovery HR. WC, but not BMI, should be preferably
used to assess the association between aerobic capacity and body composition.
PP.38.06
LOW INTENSITY ISOMETRIC HANDGRIP
EXERCISE HAS NO TRANSIENT EFFECT ON
BLOOD PRESSURE IN PATIENTS WITH CORONARY
ARTERY DISEASE
K. Goessler1,2, R. Buys1, V. Cornelissen1. 1University of Leuven, KU Leuven,
Department of Rehabilitation Sciences, Leuven, BELGIUM, 2State University of
Londrina, Research Group of Cardiovascular Response and Exercise, Londrina,
BRAZIL
Abstracts e351
Objective: Objectives: Hypertension is highly prevalent among patients with
coronary artery disease. Exercise-based cardiac rehabilitation is known to reduce
blood pressure (BP). However, less is known about the transient effect of a single
bout of exercise. Isometric handgrip exercise has been proposed as a non-pharmacological tool to lower BP, but his potential has not yet been evaluated in patients
with coronary artery disease. Therefore the purpose of this study was to investigate the acute effect of low intensity isometric handgrip exercise on BP measured
shortly after exercise in the office and during the subsequent 24 hours during daily
life activities in stable patients with coronary artery disease.
Design and method: Design: Randomized controlled cross-over design Twenty
one male patients (median age 68; range 55–70) with stable, medicated, coronary
artery disease participating in a phase III cardiac rehabilitation program were included in this study. All patients completed two experimental sessions in random
order: one control session and one low intensity isometric handgrip session. BP
was measured by means of a 24 h ambulatory blood pressure monitor pre-intervention, for one hour in the office and subsequently for 24 hours during their
routine daily practice. At the same time, physical activity was assessed by means
of a SenseWear mini device.
Results: Baseline resting BP averaged 136.1 ± 11.1/78.3 ± 6.8 mmHg and was
similar at both test occasions (p > 0.05). Following the experimental sessions, we
observed a time-effect for office BP and HR (p < 0.001 for all) which was not
different on both testing days (p-interaction > 0.05 for all). During normal daily
activities, no significant differences between both test days was found in 24 h,
daytime and nighttime BP and HR (p > 0.05 for all). No adverse events occurred.
Conclusions: Isometric handgrip exercise performed at low intensity is safe in
physically active patients with stable coronary artery disease and does not induce
a transient reduction in BP during daily life activities. Further research investing
the longer-term effects of isometric handgrip training in patients with CAD is
warranted
PP.38.07
CARDIORESPIRATORY FITNESS AND ADIPOSITY
AS MORTALITY PREDICTORS IN ELDERLY
M. De Rosa, A. Mancini, A. Lombardi, D. Leosco, N Ferrara. University Federico
II, Naples, ITALY
Objective: Age (a) decreases physical activity (PA) increasing obesity (O) but
nor associations among cardiorespiratory fitness (F), adiposity (A), nor relation
between skeletal muscle mass (SMMI),body fat (BF) and all-cause mortality(M)
in Elderly(E) was examined.
Design and method: We performed 2 y prospective study of 77 E a 60–79 y(19.8%
w) without HF, determining the association among F,A,M. F was assessed by a
maximal exercise test(T), and A by body mass index (BMI), waist circumference
(WC), and BF, respectively. Low F was defined as the lowest fifth of the sex-specific distribution of T duration. The distributions of BMI, WC, and percent BF were
grouped for analysis according to clinical guidelines. SMMI was calculated by dividing SMMI (kg) by m2. Low SMMI was defined as the first quartile of SMMI. O
(high triglycerides plus WC [HTGWC]) was defined as TG > -150 mg/dL and WC
> -90 cm (m) and>-80 cm (w). The Cox proportional hazard model was used to
evaluate the combined impact of O and low SMMI on cardiovascular and total M.
Results: There were 8 deaths (D) during 2yr. D rates adjusted for a, sex, and
examination y were across BMI groups of 18.5–24.9, 25.0–29.9, 30.0–34.9, and
> – 35.0, respectively (P = .01 for trend); 13.3 and 18.2 for normal and high WC
(>– 88 cm in w; > – 102 cm in m) (P = .004); 13.7 and 14.6 for normal and high
percent BF (>– 30% in w; > - 25% in m) (P = .51); and 32.6, 16.6, 12.8, 12.3, and
8.1 across incremental fifths of F (P < .001 for trend). The association between
WC and M persisted after further adjustment for smoking, baseline health status
(S,HS), and BMI (P = .02) but not after additional adjustment for F (P = .86).
F predicted M risk after further adjustment for(S;HS), and either BMI, WC, or
percent BF (P < .001 for trend).
Objective: Metaboreflex sensitivity is enhanced in hypertensive patients and slow
breathing training lowers blood pressure (BP) responses to static handgrip exercise in essential hypertension. Isolated systolic hypertension (ISH), which affects
more than 80% of older people, has a different pathology and it is not known
whether slow breathing can reduce the metaboreflex in these patients. This study
aims to determine the effect of slow loaded (LB) and unloaded breathing (ULB)
training on the BP responses to handgrip exercise in patients with ISH.
Design and method: Thirty older ISH patients (67 ± 5 yrs) were randomized
into LB, ULB and Control (C) groups. LB and ULB trained for 8 weeks with
inspiratory loads of 18 cm H2O or no load. All patients performed 2 minutes static
handgrip exercise (30% MVC) followed by 2 minutes post exercise circulatory
occlusion (PECO) before and after the breathing training period.
Results: The pre-training sBP responses to handgrip were increases of 44 and 42
mmHg in LB and ULB, which were reduced by 12.6 mmHg in LB and 7.2 mmHg
in ULB, the difference between groups being significant (p = 0.037). Only LB
showed a reduction in sBP during PECO (9.5 mmHg, p = 0.01), indicating that
loaded breathing reduced metaboreflex sensitivity in these patients.
Conclusions: While ULB and LB both reduced sBP during handgrip exercise,
only LB reduced sBP during PECO. This suggests that ISH patients have at least
two pathologies, one that is improved by slow breathing (both LB and ULB) together with an increased metaboreflex sensitivity, which is only reduced by an
inspiratory load.
PP.38.09
EFFECTS OF MILD DYNAMIC EXERCISE ON
CIRCULATORY AND AUTONOMIC FUNCTION IN
HEALTHY VOLUNTEERS
C. Wolff1, P.O. Julu1,2, D.J. Collier1, M. Saxena1, V. Kapil1, M. Shah1,
S. Eftychiou1, E. Mills3, L. Ansley4, A. Elliott4, O. Mukhtar1, M.D. Lobo1. 1William
Harvey Research Institute, Barts Nihr Cv Bru, Queen Mary University of London,
London, UNITED KINGDOM, 2Swedish National Rett Center, Froson, SWEDEN,
3Lidco Cardiac Systems, London, UNITED KINGDOM, 4Faculty of Health and
Lifes Sciences, Northumbria University, Newcastle, UNITED KINGDOM
Objective: Valuable insights into BP regulation have arisen from the study of
neurocirculatory responses to exercise. However most studies have focused exclusively on evaluation of responses to maximal/submaximal exercise with concomitant profound increase in muscle metabolic demand. We studied the effects
of mild exercise in healthy volunteers to obviate the confounding effects of large
metabolic changes.
Design and method: 8 healthy volunteers undertook very mild dynamic exercise
(< 3 METs) of 1 minute duration. Non-invasive arterial BP was monitored in all
8 subjects. In 5 subjects the arterial BP recording was used to derive haemodynamic variables (PulseCO®, LiDCO plc, London), including cardiac output (CO),
mean arterial pressure (MAP), systemic vascular resistance (SVR) and heart rate.
Autonomic nervous system investigation was undertaken in 7 subjects with high
resolution monitoring of arterial pressure and electrocardiography to derive indices of sympathetic and parasympathetic tone (NeuroScope®, Medifit Instruments
Ltd, London).
Results: CO increased from an average resting value of 4.8 l min-1 to 6.2 l min-1
during exercise (a 30.4% increase, p = 0.003) and settled to 4.8 l min-1 afterwards.
The reciprocal of SVR, conductance (100/SVR) was used to determine the role
of the periphery on CO in positive terms (the other driver for the increase in CO
being MAP change). The average increase in MAP and conductance was 4.4%
(p = ns) and 23.8% (p = 0.01) respectively.
Conclusions: F was a significant M predictor, independent of overall or A. To
preserve functional capacity regular PA is recommended in E.
PP.38.08
SLOW LOADED BREATHING TRAINING
ATTENUATES THE EXERCISE PRESSOR
RESPONSES IN THE ELDERLY WITH ISOLATED
SYSTOLIC HYPERTENSION
B. Sangthong1, D. Jones2, C. Jones3. 1Faculty of Physical Therapy, Rangsit University, Pathum Thani, THAILAND, 2School of Healthcare Sciences, Manchester
Metropolitan University, Manchester, UNITED KINGDOM, 3School of Physical
Therapy, Faculty of Associated Medical Science, Khon Kaen University, Khon
Kaen, THAILAND
Cardiac sensitivity to baroreceptor function (CSB) fell from an average of 5.4 ±
1.2 SEM to 2.9 ± 1.2 SEM (p < 0.05) and cardiac vagal tone (CVT) fell from an
average of 6.8 ± 1.3 SEM on a linear vagal scale to 4.1 ± 1.3 SEM, (p < 0.05).
Following exercise rebound occurred with both to values above baseline.
Conclusions: The main change driving the increase in CO was an increase in conductance rather than change in MAP. This is in contrast to dynamic cardiovascular
exercise at higher workloads where MAP increases immediately and progressively
with workload. Withdrawal of vagal tone at such mild exercise intensity is a new
finding and is consistent with gradual heart rate increase as exercise intensity
increases from the lowest levels.
PP.38.10
BLOOD PRESSURE VARIABLES, BODY MASS
INDEX AND ARM CIRCUMFERENCE PREDICT
ARTERIAL STIFFNESS AND EARLY ARTERIAL
AGING IN SEDENTARY AND PHYSICALLY ACTIVE
SUBJECTS
I. Mozos1, A. Lascu1, A. Caraba2, S. Gligor3. 1Victor Babes University of Medicine and Pharmacy, Department of Functional Sciences, Timisoara, ROMANIA,
2Victor Babes University of Medicine and Pharmacy, 1st Department of Internal Medicine, Timisoara, ROMANIA, 3West University, Department of Physical
Therapy and Special Motion, Timisoara, ROMANIA
Objective: The present study aimed to compare the predictive value of blood
pressure and anthropometric variables for arterial stiffness, endothelial dysfunction and early arterial aging (EAA) in sedentary and physically active subjects.
Design and method: A total of 90 study participants underwent arteriography.
Blood pressure variables, pulse wave velocity (PWV), brachial augmentation index (AixBrach) and arterial age (AA) were assessed. Considering physical activity level, the participants were divided in 2 groups, as follows: 61 were involved
in leisure physical activity or physical work and 29 were sedentary. Overweight
and obesity were detected in 11 patients of the first and 16 of the second group.
Results: Systolic blood pressure, diastolic blood pressure, systolic blood pressure in
the aorta, pulse pressure in the aorta (PPAo), AixBrach, PWV and AA were as follows: 121 ± 12 mmHg, 72 ± 9.92 mmHg, 111 ± 14 mmHg, 39 ± 2.27 mmHg, –45 ±
3.63%, 7.48 ± 1.39 m/s and 34.62 ± 3.15 years, respectively. Significant correlations
were found between blood pressure, anthropometric and arteriographic variables.
The best correlation was between AixBrach and PPAo (r = 0.59). Obese and overweight sedentary participants were most likely to have endothelial dysfunction (OR
= 2.31), high normal blood pressure and hypertension (OR = 1.64), and increased
pulse wave velocity (OR = 2.61). The risk decreases in obese physically active participants (OR = 1.99, 0.29 and 2.28, respectively). Lean sedentary participants are
also very likely to have endothelial dysfunction (OR- = 1.59) and arterial stiffness
(OR = 2.15). Receiver-operating characteristic curve analysis demonstrated that
body mass index (BMI) and arm circumderence (AC) are better predictors of increased PWV in sedentary than physically active study participants (AUC was 0.96,
0.95, 0.50 and 0.56, respectively). Blood pressure variables were stronger predictors
than BMI and AC for increased PWV and EAA in physically active participants and
better predictors of increased AixBrach in the sedentary group.
Conclusions: Physical activity improves arterial stiffness, endothelial dysfunction and arterial age even in obese and overweight subjects. BMI and AC are better predictors of arterial stiffness in sedentary than in physically active subjects.
Blood pressure variables are better predictors of arterial stiffness and EAA than
BMI and AC in physically active participants and of endothelial dysfunction in
sedentary individuals.
Abstracts e353
POSTER SESSION
TREATMENT ADHERENCE
PP.39.01
PERSISTENCE OF CARVEDILOL VERSUS FIRST
AND SECOND GENERATION BETA-BLOCKERS IN
THE TREATMENT OF HYPERTENSION. RESULTS
OF THE PERSEUS TRIAL
G. Simonyi1, T. Ferenci2. 1Szent Imre University Teaching Hospital, Metabolic
Center, Budapest, HUNGARY, 2Group of Physiological Regulations, János Neumann Faculty of Informatics, University of Óbuda, Budapest, HUNGARY
PP.39.02
HOW COMMON IS AMLODIPINE OVERDOSE IN
THE TREATMENT OF ARTERIAL HYPERTENSION?
E. Kociánová1, J. Vaclavik1, H. Janeckova2, D. Fridecky2, M. Kamasova1.
1Department of Internal Medicine I - Cardiology, University Hospital Olomouc
and Palacký University Faculty of Medicine, Olomouc, CZECH REPUBLIC,
2Department of Clinical biochemistry, University Hospital Olomouc and Palacký
University Faculty of Medicine, Olomouc, CZECH REPUBLIC
Objective: Amlodipine is one of the frequently used drugs in the treatment of
arterial hypertension. Plasma levels of amlodipine can be measured to assess the
treatment adherence. There is only limited data on plasma levels in patients treated
with amlodipine and correlation of plasma levels with adverse events.
Objective: According the recommendation of ESH/ESC beta blockers are recommended - as a first choice- in antihypertensive therapy. Our aim was to investigate
the newly initiated one year persistence of first and second generation of beta
blockers comparison to third generation carvedilol in hypertension.
Design and method: Using the database of the National Health Insurance of
Hungary, we choose patients who were prescribed first and second generation of
beta blockers comparison to third generation carvedilol for the first time in the
indication of hypertension (ICD: I10H0) between the 1st of October 2012 and the
30th of September 2013. These patients received no antihypertensive therapy with
similar active substances during the previous one year.
In the three groups were investigated the refill of receipts monthly. All patients
were followed for 14 month. Patients died were excluded from analysis. Sixty
days of drug discontinuation were tolerated as a Grace period. We evaluated the
proportion of persistent patients by monthly. Patients taking the carvedilol were
regarded as the reference group.
Results: During the study period 15,166 patients took a first generation betablocker, 209,828 a second generation beta-blocker and 47,851 carvedilol. One
year persistence of antihypertensive therapy was 7% in patients with a first generation beta-blockers, 17% in patients with a second generation beta-blockers and
21% in patients with carvedilol. The hazard ratio of discontinuing a first generation beta-blockers was 1.75 (95% CI, 1.72–1.78, p < 0.001), and a second
generation beta-blockers was 1.08 (95% CI, 1.07–1.09, p < 0.001) compared to
carvedilol as the reference.
Design and method: We measured 642 plasma levels of amlodipine in 343 patients treated for resistant arterial hypertension. The minimum time gap between
two measurements in one patient was three months. All patients used amlodipine
chronically and should be in steady state of the drug. The amlodipine reference
range between 6 and 18 mg/l has been regarded as therapeutic according to literature. Patients were divided into three groups - with sub-therapeutic or unmeasurable levels (group 0), with therapeutic levels (group 1) and levels above upper
therapeutic limit (group 2). Clinical status, complaints, evidence of edemas, number of antihypertensive drugs and dose of amlodipine were recorded.
Results: Only 30.7% of the measurements were within the therapeutic range. Subtherapeutic or unmeasurable level was detected in 19.9% of measurements (n =
128) and these patients were regarded as non-compliant with therapy. Level above
the upper limit was detected in 49.4% (n = 317) of specimens. In patients adherent to amlodipine, 61.7% of measurements were above the therapeutic range.
High levels of amlodipine and higher rate of overdose were more often detected
in older patients (Table 1), which is in concordance with decreased clearance of
amlodipine with age. Levels of amlodipine exceeding 3 times or more upper therapeutic limit were most commonly found in patients using higher daily doses of
amlodipine than recommended, renal impairment or using drugs interfering with
amlodipine metabolism on cytochrome CYP 3A4. 39% of these patients reported
undesirable effects of the drug.
Conclusions: Overdose by amlodipine without clinically manifest side effects is
frequent and probably undervalued in clinical practice. Risk of overdose can by
predicted by simple clinical characteristics of patients.
PP.39.03
TREATMENT DISCONTINUATION AND ADHERENCE
IN A COHORT OF BELGIAN PATIENTS NEWLY
DIAGNOSED WITH ARTERIAL HYPERTENSION
G. Karakaya1, R. Van Tielen2, I. Umbach2. 1Union Nationale des Mutualités Libres - Université Libres de Bruxelles, Brussels, BELGIUM, 2Union Nationale des
Mutualités Libres, Brussels, BELGIUM
Objective: A major problem of arterial hypertension is that many hypertensive people are not treated or do not follow their treatment correctly. Nevertheless, a good
adherence with antihypertensive medications significantly reduces cardiovascular
complications. This study was aimed to analyze the treatment discontinuations and
the adherence in a cohort of patients newly diagnosed with arterial hypertension.
Conclusions: One year persistence of the third generation beta-blocker carvedilol
was found significantly higher than the groups of first and second generation betablockers. It should be important to increase the patient adherence to antihypertensive medication.
Design and method: The pharmaceutical treatment of 18706 new patients using
for the first time an antihypertensive drug was followed during 5 years (2008–
2012) with retrospectively collected administrative database of a Belgian health
insurer. Adherence was measured using the medication possession ratio (MPR
greater than 80%). We defined treatment discontinuation as interruption of drug
treatment during at least 6 months.
M
O
N
D
A
Y
P
O
S
T
E
R
S
Results: 12% of the cohort permanently stopped the antihypertensive treatment
after the first year. On average patients under 50 years interrupted the treatment
during 6 months more than 4 times, while patients over age 50 have had 2 periods
of interruption. The correlation between the absence of treatment discontinuation
the first two years and the following three years was positive and significant (r
= 0.84). Only 22.4% of the cohort were compliant with antihypertensive therapy
during the 5 years of treatment. Over the period studied, the rate of compliance
among patients receiving one antihypertensive ATC class increased significantly
(from 63% to 75%), whereas it remained relatively stable for two combined (or
sequential) ATC classes (55%–56%) and for multi ATC classes (42%–44%). Regardless of the treatment year, compliance was particularly poor among patients
using beta blockers. The correlation between good compliance at the beginning
of the treatment (the first two years) and good compliance the following years was
positive and significant (r = 0.66).
Conclusions: The study emphasizes the necessity of early detection of illness and
continued treatment, allowing to avoid or delay complications. We also highlight
the importance to take effective action early in the treatment to improve the compliance, since the initial compliance conditions compliance over the following
years (especially among patients under 50 years, where treatment discontinuations
are more frequent and the preventive benefit high).
PP.39.04
TETRAHYDROBIOPTERIN EFFECTS LEFT
VENTRICULAR DIASTOLIC FUNCTION
BY UPREGULATING PROTEIN KINASE
C < EPSILON > SIGNALING PATHWAY IN
DESOXYCORTICOSTERONE ACETATE-SALT
HYPERTENSIVE MICE
H. Xu, Q. Wang, M. Yang, R. Ma, N. Li, X. Li, X. Lin, X. Zhang, J. Yu. Lanzhou
University Second Hospital, Lanzhou, CHINA
determinate: blood pressure (3 measurements), ECG and 6 minutes’ walk test. For
outcome: any cardiovascular event or hospitalization.
Results:
Baseline characteristics:
in study group: AVERAGE age: 56.4(3.6), 62% males, T2DM 12%, dyslipidemia
24%, obesity 32%, treatmenT with: ACEi, Sartans, Beta blockers, Diuretics, Calcium channel blockers, Statins in proportion of 80, 15, 15, 35, 35, respectively
20%; in control group: average age: 57.8(3.4), 61% males, T2DM 11%, dyslipidemia 23%, obesity 33%, in treatment with: ACEi, Sartans, Beta blockers, Diuretics, Calcium channel blockers, Statins in proportion of: 71, 16, 14, 36, 34, 22%;
Results at last visit (after 1 year):
in study group: Blood pressure measurement – average - 135/80 mmHg (3.6); ECG
(% of patients with changes) – 30%; 6 minute walking test worsening (% patients)
– 9%; 9% patients with CV events; 6 % pts with hospitalization for heart failure
In control group: average blood pressure - 144/85 mmHg(3.8); 40 % of patients
with ECG; changes; 14 % patients with CV events; 10 % pts with hospitalization
for heart failure
Conclusions: In enhanced educational group the overall results were significantly better. We obtained a better control of blood pressure closer to target
value, better blood test, ECG and echo results and very few cardiovascular
events. We obtained an excellent communication patient – physician, the confident patient adopting an optimistic attitude with higher professional and social
performances.
PP.39.06
PERSISTENCE OF RILMENIDINE THERAPY
COMPARE TO ANGIOTENSIN CONVERTING
INHIBITORS AND ANGIOTENSIN II RECEPTOR
BLOCKERS IN HYPERTENSION. THE PEAK STUDY
Objective: To identify the influence of tetrahydrobiopterin(BH4) on left ventricular diastolic function and the expression of protein kinase Ce(PKC e) in
desoxycorticosterone(DOCA) acetate-salt hypertensive mice.
G. Simonyi1, T. Ferenci2. 1Szent Imre University Teaching Hospital, Metabolic
Center, Budapest, HUNGARY, 2Physiologic Controls Group, John von Neumann
Faculty of Informatics, Óbuda University, Budapest, HUNGARY
Design and method: Male C57BL/5 mice were divided into operation group(n
= 50) and sham operation(n = 40). Mice in operation group were resected of the
left kidney and implanted DOCA pill in the cervical part, after operation, mice
were randomly divided into DOCA group (n = 22) and DOCA+BH4 group (n =
22) without the dead mice(n = 6). Mice in sham operation were only separated the
left kidney and after operation, mice were randomly separated into sham operation group (n = 20) and Sham+BH4 group (n = 20). Arterial pressure, echocardigraphy and hemodynamic method were used to investigate the DOCA model
establishment, cardiac structure and function on day 21 after operation. The next
day, cyclic guanosine monophosphate (cGMP), malonaldehyde, BH4 and PKC e
were detected by enzyme linked immunosorbent assay, Western-blot or high-performance liquid chromatography in cardiac tissues of all enthanized mice.
Objective: Hypertension is a chronic disease. In all chronic diseases treatment
adherence is important to prevent adverse consequences. No data are available in
the literature on the adherence of rilmenidine therapy.
Our aim was to investigate the newly initiated one year persistence of ARBs,
ACE-inhibitors compare to rilmenidine in hypertension.
Results: Compared to Sham group, systolic blood pressure (SBP) and diastolic blood
pressure (DBP) in DOCA group were increased (P < 0.05). The ratio of left-ventricular early diastolic filling velocity to early diastolic mitral annular velocity (E/E’),
end-diastolic pressure-volume relation (EDPVR) and Tau index were increased in
DOCA group when compared with Sham group .After BH4 treatment in DOCA
mice, EDPVR and Tau index were reduced. Superoxide dismutase (SOD) and nitric
oxide (NO) in DOCA group were reduced when compared with Sham group. After
BH4 treatment in DOCA mice, SOD and NO were increased. Compared to Sham
group, the protein level of PKCe in DOCA group was decreased (P < 0.05), while
it was increased in DOCA+BH4 group as compared with DOCA group (P < 0.05).
Conclusions: BH4 had little effect on BP, but it could improve left ventricular diastolic dysfunction in hypertensive mice, which was related to lowering the levels of
oxidative stress, increasing amounts of NO by upregulating PKCe signaling pathway.
PP.39.05
PROSPECTIVE STUDY TO ASSESS THE IMPACT
OF EDUCATION IN PATIENTS WITH SYSTEMIC
HYPERTENSION
C. Tudorica1, S. Tudorica2, A. Vintila1, A. Gurghean1. 1Coltea Clinical Hospital,
Bucharest, ROMANIA, 2Masina de Paine Ambulatory, Bucharest, ROMANIA
Objective: To assess the education impact on systemic hypertension (SH) control
and outcome after 1 year
Design and method: 100 patients with SH were randomized in two groups: enhanced educational group (which will have the predefined, standardized education
program based on the Curriculum Modules – 2 modules of 45 minutes each at
visit 0 and 6 months; phone call at month 3) and control group (will have training
taken as usual every day practice). During the 4 visits (0 – M3 –M6-M12) were
Design and method: Using the database of the National Health Insurance of Hungary, we choose patients who were prescribed ACE-inhibitors, ARBs and rilmenidine for the first time in the indication of hypertension (ICD: I10H0) between the
1st of October 2012 and the 30th of September 2013. These patients received no
antihypertensive therapy with similar active substances during the previous 1 year.
In the three groups were investigated the refill of receipts monthly. All patients
were followed for 14 month. Patients died were excluded from analysis. 60 days
of drug discontinuation were tolerated as a Grace period. We evaluated the proportion of persistent patients by monthly. Patients taking ARBs were regarded as the
reference group.
Results: During the study period 164,213 took ARBs, 185,239 ACE-inhibitors
and 37,217 rilmenidine. The 1 year persistence of antihypertensive therapy was
37% in patients with ARBs, 31% in patients with rilmenidine and 27% in patients with ACE-inhibitors. The hazard ratio of discontinuing rilmenidine 1.25
(CI, 1.24–1.27, p < 0.001), and ACEinhibitors 1,29 (CI, 1.28–1.30, p < 0.001)
compared to ARBs as the reference.
Abstracts e355
Conclusions: One year persistence of rilmenidine was found between ARBs and
ACEinhibitors.
PP.39.07
FIXED-DOSE COMBINATIONS OF
ANTIHYPERTENSIVE DRUGS MAY NOT IMPROVE
BLOOD PRESSURE CONTROL COMPARED TO
FREE DRUG COMBINATIONS – FINDINGS FROM
THE SWISS HYPERTENSION COHORT STUDY
D. Buess, T. Dieterle, J.D. Leuppi, A. Zeller, B. Martina, P. Tschudi,
K. Henny-Fullin, S. Giezendanner. Universität Basel, Basel, SWITZERLAND
Objective: Recent guidelines for the therapy of arterial hypertension recommend the use of fixed dose combinations (FDC) of antihypertensive drugs.
Due to improved compliance, FDCs are expected to improve blood pressure
(BP) control. However, while beneficial effects of FDC on compliance were
confirmed, an improvement in BP control could not be demonstrated in a
recent meta-analysis. Therefore, the goal of this subanalysis of the Swiss
Hypertension Cohort Study (HccH) was to analyze BP control in patients
receiving FDCs.
Design and method: Data from HccH were analyzed. From 2005 to 2013 1004
patients were recruited. A follow up of up to six years was performed by 91 general practitioners (GP) in Switzerland. BP control in patients receiving a fixed
dose combination of antihypertensive drugs and patients receiving a combination
of monotherapies were compared.
Results: 44.5% of all patients in our cohort were treated with a FDC, 99% of
these received a fixed combination of two agents. In patients receiving combination therapy, 69.5% received a FDC. 79.4% of the prescribed FDC contained an
angiotensin receptor blocker plus a thiazide diuretic or an angiotensin converting
enzyme inhibitor plus a thiazide diuretic. Patients with FDC received thiazide
diuretics much more frequently than patients taking single drug combinations.
BP control was 47.9% in patients receiving free combinations and 61.1% in patients receiving FDCs. BP control was significantly worse in patients receiving
FDC (x2 (1, N = 519) = 7.793, p < 0.005), even after correction for age, gender,
BMI and the prescribing GP.
Conclusions: Improved compliance but not necessarily improved BP control has
been reported in a recent meta-analysis of trials investigating the effects of FDCs.
The results of our study suggest worse BP control in patients receiving FDCs
compared with patients receiving free combination, challenging the broad usage
of FDC. Differences in BP control may be due to differences in the selection of antihypertensive drugs when prescribing FDCs compared to combinations of single
drugs. A further reason may be that dosage escalation is more difficult in patients
using FDC, thereby negatively affecting BP control.
PP.39.08
THE FIXED DOSE COMBINATION THERAPY IN
PATIENTS DIAGNOSED WITH HYPERTENSION IS
BETTER THAN ISOLATED DRUG TREATMENT
R. Cabrera Sole, L. Urrego Rivera, C. Turpin Lucas, D. Calle Salazar. University
General Hospital, Albacete, SPAIN
Objective: It is a known fact that hypertensive patients (HP), best meet the
medication when fewer tablets taken, however, little data exist on the effectiveness of the drug fixed-dose compared with the same drugs administered
separately to treat high blood pressure (HTA). In the present study, we studied
two groups of patients taking the same combination, but fixedly or separately.
To assess the effectiveness in controlling blood pressures (BP) and adherence to
treatment in patients with hypertension, who received a fixed combination of lercanidipine with enalapril (ler+enal) and another with the same combination but
separately
Design and method: We studied 88 HP (38 women and 50 men, 67 ± 7 years old)
who received ler+ enal fixed dose of 10/20 mg or 20/20 mg (Group I) required
to maintain BP below 140/90 in outpatient office, and compared with 90 HP (40
women and 50 men, age 68 ± 5 years old) called Group II received the same
medication but separately. We controlled them through self-measurement at home
(20 times monthly) and at the end of the study, all underwent to a 24 hs, ambulatory blood pressure monitoring, after 12 weeks of follow up. The percentage of
adequate monitoring of the medication was 95% for group I and 83% for group
II (p = 0.03).
Results: The other results were compared in both groups and shown in the following table:
Conclusions: According to our study, we can say that the effectiveness of the
drugs is significantly better when they are combined in fixed dose regard to the
isolated drugs and this greater efficiency increases with time tracking. Furthermore, adequate treatment compliance is significantly higher in the group with
fixed combination respect to the isolated one taking the same drugs, circumstances that should be taken into account when choosing the right treatment for our
patients.
PP.39.09
IMPACT OF A MULTIDISCIPLINARY
INTERVENTIONAL PROGRAM ON BLOOD
PRESSURE CONTROL AND HEALTHY LIFESTYLE
ADHERENCE IN PATIENTS WITH HYPERTENSION
AND METABOLIC SYNDROME
L. Bortolotto, R. Verardino, R. Santos, E. Ikeda, F. Giacchini, A. Duenhas,
I. Loyola, P. Derozier, E. Fonseca, F. Marinho, H. Lopes. Heart Institute (InCor),
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo,
Sao Paulo, BRAZIL
Objective: Assess the impact of a multidisciplinary educational program on blood
pressure control, quality of life and adherence of treatment and lifestyle modifications in hypertensive patients with metabolic syndrome.
Design and method: We included 22 subjects aged more than 18 years, with
hypertension and one or more features of metabolic syndrome according ATP
III diagnostic criteria. A multidisciplinary team including nurses, nutritionists,
physiotherapist, pharmacist, psychologist, social worker, and doctors, conducted
the interventions during 15 weekly meetings with the participants. Informative
lectures and workshops were held that aimed to health education in the different
areas. Before and after the interventional program, the patients had blood pressure measurement by a validated automatic device (OMRON) and the weight was
measured. All patients answered a SF-36 questionnaire for quality of life assessment in different domains, Morisky-Green test for adherence, nutritional diary,
stress evaluation, and were submitted to a 6-minute walk distance test to evaluate
physical performance.
Results: Themean age was 60 + 11 years, most women (80%).The systolic blood
pressure (SBP) diastolic blood pressure (DBP) and the weight measured before
and after the intervention of the multidisciplinary team, had significant reduction
SBP (147.8 ± 23 vs. 126 ± 21 mmHg, p = 0.006), DBP (86 ± 12 vs. 70.7 ± 11
mmHg, p < 0.001) and weight (85.3 ± 15 vs. 83 ± 16.5 kg, p < 0.001), respectively
before and after intervention. Also, the patients significantly improve adherence
to drugs, quality of life, physical perfomance on 6-minute walk distance test, and
adoption of healthy food and significantly decrease comsumption of salt.
Conclusions: A multidisciplinary educational program focusing on health education, have been associated with improvement of blood pressure control, weight
reduction accompanied by better physical performance, quality of life, adherence
to treatment and healthy food.
PP.39.10
EFFECT OF IMAGE MEDICINE TREATMENT
ON COGNITIVE FUNCTION AND AUTONOMIC
NERVOUS SYSTEM BALANCE IN ARTERIAL
HYPERTENSION
D. Voita1, E. Vasilevskis2, I. Kumisars1, E. Valevica1. 1University of Latvia, Research Institute of Cardiology, Riga, LATVIA, 2Riga Stradins University, Riga,
LATVIA
Objective: To evaluate the effectiveness of Image medicine treatment on cognitive function and autonomic nervous system balance in arterial hypertension
patients.
Design and method: Investigation was approved by Ethics Committee. Each patient siagned Inform Consent Form. Strong Inclusion and exclusion criteria were
elaborated, the changes in antyhypertnesive therapy during nonmedical treatment
were not allowed. Patients were tested by physician and Image medicine specialist before treatment. 13 from 17 Arterial hypertension patients (men, aged from
35–57 yrs) were included in investigation. Arterial blood pressure, heart rate, autonomic nervous system function (heart rate variability, baroreceptor function)
using Physiograph Task Force Monitor (Austria) and orthostatic tilt - table test,
Cognitive Function using Vienna test system (Schuffried, Austria), questionnaires
- SF - 36, Satisfaction with life scale and Subjective Happiness scale parameters
were analyzed before and after 1.5 months treatment.
Results: The obtained data showed that after 1.5 months nonmedical therapy
heart rate, diastolic and systolic blood pressure have statistical tendency for
decreasing. The function of arterial baroreceptor reflex statistically increased
(P = 0.006) and sympathetic - parasympathetic balance (heart rate variability)
during rest and orthisatatic test improved. The cognitive function has tendency
to increase, mainly reaction time and characteristics of attention. Subjective
Happiness scale parameters increase from 4.1 to 5.6. There are no dynamics in
Satisfaction with life.
Conclusions: The Imagine Medicine treatment lasting 1.5 months improve such
cardiovascular parameters as arterial blood pressure, heart rate, heart rate variability and arterial baroreceptor function. The function of autonomic nervous system
also improve. The cognitive function parameters, mainly reaction time, attention
and Subjective Happiness increased. Is is concluded that non medical treatment
possibilities would be added to standard therapy for better treatment results.The
next steps are follow up study and enlargement of respondents group. The study
in Control group also will be performed.
PP.39.11
THERAPEUTICAL ADHERENCE IN HYPERTENSIVE
PATIENTS
A. Correia De Oliveira, R. Mendonça e Moura, P. Pessanha. USF São João do
Porto, Porto, PORTUGAL
Objective: Determination of therapeutic adherence in patients with hipertension.
Design and method: Observational study, including 63 hypertensive patients,
taking at least one antihypertensive drug.
The patients were included in a sample, wich attended medical atendence between
september-december 2015. All hipertensive patients had more than 18 years old
and were taking at least one antihypertensive drug. All of them answered to a anomymous validated questionary regarding hipertensive drug adherence.
Results: From the 63 patients, 52% were male and 48% female. 76% never ou rarely forgot to take their antihypertensive drugs. 22% answered that
sometimes and 2% answered that always forgot to take their medication.
6% answered that it was usual to take more than one pill when feelt worse from
their health. 2% said frequently and 16% answered sometimes they didn´t take
their medications when it was finished, before attended the physician. 57% of the
patients that forgot to take their medication where males and 43% where females.
71.4% where obese or over weight. 64% where taking 3 anti-hypertensive drugs.
14.3% didn´t have normal tensional values.
Conclusions: Therapeutical adherence results from an agreement between the
physician and the patient. In this study, one quarter of the patients sometimes
forgotten to take in their anti-hipertensive medication. It is very important to make
the patient understand the importance of taking the drugs to control hipertension
and its consequences.
Abstracts e357
POSTER SESSION
LATE-BREAKERS
PP.LB03.02
POSTERS’ SESSION 3
PP.LB03.01
RENOVASCULAR HYPERTENSION AS INITIAL
MANIFESTATION OF SOLITARY RENAL ARTERY
ANEURYSM IN A YOUNG GREEK MALE
M. Gavra, M. Chertsougk, P. Vlastarakos, C. Dimosthenous, C. Badilas,
G. Tzatzahou. General Hospital of Thessaloniki Papageorgiou-Department of Internal Medicine, Thessaloniki, GREECE
Objective: To present a rare case of branch renal artery aneurysm focusing on:
-the diagnostic work-up of hypertension in a young patient
-the cause-effect relationship between renal artery aneurysm and hypertension
-the mechanism underlying renovascular hypertension
-the therapeutic approach of hypertension and renal aneurysm
-the 5-year follow-up and prognosis
Design and method: A 35 year old Greek male with no past medical history presents with de novo stage 3 hypertension with average readings of 220/130mmHg.
Basic laboratory studies revealed dyslipidaimia, normal renal function and normal albumin excretion levels. Plain kidney-ureter-bladder radiographic imaging
showed renal calcification.
The diagnostic workup for secondary hypertension included a computed tomography angiography of renal blood vessels and suprarenal glands which has shown
a renal artery aneurysm.
Despite normal perfusion was observed, the renogram showed a 8% reduction of
the left kidney function.
A thoracic computed tomography idetified no other abnormal vessels.
The magnetic angyography illustrated a 5 cm branch renal artery aneurysm with a
wall thrombus, anterior to the left kidney.
SIMVASTATIN IMPROVES MICROVASCULAR
CEREBRAL BLOOD FLOW AND ATTENUATES
ANGIOTENSIN II-INDUCED MICROCIRCULATORY
CHANGES IN A HYPERTENSION MODEL
F. Freitas, V. Estato, M.A. Lessa, E. Tibiriçá. Fiocruz - Brazil, Rio de Janeiro,
BRAZIL
Objective: Statins may reduce blood pressure through a direct regulation of RAS
and this study was designed to investigate the acute effects of simvastatin (SIM)
on cerebral microcirculation and in spontaneously hypertensive rats (SHR), and
the possible role of AT2 receptors on statins microvascular effects.
Design and method: Male Wistar normotensive rats (WKY) and SHR were divided into 4 groups of 8 animals each: WKY-CTL and SHR-CTL treated with
0.9% saline solution, and WKY+sSIM and SHR+SIM treated with SIM 30 mg/
kg/day during 3 days by gavage. We measured systolic blood pressure (SBP) and
investigated brain functional capillary density (FCD) using intravital fluorescence
videomicroscopy. Microvascular cerebral blood flow (mCBF) before and after
local administration (cranial window) of Ang II (1 mM) was investigated using
Laser Speckle Contrast Imaging, and the percentage of change on mCBF was
calculated. Cerebral AT2 receptor expression was investigated by PCR.
Results: SIM administration reduced SBP in SHR (SHR-CTL 203 ± 3
vs.SHR+SIM 172 ± 6 mmHg;p < 0.001). Cerebral FCD was reduced in hypertensive rats compared with normotensive rats (SHR-CTL 337 ± 61 vs. WKY-CTL
421 ± 35 capillaries/mm2; p < 0.05). The administration of SIM during 3 days induced a significant increase in cerebral FCD in hypertensive rats (SHR+SIM 530
± 31 capillaries/ mm2;p < 0.05). The mCBF was reduced in SHR when compared
with normotensive controls (SHR-CTL 185 ± 2 vs. WKY-CTL 231 ± 13 AU;
p < 0.05) and SIM treatment was able to increase mCBF (SHR+SIM 208 ± 9 AU;
p < 0.05) when compared with non-treated SHR (SHR-CTL). Locally applied,
Ang II elicited a reduction in mCBF of hypertensive rats and an increase in normotensive rats (SHR-CTL -13.53 ± 2% vs.WKY-CTL +13.74 ± 4%; p < 0,001),
which was attenuated in hypertensive rats treated with SIM (SHR+SIM -6.7 ± 1%;
p < 0,01vs.SHR-CTL). Additionally, AT2 receptor expression was reduced in the
brain of SHR compared with WKY (SHR-CTL 0.5 ± 0.2 vs. WKY-CTL 1.5 ± 0.15
AT2R/GAPDH p < 0,05). Treatment of SHR with SIM increased brain expression of AT2 receptor (SHR+SIM 3.1 ± 0.9 AT2R/GAPDH;p < 0,05 vs.SHR-CTL).
Conclusions: Acute treatment with SIM reversed cerebral microvascular rarefaction and restored microvascular cerebral blood flow of hypertensive rats. Furthermore, the increase in AT2 receptor expression might be associated with the positive pleiotropic effects of statins on cerebral microcirculation.
PP.LB03.03
ASSESSMENT OF CATECHOLAMINEINDUCED CARDIOMYOPATHY USING STRAIN
ECHOCARDIOGRAPHY: PRELIMINARY DATA FROM
A SINGLE TERTIARY CENTRE
A. Elenkova1, R. Shabani2, V. Vasilev1, S. Zacharieva1. 1Clinical Centre of Endocrinology and Gerontology, Medical University, Sofia, BULGARIA, 2Alexandrovska Hospital, Medical University, Sofia, BULGARIA
Immediate surgical repair was performed with ligation of the vessel and resection
of the aneurysm.
Results: Postoperatively the patient presented clinical improvement (blood
pressure around 120/80mmHg) with two antihypertensive agents, including an
inhibitor of the renin-angiotensin-aldosterone system. The dyslipidaimia was
treated with statin and ezetimibe. A renogram performed 3 months after the
surgical procedure showed a 22% decline on the left kidney function.This further reduction might be attributed to the aneurysmectomy and angioplastic renal
artery branch closure. Left renal function remained stable for the next five years.
During that time frame the patient did not present with any major cardiovascular
complications.
Conclusions: Our results are compatible with the Coral Trial and with other studies as the Renal Artery Aneurysms-A 35 year Clinical Experience. In the last one,
the surgical benefit was a decline in blood pressure while taking fewer antihypertensive agents and the maintenance of the renal function in selected cases. Our
patient had an excellent long-term clinical outcome associated with renal function
maintenance and normalization of blood pressure.
Objective: Catecholamine-induced cardiomyopathy in pheochromocytoma
patients represents a model of stress-induced cardiomyopathy with a predominantly reversible course after successful tumor extirpation. Echocardiographic strain imaging is a relatively new non-invasive method which is
increasingly used for assessment of systolic and diastolic function in patients
with metabolic cardiomyopathies. Objective: To assess the cardiac function
in patients with pheochromocytoma using conventional and strain echocardiography.
Design and method: A prospective study was conducted in a single tertiary clinical centre. We investigated 24 consecutive patients (14 men and 10 women) with
histologically verified pheochromocytomas. Clinical examination, 12-lead ECG
and echocardiography (1D- and 2D-TTE; Color, Pulsed and Tissue Doppler;
Speckle Tracking) were performed in all study participants at diagnosis of pheochromocytoma. Fourteen patients had follow-up visits 18.4 ± 10.4 months after
surgery. Paired-samples T-test was used for comparison between pre- and postoperative means of the main echocardiographic parameters: left ventricular ejection fraction (EF), LV fractional shortening (FS), LV end-diastolic and systolic
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diameters (EDD, ESD), interventricular septal thickness (IVST), LV posterior
wall thickness (PWT), deceleration time (DTE) and global longitudinal strain
(GLS).
Results: Arterial pressure normalized in twelve of the patients (85.7%) after tumor removal. Hypertension in the rest two patients became well controlled under
antihypertensive monotherapy. We did not find statistically relevant difference
between pre- and post-operative EF (66.5 ± 7.6% vs. 67.6 ± 6.34%; p = 0.883)
and ES (36.2 ± 6.8% vs. 35.9 ± 6.24%; p = 0.900). Global longitudinal strain
was pathologically reduced in all patients at diagnosis of pheochromocytoma. We
observed markedly decreased IVST (13.1 ± 1.49 mm vs. 11.6 ± 1.0 mm; p <
0.001), PWT (12.7 ± 1.26 mm vs. 11.7 ± 1.14 mm; p < 0.001) and DTE (206.4
± 36.06 msec vs. 180.9 ± 15.13 msec; p = 0.032) corresponding to a significant
improvement in GLS (–16.64 ± 1.49 vs. -19.57 ± 1.28; p < 0.001) after surgery in
comparison with baseline.
Conclusions: Classical echocardiographic parameters usually used for assessment
of cardiac function are not reliable tests in pheochromocytoma patients probably
because of the hyperkinetic state. Instead, global longitudinal strain (GLS) seems
to be a better predictor for the severity and the reversibility of catecholamineinduced myocardial damage in these subjects.
PP.LB03.04
THE EFFECT OF DIFFERENT ERYTHROPOIESISSTIMULATING AGENT TYPE TO THE INCIDENCE
OF ARTERIAL HYPERTENSION IN EUVOLEMIC
MAINTENANCE HEMODIALYSIS PATIENTS
Objective: Hypertension is still the main risk factor for premature death worldwide and, in particular, in low- and middle-income countries. We aimed to assess
prehypertension and hypertension prevalence among a predominantly Asian and
African population living in urban Suriname, a middle-income country in South
America.
Design and method: We used data from the Healthy Life in Suriname study,
in which 1,159 men and women aged 18–70 y living in the capital were randomly selected. Questionnaires on demographic factors, disease history, and use
of medication were administered. Ancestry was self-defined. During physical
examination in the local hospital, sitting blood pressure was measured in duplo
after a 5-minute rest. The prevalence of prehypertension and hypertension were
determined according to international guidelines. Differences between sex and
ethnic groups were tested using Chi-squared tests and logistic regression analyses.
Results: Participants with missing blood pressures (n = 4) and of other/mixed ethnicity (n = 199) were excluded. Of the remaining 956 participants (64% women;
mean age 43 ± 13 y), 497 subjects were Asian-Surinamese (52%) and 459 were
African-Surinamese (48%). The overall prevalence of prehypertension and hypertension was, respectively, 39 and 41%. Although hypertension prevalence did
not differ between sex (p = 0.49), men had more prehypertension than women
(p < 0.01). No differences between Asian- and African-Surinamese were found in
the prevalence of prehypertension and unadjusted hypertension. However, after
adjusting for age, African-Surinamese had significantly higher odds of having hypertension than their Asian counterparts.
G. Dorcic1, F. Simunovic2, S. Racki2, B. Devcic2, J. Radic3, B. Vujicic2. 1Emergency medicine department of Istria, Umag, CROATIA, 2Department of Nephrology,
Dialysis and Kidney Transplantation, Clinical Hospital Centre Rijeka, Rijeka,
CROATIA, 3Department of Nephrology and Dialysis, University Hospital Split,
Split, CROATIA
Objective: Arterial hypertension (AH) is an adverse effect of erythropoiesis-stimulating agent (ESA) treatment among hemodialysis (HD) patients. Among several
mechanisms considered in the pathogenesis of ESA-induced hypertension are rise
of hematocrit and erythrocyte mass and direct vasopressor action of ESA. The aim
of this study was to determine the effect of different ESA type to the incidence of
AH among euvolemic HD patients.
Design and method: We included all prevalent HD patients from the Department of Nephrology, Dialysis and Kidney Transplantation, Clinical Hospital
Centre Rijeka, from January 1, 2014, to December 31, 2015, allocated into four
groups – those without ESA, and those with short, medium and long acting
ESA, observing weekly dosage in I.U. Every six months, before starting the
midweek HD session, multifrequency bioimpedance analysis (MF-BIA) was
performed together with serum albumine and hemoglobine levels. Blood pressure (BP) and mean arterial pressure (MAP) were assessed before and at the
end of HD treatment. Patients with volume-dependent AH based on MF-BIA
assessement (>2.5 litres overhydration) and not reaching two or more measurements were excluded.
Results: A number of 350 measurements were eligible for statistical analysis,
made on 153 patients (age 69.1 ± 13.8, range 23–92 yrs, 56% male, 25% diabetic,
HD duration 61.34 ± 74.61 months). There was no statistically significant difference between the groups at the baseline. Mean weekly ESA dose was 6998.16 ±
4856.86 I.U. In comparison to non-ESA group (25% measurments); short, medium and long acting ESA showed statistically significant higher incidence of
AH (42%,p = 0,03; 50%,p = 0.002; and 43%,p = 0,018, respectively) with highest
incidence at medium and long acting ESA (p = 0,016). Both BP and MAP before
and after HD session strongly correlated with ESA dose but not with serum albumin and hemoglobin levels.
Conclusions: Our study showed that all three types of ESA increased the incidence of AH in euvolemic HD patients, with highest incidence related to
medium and long acting ESA. Systolic and dyastolic BP and MAP correlated
with weekly ESA dose while serum hemoglobine and albumin levels showed
no correlation with BP. Further investigations in greater number of patients are
needed.
PP.LB03.05
PREHYPERTENSION AND HYPERTENSION IN
URBAN SURINAME
F. Diemer1, S.M. Baldew2, G.A. Van Montrans3, G.P. Oehlers1, L.M. Brewster3.
1Academic Hospital Paramaribo, Paramaribo, SURINAM, 2Anton de Kom University of Suriname, Paramaribo, SURINAM, 3Academic Medical Centre, Amsterdam, THE NETHERLANDS
Conclusions: We found a high prevalence of prehypertension and hypertension in
this urban-only population. With only 20% having optimal blood pressure levels,
this middle-income country faces a high cardiovascular burden. Therefore, drastic
preventive measures prioritizing screening and control of hypertension need to be
taken in order to safeguard the cardiovascular health of the Surinamese population.
PP.LB03.06
LOOKING FOR MISSING HYPERTENSION
FOOTPRINTS IN THE CARDIOVASCULAR RISK
LOCUS 9P21.3: A TALE OF 7 SNPS
J.E. Gallo1,2, J.E. Ochoa3, E. Misas1,4, G. Bedoya4, G. Parati3,5, D. Aristizabal1,
J.G. Mcewen1,4, O.K. Clay1,2. 1Molecular and Cell Biology Group, Corporación
para Investigaciones Biológicas, Medellín, COLOMBIA, 2School of Medicine and
Health Sciences, Biomedical Sciences Program, Universidad del Rosario, Bogotá,
COLOMBIA, 3Department of Cardiovascular Neural and Metabolic Sciences,
San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, ITALY, 4Institute
of Biology, Universidad de Antioquia, Medellín, COLOMBIA, 5Department of
Medicine and Surgery, University of Milano-Bicocca, Milan, ITALY
Objective: A region within 9p21.3 has been consistently associated with risk of
coronary heart disease, cardiovascular disease or atherosclerosis. Neighboring
regions have associations with other chronic diseases including type 2 diabetes.
Surprisingly, the 9p21.3 cardiovascular risk region has been repeatedly reported
to lack association with conventional risk factors such as hypertension/blood pressure or hyperlipidemia/plasma lipoproteins, leading some authors to suggest that
the locus might affect cardiovascular risk via a novel, still unknown alternative
route (Holdt & Teupser 2012, 2013, McPherson 2013). We revisited the ‘missing hypertension’ enigma in the light of data from the population of Medellín,
Colombia, which has mixed ancestral origins and has been characterized within
the 1000 Genomes Project.
Design and method: For a cohort of individuals in Medellín (n>350) from
whom we had obtained clinical and physiological data, we genotyped 65 SNPs
from 9p21.3.
Results: In the raw (uncorrected) associations of our selected 9p21.3 SNPs with
physiological variables, the strongest were largely for variables or criteria representing blood pressure or hypertension. We found an island (~ 21 kb) within
the cardiovascular risk region containing seven genotyped SNPs that showed
Abstracts e359
associations with mean blood pressure, and a modest but monotonic increase in
this variable from homozygous minor-allele genotypes through heterozygous to
major-allele homozygous. The increase corresponded to the rise in cardiovascular risk found for those 7 SNPs in other population studies, and was stronger
in men. Homozygous individuals plotted versus age showed an upward shifted
regression line for the major allele. Mixed ancestry (estimated via 30 AIMs) did
not trivially explain the effect, despite strong variability in the alleles’ frequencies among continents. The 7 SNPs are located upstream of the CDKN2A gene,
possibly in regulatory DNA.
Conclusions: We could not confirm a reported lack of association between the
9p21.3 risk locus and blood pressure/hypertension in our cohort. Consistent footprints of hypertension in a population could suggest hypertension-related etiologies of cardiovascular risk rather than a novel route. Differences from other studies’ results might reflect different ways of obtaining mean blood pressure values,
a chance observation, and/or differences among populations.
PP.LB03.07
WHAT IS THE NORMAL INTER-ARM DIFFERENCE?
IT DEPENDS ON LEFT OR RIGHT HANDEDNESS:
SYSTEMATIC REVIEW AND META-ANALYSIS
S. Joshi, C. Clark, J. Campbell. University of Exeter Medical School, Exeter,
UNITED KINGDOM
Objective: Inter-arm blood pressure differences (IAD) are normally distributed,
and normal ranges for systolic IADs around +/– 10mmHg have frequently been
proposed. Some studies report higher mean blood pressure (BP) readings for right
compared to left arms, but this is not consistent. We undertook a systematic review and meta-analysis to estimate the usual difference in BP between right and
left arms, and to explore any effect of hand dominance on IAD.
Design and method: EmBase, Medline and CINAHL were searched to October
2015 using text terms for IAD. Journal collections, conference abstracts, grey
literature, and reference lists were also checked. We included studies measuring
BP simultaneously in both arms, seeking additional data from study authors where
needed. Study quality was assessed using the Newcastle-Ottawa scale.
Mean IAD (right minus left) was calculated for each study and data were pooled
by inverse variance in random effects models. Heterogeneity was quantified using
the I2 statistic and explored within subgroup analysis by study quality.
Results: We identified 1672 unique citations; 27 studies contributed to meta-analyses. Systolic BP was 1.0mmHg (95% CI 0.7 to 1.3) higher for right compared
to left arms (27 studies, 14398 subjects). Statistical heterogeneity was lower for
high quality (I2 = 14%) compared to low quality studies (I2 = 77%). Diastolic BP
did not differ between arms (0.1mmHg, –0.2 to 0.4; 24 studies: 13266 subjects).
For right handed subjects systolic BP was 1.3mmHg (1.0 to 1.7) higher in the
right arm (I2 = 0%; 6 cohorts, 3301 subjects) but did not differ in left handed subjects (0.1mmHg, –0.8 to 1.0, I2 = 0%; 272 subjects; p = 0.02). A non-significant
opposite trend was seen for diastolic BP: –0.3mmHg (1.3 to 0.7) right handed;
0.7mmHg (–0.6 to 2.1) left handed (p = 0.23).
Conclusions: Overall systolic BP is 1mmHg higher in the right compared to the
left arm. Right handedness dominates the population masking a different pattern
in left handed people. Arterial anatomy and asymmetric arm development probably explain the differences observed. The findings are relevant for BP measurement protocols favouring non-dominant arms, and for future studies of inter-arm
difference.
PP.LB03.08
helps to plan them. The CVR was stratified by the European SCORE system for
low-risk countries. A test was conducted with a pilot program providing workers
with very high CVR (SCORE > = 10). The adherence to the Mediterranean diet
was assessed by a 14-item questionnaire and physical activity by the International
Physical Activity Questionnaire (IPAQ).
Results: This pilot study included 11 patients with a mean age of 63.2 years (±
4.2). All the participants were men, 71.7% and 45.5% had hypertension and dyslipidaemia, but only 36.4% and 18.2% of them were receiving anti-hypertensive
treatment and lipid-lowering therapy at baseline, respectively. These patients,
mostly manual workers (63.6%), showed a high level of adherence to the Mediterranean diet in 27.3% of the cases, and moderate over the remaining 72.7%. 81.8%
knew they had cardiovascular risk factors. 45.5% were smokers, of which 66.6%
expressed their intention to give up smoking in the coming months. The mean
BMI was 28.1 kg/m2 and the mean waist circumference was 99.36 cm. A 36.4%
of the workers reported being physically very active in the 7 days prior to the
follow-up assessment (36.4% sufficiently active and 27.2% insufficiently active).
Conclusions: Our preliminary results suggest that there is a high potential for
improvement in lifestyle and CVR control among patients at very high cardiovascular risk. The availability of an expert system could facilitate decision-making
when providing medical advice. An expert system could be a value-added service
in order to standardize health care and to promote the best clinical practice.
PP.LB03.09
ARTERIAL STIFFNESS IN EXTREME DIPPER
TREATED HYPERTENSIVES CORRELATES WITH
24-H BLOOD PRESSURE PARAMETERS
G. Amah1, A. Pasteur-Rousseau2, A. Vovelle2, N. Kubis2, P. Bonnin2. 1Université
Diderot-Paris, Sorbonne Paris Cité, AP-HP, Hôpital Lariboisière, Physiologie Clinique, Paris, FRANCE, 2Université Diderot-Paris, Sorbonne Paris Cité, Hôpital
Lariboisière, INSERM, U965, Paris, FRANCE
Objective: It has been shown that hypertensive extreme dipper patients have
stiffer large arteries than dipper patients. The goal of our study was to correlate
the arterial stiffness of treated hypertensive extreme dipper patients according to
mean 24-h, mean day-time and mean night-time systolic (SBP), diastolic (DBP),
mean (MBP) and pulse blood pressure (PP).
Design and method: We selected 987 treated hypertensive patients who underwent 24-h ambulatory blood pressure monitoring. Extreme dipper profile was defined as a mean night-time SBP reduction of at least 20% compared to the mean
daytime SBP. Arterial stiffness was measured using carotid-femoral pulse wave
velocity (c-f PWV). Patients with secondary hypertension, diabetes mellitus renal
failure (glomerular filtration rate < 60 mL/min/1.73 m2 calculated using the Modification of Diet in Renal Disease formula), atrial fibrillation, clinical suspicion
of sleep apnoea, congestive heart failure, history of coronary artery disease, and
those working at night were excluded. Correlations between c-f PWV and 24-h,
day-time, night-time of SBP, DBP, MBP and PP were analyzed using a linear
regression model.
Results: 432 patients were selected, including 56 extreme dippers: 17 men (mean
age: 52 ± 9 years old) and 39 women (mean age: 58 ± 8 years old) (p = 0.033). Mean
BMI was of 27.06+/–5.06 kg/m2 (17.85–42.19) without any gender difference.
Significant positive linear regressions were found only between c-f PWV and
mean 24-H SBP (R = 0.59, p < 0.001), mean 24-h PP (R = 0.50, p < 0.001) and
mean 24 h MBP (R = 0.41, p = 0.002).
APPLICATION OF AN EXPERT SYSTEM TO
IMPROVE CARDIOVASCULAR RISK IN THE
WORKPLACE
E. Calvo-Bonacho1, M. Cabrera-Sierra1, L. Quevedo-Aguado1, C. FernándezLabandera1, P. Martínez-Muñoz1, J.C. Sainz-Gutiérrez1, C. Catalina-Romero1,
A. Fernández-Meseguer1, M.Á. Sánchez-Chaparro2, P. Valdivielso-Felices2,
L.M. Ruilope-Urioste3. 1Ibermutuamur, Madrid, SPAIN, 2Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, SPAIN, 3Instituto de Investigación, Hospital Universitario Doce de Octubre, Madrid, SPAIN
Objective: The aim of this study was to design, develop and test an expert system
to help professionals in clinical decision-making as providing an assessment of
the health of workers at very high CVR.
Design and method: It was designed and developed an operational web expert
system in ASP language, which gathers information on risk factors and returns an
output with recommendations for management of risk factors based on the 2012
criteria of the European Guidelines on Cardiovascular Disease Prevention. In the
case of needing an intervention or modification of drug treatment, the expert system
Conclusions: In hypertensive extreme dipper patients, the increase in c-f PWV,
reflecting increased arterial stiffness, correlates with the elevation of 24-h blood
pressure parameters, particularly mean 24-h SBP and mean 24-h PP, although
these patients were already treated. These findings should encourage practitioners
to control very effectively SBP and the other cardiovascular risk factors to avoid
worsening of the arterial stiffness.
PP.LB03.10
THE METABOLIC SYNDROME IN APPARENTLY
HEALTHY ADOLESCENTS FROM AN URBAN
POPULATION IN GUAYAQUIL,ECUADOR
F. Aguirre Palacios1, A. Coca2, M. Paredes3, M. Aguirre4. 1Military Hospital,
Guayaquil, ECUADOR, 2Hypertension and Vascular Unit Dept. of Internal
Medicine, Barcelona, SPAIN, 3Profesor of Bio statistics at Catholic University,
Guayaquil, ECUADOR, 4Md., Valencia, SPAIN
Objective: To determine the prevalence of the metabolic syndrome (MS) and the
existence of vascular inflammation in adolescents of both gender, aged 12–14
years.
Design and method: 396 apparently healthy students where included in a prospective and descriptive cross-sectional survey. Informed consent of their parents
was required, and anthropometric measurements including BP, BMI, and blood
tests were obtained to analyze MS-related parameters, and to study vascular inflammation. Percentiles of the different parameters where used, and MS was defined according to NCEP ATP III criteria.
Results: The prevalence of MS was 12.6%; obesity 1.8%, pre-HT (>P90) 7.1%,
and HT 13.7%. In patients with the MS the OR (95% CI) for high Triglycerides
was 2.3 (95% CI 1.9 to 2.7), HOMA 1.9 (95% CI 1.6–2.4), low HDL 1.8 (95%
CI 1.5–2.1), insulin 1.53 (95% CI 1.4 – 1.6), interleukin-6 1.8 (95% CI 1.1 to 2.7)
and CRP-hs 1.1 (95% CI 0.8–1.5). Vigorous exercise > 20 minutes 3 times per
week showed an inverse correlation with the BMI, but not the usual twice-a-week
physical exercise performed at the school.
Conclusions: The MS correlated with BMI, inflammation and insulin resistance,
and was associated with pre-hypertension and true hypertension compared to nonobese subjects. The adoption of healthy diets and vigorous exercise in adolescents
is crucial to prevent cardiovascular disease in the older age.
Design and method: 26 stable dialysis patients (mean age 57.27 ± 13.97) without
previous large artery damage were prospectively studied. Blood tests within 6
month were accomplished. All patients underwent two carotid-femoral pulse wave
velocity measurements at the beginning of the study and after 6 months. Carotidfemoral PWV assessment was performed on the non dialysis day. We collected
data about cerebrovascular and cardiovascular events during 6 month follow-up
and according this divided patients into two groups (with and without events).
Statistical analysis was performed using R Statistical Software.
Results: During a 6 month follow-up, 2 non cardiovascular deaths, 7 cardiovascular events (atrial fibrillation, myocardial infarction) and 1 cerebrovascular (stroke)
event were registered. Cerebrovascular and cardiovascular pathology was associated with an increase in beta2-microglobulin concentration (46.91 vs 33.51, 46.91,
p = 0.0626) and in carotid-femoral PWV at the beginning of the study (11.4 vs
10.9, p = 0.6707) and during follow-up (12.55 vs 10.00, p = 0.0369). There was no
difference between groups while comparing other laboratory parameters (albumin,
cholesterol, parathyroid hormone concentration, CRP, hemoglobin concentration,
calcium and phosphate level) and no correlation between carotid-femoral PWV
and beta2-microglobulin values. Patients with carotid-femoral PWV > 10 m/s
had 2,6 higher event risk.
Conclusions: Carotid-femoral PWV even in a short term follow-up helps indicate
patients with higher cerebrovascular and cardiovascular risk.
PP.LB03.12
ASSESSMENT OF SYSTOLIC AORTIC PRESSURE
AND WAVE FORM CALIBRATION CRITICALLY
DEPENDS ON THE ACCURATE DETERMINATION
OF MEAN ARTERIAL PRESSURE: A CASE REPORT
T. Mengden1, S. Wassertheurer2. 1ESH Excellence Centre, Bad Nauheim,
GERMANY, 2Austrian Institute of Technology, Vienna, AUSTRIA
Objective: Therefore the aim of this work is the analysis of different MAP estimation methods and its impact on derived aSBP values.
Methods: In a series of eight patients we retrospectively compared aSBP as
assessed with the Complior® device with aSBP provided with a validated oscillometric device using a generalized transfer function (ARCSolver®, MobilO-Graph®). aSBP was determined for clinical indications in patients (age:
64+9.9, sex:2 female, 6 male)with arterial hypertension or coronary artery
disease. In the case of the Complior® device the wave form calibration was
based on determination of calculated mean pressure (MAP1) and diastolic
pressures as assessed with a validated oscillometric device. In the case of
the Mobil-O-Graph® measured mean (MAP2) and diastolic pressures were
used for wave form calibration. Furthermore, measured mean and diastolic
pressures of the Mobil-O-Graph® were used for assessment of aSBP in the
Complior® device.
PP.LB03.11
CAN ARTERIAL STIFFNESS PREDICT LARGE
ARTERY DAMAGE IN SHORT TERM IN PATIENTS
ON DIALYSIS?
A. Laucyte-Cibulskiene, M. Petraviciute, L. Ryliskyte, A. Laucevicius,
M. Miglinas. Vilnius University, Vilnius, LITHUANIA
Objective: To study a short term aortic pulse wave velocity measurement value
for predicting cerebrovascular and cardiovascular events in patients on dialysis.
Design and method: As expected peripheral values of SBP and DBP where
the same for both oscillometric devices (128+ 8.7/77.5+12.7 mmHg vs
127.9+7.0/78.1+12.5 mmHg; ns). Nevertheless as depicted in the figure striking differences for aSBP were observed between the Complior® device and the
Mobil-O-Graph® (99.4+11.0 vs 139.3+8.4 mmHg; p = 0,000017) depending on
the calibration.
Simliarly as shown in the figure we observed a difference of 15 mmHg for the
two oscillometric devices between MAP1 and MAP2 (86.3+ 9.9 vs 101.0+ 8.3
mmHg,; p = 0,00006).
If we used the measured mean (MAP2) and diastolic pressures of the Mobil-OGraph® for calibration of the Complior® device as well the differences for aSBP
diminished significantly (133.7+ 10.6 vs 139.3 +8.4mmHg for Complior® and
Mobil-O-Graph® respectively; ns).
Results: The assessment on aSBP critically affects absolute aSBP values reported
to the physician. If the same calibration method is used, different results between
devices diminish. With respect to clinical practice and thresholds standardization
of MAP definition is indicated.

ESH 2016 Abstract Book Posters June 13

Transcription

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