89
Abstracts e93 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved POSTER SESSION S A T U R D A Y P O S T E R S POSTERS’ SESSION PS01: EPIDEMIOLOGY AND RISK FACTORS PP.01.01 ANTIHYPERTENSIVE TREATMENT IN ROUTINE CLINICAL PRACTICE OF SPECIALIZED CARDIOLOGICAL CENTRE: SIX-YEAR TRENDS N. Zvartau 1 , A. Krikunov 2 , A. Semakova 2 , E. Bolgova 2 , S. Kovalchuk 2 , A. Boukhanovsky 2 , A. Konradi 1 . 1 Federal Almazov North-West Medical Research Centre, Saint-Petersburg, Russia, 2 ITMO University, Saint-Petersburg, Russia Objective: Guidelines describe algorithms on how to manage high blood pres- sure; however there is lack of information on true feasibility and impact on routine clinical practice. The main objective of this study was to assess prescribed in real life practice antihypertensive treatment and six-year trends in adult hypertensive patients referred to specialized cardiology clinic. Design and method: Data included 68276 (24183 males and 43913 females) electronic records of patients, mean age 58.3 ± 13,8 years, referred due to uncon- trolled hypertension (HTN). Descriptive statistics were used to estimate the means in gender, age [under 35 years (n = 4665), 3549 (n = 9774), 5065 (n = 29682), older than 65 (n = 24155) years] and antihypertensive drug classes (AHD) and severity of HTN [1 (n = 3973), 2 (n = 30629) and 3 degree (n = 20239)] sub- groups. Linear regression was employed to determine the yearly trends. Age and gender-specific results were adjusted to Saint-Petersburg general population data for 6-years period and every studied year. Results: The mean number of prescribed AHD per patients constituted 1,93. There was a 20,1% increase in mean number of AHD during 20102013 (R 2 = 0,99; p = 0,001) with subsequent decrease by 21,2% from 2013 till 2015 (R 2 = 0,98; p = 0,01), mostly due to subgroups with more severe HTN. The most frequently prescribed AHD classes were beta-blockers (BB; 30734 cases, 45%), angiotensin receptor blockers (ARB; 19474, 28%), calcium channel blockers (CCB; 17752, 26%), ACE inhibitors (ACEi; 15178, 22%). Monotherapy was prescribed up to 20% (13691), 64% constituted ARB and ACEi. Two-drugs combinations were used by 20% (13880) of patients, the top were ARB+CCB (15,1%) and ARB+BB (12,8%). Three-drugs combinations were taken by 19% (13407) of patients and the leaders were diuretic (D)+BB +ARB (13,4%) or + ACEi (12,9%). Interesting- ly, women demand at least 2 AHD (2,03), while 13% of males used monotherapy mostly with ACEi (n = 1532) or ARB (n = 1499). There were no substantial yearly trends in AHD classes in overall population and specified subgroups. Conclusions: Results demonstrated that real-life practice is sometimes far away from recommended pathways. This may be explained by a specific population of specialized center with numerous concomitant cardiovascular and other diseases forcing to step away from optimal approach. PP.01.02 METABOLICALLY HEALTHY OBESITY AS A PART OF THE CARDIOMETABOLIC CONTINUUM Y. Zhernakova 1 , M. Azimova 1 , I. Trubacheva 2 , V. Kaveshnikov 2 , V. Serebryakova 2 , A. Rogoza 1 , E. Oschepkova 1 , I. Chazova 1 . 1 Russian Research and Production Cardiology Complex, Moscow, Russia, 2 Cardiology Research Institute, Tomsk National research Medical Center, Tomsk, Russia Objective: Was used data from epidemiological survey ESSE-RF (Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federa- tion) including adult population at the age of 2564 y.o. of Siberian city Tomsk (n = 1538, including 58% females and 42% males). Design and method: Was used the systematic stratified multistage random sam- pling creating by the territorial principle of method by Keesh. Abdominal obesity (AO) was defined by waist circumference (WC) > 80 cm in women and 94 cm in men. MS was defined according to IDF, 2005. Diabetes mellitus 2 type (DM2) by fasting glucose > 6,9 mmol/l or <7 mmol/l with hypoglycemic therapy. Statistic data calculation was done with computer-based statistic software STATISTICA 10.0 and SPSS 14.0. Results: Final analysis included 1538 persons. All examined persons have been divided into 4 groups depending on presence of obesity, metabolic syndrome (MS) and DM 2, the 1st group included people without abdominal obesity (AO), MS and DM2 (n = 611). Patients with AO, but without MS (one additional risk factor was allowed) - metabolically healthy obese have been included into the 2nd group (n = 107). Patients with MS (n = 676) have been enrolled into the 3rd group. And patients with DM2 have been entered into the 4th group (n = 144). The prevalence of obesity in studied simple was 48,1% by BMI > 30 kg/m 2 and 59% by WC. Arterial hypertension had 41,7% respondents: 15,4% in the 1st group, 32,7% in the 2nd group, 75% in the 3rd group and 92,3% in the 4th group. The prevalence of target organ damage (TOD) was growing from 1st group to 4th (Tab. 1). It was statistically significant (p < 0,0001). Conclusions: Study results showed high prevalence of obesity, especially AO (59 %) in the investigated population, prevalence of MS also was high (43%), as well as DM 2 (9,3%). Cardiometabolic continuum (CC) is a progressive process and AO is fundamental to the pathophysiology of CC. Persons with metabolically healthy obesity already had the TOD. It could mean that AO without MS is a part of CC. Therefore patients with AO need more rigorous observe as early as possible. PP.01.03 PREVALENCE OF RENAL DYSFUNCTION IN RUSSIAN POPULATION IN DEPENDENCE ON PRESENCE OF ARTERIAL HYPERTENSION AND OBESITY BY THE DATA OF EPIDEMIOLOGICAL STUDY ESSE-RF Y. Zhernakova 1 , E. Oshchepkova 1 , I. Chazova 1 , S. Chalnova 2 , S. Boytsov 2 , O. Rotar 3 , A. Konradi 3 , E. Shlyakhto 3 . 1 Russian Research and Production Cardiol- ogy Complex, Moscow, Russia, 2 National Research Center for Preventive Medi- cine, Moscow, Russia, 3 Federal Almazov North-West Medical Research Centre, Saint-Petersburg, Russia Objective: Was used data from cross-sectional epidemiological study ESSE-RF (Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation) including adult population at the age of 2564 y.o. of 10 regions RF (n = 16936, including 64% females and 36% males): Volgograd, Vologda, Voronezh, Ivanovo, Krasnoyarsk, Orenburg, Samara, Tomsk, Tyumen and Northern Osetia-Alania. Design and method: Was used the systematic stratified multistage random sam- pling creating by the territorial principle of method by Keesh. Renal dysfunction was assessed on the basis of the calculation of glomerular filtration rate (GFR). GFR was conducted on the Chronic Kidney Disease Epidemiology Collaboration (GRF-EPI). Statistic data calculation was done with computer-based statistic soft- ware STATISTICA 10.0 and SPSS 14.0. Results: Final analysis included 15570 persons. Arterial hypertension had 6820 (43,8%) respondents. The prevalence of obesity (BMI > 30 kg/m 2 ) in patients with AH was 59%. Among the patients with arterial hypertension (AH) CKD (GRF < 60 ml/min/1,73 m 2 ) was found 3 times more often than without 1,8% and 0,43% respectively, minor renal dysfunction (GRF 6090 ml/min/1,73 m 2 ) was twice higher in patients with AH (34,8%), than without (16,2%). Systolic blood pressure was significantly higher in hypertensive patients (152,6 ± 21,4 mmHg) with renal dysfunction (p < 0,0001) than without (144,8 ± 17,9 mmHg). But dia- stolic blood pressure didn’t have differences. Patients with AH and obesity had minor renal dysfunction in 1,21 time more offer and CKD in 5,3 time more offer without AH and obesity (Tab. 1). According multivariate analysis major risk factors associated with renal dysfunc- tion (odds ratio) were hypercholesterolemia 1,92 (95% CI, 1,77–2,08), fasting hyperglycemia 1,63 (95% CI, 1,41–1,89) and systolic blood pressure 1,7 (95% CI, 1,56–1,88).

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Page 1: POSTER SESSION - ESH 2017 Annual Meeting · POSTER SESSION POSTERS’ SESSION PS01: ... and educational materi-als; and improve treatment availability. Among facilities chosen for

Abstracts e93

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved

SATURDAY

POSTERS

POSTER SESSIONSATURDAY

POSTERS

POSTERS’ SESSION PS01:

EPIDEMIOLOGY AND RISK FACTORS

PP.01.01 ANTIHYPERTENSIVE TREATMENT IN ROUTINE

CLINICAL PRACTICE OF SPECIALIZED

CARDIOLOGICAL CENTRE: SIX-YEAR TRENDS

N. Zvartau1, A. Krikunov2, A. Semakova2, E. Bolgova2, S. Kovalchuk2, A. Boukhanovsky2, A. Konradi1. 1Federal Almazov North-West Medical Research Centre, Saint-Petersburg, Russia, 2ITMO University, Saint-Petersburg, Russia

Objective: Guidelines describe algorithms on how to manage high blood pres-sure; however there is lack of information on true feasibility and impact on routine clinical practice. The main objective of this study was to assess prescribed in real life practice antihypertensive treatment and six-year trends in adult hypertensive patients referred to specialized cardiology clinic.

Design and method: Data included 68276 (24183 males and 43913 females) electronic records of patients, mean age 58.3 ± 13,8 years, referred due to uncon-trolled hypertension (HTN). Descriptive statistics were used to estimate the means in gender, age [under 35 years (n = 4665), 35�49 (n = 9774), 50�65 (n = 29682), older than 65 (n = 24155) years] and antihypertensive drug classes (AHD) and severity of HTN [1 (n = 3973), 2 (n = 30629) and 3 degree (n = 20239)] sub-groups. Linear regression was employed to determine the yearly trends. Age and gender-specifi c results were adjusted to Saint-Petersburg general population data for 6-years period and every studied year.

Results: The mean number of prescribed AHD per patients constituted 1,93. There was a 20,1% increase in mean number of AHD during 2010�2013 (R2 = 0,99; p = 0,001) with subsequent decrease by 21,2% from 2013 till 2015 (R2 = 0,98; p = 0,01), mostly due to subgroups with more severe HTN. The most frequently prescribed AHD classes were beta-blockers (BB; 30734 cases, 45%), angiotensin receptor blockers (ARB; 19474, 28%), calcium channel blockers (CCB; 17752, 26%), ACE inhibitors (ACEi; 15178, 22%). Monotherapy was prescribed up to 20% (13691), 64% constituted ARB and ACEi. Two-drugs combinations were used by 20% (13880) of patients, the top were ARB+CCB (15,1%) and ARB+BB (12,8%). Three-drugs combinations were taken by 19% (13407) of patients and the leaders were diuretic (D)+BB +ARB (13,4%) or + ACEi (12,9%). Interesting-ly, women demand at least 2 AHD (2,03), while 13% of males used monotherapy mostly with ACEi (n = 1532) or ARB (n = 1499). There were no substantial yearly trends in AHD classes in overall population and specifi ed subgroups.

Conclusions: Results demonstrated that real-life practice is sometimes far away from recommended pathways. This may be explained by a specifi c population of specialized center with numerous concomitant cardiovascular and other diseases forcing to step away from optimal approach.

PP.01.02 METABOLICALLY HEALTHY OBESITY AS A PART OF

THE CARDIOMETABOLIC CONTINUUM

Y. Zhernakova1, M. Azimova1, I. Trubacheva2, V. Kaveshnikov2, V. Serebryakova2, A. Rogoza1, E. Oschepkova1, I. Chazova1. 1Russian Research and Production Cardiology Complex, Moscow, Russia, 2Cardiology Research Institute, Tomsk National research Medical Center, Tomsk, Russia

Objective: Was used data from epidemiological survey ESSE-RF (Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federa-tion) including adult population at the age of 25�64 y.o. of Siberian city Tomsk (n = 1538, including 58% females and 42% males).

Design and method: Was used the systematic stratifi ed multistage random sam-pling creating by the territorial principle of method by Keesh. Abdominal obesity (AO) was defi ned by waist circumference (WC) > 80 cm in women and 94 cm in men. MS was defi ned according to IDF, 2005. Diabetes mellitus 2 type (DM2) by fasting glucose > 6,9 mmol/l or <7 mmol/l with hypoglycemic therapy. Statistic data calculation was done with computer-based statistic software STATISTICA 10.0 and SPSS 14.0.

Results: Final analysis included 1538 persons. All examined persons have been divided into 4 groups depending on presence of obesity, metabolic syndrome (MS)

and DM 2, the 1st group included people without abdominal obesity (AO), MS and DM2 (n = 611). Patients with AO, but without MS (one additional risk factor was allowed) - metabolically healthy obese have been included into the 2nd group (n = 107). Patients with MS (n = 676) have been enrolled into the 3rd group. And patients with DM2 have been entered into the 4th group (n = 144). The prevalence of obesity in studied simple was 48,1% by BMI > 30 kg/m2 and 59% by WC. Arterial hypertension had 41,7% respondents: 15,4% in the 1st group, 32,7% in the 2nd group, 75% in the 3rd group and 92,3% in the 4th group. The prevalence of target organ damage (TOD) was growing from 1st group to 4th (Tab. 1). It was statistically signifi cant (p < 0,0001).

Conclusions: Study results showed high prevalence of obesity, especially AO (59 %) in the investigated population, prevalence of MS also was high (43%), as well as DM 2 (9,3%). Cardiometabolic continuum (CC) is a progressive process and AO is fundamental to the pathophysiology of CC. Persons with metabolically healthy obesity already had the TOD. It could mean that AO without MS is a part of CC. Therefore patients with AO need more rigorous observe as early as possible.

PP.01.03 PREVALENCE OF RENAL DYSFUNCTION IN

RUSSIAN POPULATION IN DEPENDENCE ON

PRESENCE OF ARTERIAL HYPERTENSION AND

OBESITY BY THE DATA OF EPIDEMIOLOGICAL

STUDY ESSE-RF

Y. Zhernakova1, E. Oshchepkova1, I. Chazova1, S. Chalnova2, S. Boytsov2, O. Rotar3, A. Konradi3, E. Shlyakhto3. 1Russian Research and Production Cardiol-ogy Complex, Moscow, Russia, 2National Research Center for Preventive Medi-cine, Moscow, Russia, 3Federal Almazov North-West Medical Research Centre, Saint-Petersburg, Russia

Objective: Was used data from cross-sectional epidemiological study ESSE-RF (Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation) including adult population at the age of 25�64 y.o. of 10 regions RF (n = 16936, including 64% females and 36% males): Volgograd, Vologda, Voronezh, Ivanovo, Krasnoyarsk, Orenburg, Samara, Tomsk, Tyumen and Northern Osetia-Alania.

Design and method: Was used the systematic stratifi ed multistage random sam-pling creating by the territorial principle of method by Keesh. Renal dysfunction was assessed on the basis of the calculation of glomerular fi ltration rate (GFR). GFR was conducted on the Chronic Kidney Disease Epidemiology Collaboration (GRF-EPI). Statistic data calculation was done with computer-based statistic soft-ware STATISTICA 10.0 and SPSS 14.0.

Results: Final analysis included 15570 persons. Arterial hypertension had 6820 (43,8%) respondents. The prevalence of obesity (BMI > 30 kg/m2) in patients with AH was 59%. Among the patients with arterial hypertension (AH) CKD (GRF < 60 ml/min/1,73 m2) was found 3 times more often than without 1,8% and 0,43% respectively, minor renal dysfunction (GRF 60�90 ml/min/1,73 m2) was twice higher in patients with AH (34,8%), than without (16,2%). Systolic blood pressure was signifi cantly higher in hypertensive patients (152,6 ± 21,4 mmHg) with renal dysfunction (p < 0,0001) than without (144,8 ± 17,9 mmHg). But dia-stolic blood pressure didn’t have differences. Patients with AH and obesity had minor renal dysfunction in 1,21 time more offer and CKD in 5,3 time more offer without AH and obesity (Tab. 1).According multivariate analysis major risk factors associated with renal dysfunc-tion (odds ratio) were hypercholesterolemia 1,92 (95% CI, 1,77–2,08), fasting hyperglycemia 1,63 (95% CI, 1,41–1,89) and systolic blood pressure 1,7 (95% CI, 1,56–1,88).

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e94 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

Conclusions: Study results showed high prevalence of renal dysfunction (26,5%) in the investigated Russian population, especially among patients with AH (36,6%). Obesity considerably enlarges the frequency of renal dysfunction, both at patients with AH, and without.

PP.01.04 HEALTHY HEART AFRICA IN KENYA: EVALUATION

OF PROGRAM IMPACT ON HEALTHCARE

PROVIDERS’ KNOWLEDGE AND PROVISION OF

CARE FOR HYPERTENSION

G. Yonga1, J. Jimenez2, F. O. Okello3, E. Macgregor-Skinner3, J. Herr3, E. N. Ogola4.1Aga Khan University, Nairobi, Kenya, 2AstraZeneca, Gaithersburg, USA, 3Abt Associates, Bethesda, USA, 4Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya

Objective: Despite increased hypertension (HTN) prevalence in Africa, aware-ness, detection, and treatment remains universally low. The Healthy Heart Africa (HHA) program was developed with the goal of sustainably addressing multiple barriers to HTN care, including educating healthcare providers (HCPs) on HTN management/treatment. Here, we evaluate the impact of HHA on HCP knowledge and practice in Kenya over 12 months.

Design and method: HHA collaborated with local Kenyan organizations to de-velop/update HTN guidelines; provide training, equipment, and educational materi-als; and improve treatment availability. Among facilities chosen for inclusion, the evaluation used a sample of intervention facilities selected using stratifi ed random sampling; matched comparison facilities were selected based on the implement-ing partner, location, and facility type. Facilities were surveyed at baseline and 12 months later. A difference-in-differences analysis was used to assess program ef-fects by comparing outcomes from intervention and control facilities. HTN screen-ing/treatment data were supplemental and abstracted from service delivery registers.

Results: The analysis included 66 intervention and 66 control facilities, consist-ing of dispensaries/clinics (55.9% and 67.2%, respectively), health centers (24.0% and 20.8%), and district/subdistrict hospitals (20.1% and 12.1%) (P = not sig-nifi cant for intervention vs control). At baseline, both groups did not differ sig-nifi cantly regarding HCP staffi ng and availability of basic healthcare equipment, including blood pressure (BP) machines. HHA improved HCPs knowledge of >=5 HTN risk factors and >=5 methods for reducing/managing HTN (P < 0.05 vs con-trol for all; Table). Knowledge of high/severe BP thresholds and the number of new HTN patients increased at intervention and control facilities but did not sig-nifi cantly differ between groups. Intervention versus control facilities were more likely to measure BP > 1 time in the same visit to diagnose HTN (P < 0.05), have days dedicated to HTN care (P < 0.05), use posters to increase HTN awareness (P < 0.01), and have increased access to hydrochlorothiazide (P < 0.05). Access to amlodipine and enalapril increased, but statistical signifi cance was not achieved.

Conclusions: Over 12 months, the HHA program in Kenya positively affected HCP knowledge of HTN risk factors and management, improved screening prac-tices and awareness to detect HTN, and increased access to guideline-recommend-ed HTN medication.

PP.01.05 URIC ACID AND OTHER METABOLIC PARAMETERS

AS THE CARDIOVASCULAR RISK FACTORS IN

PATIENTS WITH AND WITHOUT HYPERTENSION

L. Woznicka-Leskiewicz, A. Posadzy-Malaczynska. Department of Family Medi-cine Poznan University of Medical Sciences, Poznan, Poland

Objective: Assessment of metabolic profi le and their impact on cardiovascular risk in women and men with and without hypertension who didn`t have coronary artery stenosis in the angiography.

Design and method: We divided 100 patients in two groups: HT+ patients with arterial hypertension (25 women and 25 men); and HT- patients without arterial hypertension (25 women and 25 men). All patients underwent coronary angiography because of angina.The average age of them [yrs]: 56 and 53 (*p < 0,05). Following measurements were taken: BMI, total cholesterol (Tchol), fasting plasma glucose and uric acid. Each patient was evaluated cardiovascular risk according to SCORE and Fram-ingham scales.Statistical calculations were performed in the StatSoft Statistica 10. The t-student test was used for the statistical analysis, � Spearmann was taken to analyze the correlation of statistically signifi cant values.

Results: We revealed following results in both groups: HT+ and HT- respec-tively [*for p < = 0,05; **for p < 0,001; NS- negligible statistically].In hypertensive group women were characterized by lower fasting plasma glucose and uric acid level than men.In normotensive group women were characterized by lower uric acid level than men.In both groups women were characterized by lower cardiovascular risk accord-ing to SCORE and Framingham scales. In hypertensive group there were sig-nifi cant positive correlations between: uric acid and SCORE scale [p= 0,023] (*) [r = 0,32] moreover between uric acid and Framingham scale [p = 0,007] (**) [r = 0,37]. In normotensive group there were signifi cant positive correlations be-tween: uric acid and SCORE scale [p = 0,006] (**) [r = 0,38] moreover between uric acid and Framingham scale [p = 0,018] (*) [r = 0,33].

Conclusions: 1. Men without stenosis in coronary angiography with and with-out hypertension were characterised by worse metabolic profi le than women. 2. Men were characterized by higher cardiovascular risk according to SCORE and Framingham scales than women. 3. Uric acid was correlated with cardiovas-cular risk in both groups regardless the presence or absence of hypertension.

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Abstracts e95

PP.01.06 AMINO ACIDS KYNURENINE AND QUINOLINIC

ACID AND TARGET ORGAN DAMAGE IN

HYPERTENSIVE PATIENTS – NOVEL INSIGHTS

FROM THE STYRIAN HYPERTENSION STUDY

N. Verheyen1, M. Gaksch1, A. Meinitzer1, M. Grübler2, C. Trummer1, V. Schwetz1, M. Pandis1, K. Ablasser1, E. Kolesnik1, D. Von Lewinski1, H. Brussee1, W. März3, A. Tomaschitz1, S. Pilz1. 1Medical University of Graz, Graz, Austria, 2Bern Uni-versity Hospital, Bern, Switzerland, 3Synlab Academy, Mannheim, Germany

Objective: Experimental studies indicated a contribution of the essential amino acids kynurenine and quinolinic acid to cardiovascular disease. We therefore in-vestigated the associations between their serum concentrations and surrogates of hypertensive target organ damage in a cohort of hypertensive patients.

Design and method: Cross-sectional data from 514 hypertensive participants of the Styrian Hypertension Study were analyzed who had been enrolled at a single tertiary care hospital. Serum concentrations of kynurenine and quinolinic acid were correlated with N-terminal pro-brain B-type natriuretic peptide (NT-proB-NP) and 24-hours urinary protein-to-creatinine-ratio (PCR) in multivariate linear regression analyses.

Results: Mean age was 61.2 +/− 10.5 years (52.5 % females) and mean 24-hours ambulatory blood pressure was 127.5/76.4 +/− 13.8/9.5 mmHg. Me-dians and interquartile ranges of NT-proBNP and PCR were 82 (42–152) pg/mland 67.5 (52 – 93.4) mg/mmol creatinine, respectively. Both kynurenine and quinolinic acid were signifi canty related with NT-proBNP and PCR in uni-variate analyses. After adjustment for age, sex, systolic nighttime blood pres-sure, estimated glomerular fi ltration rate, body mass index, C-reactive protein, concomitant blood pressure and heart failure medication and other traditional cardiovascular risk factors, quinolinic acid was signifi cantly related with NT-proBNP (adjusted beta-coeffi cient = 0.133, P = 0.003) and PCR (beta = 0.216, P < 0.001), while kynurenine was not. Restricting these analyses to patients with NT-proBNP > 125 pg/ml (n = 171), both amino acids were independently related with NT-proBNP (quinolinic acid: beta = 0.249, P = 0.027; kynurenine: beta = 0.207, P = 0.027).

Conclusions: Serum concentrations of quinolinic acid and, to a less extent, kyn-urenine determine hypertensive target organ damage independently of potentially confounding factors. These clinical data extend previous experimental studies in-dicating that quinolinic acid and kynurenine may mediate target organ damage in patients with arterial hypertension.

PP.01.07 CARDIOVASCULAR RISK FACTORS IN URBAN

VERSUS RURAL AREA OF ORIGIN IN THE EASTERN

EUROPE HYPERTENSIVE PATIENTS

A. Varga1, I. Tilea1, C. M. Tatar1, S. Morar2, A. E Bocicor1. 1University of Medi-cine and Pharmacy, Faculty of Medicine, Targu Mures, Romania, 2Emergency Clinical County Hospital, Targu Mures, Romania

Objective: Study of the cardiovascular (CV) risk factors in hypertensive patients, urban versus rural (U/R) area of origin, in primary care.

Design and method: We analyzed and compared the data of 525 hypertensive patients divided in active group 485 (92.4%), deceased group 31 (5.9%) and 1.7% lost to follow-up group at the end of the study

Results: Mean age 62.06 ± 12.303 y.o, no signifi cant differences (p = 0.28) among the gender distribution or by the origin (p = 0.09) in 21.3% smokers, 42.28% pa-tients with hypercholesterolemia, and 35.23% with hypertriglyceridemia.

Risk factors: obesity, smoking/non-smoking status, hypercholesterolemia, hypertri-glyceridemia, mixed dyslipidemia and diabetes, were analyzed, with no statistical signifi cance (p > 0.05) for the prevalence of these risk factors in urban versus rural area, between the active and deceased group. In smoker versus non-smoker, we iden-tifi ed a p = 0.03 for active hypertensive patients in the urban area. Obesity was as-sociated with statistically signifi cant (p = 0.02) CV risk stratifi cation of high and very high risk. In the same two analyzed groups, the presence of different concomitant CV risk factors was not statistically signifi cant (p = 0.17); 50.7% of patients had at least 2 concomitant risk factors associated with hypertension. In the active hypertensive group, 30% of urban area, presents one CV risk factor versus 41.2% in rural area, but in the urban hypertensive patients there is a progressive increase in the percentage of patients presenting a higher number of different concomitant risk factors associated with hypertension, compared to rural areas. 52.1% of active hypertensive patients in urban area have more than two CV risk factors concurrently with hypertension. In rural area, for patients in the active group, the association of least three different CV risk factors concurrently with hypertension was found in 17.7% patients.

Conclusions: Dyslipidemia in hypertensive patients, represent a modifi able risk factor to reinforce the control strategies for, irrespective of urban or rural area. It is emphasized the importance for an individual cardiovascular risk assessment for each hypertensive patient.

PP.01.08 SINGLE-PILL VERSUS FREE ANTIHYPERTENSIVE

COMBINATION USE BY GENERAL PRACTITIONERS

IN IN BELGIUM AND LUXEMBURG

M. Leeman1, M. Dramaix2, B. Van Nieuwenhuyse3, J. R. Thomas4. 1Hypertension Clinic, ULB-Erasme University Hospital, Brussels, Belgium, 2Research Centre of Epi-demiology, Biostatistics and Clinical Research, ULB-School of Public Health, Brus-sels, Belgium, 3Servier Benelux, Brussels, Belgium, 4Pharma CS, Merchtem, Belgium

Objective: Studies suggest that the use of single-pill combinations could improve therapeutic adherence and blood pressure (BP) control in hypertensive patients. We examined the use of single-pill or free antihypertensive drug combinations, BP control, and attitude towards prescription of single-pill combinations in current general practice.

Design and method: Between January 2015 and September 2016, 742 general practitioners in Belgium and Luxemburg retrospectively collected data from 8006 consecutive hypertensive patients recently seen in their routine practice and taking at least two antihypertensive drugs.

Results: Patients (mean age 67 ± 22 years [SD], 54% men, 37% with diabetes melli-tus, 37% with a previous cardiovascular event) were treated with two (n = 4549), three (n = 2470) or more than three (n = 987) antihypertensive drugs. Combinations were free (n = 3089), single-pill (n = 2713) or mixed (n = 2204) (93 missing data). Blood pressure was 141/82 ± 21/11 mm Hg (mean ± SD). According to the 2013 ESH/ESC Guidelines, control rates were: systolic BP 47%, diastolic BP 70%, and both systolic and diastolic BP 42%. Estimation by the GPs of both systolic and diastolic BP control rate was 61%. Actual control rates were comparable whatever the type of combination. Blood pressure control was better in patients with low cardiovascular risk compared to patients with high risk (re-spectively 43% vs 33% for systolic BP control and 63% vs 47% for diastolic BP control). Patients treated with single-pill combinations were younger and had a low cardiovascular risk. In 54% (n = 4361) of the patients, physicians considered to prescribe a single-pill combination. In 1452 (18%) patients, they were willing to switch to a single-pill 2-drug combination, and in 2508 (31%) patients, they were willing to switch to a single-pill 3-drug combination. Reasons were improved adherence (71%) and better BP control (69%).

Conclusions: In patients requiring at least two antihypertensive drugs, BP control rate remains low and is overestimated by GPs. Free combinations remain largely used although many GPs seem prone to switch free to single-pill combinations. Treatment simplifi cation could improve adherence and BP control rate, which has in turn been shown to lead to reduced morbidity and mortality.

PP.01.09 HEALTHY HEART AFRICA: A COORDINATED

PROGRAM TO INCREASE AWARENESS,

SCREENING, AND TREATMENT OF HYPERTENSION

IN KENYA THROUGH COLLABORATION WITH

LOCAL HEALTHCARE SYSTEMS

A. Van Gelder1, J. Jimenez1, E. N. Ogola2, G. Yonga3. 1AstraZeneca, Gaithers-burg, USA, 2Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya, 3Aga Khan University, Nairobi, Kenya

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e96 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

Objective: Despite the high prevalence of hypertension in low-/middle-income countries, awareness, treatment, and control rates are abysmally low. As of 2015, 56% of Kenyans have never been screened for high blood pressure (BP); 8% of those living with hypertension are receiving treatment and 3% are controlled. The Healthy Heart Africa (HHA) program, initiated in Kenya, was developed to sus-tainably address barriers to hypertension care in Africa, including hypertension screening, linkage, and retention in care.

Design and method: HHA was designed to increase hypertension awareness, education, screening, and referral for primary care. Hypertension awareness and education was promoted at outreach events (health fairs, health promoters visiting communities/homes, and awareness-building activities). Healthcare providers at participating HHA facilities received training materials/support for diagnosing, treating, and managing hypertension. A diverse population, across different re-gions and healthcare facilities (rural/urban), was reached through collaboration with national/county ministries of health and local implementation partners. The industry sponsor (AstraZeneca) contributed organizational and collaborative ca-pabilities. A reliable source of high-quality, affordable hypertension medications was also sought using a competitive selection process.

Results: HHA conducted a number of stakeholder meetings at the international, national, and county level in Kenya, and 6 implementation partners were identi-fi ed: AMPATH (a largely rural treatment platform); AMREF Health Africa (an integrated healthcare group reaching urban slums); Christian Health Association of Kenya (CHAK; a large faith-based organization); Jhpiego (public, private, and faith-based health facilities); Kenyan Conference of Catholic Bishops (KCCB; Catholic health facilities including training colleges); and Population Services Kenya (PSK; private clinics/pharmacies). The Mission for Essential Drugs and Supplies (MEDS) was identifi ed as a logistics partner for medication supply. Ap-proximately 27% of Kenyan adults living in project catchment areas received hypertension messaging/education through March 2016. To date, 2,014,285 in-dividuals were screened for hypertension. There were 128,690 follow-up touch points (58,088 new patients), and patients were on combined medication/lifestyle changes for 74% of those touch points.

Conclusions: The Kenyan HHA study demonstrated that a collaborative, multi-sectoral approach between industry, government, and local healthcare partners is feasible to improve hypertension screening, diagnosis, and treatment in Africa.

PP.01.11 DEVELOPMENT OF HYPERTENSION OVER 10

YEARS DEPENDING ON BASELINE BLOOD

PRESSURE CATEGORIES IN A SWEDISH

POPULATION

K. Lundholm1, B. Daka1, M. I. Hellgren1, C. A. Larsson2, L. Rastam2, U. Lindblad1.1Institute of Medicine, University of Gothenburg, Gothenburg, Sweden, 2Dept Clin Sci, Lund University, Sweden, Malmö, Sweden

Objective: To explore the relationship between blood pressure categories at base-line and incident hypertension at follow-up in a representative Swedish population.

Design and method: A longitudinal study over 10 years in a Swedish population. Main measures were anthropometric data, blood pressure, fasting glucose, LDL, CRP, eGFR, current smoking, leisure time physical activity and medical history. Blood pressures were measured and categorized according to ESH guidelines with optimal blood pressure defi ned as <120 mmHg systolic and <80 mmHg dia-stolic, normal as 120–129/80–84 mmHg, high normal as 130–139/85–89 mmHg, and unstable as >= 140 and/or >= 90 mmHg at one or two visits but not on three. Hypertension was defi ned as ongoing treatment or readings of >= 140 and/or >= 90 mmHg at three consecutive visits. Subjects with hypertension at baseline were excluded. Data were analyzed with multivariate binary logistics regression.

Results: Among the 1129 participating subjects the proportion with optimal blood pressure at the baseline survey was 56.1 % (n = 633), normal blood pres-sure 25.9 % (n = 292), high normal blood pressure 12.5 % (n = 141), and unstable blood pressure 5.6 % (n = 63), respectively. Of those with optimal blood pressure at baseline 18 (2.8%), converted to hypertension during follow up. Correspond-ing numbers for subjects with normal, high normal and unstable blood pressure were 58 (19.9%), 56 (39.7%) and 47 (74.6%) respectively. Both normal, high nor-mal and unstable baseline blood pressure were associated with an increased risk of development to manifest hypertension compared to optimal blood pressure, with odds ratios (OR (95% CI)) of 5.4 (CI 2.9–9.9), 12.5 (CI 6.3–25) and 88 (CI 33–231), respectively, independent of age and other main cardiovascular risk fac-tors. A trend test showed that the OR for incident hypertension per unit of baseline blood pressure category was 3.8 (CI 2.9–5.0). The progression to hypertension was also independently predicted by age, BMI and heredity for hypertension.

Conclusions: Subjects with high normal or unstable blood pressure should be identifi ed in clinical practice and evaluated for global risk accounting for family

history of hypertension. Measures should be taken to avoid or postpone the devel-opment of hypertension and its complications.

PP.01.12 THE ASSESSMENT OF THE ASSOCIATED

CARDIOVASCULAR RISK FACTORS IN

HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES

C. Tudorica1, A. Vintila2, S. Tudorica3, V. Vintila4, C. Bulei1, A. Gurghean2.1Coltea Clinical Hospital, Internal Medicine and Cardiology, Bucharest, Romania, 2Carol Davila University of Medicine and Pharmacy Bucharest, Coltea Clinical Hospital, Internal Medicine and Cardiology, Bucharest, Romania, 3CMI Steluta Tudorica, Endocrinology, Bucharest, Romania, 4Carol Davila University of Medi-cine and Pharmacy Bucharest, Emergency University Hospital, Cardiology, Bucharest, Romania

Objective: To assess the presence of additional cardiovascular risk factors that could worsen long term prognosis in hypertensive and type 2 diabetes mellitus (T2DM) patients.

Design and method: Patients with arterial hypertension and T2DM were assessed between January 2015 and September 2016 in a cross sectional study. We evaluated associated cardiovascular risk factors (dyslipidemia, obesity [BMI > 30 kg/m2],smoking) and subclinical renal damage (microalbuminuria).

Results: We evaluated 180 hypertensive patients withT2DM, 49.6% male, mean age 66.3 years, mean duration of T2DM 9,6 years, mean HbA1c 8.6% (20% with HbA1c < 7%), mean duration of hypertension 12,4 years, mean blood pressure 148/102 mmHg (35% controlled). Patients were treated with oral antidiabetics for T2DM and ACEi, ARBs, CCB, diuretics for hypertension. Mean BMI was 30.4 kg/m2. 50.4% of the patients were obese, 21.1% smokers. Mean values for lipid parameters were: 186 mg/dl total cholesterol, 108.7 mg/dl LDL-C, 44.1 mg/dl HDL-C and 174.4 mg/dl triglycerides. 90% of patients had LDL-C > 70 mg/dl in spite of treatment with statins. 24.6% of patients had a history of major cardio-vascular events (more frequent in people with >9 years duration of diabetes). In patients with microalbuminuria (30% of total number), mean duration of T2DM was 9.3 years, mean HbA1c 7.8% (40% with HbA1c < 7%), mean blood pres-sure 135/94 mmHg (35% controlled), mean BMI 31.7 kg/m2. 62.3% of patients were obese, 20.1% smokers. Mean value for cholesterol was 169.1 mg/dl, LDL-C 93.3 mg/dl, HDL-C 43.7 mg/dl and triglycerides 180.8 mg/dl. 68% of patients had LDL-C>70 mg/dl in spite of treatment with statins. 30% of patients had a history of major cardiovascular events.

Conclusions: Associated cardiovascular risk factors are frequent in patients with type 2 diabetes and hypertension. Unfortunately, more than 50% of all parameters are uncontrolled in the majority of patients. A better control was achieved in pa-tients with microalbuminuria, potentially due to an increased adherence of the subjects being informed on the severity of their disease. Patients with type 2 dia-betes and hypertension remain at increased risk of developing macrovascular and microvascular complications. Large benefi ts are likely to be seen when medication is addressed to multiple risk factors simultaneously.

PP.01.13 SERUM URIC ACID IS INDEPENDENTLY

ASSOCIATED WITH DIASTOLIC DYSFUNCTION

IN APPARENTLY HEALTHY SUBJECTS WITH

ESSENTIAL HYPERTENSION

G. Georgiopoulos, C. Tsioufi s, Th. Kalos, N. Magkas, D. Roussos, G. Sarri, K. Syrmali, P. Georgakopoulos, C. Chrysochoou, D. Tousoulis. First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece

Objective: Accumulating evidence suggests a direct role of uric acid (UA) on left ventricular (LV) diastolic function in chronic kidney disease and heart failure (HF) patients. Recently, UA has been linked to LV hypertrophy (LVH) and dia-stolic dysfunction (DD) in women with preserved ejection fraction(EF)(pEF) but not in corresponding men. We sought to assess if UA could predict indices of DD in hypertensive subjects with pEF independently of gender.

Design and method: We consecutively recruited 382 apparently healthy hy-pertensive subjects (age: 61.7 ± 10.7, women: 61.3%, median EF: 64%). In 318 patients in sinus rhythm, LV mass-indexed to body surface area-was calculated (LVMI). LVH was set as an LVMI more than 116 g/m2 or 96 g/m2 in men and women, respectively. The ratio of early transmitral peak velocity (E) to the mitral annular early diastolic velocity (Em) was used as an approximation of mean left atrial pressure (E/Em).

Results: UA [median (interquartile range):5.4(2)mg/dl] independently predicted E/Em (adjusted coeffi cient:1.01, p = 0.026) while an interaction term between gender and UA was no signifi cant (p = 0.684). An ordinal score of DD was calculated taking into account increased E/Em, left atrium dilatation and LVH.

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Abstracts e97

Women with increased UA had 254% increased odds (adjusted OR = 2.54, p = 0.005) to be classifi ed in the upper range of the DD score.

Conclusions: In asymptomatic hypertensive subjects, UA is independently as-sociated with the presence of DD in both genders and correlates with its severity in women. Further prospective studies are warranted to evaluate the association of UA with adverse cardiovascular outcomes in high risk populations such as HF with pEF.

PP.01.14 URIC ACID AS A PREDICTOR OF CORONARY

ARTERY DISEASE BUT NOT STROKE IN ESSENTIAL

HYPERTENSION: DATA FROM A GREEK 8-YEAR-

FOLLOW-UP STUDY

K. Dimitriadis, C. Tsioufi s, A. Kasiakogias, G. Georgiopoulos, T. Kalos,K. Kyriazopoulos, G. Annousis, E. Andrikou, D. Tousoulis. First Cardiology Clin-ic, University of Athens, Hippokration Hospital, Athens, Greece

Objective: The exact role of uric acid in cardiovascular risk prediction remains to be further determined. The aim of the present study was to assess the predictive role of uric acid for the incidence of coronary artery disease (CAD) as well as stroke in essential hypertensive patients.

Design and method: We followed up 2415 essential hypertensives (mean age 58.4 years, 1208 males, offi ce blood pressure (BP) = 143/88 mmHg) for a mean period of 8 years. All subjects had at least one annual visit and at baseline under-went echocardiographic study and blood sampling. Moreover, CAD was defi ned as the history of myocardial infarction or signifi cant coronary artery stenosis and stroke was defi ned as rapid onset of a new neurological defi cit persisting at least 24 hours unless death supervened confi rmed by imaging fi ndings.

Results: The incidence of CAD and stroke was 2.2% and 1% respectively. Hy-pertensives who developed CAD (n = 53) compared to those without CAD at follow-up (n = 2362) had at baseline higher baseline uric acid levels (5.8 ± 1.8 vs 5.2 ± 1.5 mg/dl, p = 0.011), left ventricular mass index (LVMI) (115.7 ± 27.1 vs 103.7 ± 27.1 g/m2, p = 0.001) and prevalence of LV hypertrophy (41% vs 25%, p = 0.017) whereas no difference was observed with respect to baseline offi ce BP, renal function and lipid levels (p = NS for all). Hypertensives who developed stroke (n = 24) compared to those without CAD at follow-up (n = 2391) were older (63 ± 8 vs 58 ± 11 years, p = 0.006) whereas no difference was observed with respect to baseline offi ce BP, uric acid, renal function and lipid levels (p = NS for all). Univariate Cox regression analysis revealed that baseline uric acid levels predicted CAD (hazard ratio = 1.219, p = 0.013) but not stroke. In multivariate Cox regression model baseline glomerular fi ltration rate (hazard ratio = 1.018, p = 0.017) LVMI (hazard ratio = 1.010, p = 0.026) and uric acid (hazard ra-tio = 1.226, p = 0.016) turned out to be independent predictors of CAD, while age (hazard ratio = 1.058, p = 0.014) predicted stroke.

Conclusions: In essential hypertensive patients uric acid predicts future develop-ment of CAD, whereas exhibits no prognostic value for stroke. These fi ndings further support that uric acid estimation could improve overall risk stratifi cation in essential hypertension.

PP.01.15 SYSTOLIC ARTERIAL HYPERTENSION IN UKRAINE:

REALITIES OF CLINICAL PRACTICE BASED ON

TRIAL SYSTEM

V. Tseluyko. Kharkiv medical academy of postgraduate education, Kharkiv, Ukraine

Objective: The aim of this trial was to evaluate effi cacy of SBP control among hypertensive patients in Ukraine based on data of the register of patients.

Design and method: The register included patients who visited cardiologist in the period from 28 Oct 2015 to 15 DEC 2015. 148 doctors from 11 regions of Ukraine was involved in the creation of this register during the trial.

Results: 2964 patients (1627 (54,9%) women) aged 19 to 90 years (60,6 ± 11,5 years) were included in the register. Results of offi ce BP analysis indicate bad control of BP (average DBP 94,2 mm Hg, SBP – 164,5 mm Hg). Less than 7% of analyzed patients had target BP. Results of analysis indicate the relation between the level of SBP and DBP and age.Correlation analysis was performed for evaluation the relation between the levels of SBP and DBP and age. Results of analysis indicate the positive relation between age and SBP (rho = 0,149, p < 0,001) and negative - between age and DBP (rho = –0,158, p < 0,001).It was found the relation between the level of SBP and target-organs damage - LVH, CKD.

Conclusions: Analysis of results of the register indicates bad control of BP especially SBP in Ukraine. Only 7% of patients achieve target BP. The level of SBP increases with age and is associated with increasing of frequency of target-organs damages.

PP.01.17 ADDING HYPERTENSION-RELATED MARKERS

OF ORGAN DAMAGE TO RISK SCORE MODELS

IMPROVES CARDIOVASCULAR RISK ASSESSMENT:

RETROSPECTIVE ANALYSIS OF A LARGE COHORT

OF ADULT OUTPATIENTS

G. Tocci1,2, I. Figliuzzi1, V. Presta1, G. Gallo1, V. Costanzi1, N. Attalla1,F. Simonelli1, B. Citoni1, A. Battistoni1, A. Ferrucci1, M. Volpe1,2. 1Div. Cardi-ology, Dpt. Clinical Molecular Medicine, Fac. Medicine and Psychology, Univ. Sapienza, Sant’Andrea Hospital, Rome, Italy, 2IRCCS Neuromed, Pozzilli, Italy

Objective: Global cardiovascular (CV) risk stratifi cation is currently recom-mended in all adult outpatients in both primary and secondary prevention. Avail-able risk score charts, however, do not include markers of organ damage (OD).

Design and method: Aim. To evaluate potential value of adding different mark-ers of hypertension-related subclinical OD to US Framingham, European SCORE and Italian Cuore risk score calculators.

Methods: We retrospectically evaluated adult hypertensive outpatients, who un-derwent blood pressure (BP) assessment and global CV risk stratifi cation at our Hypertension Unit. The following defi nitions were applied: 1) cardiac OD: elec-trocardiographic (Sokolow–Lyon index: >3.5 mV; Cornell Voltage Index: men >2.4 mV; women >2.0 mV) or echocardiographic left ventricular (LV) hypertro-phy (LV mass index: men >115 g/m2; women >95 g/m2); 2) vascular OD: carotid atherosclerotic plaque (>1,5 mm); 3) renal OD: reduced estimated glomerular fi ltration rate (eGFR < 60 ml/min/1.73m2) or clearance creatinine (ClCr < 60 ml/min). Different risk score calculators were applied to all included patients.

Results: We included an overall population sample of 1,979 adult outpatients (44.0% female, age 57.2 ± 13.0 years, BMI 26,6 ± 4,4 kg/m2, clinic systolic/diastolic BP 145.4 ± 18.3/85.8 ± 10.7 mmHg), among whom 117 (5.9%) had cardiac, 161 (8.1%) vascular, and 117 (5.9%) renal OD, respectively. US Framingham, Euro-pean SCORE and Italian Cuore risk scores were all signifi cantly higher in patients with than in those without OD, independently by type and number of OD, as well as age and gender classes. In particular, direct comparisons for US Framingham CVD death, European ESC score and Italian Cuore score showed signifi cantly higher risk in those patients with both ECG-detected LV hypertrophy, ECHO-detected LV hypertrophy, carotid atherosclerosis and reduced eGFR (Figure 4a) or ClCr than in those without the corresponding markers of OD.

Conclusions: Presence of cardiac, vascular or renal OD is associated with higher risk scores, independently by type of calculators, age and gender classes. OD de-tection should be included in individual CV risk stratifi cation aimed at improving diagnostic and therapeutic process.

PP.01.18 ARE WE LOOKING IN THE RIGHT DIRECTION FOR

BLOOD PRESSURE CONTROL?

I. Tilea1, A. Varga1 S.I. Morar2, C.M. Tatar3, A.E. Bocicor1. 1Family Medicine, Faculty of Medicine, University of Medicine and Pharmacy, Targu Mures, Romania, 2Internal Medicine Clinic III, Emergency Clinical County Hospital, Targu Mures, Romania, 3Internal Medicine III, Faculty of Medicine, University of Medicine and Pharmacy, Targu Mures, Romania

Objective: The effi ciency of antihypertensive treatment of free versus fi xed com-bination and blood pressure control was assessed together with the number of antihypertensive classes used for on target blood pressure (BP) control in real life practice of adult population.

Design and method: An observational retrospective study was performed on a cohort of 484 adult hypertensive patients (mean age 62.06 ± 12.30 y.o.) from an

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e98 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

urban Family Practice, over 3 years (2011–2014). History of hypertension was recognized by at least 1 year. Subjects were classifi ed by the number of antihyper-tensive classes (6) and a fi xed combination (sartan and calcium channel blocker in variable doses) used. Relationship between BP control and age, sex, education and area of origin was also studied.

Results: Statistical analysis of pooled data showed a usage of 3 classes of antihy-pertensive drugs in 36.2% hypertensive patients in long-term treatment. One or two classes of antihypertensive drugs were used in 44.8% of the patients and 5.6% had a non-pharmacological approach. 173 hypertensive patients have been identifi ed using fi xed combination therapy. This administration has demonstrated its benefi t in achieving target BP with no statistical signifi cance, 81 patients had uncontrolled BP, versus 92 patients with controlled BP (p value = 0.40). Non-pharmacological treatment alone was found 9.9% (48 pts) in 2011 for 2014 to be used in 27 indi-viduals (5.6%); 9 hypertensive patients (33.33%) achieved the target values of BP. A statistically signifi cant difference among patients with target BP considering the number of antihypertensive classes used (p = 0.04) was demonstrated. 35.4% pa-tients with controlled BP were using 3 classes of antihypertensive drugs. Regarding the BP control reported to studied demographic data we did not identify statisti-cally signifi cant differences for systolic BP (SBP) and diastolic BP (DBP) in our particular hypertensive population of 41% of patients with high-level education.

Conclusions: Concomitant use of three antihypertensive classes ensures a better control of both SBP and DBP in our real life practice hypertensive population studied. As a future strategy for BP target control, a better education level should be promoted with long-term reduction on CV outcomes and positive impact on healthcare expenses.

PP.01.19 PREDICTORS OF CARDIOVASCULAR EVENTS

IN HYPERTENSIVE PATIENTS WITH HIGH

CARDIOVASCULAR RISK

I. Tasic1, S. Kostic2, D. Bastac3, D. Djordjevic1, M. Rihter2, M. Lovic2, D. Lovic4, D. Mijalkovic5. 1Institute for Therapy and Rehabilitation Niska Banja, Faculty of Medicine Univeristy of Nis, Nis, Serbia, 2Institute for Therapy and Rehabilita-tion Niska Banja, Niska Banja, Serbia, 3Offi ce Dr Bastac, Zajecar, Serbia, 4Inter Medica, Nis, Serbia, 5Kardiomedika, Nis, Serbia

Objective: Hypertension is a major risk factor for cardiovascular events. Patients at high risk are particularly vulnerable and require adequate treatment and control. The treatment is complex and requires good control of blood pressure and all modifi able risk factors associated with the protection of target organ damage. The goal of this study is to determine which factors have predictive signifi cance of cardiovascular events in patients with hypertension and high cardiovascular risk.

Design and method: We studied 258 participants (60% females). Each participant underwent asymptomatic organ damage: 12-lead electrocardiogram examinations, two-dimensional and Doppler echocardiographs, Doppler sonography of the ca-rotid arteries, and laboratory investigations were prospectively followed for fatal and non-fatal cardiovascular event and total mortality over a median of 7 years.

Results: Mean age in the beginning of the study was 62.7 ± 9 years, body mass in-dex of 28.9 ± 4. kg/m2, offi ce blood pressure of 150.3 ± 20/87.6 ± 13 mmHg, left ventricular mass index (LVMI) of 129.8 ± 29 g/m2, carotid intima -media thick-ness (IMT) of 0.92 ± 0.2 mm. Diabetes mellitus (DM) was in 28% patients, mean total cholesterol 5.74 ± 1 mmol/l.At a follow-up, the incidence of non-fatal and fatal cardiovascular events was 18.2%, and total mortality was 4.7%. Major cardiovascular events were more common in men (p = 0.019) and were highly correlated with systolic blood pres-sure (SBP) at the beginning of the study (p = 0.038), with cholesterol at the begin-ning of the study(p = 0.019) and at the end of the study (p = 0.028), glucoses at the beginning of the study(p = 0.004), DM at the beginning (p = 0.001) and at the end (p = 0.006), LVMI (p < 0.001) and IMT (p < 0.001) at the beginning. Patients with a cardiovascular death were signifi cantly older (p = 0.002), had higher SBP at the beginning (p = 0.017) and higher IMT (p = 0.017). During the study 7.4% of participants got cancer and its positive correlation with DM was determined at the end of the study (p = 0.002) and with IMT at the end of the study (p = 0.037).

Conclusions: Main predictors of major cardiovascular events among patients with hypertension and high risk are: age, male sex, SBP, DM and IMT.

PP.01.20 D TYPE-GENEDER DIFFERENCES IN

PSYCHOLOGICAL AND BIOLOGICAL RISK

FACTORS IN PATIENTS WITH HYPERTENSION

G. Nikolic1,3, I. Tasic2,3, O. Zikic1,3. 1Clinic for Mental Health Protection. Depart-ment of diagnose and treatment, Clinical Center Nis, Nis, Serbia, 2Institute for Therapy and Rehabilitation Niska Banja, Niska Banja, Serbia, 3University of Nis, School of Medicine, Nis, Serbia

Objective: Type D (distress) personality should be taken into account in the treat-ment and prevention of hypertension. We wanted to determine the prevalence of type D behaviour and gender differences by analyzing the clustering of psycho-logical and biological risk factors in our hypertensive patients.

Design and method: Research was conducted with 85 elderly patients with hypertension (mean age 64.5 ± 7.9; men 37.6%), through a consecutive meth-od of patient selection. Psychological variables: Type D personality, anxiety, depression, overall distress, and four dimensions of aggression were measured by: DS 14 Questionnaire, Hospital Anxiety and Depression Scale (HADS), and the Buss&Perry Aggression Questionnaire. Biological parameters, taken from a medical database were: systolic/diastolic blood pressure, total cholesterol level, high density lipoproteins (HDL), low density lipoproteins (LDL), triglyceride, blood sugar, Body Mass Index (BMI), presence of Diabetes Mellitus (DM), and Metabolic syndrome.

Results: The Type D personality was present in 58% of the sample. Preva-lence and intensity of all psychological variables and in the prevalence of metabolic syndrome (60% vs 37.1%; p = 0.038) are significant higher in D Type patients. Women with hypertension and Type D personality are more anxious and distressed, resulting in higher cholesterol (5.97 vs 5.2 mmol/l; p = 0.046), LDL cholesterolo (3.79 vs 3.1; p = 0.032), obesity (29.75 vs 28.31; p = 0.02), and prevalence of DM (28.6% vs 6.25; p = 0.05) when compared to men.

Conclusions: Hypertensive patients differ in relation to Type D personality and gender. The fi nding could indicate that the combination of female gender and Type D personality is prone to clustering risk factors for hypertension and adverse future medical events.

PP.01.21 HYPERTENSION PREVALENCE, AWARENESS,

TREATMENT AND CONTROL IN AMBULATORY

TREATMENT-NAÏVE HIV INFECTED PATIENTS IN

LILONGWE, MALAWI

H. Steffen1, S. Phiri2, T. Heller2, T. Chaweza2, M. Demir1, H. Tweya2,G. Fätkenheuer3, F. Neuhann4. 1Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, Cologne, Germany, 2Lighthouse Clinic, Lilon-gwe, Malawi, 3Clinic for Internal Medicine I, University Hospital of Cologne, Cologne, Germany, 4Public Health Institute, University Hospital of Heidelberg, Heidelberg, Germany

Objective: In the Malawian national STEPS survey (2009) raised blood pressure (BP) or antihypertensive medication was found in 36.9% male and 29.9% female participants from the general population. Little is known about the prevalence of arterial hypertension in HIV infected (HIV+) patients. As an integrated part of the ongoing prospective LighTen Cohort Study (ClinicalTrials.gov NCT02381275) we aimed at determining hypertension prevalence, awareness, treatment and con-trol in ambulatory HIV+ patients prior to starting antiretroviral therapy (ART) in Lilongwe, Malawi.

Design and method: BP values (oscillometric measurement) of adult patients who consented to participate in the study were documented in a standardized fashion together with data concerning known hypertension or antihypertensive medication (treated hypertension). BP of 140/90 mmHg or higher measured dur-ing the baseline visit was defi ned as raised blood pressure (rBP) and controlled hypertension was defi ned as values below 140/90 mmHg in treated patients. Defi -nite arterial hypertension (dHT) was defi ned as treated controlled or uncontrolled hypertension or BP of 140/90 mmHg or higher independent of hypertension his-tory during 2 or more measurements on at least 2 occasions within 8 weeks after study inclusion.

Results: Data from 1387/1415 HIV+ patients (794 females, 593 males, mean age 36.0 ± 9.3 years) could be analyzed. rBP was found in 256/1387 patients (prevalence 18.5%), dHT was confi rmed in only 103 cases for a total prevalence of 7.4% (females 7.7% vs. males 9.3%). Hypertension had been known from medical history in 71 patients, 35 of these patients received treatment (49.3%) and only eight were controlled (11.3%). However, in 22 of 36 untreated patients with a history of hypertension, BP values below 120/80 mmHg were found at the baseline visit.

Conclusions: Information from medical history concerning hypertension seems to be considerably fl awed. In view of possible drug-drug interactions with ART a strictly defi ned diagnosis of arterial hypertension is mandatory prior to starting antihypertensive treatment in HIV+ patients. Systematic mea-surements and documentation of arterial blood pressure and integrated patient instructing and educating programs at HIV centers may be helpful in order to assure hypertension diagnosis as well as improved treatment and control rates in Malawi.

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PP.01.23 HIGH UPSTROKE TIME OF ARTERIAL PULSE

WAVE IS AN INDEPENDENT PREDICTOR FOR

THE PRESENCE AND SEVERITY OF CORONARY

ARTERY DISEASE IN OLDER POPULATION

T. Shoji, S. Okada, Y. Ohno, A. Nakagomi, Y. Kobayashi. Chiba University of Graduate School of medicine, Chiba, Japan

Objective: Ankle–brachial index (ABI) is widely used to screen for the presence and severity of peripheral arterial disease. Upstroke time (UT), a time from the onset to the peak of the arterial pulse wave, is calculated during ABI measurement and serves as an auxiliary index of PAD. UT was also reported to be associated with coronary artery cal-cifi cation score by multi-detector computed tomography. However, there are no stud-ies examining relationship between UT and coronary sclerosis by invasive coronary angiography (CAG). The aim of this study was to examine the association between UT and the presence and severity of coronary artery disease (CAD) as assessed by CAG.

Design and method: We enrolled 304 patients who underwent both ABI measure-ment and elective CAG for suspected CAD. Signifi cant CAD (sCAD) was defi ned as having at least one stenotic lesion over 50%. Using univariate and multivariate logistic regression analysis, we evaluated the contribution of UT for the presence of sCAD. In patients with any CAD, relationship between UT and Gensini score was also examined.

Results: 134 patients (44.1%) had signifi cant CAD. In the CAD group, UT was higher than in the non-CAD group (CAD vs non-CAD, 156.9 ± 32.1ms vs 147.7 ± 24.0ms, P = 0.005). In both univariate and multivariate logistic regression analyses, UT was associated with sCAD (univariate, Odds Ratio(OR) 1.13[95% Confi dence Interval (95% CI) 1.02–1.22], P = 0.015; multivariate, OR 1.18 [95% CI 1.07–1.31], P = 0.001). As the age-related distribution of UT showed qua-dratic curve, we subdivided the patients at the age of 60. In patients >60 years (n = 232), both univariate and multivariate analysis demonstrated that UT was associated with sCAD (univariate, OR 1.37[95% CI 1.14–1.64]; multivariate, OR = 1.16 [95% CI 1.02–1.32], all P < 0.05). There was no association among pa-tients < 60years (n = 72). In older patients, multivariate linear regression analysis showed signifi cant correlation between UT and both Gensini and SYNTAX scores (Gensini; Coeffi cient 2.10, P = 0.002, SYNTAX; Coeffi cient 0.57, P = 0.039). No correlation was found in younger patients.

Conclusions: UT serves as independent, incremental risk for the presence and severity of CAD only in patients aged >60 years.

PP.01.24 THE ANTIHYPERTENSIVE THERAPY EFFICIENCY

AMONG OUTPATIENTS IN MOSCOW

V. Ostapenko1, O. Tkacheva1, N. Runikhina1, Y. Kotovskaya1,2, N. Sharashkina1. 1Russian Gerontology Clinical Research Center, Moscow, Russia, 2RUDN-University, Moscow, Russia

Objective: The purpose of the study is to evaluate the antihypertensive therapy effi ciency within outpatients > 65 years old in Moscow.

Design and method: The study includes 356 patients 65–93 years old. Average age was 74.8 ± 6.1 y.o., 80.4 % women, 54.8% of them with higher education and 9% still continue to work. Research conducted in Moscow polyclinic from November 2014 to May 2015. Anamnesis of arterial hypertension, cardiovascu-lar diseases and antihypertensive therapy was evaluated among 2 groups of the seniors: 65–79 y.o. (n = 277) and > 80 y.o. (n = 79). The measurement of blood pressure (BP) was made in sitting position using validated device.

Results: Based on patients self-report prevalence of arterial hypertension was 88.5% (n = 315). It was insignifi cantly higher among patients >80 y.o. (91.1%) than in group of 65–79 y.o. (87.7%). Around 92 % of the patients took antihypertensive therapy. Average BP level was 145.5 ± 24.1 / 78.8 ± 11.5 mm Hg. Systolic BP (SBP) without hypertension was 135.2 ± 17.5 mmHg. In group of treated hypertensive patients SBP was 145.8 ± 28.1 mmHg. In the group of untreated patients - 154.3 ± 26 mmHg, respectively. SBP > 140 mm Hg was observed in 51.1%, diastolic BP > 90 mm Hg in 11.8% among all patients. In 38.6% treated subjects SBP was <140 mmHg, in 34.7% - > 150 mmHg. The age has signifi cant impact on diastolic BP level. Average BP level among 65–79 y.o. patients reveal 145,5 ± 26,7 / 79,8 ± 14 mmHg. However the results of BP level among > 80 y.o. was 145,5 ± 25,3/ 75,2 ± 11,5.

Conclusions: Study describes high prevalence of hypertension and lack of ef-fi ciency antihypertensive therapy within the outpatients > 65 years in Moscow.

PP.01.25 AORTIC PULSE WAVE VELOCITY AND SOLUBLE

RAGES IN ADULT ASYMPTOMATIC OFFSPRING OF

PATIENTS WITH PREMATURE ISCHEMIC HEART

DISEASE

J. Seidlerová, P. Karnosová, M. Hronová, J. Filipovský. Internal Department II, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic

Objective: Increased aortic pulse wave velocity (PWV) is associated with high-er cardiovascular risk in a general population as well as in several pathological conditions. Similarly, decreased levels of soluble form of receptor for advanced glycation end products (sRAGE), were found in hypertensive patients. We inves-tigated whether these two markers of cardiovascular risk might be modifi ed in asymptomatic adult offspring of patients with premature onset (before age of 50) of ischemic heart disease (IHD).

Design and method: We investigated 114 offspring and 194 controls. We mea-sured PWV using SphygmoCor and sRAGE using enzyme-linked immunosorbent assay methods. In our analyses we used linear and logistic regression methods.

Results: Offspring and controls had similar age (28.5 ± 6.4 vs. 28.9 ± 5.3; p = 0.51) and blood pressure (118.6/78.9 vs. 116.5/77.0; p > 0.063). There were more men (49.1 vs. 35.6 %; p = 0.023) and smokers (50.9 vs. 32.7 %; p = 0.003) in offspring compared to control groups. After adjustment for potentiate covari-ates, PWV (6.17 ± 0.09 vs. 5.82 ± 0.06; p = 0.001) was higher while sRAGE (1308.5 ± 49.8 vs. 1478.2 ± 37.6; p = 0.008) was lower in offspring compared to control group. In multivariate logistic regression, main determinant of difference between offspring and controls were PWV, sRAGE and current smoking.

Conclusions: In our study, we observed that asymptomatic offspring of patients with premature IHD had increased aortic pulse wave velocity. This fi nding might be at least partially driven by lower levels of circulating soluble RAGEs.

PP.01.26 PROTOCOL OF THE SWISS LONGITUDINAL

COHORT STUDY (SWICOS) IN RURAL

SWITZERLAND

A. Schoenenberger1, F. Muggli2, P. Suter3, A. Gallino4, G. Parati5, G. Ehret6,R. Schoenenberger-Berzins7, T. Resink8, P. Erne8. 1Department of Geriatrics,Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland, 2Outpatient Medical Clinic, Vezia, Vezia (lugano), Switzerland, 3Department of Medicine, Outpatient Clinic, University Hospital of Zürich, Zürich, Switzerland, 4Department of Internal Medicine, Hospital San Giovanni, Bellinzona, Switzer-land, 5Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy, 6Division of Cardiology, University of Geneva, Geneva, Switzerland, 7Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzer-land, 8Laboratory of Signal Transduction, Department of Biomedicine, Basel Uni-versity Hospital and University of Basel, Basel, Switzerland

Objective: Increased longevity and consequent major changes in demographics and population lifestyles necessitate new approaches to reduce the burden of aging-related diseases (including CVD) and maintain an optimal quality of life. This study aims to examine and longitudinally follow health status and disease risk factors in a Swiss rural cohort, evaluating all health related research and practice disciplines to assure devel-opment of new implementable and successful preventive strategies for healthy aging.

Design and method: Small villages of rural regions in Switzerland with low mi-gration rates have been selected for this longitudinal prospective study. All resi-dents (age > = 6 years, no upper age limit) are eligible. Target enrolment number per village is 300. Examinations and measurements encompass medical history, anthropometry, cardiac and vascular health, pulmonary function, physical per-formance, nutritional, mental and emotional status, biochemical and molecular analyses. Follow-up examinations (identical to baseline) will be performed after 5 and 10 years, and in 10-year intervals thereafter.

Results: In the fi rst participating village, more than 300 participants have been enrolled so far. Enrollment will start in a second participating village in 2017.

Conclusions: This study will allow to: (1) identify “hidden’’ (asymptomatic and/or unrecognized) health problems which enhance risk for chronic diseases; (2) identify barriers to accessing health care and adapting health behaviours; (3) evaluate effi cacy of present preventive strategies and recommendations; (4) evalu-ate knowledge and attitude towards ongoing health programs and public health recommendations; (5) monitor change and progress towards the national health objectives; (6) formulate new preventive strategies and recommendations based on the fi ndings and knowledge base of the last 10 years; (7) formulate models for successful prevention of chronic diseases and for healthy aging.

PP.01.27 DYSLIPIDEMIA IN HYPERTENSIVE PATIENTS

UNDERGOING 24-HOURS AMBULATORY BLOOD

PRESSURE MONITORING: BAD COMPANIONS TOO

OFTEN ASSOCIATED

G. Cocci, F. Spannella, F. Giulietti, P. Balietti, L. Landi, A. Cenci, G. Rosettani, R. Sarzani. Internal Medicine and Geriatrics, Hypertension Excellence Centre of the ESH, IRCCS-INRCA, UNIVPM, Ancona, Italy

Objective: Hypertension and dyslipidemia represent two of the most relevant modifi able cardiovascular risk (CVR) factors and they often coexist. The aim of

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our study was to evaluate the characteristics of the lipid profi le of a large unselect-ed hypertensive population referred to our Centre, to underline the magnitude of this association and possible lacks in the management of dyslipidemia.

Design and method: Retrospective study on 1440 hypertensives referred to our Hypertension Centre between 2010 and 2015. Inclusion criteria were age > = 18 years, a 24-hour ambulatory blood pressure monitoring (ABPM) and a complete lipid profi le: total cholesterol (TC), HDL cholesterol (HDL-c) and triglycerides (TG). Dyslipidemia was defi ned by the presence of at least one of these char-acteristics: TC > = 200 mg/dl, calculated LDL cholesterol (cLDL) values higher than those recommended based on individual CVR, HDL-c < 40 mg/dl in men and <50 mg/dl in women, TG > = 150 mg/dl.

Results: Mean age: 55.9 ± 13.4 years. Male sex: 823(57.2%). Overweight/obese: 68%. Smokers: 18.1%. Diabetics: 10.7%. Dyslipidemia: 82.6%. Patients with pe-ripheral arterial disease (PAD): 23,7%. Mean eGFR: 75.0 ± 15.6 ml/min/1.73m2. Mean TC: 205.9 ± 39.7 mg/dl. Mean HDL-c: 51.8 ± 13.7 mg/dl. Median TG: 111 mg/dl (82–157). Mean cLDL: 129.2 ± 34.5 mg/dl. Drug therapy: 19% (statins 87.6%, ezetimibe 6.2%, others 2.2%). At target cLDL: 39% (all patients), 42.9% (treated patients). Females were less controlled, despite the same treat-ment rate with lipid-lowering drugs. Diabetics were also less controlled, despite a higher rate of treatment with lipid-lowering drugs. Patients with PAD not treated with lipid-lowering drugs were 78.3%. TG> = 150 mg/dl: 28% (all patients), 33% (treated patients). Low HDL-c (according to sex): 28.3%. Statins frequen-cies: simvastatin (34.1%), atorvastatin (27.8%), rosuvastatin (13.2%), pravastatin (10.3%), others (2.2%). High intensity statins were taken only by 2% of treated patients. The hypertensives controlled by therapy were 29.9% and patients with both controlled hypertension and cLDL were only 12%.

Conclusions: Our data show the frequent association between hypertension and dyslipidemia. Patients with at least one alteration of the lipid profi le were of-ten untreated with lipid-lowering drugs, even in the presence of increased CVR. Whenever treated, they received low-medium intensity statins and they often did not reach their therapeutic goals.

PP.01.30 THE HYPERTENSIVE POPULATION IN THE

INTERNAL MEDICINE WARD

J. Rodrigues, A. Ferreira Simões, M. Freixa, S. Úria, G. Silva. Hospital Pulido Valente, CHLN, Lisbon, Portugal

Objective: The global burden of arterial hypertension (AH) is substantial, with a prevalence of 42,2% in Portugal, therefore constituting a major health concern. The authors intended to characterize the patients hospitalized with diagnosis of AH and identify differences when compared to those without this diagnosis.

Design and method: Observational retrospective study based on the collection of clinical data of patients admitted in an internal medicine ward during 60 months. The patients were divided in two groups: those with the diagnosis of AH prior to or established during the hospitalization; and those without this diagnosis (NAH) at the time of hospital discharge. The sample was also divided by age tertiles: < 75 years; 76–83 years; > 83). There was defi ned as cardiovascular event the occur-rence of stroke or acute myocardial infarction as motif or during hospitalization and was registered all cause death.

Results: Total sample includes 1106 patients, from which 68.5% (n = 758) have the diagnosis of AH (n = 758). (1) In the AH group the female gender is more frequent (53.3% vs 50% in NAH group; p = 0.331) and the mean age is superior (79 ± 11.1 vs 72 ± 18.3 years; p < 0.001). (2) The prevalence of AH is higher as the population gets older (59.7%; 71.3%; 75.1%; p < 0.001). (3) The length of stay is slightly greater in the AH group (10.3 ± 9.4 vs 10.1 ± 10.4 days; p = 0.696). (4) The risk of AH is greater in the patients with diabetes mellitus (OR 2.7; 95% CI: 2–3.7; p < 0.001), dyslipidemia (OR 2.6; 95% CI: 2–3.6; p < 0.001), obesity (OR 3.0; 95% CI: 1.6–5.5; p < 0.001) and kidney failure (OR 2.3; 95% CI: 1.7–3.1; p < 0.001). (5) Most of the patients with cardiovascular events (73.2%; p = 0.555) or death in the hospital (51.8%; p = 0.008) have the diagnosis of AH.

Conclusions: AH is a very common diagnosis in the patients admitted to the Internal Medicine ward, particularly in the older ones, and represents a risk factor to other cardiovascular diseases and mortality. For this reason, the authors intend to draw attention to the need of establishing prevention strategies, earlier detec-tion and adequate treatment, in order to prevent other cardiovascular diseases and mortality.

PP.01.31 THE EVOLUTION OF HYPERTENSIVE POPULATION

IN THE INTERNAL MEDICINE WARD

J. Rodrigues, A. Ferreira Simões, M. Freixa, S. Úria, G. Silva. Hospital Pulido Valente, CHLN, Lisbon, Portugal

Objective: Arterial hypertension (AH) is a major health concern because of its prevalence and deaths related to its complications, being important to acknowl-edge the way it is evolving. The authors intended to identify and characterize the differences between patients with the diagnosis of AH admitted to an Internal Medicine ward 4 years apart.

Design and method: Observational retrospective study based on the collection of clinical data of patients admitted in an internal medicine ward during the year 2012 and 4 years later, in 2016. The hypertensive patients were divided in two groups: admitted in 2012 (H12); admitted in 2016 (H16). It was defi ned as car-diovascular event stroke or myocardial infarction (MI) as the motive of admission and registered all causes mortality.

Results: Total sample includes 407 patients, from which 69.8% (n = 284) have the diagnosis of AH (n = 339). (1) From 2012 to 2016 there is a fall in the number of patients with AH (74,5% in H12 vs 60,7% in H16; p < 0,001). (2) The female gen-der is more prevalent in both groups (51,8%). (3) The mean age is superior in H16 (77,9 ± 11,4 vs 80,4 ± 8,7 years; p = 0,042), as well as the length of stay (7,9 ± 6,6 vs 14,4 ± 10,6 dias; p < 0,001). (4) There is a raise in the prevalence of other dis-eases in H16: heart failure (27,1% vs 43,5%; p = 0,008); atrial fi brillation (26,1% vs 38,8%; p = 0,035); obesity (8% vs 17,6%; p = 0,022); stroke (21,1% vs 22,4%; p = 0,875). (5) The cardiovascular events (6% vs 8,2%, p = 0,604; stroke – 7% vs 8,2%, p = 0,805; MI – 2,5% vs 3,5%, p = 0,7), death (6,5% vs 9,4%; p = 0,002) or either one (14,1% vs 21,2%; p = 0,160) become more frequent in H16.

Conclusions: In the studied sample there is a decrease of the number of patients with AH, but at the same time there is a tendency of increase of the cardiovascular events and death in the hypertensive patients, highlighting the importance of pre-vention and control of these important cardiovascular risk factor.

PP.01.33 RISK FACTORS OF ARTERIAL STIFFNESS

MEASURED BY CARDIO-ANKLE VASCULAR

INDEX IN PATIENTS WITH MILDLY DECREASED

GLOMERULAR FILTRATION RATE

A. Gincaite1,3, L. Rimsevicius1,3, L. Ryliskyte2,3, J. Badariene2,3, A. Laucevicius2,3,M. Miglinas1,3. 1Center of Nephrology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania, 2Center of Cardiology and Angiology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania, 3Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania

Objective: Arterial stiffness (AF) measured by cardio-ankle vascular index (CAVI) has been proven to be an early marker of decreasing cardiac, vascular and renal function. However, most of the studies have been conducted in a general practice setting. Therefore, the aim of this study is to determine risk factors of AF in a spe-cifi c patient’s cohort with mildly decreased glomerular fi ltration rate (GFR).

Design and method: This was a retrospective study. Patients were initially recruit-ed in 2011–2013 as participants of the Lithuanian High Cardiovascular Risk pri-mary prevention program. The patients selected for the study had a GFR form 60 to 90 ml/min/1.73sqm in accordance to the KDIGO defi nition of mildly decreased GFR. The data were grouped into two sections: (1) demographic and comorbidi-ties, (2) laboratory values and instrumental tests. CAVI was chosen as a marker of impaired AF, the cut-off values were generated by implementing the median values of different age and gender groups. Stepwise multivariate logistic regression was performed and risk factors of AF were revealed in each data sections.

Results: This study included data of 653 patients aged from 40 to 70 years. Most of them were women 78.3% (n = 511), with a median GFR of 81.49 ml/min/1.73sqm [75.73–86.36]. Six different cut-off values for each gender and age stratifi ed group were generated, with a mean value of 7.7. The implementation of these values showed a distribution across AF groups, favoring the increased AF: 59.7 vs 40.3 percent. The demographic variables and comorbidities associated with AF were: age (OR per year = 1.073, CI95% 1.042–1.105, p < 0.001) and body mass index (OR per kg/sqm = 0.921, CI95% 0.887–0.956, p < 0.001). The laboratory values and instrumen-tal tests related to AF were: ankle-brachial index (OR per 0.1 = 1.426, CI95% 1.103–1.843, p = 0.007), high-density lipoproteins (OR per 0.1 mmol/L = 1.096, CI95% 1.007–1.194, p = 0.034), glucose (OR per mmol/L = 1.296, CI95% 1.088–1.544, p = 0.004) and sodium (OR per mmol/L = 1.117, CI95% 1.009–1.237, p = 0.033).

Conclusions: AF in patients with mildly decreased GFR can be predicted by various markers. The most potent predictors were age and ankle-brachial index. These mark-ers should be further studied prospectively in the context of AF and renal function.

PP.01.34 PREVALENCE OF CARDIOVASCULAR RISK

FACTORS IN AN ACTIVE POPULATION OF NORTH

ALENTEJO

A. Ribeiro2, G. Urban1. 1Universidad De Extremadura, Unidade Local de Saúde do norte alentejano, Hospital de Santa Luzia de Elvas, internal Medici, Badajoz,

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Spain, 2Unidade Local De Saude Do Litoral Alentejano, Santiago Do Cacém,Portugal

Objective: The objectives of this study are to estimate the prevalence of car-diovascular risk factors in the working population in the North Alentejo region, namely the prevalence of metabolic syndrome, hypertension, dyslipidemia, obe-sity, smoking, alcoholic and sedentary lifestyle.

Design and method: Obtaining the sample for the study will be done by con-secutive demonstration. The selection of the sample will include those patients older than 18 years who work in DELTA coffee industry and exclude patients with concomitant serious diseases that may cause alterations in nutritional status. All sample members will be required to sign an informed consent for inclusion in the study. An anamnesis will be conducted to investigate smoking, alcoholic, exercise habits, personal history of cardiovascular diseases.Both SBP and DBP will be evaluated with a digital sphygmomanometer validated in three serial determinations, after which the arithmetic mean will be discovered. The following anthropometric measures will be determined: weight, height, ab-dominal perimeter, bitrocantheter perimeter, body mass index, wrist circumfer-ence, abdominal mass index, waist size index, relation abdominal perimeter BMI, waist circumference index.

Results: The mean age of individuals was 37 years. 39% were smokers and 14% were alcoholics. Regarding the determination of blood pressure in the sample, there was a statistically signifi cant difference between the sexes and age (p = 0.000).Those over 50 years weigh more 4.88 kilos, measure about three centimeters less and their wrists, waists and hips are greater. BMI has no statistically signifi cant difference. Regarding the remaining indices, for the waist-hip ratio, there were signifi cant differences between men and women, being higher in men. The same is not the case with waist-height index and waist-Wrist- index for which there are no differences by sex.An analytical evaluation was carried out with hemogram, biochemistry, PCR for the study of several analytical parameters that complement the study of the preva-lence of cardiovascular risk factors

Conclusions: There is a signifi cant rate of cardiovascular risk factors in an active population, requiring a close medical action to reduce metabolic risk and cardio-vascular risk, reducing personnel social, family and economic costs.

PP.01.35 ROLE OF SYSTOLIC ARTERIAL PRESSURE AS

PREDICTOR OF ADVERSE OUTCOME IN PATIENTS

PRESENTING WITH MAJOR BLEEDING TO THE

EMERGENCY DEPARTMENT. AD-INTERIM RESULTS

OF A MULTICENTER POPULATION BASED STUDY

S. Bianchi2, N. Renzi1, D. Molesti1, S. Vanni2, M. Pastorelli3, A. Cipriano4, M. Santini4, U. Beerman3, F. Frosini5, F. Mecca6, P. R. Di Corato7, V. Procacci7,

P. Chiaradia8, L. Spisni8, A. Conti1. 1Dipartimento di Emergenza Nuovo Ospedale Apuano, Massa-Carrara, Italy, 2Dipartimento di Emergenza Azienda Ospedaliero Universitaria Careggi, Firenze, Italy, 3Dipartimento di Emergenza Azienda Os-pedaliero Universitaria Senese, Siena, Italy, 4Dipartimento di Emergenza Azienda Ospedaliero Universitaria Pisana, Pisa, Italy, 5Dipartimento di Emergenza Ospedale San Luca, Lucca, Italy, 6Dipartimento di Emergenza Ospedale Umberto I Mauriziano, Torino, Italy, 7Dipartimento di Emergenza Ospedali Riuniti di Foggia, Foggia, Italy, 8Dipartimento di Emergenza Ospedale Lotti Pontedera, Pontedera, Italy

Objective: Bleeding events at the Emergency Department (ED) are still under in-vestigation. Aim of the present study was to analyze baseline characteristics which could be associated with any treatment strategies and outcomes.

Design and method: Visits to the ED were considered during a 2016 three-month survey. Inclusion-exclusion criteria were as follows: presence of any bleeding event and age < 18. Clinical parameters, major-minor bleeding, site of bleeding, treatments, need of reversal treatment/transfusion and adverse outcomes were prospectively collected. Primary endpoint was the presence of major bleeding. Secondary were the composite of admission-death and the need of reversal treat-ment-transfusions

Results: Out of 155.320 visits, 2.592 patients were enrolled (mean age 64.9 ± 20.3 year). Major bleedings account for 26%. Mean systolic arte-rial pressure was 138 ± 28 mmHg, heart rate 81 ± 15 b/min, haemoglobin 12.1 ± 2.5 g/dL, creatinine 1.07 ± 0.75 mg/dL. Patients who were given anti-platelets or anticoagulants (393, 15%; 275, 11%) more likely presented with major bleeding (171, 44%; 127, 46%; p < 0.001). Overall, 179 patients received reversal treatment (108, 4%), transfusions (86, 3%), VitK(30, 1%); 59(22%) patients were given anticoagulants (p < 0.001) and 43(11%) antiplatelets (p = 0.049); 193(7%) need observation and 503(19%) admission. In-hospital death accounts for 30(1.2%) patients. Receiver Operator Characteristics analy-sis for major bleeding showed higher values of age (area 0.62, CI 0.59–0.66), creatinine (0.55, 0.52–0.59), systolic arterial pressure (0.53, 0.49–0.56) over anticoagulants (0.50, 0.48–0.54) and antiplatelets (0.51, 0.48–0.55). Age>65 (Odds Ratio, OR 6), major bleeding (OR 9), systolic arterial pressure (OR 1.10), antiplatelets (OR 2) were predictors of death at the univariate analysis; Age > 65 (OR 2), major bleeding (OR 101), antiplatelets (OR 2) and female gender (0R 0.69) of the composite endpoint of death-admission. Age > 65 (OR 1.04), major bleeding(OR 68), anticoagulants (OR 4), warfarin (OR 5) were predictors of reversal treatment-transfusion at the univariate analysis.

Conclusions: Up to 2% of population presents with bleeding events to the ED. Older age was predictor of death; older age, major bleeding and female gender predict the primary endpoint; while major bleeding, use of warfarin the composite of reversal treatment-transfusion. Older age, creatinine, systolic arterial pressure were associate with major bleeding.

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e102 Abstracts

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved

SATURDAY

POSTERS

POSTER SESSION

POSTERS’ SESSION PS02:

PHARMACOLOGICAL TREATMENT

PP.02.01 SIX-YEAR TRENDS IN ANTYHYPERTENSIVE

MONOTHERAPY AND BLOOD PRESSURE

CONTROL IN PATIENTS REFERRED TO

SPECIALIZED CARDIOLOGICAL CENTRE

N. Zvartau1, A. Krikunov2, A. Semakova2, E. Bolgova2, S. Kovalchuk2,A. Boukhanovsky2, A. Konradi1. 1Federal Almazov North-West Medical Research Centre, Saint-Peretsburg, Russia, 2ITMO University, Saint-Petersburg, Russia

Objective: Hypertension monotherapy is considered to be effective in 10–20% of patients with mild or mild-to-moderate hypertension (HTN). However latest evidence suggest sometimes a dramatic difference in effi cacy and even safety of different members of an antihypertensive drug (AD) class. These may have an impact on response rate, blood pressure control, adherence and physician prefer-ences concerning choice of precise AD for monotherapy. The main objective of this study was to describe trends in choice of antihypertensive monotherapy and blood pressure control in adult hypertensive patients referred to specialized cardi-ology clinic during the six-year period.

Design and method: We extracted 13691 monotherapy data from 68276 elec-tronic medical records of patients referred to specialized cardiology clinic due to uncontrolled or therapy-naive HTN during the period of January 2010 - December 2015. Descriptive statistics were used to estimate the means, linear regression was employed to determine the yearly trends.

Results: Overall, ACE inhibitors (ACEi) and angiotensin II receptors antagonists (ARA) remained the most commonly used antihypertensive drug classes [4326 pa-tients (31,6%) and 4504 patients (32,9%), respectively] without signifi cant 6-year trends. Approximately 16.6% of hypertensive adults were taking beta-blockers (2273 patients) and 11,8% (1616 patients) calcium channel blockers (CCBs), the use of these classes remained relatively constant during the survey period. Inter-estingly, diuretics were the less commonly used drug class without signifi cant changes during 6-year period (7,1%, 972 patients). Perindopril (41,6%) and Enal-april (20,7%) were the most commonly used ACEi during studied period. Among other classes the leaders were Metoprolol (57,%) and Bisoprolol (20.7%) for beta-blockers; Losartan (52,9%) and Valsartan (37,5%) for ARA; Amlodipine (88,5%) and Nifedipine (6,6%) for CCB and Indapamide (85,3%) and Hydrochlorotiazide (6,6%) for diuretics without signifi cant six-year trends. Blood pressure control rate on monotherapy was approximately 31% during studied period without sig-nifi cant 6-year trends. However monotherapy with ACEi and ARA provided better blood pressure control up to 35% compared to 27% on diuretics.

Conclusions: RAAS blockers are the most frequently used and effective classes for monotherapy of HTN. The choice of a precise member of an antihypertensive drug may have an impact on monotherapy success rate.

PP.02.03 EFFICACY AND TOLERABILITY OF NIFEDIPINE

GASTROINTESTINAL THERAPEUTIC SYTEM 60MG

IN CHINESE PATIENTS WITH UNCONTROLLED

HYPERTENSION

Y. Zhang1, L. Liu1, F. Lu2, Y. Zhao2, Y. Wu3, L. Chen4, Y. Sun5, W. Yao5, P. Gao6, S. Chen6, X. Ji7, J. Mu8, S. Li9. 1Fuwai Hospital, Chinese Academy of Medical Sci-ence, Beijing, China, 2Qi Lu Garden Hospital of Ji Nan, Jinan, China, 3Kai Luan General Hospital, Tangshan, China, 4FuJian Medical University Union Hospital, Fuzhou, China, 5Tianjin Medical University General Hospital, Tianjin, China, 6Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China, 7Qi Lu Hospital of ShanDong University, Jinan, China, 8The First affi li-ated hospital of Xian Jiaotong University, Xian, China, 9Bayer Healthcare Lim-ited Company, Beijing, China

Objective: Effi cacy and tolerability of nifedipine gastrointestinal therapeutic system (GITS) 60 mg once daily (QD) in uncontrolled blood pressure (BP) is not completely explored in China. Therefore, we studied the effi cacy and toler-ability of nifedipine GITS 60 mg in Chinese hypertensive patients inadequately controlled with prior monotherapy.

Design and method: This single-arm phase-4 study (NCT02413515) enrolled 278 hypertensive adults from 13 centers in China, in whom BP was uncontrolled after 4-weeks of antihypertensive monotherapy. The patients received oral nifedip-ine GITS 60 mg QD for 8-consecutive weeks. Primary endpoint was mean sitting systolic BP control rate (MSSBP; < 130 mmHg for subjects with diabetes (DM) and <140 mmHg for others) at 8-weeks. Secondary endpoints included change in MSSBP and mean sitting diastolic BP (MSDBP), 24-h SBP and DBP reduction measured by 24 hour ABPM, and safety of nifedipine GITS 60 mg.

Results: A total of 269 patients (mean age 55 ± 8.21 years, 62.8% males, 28.3% with DM) were included for effi cacy and 278 for safety analysis. At week 8, over-all MSSBP control rate was 64.7%. From baseline to 8-weeks, decrease in MSSBP and MSDBP was �15.2 ± 11.37 mmHg (147.9 ± 6.87 mmHg to 132.7 ± 11.82 mmHg) and �6.4 ± 7.87 mmHg (89.1 ± 7.13 mm Hg to 82.7 ± 8.04), respec-tively (Table 1). The control rate was lower in patients with DM From base-line to 8-weeks, mean 24-h SBP was decreased from 138.5 ± 12.78 mmHg to 131.6 ± 12.29 mmHg (diff. �6.9 ± 11.30 mmHg, 95% CI �8.29, �5.56) and mean 24-h DBP was decreased from 86.4 ± 9.32 mmHg to 82.5 ± 9.12 mmHg (diff. −3.9 ± 7.63 mmHg, 95% CI �9.47, �6.42). Fifty (18%) cases of adverse events (AEs) and 25 (9%) cases of peripheral edema were reported. No drug re-lated serious AEs and deaths occurred during the study.

Conclusions: Nifedipine GITS 60 mg QD further improved control rate of MS-SBP and MSDBP and was well tolerated in Chinese patients previously treated with standard dosage of antihypertensive monotherapy.

PP.02.04 TRANSCRIPTIONAL INTERFERENCE OF ACROLEIN

AND THEIR MODULATION BY PPAR GAMMA

LIGAND, ROSIGLITAZONE

Z. Yousefi pour1, S. Haydari1, K. Ranganna1, MA Newaz2. 1Texas Southern Uni-versity, Houston, TX, USA, 2Chicago State University, Chicago, IL, USA

Objective: Long term exposure to aldehydes can increase risk for development of cardiovascular problems and that makes understanding mechanism involved in this process important. Acrolein, an �,�-unsaturated aldehyde, has been classifi ed as a major environmental pollutant. Oxidative stress and increased infl ammatory responses have been proposed as main players in aldehydes toxicity. Peroxisome proliferator-activated receptor gamma (PPARg) has been implicated in pathology of diseases involving infl ammation and anti-infl ammatory effects of rosiglitazone, a PPARg ligand, has been investigated. In this study we investigated the pathways that might be involve in rosiglitazone’s protection against acrolein.

Design and method: Wild type mice (male, 20–25 g) were exposed to acrolein (2.5 mg/kg/day, gavage, 7 days) or acrolein and rosiglitazone (10 mg/kg/day, gavage, 10 days). Animals were sacrifi ced and liver was used to determine biochemical parameters.

Results: Acrolein increased and NADPH oxidase activity (42%) and generation of free radicals (33%+�0.22 pg/mg protein) compared to control mice (p < 0.05). Treatment with rosiglitazone reduced both free radical generation (38%) and NADPH oxidase activity (22%). Activity and protein expression of Xanthine oxi-dase was not changed signifi cantly by acrolein and rosiglitazone. Cyclooxygen-ase-2 (COX-2) activity and protein expression was increased by acrolein (25% and 35%) and rosiglitazone did not have any signifi cant effect on COX protein or activity. Acrolein reduced total antioxidant status (TAS) (65%) and rosiglitazone improved TAS by 52%. Catalase expression was reduced by 30% and rosigli-tazone increased it by 25%. PPARg activity and protein expression was reduced by acrolein (2 fold and 35% respectively) and improved when mice were treated with rosiglitazone (1.5 fold and 29% respectively). Expression of serum response factor was increased by 2-fold after exposure to acrolein and was not changed by rosiglitazone. Expression of Egr-1 protein was increased after acrolein treatment (80%) and rosiglitazone did not have a signifi cant effect on expression of Egr-1.

Conclusions: These fi ndings suggest that rosiglitazone treatment provides pro-tection against acrolein toxicity through reduction of NADPH oxidase derived superoxide production which might be SRF dependent but not Egr-1 dependent.

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Abstracts e103

PP.02.05 EFFECTS OF XANTHINE OXIDASE INHIBITORS ON

BLOOD PRESSURE, BAPWV, CAROTID ARTERIAL

IMT AND ELASTIC MODULUS IN HYPERTENSIVE

PATIENTS WITH HYPERURICEMIA

T. Yamagishi1, H. Kanai2. 1Department of Internal Medicine, Tohoku Kosai Hos-pital, Sendai, Japan, 2Department of Electronic Engineering, Graduate School of Engineering, Tohoku University, Sendai, Japan

Objective: We investigated the effects of xanthine oxidase inhibitors on blood pressure, baPWV,carotid arterial IMT and elastic modulus in hypertensive pa-tients with hyperuricemia.

Design and method: The fi fty-two patients with hypertension and hyperurice-mia (average age: 59 years old, BMI26 kg/m2) were treated with xanthine oxidase inhibitors (febuxostat or topiroxostat) for 12 months. Serum markers, offi ce and central blood pressures and brachial-ankle pulse wave velocity (baPWV) were examined. The intima-media thickness (IMT) and elastic modulus in the circum-ferential direction (E �) were simultaneously measured by the high-resolution Doppler technique, “Phased Tracking Method”.

Results: The basal values of uric acid (UA), eGFR, offi ce blood pressure (BP), pulse pressure, baPWV, central SBP (cSBP), IMT, E � were the followings:7.9 ± 1.0 mg/dL, 65.7 ± 18.3 ml/min./1.73m2, 131.7 ± 14.4/80.7 ± 10.1 mmHg, 51.0 ± 9.4 mmHg, 1528.0 ± 255.0 cm/sec, 133.4 ± 20.9 mmHg, 1.41 ± 0.57 mm, 419.6 ± 125.0kPa. After 12 months of administration of xanthine oxidase inhibitors, UA(�28%), sys-tolic BP(�2%), baPWV(�6%) and cSBP(�2%) decreased signifi cantly (p < 0.05). No changes were seen in eGFR(�1%) and pulse pressure(�3%). The drugs also decreased IMT (�14%) and E � (�14%) signifi cantly. The histogram analysis of the E q data revealed both of the drugs decreased harder components of the elasticity distribution, suggesting improvement of endothelial dysfunction.

Conclusions: Our results indicate that xanthine oxidase inhibitors may have effects on UA, blood pressure, IMT and E � and baPWV to inhibit excessive activation of xanthine oxidase in hypertensive patients with hyperuricemia. The measurement of the carotid elastic modulus may be useful to evaluate the effi cacy of drugs for improving regional atherosclerotic changes.

PP.02.06 BEETROOT JUICE LOWERS CENTRAL SYSTOLIC

BLOOD PRESSURE - A DOUBLE-BLIND

CROSSOVER PLACEBO CONTROLLED PILOT TRIAL

T. Weber1, G. Waldenberger2, B. Hametner3, S. Wassertheurer3, G. Lirk4, O. Hoeglinger2. 1Klinikum Wels-Grieskirchen, Wels, Austria, 2University of Applied Sciences, Wels, Austria, 3Austrian Institute of Technology, Vienna, Austria, 4University of Applied Sciences, Hagenberg, Austria

Objective: Dietary inorganic nitrate, originating from beetroot juice, has been shown to lower brachial blood pressure via bioconversion in the enterosalivary cir-culation. Its effects on central systolic blood pressure (cSBP) are largely unknown.

Design and method: 13 healthy young adults received 180 ml Fit Rabbit (FR) juice, containing 11.2 mmol nitrate, or matched placebo (P), at 8.00 AM in a non-fasting state (but free from coffee). Brachial and central BP was measured with a validated, oscillometric system (mobilograph, Stolberg, Germany) and a transfer function, with a measurement interval of 20 minutes during the day, at baseline (B), following FR and P. Primary endpoint was the change in averaged cSBP be-tween the time interval 7.15–8.30 and 09.00–12.30.

Results: From the fi rst to the second time interval, central SBP dropped by 3.3 mm Hg (FR) and 0.2 mm Hg (B) and increased by 1.6 mm Hg (P). The changes in the whole group were statistically signifi cant (p = 0.005), as was the change following FR (p = 0.0003) and the difference between B and FR (p = 0.05). In contrast, we observed only minor changes in brachial SBP at B (�0.8 mm Hg) and following FR (-0.2 mm Hg) and P (+1.2 mm Hg) from the fi rst to the second time interval. The BP changes were accompanied by changes in heart rate (HR): + 4.6 (RF), - 3.4 (B) and - 2.6 (P) beats per minute, respectively. The changes in the whole group were statistically signifi cant (p = 0.02), as was the change following FR (p = 0.02) and the difference between B and FR (p = 0.01). In exploratory analysis, the results were comparable, when alternative time windows for the second interval were chosen (09.–11.00 or 11.00–12.30, respectively).

Conclusions: Our results show that the effects of beetroot juice on systolic blood pressure may be more pronounced on central rather than on brachial blood pressure.

PP.02.07 SIMPLIFICATION OF ANTIHYPERTENSIVE THERAPY

IMPROVES BLOOD PRESSURE CONTROL IN

RESISTANT ARTERIAL HYPERTENSION

J. Vaclavik1, J. Flasik2, J. Jarkovsky3, K. Benesova3, E. Kocianova1, M. Kamasova1,T. Vaclavik4. 1Palacky University, Faculty of Medicine and Dentistry, Depart-ment of Internal Medicine I - Cardiology, Olomouc, Czech Republic, 2Palacky

University, Faculty of Medicine and Dentistry, Olomouc, Czech Republic, 3Insti-tute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic, 4Department of Statis-tics and Probability, Faculty of Informatics and Statistics, University of Economics, Prague, Czech Republic

Objective: Partial or total non-adherence to antihypertensive medications is a frequent cause of inadequate blood pressure (BP) control. Fixed combinations were shown to improve medication adherence and BP control, but their effect in resistant hypertension is not known. The aim of our study was to assess the effects of simplifi cation of the antihypertensive treatment using fi xed combinations in patients with resistant arterial hypertension.

Design and method: We analyzed medical records of patients with resistant arte-rial hypertension, who had antihypertensive medication adjusted and simplifi ed using fi xed combinations during an outpatient visit at our department between November 2009 and June 2015. Offi ce blood pressure and antihypertensive medi-cations were recorded and compared between baseline and the next outpatient clinical visit. Standard descriptive statistical methods were applied, statistical sig-nifi cance of BP and medication changes was calculated using Wilcoxon Rank test.

Results: We enrolled 194 patients of mean age 60 years, 63% were men. Mean baseline offi ce BP was 153.7/87.5 mmHg and patients were using mean 4.8 different antihypertensive drug classes, representing mean 5.2 antihypertensive tablets used daily. Effect of the simplifi cation of medication was assessed on next clinical visit on average 12 weeks later. Number of antihypertensive drug classes was reduced by 0.4 to 4.4, and the number of daily used antihypertensive tablets was reduced by 1.9 to 3.3 (P < 0.001 for both). Offi ce blood pressure at the next clinical visit decreased by a mean 19.8/9.9 mmHg to 133.9/77.6 mmHg (P < 0.001 for both).

Conclusions: Simplifi cation of medication using fi xed combinations markedly improved BP control in patients with resistant hypertension while signifi cantly decreasing their medication burden.

PP.02.08 INFILTRATION OF THE SPHENOPALATINE

GANGLION DECREASES BLOOD PRESSURE

IN NEWLY DIAGNOSED AND NEVER TREATED

PATIENTS WITH ESSENTIAL HYPERTENSION

E. Triantafyllidi1, C. Arvaniti2, L. Palaiodimos1, S. Vlachos1, A. Schoinas1,D. Benas1, I. Ikonomidis1, C. Batistaki2, G. Kostopanagiotou2, J. Lekakis1. 12nd Cardiology Department, Medical School, Athens, Greece, 2Pain Unit, 2nd Anes-thesiology Department, Medical School, Athens, Greece

Objective: Background: Sphenopalatine ganglion (SPG) is connected with the central nervous system through sympathetic and parasympathetic nerves. We hypothesized that SPG block through sympathetic nerves anesthesia might decrease blood pressure (BP) in recently diagnosed and never treated middle-aged hypertensive patients.

Design and method: Methods: We performed SBG block in 27 hypertensive patients (mean age 47+12 years, 19 men). All patients have been subjected to 24 hour ambulatory blood pressure monitoring prior the procedure and in a period of 21–30 days after the SBG block in order to estimate differences in 24 h average systolic (24 h SBP) and diastolic blood pressure (24 h DBP), daytime, nighttime, pre-awake and early morning SBP and DBP as well as BP load and BP variability (STD).

Results: Results: We found that 24 h SBP (p = 0.003) and DBP (p < 0.001), daytime SBP (p = 0.003) and DBP (p < 0.001) as well as daytime SBP and DBP load (p = 0.007 and p < 0.001, respectively) were decreased in total population at 21–30 days after SPG block. In 12/27 responders (24 h SBP decrease > 5 mmHg), SBP and DBP were reduced during overall 24 h (p < 0.001), daytime (p < 0.001) and nighttime periods (p = 0.005 and p = 0.03, respectively) while only SBP was decreased during 2 hours pre-awake and 2 h after awake periods (p < 0.05). Ad-ditionally, daytime SBP and DBP (p < 0.001) and nighttime SBP load (p = 0.002) were also decreased.

Conclusions: Conclusions: SBG block might be a promising, non invasive, safe, painless and easy to perform therapeutic option of BP decrease. As with renal de-nervation, SBG should be effective in those hypertensive patients with an activated SNS, so a period of patient selection should precede the application of this procedure.

PP.02.09 THE ARTERIAL STIFFNESS DYNAMICS UNDER

THE EFFECT OF ROSUVASTATIN ADDED TO

FIXED COMBINATION OF LISINOPRILE AND

HYDROCHLOROTHIAZIDE

A. Torunova1, K. Protasov1, O. Fedorishina1, V. Pervuhina2, I. Denisova3. 1Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia, 2OGAUZ IGKB N9, Irkutsk, Russia, 3MANO LDTS, Angarsk, Russia

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e104 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

Objective: The aim of our study was to assess the infl uence of rosuvastatin added to a fi xed combination of lisinoprile and hydrochlorothiazide on peripheral and central BP, pulse wave velocity (PWV)) in patients with uncontrolled hyperten-sion.

Design and method: 49 patients (26 men and 23 women aged 51.2 ± 8.7) with uncontrolled hypertension were randomized into two groups. Group 1 included 26 patients who received a fi xed combination of 10 or 20 mg/day lisinopril and 12.5 mg/day hydrochlorothiazide. Group 2 consisted of 23 patients who followed the same regimen of therapy with addition of rosuvastatin 20 mg/day. The of-fi ce and ambulatory peripheral BP, central (aortic) BP, augmentation index (AIx), carotid-femoral and carotid-radial were evaluated before and after a 24-week follow-up period.

Results: The offi ce systolic/diastolic BP decreased in both groups from 166.2 ± 19.8/103.5 ± 11.4 to 139.2 ± 14.3/87.2 ± 9.4 mmHg (p < 0.001) in the 1st group and from 168.6 ± 23.6/103.6 ± 15.6 to 135.6 ± 15.1/87.3 ± 11.5 mmHg (p < 0.001) in the 2nd one. The extent of offi ce BP decline did not differ. The ambulatory BP also decreased in both groups from 136.8 ± 9.4/84.2 ± 8.2 to 123.6 ± 9.4/75.7 ± 7.3 mmHg (p < 0.001) in the 1st group and from 141.9 ± 13.86/88.3 ± 11.4 to 120.3 ± 10.4/75.0 ± 9.0 mmHg (p < 0.001) in the 2nd one. The degree of systolic BP reduction was more pronounced in the 2nd group (-18.0 vs -26.7 mmHg, p = 0.024). Central aortic BP also decreased in both groups from 142.9 ± 15.6/93.6 ± 10.2 to 126.4 ± 15.1/85.2 ± 8.4 mmHg (p = 0.001) in the 1st group and from 151.1 ± 19.7/98.3 ± 13.7 to 123.3 ± 15.5/84.6 ± 11.8 mmHg (p < 0.001) in the other. The extent of central systolic BP reduction was only more pronounced in the 2nd group (-11.0 vs -27.7 mmHg, p = 0.035). AIx decreased in the 2nd group from 35.9 ± 8.9 to 29.2 ± 11.2% (p = 0.006). Mean carotid-femoral PWV decreased statistically in the 1st group from 9.0 ± 1.8 to 8.2 ± 1.5 m/s (p = 0.02) and from 8.8 ± 1.7 to 8.0 ± 1.3 m/s in the second one (p = 0.028). The carotid-radial PWV did not change in both groups.

Conclusions: Addition of rosuvastatin to a fi xed lisinopril/hydrochlorothiazide combination in patients with uncontrolled hypertension resulted in further decline of ambulatory and central BP and augmentation index, but was benefi cial neither for decrease of offi ce BP and carotid-femoral pulse wave velocity.

PP.02.10 EFFECT OF DIFFERENT TYPES OF COMBINED

THERAPY ON CENTRAL BP AND ARTERIAL

STIFFNESS IN PATIENTS WITH MODERATE TO

SEVERE AH: RESULTS OF A PROSPECTIVE

RANDOMIZED OPEN LABEL TRIAL

O. Torbas, Y. Sirenko, G. Radchenko. FI NSC Institute of cardiology n. a. acad. M. D. Strazhesko, Kiev, Ukraine

Objective: It is well known that the effectiveness of medications prescribed alone or as a combination may be different. The purpose of this study was to compare the effectiveness of therapy based on a combination of highly selective beta-blocker bisoprolol and hydrochlorothiazide (B+HCTZ) with a combination of well-known with suffi cient evidence base ACEI lisinopril and hydrochlorothia-zide (Liz+HCTZ) or ARB losartan and hydrochlorthiazide (Los+HCTZ).

Design and method: In this 6-month trial we included 91 patients with AH (mean systolic (oSBP)/diastolic (oDBP) BP 168,4 ± 1,5/99,6 ± 1,0 mmHg): 32 in losartan 100 mg + hydrochlorothiazide 25 mg (Los + HCTZ), 32 in lisino-pril 40 mg + hydrochlorothiazide 25 mg (Liz + HCTZ) and 27 in bisoprolol 10mg+hydrochlorothiazide 25 mg (B+HCTZ). All patients at baseline and dur-ing follow-up underwent: (offi ce) oSBP, oDBP and HR mesasurement, ABPM,

noninvasive central SBP (cSBP) measurement and evaluation of carotid-femoral (cfPWV) and carotid-radial (crPWV) pulse wave velocity, biochemical blood tests. If blood pressure after 1 month of treatment was higher than 140/90 mmHg amlodipine 5 mg was added, if it was insuffi cient the dose of amlodipine was in-creased to 10 mg after 2 months. After 3 months, if necessary, doxazosin 2–4 mg was added.

Results: Decrease of oSBP/DBP was similar in Los+HCTZ, Liz+HCTZ and B+HCTZ groups (44,7 ± 0,9/18,4 ± 1,1 mmHg, 44,5 ± 1,9/19,0 ± 2,1 and 42,4 ± 2,1/18,8 ± 2,5 mmHg in each group respectively, P = NS for difference between groups). The percentage of patients achieved target BP were 96,9% in Los+HCTZ, 93,8% in Liz+HCTZ and 92,6% in B+HCTZ groups. 24SBP/24DBP decreased by 24,6 ± 1,3/17,6 ± 1,1 mmHg in Los+HCTZ, 19,0 ± 3,3/19,3 ± 2,8 mmHg in Liz+HCTZ group and by 24,1 ± 1,8/16,9 ± 1,2 mmHg in B+HCTZ group, in addition, we observed a signifi cant reduction in average HR in this group. Dynamics of cSBP, Aix and PWV are illustrated on the picture. Reduction of cSBP in Los+HCTZ and in Liz+HCTZ groups was signifi cantly higher than in group of bisoprolol-based combination.

Conclusions: Despite of the almost equivalent brachial BP decrease according to offi ce measurement and according to ABPM data, therapy based on combinations of Los+HCTZ Liz+HCTZ signifi cantly better decreased cSBP.

PP.02.11 A DISINTEGRIN AND METALLOPROTEINASE

WITH THROMBOSPONDIN TYPE 1 MOTIF

(ADAMTS1) CAUSES RENAL FIBROSIS IN

DEOXYCORTICOSTERONE ACETATE-SALT

HYPERTENSIVE RATS

H. Toba, T. Suzuki, A. Yoshikawa, T. Noutomi, Y. Mino, S. Ishikawa, N. Toda,K. Sugino, N. Nessa, Y. Watanabe, M. Kobara, T. Nakata. Kyoto Pharmaceutical Uni-versity, Division of Pathological Sciences, Department of Clinical Pharmacology, Kyoto, Japan

Objective: The extracellular matrix (ECM) not only provides structural support in many tissues but also plays important biological roles. ECM accumulation and/or imbalance of ECM components implicate various pathological states such as excessive fi brosis. A disintegrin and metalloproteinase with thrombospondin type 1 motif (ADAMTS1) have been indicated to facilitate collagen deposition via transforming growth factor-� (TGF-�) activation in some tissues. This study in-vestigated the role of ADAMTS1 in renal fi brosis in deoxycorticosterone acetate (DOCA)-salt hypertensive rats.

Design and method: Uninephrectomized rats were treated with DOCA (40 mg/kg/week, s.c.) and 1% NaCl (in drinking water) for 0, 1, 2, or 3 weeks (n = 5–6/group). Blood pressure, urinary protein excretion, and plasma creatinine were measured. Renal sections were stained with Masson’s trichrome to detect col-lagen fi bers. The protein expression of collagen I, TGF-�, and ADAMTS1 was examined by Western blotting. The angiotensin converting enzyme (ACE) activity was also measured.

Results: Blood pressure showed time-dependent increases from 2 weeks, and the levels of proteinuria and plasma creatinine increased from 2 weeks. Masson’s trichrome-positive collagen content increased from 2 weeks with an additional in-crease in 3 weeks. On the other hand, Western blot analysis demonstrated that the collagen I protein levels equally increased in 1-, 2-, and 3-week groups, indicating that the blood pressure elevation may accelerate post-translational collagen pro-cessing but not collagen I production. The expression of ADAMTS1 (both 110kDa latent and 87kDa active forms) as well as that of TGF-� increased in 2 and 3 weeks, suggesting a potential role of ADAMTS1 as an inducer of collagen processing and deposition. The ACE activity was enhanced in 2 and 3 weeks. Since the renin-angiotensin system is reported to increase ADAMTS1 expression, the activation of ACE might relate to ADAMTS1 upregulation in DOCA-salt rat kidney.

Conclusions: ADAMTS1, which is reported to induce fi brosis in other tissues, may be an important inducer of renal fi brosis in hypertensive rats. Further investigation to show that ADAMTS1 production and activation are placed in the upstream of collagen accumulation and downstream of ACE will strengthen our hypothesis.

PP.02.13 EFFECT OF COMBINATION DRUG (ARB

IRBESARTAN 100MG PULAS CA-ANTAGONIST

AMLODIPINE 5MG OR 10MG) ON HYPERTENSIVE

PATIENTS

K. Takeda, J. Moriguchi, Y. Miyazaki, K. Nakamura, T. Yagi, S. Okuda. Kyoto Industrial Helath Association, Kyoto, Japan

Objective: To determine the blood pressure lowering effect of combination drug ARBpulasCa-antagonist), we used Irbesartan/Amlodipine Besilate (Irbesartan

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Abstracts e105

100 mg + amlodipine 5 mg, 10 mg) for the 46 hypertensive patients changes other antihypertensive drugs.

Design and method: 46 patients (average age 67.5 ± 11.9years old, male 39, female 7). Before aimius administration, ARB treated patiens 19, CCB treated patiens 19, no treatment 8. They were treated by Irbesartan/Amlodipine Besilate for 12 weeks.

Results: 12 weeks after treatment, Systolic blood pressure was from 157 ± 20 to 146 ± 17mmHg and diastolic BP was from 96 ± 10 to 88 ± 9mmHg (P < 0.001) in all 46 patients. In 19 Aimikus HD, SBP was from 159 ± 18 to 146 ± 17 mmHg(P = 0.005), DBP was 96 ± 8 to 88 ± 8 mmHg (P < 0.001). In 27 LD, SBP was from 159 ± 21 to 147 ± 18 mmHg (P = 0.027) and from 96 ± 11 to 86 ± 9 mmHg (P = 0.002).The clinical data was shown, LDL cholesterol (n = 42) 112 ± 32 to 105 ± 27 mg dl (P = 0.006)) HDL cholesterol (n = 42) 22 to 61 mg per dl (P = 0.002), HbAIC(n = 17) 6.6 ± 0.6 to 6.4 ± 0.5 % (P = 0.005), Blood glucose 118 ± 25 mg/dl to 117 ± 26, eGHR (n = 41) from 59 ± 2 to 59 ± 2 ml/min.

Conclusions: Combination drug (Irbesartan and amlodipine) was singnifi calntly lowered high blood pressre before treatment without any side effect for lipid and glucone metabolism and renal function.

PP.02.14 ANTIHYPERTENSIVE EFFECT OF LOSARTAN –

ONE-YEAR FOLLOW-UP STUDY

V. Stojanov1, N. Radivojevic1, B. Jakovljevic2. 1Multidisciplinary center for Poly-clinic Diagnostics, Assessment and Treatment of Blood Pressure Disorders, Bel-grade, Serbia, 2Institute of Hygiene and Medical Ecology, Faculty of Medicine, Belgrade, Serbia

Objective: The aim was to assess the effi ciency and safety of losartan therapy in patients with stage I and stage II hypertension during a one-year follow-up period.

Design and method: A cross-sectional study comprised 199 patients (100 men and 99 women) with stage I or stage II arterial hypertension, aged 60.9 ± 10.5 years. All patients were treated with a single daily dose of 50 mg losartan per os; the dose was increased to 5 mg after two weeks in persons who failed to decrease blood pressure adequately; the dose was increased to 100 mg if blood pressure was not regulated. Patients were followed up for one year. Blood pressure (BP) was measured by an oscillometric device at the beginning of the study, hemodynamic monitoring was performed using a thoracic bioelectric impedance method (Task Force monitor), and ambulatory blood pressure monitoring was performed by Space Labs 90202 device in all patients. The differences in selected parameters before and after the losartan therapy were tested with Student’s t-test for paired samples.

Results: Mean systolic blood pressure (SPB) at the beginning of the study was 163.8 mmHg; mean diastolic blood pressure (DBP) was 101.8 mmHg; mean heart rate was 74 beats/min. After therapy, mean SBP was signifi cantly reduced to 137.1 mmHg (p < 0.001), DBP was signifi cantly reduced to 88.9 mmHg (p < 0.001), and heart rate was 72 beats/min. At the beginning, mean % of vasoconstriction was 75 ± 15 among men, and 62 ± 13 among women. After one month of losartan therapy, mean % of va-soconstriction 38 ± 11 in men, and 34 ± 12 in women. At the end of the losartan treat-ment, mean % of vasoconstriction 10 ± 9 in men, and 9 ± 9 in women. The differences are highly statistically signifi cant (all p < 0.001). At the end, 71% remained treated with 50 mg losartan, and only 29% of patients were treated with 100 mg losartan.

Conclusions: One-year therapy with losartan is highly effi cient in the regulation of blood pressure and in decreasing vasoconstriction in hypertensive patients.

PP.02.15 EFFICIENCY OF BISOPROLOL IN THE TREATMENT

OF STAGE I HYPERTENSION “BIPREZ’’ STUDY

V. Stojanov1, N. Radivojevic1, K. Paunovic2, B. Jakovljevic2. 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

Objective: The aim was to assess the effi ciency and safety of bisoprolol therapy in patients with Stage I hypertension in three doses; 2.5 mg, 5 mg, and 10 mg.

Design and method: A cross-sectional study comprised 9060 patients (65% women and 35% men) with stage I arterial hypertension, aged 61.6 ± 11.5 years. Blood pressure (BP) was measured by an oscillometric device at the beginning of the study, and after three months of therapy. The treatment initiated with 2.5 mg bisoprolol; the dose was increased to 5 mg after two weeks in persons who failed to decrease blood pressure adequately; the dose was increased to 10 mg after fur-ther 4 weeks in persons whose blood pressure remained increased. Patients were followed up for 8 weeks in total. Blood glucose, total cholesterol, and triglycerides were measured with standard biochemical procedures. The differences in blood pressure values after eight-week therapy in comparison to the baseline were tested with Student’s t-test for paired samples.

Results: Mean systolic blood pressure (SPB) at the beginning of the study was 141.1 mmHg; mean diastolic blood pressure (DBP) was 90.5 mmHg. After eight weeks of therapy, mean SBP was signifi cantly reduced to 128.9 mmHg (p < 0.01), and DBP was signifi cantly reduced to 79.0 mmHg (p < 0.01). At the end of the eight-week treat-ment, 27.8% of the patients had normal blood pressure, 51.5% had prehypertension, and 20.7% still had stage I hypertension. The therapy lead to signifi cant decrease of heart rate from 82.2 beats/min to 71 beats/min (p < 0.01), as well as to decrease of the following biochemical parameters: glucose (from 6.05 mmol/l to 5.83 mmol/l), total cholesterol (from 5.97 mmol/l to 5.73 mmol/l), LDL-cholesterol (from 3.65 mmol/l to 3.46 mmol/l) and triglycerides (from 1.96 mmol/l to 1.82 mmol/l) (all p < 0.01).

Conclusions: Eight-week therapy with bisoprolol not only reduces blood pressure and heart rate in hypertensive men, but decreases glucose, cholesterol and triglyc-eride levels, and is metabolically neutral as well.

PP.02.16 TWO-YEAR FOLLOW-UP OF MEN WITH ARTERIAL

HYPERTENSION TREATED WITH LISINOPRIL AND

HYDROCHLOROTHIAZIDE

V. Stojanov1, N. Radivojevic1, K. Paunovic2, B. Jakovljevic2. 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

Objective: The aim was to assess the effects of two-year antihypertensive therapy with lisinopril and hydrochlorothiazide on blood pressure of hypertensive men.

Design and method: The study was designed a two-year prospective survey of persons with arterial hypertension treated with a fi xed combination of 20 mg lisin-opril and 12.5 mg hydrochlorothiazide. In total, 59 persons with newly-diagnosed arterial hypertension, aged from 30 to 80 years, were enrolled in the study. All patients were invited for control examinations two months, six months, 12 months and 24 months after the initiation of antihypertensive therapy. Blood pressure (BP) was measured by an oscillometric device at the beginning of the study, and at all control examinations. The differences from baseline values were tested with Student’s t-test for paired samples.

Results: Mean systolic blood pressure (SBP) for all men at the beginning of the study was 163.47 ± 7.73 mmHg; mean diastolic blood pressure (DBP) was 96.83 ± 6.12 mmHg. During the therapy, SBP decreased signifi cantly by 27.37 ± 11.68 mmHg after 2 months, by 36.61 ± 13.47 mmHg after 6 months, by 39.75 ± 8.93 mmHg after 12 months, and by 34.66 ± 13.42 mmHg after 24 months, in comparison to the baseline values. DBP decreased by 20.39 ± 9.57 mmHg after 2 months, by 29.63 ± 12.15 mmHg after 6 months, by 29.97 ± 10.60 mmHg after 12 months, and by 23.19 ± 10.99 after 24 months, in comparison to the baseline values. Systolic and diastolic blood pressures after 24 months of therapy were somewhat higher than those after 12 months of therapy.

Conclusions: Fixed combined antihypertensive therapy with lisinopril and hydrochlo-rothiazide is effective in hypertensive men from two months to two years of therapy.

PP.02.17 SUCCESSFUL COMPLETION OF A PHASE I,

RANDOMIZED, DOUBLE-BLIND, PLACEBO

CONTROLLED, SINGLE ASCENDING DOSE TRIAL

FOR THE FIRST IN CLASS ANGIOTENSIN

AT2-RECEPTOR AGONIST COMPOUND 21

U. Steckelings1, L. Lindblad2, A. Leisvuori3, Z. Lovro4, P. Vainio3, J. Graens2,B. Dahlof2, P. Jansson2, T. Unger5, A. Wiksten6, P. Korhonen6, M. Scheinin3,4. 1IMM - Dept. of Cardiovascular & Renal Research, University of Southern Den-mark, Odense, Denmark, 2Vicore Pharma, Gothenburg, Sweden, 3Dept. of Clinical Pharmacology, University of Turku, Turku, Finland, 4Clinical Research Services (CRST) Ltd. , Turku, Finland, 5CARIM, Maastricht University, Maastricht, The Netherlands, 6StatFinn Oy, Espoo, Finland

Objective: The angiotensin AT2-receptor (AT2R) is a main receptor of the protec-tive arm of the renin-angiotensin system (RAS), mediating tissue protective ef-fects such as anti-fi brosis and anti-infl ammation. A number of drug development projects are currently ongoing, which aim at making therapeutic use of the protec-tive RAS by targeting the receptors AT2 and MAS with selective agonists. This phase I, randomised, double-blind study was designed to test the fi rst-in-class, se-lective, non-peptide AT2R-agonist “Compound 21’’ (C21) for safety, tolerability and pharmacokinetic properties in healthy, young men.

Design and method: Male, healthy volunteers, aged 18–45 years and with a BMI of 18–30 kg/m2 were randomised and treated with escalating, single oral doses of C21 in cohorts of 8 (6 receiving C21 and 2 receiving placebo). Six dose levels were tested: 0.3, 1, 3, 10, 30 and 100 mg. Subjects were retained in the phase 1 clinic for 24 hours after dosing and further followed up for one week. A total of 17 blood samples were taken for pharmacokinetics from prior to up to 72 hours after drug intake. Safety was

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monitored by physical exams, blood pressure measurements, 12-lead ECG and clini-cal safety laboratory parameters. Potential adverse effects were documented.

Results: C21 was rapidly absorbed with median Tmax at 40 min. C21 exposure in-creased supraproportionally to dose. with Cmax increasing from 1.8 to 2004 ng/ml, and AUC(0–24) from 2.2 to 2438 h*ng/ml. T1/2 was 5.4 h on average at the 100 mg dose level. C21 was generally well tolerated with no serious or severe adverse events being recorded and no major abnormalities in the laboratory safety parameters re-lated to drug intake. In one subject’s ECG, transient PR prolongation was noted 1 hour after intake of 3 mg of C21. PR prolongation did not occur at higher doses.

Conclusions: From these data it can be concluded that orally applied C21 at doses from 0.3 to 100 mg is safe and well-tolerated and has favorable pharmacokinetic properties for further clinical development of this fi rst-in-class AT2-receptor agonist in a multiple ascending dose study.Trial registration: EudraCT 2015–005718-32

PP.02.18 AZILSARTAN MEDOXOMIL DECREASES 24-H

CENTRAL BP AND ARTERIAL STIFFNESS IN

PATIENTS WITH ARTERIAL HYPERTENSION AND

TYPE 2 DIABETES MELLITUS

E. Starostina, E. Troitskaya, V. Kulakov, S. Villevalde, Z. Kobalava. RUDN Uni-versity, Moscow, Russia

Objective: Achievement of target blood pressure (BP) is the main strategy of the prevention of cardio-vascular (CV) events in patients with type 2 diabetes mellitus (T2DM). Central aortic systolic blood pressure (SBP) is a better predictor of CVD and a better guide for anti-hypertensive treatment compared to brachial SBP. Azil-sartan medoxomil (AZM) has shown greater antihypertensive effi cacy compared to other angiotensin receptor blockers (ARB). The aim of the study was to evalu-ate changes in offi ce and 24-h central BP (CBP) and parameters of arterial stiff-ness in patients with AH and T2DM receiving ineffective free dual combination after replacement of renin-angiotensin-aldosteroneinhibitor (iRAAS) by AZM.

Design and method: 30 patients with AH and T2DM with uncontrolled blood pressure >140/85 mmHg on dual AHT were included (53% females, mean age 60.4 ± 7.6 years (M ± SD), 40% smokers). 63% received ACE inhibitors, 37% - other ARB. The other drug was thiazide diuretic in 57%, CCB in 30% and BB in 13%. RAAS inhibitor was replaced by 40 mg of AZM with up-titration to 80 mg after 6 weeks in the case of uncontrolled AH. Study duration was 12 weeks. BP was measured with a validated oscillometric device (OMRON 705CP-II). Arterial stiffness was measured by appla-nation tonometry (SphygmoCor, AtCor). 24-h peripheral and central BP monitoring was performed (BPLab Vasotens, “Petr Telegin’’). P < 0.05 was signifi cant.

Results: After 12 weeks target BP was achieved in 25 (83%) patients. Up titration of AZM was performed in 11 (37%) patients. Offi ce CBP signifi cantly decreased from 144 ± 11/84 ± 4 mmHg to 115 ± 9/67 ± 5 mmHg respectively, p < 0.05. Baseline and achieved 24-h CBP levels were as follows: 136 ± 15/82 ± 9 and 118 ± 11/69 ± 5 mmHg for daytime; 129 ± 21/74 ± 11 and 110 ± 8/64 ± 5 mmHg for nighttime; 134 ± 17/80 ± 11 and 114 ± 9/66 ± 5 mmHg for 24-h, respectively p < 0.05 for trend. There were also signifi cant changes in the parameters of arterial stiffness: pulse wave velocity decreased from 10.2 ± 2.3 to 9.5 ± 2.2 m/s; AIx@75 from 25 ± 9 to 13 ± 7%, p < 0.05. No changes in PP amplifi cation were observed.

Conclusions: Replacement of RAAS inhibitor by AZM results in signifi cant de-crease of offi ce and 24-h central BP and improvement of parameters of AS in patients with T2DM and uncontrolled AH.

PP.02.21 VASCULAR CALCIFICATION AND CELLULAR

SENESCENCE OF SMOOTH MUSCLE CELLS IS

INDUCED BY DOXORUBICIN

J. Herrmann, M. Tölle, W. Zidek, M. van der Giet, M. Schuchardt. Charité - Uni-versitaetsmedizin Berlin, Campus Benjamin Franklin, Department of Nephrology and Transplantation, Berlin, Germany

Objective: Cardiovascular disease are the leading cause of death. Changes within the vascular wall as mineralization of vascular smooth muscle cells is one pathogen-esis of cardiovascular alterations. Increased oxidative stress and cellular senescence of vascular cells are main factors in the pathogenesis. The cytostatic drug doxoru-bicin (DOX) induces the production of reactive oxygen species (ROS), activates cell apoptosis mechanisms and promote cellular senescence. The aim of this study is to investigate the effect of DOX on vascular smooth muscle cell mineralization.

Design and method: Vascular smooth muscle cells of rats (rVSMC) were used for in vitro experiments and aortic rings of rats for ex vivo experiments. Calcifi cation of cells was induced using a high phosphate medium. Calcium content was quantifi ed photometrical via o-cresol-phthalain method. Gene expression of p53, p21, alkaline phosphate (ALP), osteopontin (OPN) and core binding factor-� (cbfa1) was mea-sured via real-time PCR. ALP activity was quantifi ed using the p-nitro-phenol assay.

Results: Gene expression of senescence markers as p21 and p53 dose-dependently increase upon DOX stimulation for 24 h, 48 h and 72 h. Gene expression of ALP, OPN and cbfa1 also increase dose-dependently upon DOX stimulation for 24 to 72 h. ALP enzyme activity is signifi cantly induced by DOX stimulation during 14 days of stimu-lation. Long-term treatment of rVSMC with DOX for 14 days signifi cantly increased the mineralization of the cells as quantifi ed by the extracellular calcium content. Ex vivo experiments with aortic rings from rats confi rmed the fi ndings. Here, DOX stimulation for 14 days induces mineralization that could be found located within the media of the vessel wall by histological staining with Alizarin Red and van Kossa.

Conclusions: DOX is a robust inductor of cellular senescence and mineraliza-tion of smooth muscle cells. The data let suggest that side effects of cytostatic treatment with DOX may contribute to the high cardiovascular risk of patients by vascular aging and stiffening.

PP.02.22 ASSESSMENT OF SUITABLE ANTIHYPERTENSIVE

THERAPIES: COMBINATION WITH HIGH

DOSE AMLODIPINE/IRBESARTAN VS. TRIPLE

COMBINATION WITH AMLODIPINE/IRBESARTAN/

INDAPAMIDE (ASAHI AI STUDY)

N. Sato1, N. Nakagawa1, Y. Saijo2, N. Hasebe2, Ashi Ai Investigators3. 1Department of Cardiology, Asahikawa Medical University, Asahikawa, Japan, 2Division of Community Medicine and Epidemiology, Department of Health Science, Asahikawa Medical University, Asahikawa, Japan, 3ASAHI AI invetigators, Asahikawa, Japan

Objective: Angiotensin receptor blockers (ARBs) plus calcium channel blockers (CCBs) is a widely used combination therapy for hypertensive patients. This study aimed to determine which combination was better as the next step therapy: a com-bination with high dose CCBs or triple combination with diuretics.

Design and method: We conducted a prospective, randomized, open-label trial. Hypertensive outpatients who did not achieve their target blood pressure (BP < 140/90mmHg) with usual dosages of ARBs and amlodipine 5 mg were randomly assigned to switch treatment to Irbesartan 100 mg/amlodipine 10 mg (group ARB+C: n = 25, aged 64 ± 14 years) or indapamide 1 mg in addition to ARBs+ amlodipine 5 mg (group ARB+C+D: n = 22, aged 69 ± 9 years). The pri-mary endpoint was changes in the systolic blood pressure (SBP) and diastolic blood pressure (DBP) after the 3-month treatment period, while secondary end-points were BP changes after the 6-month treatment period, and laboratory values.

Results: At three months, the SBP/DBP signifi cantly (p < 0.01) decreased from 151/84 ± 8/13 mmHg to 130/73 ± 13/11 mmHg in group ARB+C and 152/81 ± 11/13 mmHg to 127/74 ± 16/12 mmHg in group ARB+C+D, and the effi cacy in reduc-ing the BP was similar between the two groups. Similarly, at six months, the SBP/DBP signifi cantly decreased to 131/74 ± 12/10 mmHg in the ARB+C group, and to 127/73 ± 12/12 mmHg in the ARB+C+D group. The serum potassium tended to decrease and the creatinine and uric acid levels tended to increase in the ARB+C+D group (At three months, the potassium, creatinine, and uric acid were 4.2mEq/L, 0.78 mg/dL and 5.1 mg/dL in the ARB + C group and 4.0 mEq/L, 0.87 mg/dL and 5.9 mg/dL in the ARB+C+D group, respectively). Although there were two with-drawal cases (one case for hypokalemia and one for hyperuricemia in the ARB+C+D group), both combination therapies were safe and tolerable throughout the trial.

Conclusions: High dose CCBs combined with ARBs and a triple combination with diuretics combined with CCB/ARBs produced a similar effi cacy in reducing the BP. No signifi cant adverse events were observed in either group, however, the change in the laboratory data seemed advantageous in the ARB+C group. The results from the ASAHI AI trial will provide new evidence for selecting optimal combination therapies for uncontrolled hypertensive patients.

PP.02.23 NATURAL ANTIOXIDANT ICE-CREAM ACUTELY

REDUCES BLOOD PRESSURE AND IMPROVES

VASCULAR FUNCTION IN PATIENTS WITH

METABOLIC SYNDROME

V. Sanguigni1, F. Francomano2, R. Sorge1, L. Gnessi2. 1University Tor Vergata, Rome, Italy, 2University La Sapienza, Rome, Italy

Objective: Epidemiological investigations revealed an inverse correlation be-tween the intake of polyphenols-containing foods and coronary artery disease mortality.A large number of studies has investigated the possible blood pressure (BP) lowering effect of different dietary supplements .We hypothesized that a natural antioxidant ice cream,product with a selected blend of cocoa, hazelnut and other ingredients from organic farming,could improve vascular function and decrease blood pressure in sample of patients with metabolic syndrome via an oxidative stress-mediated mechanism.

Design and method: We performed a single blind crossover study in which we measured the acute effect of natural antioxidant ice cream, on vascular function and blood pressure

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Abstracts e107

in a population of patient with metabolic syndrome. 10 subjects (5 male, 5 female), mean age 56 years, were randomly allocated to a treatment sequence with 100 mg of antioxi-dant ice cream or milk ice cream in a cross-over, single-blind design. Total polyphenol content(mg/100 g) was signifi cantly higher in antioxidant ice cream compared to milk ice cream(control (1817 vs 96). There was at least 1 week washout between the 2 phases of the study. Oxidative stress(assessed by measuring plasma hydroperoxides, analytic meth-od dROMs), Nitric oxide (NO) bioavailability (NOx),vascular function (fl ow mediated dilatation, FMD) and blood pressure were assessed at baseline, after a 24 hours abstinence from food rich in polyphenols, and 2 hours after ingestion of ice cream.

Results: Serum polyphenols (139,28 ± 28,32 vs 288,57 ± 58,12.p < 0.001), NOx (23,34 ± 5,24 vs 48,24 ± 8,66.p < 0.001), FMD (2,34 ± 1,46 vs 6,43 ± 1,86.p < 0.001) increased signifi cantly, oxidative stress (D-Roms 426,27 ± 49,03 vs 378,85 ± 38,12.p < 0.01;), and systolic (�7,17 ± 4,67 mm/Hg. p < 0.001) and diastolic (�5,48 ± 3,92 mm/Hg. p < 0.001)blood pressure decreased only after antioxidant ice cream ingestion. No changes were found after control ice cream ingestion.

Conclusions: For the fi rst time, a natural antioxidant ice cream rich in polyphe-nols was demonstrated to acutely improve vascular function and decrease blood pressure in patients with metabolic syndrome through a reduction of oxidative stress and increase of NO bioavailability. This may be a novel valuable strategy for BP lowering in the high-normal range in which current hypertension management guidelines do not recommend drug treatment.

PP.02.24 TRANSCUTANEOUS ELECTRICAL NERVE

STIMULATION (TENS) IN PERIPHERAL

POLYNEUROPATHY IN DIABETES MELLITUS,

CHRONIC KIDNEY DISEASE AND PRIMARY

HYPERTENSION

Y. Sagliker1, B. Kelle2, I. Gokcay2, H. S. Sagliker3, N. Paylar1, P. Sagliker Ozkaynak1. 1Samedsa Ltd. Srk, Sagliker Hypertension and Nephrology Unit, Adana, Turkey,2Cukurova University, Adana, Turkey, 3Cumra State Hospital, Konya, Turkey

Objective: The polyneuropathies associated with diabetes mellitus type 2 and chronic renal disease are referred by long term complications. Especially, pain-full polyneuropathy situations decrease the quality of the patient’s lifes severely. Transcutaneous Electrical Nerve Stimulation (TENS) is a method which is used in painfull polyneuropathy treatment. In our study, we tried to evaulate the an-algesic effi ciency of Transcutaneous Electrical Nerve Stimulation (TENS) in uremic&diabetic polyneuropathy patients’ life quality and recovery of symptoms.

Design and method: 60 patients admitted to the Cukurova University Faculty of Medicine, Nephrology and Endocrinology Out patient Clinics between 2010 – 2012 who had been diagnosed peripheric polyneuropathy associated with Dia-betes Mellitus and Stage 4 or 5 Chronic Renal Disease were included in this study. In Patients with diabetes mellitus type 2 and chronic renal disease. Disease re-lated symptoms, medication usings, disease and neuropathy duration time were recorded. General physical examination was performed and routine laboratory tests, vitamin B12 and folate levels were asked in all patients. Before and after the treatment of Transcutaneous Electrical Nerve Stimulation (TENS) therapy inter-national scalas such as VAS (visual analog scala), LANNS (Leeds assesment of neuropathic symptoms and signs pain scale) and NHP (Nottingham health proto-col) were performed and recorded. Transcutaneous Electrical Nerve Stimulation (TENS) therapy was applied to thepatients 30 minutes daily for 3 weeks by phys-iotherapists in Departmant of Physical Therapy of Cukurova University.

Results: Signifi cant recovery were assessed with in symptoms, in patients life quality plus some decriments in systolic and diastolic blood pressures before and after therapy by using continiously blood pressure recorders and using parameters includings VAS, LANNS and NHP scalas.

Conclusions: In our study, the symptoms of painfull polyneuropathy patients are improved withTranscutaneous Electrical Nerve Stimulation (TENS) therapy. Be-sides, there were signifi cant improvement in life quality of patients. Transcutane-ous Electrical Nerve Stimulation (TENS) therapy is a valuable alternative therapy to drug theraphy in patients. We believe every such patients must have the right to use this very advanced technologically developped treatment modality. This is a sine qua non medical approach modality.

PP.02.25 TREATMENTS OF RESISTANT PERIPHERIC

POLYNEUROPATHIES WITH DIABETES

MELLITUS, CHRONIC KIDNEY DISEASE PRIMARY

HYPERTENSION HIGH TONE ELECTRICAL MUSCLE

STIMULATION-HTEMS

Y. Sagliker1, N. Paylar1, H. SABIT Sagliker2, P. Sagliker Ozkaynak1, A. Heidland3, A. Keck3, C. Sagliker4. 1Samedsa Ltd. Srk, Sagliker Hypertension and Nephrology Unit, Adana, Turkey, 2Cumra state Hospital, Konya, Turkey, 3Würzburg Univer-sity, Würzburg, Germany, 4Family Health Center, Adana, Turkey

Objective: Chronic resistant peripheral neuropathies are leading disturbances in DM, CKD and PH patients .It has been known for thousand years applications of electrical energy by religious genius or unique animals such as electric fi sh in bottom of oceans,yoga,trancendental meditation,biofeedback approaches are reasonably somewhat effective.

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e108 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

Design and method: 20 DM patients with peripheric neuropathies on lower limbs with severe tinglings, burnings, pains, numbness, sleeping disturbances, general or local sensing abnormalities (7 parameters), 20 CKD and 10 PH patients with same symptoms included into study. Patients had severe medical treatments in-cluding analgesics, antidepressives, antianxietics, vit B complex, gabapentin like drug therapy, several types of physical therapies recently. HMTE device, HiTop 181-H (GBO Medizintechnik) applied to groups as three times a week for one hour during one month. Before study and after treatments, SBP, DBP, MAP, HR with Mobil-O-Graph NG automated continously BP recorder (APC Cardiovascu-lar), EMG-ENG detections, HbA1c, albumin, CRP values, for sempathetic ner-vous system NE. E, Dopamin, PRA, aldosteron, AII levels determined. Results before and after compared acording to universal criteria. Decriments in physical symptoms cathegorised in a scale as from 10 to 1 degree decrimentally or from 1 to 10 gradually.

Results: All three cathogories faced miraculous decriments at least 2 or 3 scales in peripheral symptoms on lower limbs for 7 parameters.Working and walking capacities improved dramatically and psycological behaviours changed, felt them-selves like never before. SBP, DBP, MAP, HR were signifi cantly decreased as expected at least 20% (Figure 1 and 2) .We expect hormonal values to be in ac-cordance with dramatical clinical improvements as well.

Conclusions: New treatment modality appears to have miraculous effects to be accepted offi cially and privately in state and private treatment centers.If we con-sider prevelances of 5 % for DM, 8% for CKD and at least 27% for PH in world presently we believe those patients have rights to be treated in reasonable fashion with this novel modality.This is a sine qua non humanitarian task.

PP.02.27 CIRCADIAN REGULATORY GENES PER2 AND

BMAL1 EXPRESSION CHANGES IN COMBINATION

CHRONOTHERAPY OF HYPERTENSION IN RATS

M. Radik, P. Potucek, G. Doka, E. Kralova, P. Krenek, J. Klimas. Comenius Uni-versity in Bratislava, Faculty of Pharmacy, Bratislava, Slovak Republic

Objective: Dosing time-dependent differences in effi cacy of combination antihy-pertensive treatment have reported contradictory outcomes and circadian system could be responsible. The aim of our study was to study changes in expression of circadian regulatory genes affected by morning and evening dosing with combina-tion treatment in short term and long term settings.

Design and method: Spontaneously hypertensive rats aged between 8–10 weeks were treated with fi xed combination of valsartan (10 mg/kg) and amlodipine (4 mg/kg), either in the morning (07:00) or in the evening (19:00) with treat-ment duration 1 and 6 weeks and with placebo group running in parallel for every treatment group. Body and cardiac characteristics were quantifi ed by gravimetric and haemodynamic measurements, respectively. Relative expressions of selected genes were analyzed using qRT-PCR method in samples from left ventricles, right ventricles, aortas and kidneys.

Results: After short term experiment, only morning treatment group demonstrat-ed signifi cantly better outcomes (p < 0.05) in terms of blood pressure control and heart rate decrease when compared to placebo, but after long term experiment this effect applied to both treatment groups, no signifi cant difference was seen between morning and evening treatment. Effect of therapy was confi rmed by sig-nifi cant >43% decrease in gene expression of atrial natriuretic peptide (Anp) in left ventricles, and >58% increase of renin (Ren) in kidneys of treatment groups except the evening groups in 1-week experiment (p < 0.05). Circadian regula-tory genes expression (Per2, Bmal1) in left ventricles, right ventricles and aortas showed antiphase rhythmic pattern in both experiments and signifi cant changes were observed in all treated evening groups by >63% increase of Per2 and >52% decrease of Bmal1 compared to placebo groups, while morning groups remained unchanged (p < 0.05).

Conclusions: In summary, circadian regulatory genes showed enhanced gene ex-pression in evening groups compared to placebo groups in both short and long term settings with morning groups unaffected by combination therapy. Although in evening groups of short term settings therapeutical effect is not yet seen, circa-dian genes are changing the same way they do in long term settings.

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Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved

SATURDAY

POSTERS

POSTER SESSION

POSTERS’ SESSION PS03:

AGEING

PP.03.04 VICTORIA STUDY: SCREENING FOR EARLY

VASCULAR AGING BY ARTERIAL STIFFNESS AND

CENTRAL HEMODYNAMICS PARAMETERS IN

PHYSICIANS

E. Shavarova1, E. Kazahmedov1, A. Orlov2, Zh. Kobalava1. 1RUDN University, Moscow, Russia, 2National Research Nuclear University MEPhI, Moscow, Russia

Objective: to analyzed parameters of central hemodynamics, arterial stiffness and vascular age, to compare passport and vascular ages in physician’s population.

Design and method: Observational multicenter screening study of doctor’s health assessment in 12 Russian cities. Demographics; smoking status; anamnesis of ar-terial hypertension with/without therapy, established CV, renal diseases, diabetes mellitus; cholesterol level were registered. Peripheral BP, central BP, pulse wave velocity (PWV), aortic and peripheral augmentation index (AI), refl ected wave transit time (RWTT) were assessed by oscillometric device BPlab Vasotens Offi ce (OOO “Petr Telegin’’).

Results: 464 individuals were included (247 normotensives (mean age 44 yrs) and 237 with arterial hypertension (AH) (mean age 58 yrs)). Central BP, PWV, and AI were signifi cantly higher in the hypertensive group comparing to normotensive group (134.1 vs 112.1 mm Hg for systolic BP, 83.1 vs 77.4 mm Hg for diastolic BP, 12.2 vs 10.9 m/sec for aortic PWV, -8.1 vs -29.3% for peripheral AI, and 22.3 vs 12.1% for aortic AI), RWTT was signifi cantly lower in hypertensive patients (118.7 versus 132.9 ms). After adjusting for confounding factors signifi cant inter-group difference was presented for central BP, RWTT, and peripheral AI. PWVao >10 m/s had 68% subjects without AH and 92% pts with AH, elevation of pulse pressure >60 mm Hg had 11% subjects without AH and 43% pts with AH. The most pts with AH (82%) and 31% of normotensives had increased vascular age comparing to passport one. The same passport and vascular age were observed in 10% pts with AH and 12% without it. Vascular age was lower than passport one in 55% of normotensives and 8% of hypertensive pts.

Conclusions: Prevalence of PWVao elevation is high in observed population and noninvasive cuff-based device could be implemented for every day practice for arterial stiffness and central hemodynamics evaluation. Early vascular aging was typical in hypertensive group. Vascular age evaluation could be useful instrument in treatment motivation improving strategy.

PP.03.05 ANTIHYPERTENSIVE THERAPY AMONG ELDERLY

OUTPATIENTS IN MOSCOW

V. Ostapenko1, O. Tkacheva1, N. Runikhina1, Y. Kotovskaya1,2, N. Sharashkina1. 1Russian Gerontology Clinical Research Center, Moscow, Russia, 2RUDN-Uni-versity, Moscow, Russia

Objective: The purpose of this study is to evaluate the antihypertensive therapy among > 65 years old outpatients in Moscow.

Design and method: Methods: The study includes 356 patients 65–93 years old. Average age was 74.8 ± 6.1 years old, 80.4 % women, 54.8% of them with higher education and 9% still continue to work. Research was conducted in Moscow polyclinic from November 2014 to May 2015. Anamnesis of arterial hyperten-sion, cardiovascular diseases and antihypertensive therapy was evaluated among 2 groups of seniors: 65–79 years old (n = 277) and > 80 years old (n = 79).

Results: Antihypertensive therapy was reported by 91.6% (n = 326) patients. Thirty four percent of the patients (n = 98) received monotherapy. Combination of two-drugs were taken by 36.8% (n = 105) of the patients. Three and four drugs combination were taken by 22.5% (n = 64) and 6.3 % (n = 18) of the patients, respectively. The study revealed ACE inhibitors and beta-blockers as most fre-quent drugs (53.7% and 50.5% of patients, respectively). The distribution of an-other groups of antihypertensive pills is following: angiotensin receptor blocker - 23.9%, diuretic - 38.6%, calcium channel blocker - 34% patients. Myocardial infarction or heart failure was registered by 24% of the patients under BB therapy. Average consumption of antihypertensive drugs of the patients in the age of 65–79

years old is 1.6 ± 1.2. and 1.8 ± 1.2 in age group of > 80 years old. Patients in the age group of 65 - 79 years old took beta-blockers more often, than patients >80 year old (41.2% vs 38%, p = 0.7). However patients group of 65–79 years old took an ACE inhibitors (40.8 % vs 50.6 %, p = 0.12) or calcium channel blocker (24.5% vs 36.7%, p = 0.04) rarely, than >80 years old patients. Reception fre-quency of angiotensin receptor blocker and diuretics were similar among above-mentioned groups (respectively,19.5% vs 17.7%, and 29.6% vs 35.4%).

Conclusions: Most hypertensive patients > 65 years old receive combination antihypertensive therapy. Combinations of ACE inhibitors + beta-blockers or ACE inhibitors + diuretic are among the most common.

PP.03.07 INFLUENCE OF ANAESTHESIA ON THE

CYTOKINE’S LEVEL IN ELDERLY WITH

CONCOMITANT CARDIOVASCULAR DESEASES

Y. Ploshchenko, O. Klygunenko. Dnipropetrovsk Medical Academy, Dnipro, Ukraine

Objective: Increase in the number of elderly patients is a serious problem for an-esthesiology. The incidence of systemic infl ammation in elderly is 20 to 30%, de-pending on the severity of the patient and other factors [Nearman H. et al., 2014]. In 40% of patients with SIRS promotes postoperative multiple organ dysfunction. This increases the number of postoperative complications and mortality increases to 50% [Menyar A. et al., 2012]. The goal of our study was to examine and evalu-ate markers of Infl ammatory Response in elderly after general anaesthesia.

Design and method: We examined 105 patients aged 60 to 82 years for abdomi-nal surgery with total intravenous anesthesia. There were representative of the gender, age, ASA, BMI, Euroscore. Preoperative patients with CVD managed in accordance with ESC Guidelines (2014). IL-1, TNF, IL-6, IL-10 in EDTA-plas-ma determined by enzyme immunoassay (set Biomedica). Data are presented as M ± m, statistically signifi cant value of p < 0,05.

Results: The severity of the patients corresponded to 48% of ASA II, 52% - ASA III. We compared the levels of IL-1, TNF, IL-6, IL-10 in elderly preoperatively, after anesthesia and to 5 days postanesthesia. Preoperatively the level of proin-fl ammatory IL 6 exceeded the norm by 64,2%, TNF - on 61,5%. The level of anti-infl ammatory IL 10 exceeded the norm by 58,4% (p = 0,000001), The in-fl ammatory activity index (IL 6/IL 10) was normal. After anaesthesia the level of IL 1 increased by 35.9% (p = 0.04). The level of IL6 increased output value to 2651% (p = 0.002). The concentration of IL 10 not statistically different from the norm and output levels. IL 6 level higher than the initial value by 2971% (p = 0,002). Not found signifi cant changes in the level of TNF. The index IL 6/IL 10 was 4125 % (p = 0,000018) above normal.

Conclusions: Elderly patients preoperative showed a non-specifi c activation of the infl ammatory response that manifested as high in pro-infl ammatory and anti-infl ammatory cytokines. After anesthesia in elderly we detected the infl ammatory activation, which was confi rmed by the increasing levels of cytokines and value index IL 6/IL 10.

PP.03.08 THE HAEMODYNAMIC MECHANISM OF THE

AGE-RELATED INCREASE IN PULSE PRESSURE IN

WOMEN

Y. Li, B. Jiang, L. Keehn, M. Cecelja, T. Spector, P. Chowienczyk. King’s College London, London, United Kingdom

Objective: An age-related increase in pulse pressure is the major cause of mor-bidity and mortality in the ageing population and is more marked in women than in men. The haemodynamic determinants of increased pulse pressure remain in-completely understood. The aim of this study is was to examine the contribution of ventricular dynamics, large artery stiffness, and pressure wave refl ection to central pulse pressure.

Design and method: A total of 2162 women aged 18 to 91 years (mean ± SD, age 57 ± 13 years) from the Twins UK cohort were studied. Non-invasive aortic fl ow velocity and blood pressure were measured by Doppler sonography and ca-rotid tonometry system respectively. Carotid-femoral PWV was measured using the SphygmoCor system. Refl ection index (the ratio of the peak of the backward pressure wave over that of the forward pressure wave) was computed from the pressure and fl ow waves.

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e110 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

Results: Central pulse pressure increased with age, from 29.5 ± 0.46 mmHg for those aged below 40 years to 52.6 ± 0.85 mmHg for those over 70 years (means ± SE, P < 0.001). PWV increased approximately 13.2 % per decade. Maximum fl ow velocity tended to increase (from 1.11 ± 0.01 to 1.16 ± 0.01 m/s over the 5 decades, P < 0.01), and ejection volume at the time of peak pulse pres-sure increased from 63.3 ± 1.41 to 72.3 ± 1.92 ml (P < 0.001) but refl ection index decreased from 0.28 ± 0.01 to 0.25 ± 0.01 (P < 0.001).

Conclusions: These results suggest that the age-related increase in central pulse pressure is driven mainly by an increase in arterial stiffening and increased ven-tricular ejection.

PP.03.09 VASCULAR AGE IN HYPERTENSIVE PATIENTS

O. Ostroumova, A. Kochetkov. Moscow State University of Medicine and Dentistry named after A. I. Evdokimov, Moscow, Russia

Objective: To evaluate vascular age in patients aged 45 to 65 years with grade 1–2 essential arterial hypertension without concomitant cardiovascular diseases.

Design and method: Case-control study. We examined 60 naive patients with un-complicated essential arterial hypertension grade 1–2 (mean age 53,6 ± 0,8 years; 31 men; mean body mass index [BMI] 31,0 ± 0,5 kg/m2; 36,7% smokers, mean offi ce systolic blood pressure [SBP] 153,2 ± 1,8 mm Hg; mean offi ce diastolic blood pressure 96,3 ± 0,8 mm Hg) and 44 healthy control individuals (mean age 51,5 ± 1,0 years; 21 men; mean BMI 26,5 ± 0,6 kg/m2; 18,2% smokers). Serum total cholesterol (TC), low- and high-density lipoprotein cholesterol (HDL-C), triglycerides, glucose and creatinine level analysis were performed. Vascular age was calculated by two techniques. First method was based on Framingham Heart Study risk tables using age, SBP, TC and HDL-C levels, and taking into account gender, smoking and diabetic history. Second method was based on SCORE proj-ect scales using age, gender, SBP, TC and smoking status.

Results: Vascular age was signifi cantly (p < 0,001) higher in hypertensive pa-tients compared to controls: according to Framingham Heart Study risk tables it was 70,6 ± 1,4 years and 55,3 ± 1,8 years, respectively; according to SCORE project scales – 59,1 ± 1,5 and 51,2 ± 1,3 years, respectively. In hypertensive pa-tients vascular age was greater than chronological age, as when it was calculated by Framingham Heart Study risk tables (delta 17,0 ± 1,1 years) and by SCORE project scales (delta 6,3 ± 1,0 years). In controls, vascular age measured by Fram-ingham Heart Study risk tables was greater than chronological (delta 3,9 ± 1,5 years) age and lower (delta -0,4 ± 0,5 years) than chronological age when it was calculated by SCORE project tables.

Conclusions: Vascular age was higher in naive middle-age hypertensive patients compared to controls. Both in hypertensive patients and in control group the high-est values of vascular age were obtained using a Framingham Heart Study risk tables, which takes into account the largest amount of clinical and laboratory data.

PP.03.10 MORTALITY RISK AMONG DISABLED ELDERLY

RESIDENTS OF LONG TERM CARE FACILITIES

DURING ONE YEAR FOLLOW-UP

B. Gryglewska1, A. Kantoch1, J. Wojkowska-Mach2, P. Heczko2, T. Grodzicki1. 1Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Kraków, Poland, 2Department of Microbiology, Jagiellonian University, Medical College, Kraków, Poland

Objective: Estimation of mortality predictors among elderly residents of long-term care (LTC) facilities.

Design and method: Study population consisted of elderly residents of 3 LTC facilities (two residential homes and one nursing home). Medical documentation was analyzed and blood pressure (BP) measurements, Abbreviated Mental Test Score (AMTS), Barthel’s Index (BI) were performed in all study participants at the beginning of the study. Main outcome measure was all-cause mortality during one year follow-up. Study population was analyzed in two groups: residents who were alive (group I) and deceased subjects (group II) during follow-up period. Results obtained in two analyzed groups were compared using U Mann-Whitney or Chi square tests. Univariate and multivariate logistic regression models were used for investigating the risk factors for mortality.

Results: The cohort consisted of 168 elderly LTC residents. Group I (n = 147) and group II (n = 21) showed similar age (78,6 ± 8,4 vs 79,5 ± 8,95 years), number of diagnosed diseases (4,2 ± 1,8 vs 4,1 ± 1,8), number of used drugs (6,4 ± 3,5 vs 8,0 ± 3,6), and BP values (129 ± 19,2/72 ± 11,2 vs 122 ± 12,4/71 ± 9,5 mmHg). However, group II revealed signifi cantly (p < 0,001) lower physical func-tion (BI:19,7 ± 24,8 vs 51,4 ± 38,0), and worse mental status (AMTS score: 4,45 ± 3,47 vs 6,88 ± 2,81). Lower mortality risk was observed among those with higher BI [OR = 0,97; CI(0,95; 0,989)], higher AMTS score [OR = 0,79; CI(0,68;

0,91)] and diagnosis of hypertension [OR = 0,21; CI (0,07; 0,61)]. However, di-agnosis of diabetes [OR = 4,5; CI(1,72; 11,76)], dementia [OR = 2,84; CI (1,11; 7,25)] and heart failure [OR = 7,34; CI (1,99; 25,06)] were associated with higher mortality risk. Diagnosis of hypertension [OR = 0,09; CI (0,03; 0,35)], diabetes [OR = 9,45;CI (2,89; 30,880)] and dementia [OR = 4,85;CI(1,57; 14,98)] signifi -cantly infl uenced on mortality risk in multivariate regression.

Conclusions: Diagnosis of diabetes and dementia increase risk of mortality in institutionalized geriatric subjects, while the presence of hypertension exerts a protective effect.

PP.03.11 INFLUENCE OF AGE ON THE RELATIONSHIP OF

RENAL FUNCTION IMPAIRMENT WITH SYSTEMIC

VASCULAR DAMAGE IN HYPERTENSION

G. Geraci, G. Mule’, M. Zammuto, M. Mogavero, C. Geraci1, S. Cottone. Dipartimento Biomedico di Medicina Interna e Specialistica, Unità di Nefrologia, PALERMO, Italy

Objective: Aging is a strong predictor of cardiovascular events. Several studies showed that aging increased risk through progressive development of morpho-functional vascular changes. Moreover, renal impairment related to aging has also been suggested to explain the increased cardiovascular risk in elderly. Vascular impairment and kidney damage have been strongly associated each other, but they have different dynamics of progression over time, and it is not known if age changes the abovementioned relationship. The aim of this study is to evaluate, in hypertensive patients, the infl uence of age on the association between renal dam-age (glomerular fi ltration rate, albuminuria and renal resistance index (RRI)) with subclinical vascular damage (carotid intima-media thickness (cIMT) and aortic pulse wave velocity (aPWV)).

Design and method: We enrolled 476 hypertensive subjects (30–90 years). The population was divided into 2 groups: subjects > 65 years (elderly hypertensives; n = 126) (EH) and subjects < 65 years (not elderly hypertensives; n = 350) (NEH). A Duplex ultrasonographic examination of both carotid and renal vasculature was performed in all patients. aPWV was assessed through oscillometric device.

Results: EH had lower eGFR and higher albuminuria, RRI, cIMT and PWV com-pared to NEH (all p < 0.001). Age signifi cantly correlated with eGFR, albumin-uria, RRI, cIMT and aPWV in the entire study population (all p < 0.001) and in the two subgroups divided by age. In EH group, as well as in NEH group, cIMT was strongly associated with eGFR and RRI (p < 0.01), but not with albuminuria. In contrast, aPWV signifi cantly correlated with all indices of renal damage (eGFR and albuminuria: p < 0.001; RRI: p < 0.01) in NEH, whereas it showed signifi cant association only with eGFR in EH (p < 0.001). The cIMT independently corre-lated with RRI and eGFR in NEH, whereas it was signifi cantly related only to RRI in EH. aPWV was independently associated with albuminuria in NEH, whereas it did not independently correlate with any indices of renal damage in EH.

Conclusions: Age is an important modifi er of the relationships between renal damage (eGFR, albuminuria and RRI) subclinical vascular involvement (cIMT and aPWV).

PP.03.12 SIGNIFICANT INTER-ARM DIFFERENCE IN BLOOD

PRESSURE IS ASSOCIATED WITH INCREASED

ARTERIAL STIFFNESS AND ABDOMINAL OBESITY

IN VERY ELDERLY HYPERTENSIVES

N. Ezhova1, Y. Kotovskaya2, S. Villevalde2, Z. Kobalava2. 1Moscow State University, Moscow, Russia, 2RUDN University, Moscow, Russia

Objective: Inter-arm difference in blood pressure (BP) and orthostatic BP re-sponse have important prognostic signifi cance in hypertensive patients. However, data on prevalence, predictors and clinical associations of those phenomena are controversial. The aim was to investigate inter-arm difference, orthostatic re-sponse and to establish their clinical associations in very elderly hypertensives.

Design and method: 67 hypertensive subjects older than 80 years (mean age 84,1 ± 3,1 years, 25,5% male, mean clinic brachial SBP 134,8 ± 23,2 mm Hg) were included in cross-sectional study. Simultaneous bilateral brachial BP mea-surements were performed using oscillometric validated cuff-based device in su-pine position and then after 2 minutes of standing. Central pulse waveform char-acteristics and arterial stiffness parameters were estimated by BPLab Vasotens system.

Results: The median of inter-arm difference in SBP (IADSBP) was 4,00 (2,5; 9,0) mm Hg. 25,4% participants had IADSBP of 10 mm Hg and more. Compared to others, those with IADSBP of 10 mmHg and more had signifi cantly higher body mass index (31,4 ± 5,7 vs 28,5 ± 4,1 kg/m2, p < 0,05), waist circumference (116,3 ± 13,6 vs 107,7 ± 11,2 cm, p < 0,05) and pulse wave velocity in aorta

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Abstracts e111

(11,7 ± 1,5 vs 10,8 ± 1,7 m/s, p < 0,05). Positive correlation between IADSBP and augmentation index was revealed (r = 0,277, p < 0,05). Patients with asymp-tomatic orthostatic hypotension (OH) (22,4% participants) had higher levels of brachial SBP and pulse pressure (PP) while central BPs and markers of arterial stiffness did not differ from those without OH.

Conclusions: Signifi cant IADSBP is associated with increased arterial stiffness and abdominal obesity in very elderly hypertensive patients, whereas there was no evidence of interrelation between orthostatic response and arterial stiffness in such patients

PP.03.13 HEART RATE VARIABILITY IN ELDERLY

HYPERTENSIVE PATIENTS UNDERGOING

CORONARY STENTING ON THE BACKGROUND OF

ACUTE CORONARY SYNDROME

O. Esina1, S. Esin2, V. Nosov1, L. Koroleva1, E. Tarlovskaya1. 1Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russia, 2Cardio Specialized Hospital, Nizhny Novgorod, Russia

Objective: To evaluate heart rate variability (HRV) in elderly patients with sys-tolic-diastolic arterial hypertension (AH) after acute coronary syndrome (ACS), undergone coronary angioplasty and stenting.

Design and method: The study included 65 elderly patients (mean age - 68,9 ± 6,3 years, men - 38 (58.5%)) with systolic-diastolic AH 1–3 degree and developed ACS requested a coronary angioplasty and stenting during the fi rst 6 hours after the onset of chest pain. ACS with ST-segment elevation was ob-served in 35 (53.8%) patients, and ACS without ST elevation - 30 (46.2%). Pa-tients received on the background of the use of anticoagulants and antiplatelet agents also a standard anti-ischemic and antihypertensive therapy. All patients in the hospital stage after coronary stenting performed 24 h ECG monitoring with the assessment of HRV.

Results: All patients showed positive dynamics in the form of the disappearance of the chest pain, the most of them reached the target blood pressure values. The time-depend analysis had no differences between patients with ST-segment eleva-tion, and without it, showing a decline of HRV in both groups (65,71% vs 76,67%). In contrast, the spectral analysis of HRV in patients with ST-segment elevation showed a statistically signifi cant effect of the predominance of parasympathetic autonomic nervous system (HF = 40,3 ± 14,0% vs 34,0 ± 14,0%, p = 0.048; LF / HF = 1,1 ± 1,0 c.u.. vs 1,4 ± 1,2, p = 0,048). ACS without ST-segment elevation was accompanied by a signifi cant prevalence of the power of very low frequency waves (VLF = 33,0 ± 16,2% vs 26,3 ± 13,1%, p = 0,032), which indicates to a high role of humoral-metabolic mechanisms of the heart rate regulation.

Conclusions: The predominance of low HRV in early hospital period, even dur-ing the adequate conservative therapy, was found in elderly patients with systol-ic-diastolic AH after coronary angioplasty with stenting due to the ACS. ACS without ST-segment elevation was accompanied by a signifi cant predominance of humoral-metabolic effects on HRV, it requires an intensifi cation of the therapy with angiotensin-converting enzyme inhibitors / angiotensin receptor blockers in these patients, which based on blood pressure values.

PP.03.14 PROGNOSTIC SIGNIFICANCE OF CLINIC AND

AMBULATORY BP LEVELS IN SUBJECTS 80 YEARS

OR MORE

K. Eguchi, Y. Imaizumi, S. Hoshide, K. Kario. Division of Cardiovascular Medi-cine, Department of Medicine, Jichi Medical University, Shimotsuke, Japan

Objective: It is not established to what extent clinic and ambulatory BP be low-ered in subjects 80 yrs or more.

Design and method: We performed this study whether clinic and ambulatory BP (ABP) monitoring were associated with future events in subjects 80 yrs or more. Clinic and ABP monitoring were performed in 520 subjects and tested the differ-ent cutoff values of clinic systolic BP (CSBP) 140 mmHg and 150 mmHg, and ambulatory daytime SBP 135, 150 mmHg or nighttime SBP 120, 135 mmHg The endpoint was set as combined events defi ned by fatal and non-fatal cardiovascular and non-cardiovascular events.

Results: The mean age was 83.2 ± 3.2 yrs, and 44% were male. In Kaplan-Meyer analysis, clinic SBP < 140, 140–150, and >150 mmHg at baseline and 12-month later had similar cardiovascular event rates (log-rank test, p = 0.25 and 0.58 re-spectively). For ambulatory daytime SBP, daytime SBP < 135, 135–150, and >150 mmHg had similar event rates, whereas for ambulatory sleep SBP, sleep SBP >135 mmHg tended to have higher event rate followed by subjects with 120–135 and <120 mmHg. In multivariable analysis adjusting for covariates, sleep SBP 120–135 was signifi cantly associated with higher event rates [Hazard ratio

(HR) 2.38, 95%CI, 1.08–5.26, p = 0.03), but was insignifi cant for the sleep SBP >135 mmHg (HR 1.46, 0.56–3.79, p = 0.44). On the other hand, clinic and awake SBP was not the risk of incident events.

Conclusions: In a large cohort sample in subjects 80 yrs or more, only sleep SBP 120–135 mmHg compared to <120 mmHg, but not clinic or ambulatory awake BP was a risk of combined outcomes.

PP.03.17 HYPERTENSION AND COGNITIVE FUNCTION

IN THE ELDERLY: PRELIMINARY RESULTS OF A

SCREENING STUDY

M. Bulgaresi1, L. Menozzi2, G. Rivasi3, F. Sgrilli4, A. Giordano5, E. Latini6, L. Martella7, E. Mossello8, A. Ungar9, N. Marchionni10. 1Tertiary Referral Centre for Hypertension in the Elderly, University of Florence, AOU Careggi, Florence, Italy

Objective: Hypertension is very common in older patients and is considered to be a risk factor for cognitive decline; the 2013 ESH/ESC Guidelines for the man-agement of arterial hypertension suggest the use of cognitive evaluation tests in the clinical assessment of elderly hypertensive patients. Nonetheless, there is still controversy over which screening test is more appropriate and cognitive impair-ment is usually under-diagnosed in these patients. Our study evaluates the ap-plication of a fi rst-line screening to assess cognitive function in old hypertensive patients without a previous diagnosis of cognitive impairment.

Design and method: in this observational study we enrolled 80 consecutive hypertensive patients referred to our Centre for Hypertension in the Elderly and aged 65 years or older. All patients underwent a fi rst-line cognitive evalua-tion with the Mini-Cog test, including three-item repetition and recall and clock drawing. If the Mini-Cog was suggestive for cognitive impairment, the patient was further evaluated with the Mini Mental State Examination (MMSE); in case of a MMSE score inferior to 28, a Neuropsychological Evaluation (NPE) was performed.

Results: the mean age of our population was 75.7 ± 5.5 (range 66–90); the 27.5% was octogenarian. The mean number of drugs of patients’ daily therapy was 6.5 ± 2.8, including 2.8 ± 1.2 anti-hypertensive drugs. For what concerns blood pressure (BP) control, all patients had both clinic and out-of-offi ce BP values in the target range. Mean systolic and diastolic BP values were similar in patients with normal and abnormal Mini-Cog Test results. A Mini-Cog Test suggestive for cognitive impairment was observed in the 20% of our study population (16/80); 5 of these patients had a MMSE score inferior to 28. After the NPE, a diagnosis of cognitive decline was confi rmed in 2 patients (2.5% of the population). The 39.1% of patients with a normal Mini-Cog Test performed an abnormal Clock Drawing Test (CDT), therefore the 51.3% of our study population had a defi cit in clock drawing.

Conclusions: According to our results, the Mini-Cog cannot be suggested as a screening test for the evaluation of cognitive function in old hypertensive patients.

PP.03.18 AN UNUSUAL CASE OF CIRCADIAN

HYPERTENSION ASSOCIATED WITH POLYDIPSIA

J. Bohlender1, J. Nussberger2. 1Div. of Clinical Pharmacology, Inselspital, Bern University Hospital, Bern, Switzerland, 2Dep. of Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

Objective: Under normal conditions, the kidneys handle a large variability of daily Na and volume intake without notable changes of blood pressure (BP). To increase the awareness of rare etiological factors during the workup of hyperten-sion, we review the case of a patient with abnormal volume handling and revers-ible circadian hypertension due to chronic polydipsia.

Design and method: A critical case analysis with discussion of the literature was performed.

Results: A 76 year old female patient was evaluated for resistant hypertension. BP recordings showed normotension in the morning and a periodic daily BP rise with hypertension in the afternoon (usually >160 mmHg systolic) associated with chronic daytime polydipsia. The abnormal circadian BP oscillations disappeared when daily drinking volume was reduced to normal. She began voluntary poly-dipsia 12 years ago after an episode of painful uroltihiasis and advise to keep her daily drinking volume high for prevention. Four years earlier she had had an ischemic stroke in the vertebrobasilar territory. She received low dose perindopril and hydrochlorothiazide but the abnormal BP rise persisted also under amlodip-ine. Her clinical workup revealed a residual neurologic syndrome after stroke, mild renal insuffi ciency, and hypertensive heart disease with normal systolic func-tion. Kidney ultrasound excluded renal artery stenosis. She showed normal serum eletrolytes and a normal plasma aldosterone/renin ratio when untreated. During

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e112 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

extensive laboratory investigations, no other etiologic factor could be detected. The rapid BP rise suggested sympathetic nervous system activation. Polydipsia is frequently associated with electrolyte distrubances but pathologic BP oscillations are exceptional. Based on a review of the literature, we discuss abnormal renal volume control and an impaired central BP regulation and barorefl ex function after brain stem infarction to explain the association of polydipsia with recurrent diurnal hypertension.

Conclusions: Chronic polydipsia may be rare. However, it may occasionally rep-resent a modifi able cause of BP elevations and treatment resistance in elderly patients particularly when volume handling is impaired by comorbidity.

PP.03.21 TELOMERE LENGTH AND ATHEROSCLEROTIC

CARDIOVASCULAR DISEASE: THE BLOOD-AND-

MUSCLE MODEL

A. Benetos1, S. Verhulst2, S. Gautier1, C. Labat1, S. Toupance1, M. Kimura3, PM Rossi4, N. Settembre5, J. Hubert5, L. Frimat5, B. Bertrand6, M. Boufi 4, X. Flecher4,N. Sadoul5, P. Eschwege5, M. Kessler5, J. Kark7, S. Malikov5, A. Aviv3. 1INSERM UMRS1116, CHRU de Nancy, Université de Lorraine, Nancy, France, 2Centre for Behavior and Neurosciences, University of Groningen, Groningen, The Netherlands, 3Center of Human Development and Aging, Rutgers, The State University of New Jersey, Newark, NJ, USA, 4North hospital, APHM, Marseille of Internal Medicine, North hospital, APHM, Marseille, France, 5CHRU de Nancy, Université de Lorraine, Nancy, France, 6Conception Hospital, APHM and UMR-S1076, Marseille, France, 7Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel

Objective: Short telomere length (TL) in leukocytes is associated with atheroscle-rotic cardiovascular disease (ACVD). It is unknown whether this relationship is due to a shorter leukocyte TL (LTL) at birth or, alternatively, to a faster LTL attrition thereafter, before or during ACVD manifestation. To assess the temporal relation of LTL with ACVD, we draw on the following fi ndings: wide LTL variation ex-ists across individuals, but at birth TLs are similar across the individual’s somatic tissues. After birth, TL attrition varies in proportion to the replicative activities of tissues. Consequently, skeletal muscle (M), a minimally proliferative tissue, dis-plays a longer TL than LTL, which represents the highly proliferative hematopoi-etic system. Accordingly, the difference between LTL and MTL and the ratio of (LTL-MTL)/MTL provides additional information on LTL attrition since early life.

Design and method: We studied 271 individuals (82 women/189 men) aged 63 ± 14 years (mean ± SD), undergoing surgery. Their TL in leukocytes and in muscle biopsies (obtained during surgery) was measured by Southern blots. We tested the following variables for association with ACVD: LTL, MTL adjusted for muscle biopsy site (MTLA), LTL-MTLA and (LTL-MTLA)/ MTLA.

Results: In all subjects, MTLA was longer than LTL and LTL-MTLA differ-ence became wider with age similarly in ACVD patients (15.9 ± 0.5 bp/year; mean ± SE) and controls (14.4 ± 0.3 bp/year). Age- and sex-adjusted LTL (P = 0.005), but not MTLA (P = 0.68), was shorter in patients with ACVD than controls. LTL-MTLA (�272 ± 73 bp) and (LTL-MTLA)/MTLA (�3.2 ± 0.8 %)

were wider in ACVD than in controls (P = 0.0003 and 0.0001, respectively). Both composite variables that combined LTL and MTL yielded better fi tting models than either LTL or MTLA by themselves, and (LTL-MTLA)/MTLA explained ACVD slightly better than LTL-MTLA.

Conclusions: This fi rst study applying the “blood-and-muscle’’ TL model in pa-tients with ACVD shows more pronounced TL attrition in ACVD patients than controls. The difference in attrition rates was not modifi ed by age during adult-hood indicating that accelerated attrition in early life is likely to be a major expla-nation of the shorter LTL in ACVD patients.

PP.03.22 REFLECTED WAVES ARE RELATED TO AORTA

LENGTH MEASURED BY MRI IN ELDERLY

L. Joly1, P. Salvi2, C. Labat, D. Mandry, E. Micard, M. Beaumont, PY Marie, A. Benetos. 1CHRU Nancy Departement of Geriatrics, Nancy, France, 2IRCCS Istituto Auxologico Italiano Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy, 3INSERM U1116 Faculty of Medicine, Nancy, France, 4CHRU Nancy Departement of Radiology, Nancy, France, 5CHRU Nancy IADI Departement, Nancy, France, 6CHRU Nancy IADI Departement, Nancy, France, 7CHRU Nancy Departement of Nuclear Medicine, Nancy, France, 8CHRU Nancy Departement of Geriatrics, Nancy, France

Objective: Central pressure waveform can be decomposed into pressure trans-mission and refl ection waves. Aorta impedance (Zc) can be measured through recording pulse pressure signal and aortic fl ow signal. Zc refl ects structural and functional properties of elastic central and peripheral muscular arteries.

Design and method: This study proposed a novel method using wave intensity analysis to assess refl ected waves by decomposition of magnetic resonance imag-ing (MRI) of central aortic fl ow and central aortic pressure waveforms measured by tonometry in 30 older subjects allowing to obtain Zc in time domain, refl ection index (IR) and refl ection magnitude (MR). Therefore a graphical user interfaces and methods for automatic signal treatments were programmed.

Results: Elderly patients were mean aged of 75.25 ± 5.85 years (14 female, 16 male). No signifi cant differences were observed between gender groups in terms of weight, height, pressure parameters and impedances parameters. Mean Zc val-ue was 424.34 ± 94.41 DSC for the whole aging population.We found a strong negative association between Zc and LVET (r = -0.53, p = 0.004) and a trend of negative association between Zc and aortic diameter, at the aortic root, (r = -0.36, p = 0.05).RM associated positively with thoracic aorta length (r2 = 0.15, p = 0.04) after ad-justment to age and height, IR also associated positively with thoracic aorta length (r2 = 0.16, p = 0.04) after adjustment to age and height.

Conclusions: This automatical signal treatment of aortic fl ow and pulse pres-sure waveform is a good MRI method for assessment of wave refl ections in older subjects allowing obtaining refl ection magnitude. What can be observed is that refl ected waves depended strongly on thoracic aorta length. Moreover, Zc is in-versely correlated to left ventricular ejection time and aortic diameter.

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Abstracts e113

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SATURDAY

POSTERS

POSTER SESSION

POSTERS’ SESSION PS04:

HEART

PP.04.01 LEFT ATRIUM FUNCTION IN SYSTEMIC ARTERIAL

HYPERTENSION

N. Zlatareva-gronkova1, A. Cherneva2, G. Dobrev3, I. Petrov4. 1Department of Cardiology, Head of Intensive Care Unit, Acibadem City Clinic Cardiovascular Center, Sofi a, Bulgaria, 2Department of Cardiology, Intensive Care Unit, Acibadem City Clinic Cardiovascular Center, Sofi a, Bulgaria, 3Department of Cardiology, Intensive Care Unit, Acibadem City Clinic Cardiovascular Center, Sofi a, Bulgaria, 4Head of Cardiology, Angiology and Electrophysiology Department, Acibadem City Clinic Cardiovascular Center, Sofi a, Bulgaria

Objective: Assessment of left atrium (LA) mechanic by 2-Dimensional Speckle tracking Imaging (STI) recently has been discussed as useful method for LA function estimation. The purpose of this study was to assess the rela-tionship between LA function (particularly reservoir function) and LA struc-tural remodeling in patients with systemic arterial hypertension. LA evalu-ation was made using conventional echocardiography, tissue Doppler, and 2-Dimensional STI.

Design and method: 48 hypertensive patients without left ventricular hypertro-phy and 36 healthy controls (age and gender matched), underwent routine trans-thoracic echocardiography and speckle tracking echocardiography of the left atrium. LA volume was calculated by the biplane Simpson’s method. Peak early diastolic transmitral fl ow velocity, peak early diastolic mitral annular motion ve-locity (E/E¹) and peak systolic LA strain were messured.

Results: LV Mass was 132.7 ± 16.5 grams in control and 180.2 ± 60.4 grams in the hypertensive patients. Left atrium volume indexed to body surface area was 19.4 ± 5.4 versus 29.4 ± 4.3 ml/m2 in controls and hypertensive subjects respectively (p < 0.001). There were also signifi cant differences between the measurements of transmitral fl ow velocities (E, A), and E/E¹ and E/A ratios in both groups. Left atrium anteroposterior diameter was higher in the hypertensive group 4.20 ± 0.58 versus 3.4 ± 0.28 cm in the contols (p < 0.001). Left atrial lon-gitudinal strain was 24.05 ± 3.18 in hypertensive patients and 32.7 ± 2.8 among controls (p < 0.001).

Conclusions: Speckle tracking imaging might be assumed as method for early detection of LA function impairment in arterial hypertension.

PP.04.05 COMPATIBILITY OF LEFT VENTRICULAR

HYPERTROPHY DIAGNOSED BY

ELECTROCARDIOGRAPHY AND BY

ECHOCARDIOGRAPHY: THE NORTHERN

SHANGHAI STUDY

Y. Zhou, S. Yu, B. Bai, Y. Lv, J. Xiong, J. Teliewubai, H. Ji, X. Fan, C. Chi, Y. Xu, Y. Zhang. Shanghai Tenth People’s Hospital Tongji University School of Medicine, Shanghai, China

Objective: To investigate the compatibility of left ventricular hypertrophy (LVH) diagnosed by electrocardiography and by echocardiography.

Design and method: Echocardiography and electrocardiography were ap-plied to defi ne LVH in 1599 elderly Chinese aged >65 years old in communi-ties located at the northern Shanghai. Echocardiographic LVH (ECHO-LVH)

was defi ned by left ventricular mass indexed for Body Surface Area (LVM/BSA) or indexed for height2.7 (LVM/height2.7). Electrocardiographic LVH (ECG-LVH) was defi ned by Sokolow-Lyon (SL), Cornell and Cornell Product (CP) criteria. LVH was defi ned by LVM/BSA > 125 g/m2 in males, >110 g/m2

in females (LVH1); LVM/BSA > 115 g/m2 in males, > 95 g/m2 in females (LVH2); and LVM/height 2.7 > 51 g/m 2.7 in males, > 47 g/m2.7 in females (LVH3).

Results: In the correlation analysis, CP had the greatest correlation coeffi cient compared with SL and Cornell, in males (0.22 vs. 0.20 & 0.19 for LVM/BSA and 0.21 vs. 0.18 & 0.19 for LVM/height2.7), in females (0.16 vs. 0.08 & 0.15 for LVM/BSA and 0.18 vs. 0.05 & 0.17 for LVM/height2.7) and in total popu-lation (0.19 vs. 0.14 & 0.17 for LVM/BSA and 0.16 vs. 0.08 & 0.16 for LVM/height2.7). In Chi-square analysis, only LVH diagnosed by SL was signifi cantly associated with LVH diagnosed by echocardiography. Moreover, CP criterion had the greatest area under curve of ROC than Cornell criterion and the SL index (0.62 vs. 0.58 & 0.54 in LVH1, 0.62 vs. 0.55 & 0.51 in LVH2 and 0.62 vs. 0.57 & 0.51 in LVH3).

Conclusions: In ECG LVH criteria, CP criterion complies better than SL index and Cornell criterion in assessing cardiac hypertrophy.

PP.04.06 LEFT VENTRICULAR-ARTERIAL UNCOUPLING

INDEPENDENTLY PREDICTS ADVERSE CARDIAC

REMODELING IN PATIENTS WITH MYOCARDIAL

INFARCTION

E. Zharikova, S. Villevalde, ZH. Kobalava. RUDN University, Moscow, Russia

Objective: Left ventricular (LV) remodeling is the precursor to developing heart failure and an important prognostic factor after myocardial infarction (MI). The value of modern non-invasive indices of LV and arterial system function in con-temporarily treated patients with MI is not established. The aim of the study was to determine the relationship of adverse remodeling with the left ventricular-arterial coupling (VAC) in patients with MI treated with percutaneous coronary interven-tion (PCI).

Design and method: In 112 patients with MI (64 (57.2%) with STEMI) and PCI (68% male, age 61.1 ± 9.5 years (M ± SD), smokers 35%, diabetes 7%, arterial hypertension 83%) 2-dimentional echocardiography was performed to assess arterial elastance (Ea) and end-systolic LV elastance (Ees) on admission and in 4 weeks and 6 months. VAC was assessed as the ratio Ea/Ees. Cardiac adverse remodeling was defi ned by ratio [follow up - initial LV end diastolic volume (LVEDV)] / initial LVEDV more than 20%.

Results: Baseline LV ejection fraction (LVEF) was 48.2 ± 4.6%, Ea 1.7 ± 0.3 mmHg/ml/m2, Ees 2.1 ± 0.3 mmHg/ml/m2, VAC 0.88 ± 0.2. At baseline all patients had LVEF >40% and VAC in optimal (0.5–1.2) range. In4 weeks after PCI VAC >1.2 was revealed in 24 (29%) patients (33% STEMI), adverse LV remodeling - in 12 (10%) patients, all of them with VAC >1.2. After 6 months VAC >1.2 was found in 67 (75%) patients (68.6% STEMI), adverse LV remodeling - in 81 (90%) patients (71.6% with VAC >1.2). Achieved VAC >1.2 was associated with adverse cardiac remodeling (odds ratio 6.16; 95% confi dence interval 2.47–15.37; p < 0.0005). In patients with achieved VAC >1.2 Ees signifi cantly decreased (from 1.9 ± 0.3 to 1.3 ± 0.2 mmHg/ml/m2,p < 0.001) and Ea signifi cantly increased (1.7 ± 0.3 to 2.1 ± 0.5 mmHg/ml/m2, p < 0.001).

Conclusions: In patients with MI treated with PCI impairment of function-ing of cardio-vascular system assessed by increased value of VAC >1.2 was revealed 75% of patients in 6 months. Increase of VAC was associated with decrease of Ees and increase of Ea. Increased VAC index >1.2 indicating LV-arterial uncoupling may be considered as early marker of adverse LV re-modeling.

PP.04.08 IMPACT OF ARTERIAL HYPERTENSION ON

CLINICAL DEVELOPMENT OF AORTIC STENOSIS

A. Zhadan, V. Tseluyko. KhMAPE, Kharkiv, Ukraine

Objective: To evaluate infl uence of arterial hypertension on clinical development of aortic stenosis before and after valve replacement.

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e114 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

Design and method: 72 patients (mean (SD) age 63.9 ± 11.8 years) with aortic stenosis who underwent aortic valve replacement. 50 were males, 22 were fe-males. 37 patients (group 1) has arterial hypertension (AH), 35 patients (group 2) has not AH. Before and 12 months after valve replacement patients underwent transthoracic echocardiography.

Results: Mean (SD) age in group 1 was 67.9 ± 8.5 year, in group 2 – 59.3 ± 13.5 years. But the time from diagnosis to surgery was higher in group 2 – 22.6 ± 13.5 years vs 14.8 ± 8.6 years in group 1. As shown in table 1 pa-tients with hypertension more often have degenerative valve lesion (60% vs 37%), while in group 2 more frequently observed bicuspid valve 16% vs 40% (p < 0.05). Also, in group 1 patients more often has CAD 43% vs 9% (p < 0.05) and permanent atrial fi brillation 26% vs 6% (p < 0.05). Despite this, the se-verity of heart failure was not exceed in the fi rst group than the second. At baseline the size of the left chambers and thickness of left ventricular wall had not signifi cant difference between groups (Table 2). At 12 months after surgery in patients without AH there was a signifi cant (p < 0.05) decrease in the size of the left ventricle (LVESD) and in the wall thickness (IVST and LVPWT). Also ejection fraction increased in the 2 group (p < 0.05). In the fi rst group all echocardioscopy parametres were unchanged during the 12 months period.

Conclusions: Patients with arterial hypertension and aortic stenosis have greater comorbidity, but this does not affect the degree of heart failure.It was not observed signifi cant difference in remodeling the left ventricle in nor-motensive and hypertensive patients with aortic stenosis before surgery.The absence of arterial hypertension positively affects on parameters of cardiac remodeling at patients with aortic stenosis 12 months after valve replacement.

PP.04.09 THE INFLUENCE OF DEPRESSION ON LEFT

VENTRICULAR HYPERTROPHY IN PATIENTS WITH

MILD TO MODERATE ARTERIAL HYPERTENSION

A. Melqonyan, P. Zelveian. Center of Preventive Cardiology, Yerevan, Armenia

Objective: The aim of this study was to investigate the infl uence of depression on the structural changes of left ventricular (LV) myocardium in patients with arterial hypertension (AH).

Design and method: In 120 patients (87 males), aged from 29 to 62 years, with newly diagnosed or untreated mild to moderate AH, by the question-naire of Hamilton (Hospital Anxiety Depression Scale – HADS), were as-sessed the presence and expressiveness of depression. Total index in the range of 8–10 points considered as subclinical anxiety/depression, more than 10 points – symptomatic anxiety/depression. All patients were under-went echocardiography in the sectoral mode («Sonos 5500», «Hewlett Pack-ard»), structural and morphometric parameters were estimated by Teincholz method. LV mass (LVM) was calculated by the formula of Devereux R., et al. LVM index (LVMI) was calculated as the ratio of LVM to body surface area. The criteria for left ventricular hypertrophy (LVH) was considered for men >125 g/m2 for women – >110 g/m2. For data collection and statistical analysis «SPSS v17.0» program was used. To evaluate intergroup differ-ences (M ± m) parametric unpaired Student’s t-test was used. To determine the linear relationship of quantitative characters, Pearson’s correlation coef-ficient was used. Fisher’s exact test was used when comparing the frequency of adverse changes. The differences at p < 0.05 were considered as statisti-cally significant.

Results: Patients with AH were divided into two groups: I group – 34 patients with clinically severe depressive syndrome and group II – 86 patients without signifi cant depressive signs. The groups were matched for age, duration of AH, body mass index, the clinical values of systolic and diastolic blood pressure. In patients with clinically severe depressive syndrome revealed signifi cantly higher LVMI (p < 0.05), as well as the high incidence of LVH (70 and 51% respectively, p < 0.05). In Group I revealed signifi cant correlation between expressiveness of depression and ventricular septal thickness, LV posterior wall, regardless of the degree of severity AH.

Conclusions: A signifi cant relationship was revealed between the expressive-ness of depression and structural changes in the LV in patients with AH. Ob-viously, long-term emotional stress is the additive cause of LVH in patients with AH.

PP.04.13 CALCIUM CT SCAN IN HYPERTENSIVE PATIENTS

A. Vintila1, C, Tudorica2, C. Bulei2, V. Vintila3. 1Carol Davila University of Medicine and Pharmacy Bucharest, Coltea Clinical Hospital, Internal Medicine and Cardiology, Bucharest, Romania, 2Coltea Clinical Hospital, Internal Medicine and Cardiology, Bucharest, Romania, 3Carol Davila University of Medicine and Pharmacy Bucharest, Emergency University Hospital, Cardiology, Bucharest, Romania

Objective: Coronary atherosclerosis is a common finding in hypertensive patients. It may be symptomatic or not. Evaluation by coronary angiogra-phy is used in clinical settings thoroughly selected due to invasiveness and potential complications. We aimed at investigating coronary CT findings in hypertensive patients with or without clinical diagnosis of coronary artery disease.

Design and method: We studied a group of 26 hypertensive patients, aged 62 +/- 14 years, in whom coronary CT has been ordered for clinical purposes. Patients were evaluated according to standards of care, including blood tests, resting ECG and transthoracic echocardiography. Data were collected and ana-lysed using SPSS 19.0.

Results: Ischemic heart disease was present in 18 patients: 1 with ECG chang-es but no symptoms, 7 with stable angina pectoris, 3 with antecedent myocar-dial infarction, 4 with coronary artery bypass grafting and 3 with percutane-ous revascularisation. Coronary CT calcium score ranged from 0 to 3292. It was correlated with age (r = 0.548, p = 0.006), presence of ischemic heart dis-ease (r = 0.740, p < 0.001) and hypertriglyceridemia (p = 0.578, p = 0.004). It was signifi cantly higher in patients with conduction disturbances on resting ECG (average values 1185 versus 257, p = 0.027). We didn’t fi nd a correla-tion between coronary calcium score and number of coronary atherosclerotic lesions (p = 0.35).

Conclusions: Coronary calcium score is a surrogate for coronary heart disease but it is not a reliable marker to identify the number, type and severity of athero-sclerotic lesions.

PP.04.14 ATRIAL FIBRILLATION IN A COHORT

OF HYPERTENSIVE PATIENTS WITH

HYPOTHYROIDISM

A. Vintila1, M. Dobrovie2, D. Vasiliu2, C. Tudorica2, C. Bulei2, V. Vintila3. 1Carol Davila University of Medicine and Pharmacy Bucharest, Coltea Clinical

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Abstracts e115

Hospital, Internal Medicine and Cardiology, Bucharest, Romania, 2Coltea Clinical Hospital, Internal Medicine and Cardiology, Bucharest, Romania, 3Carol Davila University of Medicine and Pharmacy Bucharest, Emergency University Hospital, Cardiology, Bucharest, Romania

Objective: Atrial fibrillation (AF) is a common complication in hypertensive patients. It also complicates thyroid disease. In common prac-tice there is a fear of using adequate thyroid replacement therapy due to the risk of atrial fibrillation. We aimed to investigate the association between atrial fibrillation and treated hypothyroidism in a cohort of hypertensive patients.

Design and method: We studied a group of 61 hypertensive patients with treated hypothyroidism, aged 69 ± 10 years. Patients were evaluated according to stan-dards of care, including blood tests, resting ECG and transthoracic echocardiogra-phy. Data were collected and analysed using SPSS 19.0.

Results: Atrial fibrillation was diagnosed in 21 out of 61 patients (34%). Mean age in patients with AF was 6 years higher than in patients in sinus rhythm (p = 0.032). There was a slight difference in left ventricular ejec-tion fraction in favor of patients in sinus rhythm (57 ± 4% versus 54 ± 10%, p = 0.049). Plasma levels of NTproBNP were significantly higher in patients with AF (3996 ± 3653 pg/ml as compared to 719 ± 653 in sinus rhythm, p = 0.001). Plasma levels of TSH, freeT4 and freeT3 did not differ signifi-cantly between groups. The average dose of thyroid replacement therapy was similar in patients with AF and patients in sinus rhythm (64 ± 43 mcg and 69 ± 36 mcg, respectively, p = 0.647). Presence of AF was significantly correlated with echocardiographic parameters: left atrial diameter and vol-ume, left ventricular septal thickness, left ventricular ejection fraction, right atrial and right ventricular dimensions, pulmonary artery systolic pressure (all p < 0.05). Patients with AF had significantly lower glomerular filtration rates estimated by MDRD formula than patients in sinus rhythm (58 ± 19 versus 82 ± 25 ml/min/1.73 m2, p < 0.001). There was an inverse correla-tion between presence of AF and glomerular filtration rate (r = �0.447, p < 0.001).

Conclusions: Atrial fi brillation is a common fi nding in patients with arterial hypertension and hypothyroidism. It is related to ageing, lower glomerular fi ltration rate and cardiac remodeling. We concluded that we can safely give thyroid replacement therapy in these patients without increasing the risk of atrial fi brillation.

PP.04.15 EFFECTS OF CHANGES IN MYOCARDIAL PRELOAD

ON MEASURES OF WAVE REFLECTION AND

CENTRAL PRESSURE AUGMENTATION

L. Van De Velde1, D. W. Eeftinck Schattenkerk1, P. A. H. T. Venema1, H. J. Best1, B. van den Boogaard1,2, W. J. Stok3, B. E. Westerhof3,4, B. J. H. van den Born1. 1Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands, 2Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands, 3Laboratory of Clinical Cardiovascular Physiology, Heart Failure Research Center, Academic Medical Center, Amsterdam, The Netherlands, 4Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands

Objective: Augmentation index (AIx) is often used to quantify the contribution of wave refl ection to central pulse pressure. Recent studies have challenged this view by showing how contractility induced changes in the forward pressure wave can markedly impact AIx. To further investigate the link between myocardial performance and wave refl ection parameters, we studied the effects of different hemodynamic challenges on wave refl ection and central hemodynamics in two related clinical experiments.

Design and method: Wave separation analysis of noninvasively obtained aortic pressure was used to study the morphology and timing of the forward and back-ward pressure waves. Experiments were powered to detect a signifi cant difference in AIx. In the fi rst experiment we examined the effects of head-up tilt (HUT) with and without unilateral thigh cuff in 12 young healthy volunteers (mean age 26, 50% male). In the second experiment we examined the effects of active standing in 31 middle-aged subjects (mean age 57, 65% male) before and after receiving phlebotomy.

Results: HUT or active standing signifi cantly decreased AIx (-17.7 ± 10.4% in the young population, -4.7 ± 12.3% in the middle-aged population, both P < 0.05). The fall in AIx was associated with increases in HR, diastolic pressure and systemic vascular resistance, and a decrease in SV (all p < 0.05). Infl ation of a unilateral thigh cuff attenuated the decrease in AIx by 60%, while 500 mL of blood loss augmented the fall in AIx by 167% (both p < 0.05).

Conclusions: The changes in AIx appeared to originate from a preload induced de-crease in time for the forward wave to reach maximum amplitude and a steepened downstroke in the subsequent phase of the forward pressure wave. Next to inotropic and chronotropic effects, preload emerges as yet another factor of myocardial perfor-mance that obscures the relation between wave refl ection and augmentation index.

PP.04.16 ARTERIAL STIFFNESS, VENTRICLE-ARTERIAL

COUPLING AND LV FUNCTION IN PATIENTS WITH

MODERATE TO SEVERE AH

O. Torbas, Y.U. Sirenko, G. Radchenko, O. Rekovets, V. Granich, S. Kushnir, A. Dobrokhod, P. Sidorenko, S. Polischuk. FI NSC Institute of cardiology n. a. acad. M. D. Strazhesko, Kiev, Ukraine

Objective: The aim of this study was to evaluate which factors linked to the LV function profi le in patients with hypertension and what is the role of ventricular-arterial coupling (VAC).

Design and method: We included 61 patients with moderate to severe AH. We performed offi ce BP (oBP) and heart rate (HR) measurements, ambulatory BP monitoring, central systolic BP (cSBP), augmentation index (Aix@75) and PWV measurement, CAVI index and ankle-brachial index (ABI) measurements. Echo-cardiography was performed according to local protocol with measurements of peak E velocity, peak A, the E/A ratio, peak E’ and E/E’ ratio, deceleration time (Dt), isovolumetric relaxation time (IVRT), LV myocardium mass index (LVMMI) evaluated with the ASE formula, ventricle-arterial coupling (VAC) was evaluated according to standard method. We also measured intima-media thickness (IMT). To fi nd interactions we used Spearman correlation analysis.

Results: Mean characteristics: BMI 29,6 ± 0,7 km/m2, mean age 53,6 ± 1,9 years, men/women 53/47 %, oSBP 158,8 ± 3,4 mmHg, oDBP 95,3 ± 2,2 mmHg, oPBP 61,3 ± 2,9 mmHg, HR 79,1 ± 2,5 beats/min, 24hSBP 146,0 ± 2,3 mmHg, 24hDBP 89,5 ± 1,8 mmHg, 24hPBP 60,1 ± 3,5 mmHg, cSBP 130,4 ± 3,7 mmHg, cDBP 87,2 ± 2,0 mmHg, cPBP 44,2 ± 2,8 mmHg, PWV 11,8 ± 0,5 m/s, CAVId 8,5 ± 0,3, CAVIs 8,4 ± 0,3, LVMMI (w/m) 91,9 ± 3,5 (86,7 ± 1,9 / 97,7 ± 1,6) g/m2, E/A 1,2 ± 0,2, E/E’ 7,7 ± 0,4 Dt 253,2 ± 13,4 ms, IVRT 90,7 ± 5,5 ms. E/A cor-related with ejection fraction (r = -0,868), end-systolic volume (r = 0,823), end-diastolic volume (r = 0,527), LVMMI (r = 0,42), gender (r = 0,345), p < 0,05 for all. There were no signifi cant correlation of VAC with indicators of target organ vessel damage (CAVI, PWV, ABI and IMT). From all indicators of LV DF signifi -cant correlation of VAC was found only for IVRT (r = 0,346; p < 0,05).

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e116 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

Conclusions: In this study VAC did not correlate with any of indicators of target organ vessel damage. Perhaps VAC evaluation methodologies should be checked and possibly reviewed.

PP.04.17 ADDITIONAL FACTORS THAT MAY HELP IN LV

DIASTOLIC FUNCTION ASSESSMENT

O. Torbas, Y.U. Sirenko, G. Radchenko, O. Rekovets, V. Granich, S. Kushnir, A. Dobrokhod, P. Sidorenko, S. Polischuk. FI NSC Institute of cardiology n. a. acad. M. D. Strazhesko, Kiev, Ukraine

Objective: Increased arterial stiffness may cause increased LV stiffness that may infl uence LV diastolic function (DF) and could be used also for LF DF assessment.

Design and method: We included 61 patients with moderate to severe AH. We performed offi ce BP (oBP) and heart rate (HR) measurements, ambulatory BP monitoring, central systolic BP (cSBP), augmentation index (Aix@75) and PWV measurement, CAVI index and ankle-brachial index (ABI) measurements. Echocardiography was performed according to local protocol with measurements of peak E velocity, peak A, the E/A ratio, peak E’ and E/E’ ratio, deceleration time (Dt), isovolumetric relaxation time (IVRT), LV myocardium mass index (LVMMI) evaluated with the ASE formula, ventricle-arterial coupling (VAC) was evaluated according to standard method. To fi nd interactions we used Spearman correlation analysis.

Results: Mean characteristics: BMI 29,6 ± 0,7 km/m2, mean age 53,6 ± 1,9 years, men/women 53/47 %, oSBP 158,8 ± 3,4 mmHg, oDBP 95,3 ± 2,2 mmHg, oPBP 61,3 ± 2,9 mmHg, HR 79,1 ± 2,5 beats/min, 24hSBP 146,0 ± 2,3 mmHg, 24hDBP 89,5 ± 1,8 mmHg, 24hPBP 60,1 ± 3,5 mmHg, cSBP 130,4 ± 3,7 mmHg, cDBP 87,2 ± 2,0 mmHg, cPBP 44,2 ± 2,8 mmHg, PWV 11,8 ± 0,5 m/s, CAVId 8,5 ± 0,3, CAVIs 8,4 ± 0,3, LVMMI (w/m) 91,9 ± 3,5 (86,7 ± 1,9 / 97,7 ± 1,6) g/m2, E/A 1,2 ± 0,2, E/E’ 7,7 ± 0,4 Dt 253,2 ± 13,4 ms, IVRT 90,7 ± 5,5 ms. E/A correlated with age (r = �0,308), cPBP (r = �0,44), augmentation pressure (r = �0,513), Aix@75 (r = �0,517), CAVId (r = �0,575), CAVIs (r = �0,558), EF (r = �0,398), LVMMI (r = �0,43), oPBP (r = �0,335), p < 0,05 for all. E/E’ correlated with ejection duration (r = �0,56), cDBP 0,477, cPBP 0,409, SEVR 0,468, oPBP 0,6, LVMMI 0,345, CAVId 0,41, CAVIs (r = 0,406), p < 0,05 for all. Dt correlated with end-diastolic volume (r = 0,346), cDBP (r = �0,31), ABI (r = 0,616) and IVRT correlated with ABI (r = 0,616), VAC (r = 0,346), p < 0,05 for all.

Conclusions: Indicators of LV DF signifi cantly associated with indicators of pulse wave analysis and arterial stiffness that can be used in routine clinical prac-tice for the earliest diagnosis of early progression of diastolic dysfunction.

PP.04.18 COMPARISON AMONG DIFFERENT

ELECTROCARDIOGRAPHIC CRITERIA FOR LEFT

VENTRICULAR HYPERTROPHY: RETROSPECTIVE

ANALYSIS OF A LARGE COHORT OF ADULT

OUTPATIENTS WITH HYPERTENSION

G. Tocci1,2, V. Costanzi1, G. Gallo1, F. Simonelli1, N. Attalla1, I. Figliuzzi1, V. Presta1, B. Citoni1, A. Battistoni1, A. Ferrucci1, M. Volpe1,2. 1Div. Cardiology, Dpt. Clinical Molecular Medicine, Fac. Medicine and Psychology, Univ. Sapienza, Sant’Andrea Hospital, Rome, Italy, 2IRCCS Neuromed, Pozzilli, Italy

Objective: Conventional 12-lead electrocardiogram (ECG) should be performed in all patients with hypertension (HT) in order to evaluate the presence of cardiac organ damage (OD), namely left ventricular hypertrophy (LVH), although differ-ent criteria are available.

Design and method: Aim. To evaluate LVH prevalence according to conventional and new ECG criteria in a large cohort of adult hypertensive outpatients. Methods. All patients underwent conventional 12-lead ECG, BP assessment and compre-hensive evaluation of individual global cardiovascular risk profi le according to 2013 ESH/ESC guidelines. The following ECG criteria for LVH were applied: 1) Sokolow–Lyon index: >3.5 mV; 2) Cornell Voltage Index: men >2.4 mV; women >2.0 mV. In addition, positive/negative amplitude of all ECG leads was calculated in all included outpatients. Study population was stratifi ed into three groups: 1) treated controlled HT; 2) treated uncontrolled HT; 3) resistant HT.

Results: From an overall population sample of 1,979 adult individuals, we se-lected 1,566 hypertensive outpatients, among whom 560 (35.8%) were treated controlled, 613 (39.1%) were treated uncontrolled, and 393 (25.1%) had resis-tant HT. No signifi cant difference was found for LVH prevalence according to Sokolow-Lyon criterion, whereas its prevalence increased from controlled (7.7%) to uncontrolled (9.4%) towards resistant (14.%) HT according to Cornell Voltage criterion (P < 0.040). Cornell Voltage and Product showed a trend toward increase

from the fi rst to the latter group. Among various ECG leads, only aVL amplitude showed a progressive and signifi cant increase from controlled (5.7 ± 3.8 mV) to uncontrolled (6.0 ± 3.4 mV) towards resistant (6.7 ± 3.7 mV) HT, as well as positive correlation with clinic systolic BP (Pearson r: 0.158; P < 0.001), 24-hour systolic BP (r: 0.133; P = 0.007), LVMi (r: 0.206; P < 0.001), and LVMh^2.7 (r: 0.239; P < 0.001).

Conclusions: Conclusions. Measuring aVL amplitude might represent a simple, easy and cost-effectiveness way to assess the presence of cardiac OD in adult outpatients with different degree of hypertension.

PP.04.19 LEFT ATRIUM VOLUME INDEX AND RISK PROFILE

IN HYPERTENSIVE PATIENTS WITH ACUTE

MYOCARDIAL INFARCTION

D. Toader, M. Popescu, A. Oprian, R. Musetescu. Emergency University Hospital, Craiova, Romania

Objective: The left atrium volume index (LAVi) is a recognized prognostic marker in conditions as heart failure, myocardial infarction and atrial fi brillation. Dilatation of left atrium (DLA) in the absence of chronic arrhythmia, mitral valve disease or heart transplantation, is marker of chronic elevation of left atrium pres-sure. Numerous epidemiological studies have shown that the presence of arte-rial hypertension increases the risk of coronary heart disease especially in at risk populations. LA enlargement in hypertensive patients is related to overweight, diabetes and metabolic syndrome. Aim of the study was to fi nd the presence of risk factors among the hypertensive patients with acute myocardial infarction (AMI) and the correlation with LAVi.

Design and method: A number of 98 hypertensive patients (56 males and 42 fe-males), aged 41- 85 years, admitted with ST-segment elevation AMI were evaluated during the fi rst week of hospitalization before discharge by: clinical and laboratory examination, 12 lead standard ECG. LAVi echocardiographic measurement was made using disk summation algorithm, tracing endocardial borders in apical four and two chamber view and indexing by body surface area; cut off value was 34 ml/m2.

Results: 1. In lot of study 57,14% were males (78,57% DLA) and 42,86% females (73,82% DLA). 2. Most of patients were aged 60–69 years: 34 patients (67,83% DLA). 3. Looking for age and sex distribution of patients, in all groups male sex was domi-nant: highest incidence between 50–59 years group: 71,42%, followed by 69–69 years group age: 55,88%. 4. Most of patients: 56,12% were stage 3 of hypertension (81,81% DLA) 5.68,36% of patients were diabetics (74,62% DLA) 6. Obesity was found in 68,36% of hypertensive patients with AMI. (73,13% % DLA). 7. Dyslipidemia was found in 77,55% of patients (66,31% DLA) 8.Smoking was present in 53,06% of pa-tients. (76,92% DLA when patients associated supplementary this risk factor)

Conclusions: 1. We found an association between risk factors as: male sex, age, obesity,dyslipidemia, the level of blood pressure, diabetes, and smoking and the incidence of AMI in hypertensive patients. 2. In hypertensive patients with AMI a correlation between and risk factors and left atrium enlargement was present.

PP.04.20 HEMODYNAMIC PROFILE IN CONTROLLED AND

UNCONTROLLED HYPERTENSIVE PATIENTS.

INSIGHTS FROM THE SEPHAR III STUDY

O. Tautu1, R. Darabont2, D. Dimulescu3, C. Sinescu4, C. Arsenescu-Georgescu5, D. Lighezan6, P. Gusbeth-Tatomir7, K. Babes8, I. Branza9, M. Udrescu10, L. Radulescu1, C. Acatrinei1, M. Dorobantu1. 1Carol Davila University of Medicine and Pharmacy, Emergency Clinical Hospital Bucharest, Cardiology Department, Bucharest, Romania, 2Carol Davila University of Medicine and Pharmacy, University Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania, 3Carol Davila University of Medicine and Pharmacy, Elias Emergency Hospital Bucharest, Cardiology Department, Bucharest, Ro-mania, 4Carol Davila University of Medicine and Pharmacy, Bagdasar Arseni Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania, 5Gr. T. Popa University of Medicine and Pharmacy, Institute of Cardiovascular Diseases, Cardiology Department, Iasi, Romania, 6Victor Babes University of Medicine and Pharmacy, Municipal Emergency Hospital Timisoara, Internal Medicine Department, Timisoara, Romania, 7Fresenius Nephrocare Dialysis Center, Pitesti, Romania, 8Oradea University, Medicine and Pharmacy Faculty, Emergency Clinical County Oradea, Coronary Intensive Care Department, Oradea, Romania, 9CMI Dr. Ileana Brinza, Braila, Romania, 10CMI Dr. Mihaela Udrescu, Bucuresti, Romania

Objective: Diffi culties in hypertension control may depend, among other factors, on a mismatch between choice of antihypertensive drugs and patient’s hemody-namic profi le. Aim of this study was to evaluate the hemodynamic (HD) profi le of a sample of the adult Romanian hypertensive population through impedance cardiography and to explore its possible implication for hypertension control in the frame of the nation-wide SEPHAR III survey.

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Abstracts e117

Design and method: Impedance cardiography with the HOTMAN system was performed in 889 adult hypertensive subjects, randomly selected in the frame of the SEPHAR III survey, at the second study visit, for 5–10 minutes in supine posi-tion. 771 of them had valid non-invasive hemodynamic measurements data, with estimates of volemia, vasoreactivity, inotropism and hemodynamic state. Blood pressure was measured with the auscultatory technique in seated position twice, according to ESH guidelines.

Results: Analysis of impedance cardiography recordings showed the presence of 22 different HD profi les, 9 of them including hypervolemia. The frequency of any alteration in HD modulators was signifi cantly higher in uncontrolled hyperten-sives (offi ce BP greater than 140/90 mm Hg) than in controlled ones.Regression analysis revealed a positive association between the number of al-tered HD modulators and the lack of BP control: 1 altered HD modulator: OR 2.57, 95%CI for OR (1.03–6.45); 2 altered HD modulators: OR 2.89, 95%CI for OR (1.16–7.20); 3 altered HD modulators: OR 1.67, 95%CI for OR (0.67–4.33); 4 altered HD modulators: OR 2.54, 95%CI for OR (1.04–6.25). Only 20.5% of hypertensive patients with a hyperinotropism pattern were treated with beta-blockers, only 41,4% of hypertensive patients with a vasoconstriction pattern were receiving vasodilatator drugs and only 1,4% of hypervolemic hypertensives were receiving diuretics.

Conclusions: Hypertensive patients have a multitude of different HD profi le pat-terns, which emphasizes the need of assessing their HD characteristics before choosing the more appropriate antihypertensive drug. Currently, antihypertensive treatment targets are unrelated to the HD profi le. This may lead to hemodynamic imbalance and lack of optimal BP control due to choice of drugs unable to match the individual patient’s HD profi le.

PP.04.22 IMPACT OF CARDIOPULMONARY EXERCISE

TEST IN PULMONARY ARTERIAL HYPERTENSION

PATIENTS RISK STRATIFICATION

I. Taran, Z. Valieva, T. Martynyk, I. Chazova. Russian Cardiology Research and Production Complex, Department of Pulmonary Hypertension and Heart Dis-eases, Moscow, Russia

Objective: Incremental cardiopulmonary exercise testing (CPET) is recom-mended to evaluate severity, prognosis and responses to therapy in patients with pulmonary hypertension. We aimed to evaluate the impact of CPET in pulmonary arterial hypertension (PAH) patients risk stratifi cation.

Design and method: 45 patients with PAH (mean age 43,1+11,0 years) underwent exercise on cycle ergometry. Oxygen uptake (VO2), carbon dioxide output (VCO2), expiratory gas concentrations and minute ventilation (VE) were measured breath-by-breath. Peak VO2 was defi ned as highest average of VO2 in the last minute of exercise.

Results: The majority of patients (n = 16) had III functional class (World Health Organization (WHO) classifi cation). The mean values of right atrial area and right ventricular size were 20,9 +7,4 sm2 and 3,6+0,75 sm respectively by echo-cardiography.Mean pulmonary arterial pressure and mean right atrial pressure were 53,1+12 / 7,2+6 mmHg according to the right heart catheterization. The mean value of car-diac index was 2,1+0,6 l/min/m2. The mean distance in 6-minute walking test was 420+113 m. According to the CPET the mean values of Vo2 peak and VE/Vco2 slope were 10,99+5,15 ml/kg/min and 46,2+19,78. After the thorough analysis of clinical, functional and hemodynamic status of pa-tients, we revealed, that majority of patients were belonged to the high-risk group

(n = 26), and 10 patients were belonged to the intermediate risk group. However, after the CPET performing we got the results, showing that an additional 7 pa-tients, who had been earlier in the intermediate risk group, had a high risk of mortality during 1 year. 9 patients were belonged to the low risk group, that was also confi rmed by CPET data. A signifi cant negative correlation between the functional class (WHO) and VO2 peak in patients with PAH was found (r = �0,78; p < 0,0001).

Conclusions: Risk stratification is crucial for the development of an appro-priate treatment strategy. Patients who achieve the therapy goals, no matter which specific therapy or approach is used, seem to have a better prognosis than those who do not. The CPET is necessary for pathogenic therapy effec-tiveness assessment and for making decision of therapy escalation in patients with PAH.

PP.04.23 A DIASTOLIC DYSFUNCTION SCORING SYSTEM

(DSS) FOR DETECTING LEFT VENTRICULAR

DIASTOLIC DYSFUNCTION IN HYPERTENSIVE

PATIENTS

D. Syamsul, N. Hersunarti, L. Dina Liastuti, I. Irnizarifka, R. Soerarso, B. Budi Siswanto. Department of Cardiology and Vascular Medicine Faculty of Medicine University of Indonesia, Jakarta, Indonesia

Objective: To identify factors related to left ventricular diastolic dysfunction in hypertensive patients, and to create a scoring system from those related factors.

Design and method: A cross sectional study was conducted in Tarakan General District Hospital North Borneo with hypertensive subjects on October 2016. Pa-tients characteristics, all factors related to left ventricular diastolic dysfunction, and echocardiographic data were collected and analysed.

Results: There were 132 total samples in this study, and left ventricular diastolic dysfunction was found in 40,2% samples. From logistic regression analysis, age more than 55 years old (OR 4.97, 95% CI 1.60–15.42), poor blood pressure con-trol (OR 22.33, 95% CI 4.11–121.48), left ventricular hypertrophy (OR 4.23, 95% CI 1.14–15.72), and abnormal fasting plasma glucose (OR 13.24, 95% CI 2.89–60.67) were found to have a signifi cant relation with left ventricular diastolic dysfunction and became a fi nal model variables of scoring system. Left ventricular diastolic dysfunction scoring system could be generated from those variables fi nal models. Calibration and internal validation tests for this scoring system showed good results.

Conclusions: A scoring system can be generated to detect left ventricular dia-stolic dysfunction in hypertensive patients.

PP.04.24 THE IMPACT OF HYPERTENSION ON QT

DISPERSION AND ECHOCARDIOGRAPHIC

PARAMETERS IN PATIENTS WITH ANGINA

PECTORIS

V. Stoickov1, M. Deljanin Ilic1, M. Stoickov2, I. Tasic1, M. Nikolic2, S. Mitic2. 1University of Nis, Medical Faculty, Institute of Cardiology Niska Banja, Nis, Serbia, 2Institute of Cardiology, Niska Banja, Nis, Serbia

Objective: Introduction: QT dispersion (QTd) is a measure of inhomogeneous repolarization of myocardium and is used as an indicator of arrhythmogenicity. According to the values of QTd can identify coronary patients who are at high risk of cardiac death and sudden cardiac death.

Objective: The aim of this study was to investigate the effect of hypertension on QT dispersion and echocardiographic parameters in patients with angina pectoris.

Design and method: The study included 113 patients with angina pectoris (aver-age age 57.2 years), of which 78 were with hypertension, and 35 were without arterial hypertension. There were no signifi cant differences in age and gender be-tween the two groups of patients. In all subjects exercise stress test on a treadmill

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according to the Bruce protocol and echocardiographic examination were per-formed and from standard ECG corrected QT dispersion (QTdc) and QTd was calculated.

Results: Patients with angina pectoris and hypertension had signifi cantly higher values of QTd (55.1 ± 17.1 vs 42.8 ± 19.5 ms; p < 0.01) and QTdc (59.2 ± 20.0 vs 45.5 ± 18.1 ms; p < 0.001) compared to those without arterial hypertension. Also, patients with angina pectoris and hypertension had signifi cantly higher val-ues of the thickness of the interventricular septum (12.1 ± 2.1 vs 10.8 ± 1.7 mm; p < 0.005), left ventricle posterior wall thickness (10.9 ± 1.5 vs 9.2 ± 1.4 mm; p < 0.001) and left atrium diameter (40.9 ± 4.8 vs 37.3 ± 5.4 mm; p < 0.005) compared to those without hypertension. Patients with angina pectoris and arte-rial hypertension have higher values of the left ventricular end-diastolic diameter (54.1 ± 5.8 vs 53.7 ± 7.1 mm; p-NS), and left ventricular end-systolic diameter (36.6 ± 6.1 vs 35.8 ± 6.9 mm; p-NS) and lower values of left ventricular ejection fraction (60.9 ± 11.2 vs 63.6 ± 11.9%; p-NS), but the differences were not statisti-cally signifi cant.

Conclusions: The study demonstrated that patients with angina pectoris and hy-pertension have signifi cantly higher values of QT dispersion parameters, thick-ness of the left ventricle walls and left atrium diameter in comparison to those without hypertension.

PP.04.25 INCIDENCE AND PREDICTORS OF COMBINED

CARDIOHEPATIC AND CARDIORENAL

SYNDROMES IN DECOMPENSATED HEART

FAILURE

A. Soloveva, S. Villevalde, Z. Kobalava. RUDN University, Moscow, Russia

Objective: Similar factors such as venous congestion and hypoperfusion are thought to underlie both renal and liver dysfunction in decompensated heart fail-ure (DHF). The aim of this study was to assess the prevalence of cardiohepatic syndrome (CHS) and cardiorenal syndrome (CRS) and predictors of simultaneous CHS and CRS in DHF.

Design and method: In 322 patients with DHF (190 male, 69.5 ± 10.6 years (M ± SD), arterial hypertension 87%, myocardial infarction 57%, atrial fi bril-lation 65%, diabetes mellitus 42%, known chronic kidney disease 39%, chronic anemia 29%, left ventricular (LV) ejection fraction (EF) 37.6 ± 12.6%, EF < 35% 39.1%) liver function tests (LFTs) were measured on admission. CHS was con-sidered when at least one of LFTs level exceeded upper normal limit. CRS was diagnosed as community-acquired acute kidney injury based on KDIGO 2012 Guidelines. Simultaneous CHS and CRS were considered as cardiorenohepatic syndrome (CRHS). Mann-Whitney test and multivariate logistic regression anal-ysis were performed. P < 0.05 was considered statistically signifi cant.

Results: CHS occurred in 274 (85.1%) of patients. CRS was diagnosed in 60 (18,6%) patients. Isolated CHS, isolated CRS and CRHS occurred in 78.4, 1.5 and 20.1% patients respectively. Patients with versus without CRHS had lower systol-ic blood pressure (SBP) (129 ± 18 vs 138 ± 19 mm Hg, p < 0.01), EF (32 ± 10 vs 38 ± 13U/l, p < 0.01), pulse pressure (63 ± 91 vs 30 ± 28 m Hg, p < 0.01), higher LV mass index (200 ± 50 vs 178 ± 52 g/m2, p < 0.01), LV end diastolic volume (62 ± 6 vs 56 ± 9 mm, p < 0.001), higher prevalence of severe mitral regurgitation (64.3 vs 39.6%, p < 0.001), signs of congestion – jugular venous distension (57.1 vs 39.6%, p < 0.05), hepatomegaly (85.7 vs 70.3%, p < 0.05), echo-hydroperi-cardium (46.4 vs 22.5%, p < 0.001). The independent predictors of CRHS were baseline GFR < 45 ml/min/1.73 m2 (odds ratio (OR) 3.95, 95% confi dential inter-val (CI) 2.15–7.21, p < 0.01), anamnesis of chronic HF (OR 3.78, CI 1.30–10.96, p < 0.05), SBP < 110 mm Hg on admission (OR 3.51, CI 1.55–7.94, p < 0.05), echo-hydropericardium(OR 2.98, CI 1.62–5.50, p < 0.01) and EF < 35% (OR 2.96, CI 1.61–5.44, p < 0.05).

Conclusions: Isolated CHS, isolated CRS and CRHS occurred in 78.4, 1.5 and 20.1% patients. The independent predictors of CRHS were baseline GFR < 45 ml/min/1.73 m2, anamnesis of chronic HF, SBP < 110 mm Hg on admission, echo-hydropericardium and EF < 35%.

PP.04.26 IN-HOSPITAL OUTCOME PREDICTIONS FOR

ACUTE CORONARY SINDROME PATIENTS

AFTER CORONRY ANGIOPLASTY BY MINING

ECHOCARDIOGRAPHY PARAMETERS DATA

M. Sladojevic1, S. Sladojevic2, S. Tadic1, M. Stefanovic1. 1Institute of cardiovas-cular diseases of Vojvodina, Sremeska Kamenica, Serbia, 2University of Novi Sad, Faculty of Technical Sciences, Novi Sad, Serbia

Objective: The aim of this study is to develop an in-hospital mortality prediction model for acute coronary syndrome (ACS) patients after percutaneous coronary

intervention (PCI) by performing data mining techniques on echocardiography parameters (EPs).

Design and method: A total of 2030 patients (aged 61.29 ± 11.70 years, 66.79% males), diagnosed with ACS, hospitalized, between December 2008 to December 2011, were assigned to a derivation sample and 954 patients admitted during 2012 (age 61.54 ± 11.91) were assigned to a validation sample. Each derivation sample patient was initially described using 45 EPs. Various data mining algorithms were evaluated and the most successful was chosen.

Results: In-hospital mortality in the derivation sample was 7.73%, and 6.28% in the validation sample. The best prediction results were achieved using Alter-nating Decision Tree (ADTree) classifi er, 77.78% accuracy (AUROC 0.85), and preserved good performance on validation sample, 77.99% accuracy (AUROC 0.785). ADTree identifi ed a subset of 9 key EPs: left ventricular ejection frac-tion (LVEF), left ventricular stroke volume (LVSV), left ventricular stroke volume index (LVSVI), aortic leafl et separation diameter (AOvs), aortic velocity time integral (AOVTI), right ventricle diameter (RV), right atrial apico-basal dimen-sion (RAab), right ventricle systolic pressure (RVSP) and mitral valvule maximal gradient (MVmaxPG). The resulting tree obtained from the ADtree algorithm is shown in Figure 1.

Conclusions: The ADTree is a highly accurate graphical model, suitable for ex-pert interpretation, yet relatively simple - it contains 31 nodes and 21 leaves. The model might prove very helpful in the decision-making process and optimizing treatment strategy in selected high risk ACS patients.

PP.04.27 SERUM URIC ACID LEVEL COULD BE A

PREDICTOR OF ATRIAL FIBRILLATION IN WOMEN

BUT NOT IN MEN WITH METABOLIC SYNDROME

R. Siliste, C. Homentcovschi, D. Vasiliu, I. Savulescu-Fiedler, D. Spataru, R. Ianula, A. Gurghean. U. M. F Carol Davila, Department of Internal medicine and Cardiology, Coltea Clinical Hospital, Bucharest, Romania

Objective: Uric acid (UA) is a cardiovascular risk marker associated with oxi-dative stress and infl ammation. Several studies showed the association of high levels of serum UA with atrial fi brillation (AF) in metabolic syndrome (MetS). The objective of this observational study was to investigate the gender differences of serum UA levels in patients with MetS and AF.

Design and method: We evaluated 100 patients with MetS and AF (group A) and 50 patients with MetS without AF (group B), mean age 69,28 ± 8,8, respectively 59,52 ± 9,62 years, 68%F. We excluded subjects with coronary artery disease, congestive heart failure, valvular heart disease, congenital heart disease, cardio-myopathy, renal failure, infl ammatory conditions, thyroid dysfunction, respiratory diseases, and those who were taking drugs that affect UA metabolism (apart from diuretics).

Results: AF significantly correlated with older age (p < 0.001), decreased creatinine clearance (70,39 ± 25,89 vs. 88,42 ± 23,32 ml /min/1.73 m2, p < 0.001), serum UA levels (6,47 ± 1,69 vs. 5,49 ± 1,80 mg / dl, p = 0.01), LA diameter (44,3 ± 6,33 vs. 39,03 ± 5,14 mm, p < 0.001) and LA volume (79,31 ± 23,68 vs. 57,78 ± 15,95 ml, p < 0.001). After multivariate logistic regression analysis, the independent predictors of AF were age and LA di-mensions for both men and women. The serum UA was an independent pre-dictor of AF only in women with MetS. The area under the receiver operating characteristic curve of serum UA for accuracy to detect atrial fibrillation in women was 0.87 (95% confidence interval 0.82–0.95). The cut-off point of 6.7 mg/dl had a sensitivity of 87% and a specificity of 79% to predict AF in women.

Conclusions: Serum UA level was an independent predictor of AF in women but not in men with metabolic syndrome.

PP.04.28 PEAK DP/DT IN DESCENDING AORTA IS

DECREASED IN PATIENTS AFTER AORTIC ARCH

REPAIR

M. Shiraishi1, T. Murakami1, A. Takeda2. 1Department of Cardiology, Chiba Chil-dren’s Hospital, Chiba, Japan, 2Department of Pediatrics, Hokkaido University, Graduate School of Medicine, Sapporo, Japan

Objective: One of the important problems in patients who had undergone arch repair for coarctation or interruption of the aortic arch is a future cardiovascular disease. We previously reported that a new pressure wave refl ection (PWR) oc-curred from the surgically repaired site, and it could cause the future cardiovascu-lar disease. The purpose of this study is to clarify the infl uence of the new PWR on the peak dP/dt in repaired aorta.

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Abstracts e119

Design and method: Fifteen patients after aortic arch repair without pressure gradient at the repaired site were enrolled. A pressure sensor mounted catheter recorded pressure waveforms in ascending aorta (AAo) and descending aorta (DAo). The peak dP/dt in AAo and DAo were compared with those of age-matched patients with a normal aortic arch.

Results: The patient’s age was 7.4 ± 3.2 years and they underwent the aortic arch repair at 0.08 ± 0.08 years. The systolic blood pressure was 103.1 ± 13.3 mmHg at AAo and 108.7 ± 16.4 mmHg at DAo. The peak dP/dt was 572.1 ± 100.1 mmHg/sec at AAo and 489.3 ± 75.2 mmHg/sec at DAo. The dif-ference of peak dP/dt between DAo and AAo (peak dP/dt at DAo minus peak dP/dt at AAo) was -82.8 ± 69.0 mmHg/sec. In the control subjects, the peak dP/dt was 543.3 ± 110.2 mmHg/sec at AAo and 579.4 ± 106.0 mmHg/sec at DAo. The difference of peak dP/dt between DAo and AAo in control subjects was 36.1 ± 29.7mmHg/sec. In normal aorta, the peak dP/dt in DAo is higher than that in AAo, but in repaired aorta, the peak dP/dt in DAo is lower than that in AAo. The difference of peak dP/dt between DAo and AAo in the arch repaired patients was signifi cantly lower than that in the control subjects (t = -6.133, p < 0.0001).

Conclusions: Peak dP/dt in DAo is decreased in patients after aortic arch repair. The surgical repaired site generates the new PWR and would lead to a change in the cen-tral aortic pressure waveform, which could place extra load on their left ventricles.

PP.04.30 PRESERVED CARDIOVASCULAR PERFORMANCE

AND OPTIMAL HEART RATE CONTROL

IN PATIENTS WITH POST-ISCHEMIC LEFT

VENTRICULAR DYSFUNCTION TREATED WITH

IVABRADINE FOR ONE YEAR

V. Cesario, V. Calvez, M. Montefusco, F. Brogna, M. Volpe, C. Savoia. Clinical and Molecular Medicine Department, Sapienza University of Rome, Rome, Italy

Objective: Ivabradine may contribute to reduce heart rate (HR) in patients with cardiovascular disease. We sought to defi ne the role of ivabradine on cardiovascu-lar performance in patients with left ventricular (LV) dysfunction after myocardial infarction (MI).

Design and method: We studied 16 patients with LV dysfunction after MI (NYHA II). The patients were in optimal standard treatment (including beta-blockers) for ischemic heart disease and heart failure. They were divided into two groups: one received ivabradine (IVA, n = 7, 5 to 7.5 mg bid) on top of the standard therapy; the other group received up-titration of the beta-blocker (BETA, n = 9), in order to reach HR < 65 bpm. Both groups were followed for 1 year. Routinely clinic visits were performed every three months. The parameters derived by tonometric analy-sis of the pulse waveform (central blood pressure-cBP-, carotid-femoral-pulse-wave-velocity-cfPWV-) and those derived from echocardiography: ejection frac-tion (EF-for systolic function), E/e’ (for diastolic function), and LV end diastolic volume (LV-eDV) were evaluated at beginning and after one year.

Results: Both groups were similar for sex, age, BMI, and risk factors. HR was similar in both groups at beginning and it was decreased after one year only in IVA (66,4 ± 3.58bpm reduced-to 50,6 ± 1.17bpm, P < 0.05), and not in BETA (68.56 ± 4.39bpm vs 67.25 ± 4.17bpm). Peripheral (pBP) and central (cBP) blood pressure were similar at basal in BETA vs IVA (pBP:112,7 ± 4.69/70,22 ± 3.54mmHg vs 116.1 ± 4.2/67,7 ± 2.2mmHg; cBP:103,2 ± 5.23/70,78 ± 3.52mmHg vs 105.0 ± 4.3/68,57 ± 2.17mmHg) and were increased after one year only in BETA (pBP:135 ± 2.89/83,75 ± 4.73mmHg vs basal, P < 0.05; cBP:124.5 ± 4.48/84,5 ± 4.97 mm/Hg vs basal, P < 0.05). cfPWV was similar at beginning in both groups and it was increased only in BETA after one year (BETA:7 ± 0.5m/s increased-to 9.3 ± 0.9m/s, p < 0.05; IVA:7.5 ± 0.1m/s to 7.8 ± 0.7m/s, NS). EF, LV-eDV, and E/e’ were similar in BETA vs IVA (46.2 ± 2.8% vs 48.4 ± 2.6%; 179.6 ± 10.2 ml vs 162 ± 10.6 ml, and 6.1 ± 0.6 vs 7.6 ± 0.7, respectively) and did not change over time.

Conclusions: Ivabradine reduced HR more effi caciously with no hemodynamic effect, the uptitration of beta-blocker was less effective in reducing HR after one year follow-up in patients with LV dysfunction post-MI. This was associated with increased aortic stiffness. Thus, ivabradine seems highly effective in reducing HR in post-ischemic patients with LV dysfunction.

PP.04.31 ASSOCIATION BETWEEN IN-HOSPITAL

MORTALITY AND ANTI-HYPERTENSIVE THERAPY

IN A POPULATION OF HOSPITALIZED VERY

ELDERLY HYPERTENSIVES WITH UNDERLYING

UNDIAGNOSED HEART FAILURE

F. Spannella, F. Giulietti, P. Balietti, B. Bernardi, L. Landi, M. Ricci, G. Cocci, R. Sarzani. Internal Medicine and Geriatrics, Hypertension Excellence Centre of the ESH, IRCCS-INRCA, UNIVPM, Ancona, Italy

Objective: The diagnosis of heart failure (HF) in the very elderly is diffi cult also because of many comorbidities that may mask HF symptoms and signs. Our aim was to assess the prevalence of HF and its association with in-hospital mortality in relation with anti-hypertensive drugs taken before hospitalization, in a population of very elderly hypertensives.

Design and method: Prospective observational study on 265 very elderly hypertensives consecutively admitted to our Internal Medicine and Geriatrics Department. The other inclusion criteria were an admission diagnosis different from HF, a negative history for HF and the presence of at least one symptom/sign compatible with HF. HF diagnosis was based on NT-proBNP values at admission, with a validated age-adjusted cut-off (1800 pg/ml). The main co-morbidities, laboratory parameters and drugs taken before the admission were also considered.

Results: Mean age 87.7 ± 4.9 years. Males: 113 (42.6%). Values of NT-proBNP > = 1800 pg/ml were present in 55.8% of patients. Regarding the admission diag-nosis, patients with atrial fi brillation or acute renal impairment had increased risk of HF (OR = 2.26; p = 0.006 and OR = 2.18; p = 0.016, respectively). Values of NT-proBNP > = 1800 pg/ml were associated with a greater in-hospital mortality, regardless the admission diagnosis (OR = 2.63; p = 0.002). Analyzing the phar-macological therapy taken before admission, those who were already treated with ACE inhibitors or angiotensin receptor blockers had a lower in-hospital mortality, even after adjusting for covariates (OR = 0.41; p = 0.038): age, cancer, chronic bedridden, white blood cells count and glycaemia.

Conclusions: An underlying HF is very common in very elderly hypertensives hospitalized patients, regardless the medical causes of admission. Those who were already taking ACE inhibitors and angiotensin receptor blockers, confi rmed cornerstones of hypertension treatment, showed a lower in-hospital mortality indicating the importance of these drugs in the management of very elderly hypertensives.

PP.04.32 PHOSPHORUS DEFICIENCY IN MASSRY’S

PHOSPHATE DEPLETION SYNDROME CAN BE ONE

OF THE CAUSE OF ACUTE LEFT HEART FAILURE

Y. Sagliker1, S. O. Keskek2, S. Kirim2, Y. K. Icen2, A. Yildirim2, N. Paylar1, H. S. Sagliker3, P. Sagliker Ozkaynak1. 1Samedsa Ltd. Srk, Sagliker Hypertension and Nephrology Unit, Adana, Turkey, 2Numune Education and Training Hospital, Adana, Turkey, 3Cumra State Hospital, Konya, Turkey

Objective: In this study we investigated serum phosphorus levels in patients with acute left heart failure.

Design and method: A total of 215 participants, 115 patients with acute left heart failure and 100 controls, were enrolled in the study. Patients applied to emergency room with the complaints of heart failure were assessed by echo-cardiography. Ejection Fraction (EF) levels lower than 50% were accepted as heart failure. Paients with renal disorders, hyperparathyroidism, chronic hearth failure, alcoholism, intake of medications that alter phosphorus level were ex-cluded. Mean phosphorus levels of each group were measured and compared each other. SPSS 12.0 package program (SPSS Inc., Chicago, Illinois) was used for statistical analysis. Chi square test was used to compare categorical mea-sures between the groups. Mann Whitney U or T test was used for comparison of numerical measurements between the two groups. Level of statistical signifi -cance was considered as 0.05 in all tests.

Results: There were 148 (69%) women and 67 (31%) men in present study. The mean age was 52.6 years. Demographic characteristics of participants were not signifi cantly different between the groups. Mean EF levels of groups were 40.8 versus 60.0 respectively. The difference was statistically signifi cant (P < 0.001). Mean phosphorus levels were 3.01 versus 4.27 mg/dl respectively. There was sta-tistically signifi cant difference (P = 0.041) (Table 1).

Conclusions: Phosphorus is a major intracelluler constituent. The defi ciency of phosphorus can cause a variety of signs and symptoms. Myocardial creatine phosphate, ATP, and ADP levels reduce in case of phosphate defi ciency. In addition to these, mitochondrial and myofi brillar creatine phosphokinase ac-tivities also reduces. Alterations occur in mitochondrial oxygen consumption, acid-extractable phospholipid precursors, and mitochondrial oxidation of long

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e120 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

chain fatty acids due to phosphate depletion. All these effect heart muscles and can cause heart failure. Consequently phosphorus levels should be controlled in patients with acute left heart failure. Phosporus supplementation may be a supportive treatment.

PP.04.33 COVARIABLES AND TYPES OF ABNORMAL LEFT

VENTRICULAR GEOMETRY IN YOUNG AND

MIDDLE-AGED ISCHEMIC STROKE SURVIVORS –

THE NORWEGIAN STROKE IN THE YOUNG STUDY

S. Saeed1, U. Waje-Andreasen2, N. Pristaj3, Å. Oftedal3, H. Naess2, A. Fromm2, E. Gerdts3. 1Haukeland University Hospital, Department of Heart Disease, Bergen, Norway, 2Haukeland University Hospital, Department of Neurology, Bergen, Norway, 3University of Bergen, Department of Clinical Science, Bergen, Norway

Objective: Little is known about the prevalence and covariables of abnormal left ventricular (LV) geometry in younger ischemic stroke patients.

Design and method: We used clinical and echocardiographic data from 276 patients aged 15–60 years included in the Norwegian Stroke in the Young Study. LV hypertrophy (LVH) was defined as LV mass index >46.7 g/m2.7 in women and >49.2 g/m2.7 in men. Concentric remodeling was considered present if posterior wall thickness/LV internal diameter ratio was >/ = 0.43 in the absence of LVH. Arterial damage was assessed by mean common carotid intima-media thickness (IMT) and carotid-femoral pulse wave velocity (PWV).

Results: Abnormal LV geometry was found in 37% of patients. Concentric re-modeling was the most common abnormal LV geometry, found in 21%, while LVH was found in 16% (Table 1). In multivariable logistic regression analyses, LVH was associated with high for age PWV, higher body mass index, creatinine, and presence of diabetes and hypertension (all p < 0.05). Concentric remodeling was associated with higher mean carotid IMT, older age and absence of obesity (all p < 0.05).

Conclusions: In ischemic stroke survivors < 60 years of age, abnormal LV geom-etry was common. Concentric remodeling was found in 21% and associated with higher age and mean carotid IMT. LVH was found in 16% and associated with higher arterial stiffness, hypertension and diabetes

PP.04.34 NON-INVASIVE OSCILLOMETRIC CARDIAC

OUTPUT CALCULATION

A. Reshetnik, A. Schoelzel, F. Compton, M. Toelle, M. Zidek, M. van der Giet. Department of Nephrology, Charité University, Campus Benjamin Franklin, Berlin, Germany

Objective: To assess feasibility and accuracy of oscillometric cardiac output (CO) calculation.

Design and method: A prospective comparison of oscillometric CO determi-nations and reference themodilution CO measurements was performed in 38 intensive care unit patients (June 2015 to June 2016). Thermodilution CO was obtained using transpulmonary technique (PiCCO®, Pulsion Medical Systems, Feldkirchen, Germany), and oscillometric CO was calculated using the Tel-O-GRAPH® (TG) non-invasive blood pressure measurement and hemodynamic assessment device (IEM, Stolberg, Germany). CO was indexed to body surface area and is referred to as cardiac index (CI). Bland Altman analysis was em-ployed to assess differences between oscillometric and reference CI as well as non-invasive (TG) and invasive (PiCCO®) blood pressure (BP) measurements.

Results: Two-thirds of the study population was male (68.4%), mean age was 68 years. Almost all patients were mechanically ventilated (95%) at

study entry, and vasopressor therapy was required in 76%. Oscillometric CI determination yielded significantly lower results than the reference method (3.8 ± 1.22 l/min*m2 vs. 2.73 ± 0.50 l/min*m2, p < 0.0001) with a bias of 1.08 l/min*m2 and limits of agreement of ± 2.23 l/min*m2 (percentage error 62%). With TG, both measured brachial (117.5 ± 16.0 mmHg) and estimat-ed aortic (107.2 ± 15.6) systolic BP were significantly lower than invasive PiCCO® femoral BP (123.6 ± 17.4 mmHg, p = 0.005 and p < 0.0001) with a bias of 5.9 mmHg and 16.1 mmHg, respectively, and limits of agreement of ± 23.46 mmHg and ± 23.79 mmHg.

Conclusions: TG signifi cantly underestimates CO in hemodynamically unstable patients. This fi nding could in part be explained by the signifi cantly lower BP readings obtained with TG. In addition, Bland-Altman analysis revealed a linear relationship between CO values and divergence of TG CO from reference mea-surement (fi gure). A correction factor could potentially alleviate CO underestima-tion with TG, and thus make this noninvasive easy method of CO determination more reliable

PP.04.35 PREVALENCE AND OPREDICTORS OF

PULMONARY HYPERTENSION IN A GENERAL

COMMUNITY-BASED POPULATION

S. Quartuccio1, E. Imbalzano1, M. Vatrano2, A. Lo Gullo1, G. Mandraffi no1, R Ceravolo2, A. V. Ciconte2, G. Trapani1, G. Lizio1, A. Saitta1. 1Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy, 2UTIC and Cardiology, Hospital Pugliese-Ciaccio, Catanzaro, Italy

Objective: The exact prevalence of PH in Italy is not known. Echocardiography is useful in the screening of patients with suspected PH by estimation of the pulmo-nary artery systolic pressure (PASP) by regurgitant tricuspid fl ow velocity evalu-ation, according to the simplifi ed Bernoulli equation.

Design and method: We conducted a retrospective study to estimate the prevalence of PH in 7005 patients who underwent echocardiography. Clinical data and echocardiographic results were used to determine etiological group of PH. PH causality was coded using criteria and subcategories of the ESC classifi cations.

Results: The mean age of the study population was 57.1 ± 20.5 years with 55.3% male. The prevalence of intermediate probability of PH was 8.6%, with nearly equal distribution between men and women (51.3 vs 48.7 %; P = NS) whereas the prevalence of high probability of PH was 4.3%, with slightly but not signifi cant higher prevalence in female patients (43.2 vs 56.8; p = ns); PH is more prevalent in patients with chronic obstructive pulmonary disease (COPD) or left ventricle (LV) systolic dysfunction. PH prevalence increased with age. Also, sPAP was sig-nifi cantly associated with left atrial enlargement, left ventricular ejection fraction and, in addition, an increased sPAP was related to an enlargement of the right atrium and right ventricle.

Conclusions: PH as measured by echocardiography has low prevalence in our general population, but the estimates may be higher in specifi c subgroups. Analy-sis of the registry data could be an instrument for quality control and might help identify weak points in assessment and treatment of these patients.

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Abstracts e121

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved

SATURDAY

POSTERS

POSTER SESSION

POSTERS’ SESSION PS05:

LIFESTYLE, HYPERTENSION

MANAGEMENT AND RESISTANT

HYPERTENSION

PP.05.01 EFFECT OF LONG-TERM ENRICHED POTASSIUM

SALT INTAKE ON SALT REDUCTION IN CHINESE

LIVING IN NURSING HOUSES

X. Wang1, W. Li2, D. Li3, Y. Guo4, B. Zhang5, J. Zhao6, Y. Dong7, Y. Liu8, X. Dou9, H. Zhang9, L. Liu9. 1Dalian University, Dalian, China, 2Leting County Hospital, Leting, China, 3Wuxiang County People’s Hospital, Wuxiang, China, 4Wuchuan County People’s Hospital, Wuchuan, China, 5Shouyang County People’s Hospital, Shouyang, China, 6Weihai City Wendeng Area People’s Hospital, Weihai, China, 7Tunliu County People’s Hospital, Tunliu, China, 8Beijing Fangshan Traditional Chinese Hospital Yuehua branch hospital, Beijing, China, 9Beijing Hypertension League Institute, Beijing, China

Objective: To explore whether long-term enriched potassium salt intake (KCL/NACL = 1:1 by weight) can achieve the purpose of salt reduction in Chinese liv-ing in nursing houses.

Design and method: Participants were recruited from 28 nursing houses in 4 North-ern provinces and Beijing City in 2012. The nursing houses were then randomized into 2 groups: normal salt (control group) and enriched potassium salt (intervention group), Health education about the benefi ts of salt restriction were provided for all par-ticipants. The follow-up visits including questionnaire and spot urine collection were carried out in 24–31 month and 48 month. The contents of questionnaire included the consumption of various high salt materials and number of dinners in the last month, the average salt intake per person per day at baseline and follow-up visits were calcu-lated according to food composition table. The results of spot urine electrolytes and the salt consumption at baseline and follow-ups were used for data analysis.

Results: Totally 2779 participants (intervention group 1336, control group 1443) were included in this study. The average salt intake per person per day for intervention group and control group at baseline were 12.86 ± 4.80 g and 12.58 ± 2.85 g respectively p = 0.85. No difference were found between average salt intake of two follow-up visits of control group with that at baseline (p = 0.69 and p = 0.59). But, the salt consump-tion were decreased in intervention group to 6.89 ± 1.78 g (24–31month follow-up), 8.75 ± 3.34 g (48 month-follow-up), p < 0.001 compared with baseline. Urinary sodi-um potassium ratio (UNA/K) between control and intervention groups at baseline were 7.86 vs. 8.22, p = 0.12. While, at 48th month follow-up, the UNA/K of intervention group was signifi cantly lower than control group 2.46 ± 1.71 vs. 4.21 ± 2.27, p < 0.001.

Conclusions: Our study demonstrated that long-term enriched potassium salt in-take can reduce dietary salt consumption and urine sodium potassium ratio. It might be an effective way for dietary salt restriction. Present data were from the cafeteria staff self-report and spot urine, further verifi cation by 24 hours urine specimens were necessary.

PP.05.02 TELEHEALTH AND REMOTE MEASUREMENT

TECHNOLOGIES TO IMPROVE THE MANAGEMENT

OF OVERALL CARDIOVASCULAR RISK (TELE-

REMETRI STUDY)

P. Zelveian1, J. Topouchian1,2, Z. Hakobyan1, D. Altunyan1, D. Freiha2, R. Asmar2,3. 1Center of Preventive Cardiology, Yerevan, Armenia, 2E-CoreLab, Paris, France, 3Foundation-Medical research Institutes, Geneva, Switzerland

Objective: Telemedicine system for chronic disease management is being pro-posed in many countries since many years. These systems impact the patient behaviour, medication-taking, and important physician behaviours: promoting medication regimen adherence in patients and appropriately modifying therapy when existing therapy results in inadequate therapeutic effect. We recently launched a multicentre, prospective, cross-sectional study, aimed to evaluate whether a home telehealth system that allows the patient to monitor blood pressure (BP) and blood glucose (BG), with remote educational support and feedback to the general practitioner, can improve BP control and other risk

factors, metabolic control, overall cardiovascular risk and medication adherence in hypertensive individuals, as compared to usual practice.

Design and method: 300 patients with uncontrolled hypertension and who are fol-lowed by primary care physicians will be randomized to either a “usual care group’’ or a “telemedicine group’’. Participants will receive validated electronic BP and BG measuring device connected through GPRS (FORA DUO ultima D40 g). They will self-test BP, BG and results will be uploaded and transmitted directly via a home telehealth system to a central database. Transferred data are integrated in the patient’s fi le in “e-CoreLab system’’ and will be available to the center team. Ab-normal 1 week adjustable mean values for BP and BG will be notifed and relevant abnormalities will trigger an alarm which will be sent to the investigator by SMS or e-mail. A virtual visit (phone call or video) will take place at least every 2 weeks, according to the alert trigger and objective deviation in the group receiving the phar-macological treatment with Telehealth Solution. Clinical examination, biology as-sessment and 24 hour Ambulatory BP Monitoring (BP-Lab® or Mobil-graph®) will be done at baseline and during the follow-up period (6 months).

Results: Results are expected to be available by 2018.

Conclusions: We hypothesize that more subjects in the telemedicine group will achieve BP and BG goals than in the control group. This will occur through in-creases in knowledge, self-management, shared decision-making, and improved doctor-patient interaction. We believe that telemedicine can facilitate patient care and in a cost effective manner.

PP.05.03 EVALUATION OF DRUG CONTROL EFFICACY

OF ARTERIAL HYPERTENSION IN THE PRIMARY

HEALTHCARE SYSTEM OF YEREVAN

P. Zelveian, Z. Hakobyan. Center of Preventive Cardiology, Yerevan, Armenia

Objective: Aim of the presented study was an evaluation of drug control effi cacy of arterial hypertension (AH) in the Primary Health Care (PHC) system of Yere-van city (Armenia).

Design and method: Cohort of 1532 patients with AH, which had been followed up by PHC system medical practitioners and received regular antihypertensive medications (monotherapy or combined treatment), without target blood pressure (BP) level achievement. Patients were defi ned as uncontrolled AH, when systolic (SBP) and diastolic BP (DBP) levels exceeded 140 and 90 mm Hg, respectively, in a result of three different visits. Statistical analyzes were conducted with IBM SPSS v.22 software. P value of < 0.05 was considered as statistically signifi cant.

Results: 507 men and 1025 women with 64.2 ± 10.6 and 64.5 ± 9.7y mean ages, without gender differences (p = 0.54), were analyzed. A number of 80y and more aged patients were 86 (5.6%; 95% CI 4.6, 6.9%) among examined indi-viduals. Mean levels of SBP for men and women were 166.9 ± 17.4 mmHg and 167.0 ± 16.1 mmHg accordingly, without gender differences (p = 0.92). In ad-dition, there wasn’t observed any statistical difference for mean values of DBP 97.6 ± 10.4 mmHg and 97.6 ± 9.9 mmHg accordingly (p = 0.96). Distribution of uncontrolled AH according to the age groups stated that 60–79 aged individu-als prevailed in a group of patients having uncontrolled AH. Number of such individuals was 947 (61.8%; 95% CI 59.4, 64.2%), without gender differences (p = 0.35). Antihypertensive treatment analysis showed that angiotensin convert-ing enzyme (ACE) inhibitors were assigned in more than 80% of cases of mono-therapy equally for both men and women, meanwhile the most frequent antihy-pertensive drug combination was ACE inhibitors and thiazide like diuretics (more than 30% of cases for all combinations), which amounted 20.5% of the cohort.

Conclusions: Drug control effi cacy of AH still remains incompletely y realized in the primary healthcare system of Yerevan as there is a huge prevalence of patients with uncontrolled AH. This testifi es that up to now PHC system medical practitio-ners insuffi ciently use rational combinations of antihypertensive drugs.

PP.05.04 A GAP BETWEEN SELF-ASSESSMENT AND

SCREENING SURVEY RESULTS AMONG ARMENIAN

POPULATION WITH UNCONTROLLED ARTERIAL

HYPERTENSION

P. Zelveian1, L. Dheryan2, D. Andreasyan3. 1Center of Preventive Cardiology, Yerevan, Armenia, 2Yerevan State Medical University after M. Heratsi, Yerevan, Armenia, 3National Institute of Health, Yerevan, Armenia

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e122 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

Objective: The aim of our study was to estimate a gap between self-assessment and screening survey results among Armenian population with uncontrolled arte-rial hypertension (HT).

Design and method: Cross-sectional survey conducted in Yerevan and 10 regions of Armenia. A multistage stratifi ed random cluster sampling was used to include the individuals. Totally, 1561 individuals were included in the study. Previously trained general practitioners implemented a standardized questionnaire including demographic data and risk factor information. Physical examinations included blood pressure (BP) and anthropometric measurements. HT was defi ned as sys-tolic and diastolic BP (SBP, DBP) levels equal or more 140/90mmHg, or self-reported treatment with antihypertensive medication.

Results: According to the self-assessment data, the antihypertensive treatment re-sulted in decrease of BP up to target levels in 236(77.6%) individuals, 5(4.9%) were undecided and only 53(17.4%) reported about the failure of the own BP control. Only 69(22.7%) and 109(35.9%) respondents with supposing controlled HT had controlled SBP and DBP levels accordingly. The controlled DBP indicators have been signifi -cantly higher than SBP ones in 16.9% and 11.9% of cases accordingly. There is a signifi cant gap between BP regulation self-assessment and SBP, DBP screening indi-cators accordingly 41.5 and 32.1% among women receiving treatment. Among regu-larly treated patients a gap between BP regulation self-assessment and BP screening indicators was observed only in 50–64 age group with 26.4% systolic and 18.5% dia-stolic HT. There is a signifi cant difference only in actual values of systolic (41.5%) and diastolic (26.7%) HT and self-evaluation divergence among respondents with obesity. A gap between self-assessment of respondents and higher levels of uncontrolled sys-tolic and diastolic HT was obvious according to gender monitoring, meanwhile the mentioned indicators were signifi cantly higher among women 42.6% vs. 12.7% and 23.1% vs. 8,4% accordingly. There was a 4.4% gap only for systolic HT among smok-ers. Alcohol abuse and excessive dietary salt consumption weren’t been determinants for evaluation of differences between the studied indicators.

Conclusions: There is an obvious gap between indicators of self-reported and re-ally screened cases for uncontrolled HT, which can be the basic and serious reason for ineffective control of BP in Armenian population.

PP.05.06 SLEEP AS A MEDIATOR OF THE BLOOD PRESSURE

LOWERING EFFECTS OF LOW DOSE ASPIRIN

H. Yang, M. Haack, J.M. Mullington. Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA

Objective: Long-term administration of low-dose aspirin has been shown to de-crease blood pressure (BP) only when taken at bedtime (before sleep), not day-time. However, the underlying mechanisms are unknown. The objective of the present study was to investigate whether or not sleep plays a role in lowering BP following bedtime administration of low-dose aspirin.

Design and method: Seven healthy participants completed two in-hospital stays to run through the experimental protocol. Prior to each in-hospital stay, participants took placebo or aspirin (81 mg) at bedtime (within 2 h before sleep) for 2 weeks. During both in-hospital stays, participants were permitted 8 h sleep on the fi rst night (D1), and on the following two nights (D2 and D3) were exposed to interrupted sleep (40 min sleep opportunity and 20 min experimental awakening monitored by staff, repeated between midnight and 6am). Electroencephalogram and ECG were recorded for 24 h on the fi rst night (D1: consolidated sleep) and third night (D3: interrupted sleep).

Results: Slow wave sleep was reduced from D1 to D3 (-11 minutes) in placebo but was slightly increased during the aspirin condition (+2 minutes). There was a signifi cant difference in the delta changes (D1vsD3) between placebo and aspirin stays (p = 0.037). Twenty-four hour heart rate was not different between placebo and aspirin on D1, but heart rate was higher in the placebo than aspirin following interrupted sleep (D3 (p = 0.024)).

Conclusions: The preliminary data suggest that 2 weeks of aspirin at bed-time may preserve slow wave sleep and prevent increase in heart rate when sleep is interrupted. The fi ndings implicate sleep as a mediator of the blood pressure low-ering effects of bedtime low-dose aspirin.

PP.05.07 RESULTS FROM THE FOLLOW-UP OF PATIENTS

WITH RENAL DENERVATION FOR SEVERE

HYPERTENSION

T. Yaneva-Sirakova, K. Karamfi loff, L. Dosev, V. Naunov, J. Stoykova, D. Vassilev. Medical University Sofi a, Department of Internal Medicine, Cardiol-ogy Clinic, Sofi a, Bulgaria

Objective: The benefi t from renal denervation (RDN) is still debatable. Real-world results from the every-day practice are needed. These are the results of a single center.

Design and method: This is a follow-up of the 8 patients treated with RDN - radiofrequent ablation (Symplicity Spyral) of the left and right renal arteries in a single center in Eastern Europe. All of the patients were with diffi cult to treat hypertension. The hypertension history of all was more than 10 years. Secondary causes were excluded. They were followed with offi ce-, home- and ambulatory blood pressure monitoring on the 1-st, 6-th and 12-th month with no major change of the therapy until the 12-th month. The mean age was 62.37 ± 9.85 years. 4 (50%) were males. The mean number of medication used was 5 (4 medications), at least one diuretic. The mean home measured blood pressure values on inclu-sion were 175.00 ± 7.56 mmHg for the systolic and 96.25 ± 5.17 mmHg for the diastolic. Laboratory testing, echocardiography, 24-hour ECG monitoring, ABI, coronary angiography and carotids ultrasound were also conducted. 4 (50%) of the patients had non-severe renal artery stenosis.

Results: There was a hyper-acute response with a profound blood pressure reduc-tion to below 140/90 mmHg and even less in the fi rst 24 hours after the procedure with a gradual return to the pretreatment values in the next 24 hours. The mean follow-up was 8.5 months (min. 5 months, 5 of the patients 12 months). There was a signifi cant reduction in the mean home measured blood pressure values to153.12 ± 24.34 mmHg for the systolic and 85.62 ± 9.80 mmHg for the diastol-ic (p < 0.0001). Two of the patients needed reduction of their antihypertensive therapy on the long-term. Two of the patients were non-responders. The common between them was BMI > 30 kg/m2 and longer hypertension history.

Conclusions: Renal denervation may still be effective in properly selected pa-tients. Larger samples are needed to properly defi ne responders to treatment.

PP.05.08 SANSHOOL COMPOUNDS ACTIVATES SALT-TASTE

IN HYPERTENSIVE PATIENTS

N. Yamamoto1, T. Mitani1, H. Mimura1, T. Tsuchida1, N. Miyai2, H. Kobayashi2, M. Arita2. 1Wakayama University, Wakayama, Japan, 2Wakayama Medical University, Wakayama, Japan

Objective: In Japan, reducing the consumption of miso soup and Japanese pick-les, both traditional Japanese dishes, is recommended in order to decrease dietary salt intake. With the Westernization of dietary habits, however, these dishes are now consumed frequently, and thus a reduction in their effect on sodium intake is necessary. Sanshool compounds are major active ingredients of Japanese pepper (Zanthoxylum piperitum) which are used as food additives in East Asia. Sanshool compounds cause irritant, tingling and sometimes paresthetic sensations on the tongue. This study examined associations between the frequency of intake of miso soup and Japanese traditional foods with salt restriction (pickled, seasoned cod roe and salmon) and Sanshool compounds using data obtained from hypertensive patients.

Design and method: 31 persons (16 hypertensive and 15 normotensive, age 25–80y.o) were enrolled in this study. All persons were received salt restriction edu-cation before the study. They had miso soup and Japanese traditional foods with salt restriction (pickled, seasoned cod roe and salmon) in small dishes. Then after, they licked with tongue 1 mg peel of Japanese pepper tablet. After 5–10 min, they ate the same traditional foods. They answered the self-administered questionnaire (seasoning fl avoring, seasoning with salt, level of satisfaction). In some hyperten-sive cases, we measured urinary Na/K ratio.

Results: In hypertensive patients, blood pressure was 140.4 ± 11.7/83.2 ± 6.9 mmHg. After Wilcoxon signed rank test, all persons demonstrated that season-ing fl avoring, seasoning with salt signifi cantly increased with deep feeling after sanshools tablet with miso soup, pickled with Japanese apricot, seasoned cod roe and salmon). There were no signifi cant changes in level of satisfaction with seasoned cod roe and salmon. There are no differences between normotensive subjects and hypertensive patients. We showed seasoning fl avoring, seasoning with and level of satisfaction in Table. Urinary Na/K ratio (4.78 ± 0.79) was sig-nifi cantly reduced, but blood pressure did not change in hypertensive patients after sanshools tablet.

Conclusions: These results clearly demonstrated that Sanshools increased deep feeling of seasoning fl avoring and seasoning with salt. Sanshool compounds might be effective to salt reduction in hypertensive patients.

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Abstracts e123

PP.05.09 THE EFFECT OF CATHETER BASED RENAL

SYMTHETIC DENERVATION ON RENIN-

ANGIOTENSION-ALDOSTERONE SYSTEM IN

PATIENTS WITH RESISTANT HYPERTENSION

M. Xu, C. Lu. Tianjin First Central Hospital, Tianjin, China

Objective: To explore the effect of catheter based renal symthetic denervation on renin-angiotension-aldosterone system (RAAS) and blood pressure reduction in patients with resistant hypertension, and assess the validity and security of the treatment.

Design and method: Ten patients with resistant hypertension from June 2011 to December 2011 were retrospectively reviewed, and then all of ten patients screened for eligibility were allocated to renal denervation. Primary endpoints were changes of offi ce blood pressure at 1 week, 1,3 and 6 months after proce-dure. We assessed the effectiveness of renal sympathetic denervation with heart rate (HR), renin activity (PRA), angiotension II (Ang II), aldosterone (Ald), and cretinine (Cr) before and 2 weeks after procedure.

Results: Offi ce blood pressure after catherter-based renal denervation decreased by 22.8/9.1mmHg (1mmHg = 0.133kPa), 34.8/14.7mmHg, 42.6/20.7mmHg, 43.2/21.6mmHg, at 1 week, 1,3 and 6 months, respectively (P < 0.001). Mean-while, the level of PRA, Ang II, Ald decreased by (1.11 ± 0.89)ng•ml-1•h-1 (P = 0.003), (17.06 ± 13.82) ng/L (P = 0.004), (404.5 ± 285.8) ng/L (P = 0.002), respectively; and heart rate decreased by 5.1 bpm (P = 0.002). However, the Cr level and eGFR did not change signifi cantly (P>0.05).

Conclusions: Catheter-based renal sympathetic denervation can reduce the level of renin activity, angiotension II and aldosterone, and causes substantial and sus-tained blood-pressure reduction.

PP.05.10 BLOOD PRESSURE LOWERING AND SELF-

REPORTED ADHERENCE WITH A FIXED-DOSE

COMBINATON OF PERINDOPRIL/AMLODIPINE IN

PRIMARY CARE: A NON-INTERVENTIONAL STUDY

F. P. Limbourg1, B. Weger2, H. Haller3. 1Vascular Medicine Research, Hypertension Center, Dept. of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany, 2Servier Deutschland GmbH, Munich, Germany, 3Hypertension Center, Dept. of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany, Hannover, Germany

Objective: To investigate the effect on blood pressure (BP) and adherence to med-ication after 3 months of therapy with a fi xed-dose combination of Perindopril/Amlodipine (PER/AMLO, 3.5/2.5 mg or 7/5 mg) in hypertensive patients.

Design and method: We performed a prospective, non-randomized study on the effect of 3 months of therapy with single-pill PER/AMLO medication in patients with hypertension who were previously untreated or required a change in medication. Changes in BP were assessed by offi ce BP, home BP, and 24-h BP monitoring. Adherence was measured with the Hill-Bone medication adher-ence scale.

Results: 1814 patients (830 women, 45,8%) were enrolled, mean age was 60.0 years, 16.5 % were older than 75 years, mean body mass index was 28.9 kg/m2. 1770 patients completed the 3 months follow-up, 46.0% of patients were previously untreated. Home BP was available from 1279 patients, 24-h BP was available from 167 patients. Hill-Bone questionnaire at 3 months was avail-able from 92.4% of patients. 97.7% of patients were initiated with 3.5/2.5 mg PER/AMLO, 34.7% were up-titrated to 7/5 mg after a mean time of 32.9 days. 68.5% of patients had no other antihypertensives, the most prevalent co-medi-cation were betablockers (22%). After 3 months of therapy, offi ce systolic BP (SBP) decreased from 163.6 ± 14.8 to 133.6 ± 11.9 mmHg and diastolic BP (DBP) from 95.4 ± 9.4 to 80.3 ± 7.7 mmHg (p < 0.0001 for all BP changes). Hypertension control rate with PER/AMLO was 72.3%, overall response rate was 69.1%. Home SBP decreased from 160.6 ± 14.9 to 130.9 ± 11.8 mmHg and DBP from 93.6 ± 9.5 to 79.4 ± 7.6 mmHg (p < 0.0001). 24-h SBP decreased from 150.6 ± 12.6 to 132.4 ± 11.9 mmHg and DBP from 88.9 ± 8.8 to 79.4 ± 8.5 mmHg. Mean daytime SBP/DBP decreased from 157.80 ± 13.23/92.65 ± 9.49 mmHg to 138.03 ± 12.37 /82.40 ± 8.76 mmHg. Mean nighttime SBP/DBP decreased from 141.77 ± 14.29/83.49 ± 10.60 mmHg to 124.60 ± 13.06/74.53 ± 9.72 mmHg (p < 0.0001). Perfect adherence (all questions of the scale answered with ‘none of the time’) at 3 months was 47.2%, and perfect adherence among pretreated patients improved from 20.6% to 43.6% after 3 months.

Conclusions: PER/AMLO in single-pill combinations can be successfully used in patients with hypertension previously untreated or unsuccessfully treated and shows signifi cant improvement in adherence.

PP.05.12 DRUG NON-ADHERENCE AS MAJOR CAUSE OF

SEVERE HYPERTENSION AT THE EMERGENCY

DEPARTMENT

N. Overgaauw1, J. Alsma1, A. Brink1, S. Bahmany2, A. H. van den Meiracker1, S. C. E. Schuit1, B. C. P. Koch2, J. Versmissen1. 1Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands, 2Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands

Objective: Severe hypertension is frequently encountered in the emergency department (ED). To distinguish hypertensive urgency (HU) from hypertensive emergency (HE) is essential, as in HE rapid blood pressure (BP) lowering is para-mount to prevent progressive organ damage. Medication non-adherence is consid-ered to be an important risk factor for developing HE or HU, but exact numbers are lacking. The objectives of our study were (1) to retrospectively examine the incidence of HU and HE and to identify characteristics aiding in the differentia-tion between HU and HE and (2) to prospectively assess the incidence of medica-tion non-adherence in severe hypertension.

Design and method: We (1) retrospectively analyzed patients with systolic blood pressure (SBP) of 180 mmHg or higher and diastolic blood pressure (DBP) 110 mmHg or higher who presented at our ED in 2012–2015 and performed (2) a prospective study in patients presenting at the ED with SBP 180 mmHg or higher or DBP 120 mmHg or higher from September to December 2016, in whom we measured plasma drug levels of prescribed antihypertensive drugs.

Results: We included 1126 patients in the retrospective analysis. In preliminary analyses of 700 patients, 255 (36,4%) patients met the criteria for HE and 147 (21%) for HU. Mean SBP (SD) was 203 mmHg (±18.1) and mean DBP 121 mmHg (±12). Mean age was 58 (±18) years; 54.5% were male. Of 352 patients who were previously prescribed antihypertensive drugs, 193 patients had 2 or more antihypertensive drugs. In the preliminary analysis of 22 patients of the prospective study, 6 patients were non-adherent for at least one of the prescribed antihypertensive drugs, whereas 4 patients were completely non-adherent for mul-tiple antihypertensive drugs.

Conclusions: Of all patients previously prescribed antihypertensive drugs, almost one third appeared non-adherent for at least one drug. Combining these results with the results of our retrospective study, where 28% of patients had already been prescribed two or more different antihypertensive drugs, the role of non-adherence in the etiology of HU or HE at the ED is considerably, pressing the importance to improve drug adherence to save costs and disease burden.

PP.05.13 ADVERSE EFFECTS OF SPIRONOLACTONE

DURING LONG-TERM TREATMENT OF RESISTANT

ARTERIAL HYPERTENSION

J. Vaclavik1, D. Tavacova2, E. Kocianova1, M. Kamasova1. 1Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Palacký University Faculty of Medicine, Olomouc, Czech Republic, 2Palacký University Faculty of Medicine and Dentistry, Olomouc, Czech Republic

Objective: Spironolactone had relatively few adverse effects in short term clini-cal trials, but data about their occurrence during long-term treatment of resistant hypertension are scarce.

Design and method: We retrospectively analysed medical records of patients with resistant arterial hypertension, who are followed-up at our department and were prescribed spironolactone between September 2007 and May 2015. We as-sessed the length of spironolactone use, dosage, side effects, blood pressure and biochemical fi ndings at the last clinical visit at our department.

Results: We analysed a total of 199 patients who used spironolactone for a mean time of 32 months. The mean dose of spironolactone was 28.4 mg/day. Adverse effects occurred in 46 patients (23.1 %) after a mean of 22 months of treatment and in all but two patient lead to discontinuation of spironolactone (44 patients, 22.1 %). The most common adverse effects were gynecomastia (14 patients), hy-perkalemia (13 patients), symptomatic hypotension (11 patients), mastodynia (3 patients) and impotence (2 patients).

Conclusions: Adverse effects occur during long-term treatment of resistant hy-pertension by spironolactone almost in a quarter of patients and usually neces-sitate discontinuation of this treatment. This work was supported by Palacký University in Olomouc internal grant IGA_LF_2016_038.

PP.05.14 IS RESISTANT HYPERTENSION IN ELDERLY A

CLINICAL MANIFESTATION OF HFPEF?

E. Turkoglu. Izmir Kemalpasa State Hospital, Izmir, Turkey

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e124 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

Objective: Resistant hypertension is defi ned as high blood pressure despite treat-ment with at least 3 different class of antihypertensive drugs at best tolerated doses. One of the antihypertensive drugs has to be diuretic by defi nition. Resistant hypertension is a common clinical problem, the exact prevalence is not known. Pseudo resistance (poor medical adherence, white coat hypertension) must be excluded. As a subgroup, resistant hypertensive patients have not been studied widely. The present study has investigated if the resistant hypertension in elderly is a clinical presentation of HFpEF.

Design and method: The outpatient data of 661 patients < 65 years and 254 pa-tients > 65 years, who applied between 1–30 th of April 2015 to the cardiology clinic of the Kemalpasa state hospital, is reviewed. The patients with pseudo re-sistant hypertension (i.e. poor adherence to medical therapy, inadequate dosage, white coat hypertension), secondary hypertension (i.e. chronic renal or renovas-cular disease), heart failure reduced EF are excluded. All the resistant hyperten-sive patients have had an echocardiogram, renal Doppler exam, NT-proBNP level, routine biochemistry and urine exam. 58 patients are identifi ed as true resistant hypertensive and have had EF>50, no moderate to severe valvular disease, no renal dysfunction. The present study has investigated if the NT-proBNP levels in the resistant hypertension differs with age.

Results: The mean age was 63 ± 11 years. 49 of patients were younger and 9 were older than 75 years. The cut-off levels for NT- proBNP were accepted as <300 pg/ml for patients younger than 75 years and <600 pg/ml for patients older than 75 years. The median NT-proBNP level was signifi cantly higher in the older group (p < 0,05) whereas the median NT-proBNP level was within normal limits in younger group.

Conclusions: Resistant hypertension could be the clinical manifestation of vari-ous diseases with different etiology. Resistant hypertension in older patients can be a clinical presentation of HFpEF and should be investigated and treated ac-cordingly. Because of one-center results and limited number of patients, further studies are needed.

PP.05.15 THE IMPACT OF SWITCHING FROM PROTOTYPE

TO GENERIC ATORVASTATIN ON PERSISTENCE

AND COMPLIANCE IN GREECE: THE LIPID STUDY

A. Kasiakogias, C. Tsioufi s, K. Kyriazopoulos, G. Annousis, D. Aragiannis, K. Dimitriadis, D. Tousoulis. First Cardiology Clinic, University of Athens, Hip-pokration Hospital, Athens, Greece

Objective: To investigate the effect of switching from prototype to generic atorv-astatin on adherence in hypercholesterolemic patients newly treated with atorvas-tatin under real life clinical conditions.

Design and method: We conducted a non-interventional, ambispective, single-center, cohort study in Greece between May 2015 and October 2016. All adult hypercholesterolemic patients from the largest hypertension clinic in Greece with

a documented fi rst prescription with a prototype atorvastatin during a 6-month index period were screened retrospectively. Patients that either received a second prescription of prototype atorvastatin or switched to a generic version of atorvas-tatin were identifi ed as the potential study pool. A random sample of 190 patients equally split in two cohorts comprised the study population, and were followed up prospectively. Persistence to treatment was assessed by time to discontinu-ation. Compliance was assessed by both the proportion of days covered (PDC) through the offi cial Governmental e-prescribing system and the self-administered Morisky Medication Adherence Scale (MMAS-4). Finally, treatment satisfaction was measured with the self-administered Treatment Satisfaction Questionnaire for Medication (TSQM).

Results: As per protocol 190 patients were enrolled in the study, 95 in each co-hort. There were no statistically signifi cant differences between cohorts regarding baseline characteristics, while all patients were hypertensive. The 18-month sur-vival probability estimates were 90.2% and 76.4% for the non-switch and switch cohort respectively (HR = 0.574, p = 0.1627). Non-switchers were more compli-ant than switchers as measured by both PDC (79.1% vs. 73.0%, p < 0.001) and MMAS-4 scale (percent reporting high adherence: 73.7% vs. 26.3%, p < 0.001) and presented better results in TSQM dimensions (convenience: 65.9 vs. 62.3, p < 0.001, effectiveness: 68.2 vs. 62.9, p < 0.001, side effects: 98.7 vs. 98.4, p = 0.945, global satisfaction: 67.5 vs. 57.5, p < 0.001).

Conclusions: Switching from a prototype to generic atorvastatin was associated with impaired persistence, compliance and treatment satisfaction in newly treated hypercholesterolemic patients. This new data provide a basis for further research to better understand adherence behavior.

PP.05.16 EFFECT OF RENAL SYMPATHETIC DENERVATION

ON SHORT TERM BLOOD PRESSURE VARIABILITY

IN RESISTANT HYPERTENSION. A SYSTEMATIC

REVIEW AND META-ANALYSIS

N. Vogiatzakis, C. Tsioufi s, G. Georgiopoulos, C. Thomopoulos, K. Dimitriadis, A. Kasiakogias, D. Konstantinidis, Th. Kalos, M. Doumas, V. Papademetriou, D. Tousoulis. First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece

Objective: Short-term blood pressure variability (BPV) is affected by multiple factors including the sympathetic nervous system drive. Regarding the latter, the novel interventional technology of renal denervation (RDN), by modulating the sympathetic system activation, could have a benefi cial impact on BPV. The aim of the present study is to review and meta-analyze the available evidence on the effect of RDN on short term BPV.

Design and method: We searched Medline/PubMed database until October 2016 for studies with eligible content.We performed random-effects meta-analyses for 10 outcomes of interest: a) the standard deviation (SD) of systolic blood pressure (SBP) (24-h, daytime and nighttime) b) the SD of diastolic blood pressure (DBP) (24-h, daytime and nighttime) c) the coeffi cient of variation of SBP (24-h,daytime) and d) the average real variability of SBP and DBP across 24-h.

Results: RDN reduced the standard deviation (SD) of systolic blood pressure (SBP) across 24-h (mean change in SD of 24-h SBP: -1.212 [95% confi dence intervals: -2.354/-0.071], p = 0.037) and marginally decreased the SD of systolic daytime BP (mean difference: -1.054 [95% confi dence intervals: -2.258/0.150], p = 0.086) and diastolic daytime BP(mean difference: -1.845[95% confi dence intervals: -3.675/-0.015], p = 0.048). The effect of RDN in reducing SD of SBP across 24-h or DBP across daytime was not infl uenced by absolute or relative reduction in SBP and DBP indices. (p>0.1 for all).

Conclusions: Catheter-based RDN in resistant hypertensive patients can favor-ably affect short-term BPV, independent of the level of BP reduction. Further investigation of the effect of RDN on BPV is needed in large randomized trials.

PP.05.18 TREATMENT OF “BULGARIAN HYPERTENSIVE

PATIENT’’ – GUIDELINES VERSUS REAL LIFE

PRACTICE

V. Tsanova1, E. Goshev2. 1National Multiprofi le Transport Hospital, Sofi a, Bulgaria, 2Medical Institute of Minestry of Interior, Sofi a, Bulgaria

Objective: To investigate how far real situation of evaluation and treatment of outpatients with arterial hypertension coincides with the requirements of the con-temporary guideline of ESC/ESH.

Design and method: Snapshot study, including 600 consecutive outpatients for 1 year (2015): 265 women (44%) and 335 men (56%). Age - from 18 to 70 years. All of them were referred for evaluation to cardiology practice, according to protocol of Bulgarian National Health Insurance Fund (NHIF) for treatment

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Abstracts e125

and follow up of patients with arterial hypertension by GP`s. The main source of information about their status and therapy was the personal medical fi le.

Results: I. Investigations (laboratory and instrumental techniques): No one patient had evaluation of microalbuminuria as marker of early cardiovascular damage; 8% of patients had carotid ultrasound; 15% of patients had serum uric acid; 18% of patients had fasting plasma glucose above 5,8 mmol/L without further tests to determine presence/absence of diabetes; only 38% of patients had blood pressure below 140/90 mm Hg; 80% of patients had lipid profile; 80% of patients had echocardiography II. Cardiovascular risk evaluation: 80% did not have cardiovascular risk evaluation. III. Lifestyle changes: 50 patients used step-counters and only 10 of them performed on the average over 6000 steps daily. IV. Pharmacological therapy: over 50% patients were treated with a combination of Beta-blocker and Diuretic as first choice without precise indications; approximately 50% of patients used fixed combinations – mainly ACEI/Diuretic and ARB/Diuretic, very often not as a first choice.

Conclusions: 1. The control of blood pressure in hypertensive patients is insuf-fi cient in spite of recommendations of NHIF. 2. Cardiovascular risk evaluation has not become integral part of routine care in outpatient settings. 3. Evaluation of glucose tolerance as fi rst step of diagnosis of Diabetes mellitus is often neglected. 4. The role of uric acid is neglected in the assessment of cardiovascular risk. 5. Beta-blockers combined with diuretics are still leading as fi rst choice of medi-cines to treat arterial hypertension.6. General practitioners prefer to use expensive and sophisticated methods as echocardiography rather than cheap and also infor-mative tests as microalbuminuria.

PP.05.20 INFLUENCE OF A PROGRAM OF THERAPEUTIC

EXERCISE IN DIFFERENT CLINICAL INDICATORS

RELATED TO DYSLIPIDEMIA IN ADULT SUBJECTS

FROM 26 TO 73 YEARS WITH A CARDIOVASCULAR

RISK FACTOR

P. Tarraga Lopez1, P. Rodriguez Garcia2, E. Garcia Canto2, J. Perez Soto2, A. Rosa Guillamon2, M. Meseguer Zafra2, R. Salmeron Rios1, M. Villar Inarejos1, E. Del Moral2, C. Celada4. 1EAP Zona5A, Albacete, Spain, 2Universidad Murcia, Murcia, Spain, 3Res Geriatrica Los Alamos, Albacete, Spain, 4Unidad Docente MFyC, Cartagena, Spain

Objective: to assess the infl uence of a program of therapeutic exercise in different clinical indicators related to dyslipidemia (cholesterol, HDL and LDL) among sedentary subjects with a cardiovascular risk factor.

Design and method: The sample was composed of 340 patients (132 men and 208 women) coming from two primary care centers in the town of Molina de Segura (Murcia), who participated in a 30 weeks exercise program combining strenght and cardiorespiratory training organized in a circuit training mode. As for the clinical indicators, the health professionals registered in the patient medical record those health indicators related to the biological evolution of the process by which the subjects had started the exercise program.

Results: Statistical analyzes show signifi cant improvement (p < 0.005) in the in-dicator of LDL and a nonsignifi cant improvement in indicators of total cholesterol and HDL after ending of a 3-month program of physical exercise with a frequency of 3 weekly sessions.

Conclusions: Therefore, prescribing exercise in dyslipidemic subjects from pri-mary care centers should be considered as a resource for improving own clinical indicators of disease.

PP.05.21 RATE OF CLINICAL FACILITY VISITORS AMONG

THOSE WHO WERE SUGGESTED TO HAVE

TREATMENT OR DETAILED HEALTH EXAMINATION

K. Takeda, J. Moriguchi, S. Sakuragi. Kyoto Industrial Helath Association, Kyoto, Japan

Objective: The Occupational Safety and Health Law in Japan stipulates that employers provide routine health examination (mostly once a year) to their em-ployees. Theoretically such opportunity is valuable for early detection of health problems. The effi cacy is however seldom evaluated in practice. It is the purpose of this study to examine how the examinees take advantage of the examination results for their own health care.

Design and method: Health examination reports on fasting blood glucose (FBG), blood pressure (BP) and serum LDL-C (LDL) were collected for 1400,000 rou-tine health examination examinees (at the ages of 30 s to 50 s; men and women combined). Indications on health problems were informed to the individuals with due privacy protection.

Results: Indications such as ‘treatment‘ or ‘detailed examination’ were given to 49.214 individuals, i.e., 697, 11,054 and 36,463 subjects were informed of the elevation in FBG (>126 mg/dl), BP (SBP > 160 mmHg and DBP > 100 mmHg) or LDL (>140 mg/dL) (the criteria in parentheses). Never-theless, only 25.8%, 12.7% and 9.4% of the subjects informed of the respective pathology visited medical facilities (for treatment or further detailed exami-nation) within one year after the examination. The response rate was usually higher for men than for women, and better for younger people (i.e., 30’s) than for the aged (i.e., 50’s).

Conclusions: People with pathology in FBG, BP or LDL often do not take the notice seriously enough and do not visit medical facilities for health care. The poor respect of the examination results reduces the value of the health examination to detect diabetes mellitus, hypertension, and hyperlipidemia for early treatment. Efforts are necessary to call for close attention for health in daily life.

PP.05.22 PHYSICAL ACTIVITY IN MEN WITH ARTERIAL

HYPERTENSION FROM THE WARMIA NAD

MAZURY REGION IN POLAND

P. Zielecki1, M. Szczubelek1, J. M. Harazny1,2, N. Kwella3, T. Stompor3. 1Department of Pathophysiology, University of Warmia and Mazury, Olsztyn, Poland, 2Clinical Research Center, Department of Nephrology and Hypertension, University Erlangen-Nuremberg, Erlangen, Germany, 3Department of Nephrology and Hypertension, University of Warmia Nad Mazury, Olsztyn, Poland

Objective: To investigate relationships between regular physical activity (ACT), arterial blood pressure and selected biochemical parameters in the men of the Warmia and Mazury region in Poland.

Design and method: Data were collected from 308 men aged between 21–77 (46.3 ± 11.9) years between Dec. 2014 and Dec. 2015. Health questionnaire was completed for 304 subjects. Blood pressure was measured according to the ESH/ESC guidelines. Lab tests (serum glucose, triglycerides, HDL-, LDL- and total cholesterol, serum creatinine) were measured in a certifi ed labora-tory. Analyses were performed separately for three groups depending on ACT: ACT+ (subjects that do sports at least 3 times a week, go walking or do gym-nastics every day for at least 30 minutes, i.e. who met the WHO physical activ-ity criteria; WHO+), ACT- (do sport/gymnastics or go walking occasionally or never) and ACT+/- (moderate activity, i.e. between ACT+ and ACT-). Three age groups were defi ned: < 40, 40–60, >60. The SPSS V.23 Software was used for statistical analyses.

Results: 28.9% of men meet the activity level recommended by the WHO. Regarding to age groups: < 40, 40–60, >60 in ACT+ it was 25.0%, 28.7% and 31.7% of men. In < 40 age group PP in ACT+ was significantly high-er in comparison to ACT- (49.7 ± 11.0 vs 43.9 ± 5.7mmHg, p = 0.02), due to the trend to lower DBP values in ACT+ group (82.1 ± 8.7 vs 86.0 ± 8.7 mmHg, p = 0.063). No significant difference was found in systolic, diastolic and mean arterial pressure between ACT+ and ACT- in all age groups. BMI and lab test results of the group >60 indicated significant difference between ACT+ and ACT-: BMI 27.9 ± 2.9 vs 31.2 ± 4.4 kg/m2, p = 0.03; HDL 60.1 ± 9.2 vs 47.8 ± 7.9 mg/dl, p = 0.01; Creatinine 0.9 ± 0.1 vs 1.1 ± 0.2 mg/dl, p = 0.02. No significant effect of ACT was found in labo-ratory parameters in men aged < 60.

Conclusions: The percentage of ACT+ men in Warmia and Mazury region in Poland was lower than average in Europe (29% vs 42%). The results may suggest benefi cial effect of ACT on BMI, HDL and creatinine values in older age group.

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e126 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

PP.05.25 IMPACT OF SHORT-TERM EXERCISE TRAINING

AND BETA BLOCKERS ON ARTERIAL BLOOD

PRESSURE AND QT DISPERSION IN PATIENTS

AFTER CORONARY ARTERY BYPASS GRAFT

SURGERY WITH HYPERKINETIC STATE

V. Stoickov1, M. Deljanin Ilic1, M. Stoickov2, I. Tasic1, S. Saric2, S. Andonov2, S. Mitic2. 1University of Nis, Medical Faculty, Institute of Cardiology Niska Banja, Nis, Serbia, 2Institute of Cardiology, Niska Banja, Nis, Serbia

Objective: The aim of this study was to establish the infl uence of short-term ex-ercise training and beta blockers (BB) on arterial blood pressure (BP), double product (DP) and QT dispersion (QTd) in patients after coronary artery bypass graft surgery (CABG) with hyperkinetic state.

Design and method: The study involved 135 patients after CABG with hyperki-netic state, average age 56.7 years. Patients were randomly divided into the physi-cal training group (TG: 109 patients) and control group (non-training group: 26 patients). In all subjects exercise test on treadmill according to Bruce protocol were performed. TG patients increased doses of beta blockers and are involved in rehabilitation treatment for three weeks. TG patients were instructed to follow a training program using the bicycle ergometer (10 min, 2 times a day) and walking. From standard ECG corrected QT dispersion (QTdc) was calculated.

Results: After three days, we have found signifi cant reduction of heart rate from 87.1 ± 5.8 to 75.9 ± 5.5 beats/min (p < 0.001), of systolic BP from 148.5 ± 12.7 to 142.2 ± 9.3 mmHg (p < 0.001), of diastolic BP from 90.3 ± 6.9 to 85.9 ± 4.9 mmHg (p < 0.001) and of DP from 13102.3 ± 797.8 to 12287.6 ± 633.6 beat/min x mmHg (p < 0.001) in the TG. After three weeks, we have found signifi cant reduction of QTdc from 54.5 ± 16.5 to 47.8 ± 14.7 ms (p < 0.005) in the TG. Also, in the TG, we have found signifi cant reduction of heart rate from 87.1 ± 5.8 to 69.9 ± 4.9 beats/min (p < 0.001), of systolic BP from 148.5 ± 12.7 to 136.3 ± 6.7 mmHg (p < 0.001), of diastolic BP from 90.3 ± 6.9 to 82.7 ± 3.8 mmHg (p < 0.001) and of DP from 13102.3 ± 797.8 to 10912.2 ± 602.4 beat/min x mmHg (p < 0.001). In contrast, the non-training group showed no signifi cant changes.

Conclusions: The study showed that short-term exercise training and BB have favourable effects on arterial BP, DP and QTd in patients after CABG with hy-perkinetic state. Beta blockers are enabled to properly implement and improve the program of physical training in study patients.

PP.05.26 A SYSTEMATIC REVIEW OF TELEMONITORING

ASSESSMENT FOR PATIENTS WITH HEART

FAILURE

T. Farnia1, M. C. Jaulent1, O. Steichen2. 1Inserm U1142, LIMICS (Laboratory in Medical Informatics and Knowledge Engineering in e-Health), Paris, France, 2AP-HP, Hopital Tenon, service de Médecine Interne, Paris, France

Objective: Telemonitoring (TLM) can improve heart failure (HF) management but there is no standardized evaluation framework to comprehensively evaluate the vari-ous impacts of TLM. Our objectives were to list the criteria used in published evalu-ations of HF TLM projects, to describe how these criteria are used in the evaluation studies, and to organize these criteria into a comprehensive evaluation framework.

Design and method: Articles were obtained through the Medline, Web of Science and Embase from 1990 to August 2015. Articles were eligible if they were original reports of a HF TLM evaluation study in English language. Studies of implant-able TLM devices were excluded. Each selected article was screened to extract the description of the TLM project, and of the evaluation process and criteria. A qualitative synthesis was performed.

Results: Overall, 121 articles were selected and reviewed, leading to 52 evaluation criteria classifi ed along six dimensions: technical, economic, educational, clinical, organizational and users’ perspectives. The clinical and economic impacts were evaluated in over 65% of studies whereas the educational, organizational and tech-nical impacts were studied in less than 15%. The clinical and economic impacts were studied in over 65% of studies whereas the educational, organizational and technical impacts were studied in less than 15%. Users’ perspective was the most frequently covered dimension in the development phase of TLM projects, whereas study of the clinical and economic impacts were dominating in later phases.

Conclusions: TLM evaluation frameworks should cover all of the six dimensions, ap-propriately distributed along the TLM project life cycle. Our next goal is to build such a comprehensive evaluation framework for TLM and to test it on an ongoing TLM project.

PP.05.27 MAGNESIUM SUPPLEMENTATION IN PATIENTS

WITH HYPERTENSION

A. Skrzek, K. Stolarz-Skrzypek, D. Czarnecka. Institute of Cardiology, Jagiellonian University, Collegium Medicum., Krakow, Poland

Objective: European Society of Hypertension (ESH/ESC) and Polish Society of Hypertension (PTNT) guidelines don’t recommend magnesium supplementation as an adjunctive therapy in patients with arterial hypertension. Nevertheless, Pol-ish Institute of Food and Nutrition suggests increased supplementation of magne-sium ions among hypertensive patients in everyday diet.

Design and method: The aim of the study was to assess a frequency of using magnesium supplements by hypertensive patients including demographic and clinical characteristics of the study group. From October 2015 to January 2016 data of 309 hypertensive patients from Outpatient Clinic were collected and ana-lyzed. We assessed: demographic and medical therapy data, results of offi ce blood pressure and heart rate measurements.

Results: We collected data of 309 patients aged between 19 and 84 (mean age 54,915,2 years) who were diagnosed with hypertension (HA). Mean time from diagnosis of HA was 12,8 9,9 years. The study group was represented in majority by subjects with secondary school level (40,8%) and university education (31,7%), retired (38,5%) or white-collars (26,9%). The proportion of patients using magnesium supplementation was 47,9% in the study group. Women more common than men were using magnesium supplements (68,2%, p = 0,0001). Subjects preferred organic forms of magnesium supplements (85,1%) rather than inorganic (11,5%) or chelats (3,4%). There were no signifi cant differences in SBP (142 vs 140 mmHg; p = 0,93), DBP (80 vs 82 mmHg; p = 0,42) and HR (71,5 vs 70,0 per min.; p = 0,21) in group with and without magne-sium supplementation. Pharmacological treatment and the proportion of patients that reach BP target (BP < 140/90 mmHg) were comparable in subgroup’s analysis.

Conclusions: Nearly half of hypertensive patients, especially women, use magne-sium supplements regularly. Organic forms are preferable. Supplemental doses of magnesium ions did not associate with SBP, DBP and HR values and reaching BP target in hypertensive patients.

PP.05.28 RELATIONSHIP BETWEEN UROCORTIN 2

CONCENTRATION AND METABOLIC PROFILE IN

HEALTHY SUBJECTS

O. Siga1, A. Dzieza-Grudnik1, J. Walczewska1, P. Wolkow2, A. Borys2, B. Wizner1, B. Gryglewska1, T. Grodzicki1. 1Department of Internal Medicine and Geriatrics, Jagiellonian University Medical College, Kracow, Poland, 2Center for Medical Genomics OMICRON, Jagiellonian University Medical College, Kracow, Poland

Objective: The aim of this study was to assess the relationship between the serum concentration of urocortin 2 (UCN 2) and metabolic parameters in healthy individuals.

Design and method: We examined 37 middle age healthy subjects. Evaluation included anthropometric measurements (body mass index-BMI, waist to hip ra-tio-WHR) and ambulatory blood pressure monitoring (ABPM) using SpaceLabs 90207, 90217. Moreover we evaluated metabolic parameters in blood serum after ten hours of fasting: glucose, total cholesterol, low-density cholesterol (LDL), high density cholesterol (HDL), triglycerides (TG), HbA1c, insulin, hsCRP, NT-proBNP. Glomerular fi ltration rate was estimated using the MDRD equation. For the analysis of UCN 2 concentration in blood of enrolled individuals we use ELI-SA Kit for UCN 2 (Cloud-Clone, USA).We divided the surveyed subjects into two groups according to the urocortin’s me-dian value (9,12 ng/ml). The comparative analyses between the independent groups were based on the student’s T-test, U Mann-Whitney and Chi2. To examine the rela-tionships between selected parameters we used Pearson and Spearman correlations.

Table 1

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Results: Mean age of the subjects was 45 ± 9,2, about 35% were male. Median of UCN 2 concentration was 9,12 ng/ml (IQR 7,23–15,05). There were no signifi cant differences between examined groups in age, sex, BMI, WHR, values of blood pres-sure and biochemical parameters like: glucose, HbA1c, insulin, creatinine, eGFR, hsCRP, NTproBNP, cortisol (details are presented in table 1). We observed signifi cant differences between the groups in total cholesterol, LDL and HDL. These groups did not differ in terms of statins intake. We observed an inverse relationship between UCN 2 levels and lipid values (total cholesterol r = -054, p < 0,05 LDL r = -0,4, p < 0,05). We did not observed such associations with other metabolic parameters.

Conclusions: Subjects with higher level of UCN 2 have lower concentration of total cholesterol, HDL and LDL, however changes in UCN 2 concentration were not associated with others metabolic parameters.

PP.05.29 CIRCADIAN RHYTHM OF BLOOD PRESSURE AND

TARGET ORGAN DAMAGE IN PATIENTS WITH

RESISTANT HYPERTENSION

M. Sheremet, L. Mishchenko, O. Matova, O. Gulkevych, O. Krot. National Scien-tifi c Center, M. D. Strazhesko Institute of Cardiology, Kiev, Ukraine

Objective: To investigate characteristics of circadian blood pressure rhythm, fre-quency and character of hypertensive damage of heart, kidney and carotid arteries in patients (pts.) with true resistant arterial hypertension (RAH).

Design and method: 43 essential hypertensive pts. were included in the study. According to offi ce and ambulatory BP measurement after 2 month of treatment with fi xed dose combination perindopril/indapamide/amlodipine 10/2.5/10 they were divided into two groups: the 1-st - 22 pts. with confi rmed RAH and the 2-d - 21 pts. with controlled arterial hypertension (AH). Before starting of treatment pts. were underwent ambulatory blood pressure monitoring (ABPM),, ultrasonog-raphy of heart and carotid arteries, laboratory tests (serum creatinine and 24-hour albuminuria).

Results: Two groups were comparable in age(51.4 ± 2.6vs.54.2 ± 1.9y,p = 0.63), body mass index (32.2 ± 0.9 vs. 33.4 ± 1.1 kg/m2, p = 0.35) and offi ce sys-tolic (174.4 ± 4.1 vs. 175.5 ± 4.5 mmHg, p = 0.78) and diastolic(97.3 ± 4.4 vs. 102.4 ± 2.4 mmHg) BP. But pts. with RAH had higher level of ambulatory sys-tolic BP (SBP), than patients of comparing group: average diurnal SBP 169.2 ± 2.8 vs.159.0 ± 2.8 mmHg (p = 0.03), average daytime SBP 173.5 ± 2.9 vs. 164.6 ± 2.4 mmHg (p = 0.04) and average nighttime SBP 161.9 ± 3.4 vs. 148.6 ± 4.2 mmHg (p = 0.02). Ambulatory diastolic BP doesn’t differ between two groups: average diurnal DBP 96.2 ± 3.3 vs. 89.5 ± 2.3 mmHg (p = 0.27), average daytime DBP 100.4 ± 3.5 vs. 94.0 ± 2.4 mmHg (p = 0.24) and average nighttime DBP 88.5 ± 3.2 vs. 80.6 ± 2.4 mmHg (p = 0.19). Diurnal systolic and diastolic BP index was sig-nifi cantly lower in RAH patients – 6.7 ± 1.2 vs. 10.1 ± 1.4 % and 11.6 ± 1.1 vs. 15.0 ± 1.3% respectively. Disturbance of circadian BP rhythm was detected in 72.7% RAH pts.in compare with 43.0% pts. with controlled AH. LVH(concentric type in all cases) was diagnosed at 100% RAH pts. and in 90% pts. in compar-ing group(concentric type in 61.5% of cases). Frequency of carotid atherosclero-sis (68.8 vs. 46.6%) and intima-media thickness(1.49 ± 0.07 vs. 1.17 ± 0.06 mm, p = 0.003) were signifi cantly higher at RAH than at controlled AH pts. Glomerular fi ltration rate was equal in comparing groups when albuminuria was greater in RAH pts.-18.4 ± 3.3vs.15.2 ± 2.1 mg/l(p = 0.03).

Conclusions: RAH pts. characterizes by higher level of ambulatory SBP and more frequent disturbances of BP circadian rhythm in comparing with controlled AH pts. These peculiarities of ambulatory BP is accompanied with concentric LVH, atherosclerotic and hypertensive damage of carotid arteries and signs of kidney injury.

PP.05.30 NEUROHUMORAL AND ENDOTHELIAL

RESPONSES TO HEATED WATER-BASED

EXERCISE IN RESISTANT HYPERTENSIVE

PATIENTS THE NEUROHUMORAL AND

ENDOTHELIAL RESPONSES TO THE BLOOD

PRESSURE (BP) LOWER

L. Galvani de Barros Cruz1, G. Seravalle2, E. A. Bocchi1, G. Grassi3, GV Guimaraes1. 1Laboratory of Physical Activity and Health heart Institute, Sao Paulo, Brazil, 2Istituto Auxologico Italiano IRCCS Ospedale San Luca, Milano, Italy, 3IRCCS Multimedica, Sesto San Giovanni, Italy

Objective: The neurohumoral and endothelial responses to the blood pressure (BP) lowering effects of heated water-based exercise (HEx) in resistant hyperten-sion (HT) patients remain undefi ned.

Design and method: We investigated these in 44 true resistant HT patients (age 53.3 ± 0.9 years, mean ± SEM). They were randomized and allocated

to 2 groups, 28 to a HEx training protocol, which consisted of callisthenic exercises and walking in a heated pool for 1 h, three times weekly for 12 weeks and 16 patients to a control group maintaining their habitual activities. Measurements made before and after 12 weeks of HEx included clinic and 24-h BP, plasma levels of nitric oxide, endothelin-1, aldosterone, renin, norepinephrine and epinephrine, as well as peak VO2, and endothelial function (reactive hyperemia).

Results: After 12 weeks of HEx patients showed a signifi cant decrease in clinic and 24-h systolic and diastolic BPs. Concomitantly, nitric oxide increased sig-nifi cantly (from 25 ± 8 to 75 ± 24 mcmol/L, P < 0.01), while endothelin-1 (from 41 ± 5 to 26 ± 3 pg/mL), renin (from 35 ± 4 to 3.4 ± 1 ng/mL/h), and norepineph-rine (from 720 ± 54 to 306 ± 35 pg/mL) decreased signifi cantly (P < 0.01). Plas-ma aldosterone also tended to decrease, although not signifi cantly (from 101 ± 9 to 76 ± 4 pg/mL, P = NS). Peak VO2 increased signifi cantly after HEx (P < 0.01), while endothelial function was unchanged. No signifi cant change was detected in the control group.

Conclusions: The BP-lowering effects of HEx in resistant HT patients were ac-companied by a signifi cant reduction in the marked neurohumoral activation char-acterizing this clinical condition.

PP.05.32 PROFOUND SYMPATHETIC NERVOUS SYSTEM

ACTIVATION IN PATIENTS WTH RESISTANT

HYPERTENSION

M. Schlaich1, D. Hering1, G. Lambert2, N. Eikelis2, S. Philipps2, E. Lambert2, Y. Sata2, M. Esler2. 1School of Medicine and Pharmacology, Royal Perth Hospital Unit, Perth, Australia, 2Baker IDI Heart & Diabetes Institute, Melbourne, Australia

Objective: Sympathetic nervous system activation is established as a major con-tributor to the development of human arterial hypertension. The relevance of neu-ral mechanisms in resistant hypertension has not yet been investigated in detail. We therefore aimed to assess the degree of regional sympathetic activation in patients with resistant hypertension.

Design and method: We combined microneurographic assessment of central sympathetic outfl ow with renal noradrenaline kinetics using radiotracer dilution methodology to comprehensively assess the level and pattern of sympathetic ac-tivation in 49 patients with resistant hypertension (RH). Matching data from pa-tients with essential hypertension (EH: n = 70) and normotensive control subjects (NT: n = 40) were analyzed for comparison.

Results: Systolic and diastolic offi ce blood pressure levels were highest in patients with RH. Both muscle sympathetic nerve activity and renal nor-adrenaline spillover (NT: 73 ± 52 vs EH: 132 ± 87 vs RH: 245 ± 187 ng/min; p < 0.01) were substantially elevated in RH. Compared to patients with es-sential hypertension the level of renal sympathetic nerve activity was almost doubled and more than three-fold higher in RH compared to normotensive control subjects.

Conclusions: Our results provide unequivocal evidence for a profound activa-tion of the sympathetic nervous system in patients with resistant hypertension. While these fi ndings cannot necessarily establish a cause-effect relationship, they substantiate the notion that specifi c targeting of renal sympathetic nerves is an at-tractive and well-founded therapeutic approach to improve blood pressure control, particularly in patients with resistant hypertension.

PP.05.33 IMMEDIATE REDUCTION OF PULSE WAVE

VELOCITY AS A MARKER OF EFFICACY OF RENAL

DENERVATION THERAPY IN HEMODIALYSIS

PATIENTS WITH RESISTANT HYPERTENSION

F. Scalise, A. Sorropago, C. Auguadro, G. Sorropago, C. Ballabeni,F. Maccario, R. Galato, G. Mancia. Policlinico Di Monza, Monza, Italy

Objective: Aim of the study is to evaluate the acute variations of Pulse Wave Velocity (PWV) after trans-catheter renal denervation (RDT), as index of arte-rial stiffness variation, in hemodialysis patients affected by resistant hypertension (RH). The hypothesis was that interruption of the nervous fi bers that run along renal arteries, might directly and refl exly reduce systemic sympathetic tone with a BP dependant but also independent increase of arterial distensibility.

Design and method: We enrolled 5 consecutive patients affected by RH (4 men, 1 women, mean age 50 years). The entire cohort underwent bilateral RDT pro-cedure with the EnligHTN System (St. Jude Medical). Invasive measurement of PWV were obtained before and after the procedure using a dedicated catheter FS-Stiffcath (Flag Vascular, Italy). Measurements included systolic blood pressure (SBP), diastolic (D) BP, mean (M) BP and Heart rate (HR).

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Results: PWV was reduced from 14,12 to 11,89 m/sec (change 2,23 m/sec, p-value 0.01)) by RDT which was also accompanied by a reduction of SBP (from 162,6 to 130,4 mmHg, p-value 0.02). DBP (from 97,4 to 83,6 mmHg, p-value 0.04) and MBP (from 119,3 to 99,2 mmHg, p-value 0.03) with no signifi cant change in HR (from 78 to 72 bpm, p-value 0.74). Calculation of the percent differences showed the magnitude of the PWV reduction (23.7%) to be greater than that of SBP, DBP and MBP (18.7%.13,8% and 16.1%, respectively). The Pearson’s correlation analysis did not demonstrate signifi -cant correlations between the change in PWV and changes in HR (r = 0.335, p = 0.345), SBP (r = 0.176, p = 0.626), DBP (r = 0.178, p = 0.623) or MBP (r = 0.192, p = 0.596).

Conclusions: Bilateral RDT procedure produced an acute signifi cant decrease in PWV. There was also an acute signifi cant reduction of SBP, DBP and MBP which, however did not show a signifi cant relationship with the PWV changes. This suggests that improvement of arterial stiffness by RDT maybe at least in part BP independent possibly in relation to the reduction of the stiffening effect of the sympathetic activity on the arterial wall. If so, the acute decrease in PWV by RDT might represent a marker of the effi cacy of the RDT procedure.

PP.05.34 METABOLIC SYNDROME-RELATED FEATURES IN

CONTROLLED AND RESISTANT HYPERTENSIVE

SUBJECTS

A. Santa Catharina1, R. Modolo1, A. Ritter1, A. Sabbatini1, N. Correa1, V. Brunelli1, N. Fraccaro1, A. Almeida1, H. Lopes2, H. Moreno1, A. De Faria1. 1Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil, 2Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil

Objective: The purpose of this study was to evaluate the prevalence of metabolic syndrome (MetS) and the clinical features associated with it in resistant and mild to moderate hypertensives.

Design and method: This cross-sectional study included 236 patients, (i) 129 mild to moderate hypertensive patients and (ii) 107 patients with resistant hyper-tension (RHTN). We determined blood pressure measurements, bioimpedance pa-rameters and adipokines levels. Target organ damages such as microalbuminuria (MA), cardiac hypertrophy and arterial stiffness were also assessed.

Results: We found a prevalence of 73% in resistant and 60% in mild-to-moderate hypertensive patients. The patients with MetS showed a higher prevalence of MA equal or higher than 30 mg/g compared to their counter-parts (20% vs. 4%). Adiponectin levels were signifi cantly lower in patients with MetS (5.30 vs. 7.50 mg/mL), while leptin demonstrated to be increased in those patients, compared to the subjects without MetS (21.0 vs. 15.7 ng/mL). Finally, in a multiple regression analysis MA (OR = 8.51; p = 0.01), leptin/adiponectin ratio (LAR) (OR = 4.13; p = 0.01) and RHTN (OR = 3.75; p = 0.03) were independently associated with the presence of MetS, apart from potential confounders.

Conclusions: Our fi ndings suggest that the metabolic derangements present in MetS tend to develop early signs of end-organ damage with hormonal changes in hypertensive patients. Indeed, LAR may be useful as a reliable biomarker for identifying those who are at risk for developing MetS.

PP.05.36 RENAL DENERVATION IN COMPARISON TO

INTENSIFIED PHARMACOTHERAPY IN TRUE

RESISTANT HYPERTENSION. TWO-YEAR

OUTCOMES OF RANDOMISED PRAGUE-15 STUDY

J. Rosa1, P. Widmsky2, P. Waldauf3, T. Zelinka1, O. Petak1, M. Taborsky4, M. Branny5, P. Tousek2, K. Curila2, L. Lambert6, F. Bednar2, R. Holaj1, B. Strauch1, J. Vaclavik4, E. Kocianova4, I. Nykl5, O. Jiravsky5, T. Indra7, Z. Kratka1, J. Widimsky Jr.1. 1Centre for Hypertension, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic, 2Cardiocentre, University Hospital Královské Vinohrady and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic, 3Department of Anaesthesiology, University Hospital Královské Vinohrady and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic, 4Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Palacký University Faculty of Medicine, Olomouc, Czech Republic, 5Cardiocentre, Nemocnice Podlesi, Trinec, Czech Republic, Trinec, Czech Republic, 6Department of Radiology, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic, 7Department of Nephrology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic

Objective: This randomised, multicentre study compared the effi cacy of renal denervation (RDN) versus spironolactone addition in patients with true resistant hypertension. We present the 24-month data.

Design and method: A total of 106 patients with true resistant hypertension were enrolled in this study: 52 patients were randomised to RDN and 54 patients to the spironolactone addition, with baseline systolic blood pressure of 159 ± 17 and 155 ± 17 mmHg and average number of drugs 5.1 and 5.4, respectively. Two-year data are available in 86 patients. Spironolactone addition, as crossover after one year, was performed in 23 patients after RDN, and spironolactone addition fol-lowed by RDN was performed in 5 patients.

Results: Similar and comparable reduction of 24-hour systolic blood pressure after RDN or spironolactone addition after randomisation was observed, 9.1 mmHg (p = 0.001) and 10.9 mmHg (p = 0.001), respectively. Similar decrease of offi ce blood pressure was observed, 17.7 mmHg (p < 0.001) versus 14.1 mmHg (p < 0.001), while the number of antihypertensive drugs did not differ signifi cant-ly between groups. Crossover analysis showed non-signifi cantly better effi cacy of spironolactone addition in 24 h systolic and offi ce systolic blood pressure reduc-tion than RDN (3.7 mmHg, p = 0.27 and 4.6 mmHg in favour of spironolactone addition, p = 0.28, respectively). Meanwhile, the number of antihypertensive drugs was signifi cantly increased after spironolactone addition (+0.7, p = 0.001).

Conclusions: In the settings of true resistant hypertension, spironolactone addi-tion (if tolerated) seems to be of better effi cacy than RDN in blood pressure re-duction over a period of 24 months. However, by contrast to the 12-month results, blood pressure changes are not signifi cantly greater.

PP.05.37 LONG-TERM OBSERVATIONS OF KIDNEY BLOOD

FLOW AFTER RENAL SYMPATHETIC DENERVATION

IN PATIENTS WITH RESISTANT HYPERTENSION

T. Ripp, V. Mordovin, N. Ryabova, S. Pekarskiy, G. Semke, A. Falkovskaya, V. Lichiaki, I. Zubanova, S. Popov. Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia

Objective: We studied the renal blood fl ow and the dynamics of renal function (serum creatinine) by signifi cant reduction in blood pressure after endovascular renal sympathetic denervation (RSD) in long-term observations.

Design and method: Single-institution study was initiated in essentially hyper-tensive patients with BP > 160/100 mm Hg despite three or more antihypertensive drugs. All participants of research have given the informed agreement. Primary

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Abstracts e129

effi cacy endpoints: changes of renal function at 1 (n = 37), 2 (n = 32) and 3(n = 11) Years after RSD, secondary – changes in renal blood fl ow (ultrasound dopplerogra-phy velocity (V) and resistive index (RI)) during 1st years, at 24 and 36 months after RSD. RSD was done bilaterally using transfemoral access (4–8 ablation points, tem-perature control mode, target t = 50 C, power limit = 8 watt, duration = 2 min). The patients were instructed to maintain pharmacotherapy unchanged during the study.

Results: RSD was performed in patients 52.2 ± 9.1 old years of remaining 12 month of follow-up, Two treated patients refused to continue in the study, 1 patient moved and was lost to follow-up. No immediate damage of renal arteries was detected in all cases by intraoperative rational control angiography. Serum creatinine did not change signifi cant through follow up: start 82.7 ± 19.6, after 1Y 86.2 ± 23.8 p = 0.11 and 2Y 86.7 ± 20.7 = 0.07 and 3Y 79.6 ± 16.0 p = 0.21. No signifi cant changes in renal blood fl ow were found initially and during 1/ 2/ 3 years of follow-up: Vtrunc 80.0 ± 20.0 and 83.0 ± 20.7/90.3 ± 18.7/89.2 ± 17.6 cm/s p = 0.34/0.18/0.26; Vsegm. 43.5 ± 9.2 and 44.1 ± 9.9/40.2 ± 10.2/48.3 ± 7.9 cm/s p = 0,64/0,09/0.16. But the RI in the seg-mental arteries was signifi cantly decreased after RSD 0.65 ± 0.09 and 0.59 ± 0.06/0.62 ± 0.06/0.59 ± 0.08 p = 0.008/0.041/0.045.

Conclusions: Kidney blood fl ow and serum creatinine did not change signifi cant-ly, but a signifi cant and prolonged reduced peripheral vascular resistance after re-nal sympathetic denervation in patients with resistant hypertension by long-term observations of after the RSD.

PP.05.38 EFFICIENCY OF RENAL DENERVATION IN

PATIENTS WITH RESISTANT HYPERTENSION AND

OBESITY

L. Plashchinskaya, A. Mrochek, D. Goncharik, A. Chasnoits, V. Barsukevich, A. Savchemko, Y. Persidskikh, I. Lazareva. RSPC Cardiology, Misk, Belarus

Objective: The aim of our study was a compare of effi ciency of renal denervation (RDN) in patients with resistant hypertension (RH) and the normal body weight and obesity.

Design and method: 92 patients with RH included, the average age – 52 [19; 68]. All patients underwent RDN. Patients divided into 4 groups. 1 group - the non-obese (body mass index (BMI) less than 29.9 kg/m2), group 2 - obesity I (BMI = 30–34.9 kg/m2), group 3 - obesity II (BMI = 35–39.9 kg/m2), group 4 – obesity III (BMI = 40 kg/m2. RDN performed by an experienced electrophysi-ologist at the renal arteries (RA) using specialized electrode Symplicity. Offi ce systolic blood pressure (SBP) and diastolic blood pressure (DBP), 24-hour am-bulatory blood pressure monitoring (ABPM) measured before and at 3, 6 and 12 months of follow-up. These data analyzed separately for each group.

Results: The values of offi ce BP and ambulatory BP were signifi cantly different in 4 groups at all-time points of observation. On visits at 6 and 12 months after the RDN offi ce SBP reduction was more in patients with obesity III Degree. There was a signifi cant difference in the reduction of offi ce SBP at 6 months by average 14.4 mm Hg in the group obesity III versus with obesity I (p = 0,025). Best decrease of ambulatory 24-hour SBP was also observed in the group with obesity III. The reduction of ambulatory 24-hour SBP was signifi cantly higher at average 25.8 mm Hg in patients with obesity III versus obesity I (p = 0,04). There was no signifi cant difference in the reduction of ambulatory 24-hour DBP in all groups. A signifi cant positive correlation between baseline body mass index of patients and reduction of offi ce SBP of 6 months and ambulatory 24-hour SBP at 12 months was found (Spearman, r = 0,22, p < 0,05; Spearman, r = 0,25, p < 0.05 respectively).

Conclusions: A signifi cant positive correlation between baseline body mass index and a response to the RDN was found. The patients with obesity III degree have the greatest reduction in offi ce SBP and ambulatory 24-hour SBP.

PP.05.39 TWENTY-FOUR HOUR AMBULATORY BLOOD

PRESSURE LEVEL IS CORRELATED WITH ALTERED

PSYCHOLOGICAL PROFILES IN PATIENTS

WITH APPARENTLY TREATMENT-RESISTANT

HYPERTENSION

E. Berra1,2, G. Petit3, C. George1,4, A. Capron4,5, P. Wallemacq4,5, P. de Timary3, A. Persu1,6. 1Department of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium, 2Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy, 3Adult Psychiatry Department and Institute of Neuroscience, Cliniques Universitaires Saint-Luc, Brussels, Belgium, 4Clinical Chemistry Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium, 5Louvain Center for Toxicology and Applied Pharmacology, Université Catholique de Louvain, Brussels, Belgium, 6Pole of Cardiovascular Research, Institut de Re-cherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium

Objective: Clinicians following patients with apparently treatment-resistant hypertension (aTRH) agree that a substantial proportion of these patients have a peculiar psychological profile. The latter may adversely affect blood pressure (BP) control, either by impacting drug adherence, or through other, poorly explored psycho-physiological mechanisms. The aims of this pilot study were to explore the psychological profile of patients with aTRH using validated questionnaires and to look for its relation with BP control and drug adherence.

Design and method: Psychological profi le was evaluated using the Emotion Regulation Questionnaire (ERQ), the Toronto Alexithymia Scale (TAS 20), the Cognitive Emotion Regulation Questionnaire (CERQ), the Brief Symptom Inven-tory (BSI) and the Post Traumatic Diagnostic Scale (PDS). Adherence status was assessed by urine drugs quantifi cation using liquid chromatography-mass spec-trometry assays.

Results: The analysis included 35 consecutive outpatients with aTRH (mean age: 51 years, 54% females, offi ce BP: 180/105 mmHg, 24-hour ambulatory BP: 160/100 mmHg, mean number of antihypertensive drugs: 4.9). Twenty-four hour systolic BP level adjusted for the number of antihypertensive drugs signifi cantly (p < 0.05) correlated with alexithymia (TAS 20; r = 0.50), in particular diffi culty to identify and describe feelings (r = 0.47 and 0.45); with self-blame (r = 0.65), rumination (r = 0.59), dramatization (r = 0.63), blame of others (r = 0.46) and more generally non-adaptive strategies in the cognitive regulation of emotions (r = 0.72) assessed by CERQ; with anxiety (r = 0.51), depression (r = 0.46) obsession (r = 0.47), hostility (r = 0.51) and paranoia (r = 0.63) evaluated with BSI; with intrusion (r = 0.66) and avoidance/blunted emotional perception (r = 0.69) assessed by PDS. Despite a high proportion of partly adherent (40%) or non-adherent (31%) patients, these correlations remained unaffected after adjustment for adherence. Adherence level was not associated with BP level, the number of antihypertensive drugs or the afore-mentioned psychological characteristics.

Conclusions: While poor drug adherence is common in patients with aTRH, it does not entirely explain poor BP control. Our results suggest that, in patients with aTRH, resistance to drug treatment is infl uenced by a deleterious constellation of psychological characteristics, irrespective of drug adherence. More research is needed to confi rm these results, explore the underlying mechanisms and defi ne the best strategies to improve BP control in this challenging subset of patients.

PP.05.40 CONTINUATION OF A RANDOMIZED DOUBLE-

BLIND CONTROLLED TRIAL OF DISTAL RENAL

DENERVATION VERSUS CONVENTIONAL MODE

OF THE INTERVENTION FOR TREATMENT OF

RESISTANT HYPERTENSION

S. Pekarskiy, A. Baev, V. Mordovin, G. Semke, T. Ripp, A. Falkovskaya, V. Lichikaki, M. Kuzmichkina, S. Triss, S. Popov. Cardiology Research Institute of Tomsk National Med Res Centre, Tomsk, Russia

Objective: Recently we demonstrated in a double-blind, randomized, con-trolled study (ClinicalTrials.gov NCT02667912) that “distal’’ renal denerva-tion in segmental branches of renal artery is more effective for treatment of resistant hypertension than “conventional’’ mode of the therapy in main trunk only. Then we continued the study to increase our experience with distal renal denervation.

Design and method: Patients with true drug-resistant essential hypertension were randomized either to “conventional’’ treatment restricted to the main re-nal artery or to “distal’’ treatment applied mainly in segmental branches of the artery beyond the bifurcation. Computer-based treatment assignment was performed in the catheterization laboratory at the time of the procedure by the interventional radiologist and remained unknown to patients, investigators, and other outcomes assessors for the entire study period. Baseline antihy-pertensive pharmacotherapy was maintained as strictly as possible during the follow up.

Results: A total of 55 patients were finally enrolled and 51 patient com-pleted 6 months follow-up. Per protocol analysis again showed a signifi-cantly greater decrease of 24-hour mean systolic BP (primary outcome) in the distal therapy group (n = 27) as compared to the group of conventional renal denervation (n = 24): �21.1 ± 19.3 vs �10.3 ± 17.8 mmHg; P < 0.05. No major safety issues were observed in either group. No significant change of blood flow in segmental branches of renal artery was detected by Doppler flowmetry.

Conclusions: These data continue to show that distal renal denervation in seg-mental branches of renal artery is signifi cantly more effective for treatment of resistant hypertension than the conventional intervention in main trunk only.

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PP.05.41 RELATIONSHIP BETWEEN HUMORAL FACTORS,

MYOCARDIAL REMODELING AND HEART RATE

VARIABILITY IN RESISTANT HYPERTENSIVE

PATIENTS

T. Ovdiienko, L. Mishchenko, O. Kupchynska, O. Matova, A. Logvinenko, M. Sheremet, O. Gulkevych. SI NSC ACAD. M. D. Strazhesko Institute of Cardiology of Nams of Ukraine, Department of Hypertensive Disease, Kiev, Ukraine

Objective: Decrease of heart rate variability (HRV) (decrease of SDANN < 100 ms) and left ventricular (LV) hypertrophy can be independent risk factors for future cardiovascular complications. The purpose of this study was to determine relation between humoral factors (plasma renin activity -PRA, plasma aldosterone – pALD, 24 hour urinary metanephrines – uMET), myocardial re-modeling and HRV in resistant hypertensive (RH) patients (pts).

Design and method: 24 h Holter ECG monitoring has been recorded in 20 true RH pts (20pts by mean age 51.0 ± 2.8yrs) using Meditech EC-GO System. The analysis of HRV included time parameters (SDNN, SDANN, SDNN-I, pNN50%, RMSSD). Echocardiography of all patients has been carried out. The level of PRA, pALD, uMET has been determined by standard methods.

Results: The analysis of HRV in 20 RH pts showed initial state HRV – SDNN - 105,5 ± 4,2 mc, SDANN - 97,5 ± 5,03 mc, SDNN-I - 38,6 ± 3,04 mc, RMSSD - 42,9 ± 6,7 mc, pNN50% - 8,8 ± 1,4. The significant linear relation was found between level of uMET and time parameters of HRV (SDNN-I, RMSSD): with SDNN-I r = 0,564, p < 0,05, RMSSD r = 0,502, p < 0,05 in these pts. No significant difference was established between parameters of myocardial remodeling (PWT, IVST, RWT, LVID, LVMI) in pts with SDANN < 100mc and pts with SDANN>100mc. In comparison, pts with SDANN < 100mc showed positive correlation of time parameter SDNN with PWT (r = 0,652, p < 0,05), IVST (r = 0,651, p < 0,05), LVMI (r = 0,661, p < 0,05), and time parameter RMSSD with IVST and LVMI and its absence in pts with SDANN>100mc and in the general group of pts. The analysis of humoral factors in pts with SDANN>100mc showed linear relation between level of uMET and SDANN (r = 0,727, p < 0,05). In comparison, in pts with SDANN < 100mc inverse relation between level of uMET and SDANN (r = �0,729, p < 0,05) and linear relation with SDNN-I (r = 0,750, p < 0,05) were revealed.

Conclusions: These fi ndings indicate that decrease of heart rate variability in re-sistant hypertensive pts is closely associated with left ventricular hypertrophy and level metanephrines.

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Abstracts e131

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved

SATURDAY

POSTERS

POSTER SESSION

POSTERS’ SESSION PS06:

BLOOD PRESSURE MEASUREMENT AND

VARIABILITY

PP.06.02 REGULAR HOME BLOOD PRESSURE

MEASUREMENTS AND NORMAL WEIGHT LINKED

WITH HYPERTENSION CONTROL IN VERY OLD

HYPERTENSIVE SUBJECTS

B. Wizner1, O. Siga1, B. Gryglewska1, A. Wilkins2, J. Walczewska1, T. Grodzicki1. 1Jagiellonian University Medical College, Department of Internal Medicine and Gerontology, Kracow, Poland, 2Servier Poland, Warsaw, Poland

Objective: The uncontrolled hypertension (HT) is more prevalent in elderly peo-ple, however aging process contributes but does not determine the development of resistance to therapy in advanced old age. The aim of the study was to compare HT management and cardiovascular profi le in very old patients with uncontrolled and controlled HT in offi ce settings.

Design and method: The cross-sectional study has been conducted between May and June 2014 in Poland in cooperation with Servier Poland. Each of the physi-cians attending in the study enrolled consecutive six adult patients during a rou-tine control visits who met the criteria: HT diagnosis had to be confi rmed and documented in patient’s medical record, antihypertensive treatment for at least6 weeks and offi ce blood pressure (OBP) = > 140 and/or 90 mmHg. Of 6565 patients aged 18 to 95 years, to the present analysis included 433 patients aged80 years and more. Control of HT was defi ned as averaged OBP < 150/90 mmHg. OBP was measured at least twice with an interval 1 to 2 minutes, in a sitting position after a few minutes of rest using the appropriate cuff size and validated devices. Based on the information available for physician from medical records as well as standardized interview with the patients, history on comorbidities, phar-macotherapy regimen, presence of cardiovascular risk factors, availability of self BP measurement at home were established. Additionally the anthropometric mea-surement (weight, height, waist) were taken.

Results: The selected comparison were presented in the Table. There were no signifi cant difference between the groups in relation to the pharmacotherapy regi-men, including number of antihypertensive drugs, time of last modifi cation of the treatment, prevalence of smoking, hypercholesterolemia and comorbidities (coronary and cerebrovascular diseases, heart failure, chronic kidney diseases and diabetes). Data are presented as means ± standard deviations or median [Q1-Q3] and number (percentage).

Conclusions: In our study, regular BP control at home and lack of obesity were associated with better hypertension control in octogenarians. The results indicate on non-pharmacological management of HT and self BP control to be as impor-tant in the very elderly as in younger patients.

PP.06.05 IS OFFICE BLOOD PRESSURE MEASUREMENT

RELIABLE FOR INDIVIDUAL DECISION MAKING –

RESULTS OF THE IPARR TRIAL

A. S. Vischer1,2, C. Winterhalder3, L. Leonardi3, A. Maseli3, J. Eckstein3, T. Burkard1,2. 1University Hospital Basel, Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, Basel, Switzerland, 2University Hospital Basel, Department of Cardiology, Basel, Switzerland, 3University Hospital Basel, Department of Internal Medicine, Basel, Switzerland

Objective: Standard operating procedures (SOP) for offi ce blood pressure mea-surement (OBPM) vary highly between different guidelines. Similarly, outcome studies have used different methods to measure offi ce blood pressure. Until today OBPM is used for clinical decision making. We aimed to compare an OBPM pro-cedure based on the one used in the SPRINT study, but attended by an operator, to a single OBPM as used in early outcome studies and many clinical settings.

Design and method: In this cross-sectional, single-center trial, 1000 adult sub-jects were recruited until February 2016. Seven sequential blood pressure mea-surements were performed after fi ve minutes of rest in a quiet room and in sitting position in the presence of an operator. The initial measurement was taken using a standard device (Omron HBP-1300 professional blood pressure monitor, ap-propriate cuff size), alternating with a tested smartphone app. Over all, 4 standard and 3 smartphone measurements were taken, however, only the standard measure-ments were used for this study. The standard OBPM were spaced 2 min apart. Ad-ditional information about cardiovascular risk factors, concomitant disease, and medication were collected. We compared the fi rst measurement out of 4 to the mean of last three measurements.

Results: Complete measurements were available in 802 subjects. The fi rst mea-surement had a median of 129 mmHg (IQR 116–140) in comparison to the mean of the last 3 measurements of 123 mmHg (IQR 113–134), which were signifi cant-ly different (p-value < 0.0005). The Bland-Altman plot showed a high variability between the measurement methods (Figure 1). 662 subjects (82.5%) showed a difference of >2mmHg, 441 (55.0%) a difference of >5mmHg and 208 (25.9%) of >10mmHg between the methods. Both a decrease and increase of the values were observed and could not be predicted clinically.

Conclusions: There are signifi cant differences in the results of two different SOP leading to a discrepancy of more than 5 mmHg in more than half of the patients in one measurement session. This difference could not be predicted by clinical parameters obtained in the trial. Therefore OBPM seems to be unreliable for indi-vidual clinical decision making until there are proper SOP.

PP.06.06 PHENOTYPES OF BLOOD PRESSURE IN PATIENTS

WITH RHEUMATOID ARTHRITIS

S. Velmakin, E. Troitskaya, S. Villevalde, Z. Kobalava. RUDN University, Moscow, Russia

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Objective: Patients with rheumatoid arthritis (RA) have increased cardiovascu-lar risk. Arterial hypertension (AH) is highly prevalent, and seems to be under-diagnosed and under-treated among patients with RA. Data on ABPM profi le in patients with rheumatoid arthritis are lacking.The aim of the study was to evaluate ABPM parameters and characterize pheno-types of blood pressure (BP) in patients with RA.

Design and method: 58 patients with RA (EULAR 2010) without known cardio-vascular disease were examined (76% females, age 55,9 ± 15,8 (M ± SD) years, 10% smokers, 56% with AH, 34% with dyslipidemia). Median duration of RA was 8,5 years (IQR 3–16). Seropositive RA was diagnosed in 69% of patients. All patients received disease-modifying antirheumatic drugs (DMARDs), 22(38%) - biological treatment. Median duration of AH was 4,0 years (IQR 0–12 years). All patients with AH received antihypertensive treatment. 24-h peripheral and central BP monitoring was performed (BPLab Vasotens, «Petr Telegin»). P < 0.05 was considered signifi cant.

Results: Mean offi ce BP was 126 ± 19/78 ± 11 mmHg (peripheral) and 118 ± 20/80 ± 11 mmHg (central). 10 (17%) patients had elevated offi ce BP (>140/90 mmHg). Mean BP values for peripheral and central BP were as follows: 125 ± 13/73 ± 9 and 116 ± 13/75 ± 9 mmHg for 24-h BP; 127 ± 14/74 ± 9 and 117 ± 13/77 ± 9 mmHg for daytime BP; 119 ± 13/69 ± 10 and 112 ± 14/71 ± 10 mmHg for nighttime BP. AH according to daytime BP was found in 14 (24,1%) pts, nighttime BP – in 28 (48,3%) pts, 24-h BP - in 9 (31,0%) pts. Phenotypes of BP were as follows: sustained normotension – in 36 (62,1%), masked hyper-tension in 12 (20,7%), sustained AH – in 8 (13,8%), white-coat hypertension in 2(3,4%) patients. Isolated nocturnal AH was observed in 12(20,7%) pts. 10 (17%) patients had isolated elevated central BP. 20 (34,5%) pts had elevated central SBP according to individual reference values; all patients with high offi ce BP had el-evated central BP.

Conclusions: High prevalence of AH is observed in patients with RA free of CVD and most of patients have satisfactory control of offi ce BP. Relatively high prev-alence of masked and isolated nocturnal hypertension despite antihypertensive treatment are observed in this population. These fi ndings may help to optimize hypertension treatment in patients with RA.

PP.06.08 PREVALENCE AND CLINICAL OUTCOMES OF

WHITE COAT AND MASKED HYPERTENSION

COMPARED TO NORMOTENSION AND SUSTAINED

HYPERTENSION

G. Tocci1,2, F. Simonelli1, N. Attalla1, M. D’Agostino1, V. Presta1, I. Figliuzzi1, G. Gallo1, V. Costanzi1, B. Citoni1, A. Battistoni1, A. Ferrucci1, M. Volpe1,2. 1Div. Cardiology, Dpt. Clinical Molecular Medicine, Fac. Medicine and Psychology, Univ. Sapienza, Sant’Andrea Hospital, Rome, Italy, 2IRCCS Neuromed, Pozzilli, Italy

Objective: The prognostic signifi cance of white-coat (WCHT) and masked hy-pertension (MHT) compared to normotension (NT) and sustained hypertension (SHT) is still debated.Aim. To evaluate prevalence and long-term clinical outcomes of NT, WHCT, MHT and SHT.

Design and method: We analysed home, clinic and 24-hour ambulatory blood pressure (BP) levels from a large cohort of untreated adult outpatients who were consecutively evaluated at out Hypertension Unit between January 2007 and De-cember 2015. The following defi nitions were applied: NT (clinic BP < 140/90 mmHg; 24-hour BP < 130/80 mmHg), WCHT (clinic BP > = 140/90 mmHg; 24-hour BP < 130/80 mmHg), MHT (clinic BP < 140/90 mmHg;24-hour BP > = 130/80 mmHg), and SHT (clinic BP > = 140/90 mmHg; 24-hour BP > = 130/80 mmHg). Systematic research throughout the regional med-ical database was performed to estimate incidence of myocardial infarction, stroke and hospitalizations for HT and heart failure (HF).

Results: Among a total study sample of 2,209 adult untreated individuals, 377 (17.1%) had NT, 351 (15.9%) WCHT, 149 (6.7%) MHT, and 1,332 (60.3%) SHT. During an average follow-up of 120.173.9 months, WCHT was associated to re-duced risk of developing stable HT [OR 95% CI: 0.593 (0.450–0.780); P < 0.001] and high risk of hospitalization for HT [OR 95% CI: 1.927 (1.233–3.013); P = 0.04] and HF [OR 95% CI: 3.449 (1.321–9.007); P = 0.011], whereas MHT was associated to an increased risk of myocardial infarction [OR 95% CI: 5.090 (2.228–11.625);P < 0.001], hospitalization for HT [OR 95% CI: 2.553 (1.446–4.508); P = 0.001] and HF [OR 95% CI: 4.214 (1.449–12.249); P = 0.008] com-pared to SHT.

Conclusions: Our fi ndings confi rmed that, despite relatively low prevalence, both WCHT and MHT were associated to high of developing myocardial infarction and hospitalizations for HT and HF.

PP.06.09 POTENTIAL IMPACT OF STATIN USE ON DAY-TIME

AND NIGHT-TIME BLOOD PRESSURE LEVELS:

A RETROSPECTIVE ANALYSIS OF A LARGE

DATABASE OF 24-HOUR AMBULATORY BLOOD

PRESSURE MONITORING

G. Tocci1,2, V. Presta1, I. Figliuzzi1, V. Costanzi1, G. Gallo1, N. Attalla1, F. Simonelli1, B. Citoni1, A. Battistoni1, A. Ferrucci1, M. Volpe1,2. 1Div. Cardiology, Dpt. Clinical Molecular Medicine, Fac. Medicine and Psychology, Univ. Sapienza, Sant’Andrea Hospital, Rome, Italy, 2IRCCS Neuromed, Pozzilli, Is, Italy

Objective: Assumption of drugs inhibiting the hydroxy-methyl-glutaril-coA (or statins) is recommended at bed-time and evidence demonstrated a strong and in-dependent correlation between night-time blood pressure (BP) and increased risk of cardiovascular events.

Design and method: To evaluate the effects of statins on night-time BP levels. We analysed data derived from a large cohort of adult individuals, who consecu-tively underwent home, clinic and ambulatory BP monitoring at our Unit. All BP measurements were performed and BP thresholds were set according to recom-mendations from European guidelines. Study population was stratifi ed according to statin use.

Results: We included an overall sample of 5,634 adult individuals (female 48.9%, age 60.511.6 years, BMI 27.04.6 kg/m2, clinic BP 144.318.4/90.912.4 mmHg, 24-hour BP 130.713.4/79.09.7 mmHg), among whom 17.3% received and 82.7% did not received statins. Treated outpatients were older, had higher BMI and prev-alence of risk factors and comorbidities than those who were untreated (P < 0.001 for all). Although they received more antihypertensive agents, they showed lower diastolic BP levels at all BP measurements, including night-time (67.39.4 vs. 70.99.7 mmHg; P < 0.001) periods, than those observed in untreated patients. Statin use was also associated with lower diastolic BP load during night-time pe-riod (43.428.9 vs. 52.329.5; P < 0.001). Finally, statin use resulted the strongest and independent factor associated with 24-hour [OR(95% CI): 1–513(1.295–1.767); P < 0.001] and night-time [OR(95% CI): 1.357(1.161–1.587); P < 0.001] BP control, even after adjusting for age, BMI, number of antihypertensive drugs and diabetes.

Conclusions: Statin use was associated to a signifi cantly lower diastolic BP lev-els. These effects were independently observed, even after correction for major cardiovascular risk factors and comorbidities, as well as number and type of anti-hypertensive drug classes.

PP.06.10 BLOOD PRESSURE VARIABILITY AND TARGET

ORGAN DAMAGE IN HYPERTENSION

D. Terentes-Printzios, C. Vlachopoulos, N. Ioakeimidis, P. Xaplanteris, K. Aznaouridis, A. Angelis, C. Georgakopoulos, P. Pietri, NP. Skliros, D. Tousoulis. 1st Cardiology Department, Athens Medical School, Hippokration Hospital, Athens, Greece

Objective: Hypertension is associated with several markers of subclinical target organ damage (TOD). Short-term blood pressure variability (SBPV) is a prognos-tic factor for cardiovascular events in hypertensives. We hypothesized that there is a relationship between SBPV and TOD in never-treated hypertensives.

Design and method: We enrolled 943 consecutive essential hypertensives (mean age 53 ± 12 years, 497 males). Markers of subclinical TOD [left ventricular mass index (LVMI), pulse wave velocity (PWV), total arterial compliance (TAC), ankle-brachial index (ABI) and estimated glomerular fi ltration rate (eGFR)] and 24-h ambulatory blood pressure were evaluated in all patients. LVMI was as-sessed echocardiographically using the Devereux formula. Carotid-femoral PWV was estimated with the Complior. eGFR was calculated by the Cockcroft-Gault formula. ABI was calculated by dividing the highest ankle systolic blood pres-sure by the highest brachial systolic blood pressure. The ratio of stroke volume to pulse pressure was measured echocardiographically as a surrogate of TAC. SBPV was calculated as follows: 1) SD of 24-hour, daytime, or nighttime SBP and 2) weighted SD of 24-hour SBP.

Results: In multivariable regression analysis, all four variables of SBPV exhibited signifi cant association with LVMI (p = 0.014, p = 0.002, p = 0.002 and p < 0.001, respectively), PWV (p = 0.021, p = 0.015, p = 0.055 and p = 0.006, respectively) and TAC (p = 0.048, p = 0.020, p = 0.036 and p = 0.006, respectively). In multi-variable analysis, ABI and eGFR were not associated with indices of SBPV. We assessed TOD based on 2013 European Guidelines for Hypertension [left ven-tricular hypertrophy (LVMI>115 g/m2 in men and >95 g/m2 in women), increased PWV (PWV>10m/s), decreased ABI (ABI < 0.9) and decreased renal function (eGFR < 60 ml/min)]. In multivariable logistic regression analysis, SBPV indices were not associated with markers of TOD (P>0.05).

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Conclusions: Our fi ndings support a complex relationship between SBPV and TOD in hypertension. Specifi cally, SBPV is more closely related to markers of ventricular and vascular compliance than other markers of TOD in hypertension.

PP.06.11 ASSOCIATION BETWEEN AMBULATORY

ARTERIAL STIFFNESS INDEX, MARKERS OF

BLOOD PRESSURE VARIABILITY AND INDICES

OF SUBCLINICAL VASCULAR DAMAGE IN OBESE

CHILDREN

A. Tagetti, S. Bonafi ni, P. Minuz, C. Fava. General Medicine and Hypertension Unit, Department of Medicine, University of Verona, Verona, Italy

Objective: Ambulatory Arterial Stiffness Index (AASI) and symmetric AASI (sAASI) have been proposed as indices of arterial stiffness easily obtained by24-hour ambulatory blood pressure monitoring (ABPM). Moreover, ABPMallows the analysis of indices of BP variability such as day and night SD, noctur-nal BP dipping, weighted 24-h SD (wSD), average real variability (ARV). Therelationship between these indices and other markers of vascular subclinical damage has seldom been evaluated in children. Aim of the present study was toaddress this issue in a sample of obese children.

Design and method: 45 obese children (27 males,18 females), were included. Children underwent vascular measurements, including: (i) offi ce and 24-hour am-bulatory BP; (ii) brachial fl ow-mediated dilatation (FMD), carotid intima media thickness (cIMT), and distensibility (cDC) measured using ultrasound; and (iii) systemic arterial stiffness (SIDVP) measured using digital volume pulse analysis. From ABPM (if at least 70% of the programmed BP measurements were correctly recorded), we calculate AASI, sAASI, ARV, SD, SD, systolic and diastolic dip-ping and wSD.

Results: ARV showed a signifi cant correlation with SIDVP (r = 0.379; p = 0.023), index of systemic stiffness. AASI but not sAASI correlated with FMD (r = 0.361; p = 0.031), marker of endothelial function. In the population divided in hyper-tensive (n = 11)/normotensive (n = 34), on the basis of offi ce BP values above 95th percentile according to sex and age, ARV was associated with SIDVP only in normotensive (r = 0.446; p = 0.015) but not in hypertensive children (rspear-man = 0.000; p = 1). In normotensive, z score-BMI was correlated with both sAASI and wSD (respectively 0.340; p = 0.049 and 0.423; p = 0.014), wSD corre-lated with FMD (r = 0.384; p = 0.048); in hypertensive children, ARV correlated with FMD (r = 0.828; p = 0.011; rspearman = 0.738; p = 0.037). No indices of BP variability correlated with cIMT or cDC.

Conclusions: BP variability, in particular ARV, shows a correlation with systemic but not local vascular stiffness in a sample of obese children, suggesting a rela-tion between daily BP variability and arterial elastic properties. Some other rela-tions between BP variability and endothelial function, were detectable only in the subgroups of children divided according to hypertensive status. Further studies, especially perspective ones, are needed to clarify the pathophysiological signifi -cance of these relations.

PP.06.12 B-TYPE NATRIURETIC PEPTIDE IS A

DETERMINANT OF THE NOCTURNAL INCREASE IN

BLOOD PRESSURE INDEPENDENTLY OF ARTERIAL

HYPERTROPHY AND HYPOXIA

Y. Tabara1, M. Igase2, T. Miki2, Y. Ohyagi2, F. Matsuda1, K. Kohara2. 1Kyoto University Graduate School of Medicine, Kyoto, Japan, 2Ehime University Graduate School of Medicine, Matsuyama, Japan

Objective: Loss of the nocturnal blood pressure (BP) drop is a risk factor for car-diovascular outcomes. However, clinical parameters that predispose to changes in nocturnal BP are currently uncertain. Given the possible involvement of salt sen-sitivity in nocturnal BP levels, we investigated a hypothesized association between plasma B-type natriuretic peptide (BNP) levels, a marker of body fl uid retention, and nocturnal BP in a general population.

Design and method: Study subjects were 1,020 general individuals. Subjects were divided into four groups (riser, non-dipper, dipper, and extreme dipper) by their percent changes in nocturnal systolic BP measured using an ambulatory BP monitor.

Results: Plasma BNP levels were positively associated with circadian BP change (� = 0.162, P < 0.001) independently of carotid hypertrophy (� = 0.133, P < 0.001), and awake heart rate (� = �0.102, P = 0.001) and systolic BP (� = �0.246, P < 0.001). Risers showed 1.6 times higher BNP levels than dippers, while oxygen desaturation during sleep was frequently observed in non-dippers. Results of multinomial logistic regression analysis indicated that BNP level was a signifi cant determinant for the riser pattern (odds ratio = 1.27 (BNP 10 pg/ml),

P < 0.001), while oxygen desaturation was specifi cally associated with the non-dipping pattern (odds ratio = 1.04, P = 0.001). When subjects were subdivided by BNP level, risers were more frequent in the high BNP subgroup (19.5%) than in the low BNP subgroup (6.7%) (odds ratio = 3.39, P < 0.001).

Conclusions: A slight increase in plasma BNP level was independently associated with rising nocturnal BP. Our results may help to understand the pathophysiology of circadian BP variation, and be a clue to identify individuals who require careful BP monitoring.

PP.06.13 ANXIETY AS A PERSONALITY TRAIT CORRELATES

WITH SHORT-TERM SYSTOLIC BLOOD PRESSURE

VARIABILITY

B. Symonides1, D. Wolynczyk-Gmaj2, M. Fornal-Pawlowska2, G. Splocharski1, Z. Gaciong1, M. Wojnar2. 1Medical University of Warsaw, Department of Internal Medicine, Hypertension and Vascular Medicine, Warsaw, Poland, 2Medical University of Warsaw, Department of Psychiatry, Warsaw, Poland

Objective: Systolic blood pressure variability (SBPV) was found to increase car-diovascular risk independent of basal BP values. We studied the relationship be-tween anxiety, which is one of risk factors for hypertension, and short-term SBPV in a group of subjects referred for 24-hr ambulatory BP monitoring (ABPM) be-cause of “labile’’ hypertension.

Design and method: Nineteen subjects without any concomitant diseases and not taking any centrally acting drugs (9/10 males/females, age 52.9 ± 15.8 yrs., range: 23–76) were examined.Their offi ce SBP and daytime SBP were 138 ± 10 mm Hg (range: 116–155 mmHg) and 126 ± 12 mmHg (range: 105–153 mm Hg), respectively. Anxiety was measured as a current symptom and a personality trait using State-Trait Anxiety Inventory (STAI). Short-term BPV was calculated as a standard deviation (SD) and coeffi cient of variance (CV) of systolic BP (SBP).

Results: SBPV expressed as SD was 14.4 ± 3.7 mmHg (range: 9.0–24.4 mmHg), 12.8 ± 3.7 mmHg (range: 8.6–23.7 mmHg) and 11.4 ± 3.0 mm Hg (range: 7.8–18.0 mmHg) and expressed as CV was 12 ± 11 % (range: 8–22 %), 10 ± 3 % (range: 7–19 %), 10 ± 3 % (range: 7–14 %) for daily, daytime and nighttime measurements, respectively. On the STAI-trait and STAI-state subscales the average scores were, respectively, 43.2 ± 9.4 (range: 22–60) and 37.1 ± 10.6 (range: 25–62). There was no correlation between daily, daytime and nighttime SBP and STAI scores on both subscales. However, STAI-trait correlated signifi cantly with SBP daytime SBPV - SD (r = 0.56, p = 0.013) and CV (r = 0.58, p = 0.0086) and STAI-state with offi ce SBP (r = 0.49, p = 0.0218) and CV of daytime SBPV (r = 0.46, p = 0.0498).

Conclusions: In a small group of subjects, anxiety assessed as a personality trait correlated with daytime variability of SBP. Further studies are needed to evalu-ate relationship between anxiety and cardiovascular risk related to BP variability.

PP.06.15 DETERMINANTS OF WHITE-COAT AND MASKED

HYPERTENSION IN THE GENERAL POPULATION:

THE DIDIMA STUDY

K.G. Kyriakoulis, A. Ntineri, P.G. Kalogeropoulos, E.K. Aissopou, G.S. Stergiou. Hypertension Center STRIDE-7, University of Athens, Third Department of Medicine, Sotiria Hospital, Athens, Greece

Objective: White-coat (WCH) and masked hypertension (MH) are common phenotypes between normotension and hypertension. This cross-sectional study investigated the clinical profi le associated with increased likelihood for these phenomena.

Design and method: Offi ce (1 visit, 3 measurements) and home (3 days, 12 read-ings) blood pressure (BP) measurements were obtained in a general population study at Didima, Argolida, Greece. Average offi ce and home BP were used to defi ne WCH and MH. Participants’ characteristics (age, gender, BMI, diabetes and cardiovascular disease history, smoking, antihypertensive treatment) were as-sessed as potential determinants of WCH and MH.

Results: 665 adults (age 54.4 ± 17.7 years, 42% men, 14.1% treated, 28.1% with offi ce hypertension) were analyzed. The overall prevalence of WCH and MH was 8.7% and 7.5%, respectively (8.8% and 6.3% in untreated subjects, respectively). In multivariate logistic regression analysis, younger age (p = 0.004), untreated status (p = 0.044) and lower offi ce BP (p = 0.01 for stage I versus stage II hypertension) were independent predictors of WCH among participants with offi ce hypertension. For MH independent predictors were male gender (p = 0.034), ageing (p < 0.001), obesity (p < 0.001), antihypertension treatment (p = 0.03) and high-normal offi ce BP (p = 0.01) among participants with offi ce normotension. In sensitivity analy-sis performed in untreated subjects with offi ce hypertension, only female gender

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(p = 0.048) and younger age (p = 0.001) increased the odds for WCH. In untreated subjects with low offi ce BP older age (p < 0.001), higher BMI (p = 0.001), diabe-tes (p = 0.04) and high-normal offi ce BP (p = 0.005) independently predicted MH.

Conclusions: In this general population study, age, gender, antihypertensive treat-ment and offi ce BP level consistently predicted WCH and MH.

PP.06.16 HOME VERSUS AMBULATORY BLOOD PRESSURE

AND TARGET-ORGAN DAMAGE IN CHILDREN AND

ADOLESCENTS

A. Ntineri1, M. Zeniodi1, A. Kollias1, G. Servos2, D. Georgakopoulos2, I. Moyssakis3, A. Vazeou4, G.S. Stergiou1. 1Hypertension Center STRIDE-7, University of Athens, Third Department of Medicine, Sotiria Hospital, Athens, Greece, 2Department of Cardiology, P. & A. Kyriakou Children Hospital, Athens, Greece, 3Cardiology Department, Laikon Hospital, Athens, Greece, 4First Department of Pediatrics, P. & A. Kyriakou Children Hospital, Athens, Greece

Objective: This study compared home (HBP), ambulatory (ABP) and clinic (CBP) blood pressure (BP) in terms of their association with preclinical organ damage in children and adolescents.

Design and method: Apparently healthy children and adolescents referred for elevated BP and healthy volunteers (age range 6–18 years) were subjected to: (i) CBP (2–3 visits, triplicate measurements, mercury sphygmomanometer), HBP (6–7 days, duplicate morning and evening measurements, validated oscillometric arm-cuff device with automated memory) and ABP (24-hours, 20 min-intervals, validated oscillometric device) measurements, (ii) echocardiographic determina-tion of left ventricular mass index (LVMI); (iii) measurement (ultrasonography) of the common carotid intima-media thickness (IMT).

Results: A total of 158 young individuals (mean age 12.9 ± 2.6 years; age range: 6–18, 108 males) were analyzed (143 had measurements of LVMI and 80 IMT). Average CBP was 119.1 ± 13.5/69 ± 8.9 mmHg (systolic/diastolic), HBP 120.2 ± 11.3/68.9 ± 6.5 mmHg and 24-hour ABP 119.4 ± 10.2/66.8 ± 5.4 mmHg. Offi ce hypertension was diagnosed in 25% of subjects, ambulatory hypertension in 23% and home hypertension in 25%. Signifi cant agreement was observed between HBP and ABP in detecting hypertension (85% agreement, kappa = 0.58). LVMI was correlated with pulse pressure (coeffi cient r = 0.25/0.26/0.21 for 24-hour/daytime/nighttime ABP, 0.23 for HBP and 0.19 for CBP; all p < 0.05). IMT was correlated with pulse pressure (coeffi cient r = 0.30/0.28/0.30 for 24-hour/daytime/nighttime ABP, 0.39 for HBP and 0.25 for CBP; all p < 0.05). In multivariate stepwise regres-sion analysis (with age, gender, body mass index, and CBP, HBP, 24-hour/daytime/nighttime pulse pressures as independent variables; each BP parameter introduced once at a time in each model), the variation of LVMI was best determined (R2 = 0.20) by awake ABP pulse pressure and IMT (R2 = 0.22) by home pulse pressure.

Conclusions: In young individuals, HBP and ABP measurements appear to be similar in terms of their association with preclinical organ damage and superior to the conventional CBP measurements.

PP.06.17 EFFECT OF CALIBRATION METHOD ON THE

ASSOCIATION BETWEEN 24-HOUR CENTRAL

BLOOD PRESSURE AND TARGET-ORGAN DAMAGE

IN YOUNG INDIVIDUALS

A. Kollias1, A. Ntineri1, A. Destounis1, G. Servos2, D. Georgakopoulos2, I. Moyssakis3,A. Vazeou4, G.S. Stergiou1. 1Hypertension Center STRIDE-7, University of Athens, Third Department of Medicine, Sotiria Hospital, Athens, Greece, 2Department of Cardiology, P. & A. Kyriakou Children Hospital, Athens, Greece, 3Cardiology Department, Laikon Hospital, Athens, Greece, 4First Department of Pediatrics, P. & A. Kyriakou Children Hospital, Athens, Greece

Objective: Accumulating evidence suggests that central (aortic) blood pressure (BP) may refl ect the hemodynamic stress on target organs more accurately than brachial BP. However, the optimal method for the calibration of the brachial pres-sure waveform for the accurate assessment of the central BP is debatable. This study investigated the impact of the calibration mode (either with systolic and dia-stolic [C1] or the mean and diastolic brachial BP [C2]) on the association between ambulatory central BP and target-organ damage in young individuals.

Design and method: Apparently healthy adolescents and young adults (age 12–25 years) referred for elevated BP and healthy volunteers were subjected to: (i) 24-hour ambulatory peripheral and central BP monitoring using a noninvasive brachial cuff-based oscillometric device (Mobil-O-Graph 24 h PWA); (ii) determination of left ventricular mass index (LVMI) and of the carotid intima-media thickness (cIMT).

Results: Data from 99 subjects were analyzed (mean age 18.4 ± 4.5 years, 80 males, body mass index [BMI] 24.9 ± 5.2 kg/m2, 24 subjects with 24-hour bra-chial BP > = 95th percentile for adolescents or > = 130/80 mmHg for adults). 24-hour central C2 systolic/diastolic BP was higher than C1 (131.3 ± 13.7/73 ± 7.8 vs. 110.2 ± 9.5/72.5 ± 7.9 mmHg respectively, p < 0.05 for systolic/diastolic). Hyper-tensive compared to normotensive subjects presented higher values of both 24-hour central BP C2 (143.6 ± 12.5/82.6 ± 7.1 vs. 127.4 ± 11.7/70 ± 5.1 mmHg) and C1 (122.6 ± 7.9/82.2 ± 6.9 vs. 106.3 ± 5.8/69.3 ± 5.2 mmHg) (all p < 0.05). 24-hour cen-tral C2 vs. C1 systolic BP was more strongly associated with cIMT (r = 0.48 vs. 0.29 respectively, p < 0.05 for comparison), whereas no difference was observed in LVMI (r = 0.30 vs. 0.34 respectively, p = NS). In multivariate regression analyses (with age, gender, BMI and 24-hour central systolic BP as independent variables), the variation of cIMT was better determined when 24-hour central systolic BP C2 was included in the models as compared to C1 (improvement in the models’ R2 from 0.26 to 0.33).

Conclusions: These data suggest that in young individuals the method selected for the calibration of the peripheral pressure waveform in 24-hour monitoring is important and affects the relationship between central BP and cIMT.

PP.06.18 SEASONAL BLOOD PRESSURE CHANGES

IN HIGH NORMAL, NORMAL AND OPTIMAL

BLOOD PRESSURE PATIENTS WITHOUT

ANTIHYPERTENSIVE MEDICATION

M. Smirnova1, V. Gorbunov1, D. Volkov1, Y. Koshelyaevskaya1, A. Deev1, S. Boytsov1, N. Furman2, P. Dolotovskaia2, M. Shamiunov2. 1National Research Center for Preventive Medicine, Moscow, Russia, 2Saratov State Medical University, Institute of Cardiology, Saratov, Russia

Objective: Many investigators supposed that seasonal blood pressure (BP) chang-es are one of the reasons of fatal and nonfatal cardiovascular events. These studies included mainly the patients with arterial hypertension and the division of patients into groups with high normal (HNBP) or normal and optimal BP was not done. The aim of study was to estimate the seasonal differences in clinical (CBP) and ambulatory BP (ABP) in patients with HNBP and normal and optimal BP.

Design and method: The ambulatory patients from the ABP monitoring database (>2000 patients) were selected according to the following criteria: absence of any antihypertensive treatment, availability of CBP and ABPM records in winter or summer, CBP < 140 and 90 mmHg. Standard statistical methods were used.

Results: The preliminary data of the on-going study are demonstrated. We se-lected 355 patients: 206 with HNBP and 149 with normal and optimal BP. The main characteristics of groups and seasonal BP changes are presented in Table. In patients with HNBP only systolic CBP was signifi cantly higher in winter than in summer. We found similar tendency for ABP data in these patients despite rela-tively small differences. In patients with normal and optimal BP only diastolic ABP was higher in winter; in contrast, nighttime systolic BP was higher in sum-mer. At the same time, average values of CBP and ABP in the normal and optimal BP group did not exceed threshold limits.

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Conclusions: Some of the ABP parameters in patients with HNBP without anti-hypertensive medication are increased in winter and exceed normal values. This factor may contribute to the increase of cardiovascular events incidence in winter. The problem should be studied in prospective investigations.

PP.06.19 MASKED HYPERTENSION IN UNTREATED

PATIENTS WITH HIGH NORMAL, NORMAL AND

OPTIMAL BLOOD PRESSURE

M. Smirnova1, V. Gorbunov1, D. Volkov1, A. Deev1, Y. Koshelyaevskaya1, S. Boytsov1, N. Furman2, P. Dolotovskaia2, M. Shamiunov2. 1National center for preventive medicine, Moscow, Russia, 2Saratov State Medical University, Institute of Cardiology, Saratov, Russia

Objective: The high normal blood pressure (HNBP) is associated with masked hypertension (MH) according to some studies. Moreover, there exists some evi-dence that HNBP may be considered as abnormal BP level and is associated with increased risk of cardiovascular events. The aim of our study was to estimate the MH prevalence in ambulatory patient’s groups with HNBP, normal and optimal BP.

Design and method: The patients from the ambulatory BP monitoring (ABPM) database (>2000 patients) were selected according to the following criteria: ab-sence of any antihypertensive treatment, availability of clinical (CBP) and ABPM records, CBP < 140 and 90 mm Hg. The standard statistical methods were used.

Results: The total number of the patients was 206 with HNBP and 149 with nor-mal and optimal BP. The main characteristics of groups are presented in the Table. The MH prevalence in patients with HNBP was 85,0%; in the normal and optimal BP group it was 59,1% despite normal average ABP parameters in this group.

Conclusions: The MH prevalence in patients with HNBP was very high but the MH prevalence in patients with normal and optimal BP was also unexpectedly high. Further research is needed, including the assessment of cardiovascular prog-nosis in these patient’s groups.

PP.06.21 VOLUME-COMPRESSIVE OSCILLOMETRY IN

NONINVASIVE ASSESSMENT OF HEMODYNAMIC

PARAMETERS IN HYPERTENSIVE PATIENTS

S. Padaryan, E. Shavarova, V. Degtyarev, Y. Kotoskaya, Z. Kobalava. RUDN Uni-versity, Moscow, Russia

Objective: To evaluate hemodynamic parameters in patients with arterial hyper-tension (AH) before and during antihypertensive treatment using volume-compres-sive oscillometry (VCO) - new cuff-based device. The main advantages of VCO comparing to other oscillometry technic of BP registration is formation and record-ing the curve automatically in synchronism with the cuff infl ation and recording the artery response by changing the cuff volume throughout the all period of cuff compression. VCO diagram could considered as indicator of aortic stiffness.

Design and method: 45 untreated patients hospitalized with AH without acute coronary syndrome, severe valve problems, secondary hypertension, advanced chronic heart failure were enrolled. Mean age 55 ± 11.8 yrs, 51% male, mean BMI - 28.9 ± 6.7 kg/m2. Antihypertensive treatment included combination of am-lodipine 5 mg/fosinopril 10 mg per day. The pulse wave velocity (PWV), brachial blood pressure (BP), cardiac index, stroke index and systemic vascular resistance were measured twice (at admission and discharging) by VCO (EDTV, Russia).

Results: The mean systolic BP by VCO at admission was 147.7 ± 14.8 mm Hg (by Korotkoff method 161 ± 9.8 mm Hg), diastolic 83.1 ± 14.1 mm Hg (by Korot-koff method 99 ± 11.3 mm Hg) and mean pulse pressure 64 ± 9.5 mm Hg. Mean heart rate was 70.4 ± 14.5 bpm. Mean cardiac index was 3.08 ± 0.44 l/(min*m2), stroke index - 45.7 ± 11.7 ml/m2 and systemic vascular resistance (SVR) was 1373 ± 236 dyn*s/cm5. Mean PWV in these population was 7.6 ± 1.1 m/sec. Af-ter treatment with mean duration of hospitalization 6.3 ± 2.5 days, systolic and diastolic BP by VCO were reduced to 123.3 ± 10.8 mm Hg and 57.5 ± 13.3 mm Hg respectively (p < 0.05). Mean pulse pressure increased to 65.9 ± 11.8 mm Hg nonsignifi cantly. Mean stroke index increased to 49.7 ± 16.7 ml/m2 and SVR decreased to 1169 ± 374 dyn*s/cm5. We found no signifi cant changes in cardiac index, heart rate and PWV.

Conclusions: Systolic and diastolic BP by VCO is signifi cantly lower comparing to Korotkoff method. Next studies are needed to determine the feasibility of VCO in noninvasive assessment of central hemodynamics.

PP.06.22 CENTRAL HOME AND OFFICE BLOOD PRESSURE

MEASUREMENT TO EVALUATE CHANGES

ASSOCIATED WITH DIET SALT REDUCTION

W. Sebba Barroso, A.C. Arantes, R. Bernardes Rodrigues, Y. Cassia Luciana Araujo, A. Cristina De Souza, M. Borges Euzebio, T. Cristina Dos Santos Neiva,L. Rezende Mikhael, T. Veiga Jardim, A.L. Lima Souza, P.C. Veiga Jardim. Hypertension League, Federal University Goiás, Goiânia, Brazil

Objective: There are several different methods available for the measurement of blood pressure (BP). Therefore, it is essential to understand the differences be-tween them in the wide range of different clinical settings.Single-blind clinical trial that aims to study and analyses sensibility of some BP measurements methods to evaluate BP reductions after an intervention to reduce salt intake in normotensive, pre-hypertensive and normotensive groups.

Design and method: 55 public educational institution servers. Average age of 45.5 years (± 10.6), 58.2% of the sample were male.BP measurements were performed after the intervention to reduce the intake of diet adding salt to 4 g/day.The following methods were performed: offi ce BP measurement; home blood pressure measurement (HBPM) and central blood BP measurement by tonom-etry. Participants were classifi ed by offi cel BP measurement as normotensive (18), pre-hypertensive (15), and hypertensive (22). Blood pressure measurements were performed according to the latest Brazilian guidelines of hypertension. All of the participants signed a consent form.

Results: No differences were noticed regarding the age or gender distribution between the groups. In normotensive group offi ce BP showed decreases of the systolic blood pressure (SBP) of 2.5 mmHg, and diastolic blood pressure (DBP) of 1.4 mmHg, neither of them had statistical signifi cance. HBPM showed no sig-nifi cant decrease both in SBP as DBP and central BP measurement revealed a signifcant decreased of the SBP (3,6 mmHg) and a reduction of DBP (1,6 mmHg) without signifi cance. Among pre-hypertensives participants, SBP and DBP had signifi cant changes neither in offi ce, nor in HBPM. Central blood pressure mea-surement reveal signifi cant SBP reduction of 4,8 mmHg and non signifi cant DBP reduction of 2,2 mmHg. BP reduction in all hypertensive group was 4.4 mmHg for SBP and 4.1 mmHg for DBP. HBPM reduction was of 1,6 mmHg for SBP and 0,6 mmHg for DBP. Concerning central blood pressure measurement in this group there was signifi cant reduction both for SBP (5.5 mmHg) and DBP (5,1 mmHg).

Conclusions: Central Blood Pressure Measurement was the method that better identifi ed reductions of SBP in all of the group. Evidences of signifi cant DBP reduction was found only in the hypertensive group.

PP.06.24 THE EVOLUTION OF HYPERTENSION - FROM

THE WHITE COAT (WCH) TO THE SUSTAINED

HYPERTENSION (SH)

C. Santos Moreira1, P. Alcântara1, C. Alcântara1, F. Veloso1, C. Saldanha2, J. Martins E Silva2, J. Braz Nogueira1. 1Department of Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal, 2Institute of Molecular Medicine, Faculty of Medicine of University of Lisbon, Lisbon, Portugal

Objective: Several studies demonstrated that both WCH were independently as-sociated with increased target organs lesions and incident cardiovascular events. The goal of this study was to evaluate the evolution of patients with WCH over a 12-year period and to look for predictive risk markers of evolution for SH.

Design and method: Patients initially with WCH were followed for a period 12 years and had clinical clinical, laboratory, electrocardiogram and ambulatory blood pressure evaluations every six months.We considered 4 groups. G1: WCH at the end of 12 years; G2: conversion to SH between 6 and 9 years; G3: conversion to MH between 3 and 6 years; G4: conver-sion to MH before 3 years. The model was ANOVA, with p < 0.01 (two-tailed).

Results: The study comprised 130 patients, 55 men; 75 women, with an initial age of 57.5 ± 9.3 years and a body mass index of 28.4 ± 4.3 kg/m2. Twenty patients were lost in follow-up. Groups 1, 2, 3 and 4 have respectively 13, 16, 16 and 41 patients. alysing the initial parameters, the values of systolic and diastolic blood pressures in the clinic and ambulatory monitoring did not present signifi cant differences, as the laboratory parameters, except for microalbuminuria (mg / 24 h) (G1: 32.8 + 18.3; G2: 23, G3: 12.3 + 8.9, G4: 7.2 + 8.2, p < 0.01), the plasma viscosity index (mPa.A) (G1: 1.32 + 0), G3: 1.18 + 0.07, p < 0.01) and the amino-terminal peptide of procollagen type III (G1: 15.3 + 0.87, G2: 14.3 + 0.75, G3: 12.1 + 0.84, G4: 10.0 + 0.75, p < 0.01).

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e136 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

Conclusions: Accumulating evidence focusing on the association of WCHT with target organ damage indicates that the risk conveyed by this condition is intermedi-ate between normotension and sustained hypertension. We can see that there are al-ready previous markers of vascular lesion that may be correlated with the evolution of the disease. In view of the evolution and relationship with organ damage, the need to carry out therapy prior to the maintained hypertension phase could be considered.

PP.06.25 BETA-BLOCKERS ARE THE ONLY

ANTIHYPERTENSIVE DRUGS THAT BLUNT THE

DURATION OF WHITE-COAT EFFECT ESTIMATED

WITH AMBULATORY BLOOD PRESSURE

MONITORING

F. Salvo1, M. Albano1, C. Vallo1, C. Lonati2, P. Fogliacco1, A. R. Errani1, M. Berardi1, 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: The presence of white-coat effect (WCE) on ambulatory blood pres-sure monitoring (ABPM) can increase mean blood pressure (BP) values determin-ing an overestimation of the diagnosis of arterial hypertension. We previously found that WCE duration (WCEd) is longer in females than in males and sig-nifi cantly blunted by beta-blockers in males; however the infl uence of the other antihypertensive drugs was not established.

Design and method: We analysed 281 ABPM (M/F 101/180) in which the fi rst systol-ic value was at least 10 mmHg higher than mean diurnal systolic BP (mDSBP). WCE was evaluated during the fi rst two hours of recording as the mean value of systolic BP (WCE magnitude, WCEm) and as WCEd i.e. the sum of the time intervals in minutes (min) following a systolic BP value of at least 10 mmHg higher than mDSBP. The relation between WCE and drug classes (angiotensin-converting enzyme/angiotensin receptor blockers, beta-blockers, calcium channel blockers, thiazide diuretics, alpha-blockers, central alpha-agonists and anti-aldosterone) was evaluated with a multivariate regression analysis with a p-value < 0.01 considered as statistically signifi cant.

Results: Mean age was 65 ± 1 years (M/F 66 ± 1/64 ± 1 years, n.s.) and overall mDSBP was 138 ± 1 mmHg, without differences between genders. Mean WCEm and WCEd were respectively 151 ± 1 mmHg (M/F 149 ± 2/152 ± 1, n.s.) and 63 ± 1.5 min (M/F 59 ± 2/66 ± 2, p < 0.02). The multivariate regression analy-sis showed that WCEd was correlated only with beta-blockers and male gender (table), whereas there were no relationship of WCEm with any drugs.

Conclusions: WCEd is shorter in men than in women regardless of drug therapy and beta-blockers are the only antihypertensive drugs that seem to reduce WCEd estimated with ABPM, whereas they do not affect WCEm.

PP.06.26 EFFECT OF STANDARDIZED ALGORITHMIC

TREATMENT ON HOME BLOOD PRESSURE

VARIABILITY: GENDER DIFFERENCES IN

LONGITUDINAL REAL-LIFE STUDY

K.M. Amosova, I.U. Rudenko. O. O. Bogomolets National Medical University, Kiev, Ukraine

Objective: Home blood pressure (BP) variability (HBPV) is a signifi cant predic-tor of cardiovascular events, but gender differences in the drug treatment effect on HBPV remains uncertain. Our purpose was to compare the effect of 6 month (M) standardized algorithmic treatment on HBPV in men and women < 75 years with uncomplicated hypertension (UH).

Design and method: To PERFECT-BP prospective observational study (IS-RCTN75706523) subanalysis were included 209 newly diagnosed (14,4%) or treated but uncontrolled (BP < 200/120mmHg) UH patients (pts) aged 59 ± 9,5, 89(42,6%) male, 120(57,4%) female, 27(12,9%) diabetics. Home BP monitoring (HBPM) was performed by standardized automatic Microlife BP3AG1 device with individually selected cuff, thrice in the morning and in the evening, for 7 consecutive days before each visit at day 7, M1, 2, 3, 6. At visit 1 pts were prescribed or switched to perindo-pril/amlodipine fi xed-dose combination (FDC). Step 2 was FDC uptitration, step 3 – indapamide SR, step 4 – spironolactone, step 5 – moxonidine or doxazosin. HBPV

was defi ned as the standard deviation (SD) and the coeffi cient of variation (CV) of the daily BP average of 6 readings of 7 consecutive days (42 BP readings).

Results: By 6 M, target offi ce BP was attained in 71(79,8%) men vs 103(85,8%; p > 0,05) women, home BP < 135/85 mmHg – in 51(57,3%) vs 87(72,5%, p < 0,03) and both – in 47(52,8%) vs 80(66,7%, p < 0,05). Home systolic BP (SBP) in men and women reduced from 148,8 ± 17,9 and 145,7 ± 16,8 mmHg (p < 0,05) to 134,7 ± 12,2 and 129,4 ± 10,8 mmHg (p < 0,01), diastolic (DBP) – from 87,3 ± 10,5 and 83,6,5 ± 9,8 mmHg (p < 0,05) to 79,5 ± 7,9 and 77,4 ± 5,7 mmHg (p > 0,05); home SBP SD – from 8,2 ± 3,5 and 8,8 ± 4,6 mmHg (p > 0,05) to 4,9 ± 2,4 and 6,2 ± 3,7 mmHg (p < 0,001), SBP CV – from 5,2 ± 2,2 and 5,7 ± 2,6% (p > 0,05) to 3,8 ± 1,5 and 4,5 ± 2% (p < 0,01); home DBP SD – from 5,7 ± 3 and 6,1 ± 3 mmHg (p > 0,05) to 3,6 ± 2 and 4,9 ± 3 mmHg (p < 0,01), CV – from 6,1 ± 3 and 6,9 ± 3% (p > 0,05) to 4,7 ± 2 and 5,9 ± 3% (p < 0,01).

Conclusions: Better home BP control in women compared to men is associated with higher rates of home SBP and DBP variability after 6 M of standardized algorithmic treatment based on FDC in real life setting.

PP.06.27 THE EFFECT OF NIGHTTIME AIRCRAFT NOISE

EXPOSURE ON CIRCADIAN BLOOD PRESSURE

PROFILE

M. Rojek1, M. Rajzer1, T. Pizon2, P. Skalski3, D. Czarnecka1. 11st Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian Univer-sity Medical College, Cracow, Poland, 2Department of Observational and Internal Medicine, University Hospital, Cracow, Poland, 3Institute of Aviation, Warsaw, Poland

Objective: Nocturnal aircraft noise as environmental stressor causes activation of autonomic and endocrine systems.That might result in changes in sleep structure and increases in blood pressure and heart rate. Aim of the study was to investigate effects of nighttime exposure to aviation noise on quality of sleep,and hemody-namic parameters-heart rate and blood pressure profi le.

Design and method: Study group was randomly recruited among inhabitants of area exposed to high nighttime aircraft noise levels, exceeding 50db(A). Control group was recruited accordingly in the area of low nighttime aircraft noise exposure, below 45db(A). Inclusion criteria involved age (40–65yrs) and time of residence in given area (min.3 yrs). Sites were selected based upon acoustic maps.Anthropometric and demographic data, information on habits and sleep quality were collected via questionnaire. In both groups 24 h ambulatory blood pressure monitoring (ABPM) was performed in order to determine 24 h, day and night BPs and heart rate. Based on ABPM results, participants were assigned to the dipper, non-dipper, reverse dipper and extreme dipper group. The relation between noise exposure, sleep pattern, BPs and HR was determined.

Results: Study group (n = 101pts) and control group (n = 100 pts) were of equal age (53.5 vs 53.6 yrs), BMI (27.2 vs 27.7 kg/m2) and gender ratio (65% vs 71% women). Neither 24 h BPs nor daytime BPs did not statistically differ between groups.Night-time BPs analysis detected difference between groups in DBPN(66.6 vs 63.6 mmHg,) and MAPN(81.6 vs 79.1 mmHg) but no in SBPN and PPN. Heart rate was higher in study group (73.1 vs 70.3 bpm).In BP profi le analysis we found physiological night BPdrop disturbance in study group- only 34%dippers vs 54% in control.Sleep quality survey revealed sleep deterioration in study group-89% suffered from poor sleep quality (diffi cult falling asleep, waking up at night, early waking) and consequently- presented impaired daytime performance; in comparison-42% of control reported similar disorders.

Conclusions: Long-term exposure to nighttime aircraft noise is associated with sleep dis-turbance and physiological circadian blood pressure profi le alterations. The effect might be partially masked by habituation to noise.However, biologic adaptation is often incom-plete and requires physiologic resources therefore putting strain on organism as whole.

PP.06.28 RELATIONSHIPS OF BLOOD PRESSURE

AND CIRCADIAN RHYTHM WITH VASCULAR

REACTIVITY FOR HYPERTENSIVE PATIENTS

T. Ripp1, V. Mordovin1, E. Ripp2, N. Rebrova1,2, S. Pekarsky1, A. Falkovskaya1, V. Lichikaki1, E. Sitkova1, I. Zyubanova1. 1Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia, 2Siberian State Medical University, Tomsk, Russia

Objective: We studied relationships of blood pressure and circadian rhythm with cerebrovascular reactivity (CVR) for hypertensive patients.

Design and method: All participants of research have given the informed agree-ment. We used ultasonography of transcranial Doppler`s method in the middle cere-bral arteries from temporal window. We studied the measurement of blood pressure (BP): ABPM and offi ce BP control and the changes of fl ow Velocity mean (Vm) starting, during hypercapnia (inhalation 2 min 4% mixture of carbonic gas (MCG) with air or hyperoxia 100% oxygen and FmV in period of recovery (rec), air-in-halation 2 min of 124 patients with essentially hypertensive (BP > 140/90 mm Hg

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Abstracts e137

without antihypertensive drugs), age 55.2 ± 12.3years. High - resolution annular array scanners was determined - a nominal axial resolution of 0.2 mm and 30 frames per second’s acquisition rate with a 2.5–4 MHz sectored array transducer in the quiet, dark, warm room. We used Indexes of FVm; IFVm = (Vm0-Vm)/Vm0*100, Speed Modifi cation of FVm: SM = (Vm-Vm0)/120, Index of Recovery of FVm: IR = Vm0/Vmrec: Vm0, BP0 are starting and Vm, BP are the parameters at period of inhalation, Vmrec is Vm after 120 sec.-time of inhalation.

Results: BP was higher in patients with the opposite reaction in the state of hy-peroxia: average daily BP-142.2 ± 12.6/87.4 ± 10.1mmHg, and the daily index SBP below 6.0 ± 1.2% than in patients with impaired only hyperoxic reaction: average daily BP-136.2 ± 7.6/83.4 ± 10.3mmHg, p = 0.011/0.016 and day/night index 14.2 ± 2.6% p = 0.000. Patients had statistically signifi cant difference CVR settings when comparing groups with impaired circadian rhythm of blood pres-sure by the type of non-dipper and night-picker and with high temporal index in the night compared to patients with a dipper-type. These were the parameters: the rate of change of blood fl ow velocity, deceleration test speed under hyperoxia and hypercapnia, decreased blood fl ow at the time of the index hypercapnia.

Conclusions: Patients with the opposite reaction during hyperoxia had higher level of offi ce BP and ABPM at the control. Disturbance of the circadian rhythm of BP by the type of non-dipper and night-picker met 3 times more often in patients with opposite reactions CVR, compared with patients who had a normal type of CVR

PP.06.29 DAY-TO-DAY VARIABILITY OF THE MEAN

SYSTOLIC AND DIASTOLIC PRESSURE IN

AMBULANT BLOOD PRESSURE MONITORING

A. Reshetnik, M. Toller, W. Zidek, M. van der Giet. Department of Nephrology, Charité University, Campus Benjamin Franklin, Berlin, Germany

Objective: To assess day-to-day variability of the mean blood pressure values obtained during the ambulant blood pressure monitoring (ABPM)

Design and method: We included 27 patients from our ambulatory hyperten-sion unit between March and October 2016. All patients were treated with an-tihypertensive medication and were on stable drug regimen at least four weeks before study entry. Two to three daytime ABPM readings (at least 12 hours) were obtained during one week. The patients remained on stable medication during this period of time. All ABPM readings were performed with Ultralite 90207 (Spacelabs Healthcare, Snoqualmie, Washington, USA). Day-to-day variability of mean daytime systolic (SBP) and diastolic blood pressure (DBP) was determined.

Results: 64 ABDM readings were performed. Half of the study population was male (51.8%) and mean age of the patients was 57.9 ± 12.8 years. Mean SBP was 127.9 ± 15.9 mmHg and mean DBP was 75.7 ± 11.2 mmHg. Mean SBP and DBP of the single readings didn’t differ signifi cantly. Mean day-to-day difference was 6.7 ± 6.8 (95%CI -6.6 – 20) mmHg for SBP and 4.5 ± 4.1 (95%CI -3.5 – 12.5) mmHg for DBP.

Conclusions: Though the changes in the mean SBP and DBP were not statisti-cally signifi cant in our study collective, we observed clinically important day-to-day variability of the mean SBP and DBP despite unchanged medical regimen. Current expert recommendation is to consider decrease of mean SBP of at least 5 mmHg in ABPM as signifi cant effect of antihypertensive drug or intervention. The observed variability of mean SBP in the ABPM in our study exceeds the rec-ommended cut-off. Study results point out that the currently recommended cut-off value might probably not always be able to show real intervention effect, which should be considered in the design of future studies.

PP.06.31 MISSED ARTERIAL HYPERTENSION BY OFFICE

BLOOD PRESSURE MEASURED ACCORDING TO

THE NICE 2013 GUIDELINES – RESULTS FROM THE

IPARR TRIAL

T. Burkard1,2, C. Winterhalder3, L. Leonardi3, A. Maseli3, T. Schoen2, J. Eckstein2, A. S. Vischer1,2. 1University Hospital Basel - Medical Outpatient Department and Hypertension Clinic, Basel, Switzerland, 2University Hospital Basel - Department of Cardiology, Basel, Switzerland, 3University Hospital Basel - Department of Internal Medicine, Basel, Switzerland

Objective: Standard operating procedures (SOP) for offi ce blood pressure mea-surement (OBPM) vary highly between different guidelines. The NICE 2013 guidelines for arterial hypertension (AH) SOP recommends a fi rst blood pressure measurement (BPM) after 5 minutes rest and a second BPM if blood pressure (BP) is > 139 mmHg systolic (s139) or >89 mmHg diastolic (d89). We aimed to study how many probably hypertensive patients may be missed by this approach due to short term masked hypertension (STMH).

Design and method: In this cross-sectional, single-centre trial, 1000 adult subjects were recruited. Seven sequential BPM were performed by an operator after fi ve minutes rest in a quiet room and in sitting position. The BPM were taken using a standard device (Omron HBP-1300 professional BP monitor, appropriate cuff size), alternating with a tested smartphone app. Standard BPM were spaced 2 minutes apart. Overall, 4 standard and 3 smartphone BPM were taken, however, only stan-dard BPM were used for this study. Additional information about cardiovascular risk factors, concomitant disease, and medication were collected. We compared the fi rst BPM out of four to the three following BPM. STMH was defi ned as fi rst BP < s140 and <d90 mmHg and one of the consecutive BPM >s139 or >d89 mmHg.

Results: Complete measurements were available in 802 subjects. We identifi ed 528 (65.8%) subjects with a BP < s140 and <d90 mmHg in the fi rst measurement. In 61/528(11.6%) subjects at least one consecutive BPM was > s139 or >d89 mmHg and in 18/528 (3.4%) the mean of 2nd-4th measurement was >s139 or >d89 mmHg. 412/802 (51.4%) subjects had no history of AH and normal fi rst BPM. In this group STMH was present in 45/412 (10.9%). Subjects with STMH showed no differences in clinical parameters in comparison to subjects with normal BPM over all measurements.

Conclusions: By applying the SOP for OBPM suggested by NICE we found short term masked hypertension in more than 10% of all apparently normotensive sub-jects and especially in 11% of apparently normotensive subjects without known AH. Therefore by this SOP a signifi cant proportion of patients may be missed for further evaluation.

PP.06.32 VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY

AND ITS CORRELATION WITH DECLINE IN KIDNEY

FUNCTION IN PATIENTS WITH TYPE 2 DIABETES

MELLITUS

H. Husin, Y. Chia, H. Hadi. University of Malaya, Kuala Lumpur, Malaysia

Objective: Blood pressure variability (BPV) is associated with poorer outcomes in patients with diabetes. Research on the characteristics of visit-to-visit BPV and its prognostic implications is limited. This study aimed to determine the value of BPV, associated factors of systolic BPV and its correlation with decline in kidney function in patients with type 2 diabetes mellitus (T2DM).

Design and method: This was a 10-year retrospective cohort study of 333 pa-tients with T2DM at a primary care clinic. Blood pressure (BP) at every follow up visit from 2005 to 2014 were captured. BPV was defi ned as the standard deviation of the BP readings. Decline in kidney function was expressed as the annual rate of decline in estimated glomerular fi ltration rate (eGFR). Factors associated with visit-to-visit systolic BPV was determined using Pearson’s correlation coeffi cient and independent t-test. Independent association of decline in annual eGFR rate was determined using multivariate linear regression analysis.

Results: This study involved 112 male patients (33.6%) and 221 female patients (66.4%). The mean age of patients at baseline was 57.8 ± 9.5 years old. By the end of study period, the mean duration of years of diabetes was 15.9 ± 6.2 years and 298 (89.5%) of patients had co-morbid hypertension. The mean visit-to-visit systolic BPV was 12.7 ± 3.1 mmHg. Higher systolic BPV was found in patients who were older, females, with co-morbid hypertension, more frequent clinic vis-its, higher mean systolic BP, higher mean total cholesterol and users of antihy-pertensive medications. The mean annual decline in eGFR rate in this study was -0.78 ± 1.60 ml/min/1.73m2. Independent factors associated with decline in kid-ney function were systolic BPV, longer duration of diabetes and use of diuretics.

Conclusions: The visit-to-visit standard deviation of BPV in patients with T2DM is 12.7 mmHg. Systolic BPV is an independent risk factor associated with decline in kidney function. Hence visit-to-visit BPV is an important additional target to reduce decline in kidney function in patients with T2DM.

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e138 Abstracts

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved

SATURDAY

POSTERS

POSTER SESSION

POSTERS’ SESSION PS07:

KIDNEY AND RAAS

PP.07.04 EFFECT OF ANGIOTENSIN-CONVERTING ENZYME

INHIBITORS ON PLASMINOGEN ACTIVATOR

INHIBITOR – 1 LEVEL IN HYPERTENSIVE PATIENTS

WITH IGA NEPHROPATHY

D. Xydakis1, E. Antonaki1, M. Tzanakakis1, K. Kostakis1, A. Papadaki2, A. Papadogiannakis1. 1Nephrology Department, Venizeleio Hospital, Herakleio, Greece, 2Nephrology Department, Chania Hospital, Chania, Greece

Objective: ACE inhibitors have a central role in the treatment of IgA nephropathy and especially on its evolution. IgA nephropathy is characterized by accumulation of extracellular matrix (ECM) in the kidney. PAI-1 plays a critical role in ECM remodeling in the kidney. In the present study we examined the effects of ACE inhibitors on PAI-1, a downstream mediator of angiotensin II.

Design and method: 61 patients (37/24 M/F, 65.1 ± 13.4 years) with IgA ne-phropathy were included in our study. Patients with chronic renal failure, sec-ondary form of hypertension, myocardial infraction, cerebrovascular disease and other form of nephropathy were excluded. All antihypertensive medications were discontinued for 2 weeks. At the end of this period, in all patients were measured albumin excretion rate (AER), plasma renin activity, aldosterone, plasma level of PAI-1, fi brinogen (base line measurement), IL-6, CRP. Patients were then treated with perindopril 5 mg/day in a single dose. Plasma levels of renin, aldosterone, PAI-1, fi brinogen, IL-6, CRP were measured again at a 4 and 8 weeks period.

Results: The effect on blood pressure (systolic, diastolic) of perindopril was of statistical signifi cance. Base line levels of PAI-1 were 53.3 ± 12.3 ng/ml. PAI-1 levels at the 4th week were decreased signifi cantly (29.9 ± 5.4 ng/ml post treat-ment vs 53.3 ± 12.3 ng/ml pre treatment, p < 0.05).At the 8th week, levels of PAI-1 were reduced, but not signifi cantly in comparison with the end of the 4th week (27.7 ± 6.9 ng/ml vs 29.9 ± 5.4 ng/ml, p>0.05).

Conclusions: Our data suggest that ACE inhibitors decrease plasma levels of PAI-1 in patients with IgA nephropathy, especially during the fi rst four weeks of treat-ment. These drugs may infl uence the progression of IgA nephropathy by reducing renal matrix expansion, a process that central role has PAI-1.

PP.07.05 ORAL PARICALCITOL THERAPY REDUCES

ARTERIAL STIFFNESS IN HYPERTENSIVE

PATIENTS WITH CHRONIC KIDNEY DISEASE AND

SECONDARY HYPERPARATHYROIDISM: DATA

FROM A 1-YEAR FOLLOW-UP STUDY

K. Dimitriadis, K. Tsioufi s, M. Giakoumis, Th. Kalos, M. Kouremeti, K. Kyriazopoulos, G. Annousis, D. Konstantinidis, D. Petras, D. Tousoulis. First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece

Objective: Arterial stiffness is linked to the progression of atherosclerosis, while activation of vitamin D receptor exerts favorable cardiovascular effects in patients with renal insuffi ciency. In this study we investigated the effects of oral treatment with paricalcitol, a potent vitamin D receptor activator on arterial stiffness and osteopontin, a marker of atheroscleroris, in hypertensive patients with chronic kidney disease (CKD) and secondary hyperparathyroidism.

Design and method: We followed up 29 treated hypertensive patients (mean age 74.1 years, 19 men, offi ce blood pressure = 132/85 mmHg) with CKD stages 3–5 [mean glomerular fi ltration rate (GFR) = 19.4 ml/min/1.73 m2], who were on therapy with oral paricalcitol for 1 year. All patients at baseline underwent a com-plete physical examination, while venous blood samples were drawn for estima-tion of metabolic profi le, levels of intact parathormone, phosphorus and calcium and osteopontin. Arterial stiffness was estimated based on carotid-femoral pulse wave velocity (PWV) measured with an automated device.

Results: After 1 year of treatment with paracalcitol compared to baseline there was no statistical difference in levels of GFR (19.5 ± 4.8 ml/min/1.73m2 vs 18.0 ± 2.3 ml/min/1.73m2, p = 0.318) and calcium (9.11 ± 2.3 vs 8.98 ± 2.2 mg/dl,p = 0.344). Regarding the metabolic profi le of patients, levels of glucose, lipids

or uric acid did not differ, while the product of calcium x phosphorus exhibited no pathological values. Additionally, carotid-femoral PWV was reduced after 1 year treatment with oral paricalcitol from 11.8 ± 2.6 m/sec to 11.2 ± 2.4 m/sec (p < 0.05), while blood pressure values and osteopontin levels 1 year after therapy compared to baseline values had no statistical difference (p = NS).

Conclusions: Treatment with oral paricalcitol in hypertensive subjects suffering from CKD stages 3–5 and secondary hyperparathyroidism is accompanied by amelioration of arterial stiffness as refl ected by the reduction of carotid-femoral PWV. These fi ndings suggest that paricalcitol exerts pleiotropic favorable effects on the vascular system, thus improving cardiovascular prognosis in high risk hy-pertensive patients.

PP.07.06 EFFECT OF MOXONIDINE ON THE ALDOSTERONE/

RENIN RATIO CALCULATED BY BOTH

PLASMA RENIN ACTIVITY AND DIRECT

RENIN CONCENTRATION IN HEALTHY MALE

VOLUNTEERS

A. Ahmed1, R. D. Gordon1, G. Ward2, M. Wolley1, M. Stowasser1. 1Endocrine Hypertension Research Centre, Univ of Qld School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia, 2Sullivan & Nicolaides Pa-thology, Brisbane, Australia

Objective: The most popular screening test for primary aldosteronism (PA) is the plasma aldosterone/ renin ratio (ARR). Medications, dietary sodium, posture and time of day all affect renin and aldosterone levels, and can result in false negative or positive ARRs if not controlled. Most antihypertensive medications affect the ARR and can interfere with interpretation of results. To our knowledge, no study has been undertaken to evaluate the effects of moxonidine on the ARR.

Design and method: Normotensive, non-medicated male volunteers (n = 20) underwent measurement (seated, midmorning) of plasma aldosterone (by HPLC-tandem mass spectrometry), direct renin concentration (DRC), renin activity (PRA), cortisol, electrolytes and creatinine and urinary aldosterone, cortisol, elec-trolytes and creatinine at baseline, and after one week of moxonidine at 0.2 mg/d and a further fi ve weeks at 0.4 mg/d.

Results: Compared with baseline, despite the expected signifi cant falls in both systolic and diastolic blood pressure, levels of plasma aldosterone [median 134 (range 90–535) pmol/L], DRC [20 (10–37) mU/L], PRA [2.2 (1.0–3.8) ng/mL/h] and ARR using either DRC [8.0 (4.4–14.4)] or PRA [73 (36–218)] were not sig-nifi cantly changed after either one [135 (98–550) pmol/L, 20 (11–35) mU/L, 2.0 (1.2–4.1) ng/mL/h, 8.8 (4.2–15.9) and 73 (32–194) respectively] or six weeks 130 (90–500) pmol/L, 22 (8–40) mU/L, 2.1 (1.0–3.2) ng/mL/h, 7.7 (4.3–22.4) and 84 (32–192)] of moxonidine. There were no changes in any urinary measurements.

Conclusions: Moxonidine was associated with no signifi cant change in the ARR and may therefore be a good option for maintaining control of hypertension when screening for PA.

PP.07.07 USE OF BETABLOCKERS ASSOCIATED WITH LESS

ORTHOSTATIC RESPONSE IN DIALYSIS PATIENTS:

SHOULD WE BE MORE CAREFUL ABOUT IT?

M. Schiavone1, M. E. Biain2, M. Magenta2, G. Lahan2, C. Diaz2, G. Fernandez Candia1, F. Speranzoni3, J. Montagnana3, R. Pereira3, S. Gonzalez4, F. Inserra4, C. Castellaro2,3,4. 1Faculty of Biomedical Science, Austral University, Derqui, Argentina, 2Nephrology Section, Department of Medicine, CEMIC, Buenos Aires, Argentina, 3Hypertension Unit, CEMIC, Buenos Aires, Argentina, 4Cardio-metabolic Unit, Hospital Universitario Austral, Derqui, Argentina

Objective: 1-Analyze the prevalence of orthostatic hypotension in patients on dialysis.2-To establish if orthostatic hypotension is associated with specifi c hemo-dynamic changes in supine position and standing.3-Determine independent predic-tors of orthostatic hypotension

Design and method: Within a cardiovascular evaluation program for patients in ESRD (PRECADIA), 68 patients attended the interdialysis day to undergo a hemodynamic evaluation.BP (Microlife-AFIB200) and hemodynamics was determined with impedance car-diography in supine position and after the third minute of standing. Following vari-ables were analyzed: Systolic blood pressure (SBP), Diastolic blood pressure (DBP),

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Abstracts e139

heart rate (HR), stroke volume (SV), systemic vascular resistance index(SVRI) and thoracic fl uid content (TFC). Patients were classifi ed into 2 groups according to the presence (HIPOT) or not (EST) of orthostatic hypotension defi ned as a drop of20 mmHg or more of SBP and/or 10 mmHg or more of DBP when standing. Hemo-dynamic variables were analyzed according to: 1-baseline conditions and 2-differ-ences (Delta:standing-lying) between the two groups (t-test and Mann-Whitney U test). Independent predictors of orthostatic hypotension were determined adjusting for age, sex, BP, anthropometric variables, time on dialysis and medication through a logistic regression.

Results: We included 53 patients (age:61.3 ± 14.85 years, SBP:140 ± 33.49 mmHg, DBP:79.64 ± 14.24 mmHg, females 28 (53.8%)). 12 patients(32.7%) had orthostatic hypotension. There were no signifi cant differences in age, sex, BMI, time on dialysis, diabetes prevalence and CV events between both groups. 92,31% of the HYPOT group received BB, the EST group only reached 50% (p = 0.0303).In supine position, there were no hemodynamic differences between the two groups. By standing the HYPOT group showed lower Delta-SVRI (p = 0.026), Delta-DBP(p < 0.0001) and Delta-SBP (p < 0.0001). There were no signifi cant differences in Delta-TFC. In logistic regression, the use of BB was an independent variable for orthostatic hypotension.

Conclusions: The use of BB was a determinant factor to attenuate or to nullify the compensatory increase of the vascular resistances by standing, and consequently to favor the development of hypotension when standing. It should be evaluated whether or not this phenomenon is associated with a higher rate of events, and if this measurement adds value when deciding whether to use BB in this population.

PP.07.08 PULSE PRESSURE AND INHIBITION OF THE

RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM IN

ESSENTIAL HYPERTENSIVE PATIENTS ASSUMING

ACE INHIBITORS OR ANGIOTENSIN RECEPTOR

BLOCKERS

P. Balietti, F. Spannella, F. Giulietti, E. Borioni, F.E. Lombardi, G. Cocci, R. Sarzani. Internal Medicine and Geriatrics, Hypertension Excellence Centre of the ESH, IRCCS-INRCA, UNIVPM, Ancona, Italy

Objective: Increased levels of plasma aldosterone appear to associate with in-creased vascular fi brosis/reduced arterial compliance in hypertensive patients. Higher pulse pressure (PP) is considered a good index of reduced vascular elastic-ity. ACE inhibitors (ACE-I) and angiotensin receptor blockers (ARBs), reducing plasmatic aldosterone concentration (PAC) despite increase plasma renin activity (PRA), might reduce arterial stiffness. Our aim was to investigate the relationship between PP and inhibition of the RAAS, evaluated by the ratio of PRA on PAC, in a population of essential hypertensive patients in stable treatment with ACE-I or ARBs.

Design and method: We recruited 183 consecutive patients with essential hypertension treated with ACE-I or ARB in the previous 6 months. For the analysis, PRA-PAC ratio (PRA/ PAC, PRA in ng/ml, PAC in ng/dl) was multi-plied by 100 and divided into tertiles. An ambulatory blood pressure monitor-ing was performed just before the dosages of PRA-PAC, without changes in drug therapy.

Results: Males: 115 (62.8 %), mean age: 58.8 ± 11.7 years. PRA/PAC Tertiles (1st: 0.02–0.57; 2nd: 0.59–2.84; 3rd: 2.94–50.98). There was no difference in age, sex, BMI or anti-hypertensive drugs between PRA/ PAC tertiles. A linear

association emerged between PP and PRA/PAC (24 h-PP: r = -231, p = 0.002; daytime-PP: r = -189, p = 0.01; nighttime-PP: r = -231, p = 0.002). Increasing PRA/PAC tertiles were associated to a reduction of all PPs that was statistically signifi cant for the 24 h-PP (1st: 56.0 ± 12.2 mmHg; 2nd: 50.5 ± 10.1 mmHg; 3rd: 49.7 ± 12.6 mmHg; p = 0.006). In the multiple regression analysis, the associa-tion between 24 h-PP and PRA/PAC tertiles remained signifi cant even after ad-justing for sex, age, BMI, blood pressure control, diabetes, smoking and eGFR (b = -0.158; p = 0.017).

Conclusions: Higher values of the PRA/PAC, that refl ect adequate inhibition of the RAAS by ACE-I or ARBs at doses/molecules prescribed, are associated with lower PP values. These fi ndings suggests that effective ACE-I/ARBs therapy is likely to reduce arterial stiffness.

PP.07.10 PRIMAR HYPERTENSION. EARLY

NEPHROSCLEROSIS BEGINS FIRST WITHIN THE

LEFT KIDNEY. ERGUN’S SIGN

Y. Sagliker1, Y. Ergun2, H. Sabit Sagliker3, N. Paylar1, K. Aikimbaev4, H. Firinciogullari4, P. Sagliker Ozkaynak1, Y. Ergun5. 1Samedsa Ltd. Srk, Sagliker Hypertension and Nephrology Unit, Adana, Turkey, 2Algomed Hospital, Adana, Turkey, 3Cumra State Hospital, Konya, Turkey, 4Cukurova University, Adana, Turkey, 5KMaras University, KMaras, Turkey

Objective: The aim of the present study was to further investigate the observation noticed that is nephrosclerosis starts fi rst in left kidney

Design and method: Kidneys of hypertensive patients (n = 51) were evaluated both by ultrasonography and color doppler ultrasonography.

Results: Shrunk kidneys were detected on the right side in 11 and left in 15 cases. Parenchymal echogenicity was significantly higher on the left side as compared to the right (45 versus 14). Alterations in parenchymal/pyelon ratios were found in 22 and 29 cases concerning the right and left side, re-spectively. Parenchymal/ pyelon border irregularities were determined in 12 cases in the right and 42 in the left kidneys. Nephrosclerosis occurred domi-nantly in left kidney when compared with the right one (44 versus 16). Right and left renal artery angles were found to be below 60 degrees in 13 and 24 cases, respectively.

Conclusions: Results showed that nephrosclerosis appears fi rst in the left kidney and this phenomenon may be called as Ergün sign.

PP.07.11 EFFECTS OF DUAL BLOCKAGES OF THE RENIN

ANGIOTENSIN SYSTEM IN PATIENTS WITH HEART

FAILURE AND RENAL DYSFUNCTION: SYSTEMATIC

REVIEW AND METANALYSIS

A. Rodrigues Silva1, A. Goes Martini1, G. de Luca Canto2, E. Neves da Silva Guerra1, F. de Assis Rocha Neves1. 1University of Brasilia, Brasília, Brazil, 2Federal University of Santa Catarina, Santa Catarina, Brazil

Objective: Renin-angiotensin system (RAS) blockade has been widely used in heart failure (HF) treatment since it signifi cantly improves the morbidity and mortality. To effectively block RAS more effi ciently, it has been proposing the combination of inhibitors of RAS. However, the use of dual blockade in patients with HF is still controversial, since adverse effects such as renal impairment are frequent. Therefore, it is critical to investigate the use of dual blockade of RAS in patients with HF that also display renal dysfunction (RD).

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e140 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

Design and method: Design: Systematic review and meta-analysis of random-ized trials.Data sources: the Cochrane Library, EMBASE, LILACS, PubMed and Web of Science. Clinical registries: ICTRP and NCT (Clinicaltrials.gov), Grey literature: Google Scholar, OpenGrey. Others: Handsearching of bibliographies.Intervention: Angiotensin receptor blocker (ARB) plus angiotensin converting enzyme inhibitors (ACEi) or aliskiren plus ARB or ACEi.Outcomes: Death, cardiovascular (CV) death or HF hospitalization and adverse events.

Results: Of 4,608 non-duplicate records screened, 3 randomized trials were included, totaling 13,680 patients. The metanalysis for death showed a Haz-ard ratio (HR) of 0.92 (0.84–1.01) p 0.07.However, metanalysis showed a significantly reduced CV death or HF hospitalization (HR 0.89–0.83–0.99, p 0.0006) favor to dual blockade of RAS, without difference between the groups with and without RD (test for difference Chi2 = 0.59, df = 1 (P = 0.44); I2 = 0%). For adverse events combined therapy exhibited a 29% increase in risk for renal impairment, 35% increase for hyperkalemia, and 28% increase for hypotension.Limitations: Only a few studies published the data of patients with heart failure and renal dysfunction. We could not analyze patients with proteinuria and normal renal function due to lack of data.

Conclusions: This metanalysis demonstrated that dual-blockade of RAS reduces the risk of CV death and HF hospitalization by 11%. Additionally, the protection was similar between patients with and without RD. Since the renal impairment, hypotension and hyperkalemia are monitored by daily basis exams, the recom-mendation for the use should not be categorically contraindicated. It is recom-mended to evaluate the cost-benefi t ratio of each patient.

PP.07.12 HEMATOCRIT UREA AND GENDER (H.U.G.E.)

FORMULA AND THE CKD PROGNOSIS

CONSORTIUM EQUATION: CORRELATION WITH

KDIGO RISK TABLE IN SPANISH POPULATION

J. M. Urbano1, N. R. Robles2, D. Fernandez-Berges3, F. J. Felix4, L. Lozano5, I. Miranda3. 1Hospital Distrital de Elvas, Elvas, Portugal, 2Hospital Infanta Cristina, Badajoz, Spain, 3Hospital de Don Benito-Villanueva de la Serena, Don Benito, Spain, 4C. S. Villanueva de la Serena, Villanueva de la Serena, Spain, 5C. S. Merida, Merida, Spain

Objective: To compare, in the HERMEX survey sample, the results of the use of the CKD Prognosis Consortium equation to calculate the risk of end-stage renal disease with the results of the KDIGO Progression Risk Table and the HUGE formula.

Design and method: From a sample of 2,813 subjects, 113 ones have an estimat-ed glomerular fi ltration rate < 60 ml/min. Hematocrit, urea, creatinine and micro-albuminuria were analyzed and then they were estimated the risk of progression to end-stage renal disease using the CKD Progression Consortium on line (http://www.kidneyfailurerisk.com), the risk of progression from the KDIGO Risk Table and the HUGE formula score.

Results: Using the KDIGO Risk Table 83 (73.5%) of subjects were at medium risk, 23 (20.4%) ones at high risk and 7 (6.19%) patients at very high risk of progression of chronic kidney disease. Using the estimation from the CKD Con-sortium equation that calculate the risk of progression to end-stage renal failure 108 (95.6%) subjects were at low risk of progression, 2 (1.7%) ones had a medium risk and the three left (2.65%) had a high risk. Compared with KDIGO Risk Table, the sensitivity was 0.23 (95%CI 0.10–0.43) and the specifi city was 1.0 (95%CI 0.94–1.00). The positive predictive value was 1.00 (95%CI 0.56–1.00) and the negative predictive value was 0.78 (95%CI 0.69–0.85). From the HUGE formula score only 33 (29.2%) patients had renal failure of them fi ve have risk of pro-gression to end-stage renal disease. The sensitivity was 1.00 (95%CI 0.46–1.00)

and the specifi city 0.74 (95%CI 0.65–0.82). The positive predictive value was 0.15 (95%CI 0.06–0.33) and the negative predictive value was 0.85 (95%CI 0.67–0.94). When H.U.GE formula results were compared with KDIGO Risk Table outcomes the sensitivity was 1.00 (95%CI 0.86–1.00) and the specifi city was 0.96 (95%CI 0.89–0.99).

Conclusions: There was not a good correlation between the KDIGO progression Risk Table and the equation to estimate end-stage renal disease risk. The KDIGO table must be used for nephrologist´s referral. Contrariwise, the HUGE formula got a good correlation with the KDIGO table.

PP.07.13 CHRONIC RENAL DISEASE ACCORDING TO THE

TIME OF EVOLUTION OF DIABETES IN PATIENTS

INCLUDED IN THE IBERICAN STUDY

D. Rey Aldana1, A. Barquilla Garcia2, F. J. Alonso Moreno3, R. M. Mico Pérez4, A. Santo González5, O. García Vallejo6, A. Calderón Montero7, A. P. Martínez Barseló8, M. Ruiz Peña9, I. Gil Gil10. 1C. S. A. Estrada XXI Santiago de Compostela, Pontevedra, Spain, 2C. S. Trujillo, Caceres, Spain, 3C. S. Silleria, Toledo, Spain, 4C. S. Fontanars Dels Alforins, Valencia, Spain, 5C. S. Sangonera La Verde, Murcia, Spain, 6C. S. Comillas, Madrid, Spain, 7C. S. Rosa De Luxemburgo, Madrid, Spain, 8C. S. Hijar, Teruel, Spain, 9U. G. C Los Barrios, Cadiz, Spain, 10C. A. P. Vielha, Barcelona, Spain

Objective: The general aim of IBERICAN study is to know the prevalence and incidence of cardiovascular risk factors and cardiovascular and renal disease in Spain. The aim of this abstract is to know the prevalence of chronic kidney disease according to the time of evolution of diabetes.

Design and method: The IBERICAN Study is a longitudinal, observational, and multicentric study with subjects between 18 to 85 years of age, recruited in Pri-mary Care (PC) and who will be followed up at least 5 years. The fi nal sample size is estimated in 7,000 patients. We show the baseline characteristics of the patients in the fi rst visit (n = 3,042). The glomerular fi ltrate was estimated by CKD-EPI equation, and the evolution time of diabetes was classifi ed into three categories (<5 years, 5–10 years y >10 years) that divided the sample into 34,1%, 31,4% y 34,5% of the patients.

Results: The prevalence of diabetes was 19% (n = 572) and the mean evo-lution time was 9.1 ± 6.2 years. In diabetics with more time of evolution, the nephropathy was more frequent (55.6% vs 28.9% vs 15.6%, p = 0.009). Chronic kidney disease was more prevalent in patients with more evolution time of diabetes (22.6% vs 14.0% vs 8.8%, p = 0.002). Also, the presence of glomerular fi ltrate < 60 ml / min (11.2% vs 6.4% vs 6.4%, p = 0.043) and the simultaneous lesion of GF < 60 ml / min associated with albuminuria (10.1% vs 5, 8% vs 1.8%, p = 0.043) was higher in patients with more evolution time of diabetes.

Conclusions: The diabetic patients with more evolution time of the disease, pre-sented a higher prevalence of all forms of renal injury.

PP.07.14 RENAL DOPAMINERGIC SYSTEM DYSFUNCTION

ASSOCIATED TO HIGH BLOOD PRESSURE AND

INFLAMMATION IN FRUCTOSE OVERLOAD

INDUCED METABOLIC SYNDROME

A. Puyó1, N. Rukavina Mikusic2, N. Kouyoumdzian2, G. Robbesaul2, M. Alvarez Primo1, H. Lee1, J. Toblli2,3,4, B. Fernández2, M. Choi1,2,4. 1Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina, 2Instituto de Investigaciones Cardiológicas (ININCA), Buenos Aires, Argentina, 3Hospital Alemán, Buenos Aires, Argentina, 4Consejo de Investigaciones Científi cas y Técnicas (CONICET), Buenos Aires, Argentina

Objective: The renal dopaminergic system (RDS) promotes sodium excretion and anti-infl ammatory actions. Fructose overload (FO) produces in the rat hemody-namic and metabolic changes similar to the human metabolic syndrome. These changes are associated to an impairment of the RDS, leading to renal infl amma-tion, sodium retention and blood pressure elevation. The aim of this study was to evaluate RDS state and its relation to hypertension and overexpression of renal infl ammatory markers in the FO experimental model.

Design and method: Six groups of male Sprague Dawley rats (six weeks at the beginning of the treatment) were studied: Control (C4, C8 and C12, tap water to drink) or FO (F4, F8 and F12, 10% w/v of fructose solution to drink), during 4, 8 and 12 weeks (n = 8/group/period). Urinary L-dopa and dopamine (DA) (HPLC), diuresis and albuminuria were determined. Systolic blood pressure (SBP) (tail cuff) and metabolic parameters were measured. Western blot analysis of renal expression of dopamine 1 receptor (D1R), NFkappa-beta, IL-6, TNF-alpha, TGF-beta1 and nephrin were performed.

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Abstracts e141

Results: Fructose overload increased SBP (mmHg, C4: 121 ± 8 vs. F4: 145 ± 1*; C8: 130 ± 4 vs. F8: 161 ± 10#; C12: 133 ± 5 vs. F12: 163 ± 4#), which positively correlated (R2 = 0.78; p < 0.002) to urinary L-dopa/DA index (C4: 0.49 ± 0.05 vs. F4: 1.9 ± 0.09#; C8: 0.53 ± 0.06 vs. F8: 2.35 ± 0.1#; C12: 0.54 ± 0.07 vs. F12: 2.57 ± 0.2#). A signifi cant decrease in the D1R expression was related to a sig-nifi cant increase in nFkappa-beta, IL-6, TNF-alpha, TGF-beta1 expression since week 4. Microalbuminuria (C12:13.11 ± 1.4 vs F12:57.6 ± 2.5#) and a decrease in nephrin expression (C12: 1.00 ± 0.10 vs. F12: 0.73 ± 0.05#) were observed only at week 12. (*p < 0.05, #p < 0.01 vs. C).

Conclusions: Fructose overload was associated to an L-dopa/DA index increase and D1R expression decrease since week 4 of treatment. The renal dopaminergic system dysfunction was accompanied by an increase in blood pressure levels and renal expression of infl ammatory markers in all experimental periods studied. Alteration of L-dopa/DA index could be an earlier marker of renal dysfunction than the structural damage evidenced by microalbuminuria and decreased nephrin expression in week 12 of fructose treatment.

PP.07.15 PREVALENCE AND CHARACTERISTICS OF THE

PATIENTS WITH MICROALBUMINURIA IN THE

IBERICAN STUDY

M. Prieto Díaz1, E.J. Gamero De Luna2, F. Unzeta Aramburu3, M. Laborda Peralta4, R. Piedra Castro5, Ma Martin Linares6, O. Mahmoud Atoui7, R.M. Aldecoa Garcia8, F.V. Martinez Garcia9, F. Leiva Cepas10. 1Primare Care Health Center Vallobin - La Florida, Oviedo, Spain, 2UGC El Juncal, Sevilla, Spain, 3Primare Care Health Center Llucmajor, Baleares, Spain, 4Primare Care Health Center Yepes, Huerta Offi ce, Toledo, Spain, 5Primare Care Health Center Azuqueca de Henares, Guadalajara, Spain, 6Primare Care Health Center Llutxent, Quatredonda Offi ce, Valencia, Spain, 7Primare Care Health Center Bembibre, León, Spain, 8Primare Care Health Center Besos, Barcelona, Spain, 9Primare Care Health Center Astorga II, León, Spain, 10UGC Occidente, Villarubia Offi ce, Córdoba, Spain

Objective: The general aim of IBERICAN study is to know the prevalence and incidence of cardiovascular risk factors and cardiovascular and renal disease in Spain. The aim of this abstract is to know the prevalence of microalbuminuria and its relation with cardiovascular risk factors (CVRF), target organ damage (TOD) and cardiovascular-renal disease (CVD) in the IBERICAN Study.

Design and method: The IBERICAN Study is a longitudinal, observational, mul-ticentric study with subjects between 18 to 85 years of age, recruited in Primary Care and who will be follow up at least 5 years. The fi nal sample size is estimated in 7,000 patients. We show the baseline characteristics of the patients in the fi rst visit (n = 3,042). We analyzed patients with microalbuminuria and we analyzed their association with the presence of CVRF, TOD (left ventricular hypertrophy (LVH), ankle/brachial index < 0,9, glomerular fi ltration < 60 ml/min) and with CVD. Microalbuminuria was defi ned: albumin/creatinine ratio between 30 and 299 mg/g, according to the Guide KDIGO-2012.

Results: 3,042 subject including. 2,202 subject with albumin/creatinine ratio de-termined, microalbuminuria: 212 (9.6%, in men was higher than women: 13.3% vs 6.6%, p < 0.001), mean age 62.3 ± 14 years, 37.7% women. The prevalence of CVRF between microalbuminuria vs no microalbuminuria were: hyperten-sion 72.2% vs 49,9%, p < 0.001; dyslipidemia 66% vs 51.6%, p < 0.001; diabe-tes 44.3% vs 19.1%, p < 0.001; obesity 41% vs 33.7%, p < 0.05; alcohol 19,3% vs 10,5%, p < 0,001; smoker 18% vs 16.4%, p = NS. TOD were more frequent with the microalbuminuria: LVH 13% vs 4.1%, p < 0.001; ankle/brachial index 26.8% vs 16.9%, p = NS; glomerular fi ltration < 60 ml/min 13 % 24.4% vs 7.1%, p < 0.001. The prevalence of cardiovascular disease was higher in patients with microalbuminuria: 25.6% vs 15.4%, p < 0.001, ischemic heart disease 11.4% vs 7.9%, p = NS; stroke 8.1% vs 4.6%, p < 0.05; peripheral arterial disease 11.8% vs 4.4%, p = 0.001, and heart failure 7.1% vs 2.7%, p = 0.001. Cardiovascular risk high or very high was: 83.1% vs 59.4%, p < 0.001.

Conclusions: Patients with microalbuminuria was more prevalent in men, with higher prevalence of cardiovascular risk factors, subclinical organ injury and es-tablished cardiovascular disease. The cardiovascular risk high or very high was more prevalent in patients with microalbumiuria.

PP.07.16 RELATIONSHIP BETWEEN PLASMA RENIN

ACTIVITY, PLASMA ALDOSTERONE AND

SELECTED ASYMPTOMATIC ORGAN DAMAGE

INDICES IN ESSENTIAL ARTERIAL HYPERTENSION

T. Pizon1, M. Rajzer2, M. Wach-Pizon1, W. Wojciechowska2, T. Drozdz2, M. Rojek2, D. Czarnecka2. 1Department of Observation and Internal Medi-cine, University Hospital, Krakow, Poland, 21st Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland

Objective: To assess the relationship between plasma renin activity (PRA), se-rum aldosterone concentration (ALDO) and selected asymptomatic organ damage (AOD) indices in mild primary arterial hypertension (AH).

Design and method: In 122 patients (61 men and 61 women) with untreated essential AH stage 1 (140/90 > BP < 160/100 mm Hg) and age 30–75 years we measured PRA, ALDO, and selected AOD indices (left ventricular mass index, carotid artery intima media thickness, carotid-femoral pulse wave velocity (cf-PWV), central aortic pulse pressure (cPP), estimated glomerular fi ltration rate (eGFR)). Although the study group included only patients with mild essential AH without typical indications to perform screening for primary aldosteronism we decided to exclude patients with an aldosterone-to-renin ratio (ARR) >100 ng/dl/ng/ml/h and aldosterone concentration >15 ng/dl.

Results: Based on PRA results, patients were divided into two subgroups, “low-renin’’ and “high-renin’’, according to the Laragh and Alderman criteria (low-renin: PRA < 0.65 ng/ml/h, high-renin: PRA > 0.65 ng/ml/h). Patients with high PRA (>0.65 ng/ml/h) were characterized by lower plasma sodium concentration, several times lower aldosterone-to-renin ratio (ARR), higher ALDO, but similar level of AOD indices compared to patients with low PRA. Among AOD indi-ces, cfPWV (p = 0.04) and cPP (p = 0.019) increased with ARR, while eGFR decreased with ALDO (p = 0.008). After adjusting for age, sex, and BMI, only eGFR was signifi cantly correlated with ALDO (Table 1). In subjects with si-multaneously high PRA and ARR values, we found signifi cantly higher cfPWV (p = 0.02) and cPP (p = 0.04) and lower eGFR (p = 0.02) than in those with high PRA but low ARR values.

Conclusions: In mild hypertension, assessment of RAAS infl uence on AOD should include the reciprocal relationship between renin and aldosterone. PRA itself has no predictive value for AOD. More advanced arterial stiffness and renal impairment are associated with increased PRA and ARR. RAAS activity might be useful in AOD prediction and hypertension severity assessment.

PP.07.17 GLYCATED HEMOGLOBIN A1C IS A STRONG

DETERMINANT OF KIDNEY FUNCTION AND

ALBUMIN EXCRETION IN HYPERTENSIVE

PATIENTS WITH METABOLIC SYNDROME

P. Pietri1, C. Vlachopoulos2, N. Ioakeimidis2, D. Terentes-Printzios2, C. Stefanadis1. 1Athens Heart Center, Athens, Greece, 21st Cardiology Department, Athens Medical School, Athens, Greece

Objective: Kidney dysfunction, defi ned either as estimated glomerular fi ltration rate (eGFR) below 60 ml/min/1.73 m2 or as the presence of microalbuminuria, is associated with adverse cardiovascular events in hypertensive patients. Metabolic syndrome (MS) is a cluster of cardiometabolic abnormalities and conveys a high cardiovascular risk. Insulin resistance constitutes the main underlying pathophysi-ological mechanism of MS. Whether it is insulin resistance or hyperglycemia per se that has the greater effect on kidney function in patients with MS, is not thor-oughly investigated.

Design and method: We studied 526 never treated hypertensive patients with MS, defi ned by ATP III criteria, free from overt cardiovascular disease. Kidney function was estimated in all patients by calculating eGFR using the MDRD for-mula. Urine albumin concentration was measured after 24 h urine collection and albumin-to-creatinine ratio (ACR) was calculated. Insulin resistance was assessed by applying the homeostasis model assessment (HOMA-IR). Glycated hemoglo-bin A1c (HbA1c) was measured in all participants.

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Results: Mean values of HbA1c and HOMA-IR were 5.9% and 3.4, respectively. In univariate analysis, eGFR was related to age, male gender, smoking, total cho-lesterol, hsCRP, fasting glucose, HbA1c (r = -0.23, p < 0.001) and HOMA-IR (r = -0.09, p = 0.04). Accordingly, ACR was related to age, smoking, BMI, waist-to-hip ratio, mean arterial pressure, hsCRP, fasting glucose, HbA1c (r = 0.37, p < 0.001) and HOMA-IR (r = 0.22, p < 0.001). In linear regression analysis, after adjustment for several confounders, an independent association was demonstrated between eGFR and HbA1c (b = -0.38, p = 0.04), whereas the association of eGFR with HOMA-IR became non signifi cant (b = -0.02, p = NS). Similar pattern was also evident for ACR since a strong association with HbA1c (b = 0.58, p = 0.001) was established, whereas no relationship between ACR and HOMA-IR was ob-served (b = 0.06, p = NS).

Conclusions: In hypertensive patients with MS, HbA1c is a strong determinant of kidney function independently of insulin resistance or other components of MS. It might be suggested that the impaired kidney function and microalbuminuria, associated with abnormal glucose regulation, may mediate part of the increased cardiovascular risk related to MS. Thus, measurement of HbA1c may add in risk stratifi cation and may serve as a treatment target in hypertensive patients with MS.

PP.07.18 CHRONIC KIDNEY DISEASE, END STAGE RENAL

DISEASE, AND KIDNEY TRANSPLANTATION IN

SURINAME

V. Nannan Panday1, F.S. Diemer2, Y.C. Haan1, A. Punwasi3, C. Rommy4, G.A. Van Montfrans1, G.P. Oehlers2, L.M. Brewster1,5. 1Dept. of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, 2Dept. of Cardiology, Academic Hospital of Paramaribo, Suriname, Paramaribo, Surinam, 3Dept. of Internal Medicine and Surrenal Dialysis Center, Paramaribo, Surinam, 4Faculty of Medicine, Anton de Kom University, Paramaribo, Surinam, 5Dept. of Public Health, Anton de Kom University, Paramaribo, Surinam

Objective: The high hypertension and diabetes burden in low and middle income countries is expected to lead to an increase in chronic kidney disease (CKD) and the need of renal replacement therapy. We aimed to estimate the prevalence of CKD and end stage renal disease (ESRD), and assess the availability of kidney transplantation in Suriname, a middle income country with a current population size of nearly 574.000 persons of mainly South Asian and African descent. Our previous studies showed that around 80% of the adult population is prehyperten-sive or hypertensive, and around 26% has prediabetes or diabetes.

Design and method: We analysed data of the Healthy Life in Suriname (HELISUR) study, a random population sample, to estimate the number of patients with CKD (eGFR < 60 ml/min/1.73m2) and ESRD (eGFR < 15 ml/min/1.73m2); and analysed data of dialysis centers to assess the number of patients on renal replacement therapy.

Results: We found that around 2% of the adult population had CKD (est. n = 11.500). Of these, 63% had an eGFR of 30–59; 28% of 15–29, and 9% of < 15 mL/min/1.73 m2 (est. n = 1035). The number of patients on hemodialysis has starkly increased in the past years. In 2014, 516 patients were on maintenance dialysis. The majority of these patients (76%) had a history of hypertension, 47% had a history of diabetes, and 30% had both conditions. There was no health care facility to provide renal transplants or predialysis care. Although all patients had health insurance, patients experienced diffi culties in accessing dialysis. In particu-lar transportation to the clinic and out-of-pocket expenses for drugs were unaf-fordable for low-income patients.

Conclusions: The high cardiovascular risk burden in Suriname creates a chal-lenge for the health-care system to provide and sustain renal replacement therapy. Kidney transplantation is not available in Suriname. A previous study showed this to be mainly due to the lack of technical means to perform the procedure and the lack of eligible donors. Thus, our results highlight the need for effective popula-tion-based strategies to reduce the cardiovascular disease burden of hypertension and diabetes, and prevent kidney failure.

PP.07.19 ASSOCIATION OF MAXIMUM SPEED OF BLOOD

PRESSURE RISE DURING 24-H ABPM WITH

SUBCLINICAL RENAL DAMAGE IN ESSENTIAL

HYPERTENSION

G. Mule, F. Gervasi, M. G. Vario, C. Cusumano, R. Salemi, L. Guarino, M. Guarneri, F. Vaccaro, T. Viola, S. Cottone. Unit of Neprrology and Hypertension; ESH Excellence Center; DIBIMIS; University of Palermo, Palermo, Italy

Objective: Experimental studies documented that the mechanical injury of intra-vascular pressure on the vessel wall, which results in vascular remodelling and ath-erosclerosis, may be more closely associated to oscillatory than to steady laminar

shear stress This suggests that the hypertensive patient’s prognosis may depend not only on average BP level but also on the degree and rate of BP variation. Little is known about the relationships between early renal abnormalities and the rate of BP changes assessed by intermittent 24-h ambulatory BP monitoring (ABPM).Our study was aimed to analyse the relationships between subclinical renal dam-age (SRD), defi ned as the presence of microalbuminuria or an estimated glomeru-lar fi ltration rate (eGFR) between 30–60 ml/min/1.73 m2 and the maximum speed of BP rise (Max Slope BP) during a 24-h BP recording

Design and method: The study population consisted of 389 untreated essential hypertensives (mean age: 49 ± 13 years; males 58%), which underwent 24-h ABPM, 24-h albumin excretion rate (AER) measurement and GFR estimation, using the CKD-EPI equation.The Max Slope BP was calculated as the fi rst derivative of the curve obtained by fi tting partial Fourier series to raw BP data recorded by discontinuous 24-h ABPM.

Results: The Max Slope of systolic BP (SBP) was higher in subjects with SRD (n = 117) than in those without SRD (n = 272) (fi gure) and showed signifi cant cor-relations with AER (r = 0.215; p < 0.001) and with eGFR (r = - 0.153; p = 0.002). Only the former of these correlations remained signifi cant (b = 0.18; p = 0.001), after adjustment for age, gender, 24 h average SBP and other potential confound-ers in multiple linear regression analyses. Moreover, multiple logistic regression analysis showed that the probability of having SRD was independently associated with Max Slope SBP (OR: 1.54; p = 0.001).

Conclusions: Our results seem to suggest that in essential hypertension, the speed of BP fl uctuations are associated with SRD and in particular with microalbumin-uria. It is likely that these associations may contribute to explain the increased cardiovascular risk conferred by SRD.

PP.07.21 KIDNEY INJURY, VASCULAR REACTIVITY

AND STIFFNESS IN GENDER SUBGROUPS OF

HYPERTENSIVE PATIENTS

S. Mironova1, I. Iudina1, M. Ionov1, T. Makhmatova1, N. Avdonina1, I. Emelyanov1, N. Zvartau1,2, A. Konradi1,2. 1Almazov Federal North-West Medical Research Centre, Saint-Petersburg, Russia, 2Almazov Federal North-West Medical Research Centre, ITMO University, Saint-Petersburg, Russia

Objective: Chronic renal disease and hypertension are strongly associated with vascular damage, endothelial dysfunction (ED) and increased vascular stiffness. We hypothesized that several novel, potentially more sensitive biomarkers of kid-ney damage may be differently related to vascular stiffness and reactivity in male and female patients with different severity of hypertension.

Design and method: Urine levels of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver fatty-acid binding protein(L-FABP) and serum levels of Cystatin C (sCys) and serum creatinine (sCr) were measured by quantitative enzyme immunoassay in 92 hypertensive patients,46 males (mean age 46,3 ± 13,4years) and 46 females (mean age 55,2 ± 8,9 years). Renal function (GFR) was analyzed using MDRD and the CKD Epidemi-ology Collaboration (EPI) sCr equation and CKD-EPI sCys equation. Instrumen-tal examination was performed after 5 days of discontinuation of antihypertensive medications including applanation tonometry (SphygmoCor, Artcor Medical) with the calculation of central aortic pressure, pulse wave velocity (PWV) and augmentation index (AI). Endothelial function was assessed by reactive hyper-emia index (RHI) with EndoPAT device (Itamar Medicals).

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Abstracts e143

Results: Female patients were characterized by higher NGAL (16.6 +/- 12.8 ver-sus 6.0 +/- 4.3 ng/ml, respectively; p = 0.0001) and lower sCys-estimated GFR (88.0 +/- 14.1 mL/min/1.73m2 versus 95.6 +/- 19.1; p = 0.04), while there were no differences in sCr-estimated GFR, KIM-1, L-FABP and Cystatin C levels. There were also no differences in RHI and PWV levels between groups. In fe-males novel biomarkers levels were associated with increased arterial stiffness (PVW>10 m/s): sCys-estimated GFR (r = 0.351, p = 0.02), Cystatin C and L-FABP (r = 0.285, p = 0.06; r = 0.405, p = 0.01, respectively). In males patients Cystatin C and L-FABP levels were associated with lower RHI (r = -0,704, p = 0.005; r = -0.651, p = 0.03, respectively), KIM-1 levels were associated with increased PWV (r = 0.612, p = 0.06) only in patients with severe and resistant hypertension.

Conclusions: Cystatin C and L-FABP seem to be associated with increased arte-rial stiffness in hypertensive females and vascular reactivity in severe, resistant to treatment hypertensive males. Arterial stiffness in males is linked mostly to KIM-1 levels.

PP.07.22 BIOMARKERS OF KIDNEY INJURY IN GENDER

SUBGROUPS OF HYPERTENSIVE PATIENTS

S. Mironova1, I. Iudina1, M. Ionov1, T. Makhmatova1, N. Avdonina1, I. Emelyanov1, N. Zvartau1,2, A. Konradi1,2. 1Almazov Federal North-West Medical Research Centre, Saint-Petersburg, Russia, 2Almazov Federal North-West Medical Research Centre, ITMO University, Saint-Petersburg, Russia

Objective: Hypertension still remains one of the leading causes of end-stage re-nal disease, and early detection of kidney injury may affect treatment strategy and patient’s prognosis. Serum creatinine with following estimation of glomerular fi ltration rate (eGFR) are the most commonly used markers of renal function, though they are frequently delayed and infl uenced by multiple non-renal factors, including gender. The aim of the present study was to compare conventional and novel, potentially more sensitive biomarkers of kidney injury in hypertensive pa-tients of different gender.

Design and method: Urine levels of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver fatty-acid binding protein (L-FABP) and serum levels of Cystatin C (sCys) and creatinine (sCr) were measured by quantitative enzyme immunoassay in 92 hypertensive patients, 46 males (mean age 46,3 ± 13,4years) and 46 females (mean age 55,2 ± 8,9 years). Renal function was analyzed using MDRD and the CKD Epidemiology Collaboration (EPI) sCr equation and CKD-EPI sCys equation. Instrumental examination was performed after 5 days of discontinuation of antihypertensive medications including ambula-tory blood pressure monitoring (ABPM, SpaceLabs 90207), applanation tonome-try (SphygmoCor, Artcor Medical) with the calculation of central aortic pressure.

Results: Female patients were characterized by higher NGAL (16.6 +/- 12.8 ver-sus 6.0 +/- 4.3 ng/ml, respectively; p = 0.0001) and lower sCys-estimated GFR (88.0 +/- 14.1 mL/min/1.73m2 versus 95.6 +/- 19.1; p = 0.04), while there were no differences in sCr-estimated GFR, KIM-1, L-FABP and Cystatin C levels between gender subgroups. Higher NGAL concentrations in females were associated with mean 24-hours systolic blood pressure (BP) level (r = 0.269, p = 0.06), sCys-es-timated GFR - with mean night systolic BP and central systolic BP (r = -0,356, p = 0.03; r = -0.302, p = 0.05, respectively).

Conclusions: NGAL and sCys-estimated GFR seemed to be potentially earlier and more sensitive biomarkers of kidney injury compared to conventional serum creatinine level and sCr-estimated GFR and are associated with blood pressure levels in hypertensive females.

PP.07.23 SERELAXIN ATTENTUATES THE PRESSOR

RESPONSE TO ANGIOTENSIN II IN AGEING

FEMALES VIA AN ANGIOTENSIN TYPE 2

RECEPTOR MEDIATED PATHWAY

K. Mirabito Colafella1,2,3, L. Hilliard1,2, T. Gaspari1,4, Y. Wang1,4, R. Widdop1,4, C. Samuel1,4, K. Denton1,2. 1Biomedicine Discovery Institute, Monash University, Melbourne, Australia, 2Department of Physiology, Monash University, Melbourne, Australia, 3Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands, 4Department of Pharmacology, Monash University, Melbourne, Australia

Objective: Protection against cardiovascular disease (CVD) is lost post-meno-pause and this is chiefl y attributed to ovarian steroid defi ciency. However, estro-gen/progestin replacement does not confer cardio-protection and may increase CVD risk. We, and others, have demonstrated that the angiotensin type 2 receptor (AT2R) plays a greater role in the regulation of arterial pressure and renal function in adult females than males, and that these effects wane with age. Recently it was discovered that the vasodilatory and anti-fi brotic effects of relaxin are mediated

via heterodimers formed between the cognate relaxin family receptor 1 (RXFP1) and the AT2R. The aim in the present study was to determine if targeting the RXFP1-AT2R axis confers cardiovascular protection in aging mice.

Design and method: Mean arterial pressure (MAP) was measured via radiote-lemetry in aged (16–18 month old) FVB/N male and female mice at baseline and during infusion of vehicle, recombinant human relaxin (RLX, 20.8 ug/kg/h s.c.) or RLX plus the AT2R antagonist, PD123319 (125 ug/kg/h s.c.) for 3 days. Thereafter, MAP was measured for 21 days during angiotensin II (AngII, 36 ug/kg/h s.c.) or vehicle infusion. At the end of the study, aortic vascular reactivity, cardiac and renal fi brosis, and cardiac and renal expression of the angiotensin receptors and RXFP1 were determined.

Results: Basal MAP was higher in aged male than female mice (101 ± 1 and 94 ± 1 mmHg, respectively). The pressor response to AngII was similar in vehicle treated male and females (34 ± 3 and 35 ± 5 mmHg, respectively on day 21 of An-gII infusion). RLX attenuated the pressor response to AngII in aged female mice by ~40%, an effect that was reversed by AT2R blockade. Furthermore, AngII-induced endothelial dysfunction and tissue fi brosis was reduced in RLX-treated aged female mice. RLX did not attenuate pressor responsiveness to AngII in aged male mice.

Conclusions: Our results support the novel interaction between the RXFP1 and the AT2R and demonstrate that the AT2R is integral to the cardio-protective prop-erties of RLX in females. Mechanistic understanding of these pathways will pro-vide new therapeutic targets for the treatment of CVD in both men and women.

PP.07.24 PLATELET-DERIVED GROWTH FACTOR B: A NOVEL

DETERMINANT OF JUXTAGLOMERULAR CELL

PHENOTYPIC PLASTICITY?

A. Martini1, E.C.H. Friesema2, A.H.J. Danser2, T.L. Reudelhuber3. 1University of Brasilia - Department of Molecular Pharmacology, Brasilia, Brazil, 2Erasmus Medical Center - Department of Internal Medicine, Rotterdam, The Netherlands, 3Institut de Recherches Cliniques de Montréal - Departments of Medicine and Biochemistry, Montréal, Canada

Objective: Renin, a key component in the regulation of blood pressure, is produced by the highly specialized renal juxtaglomerular (JG) cells. These cells may be de-rived from vascular smooth muscle cells (VSMC) and they can reversibly differenti-ate in response to certain stimuli. Because these cells rapidly differentiate when re-moved from the kidney, the biochemical mechanism responsible for this phenotypic plasticity is currently unknown. To overcome this limitation, we quantifi ed gene expression in human renin-producing tumors (reninomas) and subsequently studied the effect of the most promising ligands on renin synthesis in (pro)renin-producing As4.1 cells, which are derived from a mouse JG cell-targeted tumor.

Design and method: Transcriptome analysis was performed on four reninomas. The most highly expressed genes common in all reninomas were subsequently used for in situ hybridization in the mouse kidney. This approach yielded 43 genes, from which 12 ligands were selected. As4.1 cells were incubated for 48 hours with conditioned medium derived from human embryonic kidney (HEK) 293 cells transfected for 48 hours with the mouse cDNA encoding these ligands. Subsequently, As4.1 medium, and cell lysate or RNA were collected, and (pro)renin was measured in these samples by enzyme-kinetic assay.

Results: Under control conditions, As4.1 cell medium contained predominantly (>95%) prorenin. In contrast, cell lysates contained renin only, at levels correspond-ing to < 1% of the total amount of (pro)renin in the medium (i.e., 161 ± 61 mg angiotensin I/ml.hr, mean ± SEM). Among the tested ligands, only platelet-derived growth factor B (PDGF-B) affected the medium and cellular (pro)renin levels, as well as As4.1 renin gene expression, inducing parallel decreases of 64 ± 5%, 53 ± 10% and 84 ± 5%, respectively. Additionally, PDGF-B-exposed As4.1 cells displayed a more elongated and aligned shape with no apparent alteration in their viability. This was accompanied by a downregulated expression of a-smooth mus-cle actin (P < 0.01), and an upregulated expression of interleukin-6 (P < 0.0001), suggesting a phenotypic shift from myo-endocrine to infl ammatory. No signifi cant changes in the JG cell marker aldo-keto reductase 1B7 (Akr1b7) were observed.

Conclusions: PDGF-B might be one of the factors involved in JG cell phenotypic plasticity.

PP.07.26 REPRODUCIBILITY OF CIRCADIAN BLOOD

PRESSURE VARIATIONS IN CHRONIC KIDNEY

DISEASE PATIENTS

K. Manousopoulos, A. Lykka, F. Michas, K. Kostogianni, A. Dimitriou,N. Zakopoulos, E. Manios. National and Kapodistrian University of Athens, Med-ical School, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece

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Objective: Previous studies have demonstrated a signifi cant link between the cir-cadian rhythm of blood pressure (BP) and cardiovascular events, namely that the absence of a nocturnal fall in BP and an exaggerated morning BP surge, are as-sociated with more severe target organ damage and increased cardiovascular risk in chronic kidney disease (CKD) patients. Aim of our study was to investigate the reproducibility of circadian BP variations in CKD patients.

Design and method: A total of 35 CKD patients underwent 24-h ambulatory BP monitoring at baseline and 1 month. Morning BP surge was defi ned as the sleep-trough surge, calculated by subtracting the morning BP (mean of 4 readings over 2 hours just after wake-up) from the lowest nocturnal BP (mean of 3 readings cen-tered around the lowest nighttime BP) and as the prewaking surge (morning BP mi-nus the 4 readings over 2 hours before waking). The degree of nocturnal BP dipping (%) was calculated as 100[1 – nighttime BP/daytime BP] for both systolic and dia-stolic BP. Dippers were defi ned as subjects with nocturnal BP fall >10% and non-dip-pers as patients with nocturnal BP fall < 10%. Nocturnal hypertension was defi ned as nighttime SBP > = 120 mmHg and/or DBP > = 70 mmHg. Statistical analysis was performed by means of reliability analysis (intraclass correlation coeffi cient (ICC)) for continuous variables and kappa agreement coeffi cient for categorical variables.

Results: The ICC for sleep-trough surge was 0.360 (p = 0.097) and for prewak-ing surge was 0.541 (p = 0.012). As far as systolic and diastolic dipping are con-cerned, the ICC values were 0.674 (p = 0.001) and 0.371 (p = 0.087), respectively. The kappa agreement coeffi cient for systolic non-dippers was 0.517 (p = 0.002), for diastolic non-dippers was 0.157 (p = 0.332), and for nocturnal hypertensives was 0.208 (p = 0.215).

Conclusions: Prewaking morning BP surge is more reproducible than sleep-trough surge in CKD patients. Systolic BP dipping demonstrates greater repro-ducibility than diastolic BP dipping and nocturnal hypertension in CKD patients.

PP.07.27 ASSOCIATION OF NOCTURNAL HYPERTENSION

AND NON-DIPPING PATTERN WITH CAROTID

ARTERY INTIMA-MEDIA THICKNES IN CHRONIC

KIDNEY DISEASE PATIENTS

K. Manousopoulos, A. Lykka, F. Michas, K. Kostogianni, A. Dimitriou, N. Zakopoulos, E. Manios. National and Kapodistrian University of Athens, Medical School, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece

Objective: Recent studies have demonstrated that nocturnal hypertension is better associated with target organ damage development and cardiovascular morbidity and mortality than non-dipping pattern in hypertensive patients. However, the role of nocturnal hypertension and non-dipping pattern, in terms of target organ dam-age involvement, in chronic kidney disease (CKD) patients is unclear. Aim of our study was to evaluate the impact of nocturnal hypertension and non-dipping pattern on common carotid artery intima-media thickness (CCA-IMT) in CKD patients.

Design and method: A total 69 CKD patients, referred for evaluation at the Hy-pertension Unit of our department, underwent 24-h ambulatory blood pressure (BP) monitoring and CCA-IMT ultrasonographic measurements. The degree of nocturnal BP (BP) dipping (%) was calculated as 100[1 – nighttime SBP/daytime SBP]. Dippers were defi ned as subjects with nocturnal BP fall >10% and non-dippers as patients with nocturnal BP fall < 10%. Nocturnal hypertension was de-fi ned as nighttime SBP > = 120mmHg or DBP > = 70mmHg. Statistical analysis was performed by means of independent-samples T test and ANCOVA.

Results: The percentages of nocturnal hypertensives, systolic non-dippers and diastolic non-dippers were 68%, 65% and 50%, respectively. Systolic (r = -0.289, p = 0.019) and diastolic dipping (r = -0.352, p = 0.004), as continuous variables, signifi cantly correlated with CCA-IMT. However, CCA-IMT did not differ signif-icantly between systolic non-dippers (1.025 mm) and dippers (0.949 mm). In con-trast, diastolic non-dippers (1.067 mm, p = 0.011) and nocturnal hypertensives (1.045 mm, p = 0.010) presented signifi cantly higher CCA-IMT values than dia-stolic dippers (0.929 mm) and subjects with nocturnal normotension (0.898 mm), respectively, even after adjustment for demographic characteristics and baseline risk factors.

Conclusions: Nocturnal hypertension and diastolic non-dipping pattern are as-sociated with increased CCA-IMT values in CKD patients.

PP.07.29 BLOOD PRESSURE VARIABILITY IS INCREASING

FROM THE FIRST TO THE SECOND DAY OF THE

INTERDIALYTIC INTERVAL IN HEMODIALYSIS

PATIENTS

A. Karpetas1, C. Loutradis2, A. Lazaridis2, A. Bikos3, G. Tzanis2, G. Koutroump-as4, K. Mavromatidis1, V. Liakopoulos5, P. Zebekakis5, L. M. Ruilope6, G. Parati7, P. S. Sarafi dis1. 1Therapeutiki Hemodialysis Unit, Thessaloniki, Greece,

2 Department of Nephrology, Hippokration Hospital, Aristotle University of Thes-saloniki, Thessaloniki, Greece, 3Pieria Hemodialysis Unit, Katerini, Greece, 4He-modialysis Unit, Achillopouleion General Hospital, Volos, Greece, 5Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Ar-istotle University of Thessaloniki, Thessaloniki, Greece, 6Hypertension Unit, Hos-pital 12 de Octubre, Madrid, Spain, 7Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy

Objective: Patients with end-stage-renal-disease under hemodialysis have in-creased cardiovascular risk and experience severe BP fl uctuations during the di-alysis session and the subsequent interdialytic period. BP variability (BPV) may be an additional risk factor for cardiovascular events and preliminary data suggest increased BPV with advancing stages of CKD. This is the fi rst study to examine BPV during the whole intra- and interdialytic period in hemodialysis patients with ambulatory blood pressure monitoring (ABPM).

Design and method: A total of 160 patients receiving maintenance hemodialysis had 48-hour ABPM with the Mobil-o-Graph device during a regular dialysis ses-sion and the subsequent interdialytic interval. Brachial and aortic BPV were cal-culated with validated formulas and were compared between Day 1 and Day 2 of the interdialytic period (44-hours), Day 1 and Day 2 of the total 48-hour interval (including the dialysis session), and between the two respective daytime periods and nighttime periods.

Results: All brachial systolic BPV indices [standard deviation (SD): 14.75 ± 4.38 vs 15.91 ± 4.41, p = 0.001; weighted SD (wSD): 13.80 ± 4.00 vs 14.89 ± 3.90, p < 0.001; coeffi cient of variation (CV): 11.34 ± 2.91 vs 11.93 ± 2.94, p = 0.011; average real variability (ARV): 11.38 ± 3.44 vs 12.32 ± 3.65, p < 0.001)] were increasing from Day 1 to Day 2 of the 44-h interdialytic period. Similarly, all indexes of diastolic BP variability were sig-nifi cantly increased in Day 2, with the exception of CV. Aortic systolic and diastolic BPV indices displayed a similar pattern. Further, all studied bra-chial systolic and diastolic BPV indexes were also lower during daytime 1 than daytime 2 (systolic ARV 11.56 ± 3.98 vs 12.44 ± 4.03, p = 0.002); sys-tolic ARV was lower in nighttime 1 compared to nighttime 2 (11.20 ± 5.09 vs 12.18 ± 4.66, p = 0.045). In multivariate analysis pre-dialysis SBP, age, diabetes, heart failure and use of statins were independently associated with increased SBP ARV.

Conclusions: BPV is increased in Day 2 compared to Day 1 of the interdialytic period in hemodialysis patients; this could be another mechanism involved in the complex cardiovascular pathophysiology and increased cardiovascular mortality of these individuals.

PP.07.30 AMBULATORY PULSE WAVE VELOCITY

AND AUGMENTATION INDEX PREDICT

CARDIOVASCULAR EVENTS AND ALL-

CAUSE MORTALITY BETTER THAN OFFICE

AND AMBULATORY BLOOD PRESSURE IN

HEMODIALYSIS PATIENT

P. A. Sarafi dis1, V. Liakopoulos2, C. Loutradis1, A. Karpetas3, A. Piperidou1, G. Koutroumpas4, V. Raptis5, C. Syrgkanis4, G. Efstratiadis1, G. London6, C. Zoccali7. 1Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece, 2Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece, 3Therapeutiki Hemodialysis Unit, Thessaloniki, Greece, 4Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece, 5Pieria Hemodialysis Unit, Katerini, Greece, 6Hospital and FCRIN INI-CRCTC, Manhes, France, 7CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy

Objective: Patients with end-stage renal disease have extremely high rates of cardiovascular events and mortality. Arterial stiffness and augmentation of the aortic blood pressure (BP) component measured in offi ce conditions are known cardiovascular risk factors in hemodialysis patients. This study examines the prog-nostic signifi cance of ambulatory brachial and central BP, ambulatory pulse wave velocity (PWV), and ambulatory heart-rate-adjusted augmentation index (AIx75) in this population.

Design and method: In this prospective cohort study, 170 hemodialysis patients underwent 48-hour ambulatory monitoring with Mobil-O-Graph NG device dur-ing a standard inter-dialytic interval and followed-up for a mean of 28.1 ± 11.2 months. The end-points studied were: (i) all-cause mortality; (ii) cardiovascular death (fatal myocardial infarction, fatal stroke or sudden death); (iii) a combined outcome of cardiovascular death, non-fatal myocardial infarction and non-fatal stroke; (iv) a combined outcome of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, coronary revascular-ization or hospitalization for heart failure.

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Results: During follow-up, 37 (21.8%) patients died and 46 (27.1%) had a car-diovascular event or died from cardiovascular causes. Cumulative survival was not different for quartiles of pre-dialysis SBP, 48-hour peripheral SBP, central SBP and central PP, but was progressively shorter with higher ambulatory PWV [95.3%, 85.7%, 61.9% and 69.8% for quartiles 1 to 4 (logrank p < 0.001)] and AIx75 (90.7%, 78.6%, 73.8%. and 69.8% for quartiles 1 to 4 (logrank p = 0.013)]. Similarly, the Hazard Ratios for cardiovascular mortality, for cardiovascular death, or non-fatal MI, or non-fatal stroke, as well as the combined outcome of cardio-vascular events were similar for quartiles of predialysis SBP, 48-hour peripheral SBP and 48-hour central SBP, but were progressively increasing with higher quar-tiles of ambulatory PWV and ambulatory AIx75. In multivariate Cox-regression analysis 48h-ambulatory-PWV was the only vascular parameter independently associated with mortality (HR: 1.604, 95%CI: 1.141–2.255; per m/s increase).

Conclusions: Ambulatory PWV and ambulatory AIx75 are independently asso-ciated with the risk of cardiovascular events and mortality in this hemodialysis population, whereas offi ce and ambulatory BP are not. These fi ndings add to the evidence suggesting that arterial stiffness is probably the most prominent cardio-vascular risk factor in hemodialysis.

PP.07.32 IS RENAL SYSTEM FUNCTION EXAMINED WELL

ENOUGH (ACCORDING TO THE RUSSIAN FEDERAL

REGISTER OF ARTERIAL HYPERTENSION)

E.V. Oshchepkova, N.V. Lazareva, U.Y. Kantorova, I.E. Chazova. Cardiology Re-search Complex, Moscow, Russia

Objective: to determine renal system damage in the selection of patients with arterial hypertension under care and treatment in primary health care.

Design and method: The analysis carried out with the hypertension Register method (a software with remote access, specially trained doctors made data inputs from medical records into the Register) included a selection of 29 126 patients with hypertension from 30 regions of Russia from 2010–2015: 35% were male (n = 10339), males younger than females by 4 years (61 ± 12 years and 65 ± 12 years respectively. Chronic renal disease (CRD) was studied and glomerular fi ltra-tion rate was calculated (by MDRD formula) (ml/min/1.73 sq.m).

Results: creatinine data were present in the medical records of only 61% of patients with hypertension. The average level of creatinine in males was 90 ± 18 mcM/l, in females – 83 ± 16 mcM/l. In general, in the total sample CRD of I stage – 21%, II stage – 51%, III stage – 24%, IY-Y stage – 4%. In patients with high and very high risk normal renal system function was observed only in 18% of cases, II stage CRD was prevalent with 52%, moderately diminished function (IIIa stage) observed in 24% and signifi cantly diminished function (IIIb stage) – in 5% of patients with hy-pertension. Dramatically diminished renal system function (CRD of YI stage) was observed in 0.5% and end-stage kidney failure (CRD of Y stage) – in 0,1% of cases.Analysis of blood pressure revealed I stage hypertension in 43% (n = 12036), II stage hypertension in 12% (n = 3461), III stage hypertension in 3% (n = 998) and BP < 140/90 mm Hg in 38%. 81% of patients with hypertension (n = 23534) be-long to the high and very high cardiovascular risk.

Conclusions: according to the hypertension Register in patients with hyperten-sion in primary health care examination of the renal system is nonoptimal; in 30% of patients with high risk diminished renal system function is found.

PP.07.33 HIGH PREVALENCE OF RENAL DYSFUNCTION

AND ALBUMINURIA IN PATIENTS WITH ARTERIAL

HYPERTENSION AND DIABETES MELLITUS IN

HOSPITAL CLINICAL PRACTICE

V. Kulakov, N. Manukhina, S. Villevalde, Z. Kobalava. RUDN University, Moscow, Russia

Objective: Chronic kidney disease (CKD) is recognized as an independent car-diovascular disease (CVD) risk state. Arterial hypertension (AH) and type 2 dia-betes mellitus (T2DM) are leading risk factors for both CVD and CKD. The aim of the study was to assess the prevalence of decreased glomerular fi ltration rate (GFR) and high/ very high albuminuria in patients with AH and T2DM.

Design and method: In 319 patients with AH and T2DM admitted in city clinical hospital (37% men, age 65 ± 11 years (M ± SD), body mass index 30 ± 7 kg/m2, blood pressure 135 ± 16/80 ± 9 mmHg, median AH duration 12 years (interquartile range 10;15), T2DM duration 10 years (4;15), dyslipidemia 70%, chronic heart failure 50%, anemia 28%, atrial fi brillation 20%) GFR was assessed by CKD-EPI equation and albuminuria – by albumin/creatinine ratio (ACR) in spot urine morn-ing sample.

Results: GFR < 60 ml/min/1.73 m2 was revealed in 127 (39.8%) patients, where-in GFR in the range of 45- < 60, 30- < 45, 15- < 30, < 15 ml/min/1.73 m2 was

found in 18, 17, 5 and 0.6% respectively. ACR>30 mg/g was detected in 123 (39%) of patients, wherein ACR in the range 30- < 300 and >300 mg/g was found in 29 and 10%. CKD criteria (GFR < 60 ml/min/1.73 m2 and/or ACR>30 mg/g) were detected in 182 (57%) patients. Non-albuminuric CKD (GFR < 60 ml/min/1.73 m2 without albuminuria) was found in 59 (18.5%) patients, isolated (without GFR decrease < 60 ml/min/1.73 m2) high/ very high albuminuria - in 55 (17%) patients, combined decreased GFR and high/very high albuminuria – in 68 (22%) patients. Patients with vs without albuminuria were older (67.2 ± 10.8 vs 63.7 ± 10.7 years), more aware of kidney diseases (59 vs 41%), had lower level of hemoglobin (122 ± 23 vs 130 ± 21 g/l), p < 0.05 for all. Patients with vs without CKD criteria were older (67 ± 10 vs 60 ± 11 years), had higher prevalence of anemia (34 vs 10%), heart failure (55 vs 32%).

Conclusions: High prevalence (57%) of CKD criteria was revealed in hospital-ized patients with AH and T2DM. GFR < 60 ml/min/1.73 m2 was found in 39.8% of patients, ACR>30 mg/g – in 39%, combined decreased GFR and high/ very high albuminuria – in 22% of patients.

PP.07.34 GENETIC VARIANT OF ANGIOTENSIN IV

RECEPTOR (AT4) AND PLASMA ANGIOTENSIN II

CONCENTRATION

T. Konoshita, S. Kaeriyama, M. Urabe, T. Nakaya, M. Yamada, M. Ichikawa,S. Sato, K. Yamamoto, M. Imagawa, M. Fujii, Y. Zenimaru, J. Suzuki,Y. Makino. Department of Endocrinology and Metabolism, University of Fukui Hospital, Fukui, Japan

Objective: It is well known that the renin angiotensin system (RAS) plays a piv-otal role in the development of cardiovascular, renal and metabolic conditions. Angiotensin IV receptor (AT4) is a newly emerging component of the RAS. AT4 is a membrane type aminopeptidase and also designated as LNPEP. Actually AT4 converts angiotensin III to angiotensin IV and to further degraded fragments. Thus it is thought that AT4 exerts the enzyme action for the direction of the reduc-tion of angiotensin II. We therefore tested the hypothesis that genetic variants of AT4 could show signifi cant effects on plasma angiotensin II concentrations.

Design and method: The required sample size of the study was calculated as about 500 cases tentatively with log-transformed plasma angiotensin II concentra-tions using a bilateral ANOVA with protection against type I error of 5% and 80% of power. We enrolled consecutive 692 subjects who had consulted our hospitals for life style related diseases. Genomic DNA was isolated from human leukocytes by QIAamp kit. Genotypes were assayed with genomic DNA for a C/T variant of AT4 (rs2303138) using real-time PCR system by TaqMan method. The statistical differences of plasma angiotensin II concentrations among the genetic variants were evaluated.

Results: The log-transformed concentrations (log (plasma angiotensin II+1)) with each genotype of AT4 were as follows: CC (260 cases) 0.98 ± 0.48, CT (325 cases) 0.834 ± 0.43, TT (107 cases) 0.78 ± 0.39 (CC vs CT, p = 0.0001; CC vs TT, p < 0.0001; CT vs TT, p = 0.25). Geometric means of these values correspond to 8.51 pg/ml, 5.82 pg/ml and 4.98 pg/ml, respectively.

Conclusions: Thus, it is found that a genetic variant of AT4 may have a signifi cant impact on the plasma angiotensin II concentrations. Furthermore this may imply that the genetic variant has pathophysiological effects on cardiovascular, renal and metabolic conditions.

PP.07.36 THE PROGNOSTIC ROLE OF STIFFNESS

INDEX DETERMINED BY FINGER

PHOTOPLETHYSMOGRAPHY IN CHRONIC KIDNEY

DISEASE

I. Kesoi1, B. Sagi2, T. Vas2, T. Kovacs2, I. Wittmann2, J. Nagy2. 1Health CenterDept. of Internal Medicine, Komló, Hungary, 22nd Department of Internal Medicine and Nephrology Centre, Hungary

Objective: Arterial stiffness has a prognostic role in chronic cardiovascular dis-eases. Pulse wave velocity (PWV) determined by the carotid-femoral pulse detec-tion is accepted as a gold standard method. Further diagnostic procedures are in use to assess the arterial stiffness including the fi nger photoplethysmography. The prognostic role of this method is unknown. The goal of our investigation was to determine the prognostic signifi cance of the arterial stiffness measured by the photoplethysmographic method in a homogenous group of chronic kidney disease patients.

Design and method: One hundred and three IgA nephropathy patients with chron-ic kidney disease stage 1–4 were investigated and followed (67 male, 36 female, 45 ± 11 years). End stage renal disease was an exclusion criterion. The stiffness in-dex was determined by the volume alteration of the digital artery during the cardiac cycle. This merit showed a strong correlation with the PWV investigated by other

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e146 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

methods in earlier studies. The average following time was 67 (6–107) months. The patients were divided into two groups according to the stiffness index; the cut-off point was 10 m/s. The combined end point was total mortality, any cardiovascu-lar event including stroke, myocardial infarction or cardiovascular procedure and achieving the end stage renal disease including renal replacement therapy.

Results: The patients with increased stiffness index (>10 m/s) had signifi cantly more end point events (19/43 vs. 10/60, �2: 5.860, P = 0.015 by Mantel-Cox log-rank test). Using the Cox regression model stiffnex index has been proved an

independent predictor on survival among several cardiovascular risk factors (age, hypertension, diabetes, obesity, lipid disturbances and renal function) in chronic kidney disease. Every 1 m/s increase in stiffnes index resulted in a 17 % gain in the occurrence of the combined end point.

Conclusions: Stiffness index determined by fi nger photoplethysmography is an eligible parameter to assess the prognosis in chronic kidney disease. In IgA-ne-phropathy increased stiffness index seems to be a good prognostic tool for identi-fi cation of highest-risk patients.

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Abstracts e147

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved

SATURDAY

POSTERS

POSTER SESSION

POSTERS’ SESSION PS08:

METABOLIC DISORDERS AND SLEEP

APNOEA

PP.08.01 PECULIARITY OF BLOOD PRESSURE PROFILE

AND PULSE WAVE VELOCITY IN PATIENTS WITH

ARTERIAL HYPERTENSION AND METABOLIC

SYNDROME

S. Gurgenyan1, S. Vatinyan1, S. Aroyan1, P. Zelveian2. 1Institute of Cardiology, Yerevan, Armenia, 2Center of Preventive Cardiology, Yerevan, Armenia

Objective: The aim of our study was to estimate the relationship between pulse wave velocity (PWV) and blood pressure (BP) profi le parameters in patients with arterial hypertension (AH) and metabolic syndrome (MS).

Design and method: We investigated 180 patients with mild to moderate AH (mean age 58 ± 10 years, 102 male and 78 female). Noninvasive 24-hour BP re-cordings (TM-2425, A&D) were performed with intervals of 15 min in day- and 30 min nighttime. We assess the following parameters: mean values and variabil-ity parameters of 24-h, day-, nighttime systolic (S), diastolic (D) and pulse (P) BP-s, SBP and DBP loads (under the curve – AUC), percentage of nocturnal fall of SBP and DBP. Differences in estimated parameters (M ± SE) between groups were tested by Student t-test. P < 0.05 was considered as statistically signifi cant.

Results: In 82 patients from 180 with mild to moderate AH, were observed MS. In patients with MS mean values of SBP, DBP and PBP were signifi cant higher then in patients without MS. AUC of SBP and DBP were statistically signifi cantly higher in patients with MS also. NF of SBP and DBP was statistically insuffi -cient in group of patients with MS. In patients with MS were observed signifi -cantly high values of PWV in comparison with group of patients without MS (14.30 ± 1.21 vs. 12.01 ± 0.45, p>0.5). In patients with MS and AH were signifi -cant correlation between mean values of 24-hour SBP and PBP between PWV (r = 0.515, r = 0.403 and r = 0.496, p < 0.05).

Conclusions: In patients with AH the Metabolic syndrome caused the disturbance of BP profi le and has a negative infl uence on arterial stiffness.

PP.08.02 THE INFLUENCE OF IMPAIRMENT OF THE

STRUCTURE AND QUALITY OF SLEEP ON LEFT

VENTRICULAR REMODELING IN PATIENTS WITH

OBSTRUCTIVE SLEEP APNEA AND ARTERIAL

HYPERTENSION

T. Ustyan, A. Matevosyan, P. Zelveian. Center of Preventive Cardiology, Yerevan, Armenia

Objective: The aim of this study was to investigate the infl uence of the structure and quality of sleep on the remodeling of left ventricle (LV) in patients with ob-structive sleep apnea syndrome (OSAS) and arterial hypertension (AH).

Design and method: 140 patients (46.0 ± 1.0y, 111m and 29w) with mild to moderate AH underwent overnight polysomnography («EMBLA-N7000») and were divided into groups: I group – 86 patients (46.4 ± 1.2y, 17w and 69m) with AH and OSA, and group II – 54 AH patients (45.3 ± 1.7, 42m and 12w) with-out OSAS. Echocardiographic examination was carried out in the sectoral mode («Sonos 5500»). LV mass was calculated by the formula of Devereux R. and in-dexed to body surface area (LVMI). LV hypertrophy (LVH) was considered for men >125 g/m2, for women – >110 g/m2. Statistical analysis was performed by the program «SPSS v17.0». Student’s t-test, Fisher’s exact test, Pearson’s corre-lation coeffi cient and multivariate regression analysis was used. P < 0.05 were considered as statistically signifi cant.

Results: The groups were matched for age, sex, duration of AH, body mass in-dex, blood pressure values. In patients with severe sleep patterns signifi cantly higher LVMI(p < 0.01) as well as the high incidence of LVH (87 and 48% respec-tively, p < 0.05) were detected. In Group I statistically signifi cant relationship was found between the awakening index and the LVMI (p < 0.05). In patients with OSAS, the thickness of the interventricular septum and posterior wall of the LV had negative correlations with the duration of REM sleep and positive

correlation with the proportion between S1 and S2 stages of sleep. Multiple cor-relation coeffi cient when included in the regression equation parameters REM and NREM sleep phases, was R = 0.39(R2 = 0.16, p < 0.05), but when added to the regression equation of the «awakening index» multiple correlation coeffi cient increased to R = 0.44(R2 = 0.21, p < 0.02).

Conclusions: In patients with OSAS and AH, the sleep quality is signifi cantly correlated with the structural changes of LV. It is obvious that the disturbance of the sleep structure (disturbance of the proportions of REM, NREM sleep and «slow-wave» phase) potentiates the sympathicotonic effect of micro- and macro-awakenings, and has an additive effect on the remodeling of the left ventricle.

PP.08.03 SLEEP BREATHING DISORDERS AS A KEY

DETERMINANT FOR DEVELOPMENT OF

UNCONTROLLED ARTERIAL HYPERTENSION

P. Zelveian, A. Matevosyan. Center of Preventive Cardiology, Yerevan, Armenia

Objective: The purpose of this study is to investigate the role of sleep disordered breathing, particularly obstructive sleep apnea-hypopnea syndrome (OSAS) in inadequate control of blood pressure in patients with arterial hypertension (AH).

Design and method: 72 patients with AH (mean age 48.0 ± 11.2y) and regular antihypertensive treatment, as a monotherapy or combined treatment have been included in the given study. All patients have had apnea-hypopnea index (AHI) values > = 5.0 episode/hour according to the polysomnographic investigation. Men (n = 64) and patients with severe OSAS (AHI > = 30.0 episode/hour) have prevailed in the study population (88.9% and 79.2%, respectively).

Results: 48 (66.7%) patients with OSAS and antihypertensive treatment have had uncontrolled and different severity degrees of AH in the moment of investiga-tion. Meanwhile the I, II and III degrees of AH have been stated in 29.2%, 22.2% and 15.3% of cases respectively. It is noteworthy that antihypertensive treatment parameters characterizing drug quantity and doses, their pharmacological groups and combinations have been equivalent for both groups of patients with controlled and uncontrolled AH, therefore couldn’t motivate the fact for insuffi cient control of AH. In this view uncontrolled AH has been revealed in 73.7% of patients with severe OSAS (AHI) > = 30.0 episode/hour), while the same ratio has been only 40.0% for groups of patients with mild or moderate OSAS. It should be noted that OSAS conditioned micro- and macro-arousals induced by the apnea-hypopnea episodes, sleep fragmentation and changes of its structure, including impaired relations between «slow-wave» and «rapid-wave» different stages lead to the sig-nifi cant changes of sympathetic-parasympathetic equilibrium, which, by itself, can suppose additional diffi culties in AH drug control.

Conclusions: The two-third of patients with OSAS, despite of the presence of com-bined antihypertensive treatment, has had high blood pressure levels. Thus severity of OSAS can be considered as a key predictor for manifestation of uncontrolled AH.

PP.08.07 DIFFERENCES IN CARDIAC REMODELING,

COMORBIDITIES AND TREATMENT OF

HYPERTENSIVE PATIENTS WITH AND WITHOUT

TYPE 2 DIABETES MELLITUS

A. Vintila1, M. Dobrovie2, D. Vasiliu2, M. Horumba2, V. Vintila3. 1Carol Davila University of Medicine and Pharmacy Bucharest, Coltea Clinical Hospital, In-ternal Medicine and Cardiology, Bucharest, Romania, 2Coltea Clinical Hospital, Internal Medicine and Cardiology, Bucharest, Romania, 3Carol Davila University of Medicine and Pharmacy Bucharest, Emergency University Hospital, Cardiol-ogy, Bucharest, Romania

Objective: Type 2 diabetes mellitus (T2DM) is a common comorbidity in hyper-tensive patients. This association is known to worsen the prognosis of the disease. Our aim was to assess differences in cardiac remodeling, comorbidities and treat-ment of hypertensive patients with and without type 2 diabetes mellitus.

Design and method: We evaluated a cohort of 200 hypertensive patients, of whom 103 had associated T2DM. Blood tests requested by standard of care and echocardiography have been performed in each patient. We recorded medication history, blood pressure control and comorbidities.

Results: Left atrial diameter, left ventricular posterior wall and septal thickness, right atrial and right ventricular diameter had higher values in diabetic versus nondiabetic patients, while left ventricular ejection fraction was slightly lower in

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diabetic patients (table 1). Diabetics had more mitral and tricuspid regurgitation (p < 0.001) and higher pulmonary artery systolic pressure (35.4 vs. 28.8 mmHg, p = 0.016). The number of antihypertensive agents was higher in diabetic patients (3.5 vs 2.7, p < 0.001). More diuretics and central sympathetic inhibitors were needed in diabetic patients (78% vs 54% and 21% vs 19%, respectively, both p < 0.05). Statin were more frequently used in diabetics (97% vs 65%, p = 0.008). Patients with diabetes suffered more frequently from ischemic heart disease (50% vs 30%, p = 0.004).

Conclusions: Cardiac remodeling was more prominent in diabetic patients, while hypertensive control was achieved with more intensive treatment, including more diuretics and central sympathetic inhibitors. Dyslipidemia and statin treatment were more frequently encountered in diabetic patients, statins being prescribed in the majority of patients. Hypertensive patients with type 2 diabetes mellitus suf-fered more frequently from ischemic heart disease.

PP.08.13 EFFECTS OF MULTIELECTRODE RENAL

DENERVATION ON SYMPATHETIC NERVE ACTIVITY

AND INSULIN RESISTANCE IN METABOLIC

SYNDROME

K. Dimitriadis, K. Tsioufi s, A. Kasiakogias, Th. Kalos, G. Liatakis, L. Nikolopoulou, E. Koutra, D. Konstantinidis, E. Andrikou, D. Tousoulis. First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece

Objective: This study aimed to investigate the effects of renal denervation (RDN) on sympathetic nerve activity and insulin resistance in patients with metabolic syndrome at 3 months post-RDN.

Design and method: Seventeen patients fulfi lledat least 4/5 criteria for meta-bolic syndrome and under stable use of at least two anti-hypertensive drugs at maximum tolerated doses for at least 4 weeks were enrolled and randomized in 3:1 ratio to RDN [n = 13, 12 males, age: 58 ± 7 years] and Control groups [n = 4, 3 males, age: 60 ± 5 years]. Both groups were followed up for 3 months. Muscle sympathetic nerve activity (MSNA)measurements were performed to as-sess sympathetic nerve activityat fasting state and during standard 75 g oral glu-cose tolerance test (OGTT).Blood sampling was also performed to assess insulin resistance(HOMA-IR).

Results: In the RDN group, offi ce BP reduced by 16 ± 21/10 ± 11mmHg (P = 0.01/0.007); average 24-hour BP reduced by 14 ± 16/5 ± 8mmHg (P = 0.008/0.03); waist circumference reduced by 3.1 ± 3.6 cm (P = 0.008);and MSNA at fasting state reduced from 55 ± 9 bursts per minute/82 ± 15 bursts per 100 heart beats to 46 ± 8 bursts per minute/71 ± 15 bursts per 100 heart beats (P = 0.0008/0.006) at 3 months post-RDN. During OGTT, while blunted MSNA responseswere notedat baseline throughout the 120-minute test (P>0.05/0.05vs. MSNA at fasting state), improved MSNA responses with burst frequency/burst incidence increased to 52 ± 8 bursts per minute/76 ± 12 bursts per 100 heart beats (P < 0.001/0.04 vs. the MSNA at fasting state, n = 13) at 30 minutes and to58 ± 16 bursts per minute/80 ± 14 bursts per 100 heart beats (P = 0.004/0.008 vs. the MSNA at fasting state, n = 10) at 120 minutes were observed at 3 months post-RDN.No such improvements were observed in the 4 control group subjects at 3 months follow-up. No statistical signifi cant change was observed in the HOMA-IR in both groups at 3 months.

Conclusions: In this pilot study of patients with metabolic syndrome and associ-ated hypertension, RDN reduced elevated sympathetic nerve activity and restored the normal neural response to oral glucose loading. Strategies to target specifi cally the elevated sympathetic nerve activity may provide substantial clinical benefi ts in this setting.

PP.08.14 PREVALENCE OF ATHEROSCLEROSIS AND

ARTERIAL STIFFNESS IN PATIENTS WITH

ARTERIAL HYPERTENSION AND TYPE 2 DIABETES

MELLITUS

E. Troitskaya, E. Starostina, Z. Kobalava. RUDN University, Moscow, Russia

Objective: Type 2 diabetes mellitus (DM) is an independent risk factor of coro-nary heart disease (CHD), stroke and peripheral arterial disease.Preclinical detec-tion of vascular lesions – is an important strategy for the prevention of cardio-vascular events in patients with type 2 DM. Aim of the study was to evaluate the degree of atherosclerosis and arterial stiffness in patients with arterial hyperten-sion and type 2 diabetes mellitus (DM).

Design and method: The study included 55 patients with HTN and DM (19 (38%) male, mean age 61.6 ± 12.7 years, mean offi ce BP 142.5 ± 25.5/82.7 ± 10.7mmHg), GFR 64 ± 18.4 ml/min/1.73m2, LDL-C 3.4+1.19 mmol/l). Target HbA1c levels were achieved in 6 (10.9%) patients. All patients received antihy-pertensive medications: ACEIs – 55 (100%), beta-blockers 12 (21.8%), calcium channel blockers 51 (92.7%), thiazide diuretics 35 (63.6%). Target BP value (<140/85 mmHg) was achieved in 29 (52.7%) patients. Carotid-femoral (CF) and carotid-radial (CR) pulse wave velocity (PWV, Sphygmocor, AtCor) were as-sessed, cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) were calculated (VaSera 1500, Fukuda Denshi). Stiffness gradient was assessed by CF-PVW/CR-PWV ratio, with values >1 indicating the loss of gradient.

Results: In the study group mean PP values were 61.0 ± 14.3 mmHg; 10 (18.1%) patients had elevation of PP > 60 mmHg. Mean CR-PWV was 7.7 ± 1.18 m/s, mean CF-PWV – 10.3 ± 2.0 m/s, increased CF-PWV >10 m/s was noted in 15 (27.2%) patients. Mean stiffness gradient was 1.3+0.37, values of CF-PWV/CR-PWV >1 were found in 51 (92.7%) patients. Mean CAVI was 8.5 ± 1.8, with ele-vation >9.0 – in 23 (49%) patients. Mean ABI was 1.03 ± 0.1, ABI decrease < 0.9 was present in 5 (9%), increase >1.3 in 2 (3.6%) patients.

Conclusions: Markers of arterial stiffness in HTN patients with DM receiving effective antihypertensive treatment in 52.7% of cases are more prevalent than markers of atherosclerosis. The prevalence of arterial stiffness varies depending on the diagnostic method used. Patients with HTN and DM are characterized by early loss of stiffness gradient from aorta to peripheral arteries.

PP.08.17 COMPARISON OF FOUR QUESTIONNAIRES IN

EVALUATING THE PREVALENCE OF HIGH INDEX

OF CLINICAL SUSPICION OF OSA IN TREATED

HYPERTENSIVE PATIENTS - DATA FROM THE

POL-FOKUS STUDY

P. Talarowska1, J. Wolf2, A. Prejbisz1, M. Klocek3, J. Gasowki3, R. Topor-Madry3, W. Lesniak3, D. Czarnecka3, K. Kawecka-Jaszcz3, K. Narkiewicz2, A. Januszewicz1. 1Institute of Cardiology, Warsaw, Poland, 2Medical University of Gdansk, Gdansk, Poland, 3Jagiellonian University Medical College, Krakow, Poland

Objective: Polysomnography remains a gold standard for the diagnosis of obstruc-tive sleep apnoea (OSA). Due to limited availability and high number of hyperten-sive patients with OSA several questionnaires were introduced to select patients at high risk of OSA. The purpose of this evaluation was to compare the prevalence and clinical characteristics of patients at high risk of OSA selected on the basis of four different questionnaires in a large sample of patients with hypertension (HTN).

Design and method: In a sub-study of the cross-sectional questionnaire-based observational Pol-Fokus study we included 3477 hypertensive patients (mean age 62.7 +/- 12.7 years; F 57.5%, M 42.5%) attending a routine visit in primary or specialist care. To be included patients had to be > 18 years old and had to be treated for at least 12 months with antihypertensive drugs. We defi ned HTN con-trol as offi ce blood pressure (BP) levels both < 140 mmHg/ < 90 mmHg. High risk of OSA was assessed by means of STOP-Bang and Berlin questionnaires (BQ), NoSAS score and Epworth Sleepiness Scale (ESS). Cardiovascular (CV) risk was evaluated according to 2013 ESH/ESC guidelines.

Results: The frequency of patients at high risk of OSA depended on the question-naire used: NoSAS (63,7%), BQ (41.0%), STOP-Bang (33.9%) and ESS (15.1%). Highest concordance of results was found between STOP-Bang and ESS (68.7%) and between STOP-Bang and BQ (75.5%). When STOP-Bang was used as a refer-ence test the sensitivity and selectivity of other tests were for ESS (26% and 90%), BQ (76% and 77%) and NoSAS (91% and 50%). Irrespectively of the question-naire used, patients at high risk of OSA were characterized by higher percentage of males, lower rate of HTN control, higher prevalence of CV disease or chronic kidney disease and by higher rate of high/very high cardiovascular risk.

Conclusions: Our results showed discordance in results of commonly used ques-tionnaires for selection of patients at high risk of OSA. However there were no

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Abstracts e149

major differences in clinical characteristics of patients at high risk of OSA se-lected by means of those questionnaires.

PP.08.19 THE RELATIONSHIP BETWEEN OBESITY AND

VISIT-TO-VISIT VARIABILITY IN SYSTOLIC BLOOD

PRESSURE: A 30-MONTHS PROSPECTIVE

FOLLOW-UP STUDY

S. Stojanovic1, M. Deljanin Ilic1, S. Ilic1, N. Tasic2, D. Tasic2, B. Ilic1, D. Petrovic1,D. Dragisic2, D. Simonovic1. 1Institute of Cardiology Niska Banja Medical Faculty University of Nis, Nis, Serbia, 2University Hospital Center Dr Dragisa Misovic Dedinje, Belgrade, Serbia

Objective: The prevention of obesity and strategy for better patient compliance in effi cient blood pressure control in obesity-related diseases are primary. The aim of this study was to clarify the change in parameters of obesity and systolic blood pressure (SBPV) during 30-months follow-up periods after starting the antihyper-tensive treatment and healthy lifestyle in hypertensive patients.

Design and method: Prospective study included 300 randomly selected previously untreated hypertensive patients (148 men and 152 women, mean age 67.7 ± 9.8 years), who were divided according to body mass index (BMI more than or equal to 30 kg/m2) to groups of obese (n = 216) and non-obese examinees (n = 84). The study comprised three visits during the follow-up period of 30-months. Obesity was defi ned according to both BMI and waist circumference (WC). SBPV for each examinee was evaluated at each visit using the standard deviation (SD) from 3 values of SBP. In order to estimate detailed evaluation of distribution SBPV quartiles of SBP-SD were formed.

Results: The prevalence of overweight/obesity was very high according to both BMI and WC at the beginning of the study, and there was signifi cant decrease in these values at the end of the study (72%, 64%,22%, 19% p < 0.001). SBP and SBP-SD were signifi cantly higher in the group of obese hypertensive patients than in the group of non-obese patients (129.41 ± 8.41 vs 119.04 ± 7.32 mmHg, 9.27 ± 5.28 vs 6.50 ± 3.52; p < 0.01). There was statistically stronger correlation between SBP-SD and BMI as the parameter of total obesity compared to WC as the parameter of central obesity (0.422 vs. 0.381, p < 0.01). The analysis showed statistically signifi cant average decrease of SBP-SD for 9.1 mmHg, BP for 31/10 mmHg, BMI for 3.5 kg/m2 and WC for 10 cm. The highest SBPV was recorded in the 4th quartile in obese patients (40.22 ± 7.14 mmHg).

Conclusions: During the 30-months period after starting antihypertensive medi-cation and healthy lifestyle with titrated dose of same class of antihypertensive drugs, reduction of body weight was associated with reduction of blood pressure values, and lower value of blood pressure variability.

PP.08.20 PREVALENCE OF ATHEROSCLEROSIS AND

ARTERIAL STIFFNESS IN PATIENTS WITH

ARTERIAL HYPERTENSION AND TYPE 2 DIABETES

MELLITUS

E. Starostina, E. Troitskaya, Y. Kotovskaya, Z. Kobalava. RUDN University, Moscow, Russia

Objective: The aim of the study was to assess the degree of atherosclerosis and arterial stiffness in patients with arterial hypertension and type 2 DM.

Design and method: The study included 55 patients with HTN and DM (19 (38%) males, mean age 61.6 ± 12.7 years, mean offi ce BP 142.5 ± 25.5/82.7 ± 10.7 mmHg, HR 75.4 ± 10.2 beats/min), GFR 64 ± 18.4 ml/min/1.73m2, LDL-C 3.4+1.19 mmol/l).All participants previously received antihypertensive medications:ACEIs – 55 (100%), beta-blockers 12 (21.8%), calcium channel blockers 51 (92.7%), thiazide diuretics 35 (63.6%); 4 (7.27%) patients received statins. Target BP values (<140/85 mmHg) were achieved in 29 (52.7%) patients. Carotid-femoral (CF) and carotid-radial (CR) pulse wave velocity were assessed (Sphygmocor, AtCor), cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) were evaluated (VaSera 1500, Fukuda Denshi). Increased arterial stiffness was defi ned as an elevation of pulse pressure (PP) > 60 mmHg, PWV >10 m/s, CAVI >9.0, ABI decrease < 0.9 was considered as a marker of subclini-cal atherosclerosis, ABI > 1.3 as a sign of noncompressible arteries. Stiffness gradient was assessed by CF-PVW/CR-PWV ratio, with values >1 indicating the loss of gradient.

Results: In our group mean PP values were 61.0 ± 14.3 mmHg;10 (18.1%) pa-tients had elevation of PP > 60 mmHg. Mean CR-PWV was 7.7 ± 1.18 m/s, mean CF-PWV – 10.3 ± 2.0 m/s, increased CF-PWV >10 m/s was noted in 15 (27.2%) patients. Mean stiffness gradient was 1.3+0.37,values of CF-PWV/CR-PWV >1 were found in 51 (92.7%) patients. Mean CAVI was 8.5 ± 1.8, with elevation > 9.0 – in 23 (49%) patients. Mean ABI was 1.03 ± 0.1, ABI decrease < 0.9 was present in 5 (9%), ABI increase >1.3 in 2 (3.6%) patients.

Conclusions: Markers of arterial stiffness in HTN patients with DM receiving effective antihypertensive treatment in 52.7% of cases are more prevalent than markers of atherosclerosis. The rate of arterial stiffness varies depending on the diagnostic method used. The highest number of patients is diagnosed with arterial stiffness by CAVI measurement,the lowest number by PP, which may refl ect the greater sensitivity of PP to antihypertensive therapy. Patients with HTN and DM have an early loss of stiffness gradient from aorta to peripheral arteries.

PP.08.21 RELATIONSHIP OF METABOLIC SYNDROME

AND RISK OF DEVELOPING CARDIOVASCULAR

DISEASE AND DIABETES FOR POPULATION OF

KAZAKHSTAN

M. Sorokina1, B. Koichubekov1, Ye. Laryushina2, L. Turgunova3, R. Bakirova4. 1Karaganda state medical university, Department of Medical biophysics and informatics, Karaganda, Kazakhstan, 2Karaganda State Medical University - Department of Internal Diseases2, Karaganda, Kazakhstan, 3Karaganda State Medical University - Department of Internal Diseases3, Karaganda, Kazakhstan, 4Karaganda State Medical University - Department of propedeutics of internal diseases, Karaganda, Kazakhstan

Objective: Metabolic syndrome (MS) is a combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes. Some studies have examined the relationship between MS and psychological risk factors such as depression, anxiety, tension, current perceived stress and anger. We researched risks of cardiovascular diseases, diabetes, the prevalence of states of anxiety and depression among Central Kazakhstan’s population with MS.

Design and method: 3683 Central Kazakhstan citizens (2829 women and 854 men) aged 18 to 65 (45 ± 12,71 (M ± Std.Dev)) were examined. 543 people were diagnosed with metabolic syndrome which accounted for 14,74% (CI: 13,61; 15,93). SCORE, FINDRISK charts were used to evaluate risks. PHQ-9 and GAD-7scales were used to determine levels of depression and anxiety.

Results: Most important differences were determined for the prevalence of diabe-tes and cardiovascular disease risks. Clearly increased risk for diabetes was found for 19,7% (CI 16,34; 23,06) of people with MS, almost 80,46% (CI 77,11; 83,81) had high risk of cardiovascular disorders. Depression states were common among people with MS - almost 25% of examined had moderate, moderately severe or severe depressions. Severe anxiety level was observed for 18,05% (CI 14,8; 21,3). Among women, diabetes risks were more pronounced, whereas for men it were cardiovascular risks. Severe anxiety was observed more frequently among women than among men (19,27% (CI 15,57; 22,97) and 12,75% (CI 6,28; 19,22) respec-tively). However, almost 9% of men and 5,5% of women had moderately severe and severe depressions.

Conclusions: The prevalence of metabolic syndrome in Central Kazakhstan is signifi cantly lower than in Europe or the U.S. However, as is the case for other countries, high risk of development of diabetes and cardiovascular disorders are observed among people with MS. Gathered results confi rm the role of anxiety and depression conditions in MS development.

PP.08.22 METABOLIC SYNDROME PREVALENCE AMONG

KAZAKHSTAN’S POPULATION

M. Sorokina1, B. Koichubekov1, Ye. Laryushina2, L. Turgunova3, R. Bakirova4, I. Korshukov1. 1Karaganda state medical university - Department of Medical biophysics and informatics, Karaganda, Kazakhstan, 2Karaganda state medical university - Department of internal diseases2, Karaganda, Kazakhstan, 3Kara-ganda state medical university - Department of of internal diseases3, Karaganda, Kazakhstan, 4Karaganda state medical university - Department of propedeutics of internal diseases, Karaganda, Kazakhstan

Objective: Metabolic syndrome is characterised by high blood pressure, high blood sugar levels, high triglyceride levels, low high-density lipoprotein choles-terol levels and excess body fat around the waist. People with metabolic syndrome have the risk of developing cardiovascular diseases. However, early diagnosis, intervention and treatment can decrease the cardiovascular risk. In this research, the prevalence of metabolic syndrome among Kazakhstan’s population and socio-demographic characteristics of metabolic syndrome were evaluated.

Design and method: 3683 Kazakhstan citizens (2829 women and 854 men) aged 18 to 65 were examined. Metabolic syndrome is diagnosed according to measure-ments of waist, triglyceride level, high-density lipoprotein cholesterol level, blood pressure and fasting plasma glucose.

Results: 543 people (282 city dwellers and 261 villagers, 102 men and 441 wom-en) were diagnosed with metabolic syndrome, which accounted for 14,74% of examined population. It is necessary to point out that 30 people (5,52% cases) were aged 40 or less. 11,23% of metabolic syndrome cases belonged to ‘40 to 48’

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e150 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

age group. For‘48 to 56’ age group metabolic syndrome frequency increased more than twice and constituted 38,12%. A maximum number of metabolic syndrome cases was identifi ed for ‘56 to 65’ group and amounted to 45,12%. Among men metabolic syndrome frequency totalled 11,94% and was signifi cantly different from metabolic syndrome frequency among women (15,4%). 78,23% of women and 73,53% of men with metabolic syndrome were ‘50 or older’. Among people with metabolic syndrome for age group ‘40 and younger’ the percentage of men (10,78%) was signifi cantly higher, than of women (4,50%). Among people with metabolic syndrome only 18,11% of cases were individuals with higher educa-tion. More than half of all individuals with metabolic syndrome were engaged in physical labor. Percentage of widowed individuals among people with metabolic syndrome (20,93%) was signifi cantly higher compared to percentage of widowed people without metabolic syndrome (8%).

Conclusions: Analysis of metabolic syndrome prevalence, for Kazakhstan citi-zens discovered that the maximum number of people with metabolic syndrome was found for ‘56 to 65’ group. Metabolic syndrome occurs more frequently among women than men. Among men, metabolic syndrome manifests itself ear-lier in life.

PP.08.27 PREVALENCE AND CLINICAL BACKGROUND

OF ATRIAL FIBRILLATION IN JAPANESE TYPE 2

DIABETES

A. Sato1, S. Ootake2, Y. Uchigata2. 1Clinical Laboratory, Diabetes Center, Tokyo Women’s Medical University, Tokyo, Japan, 2Diabetes Center, Tokyo Women’s Medical University, Tokyo, Japan

Objective: The atrial fi brillation (AF) is one of the most common arrhythmia in clinical practice, but little is known about its risk factors. Some studies have reported that diabetes contains a risk factor of AF. The aim of this study is to investigate the prevalence of AF in Japanese type 2 diabetes and clinical back-grounds of them.

Design and method: We conducted a retrospective observational study of 1650 patients with type 2 diabetes who were taken 12-lead electrocardiograms at their fi rst visit to our hospital from January 2004 to December 2005. AF was diagnosed by physicians. We investigate the prevalence of AF and clinical back ground based on clinical records including heart disease and stroke. Then, risk factors were examined by comparing clinical backgrounds and the result of biochemical tests between the group with AF and the group without AF.

Results: The mean age was 60(13) year-old, BMI 24.8(4.3) kg/m2, HbA1c 8.6 (2.3) %, and blood pressure 141(24) / 80(13) mmHg. Prevalence of AF in all type 2 diabetes was 4.4%, 5.4% in man and 2.5 % in woman, respectively. The preva-lence of AF was increased 8.9% at the age of 70 to 80. As for basal heart disease, hypertension was observed 70.8%, valvular heart disease 16.7%, ischemic heart disease 13.9%, and other heart diseases 9.7%. Nine patients out of 72 patients with AF had already had stroke. Old elderly and elevated uric acid were indepen-dent factors for non valular AF in type 2 diabetes (p < 0.001, p < 0.05).

Conclusions: The high prevalence of AF was found in Japanese type 2 diabetes, especially in the age of 70 and over. Compared to the general population, the tendency to be older and higher prevalence was the same, but prevalence was high in each generation.

PP.08.29 MARKED INSULIN RESISTANCE IN FAT CELLS OF

SUBJECTS WITH INCREASED CARDIOVASCULAR

RISK

M. Ryden, P. Arner. Karolinska Institutet, Stockholm, Sweden

Objective: Adipose tissue dysfunction may be a pathophysiological factor pro-moting cardiovascular disease due to altered lipid metabolism in fat cells. We pre-viously showed that impaired ability to mobilize lipids from adipocytes following catecholamine stimulation links adipose tissue to cardio-metabolic disease (J Clin Invest, 1995 and Nature, 2011). If such defects also involve effects of the major anabolic hormone insulin is unknown and was presently examined.

Design and method: Abdominal subcutaneous adipose tissue was obtained from 555 women and 167 men who were scored for cardiovascular risk factors according to ATP III criteria. Insulin-stimulated lipogenesis (lipid synthesis from glucose) and insulin-inhibited lipolysis (hydrolysis of neutral lipids) were determined in vi-tro in isolated fat cells. Half maximum effects (sensitivity) and maximum effects (responsiveness) for insulin were determined and related to ATPIII risk score in multivariate analysis adjusting for age, gender and either body mass index (BMI) or fat cell size.

Results: Independently of age, sex and BMI, ATPIII score was negatively cor-related with sensitivity as well as responsiveness (�-values 0.13–0.30) of insulin inhibition of lipolysis and stimulation of lipogenesis. Similar results were obtained if associations were corrected for fat cell size instead of BMI. Together variations in the sensitivity and responsiveness of insulin action on fat cell lipid metabolism explained as much as 25% of the variation in ATPIII scores (adjusted r2). Variation in insulin sensitivity refl ects changes in initial insulin signal events (receptor num-ber, affi nity and coupling) whereas changes in insulin responsiveness refl ect distal events in hormone signaling that are beyond the receptor. Because insulin signal-ing to lipolysis and lipogenesis diverge after phosphoinositide 3-kinase, the results suggest that the negative association between ATPIII and insulin action is attributed to multiple changes in hormone signaling, possibly involving its receptor and/or the insulin receptor substrate proteins in addition to phosphoinositide 3-kinase.

Conclusions: Increased cardiovascular risk is strongly linked to resistance of the major metabolic actions of insulin in subcutaneous human fat cells. This is inde-pendent of age, sex, BMI and fat cell size. The mechanisms behind the resistance are currently studied and preliminary data will be reported.

PP.08.30 DIABETES MELLITUS IN HYPERTENSIVE PATIENT

- SYNONYM OF CARDIOVASCULAR RISK

INCREASE?

M. Freixa, A. Ferreira Simões, J. Rodrigues, S. Úria, G. Silva. Hospital Pulido Valente, CHLN, Lisbon, Portugal

Objective: Hypertension (HT) is an independent cardiovascular risk factor (CVRF), but the association with diabetes mellitus (DM) may lead to increased cardiovascular morbidity and mortality. The authors sought to study the associa-tion between HT and DM in hospitalized patients.

Design and method: Retrospective study of 1106 patients admitted to an Internal Medicine ward between January 2012 and November 2016. Patients with HT were selected and grouped according to the presence of DM: G1 - diabetic hyperten-sive patients; G2 - non-diabetic hypertensive patients. We defi ned cardiovascular events (CVE): acute myocardial infarction (AMI) and stroke, reasons for hospital-ization; and considered in-hospital mortality of all causes.

Results: (1) 758 patients (68.5% of the population) were included. (2) In G1 the mean age was lower (77.7 ± 9.8 vs 79.8 ± 11.8 years, p = 0.014) and the hos-pital length of stay was higher (11.2 ± 10.9 vs 9.9 ± 8.5 days; p = 0.075). (3) In G1 there was a higher prevalence of heart failure (38.7vs28.5%, p = 0.004) and ischemic heart disease (19.2vs11.6%, p = 0.004), cerebrovascular disease (14.3vs21.3%; p = 0.018), being similar in chronic kidney disease (32.8vs31.5%, p = 0.816) and atrial fi brillation (25.9vs24.8%, p = 0.729). (4) There is a greater association with other CVRF in G1: obesity (16.2vs7.3%, p < 0.01) and dyslipid-emia (51.9vs33.5%, p < 0.01). (5) There were no differences in CVE (4.5vs5.9%, p = 0.422, AMI 3.0vs2.4%, p = 0.641, stroke 4.5vs6.7%, p = 0.222), mortality (2,6vs4.5%, p = 0,208) and in the combined CVD and mortality (10.2vs12.4%, p = 0.356).

Conclusions: In this sample, the presence of DM did not confer disadvantage in hypertensive patients contrary to expectations. This may be due to a earlier and rigorous control of CVRF, in particular of hypertension, in the diabetic patient, with more effective therapeutic strategies, which cooperate for a greater preven-tion of CVD and better cardiovascular outcome.

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Abstracts e151

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved

SATURDAY

POSTERS

POSTER SESSION

POSTERS’ SESSION PS09:

LARGE ARTERIES AND

MICROCIRCULATION

PP.09.01 A COMPARATIVE ANALYSIS OF LARGE ARTERIES

STIFFNESS OF SYSTEMIC CIRCULATION IN

PATIENTS WITH IDIOPATHIC PULMONARY

ARTERIAL HYPERTENSION, WITH ARTERIAL

HYPERTENSION AND HEALTHY

I. Zhyvylo. Institute of Cardiology named after M. D. Strazhesko, Kiev, Ukraine

Objective: We evaluated arterial stiffness of elastic (PWVe) and muscular (PWVm) types in patients with idiopathic pulmonary arterial hypertension (IPAH) compared with patients with arterial hypertension (AH) and control group of healthy people.

Design and method: We included 70 patients: I group - 36 patients with IPAH, II group - 16 patients with AH, III control group – 18 healthy people. Follow-ing measurements were performed: measurement of carotid-ancle vascular index (CAVI) (VaSera 1500N, Fukuda Denshi, Japan), noninvasive central SBP (cSBP) measurement of PWVe and PWVm (Sphygmocor, AtCor, Australia). We usedT-test for independent samples.

Results: All groups were similar by age (42 ± 2,2; 41,4 ± 3,2; 39,1 ± 2,2 years respectively, NS). IPAH group signifi cantly differed from AH group by lower level of SBP/DBP (113,9 ± 2,1/76,6 ± 1,6 mmHg vs 144,1 ± 4,7/89 ± 2,8 mmHg, p < 0,0001). Subsequently cSBP was also slightly lower in this group (98,3 ± 1,6 vs 131,3 ± 5,1 mmHg, p < 0,0001). I and III groups were similar by levels of PWVm (8,1 ± 0,3 vs 7,9 ± 0,3, respectively, NS), but I and II groups differed by it (8,1 ± 0,3 vs 9 ± 0,4, respectively, p < 0,1). Although CAVI were similar by I and II group (right 7,2 ± 0,2 vs 7,5 ± 0,3 and left 7,5 ± 0,2 vs 7,5 ± 0,3, respectively, NS). CAVI were higher in IPAH group than in the control group (right 7,2 ± 0,2 vs 6,0 ± 0,1, p < 0,0001 and left 7,5 ± 0,2 vs 6,1 ± 0,1, p < 0,0001 respectively).

Conclusions: The defi nition of CAVI, which does not depend on the level of sys-temic blood pressure, helps to identify the elastic properties impairment of the systemic circulation arteries in patients with IPAH. The stiffness of large arteries of systemic circulation is similar in patients with IPAH and with AH.

PP.09.03 CONCORDANCE BETWEEN TWO FORMS

OF ARTERIAL STIFFNESS REGISTER AND

CORRELATION WITH BRACHIAL AND CENTRAL

BLOOD PRESSURE

S. Yun Viladomat, E. Acosta Francisco, A. de la Sierra. Hospital Universitari Mútua de Terrassa, Terrassa, Spain

Objective: Carotid-femoral pulse wave velocity (cfPWV) is recognized as the gold standard for the assessment of arterial stiffness. Cardio Ankle Vascular Index (CAVI), which is determined automatically has been proposed as an alternative. We aimed to assess the correlation between these two methods and their associa-tion with central and peripheral BP.

Design and method: These is an observational study in 43 essential hypertensive patients, 60% males, aged 48 ± 14 years. cfPWV was determined by pulse wave-form analysis using the validated and calibrated Sphygmocor Xcel device (AtCor Medical, West Ryde, Australia). Brachial and central BP (transfer function) were determined used the same device. CAVI and the ankle-brachial index were deter-mined by VaSera VS-Series Vascular Screening System (Fukuda Denshi, Tokyo, Japan). Agreement between the two methods was assessed by both Pearson’s and intraclass correlation coeffi cients. The correlation between either cfPWV or CAVI with central and peripheral BP were estimated by Pearson’s correlation coeffi -cients and possible differences evaluated by calculating z-statistics.

Results: Mean values of cfPWV CAVI were respectively 7.5 ± 1.9 m/s and 8.6 ± 2.0 units. The concordance between CAVI and PWV was considered good (Pearson’s correlation coeffi cient of 0.724 (p < 0.001) and intraclass correlation coeffi cient of 0.840). Correlations were all signifi cants for both cfPWV and CAVI and for both

central and peripheral SBP and PP. No differences were observed between the inten-sity of correlation obtained by CAVI or PWV (non-signifi cant z statistics).

Conclusions: There is a good correlation between the measurement of arterial stiffness by PWV and CAVI, and both measures are similarly correlated with BP.

PP.09.04 REFERENCE VALUES OF CARDIO-ANKLE

VASCULAR INDEX IN A RANDOM SAMPLE OF A

CAUCASIAN POPULATION

P. Wohlfahrt, R. Cifkova, N. Movsisyan, S. Kunzova, J. Lesovsky, M. Homolka,V. Soska, P. Dobsak, L. Lopez-Jimenez, O. Sochor. International Clinical Re-search Center St. Anne University Hospital, Brno, Czech Republic

Objective: Cardio-ankle vascular index (CAVI), a parameter of arterial stiffness, has been increasingly used for cardiovascular risk estimation. Currently used CAVI reference values are based on the Japanese population. It is not clear wheth-er the same reference values can be used in the Caucasian population. The aim of the present study was to describe cardiovascular risk factors infl uencing CAVI and to establish CAVI reference values.

Design and method: In total, 2160 individuals randomly selected from the Brno city population aged 25–65 years were examined. Of these, 1 347 subjects were free from cardiovascular disease, non-diabetic and untreated by anti-hypertensive or lipid-lowering drugs, forming the reference value population. CAVI was mea-sured using the VaSera VS-1000 device.

Results: At each blood pressure level, there was a quadratic association between CAVI and age, except for the linear association in the optimal blood pressure group. While there was no association between blood pressure and CAVI in younger subjects, there was a linear association between CAVI and blood pressure after 40 years of age. Refer-ence values by age and gender were established. In each age group, except for the male 60–65 group, reference values in whites were lower than in the Japanese population with the difference ranging from -0.29 to 0.21 for males, and from -0.38 to -0.03 for females.

Conclusions: This is the fi rst study providing CAVI reference values in a random sample of the Caucasian population. Our results suggest that the currently used values slightly overestimate CAVI in younger whites, which may underestimate cardiovascular risk.

PP.09.05 THE POLISH REGISTRY FOR FIBROMUSCULAR

DYSPLASIA (ARCADIA-POL STUDY) –

DISTRIBUTION OF VASCULAR BED INVOLVEMENT

AND COMPLICATIONS IN PATIENTS WITH

FIBROMUSCULAR DYSPLASIA

E. Warchol-Celinska1, K. Hanus1, E. Florczak1, A. Prejbisz1, M. Januszewicz2,I. Michalowska3, L. Swiatlowski4, P. Talarowska1, H. Janaszek-Sitkowska1, L. Stryczynski5, M. Protasiewicz6, A. Niemirska7, M. Litwin7, K. Grygiel8,

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e152 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

K. Madej8, S. Nazarewski8, A. Witkowski9, M. Szczerbo-Trojanowska4,A. Tykarski5, A. Januszewicz1. 1Institute of Cardiology - Department of Hyperten-sion, Warsaw, Poland, 2Medical University of Warsaw -2nd Department of Radiol-ogy, Warsaw, Poland, 3Institute of Cardiology - Department of Radiology, Warsaw, Poland, 4Independent Public Central Clinical Hospital4- Department of Interven-tional and Neuroradiology, Lublin, Poland, 5Medical University of Poznan -De-partment of Hypertension, Angiology and Internal Medecine, Poznan, Poland, 6University Teaching Hospital in Wroclaw - Department of Cardiology, Wroclaw, Poland, 7Child Health Center - Department of Nephrology, Kidney Transplant and Hypertension, Warsaw, Poland, 8Medical University of Warsaw -Department of General, Vascular and Transplant Surgery, Warsaw, Poland, 9Institute of Cardiol-ogy - Department of Interventional Cardiology and Angiology, Warsaw, Poland

Objective: To assess the vascular bed involvement and vascular complications in patients with fi bromuscular dysplasia (FMD) enrolled into ARCADIA-POL study.

Design and method: Out of 182 patients enrolled into ARCADIA-POL study since January 2015 (instituted on the basis of Polish-French collaboration) we present 144 patients with confi rmed FMD in at least one vascular bed. A standard-ized FMD data form was used for data collection. All patients underwent detailed clinical evaluation including ABPM, biochemical evaluation, biobanking, duplex Doppler of carotid and abdominal arteries and whole body angio-CT.

Results: In our analysis we included 144 patients with confi rmed FMD (112F[77.8%], 32M[22.2%], mean age:41.1 ± 16.3 years. 132 patients (91.7%) were hypertensives. The mean age at the diagnosis of hypertension was 33.9 ± 15.4 years and the FMD was diagnosed 6.8 ± 10.6 years later with the mean age at the diagnosis of FMD of 40.7 ± 16.3 years.In the analyzed group FMD was identifi ed in renal arteries in 127 (88.2%) patient as well as in carotid, intracranial and vertebral arteries in 24(16.7%), 20(13.9%) and 9(6.3%) patients, respectively. FMD was also identifi ed in celiac trunk and mesenteric, iliac and splenic arteries in 19(13.2 %), 11(7.6%), and 15(10.4%) patients, respectively.In 56 patients (38.9%) FMD was identifi ed in two or more vascular beds. Two vascular beds were involved in 23.6%(34 pts), three in 9%(13 pts), four in 3.5%(5 pts), fi ve in 2.1 %(3 pts) and six in 0.7%(1 pt).Arterial dissection(s) or aneurysms in various vascular beds were found in 10.4% and 33.3% of patients respectively.Aortic abnormalities coexisting with FMD lesions were found in 3 patients(2.1%).Severe FMD - defi ned as fi rst onset of FMD < 30 years, affecting at least 3 vascular beds complicated with thrombosis or dissection requiring an endovascular or surgi-cal repair, with no infl ammatory background - was identifi ed in 5 patients (3.5%).

Conclusions: The data of ARCADIA-POL registry showed that renal FMD was the most frequent, but also cerebrovascular FMD was found in relatively large proportion of patients. Our data revealed high incidence of FMD lesions coexist-ing in different vascular beds as well as relatively frequent occurrence of vascular complications.

PP.09.08 HEART STRUCTURE AND VASCULAR FUNCTION IN

YOUNG PATIENTS AFTER ENDOVASCULAR REPAIR

FOR BLUNT THORACIC AORTIC INJURY

P. Vallerio1, I. D’Alessio3, A. Maloberti1, M. Varrenti1,3, S. Maggioni3, V. Cantu3, M. Carbonaro3, M. C. Ferrara3, E. Spada3, B. Palmieri2, A. Lista2, C. Giannattasio1,3.1Cardiology IV, A. De Gasperis Department, Ospedale Niguarda Ca Granda, Mi-lan, Italy, 2Vascular Surgey, Ospedale Niguarda Ca Granda, Milan, Italy, 3Medi-cine and Surgery Department, Milano-Bicocca University, Milan, Italy

Objective: Thoracic Endovascular Aortic Repair (TEVAR) currently represents the gold standard of treatment for blunt thoracic aortic injury (BTAI). Neverthe-less there is an ongoing debate surrounding its safety and effi cacy and its subse-quent cardiovascular effects. The present study is aimed at assessing heart and aortic structure and function after TEVAR in BTAI young patients.

Design and method: In 20 patients (18 men, age 41 ± 14 years) treated with TEVAR (11 with Gore CTAG, 9 with Medtronic Valiant) after BTAI, between 2004–2015, after a median follow-up time of 3 years (range 12–1 years; T1) we measured brachial Blood Pressure (BP, sfi gmomanometry) and Pulse Wave veloc-ity (cfPWV, sphygmocor) and obtained an echocardiogram with Left Ventricular Mass Index (LVMI) calculation.

Results: At baseline all the patients were normotensive; At T1 evaluation patients showed mean normal BP value (131 ± 12/85 ± 10) while 11 of them (55%) were hypertensives. Also LVMI (81,84 ± 28,11 g/m2) and PWV (7,58 ± 1,48 m/s) mean values were within the normal range. When patients were divided accord-ingly to the used graft patients treated with Medtronic Valiant showed a signifi -cantly higher LVMI (97.17 ± 35.78 vs 69.58 ± 11.24 g/m2; p < 0,05) and PWV (7,78 ± 1,74 vs 6,45 ± 1,54 m/s; p < 0,05) compared with those treated with Gore CTAG. Same fi gures were fouded when patients were divided accordingly to the treating time with those treated more than 3 years before the evaluation that

showed higher LVMI (91,16 ± 34,73 vs 70,20 ± 9,44 g/m2; p < 0,01) and PWV (7,50 ± 1,98 vs 6,38 ± 1,04 m/s; p < 0,05).

Conclusions: Our study showed for the fi rst time that descending aorta TEVAR for BTAI is associated after some years with the development of hypertension and heart and vascular alterations. The presence of TEVAR modify aortic functional properties and induce in young subject an increase in BP and LVMI probably related to the presence of a rigid aorta .These fi ndings suggest to include a cardio-logic follow up of young patients treated with TEVAR.

PP.09.09 IMPROVEMENT OF ENDOTHELIAL GLYCOCALYX

AND AORTIC STIFFNESS AFTER ONE YEAR

OF SUCCESSFUL TREATMENT IN UNTREATED

PATIENTS WITH ESSENTIAL HYPERTENSION

E. Triantafyllidi, S. Vlachos, D. Vlastos, D. Benas, I. Ikonomidis, M. Varoudi, A. Schoinas, J. Lekakis. 2nd Department of Cardiology, Medical School, Athens, Greece

Objective: Aortic stiffness is considered a valuable index of subclinical damage in hypertensives offering to cardiovascular risk estimation. The integrity of endothelial glycocalyx plays a vital role in vascular permeability, infl ammation and elasticity. We aimed to explore any changes in both aortic stiffness and endothelial glycocalyx in hypertensive patients under medical treatment (MT) or just life style changes (LSC).

Design and method: We studied 114 patients with newly diagnosed essential hy-pertension (mean age 48+10 years, 80 males). At baseline, we performed carotid-femoral artery PWV to evaluate aortic stiffness. Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranged from 5–25 microme-ters) was measured as a non-invasive accurate index of reduced endothelial glyco-calyx thickness. Twenty six patients (23%) decided to follow only LSC (Group A)while 88 patients (77%) started MT (Group B). All patients re-evaluated at 12+7 months but no earlier than 6 months. Blood pressure (BP) < 140/90 mmHg was considered as controlled (offi ce and/or home measurements).

Results: There were no signifi cant differences within Groups A and B regarding baseline evaluation of systolic blood pressure (SBP), PWV and PBR 5–25. In Group A, systolic blood pressure (SBP), PWV and PBR were not different from baseline evaluation. However, in the subgroup of LSC with controlled hyperten-sion (Group AC, 9/26), we found that SBP and PWV were reduced (p < 0.05). In Group B, SBP (p < 0.001) and PWV (p = 0.002) were reduced. In the subgroup of MT with uncontrolled hypertension by the physician but controlled by the patient and treated for at least 12 months (Group BUC, 10/88 patients) we found that SBP, PWV and PBR5–25 were decreased (p < 0.05).

Conclusions: Cardiovascular risk reduction in hypertensives is based not only in SBP control but also in target organ damage improvement. Our results un-derline that the expected improvement of aortic stiffness induced by BP control is present independently of the choice of the treatment. Secondly, improvement of endothelial glycocalyx needs long term treatment. Finally, our study shows the importance of the information received by the patients regarding their BP control at home regarding the white coat effect phenomenon in offi ce measure-ments.

PP.09.10 HEART RATE REDUCTION DOES NOT LEAD TO

AN INCREASE IN CENTRAL BLOOD PRESSURE

IN SICK SINUS SYNDROME PATIENTS WITH

PERMANENT PACEMAKERS

T. Teeäär1, M. Serg1, J. Kals1, M. Zilmer2, J. Eha1, P. Kampus1. 1University of Tartu, Institute of Clinical Medicine, Department of Cardiology, Tartu, Estonia, 2University of Tartu, Institute of Biomedicine and Translational Medicine, Department of Biochemistry, Tartu, Estonia

Objective: Central aortic blood pressure may be superior to brachial blood pressure in predicting cardiovascular target organ damage. Heart rate (HR) re-duction with non-vasodilating beta-blockers has been associated with an unfa-vourable central blood pressure profi le in hypertensive patients. However, the interaction between HR and central hemodynamics remains unclear. The aim of this study was to evaluate the isolated role of HR on central hemodynamics in sick sinus syndrome patients with permanent pacemakers in a range of HR-s from 40 to 90 bpm.

Design and method: We included 27 subjects (mean age 66 years, 12 men) with dual-chamber pacemakers implanted due to sick sinus syndrome. We determined central blood pressure, central augmentation index (cAIx) and carotid-femoral pulse wave velocity (cf-PWV) noninvasively during AAI-pacing from low (40 bpm) to middle (60 bpm) and high (90 bpm) HR level with an oscillometric cuff-based device (Sphygmocor XCEL, AtCor Medical, Australia).

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Results: The mean HR-s at low, middle and high HR levels were 49, 60 and 87 bpm, respectively (p < 0.01). From the low to middle HR level, central sys-tolic blood pressure (cSBP) increased (mean 117 and 121 mmHg, respectively, p < 0.01) in parallel with brachial systolic blood pressure (bSBP) (mean 126 and 131 mmHg, respectively, p < 0.01). From the middle to high HR level, bSBP in-creased (mean 131 and 133 mmHg, respectively, p = 0.09) compared to cSBP which remained unchanged (mean 121 and 121 mmHg, respectively; mean differ-ence in pSBP-cSBP from the middle to high HR level 2 mmHg (95% CI 1.6, 2.7 mmHg, p < 0.01)). cAIx remained unchanged from the low to middle HR level but decreased thereafter. Increasing HR resulted in an increase in cf-PWV from the low to middle and from the middle to high HR level.

Conclusions: Our study provides evidence to suggest that in an acute setting, sick sinus syndrome patients with HR-s below 60 bpm may have a lower central blood pressure compared to patients with higher HR-s despite the known augmenting effects of low HR on central blood pressure. However, the results need to be con-fi rmed in a chronic setting.

PP.09.11 AORTIC PRESSURE WAVE REFLECTION IN

YOUNG INDIVIDUALS: DIURNAL VARIATION,

DETERMINANTS AND ASSOCIATION WITH

TARGET-ORGAN DAMAGE

A. Kollias1, A. Ntineri1, A. Destounis1, G. Servos2, D. Georgakopoulos2, I. Moyssakis3, A. Vazeou4, G.S. Stergiou1. 1Hypertension Center STRIDE-7, Uni-versity of Athens, Third Department of Medicine, Sotiria Hospital, Athens, Greece, 2Department of Cardiology, P. & A. Kyriakou Children Hospital, Athens, Greece, 3Cardiology Department, Laikon Hospital, Athens, Greece, 4First Department of Pediatrics, P. & A. Kyriakou Children Hospital, Athens, Greece

Objective: Augmentation index (AIx) refl ects aortic pressure augmentation and is independently associated with cardiovascular risk in adults. It is determined by structural and functional cardiovascular properties and increases with aging. This study examined AIx in terms of 24-hour variation, determining factors and association with indices of preclinical target-organ damage in young individuals.

Design and method: Apparently healthy children, adolescents and young adults (age 10–25 years) referred for elevated blood pressure (BP) and healthy volun-teers were subjected to: (i) 24-hour ambulatory monitoring of BP, central hemody-namics (including AIx adjusted to a heart rate of 75 bpm), and pulse wave velocity (PWV), using a noninvasive brachial cuff-based oscillometric device (Mobil-O-Graph 24 h PWA), and (ii) assessment of left ventricular mass index (LVMI) and common carotid intima-media thickness (cIMT).

Results: Data from 108 untreated subjects were analyzed (mean age 17.8 ± 4.7 years, 86 males, body mass index 24.7 ± 5.1 kg/m2, 28 subjects with 24-hour BP > = 95th percentile for children/adolescents or > = 130/80 mmHg for adults). Fe-males had higher 24-hour AIx than males (21.7 ± 3.9 vs. 12.7 ± 5.6%, p < 0.01; adjusted for height). Hypertensive subjects tended to have higher 24-hour AIx than normotensives (15.9 ± 7.1 vs. 14.1 ± 6.1%, p = NS). Daytime AIx was higher than nighttime (17.0 ± 7.7 vs. 10.4 ± 6.9% respectively, p < 0.01). Average nighttime dipping of AIx was 40.7% (77% of the subjects had >10% nocturnal dip). In chil-dren < 18 years (n = 59), 24-hour AIx was inversely associated with age (r = �0.28) and height (�0.54), whereas after the age of 18 years (n = 49), AIx was inversely re-lated to height (-0.60), but positively to age (0.37). After adjustment for age, height and gender, partial correlation coeffi cients for AIx were as follows: r = 0.30/0.33 with 24-hour systolic/diastolic BP and r = 0.25 with 24-hour PWV (all p < 0.05), whereas no signifi cant association was observed with LVMI and cIMT.

Conclusions: These data suggest that in children AIx decreases with age until adulthood and increases thereafter. The effect of body height on AIx is stronger than that of aging. It appears that this index cannot be used as a surrogate index of cardiovascular risk at least until body height reaches its maximum.

PP.09.15 CHRONIC HEMODIALYSIS CONTRIBUTES TO

INCREASED ARTERIAL STIFFNESS AND TO

IMPAIRED DIASTOLIC FUNCTION IN PATIENTS

WITH END-STAGE RENAL DISEASE AFTER SIXTY

MONTHS OF TREATMENT

V. Calvez, M. Palladino, V. Cesario, F. Brogna, C. Fofi , G.M. Ciavarella, G. Punzo, M. Volpe, C. Savoia. Clinical and Molecular Medicine Department, Sapienza University of Rome, Rome, Italy

Objective: Dialysis may induce vascular stiffness partly through alterations of calcium/phosphate levels. We sought to determine the role of dialytic age (DA) on the indexes of structural alterations in the cardiovascular system.

Design and method: We studied 14 patients on chronic hemodialytic therapy. Twen-ty-four newly diagnosed never treated hypertensive patients and 16 normotensive

controls were also studied. The patients on hemodialysis were divided in two groups with respect to the DA: < 60-months (DA < 60, n = 7) or >60-months (DA>60, n = 7). The levels of calcium/phosphate were evaluated retrospectively on repeated measurements performed after the dialytic treatment over months. After the dialytic treatment, when dry weight was reached, we evaluated peripheral blood pressure (pBP), the parameters derived by tonometric analysis of the pulse waveform (central blood pressure-cBP-, Subendocardial Viability Ratio-SEVR-, carotid-femoral-pulse-wave-velocity-cf-PWV-) and those obtained by echocardiography: ejection fraction (EF-for systolic function) and E/e’ (for diastolic function). The ultrafi ltration volume was also evaluated.

Results: All the groups were similar for sex and BMI, both DA < 60 and DA>60 were older than hypertensives and controls (58.33 ± 3.71 and 59.83 ± 7.98 vs 44.14 ± 1.28 and 40.63 ± 2.05 years, respectively,P < 0.05). In both DA < 60 and DA>60 calcium/phosphate levels and ultrafi ltration volume were similar. pBP was signifi cantly increased and similar to hypertensive patients in DA>60 vs DA < 60 (systolic-pBP: 154.2 ± 4.51 mmHg vs 132.5 ± 5.18 mmHg,P < 0.01 and diastolic-pBP:90.4 ± 49 mmHg vs 78.5 ± 3.3 mmHg, P < 0.01). cBP was increased and similar to hypertensive patients in DA>60 vs DA < 60 (systolic-cBP: 140.8 ± 8.4mmHg vs 111.2 ± 3.36 mmHg, P < 0.001 and diastolic-cBP: 88.2 ± 3.73mmHg vs 72.33 ± 7.78mmHg, respectively, P < 0.05). cf-PWV was similar in normotensive, hypertensives and DA < 60, whereas it was increased only in DA>60 vs the other groups (9.6 ± 1.4m/s vs 6.19 ± 0.28 m/s and 7.03 ± 0.22 m/s and 7.13 ± 1.4 m/s, respectively,p < 0.05). SEVR was similar in all the groups. EF was preserved and similar in all the groups. E/e’ was signifi cantly increased in both groups on dialysis vs hypertensives and normotensives, however E/e’ was signifi cantly higher in DA>60 vs DA < 60 (9.16 ± 1.14 vs 6.96 ± 0.72,P < 0.01).

Conclusions: Only patients with DA>60 presented increased aortic stiffness and diastolic dysfunction independently of calcium/phosphate levels. This was associ-ated to higher BP. Hence chronic hemodialytic treatment, particularly after 60 months, may play a putative role for the development of cardiovascular alterations in patients with end-stage renal disease.

PP.09.16 INFLUENCE OF CHRONIC HEPATITIS C AND

HYPERTENSION IN THE ARTERIAL DISTENSIBILITY

P. Alcântara1, F. Serejo2, C. Alcântara1, F. Veloso1, C. Santos Moreira.1Department of Intern Medicine I Faculty of Medicine of University of Lisbon - CHLN-HS, Lisbon, Portugal, 2Department of Hepatology Faculty of Medicine of University of Lisbon /CHLN-HSM, Lisbon, Portugal

Objective: The assessment of arterial distensibility is an independent predictor of cardiovascular disease. Distensibility decreases with age and increases with hypertension. The objectives of this study were to evaluate these parameters in patients with normotensive (NHC) and hypertensive chronic hepatitis c (HTHC) compared with hypertensive (HT) patients and controls (C).

Design and method: We study the infl uence of hepatitis C and hypertension in aortic distensibility. The groups were matched by sex and age. Sphygmocor® was used for the determination of cfPWV (carotid-femoral Pulse Wave Velocity) and central Augmentation Index% (AIx). Blood pressure (BP), ambulatory blood pres-sure (ABPM), body mass index (BMI), lipid profi le (LP) and serum creatinine (SC) were also evaluated. The model was two-ways ANOVA, with p < 0.01 (two-tailed).

Results: Our sample was 40 patients with hepatitis, 20 HTHC and 20 NHC, which were compared with 20 HT and 20 C. Age, sex, BMI, PL and CS did not pres-ent signifi cant differences between the groups. Hypertensive patients presented signifi cantly higher blood pressure values than ABPM and ABP, and the differ-ence between those with and without hepatitis was not signifi cant. The values of cfPWV (C: 6.9 + 1.1, HT: 10.09 + 1.73, NHC: 8.02 + 1.3, HTHC: 12.8 + 2.17) showed signifi cant statistical differences in Hypertension (p < 0.01) and liver dis-ease (p < 0.01). The values of AIx (C: 18.0 + 10.5, HT: 26.0 + 9.5, NHC: 20.1 + 10.3, HTHC: 29.2 + 10.4) signifi cantly increased in relation to hypertensive disease (p < 0.01) and liver disease (p < 0.01).

Conclusions: This study suggests that arterial distensibility is increased in arterial hypertension, as well as in liver disease due to chronic hepatitis c, both of which function as factors that cumulatively aggravate arterial injury. We can also verify that patients with chronic hepatitis c already have parameters of arterial lesion.

PP.09.17 REPRODUCIBILITY OF THE EVALUATION OF THE

WALL TO LUMEN RATIO OF RETINAL ARTERIOLES

WITH TWO DIFFERENT NON-INVASIVE

APPROACHES: SCANNING LASER-DOPPLER

FLOWMETRY AND ADAPTIVE OPTICS

C. De Ciuceis1, M. A. Coschignano1, S. Caletti1, C. Rossini1, S. Duse2, F. Docchio3, S. Pasinetti3, F. Zambonardi3, F. Semeraro2, G. Sansoni4, C. Agabiti Rosei1, P. Pileri1, E. Agabiti Rosei1, D. Rizzoni1,5. 1Clinica Medica,

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Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, 2Chair of Ophtalmology, University of Brescia, Brescia, Italy, 3Department of Mechanical and Industrial Engineering, University of Bres-cia, Brescia, Italy, 4Department of Information Engineering, University of Brescia, Brescia, Italy, 5Istituto Clinico Città di Brescia, Division of Medi-cine, Brescia, Italy

Objective: The evaluation of the morphological characteristics of small resistance arteries in human beings in not easy. The gold standard is generally considered to be the evaluation of the media to lumen ratio of subcutaneous small vessels obtained by local biopsies and measured by wire or pressure micromyiography. However, non-invasive techniques for the evaluation of retinal arterioles were recently proposed, in particular two approaches seem to provide interesting in-formation: scanning laser Doppler fl owmetry and adaptive optics; both of them provide an estimation of the wall to lumen ratio (WLR) of retinal arterioles. The reproducibility of such measurements was previously stated to be acceptable (co-effi cient of variation < 10% for SLDF, < 4% for RTX-1), however, no direct com-parison of the two techniques in the same population was previously performed.

Design and method: Therefore, we evaluated 18 subjects and patients (10 nor-motensives, 8 hypertensives, 7/18 severely obese). In all of them an evaluation of the WLR of retinal arterioles was made by Scanning Laser Doppler Flowm-etry (SLDF, Heidelberg Engineering, Heidelberg, Germany) and adaptive optics (RTX-1, Imagine Eyes, Orsay, France). The same operator evaluated the same ac-quired images in two different days (intra-observer variability), and two different operators evaluated the same images in the same day (inter-observer variability).

Results: The results are reported in the Table (***p < 0.001). Variation coeffi cient of SLDF is much greater than that of AO.

Conclusions: It is clear how the reproducibility of the evaluation of the WLR with adaptive optics is far better, as compared with SLDF, since the variation coef-fi cient are clearly lower. This may be important in terms of clinical evaluation of microvascular morphology in a clinical setting.

PP.09.18 CANRENONE DECREASES SYSTEMIC ARTERIAL

STIFFNESS IN ESSENTIAL HYPERTENSIVES

M. Rescaldani1, E. Gherbesi1, G. Bolla1, M. Vanasia2, C. Sala1, F. Lombardi1.1University of Milan and Fondazione IRCCS Ospedale Maggiore Policlinico,Milano, Italy, 2Therabel GiEnne Pharma, Milano, Italy

Objective: Aldosterone induces vascular fi brosis and increases arterial stiffness (AS) of conductance arteries via mineralocorticoid-receptor (MR) activation. In uncomplicated essential hypertensives (EHs) we measured systemic AS at base-line and after chronic administration of MR-antagonist Canrenone.

Design and method: Twenty EHs (age 50 ± 12 yrs, M/F = 15/10, clinic BP 159/87 ± 2.4/2.2) on chronic treatment with an ACE inhibitor or angiotensin II antagonist plus hydrochlorothiazide at maximal doses, were randomly assigned to Canrenone 50 or 100 mg/day for 3 months. Blood pressure (BP, sphygmomanom-eter), heart rate (HR, EKG), stroke volume index (SVI, impedance cardiography) were measured in supine patients before and after Canrenone. AS was assessed as the ratio of pulse pressure (PP) to SVI.

Results: Canrenone decreased PP (from 68.7 ± 2.9 to 51.9 ± 2.9 mmHg, means ± sem, p < 0.01) without affecting SVI (33.2 ± 1.4 vs 31.5 ± 1.4 ml/m2) and HR (64.4 ± 1.9 vs 65.5 ± 2.2 bt/min). Thus, AS decreased from 2.14 ± 0.13 to 1.70 ± 0.12 mmHg/ml/m2 (Figure), the decrements induced by low and high canrenone dose being not different (-0.49 ± 0.11 vs -0.39 ± 0.19 mmHg/ml/m2, respectively).

Conclusions: Chronic treatment with MR-antagonist Canrenone decreases sys-temic arterial stiffness in uncomplicated EHs; this effect may improve cardiovas-cular risk profi le in these subjects.

PP.09.19 LONG-TERM WELL-CONTROLLED BLOOD

PRESSURE LEVELS AND CAROTID ELASTICITY IN

YOUNG HYPERTENSIVE SUBJECTS

M. Puato1, M. Rattazzi2, R. Pesavento1, C. Fania1, P. Palatini1, P. Pauletto2.1Dipartimento di Medicina, Azienda Ospedaliera Universitaria di Padova,Padova, Italy, 2Medicina Interna I, Ospedale Ca Foncello, Treviso, Italy

Objective: Aim of the study was to evaluate the impact of long-term well-con-trolled blood pressure (BP) on local arterial stiffness in hypertensives. Arterial stiffness increases with age and this process can be exacerbated by the presence of cardiovascular risk factors such as hypertension. Carotid distensibility evaluation is a reliable method that could refl ect the stiffness of arteries.

Design and method: We studied 40 young hypertensives (mean age 49.7 years) that had been kept on pharmacological treatment and/or on lifestyle modifi cation for at least 12 months (mean 38 months) to maintain target BP. Follow-up visit were scheduled every 6-month. Carotid compliance coeffi cient (CC) and disten-sibility coeffi cient (DC) were measured by B-mode based system coupled with dedicated software. We assessed mean carotid intima-media thickness (IMT) and maximum IMT in each carotid artery segment, bilaterally. Endothelial function was evaluated by post-occlusion fl ow mediated dilation (FMD). Forty normoten-sive subjects paired for age and sex served as controls.

Results: In the hypertensives, BP levels were well controlled (offi ce BP 131/79 mmHg). Compared to controls, signifi cantly higher BP levels and BMI were present in hypertensives, whereas age and metabolic parameters were similar. Compared to normotensives, carotid elasticity was signifi cantly impaired in hypertensives (DC 24.5 ± 8.9 vs 36.9 ± 8.5 10–3/kPa, and CC 0.92 ± 0.34 vs 1.28 ± 0.36 mm2/kPa). Local stiffness parameters were inversely related to age, BP, and LDL-cholesterol. Moreover, DC and CC were inversely related to IMT measurements and directly with FMD values.

Conclusions: In hypertensives with long term well-controlled BP, it is evident an increase in arterial local stiffness respect normotensive controls.

PP.09.20 AMBULATORY VASCULAR INDEX: A NOVEL

MEASURE OF ARTERIAL STIFNNESS IN

AMBULATORY CONDITIONS OVER THE 24-HOUR

I.N. Posokhov1, T. Pereira2, S. Omboni3. 1Hemodynamic Laboratory Ltd, Nizhniy Novgorod, Russia, 2Escola Superior de Tecnologia da Saúde de Coimbra, InstitutoPolitécnico de Coimbra, Coimbra, Portugal, 3Clinical Research Unit, ItalianInstitute of Telemedicine, Varese, Italy

Objective: The current hypertension management involves both ambulatory blood pressure (BP) monitoring (ABPM) and evaluation of the arterial stiffness by measuring pulse wave velocity (PWV). Stiffness parameter b is a promising estimate of arterial stiffness characterized by a less dependency on BP. b is used to calculate the well-known cardio-ankle vascular index (CAVI), which is measured in the segment between heart and ankle. However, at present, CAVI may be ob-tained only at rest and thus may not return information on arterial stiffness in the dynamic conditions of everyday life.Recently available technologies now allow 24-h pulse wave analysis (PWA) inte-grated in ABPM devices and may provide an easy way to obtain PWV. They can also make possible to evaluate b in the corresponding segment and ambulatory BP in a single procedure. For methodological analogy with CAVI we decided to call new index AVI, which means Ambulatory Vascular Index. The aim of this part of the pilot study is to evaluate the features of the AVI in healthy volunteers.

Design and method: Data of 179 healthy volunteers (BP and PWV) were col-lected with BPLab® ABPM device and validated Vasotens® PWA technology. AVI is calculated using BP and PWV of each measurement and then averaged for 24-h period. We used following formula: AVI = 2�/�P[lnPs/Pd]PWV2, where �: blood density, �P:Ps-Pd or systolic minus diastolic BP.

Results: 24-h average AVI in volunteers was 15.4 ± 3.8, while 24-h average PWV was 9.3 ± 1.1 m/s (mean ± SD). There was no correlation between AVI and 24-h systolic BP (r = -0.02, n/s, fi g.1, a), but 24-h PWV was signifi cantly associated

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with SBP (r = 0.36, p < 0.05, fi g.1, b). Both AVI and PWV were signifi cantly re-lated with age (r = 0.43, p < 0.05 and r = 0.42, p < 0.05, fi g.1 c and d respectively).

Conclusions: Our pilot study suggests that the AVI is a feasible estimate of arte-rial stiffness, with the advantage of being independent on BP. However, further study of the AVI feasibility, methods of calculation, and the role in integrated ap-proach for evaluating aortic stiffness in relation to cardiovascular risk, are needed. AVI may be interpreted in similar way like other age-dependent indices of arterial stiffness.

PP.09.21 PULSE WAVE VELOCITY WITHOUT PREVIOUS

CARDIOVASCULAR EVENTS

S. Pinto, J. Pires, F. Ferreira, M. Teixeira, V. Ribau, C. Neves, J. Mesquita Bastos. Centro Hospitalar Baixo Vouga, Aveiro, Portugal

Objective: Pulse wave velocity (PWV) is considered a marker of cardiovascular (CV) risk prognosis. The authors aimed to evaluate an hypertensive group of hy-pertensive patients who was submitted to PWV and to study association between this indicator and other features.

Design and method: Retrospective study of all hypertensive patients evaluated by PWV in a Portuguese average-size hospital Arterial Hypertension Consultation (n = 373). Continuous variables are expressed as mean and were compared using the unpaired Student’s t-test. Categorical variables are expressed as frequencies and percentages and were compared using the chi-squared test.

Results: Considering the 373 patients (188 men, 52.8%), the means of age (55.06 years ± 15.21), systolic blood pressure (BP) (144.20 mmHg ± 19.63), systolic BP24 hours (125.96 mmHg ± 11.54), diastolic BP24 hours (75.65 mmHg ± 8.33) and body mass index (28.38 Kg/m2 ± 4,67) were calculated. Comparing the group of patients with PWV>10 m/s with the patients with lower PWV, the fi rst had higher age (65.08 ± 10.56 versus 50.59 ± 14.78 years), high-er prevalence of male (64.00% versus 47.8%, p = 0.00), higher prevalence of previous event (18.0% versus 9%, p = 0.014), diabetes (49.5% versus 17.6%, p = 0.00) and dyslipidemia (79.3% versus 57.1%, p = 0.000). It also had higher prevalence of diastolic dysfunction (61.2% versus 25.2%, p = 0.00) and fall of nocturnal blood pressure (43.3% versus 64.3%, p = 0.041). Considering the refractory blood pressure patients, in the group with higher PWV, there was a prevalence of 31.5% versus16.3% in the lower PWV group (p = 0.001)

Conclusions: PWV may enable better recognition of high-risk populations that might benefi t from more aggressive CV disease risk factor management.

PP.09.22 PULSE PRESSURE AMPLIFICATION USING

24-HOUR AMBULATORY BLOOD PRESSURE

M. Pikilidou1, E. Papakonstantinou1, M. Antoniou1, M. Yavropoulou2, L. Hadjistavri1, G. Kladas1, P. Georgianos1, A. Ptinopoulou3, P. Zebekakis1. 1Hypertension Excellence Center, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece, 2Division of Endocrinology and Me-tabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thes-saloniki, Greece, 3Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom

Objective: The blood pressure wave changes as it travels from the central elastic arteries to the muscular conduit arteries. As a consequence, in healthy subjects,

the amplitude (pulse pressure, PP) of the pressure wave increases gradually from the aorta to the periphery. This phenomenon, is known as PP amplifi cation (PPA). It is mathematically defi ned as the peripheral pulse pressure/central pulse pres-sure ratio. Until now the clinic PP was used in the nominator. Our study aimed in fi nding differences between these two indices using clinic and ambulatory BP measurements.

Design and method: We recruited 87 drug naïve (mean age = 52.2 ± 12.5) 55 females, newly diagnosed hypertensive patients that visited the hypertension clinic of a tertiary hospital. Central systolic aortic BP (CSBP), Central diastolic BP (CDBP) was assessed by applanation tonometry and PWV was measured by Sphygmocor (Atcor Medical), 24-hour SBP and 24-hour DBP were also measured (Spacelabs 90217), and clinic SBP and DBP were measured according to inter-national guidelines. The PPA ratio was defi ned as the peripheral pulse pressure/central pulse pressure and PPA 24-hour, and PPA daytime and PPA nighttime were calculated accordingly.

Results: PPA was signifi cantly correlated with PPA 24-hour (r = 0.68, p < 0.001), and PPA daytime (r = 0.67, p < 0.001) and PPA nighttime (r = 0.43, p < 0.001). However there were signifi cant differences between the different PPAs. PPA was signifi cantly higher than all the 24-hour indices 1.24 ± 1.8 vs 1.15 ± 2.7 for PPA 24-hour, 1.17 ± 0.27 for PPA daytime and 1.08 ± 0.48, p < 0.001 for all comparisons.

Conclusions: PPA was different when ambulatory blood pressure indices were used for its calculation. PPA using 24-hour indices should be tested to investigate whether it better correlates with cardiovascular markers.

PP.09.23 SMOKING ACCELERATES WAVE REFLECTIONS IN

PREHYPERTENSIVE INDIVIDUALS

P. Pietri1, C. Vlachopoulos2, D. Terentes-Printzios2, C. Georgakopoulos2, C. Stefanadis1.1Athens Heart Center, Athens, Greece, 21st Cardiology Department, Athens Medical School, Athens, Greece

Objective: Aortic stiffness and wave refl ections are independent predictors of cardiovascular disease. Moreover, aortic stiffness is a major contributor to the development of arterial hypertension. Smoking is related to increased aortic stiff-ness and wave refl ections, although with inconsistent results among the studies. Subjects with upper normal blood pressure (BP) are prone to the development of arterial hypertension and the increased aortic stiffness and wave refl ections may serve as potential mechanisms towards this direction. The aim of the present study was to investigate the chronic effect of smoking on aortic stiffness and wave refl ections in prehypertensive subjects.

Design and method: The study consisted of 137 middle-aged, prehypertensive adults (mean age = 49 years) with no history of cardiovascular disease. Prehy-pertension was defi ned according to the offi ce BP values, as high normal SBP of 130–139 mmHg and/or high normal DBP of 85–89 mmHg. Aortic stiffness was assessed by measuring carotid-femoral pulse wave velocity (PWV) using the Complior device. Wave refl ections were evaluated by pulse wave analysis using the Sphygmocor device. Heart rate-corrected augmentation index (AIx75) was used as a measure of wave refl ections. High-sensitivity C-reactive protein (hsCRP) was measured as an infl ammatory marker.

Results: Smokers (n = 52) had signifi cantly increased AIx75 compared to non-smokers (21.5 ± 14.6% vs 15.2 ± 15.1%, p = 0.02). On the contrary, no differ-ence in PWV was observed between the two groups (6.6 ± 0.9 vs 6.6 ± 1.3 m/s, p = NS). Levels of hsCRP were higher in smokers compared to non smokers (1.17 ± 0.17 vs 0.85 ± 0.78 mg/dl, p = 0.02). The difference in AIx75 between the two groups remained signifi cant even after adjustment for age, gender, BMI, mean BP, total cholesterol, blood glucose and hsCRP (p < 0.001).

Conclusions: Smoking is associated with increased wave refl ections in prehyper-tensive individuals. Considering that wave refl ections are mainly determined by peripheral resistance, it might be assumed that, at the early stages of hypertension, smoking exerts its detrimental effects predominantly on the peripheral microcir-culation and not on the large, elastic arteries. Whether quitting smoking may be associated with regression of microvascular remodeling and delay of arterial hy-pertension onset, is a question that warrants further investigation.

PP.09.25 DEVICES FOR THE NON-INVASIVE ASSESSMENT

OF AORTIC PULSE WAVE VELOCITY: EVALUATION

OF SHORT-TERM REPEATABILITY

A. Grillo1, F. Scalise2, F. Moretti1, M. Rovina3, L. Salvi4, L. Gao5, C. Baldi3, A. Faini6, S. Millasseau7, R. Carretta3, P. Salvi6, G. Parati1,6. 1Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy, 2Policlinico di Monza, Interventional Cardiology Laboratory, Monza, Italy, 3Department of

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Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy, 4De-partment of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy, 5Department of Cardiology, Peking University First Hospital, Beijing, China, 6Department of Cardiovascular Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy, 7Pulse Wave Consulting, St Leu la Foret, France

Objective: Aortic pulse wave velocity (PWV) is a validated indicator of central arterial stiffness and cardiovascular risk. We aimed to compare the repeatability of PWV measures obtained with non-invasive devices.

Design and method: We evaluated the repeatibility of non-invasive measures of PWV, obtained with 4 devices measuring two-points carotid-femoral PWV (Com-plior, PulsePen ETT, PulsePen ET, SphygmoCor), and with 2 devices estimating PWV from the oscillometric cuff-derived brachial pulsewave (BPLab, Mobil-O-Graph). 102 patients planned to undertake a cardiac catheterization (age 65 ± 13 years, 70.6% males) were enrolled. Repeated measures of PWV were obtained with all devices in a single session, 15 minutes apart. Duplicate PWV and carotid-femoral PTT measurements were compared using different indices. Coeffi cients of variation (CV%) and their confi dence intervals (CI) are reported.

Results: Devices evaluating carotid-femoral PWV showed a good repeatability (CV%[CI] for Complior: 8.8[7.3–10.1]; PulsePen ETT: 8.0[6.2–9.5]; PulsePen ET: 5.8[4.9–6.6]; SphygmoCor: 9.5[7.7–11.0]), whereas the repeatability of PWV estimated by cuff-based devices was slightly higher (BPLab: 5.5[4.2–6.6], Mobil-O-Graph: 3.4[2.9–3.8]). A lower repeatability of carotid-femoral PWV was present for greater arterial stiffness values (CV%[CI] for PWV < 10 m/s vs PWV> = 10 m/s: Complior 7.0[5.4–8.3] vs 10.5[8.0–12.5], PulsePen ETT 6.3[3.6–8.1] vs 9.2[6.5–11.3], PulsePen ET 4.9[3.5–6.0] vs 6.5[5.3–7.6], Sphyg-mocor 8.5[5.7–10.6] vs 10.3[7.7–12.3]. No such difference was observed with cuff-based devices (BPLab 6.0[3.6–7.7] vs 5.1[3.5–6.4], Mobil-O-Graph 3.5[2.8–4.1] vs 3.2[2.6–3.7]). Differences between repeated PWV measurements were not correlated with concomitant blood pressure (R2: 0.005) or heart rate differences (R2: 0.013).

Conclusions: Short-term repeatability of PWV measures was good but not ho-mogenous among different devices. A greater repeatability was observed with cuff-based devices, compared to devices measuring carotid-femoral PWV. This is probably due for Mobil-O-Graph to the algorithm for PWV assessment, which considers age and mean blood pressure, and for BPLab to the automated editing procedure which eliminates highly variable PWV values. Repeatability of PWV is not infl uenced by blood pressure or heart rate concomitant changes. For carotid-femoral PWV, the repeatability of measures is lower for higher PWV values. These results could be usefully considered when assessing PWV in a clinical setting.

PP.09.26 RADIATION-INDUCED VASCULAR DAMAGE IN

HODGKIN LYMPHOMA SURVIVORS

A. Paini1, M. Salvetti1, M. Buglione2, F. Trevisan, L. Baushi2, S.M. Magrini2,M.L. Muiesan1. 1Internal Medicine, University of Brescia, Brescia, Italy,2Department of Radiation Oncology, University of Brescia, Brescia, Italy

Objective: New chemotherapeutic drugs and radiation therapy have signifi cantly improved cancer patient’s survival, although the cardiovascular (CV) side effects of cancer treatment are increasingly important. In previous studies, an increased risk of cerebrovascular complications such as stroke and transient ischemic attack was described in patients undergoing neck radiotherapy.Aim of our study was to evaluate vascular carotid structural (IMT, plaque) and functional (carotid stiffness) damage, and changes in arterial stiffness (Carotido-femoral pulse wave velocity; cf-PWV) in Hodgkin Lymphoma survivors previ-ously treated with radiotherapy.

Design and method: We enrolled 206 Hodgkin lymphoma survivors(mean age 54 ± 14 years, 51% males, mean follow-up of 9 ± 6 years). CV risk factors were investigated and atherosclerotic carotid damage was assessed by standard carotid ultrasound evaluation for intima-media thickness(IMT) measurement(MeanMax-IMT, CBMax, Tmax; n = 167); in 141 patients radiofrequency-based carotid stiff-ness analysis(distensibility; distensibility coeffi cient, DC; compliance coeffi cient; CC)was also performed. Cf-PWV measurement were obtained in 154 patients.

Results: a signifi cant correlation between radiotherapy dose and: MeanMax-IMT(r = 0.20; p < 0.05),Tmax(r = 0.20; p < 0.05), distensibility(r = 0.24; p < 0.05),DC(r = 0.24; p < 0.05),CC(r = 0.24; p < 0.05)was observed. Patients were divided into 4 groups according to radiotherapy dose(Dose: 20–30; 31–36; 37–42; >42 Gy). An increase in Tmax(1.27 ± 0.61, 1.35 ± 0.59, 1.46 ± 0.69, 1.76 ± 1.12 mm, p for trend < 0.05) and in the prevalence of carotid plaque(29%, 31 %, 47% and 55%, p for trend < 0.05) was observed as related to dose-category. One-hundred-seventeen patients received neck irradiation(67 bilateral;50 unilat-eral). In unilaterally irradiated patients, MeanMaxIMT was greater in the irradi-ated side as compared to unirradiated carotid artery and the difference reached

statistical signifi cance in the group of patients who received a high radiotherapy dose (0.97 ± 0.35 vs 0.92 ± 0.34 p < 0.05). Cf-PWV was signifi cantly greater only in patients that received high dose (>42 Gy), as compared to all the other dose groups(9.7 ± 2.3 vs 8.3 ± 2.2, 8.0 ± 1.5 and 8.3 ± 1.4, p < 0.05).

Conclusions: In this large number of Hodgkin Lymphoma survivors, carotid IMT, plaque prevalence and aortic and carotid stiffness were signifi cantly related with radiotherapy doses. Carotid IMT, carotid and aortic stiffness were signifi cantly higher in the irradiated carotid arteries, but only at doses >42 Gy, suggesting that there may be a dose threshold for radiotherapy-induced carotid wall damage.

PP.09.27 DYNAMICS OF PARAMETERS OF CENTRAL

PRESSURE DURING THE THERAPY WITH

DIFFERENT DOSES OF ATORVASTATIN IN

PATIENTS WITH STEMI

A. Khromova, L. Salyamova, N. Burko, V. Oleynikov. Penza State university, Penza, Russia

Objective: to study the effect of different doses of atorvastatin on the parameters of the central pressure in patients with acute myocardial infarction with ST seg-ment elevation (STEMI).

Design and method: The study included 85 STEMI patients aged 35 to 65 years in the fi rst 24–96 hours of the onset of the disease. The control group (C) in-cluded 46 patients treated with atorvastatin 20 mg/day. Main group (A) consisted of 39 patients treated with atorvastatin 80 mg/day. Initially 7–9 hours from the onset of the disease, and after 24 weeks, patients underwent applanation tonom-etry by SphygmoCor (AtCorMedical, Australia). The following parameters were analyzed: aortic systolic (SBPao), diastolic (DBPao) and pulse pressure (PPao). Ultrasound of the common carotid artery (CCA) was performed using the high-frequency RF signal on the MyLab 90 (Esaote, Italy) on the following indicators: local systolic (LocPsys) and local diastolic (locPdia) pressure in the CCA.

Results: In the group C offi ce SBP initially was 113,1 ± 0,4, DBP - 70 (65;75) mmHg; at week 24 -115 (110;125) (p = 0,06), and 70 (70;80) mmHg (p = 0,2). SBPao increased from 101 ± 9,4 to 109,1 ± 12,0 mmHg (p < 0,01), PPao from 29,4 ± 6,2 to 34,2 ± 8,1 mmHg (p < 0,01). DBPao has not changed: initially - 71 (66;80); follow-up - 71,5 (71; 81) mmHg (p = 0,07). In group A offi ce BP at baseline was 116,4 ± 9,5 and 75 (65;80) mmHg; 24 weeks later - 117,8 ± 10,1 (p = 0,3) and 75 (70;80) mmHg (p = 0,6). Aortic pressure parameters increased: SBPao from 103,9 ± 9,8 to 109,3 ± 9,9 mmHg (p < 0,01), PPao from 27,0 (24;31) to 32,9 ± 7,5 mmHg (p < 0,01). DBPao has not changed: baseline - 76 (66;86); at follow-up - 76,4 ± 9,4 mmHg (p = 0,7). In control group at baseline: LocPsys 103,4 (93,6;114,1); locPdia 70 (60;75) mmHg; at follow-up - 108,8 (101,7;119,5), and 70 (70;80) mmHg, respectively (p < 0,01). In group A at 7–9 day - LocPsys was 107,7 (100,9;115); locPdia - 75 (65;80) mmHg; after 24 weeks no signifi cant dynamics has been identifi ed: 105,7 (99,9;115,7) (p = 0,8), and 70 (70;80) mmHg (p = 0,9).

Conclusions: An increase of SBPao and PPao was registered in both groups. In control group an increase in the pressure parameters in the OCA has been shown.

PP.09.28 FEATURES OF LOCAL VASCULAR STIFFNESS IN

PATIENTS WITH CORONARY HEART DISEASE AND

ARTERIAL HYPERTENSION

L. Salyamova, A. Khromova, E. Melnikova, V. Oleynikov. Penza State university, Penza, Russia

Objective: to study the effect of high blood pressure (BP) on the parameters of the local rigidity of the common carotid artery (CCA) in patients with coronary heart disease (CHD).

Design and method: Study included 68 subjects. Group 1 consisted of 24 normo-tensive subjects. Group 2 included 25 patients with CHD. Group 3 consisted of 19 patients with CHD and arterial hypertension (AH) 1–2 degrees. Patients of group 3 had higher values of offi ce systolic and diastolic BP. Local stiffness of CCA was evaluated using the ultrasonic device MyLab 90 (Esaote, Italy) with technology of high frequency RF signal on the following parameters: QIMT- intima-media thickness, loc P sys - local systolic BP in the carotid artery, loc P dia - local diastolic pressure, stiffness index beta, augmentation index AIx, local pulse wave velocity PWV.

Results: Values of QIMT prevailed in patients with CHD with hypertension and without: group 1 - 559 (479;666) um, in group 2 - 699 (614;818) um, group 3 - 749 (626;810) um (p1–2.3 < 0,05). Level of loc P sys, and loc P dia in healthy sub-jects was 101,8 (96,7;110,2), and 70 (70;80) mmHg, in CHD patients with normal BP - 104 (99,3;111,7) and 70 (70;80) mmHg, in patients with CHD and hyperten-sion - 120 (113,6;138,1) and 90 (80;90) mmHg (p1,2–3 < 0,05). Average values

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of the index beta in group 1 - 7,0 (5,3;10,0), patients in group 2 - 9,1 ± 2,9; group 3 - 8.5 (11,1;14,9) (p1,2–3 < 0,05). Healthy subjects and CHD patients were not different on parameter Aix - 3,1 (0,5;6,1), and 2,5 ± 4,5%, correspondingly. The highest value of the parameter were registered in the group 3 - 7,0 (1,3;11,3)% (p1,2-3 < 0,05). PWV also prevailed in patients with CHD and hypertension (9,7 (8,2;10,8) m/s) compared with healthy subjects (5,9 (5,5;7,2) m/s), and patients with CHD (7,0 ± 1,2 m/s) (p1,2-3 < 0,05).

Conclusions: patients with CHD differ from healthy individuals on a number of indicators of local arterial stiffness. Parameter QIMT prevailed in patients with CHD. In patients with CHD and hypertension an increase of local pressure, PWV, and the index beta has been revealed in contrast to the comparison group.

PP.09.29 DISTRIBUTION OF CENTRAL AORTIC PRESSURE

VALUES AND HIDDEN CENTRAL HYPERTENSION

IN A LARGE COHORT OF ARGENTINA

S. Obregon, M. Koretzky, F. Botto, A. Di Leva, G. Fischer Sohn, J. H. Bang,C. Kotliar. Hospital Unioversitario Austral, Pilar, Argentina

Objective: The objetive is to determine the distribution of central aortic pressure values in a large cohort of Argentina, and the distribution of elevated central aortic pressure values in normotensives and controlled hypertensives.

Design and method: From a large prospective cohort of 10300 subjects in a car-diovascular prevention programme (2013–2015), 8249 individuals were evaluated with central aortic pressure measurements (median arterial pressure calibration / Mobil-O-Graph, IEM, Germany). Associations with cardiovascular risk factors and other hemodynamic variables were performed in a group of 1473 normotensive people with complete clinical data, and also a group of 945 controlled hyperten-sives (bSBP/bDBP < 140/90 mm Hg). Elevated aSBP was considered as 130 mm Hg or higher. Analysis of variables was performed with Excel 2016 and SPSS 22.

Results: More than a half (53.3 %) of the total population (54.5 ± 13.4 years; 61.2 % male; bSBP/bDBP 128.8 ± 15.9/83.4 ± 11.4 mm Hg; cSBP/cDBP 132.8 ± 18.7/85 ± 11.8 mm Hg) were observed with an elevated aSBP (56.3 ± 13.8 years; 67.8 % male; bSBP/bDBP 137.9 ± 14.5/87.9 ± 11.4 mm Hg; cSBP/cDBP 146.2 ± 14.5/90.1 ± 11.6 mm Hg). In normotensives (52.5 ± 11.7 years; 58.1 % male; bSBP/bDBP 123 ± 9.8/81.2 ± 9.1 mm Hg; cSBP/cDBP 126.4 ± 14/82.6 ± 9.4 mm Hg), elevated aSBP was found in a proportion of 33.9 % (53.6 ± 12.2 years; 69.8 % male; bSBP/bDBP 129.3 ± 7/84.4 ± 8.6 mm Hg; cSBP/cDBP 139.5 ± 8.5/86.5 ± 8.9 mm Hg). In controlled hypertensives (52.5 ± 11.7 years; 67.7 % male; bSBP/bDBP 123 ± 9.8/81.2 ± 9,1 mm Hg; cSBP/cDBP 126.4 ± 14/82.6 ± 9.4 mm Hg), 50 % were observed with elevated aSBP (59.6 ± 10 years; 71.9 % male; bSBP/bDBP 126.8 ± 9.1/83.6 ± 9 mm Hg; cSBP/cDBP 133.3 ± 13/85.5 ± 9.5 mm Hg).

Conclusions: A large proportion of patients with elevated aSBP was observed in this population of Argentina, both in one third of normotensive patients and half of controlled hypertensives. This data contributes to considering the so called hidden central hypertension as a frequent clinical situation for future hypertension research and management.

PP.09.30 AN EXTENDED ONE-DIMENSIONAL ARTERIAL

NETWORK MODEL FOR THE SIMULATION OF

PRESSURE AND FLOW IN UPPER AND LOWER

LIMB EXTREMITIES

H. Obeid1, N. Stergiopulos3, M. Hallab4, P. Boutouyrie2, S. Laurent2, P. Segers1. 1IBiTech-bioMMeda, ELIS department, iMinds Medical IT, Ghent University, Ghent, Belgium, 2Hôpital Européen Georges-Pompidou, Inserm U970, Paris, France, 3Laboratory of Hemodynamics and Cardiovascular Technology, Ecole Polytechnique Fédérale de Lausanne EPFL, Lausanne, Switzerland, 4Department of gerontology, University hospital Nantes, Nantes, France

Objective: Arterial pulse wave velocity and pulse waveform analysis have become an established component of cardiovascular research. As validation and assessment of devices is not always trivial in an in vivo setting, arterial network computer models may be useful for that purpose. It is, however, mandatory that the model includes suffi cient detail, especially when analysing peripheral waveforms.To extend the existing 1D arterial network model (103 segments) of Reymond et al. to a more detailed model (143 segments) including the foot and hand circulation (radial and tibial arteries). The goal is to (i) extend the existing 1D arterial network model (103 segments) of Reymond et al. to a more detailed model (143 segments) including the foot and hand circulation (Radial and Tibial arteries); (ii) use the extending model as testing tool for pOpmètre® (fi nger – toe pulse wave velocity).

Design and method: The arterial tree dimensions and properties were taken from the literature and completed with data from patient scans. The model solves the

one-dimensional form of the Navier-Stokes equations over each arterial segment. A non-linear viscoelastic constitutive law for the arterial wall was considered.

Results: Comparison of simulations with and without detailed hand and foot cir-culation demonstrate important differences in waveform morphology in the distal beds. The completed model predicts pressure and fl ow waves in the hand and foot arteries which are in good qualitative agreement with the published in-vivo measurements. The agreement is especially good for the shape and wave details of the fl ow wave, where all features are reproduced in a rather faithful manner. The correlation between ftPWV and aPWV was good and signifi cant (R2 = 0.95). The Bland and Altman analysis, mean difference was 0.4 m/s, classifying the ftPWV as good agreement with reference method.

Conclusions: The extended model yields realistic pressure and fl ow waveforms in arteries of the hand and the foot. After full validation, the extended model used to assess the performance of diagnostic and screening devices relying on peripheral hemodynamics signals, the pOpmètre® (fi nger – toe PWV), where the correlation with the refernce method showed a good agreement.

PP.09.31 CALCULATION OF CENTRAL BLOOD PRESSURE

BY ANALYZING THE CONTOUR OF THE

PHOTOPLETHYSMOGRAPHIC PULSE MEASURED

AT THE FINGER WITH THE POPMÈTRE® DEVICE

H. Obeid1, H. Khettab1, M. Hallab3, M. Feuilloy4, P. Boutouyrie1,2, S. Laurent1,2. 1HEGP and Inserm U970, Paris, France, 2Paris Descartes University, Paris, France, 3University Hospital of Nantes, Nantes, France, 4School of electronics West, Boulaye, France

Objective: Analysis of the contour of the peripheral pulse to assess arterial prop-erties was fi rst described in the nineteenth century. The reference technique to estimate central blood pressure (CBP), non-invasively, is by analyzing the radial pressure pulse acquired using a tonometer and then to establish a transfer function relating the radial pressure to the CBP. An alternative technique utilizes a volume pulse. This may conveniently be acquired optically from a fi nger (digital volume pulse obtained with the photodiode of the pOpmètre® device- Axelife SAS- France).The objective is to establish a transfer function estimating the central blood pres-sure (CBP), calibrated with a brachial pressure cuff and using the parameters ob-tained with the contour analysis of the photoplethysmographic pulse measured at the fi nger with the pOpmètre® system.

Design and method: We positioned the photodiode sensor on the fi nger, insuring that the sensor’s lens is in contact with the pulp. Brachial blood pressure measure-ment was performed with a cuff adapted to the arm circumference and an oscil-lometric device (Omron M10 -IT). The central blood pressure values measured with Sphygmocor used as the reference values, with similar calibrating pressures. Multiple regression analysis was done to establish the transfer functions. Pear-son’s correlation and Bland Altman graph were performed for agreement.

Results: 69 subjects were included: 24 healthy subjects and 45 patients with es-sential hypertension aged 33 ± 8 years and 59 ± 17 years respectively. The corre-lation between the estimated central systolic pressure (CSP) and the reference one, was good and signifi cant (r2 = 0.94; p < 0.0001). A better correlation was found in terms of central diastolic pressure (CDP) (r2 = 0.95; p < 0.0001). The Bland and Altman analysis, mean difference was 4 mmHg p < 0.0001 (CSP) versus 3 mmHg p < 0.0001 (CDP), the standard deviation of the difference was 5 mmHg (CSP) versus 4 mmHg (CDP), classifying the estimation as good agreement.

Conclusions: The estimation of the central blood pressure with the fi nger pulse qualifi es as good agreement with the reference technique for the central systolic and diastolic pressure estimation.

PP.09.33 THE EFFECTS OF SMOKING ON CENTRAL BLOOD

PRESSURE IN MIDDLE-AGED AND ELDERLY

JAPANESE INDIVIDUALS

N. Nagatomo1, N. Miyai1, Y. Okano1, M. Morishita1, Y. Uchikawa1, M. Yamamoto1,M. Shimabukuro2, K. Mure2, M. Utsumi1, T. Takeshita2, M. Arita1. 1Wakayama Medical University, School of Health And Nursing Science, Wakayama, Japan, 2Wakayama Medical University, School of Medicine, Department of Public Health, Wakayama, Japan

Objective: The aim of this study was to investigate the effect of smoking habits on central blood pressure in a population-based sample of middle-aged and elderly individuals.

Design and method: A total of 406 normotensive and untreated hypertensive (stage-1) individuals (mean age; 59 ± 10 years) without a history of cardiovas-cular disease, renal disease and arteriosclerosis obliterans was recruited for this study. When the subject was in a comfortable seated position the peripheral

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brachial pressures were measured, and then the brachial waveform was cap-tured by a standard brachial cuff (SphygmoCor XCEL) and the central aortic pressures were estimated using a generalized transfer function. Smoking status was determined by questionnaire. Current smokers and former smokers were asked how many cigarettes they smoked per day and the number of years spent smoking. Brinkman Index (BI) values were calculated as the number of ciga-rettes smoked per day multiplied by the number of years of smoking.

Results: The subjects were divided into subgroups according to cumulative num-ber of cigarettes smoked; never-smokers (N = 292), mild-to-moderate smokers (BI of < 800 per lifetime, N = 64), and heavy smokers (BI of > = 800 per lifetime, N = 50). Central systolic pressure was higher in both heavy smokers (123mmHg,

P < .001) and mild-to-moderate smokers (117 mmHg, P = .070) than those in never-smokers (112 ± 14mmHg) after adjustment for sex, age, and body mass index (p for trend < .001). This dose-response increase by smoking status was not clearly demonstrated in brachial systolic pressure. A stepwise multiple regression analysis revealed that the heavy smoking (� = .192, P < .001), age (� = .231, P < .001), body mass index (� = .278, P < .001), and LDL cholesterol (� = .099, P = .028) were se-lected as signifi cant determinants of central systolic pressure independent of sex.

Conclusions: These results suggest that smoking habits may have greater impact on central aortic pressure than peripheral brachial pressure and hence could be identifi ed by abnormal increases in central systolic pressure and wave refl ection even before clinical manifestation of hypertension.

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PP.10.01 HIGH INFLAMMATORY ACTIVITY IS A POSSIBLE

PREDICTOR OF ARTERIAL STIFFNESS INCREASE

IN PATIENTS WITH RHEUMATOID ARTHRITIS

S. Velmakin, O. Lukina, E. Troitskaya, S. Villevalde, Z. Kobalava. RUDN Univer-sity, Moscow, Russia

Objective: Patients with rheumatoid arthritis (RA) are at higher risk of cardio-vascular morbidity and mortality. Aortic stiffness is a predictor of CVD. Chronic infl ammation plays a role in the development of atherosclerosis in RA. Relation-ships between infl ammation and arterial stiffness in patients with RA are not well understood. The aim of the study was to evaluate parameters of arterial stiffness and their associations with infl ammation activity in patients with RA.

Design and method: 42 patients with RA (EULAR 2010) were examined (67%fe-male, age 59.7 ± 15.2 years, 14% smokers, 60% with AH, 47% with dyslipidemia. Median duration of RA was 9 years (interquartile range (IQR)3–17). Seropositive RA was diagnosed in 42% of patients. All patients received disease-modifying antirheumatic drugs (DMARDs),20% - biological treatment. hs-CRP and RF were assessed in all patients. Arterial stiffness was measured by applanation tonom-etry (SphygmoCor, AtCor) and cardio-ankle vascular index (CAVI) was assessed (VaSera1500). p < 0.05 was considered signifi cant.

Results: Median CRP was 13 mg/dl (IQR 3–24 mg/dl), median RF was 32 IU/ml (IQR8–165 IU/ml). Median PWV was 9.4 m/s (IQR7–11m/s). PWV increase>10m/s was observed in 16(37.8%) patients. Patients with PWV>10m/s were older (72.0 ± 8.5vs53.3 ± 14.9 years), had higher BMI (30.5 ± 5.9vs24.9 ± 4.5 kg/m2) and longer duration of AH (median 14 years [IQR 7.5–18] vs 0 years [IQR 0–4.5]) and higher BP levels (143 ± 21/84 ± 9vs124 ± 13/78 ± 9 mmHg). They also had higher levels of LDL-C (3.0 ± 1.0vs4.1 ± 0.8 mmol/l), plasma glucose (5.6 ± 0.9vs4.9 ± 0.8 mmol/l), hs-CRP (median 9[IQR 2–17.1] vs 22[IQR 13–56.6] mg/dl) and CAVI (9.2 ± 0.5vs7.2 ± 1.2), p < 0.05 for trend. Spearmen analysis revealed positive correlations of PWV with age (r = 0.65), BMI (r = 0.53), SBP (r = 0.62), DBP (r = 0.41), LDL-C (r = 0.60), glu-cose (r = 0.38), AH duration (r = 0.69) and hs-CRP (0.28), p < 0.05 for trend.Mul-tiple regression analysis confi rmed that age (� = 0.3, p = 0.0012), AH duration (� = 0.4, p = 0.0001), SBP (� = 0.42, p < 0.0001) and hs-CRP-level (� = 0.26, p = 0.0004) were independent predictors of arterial stiffness increase.

Conclusions: Infl ammatory activity as well as other traditional risk factors is a predictor of arterial stiffness increase in patients with RA receiving DMARDs.

PP.10.02 METABOLIC SYNDROME PRECIPITATES

DETERIORATION OF ENDOTHELIAL FUNCTION IN

YOUNG ADULTS

D. Terentes-Printzios, C. Vlachopoulos, P. Xaplanteris, N. Ioakeimidis,A. Angeis, C. Georgakopoulos, P. Pietri, N.P. Skliros, D. Tousoulis. 1st Cardiology Department, Athens Medical School, Hippokration Hospital, Athens, Greece

Objective: Vascular senescence, as assessed by structural and functional proper-ties of the arteries, and metabolic syndrome (MS) are independent prognostic fac-tors of cardiovascular risk. We examined whether MS precipitates the progression of vascular senescence.

Design and method: One hundred and forty-two subjects (mean age 52 years, 94 men) with no established cardiovascular disease were investigated in two examina-tions over a 2-year period (mean follow-up visit 1.84 years). Metabolic syndrome was defi ned by the ATP III criteria. Subjects had at the beginning and end of the study determinations of carotid-femoral pulse wave velocity (PWV), aortic augmentation index corrected for heart rate (AIx75), brachial fl ow-mediated dilatation (FMD), ni-troglycerin-mediated dilatation (NMD) and carotid intima-media thickness (cIMT). Based on these measurements the annual absolute changes were calculated.

Results: At baseline patients with MS compared with patients without MS had lower values of FMD (6.0% vs. 7.0%, P = 0.025), but there were no statistical-ly signifi cant differences for PWV (7.04m/s vs. 7.26m/s, P = 0.242), AIx@75

(19.9% vs. 20.3%, P = 0.846) and cIMT (0.68 mm vs. 0.68 mm, P = 0.957). For the overall population, there were no statistically signifi cant differences in the an-nual absolute changes of PWV, NMD, FMD, AIx75 and cIMT (p>0.05). However, when a subgroup of patients < 60 years with more rapid progression of endothe-lial aging was investigated, MS was associated with almost 7 times higher annual change of FMD [-0.89% (95% CI:-1.50 to -0.28) in patients with MS vs. -0.13% (95% CI:-0.36 to 0.10) in patients without MS, P = 0.032]. This difference was not evident in the other vascular biomarkers.

Conclusions: Presence of MS is associated with deteriorated endothelial func-tion as well as accelerated progression of endothelial dysfunction, especially in young adults.

PP.10.03 ASSOCIATION BETWEEN N-TERMINAL

PRO-BRAIN NATRIURETIC PEPTIDE AND

MARKERS OF INFLAMMATION IN YOUNG

HEALTHY ADULTS

A. Sorokina, Y. Orlova. Lomonosov Moscow State University based of Separate Subvision Medical Scientifi c and Educational Center, Moscow, Russia

Objective: The B type natriuretic peptide (BNP) plays an important role in regu-lating blood pressure, blood volume, and water and salt balance. BNP can also modulate proliferation of cells of the immune system, various cytokines and their related substances involved in the infl ammatory response. Recently its asso-ciation with infl ammatory markers has been demonstrated during cardiovascular diseases. The role of BNP/NT-ProBNP as infl ammatory biomarker has not been evaluated enough in apparently healthy subjects. The aim of this study was to investigate the correlation between NT-proBNP and markers of infl ammation in young apparently healthy adults.

Design and method: We investigated 282 healthy young adults, mean age 18,5 ± 1,7 years, 47% male. NT-proBNP, erythrocyte sedimentation rate (ESR), high sensitive C-reactive protein (hs-CRP), interleukin 6 (IL-6), fi brinogen (FBG) were measured.

Results: NT-proBNP level was 58, 61 ± 2,39 pg/ml (M ± m). Multivariate regres-sion analysis showed a positive association between NT-proBNP levels and ESR (p < 0.001), hs-CRP (p = 0.016). There was no signifi cant association between NT-proBNP and IL-6 (p = 0.445), FBG (p = 0,063).

Conclusions: Our results link the endocrine function of the heart to the infl am-mation, mainly hs-CRP and ESR. Additional clinical studies would be required to precisely ascertain the role of NT-ProBNP as prognostic marker of infl ammation.

PP.10.08 SUBCLINICAL ATHEROSCLEROSIS AND BLOOD

PRESSURE LEVELS DURING 5 YEARS OF ANTI-

TNFALPHA TREATMENT IN PSORIATIC ARTHRITIS

PATIENTS

M. Puato1, R. Pesavento1, M. Rattazzi2, A. Ortolan3, R. Ramonda3, P. Pauletto2.1Clinica Medica 3, Department of Medicine DIMED, University of Padova,

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Padova, Italy, 2Medicina Interna I, Ospedale Ca Foncello, Treviso, Italy,3Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy

Objective: The aim of this study was to evaluate the effect of 5 years of anti-TNFalpha treatment on subclinical atherosclerosis progression. Psoriatic Arthritis (PsA) is associated with accelerated atherosclerosis and increased cardiovascular mortality. Infl uence of anti-TNFalpha treatment of PsA in subclinical atheroscle-rosis is still unclear.

Design and method: Twenty-seven consecutive PsA patients were evaluated be-fore TNF blockers therapy (T0), after 2 years (T1) and after 5 years (T2) of treat-ment. Subclinical atherosclerosis was evaluated through carotid duplex scanning, analyzing intima-media thickness (IMT) and fl ow-mediated dilation (FMD). IMT values were expressed as IMT mean (cumulative mean of all the IMT mean in every analyzed carotid segment) and M-MAX (cumulative mean of all the higher IMT in every analyzed carotid segment). Response to therapy was studied by the evaluation of DAS 28 (disease activity score), and C-reactive protein (CRP).

Results: A good response to treatment was evident already at T1, with a sig-nifi cant decrease of DAS 28 (4.16 vs 2.30, p < 0.01) and CRP (11.25 vs 2.91, p < 0.01). The effi cacy was preserved from T1 to T2 in terms of DAS 28 (2.30 vs 2.40, p = ns), CRP (2.91 vs 2.73, p = ns). From T0 to T1 there was a signifi cant increment in both IMT-mean and M-MAX (0.72 vs 0.91 and 0.89 vs 1.06, re-spectively, p < 0.01). At T2 IMT-mean did not change signifi cantly (0.91 vs 0.92, p = ns), while M-MAX worsened further (1.10 vs 1.06, p < 0.05). No signifi cant variation in FMD values was observed during the 5-year follow up (T0 5.40%, T1 5.37%, T2 5.40%, p = ns). Noteworthy, systolic blood pressure and BMI remained stable from T0 to T2 (132 vs 131 mmHg, p = ns, and BMI 26 vs 25, p = ns), while diastolic blood pressure decreased signifi cantly (79 vs 74 mmHg, p = 0.001).

Conclusions: Our data revealed that in patients with PsA, despite treatment with TNF blockers, there is still a gradual, albeit slight progression of subclinical ath-erosclerosis assessed by ultrasonography. Other infl ammatory mechanisms not re-lated to TNF may be responsible of the progression of the atherosclerotic disease.

PP.10.09 COMPARISON OF THE DETRIMENTAL EFFECT

OF PSORIASIS AND RHEUMATOID ARTHRITIS

MEASURED ON CENTRAL HAEMODYNAMIC

PARAMETERS IN PREVALENT OVERWEIGHT-

OBESITY AND HYPERTENSIVE POPULATION

C. Paterno Marchioli. Cardiovascular Research, Clinical and Instrumental, Foggia, Italy

Objective: Autoimmune chronic infl ammatory conditions such as psoriasis (PS) and rheumatoid arthritis (RA) are associated with increased cardiovascular risk. People with PS was associated with increased risk of diabetes mellitus, obesity, high blood pressure, high cholesterol, stroke, and heart attack. Rapid increase in myocardial infarction risk following diagnosis of RA. The objective of this study was assessed the damage on central haemodynamic parameters (CHP) in patients with PS and RA, both gender.

Design and method: In a retrospective cross-sectional study 68 patients was en-rolled in the last 6 years: female 44 (PS/AR 32/12; average age 56) and male 24 (PS/AR 21/3; average age 48). The CHP were assessed non-invasively by a SphygmoCor device (Atcor-Sydney, Australia), according to method’s standard. The augmentation index (AIx) was evaluated in correlation to age and gender in each patient. All patients enrolled in the study had not cardiovascular, endocrine, renal and metabolic decompensated diseases.

Results: In female/male was observed high prevalence of high blood pressure: 89%/83%, overweight-obesity: 82%/92%, and hyperlipidaemia (IIa + IIb): 64%/38%. Female in menopause: 73%. In female/male was observed smoking: 16%/33% and diabetes mellitus type 2: 18%/29%. In the groups of patients with psoriasis and rheumatoid arthritis, comparing each gender with the same gender, according to all measurements of the CHP did not found statistically signifi cant differences, except pulse pressure (p = 0.03) in men. The measurements in PS/AR Female - PS/RA Male of Central Aortic Pressure (132.5/135.3 - 121.4/12.8), End-Systolic Pressure (120.9/123.7 - 113.2/119.3), Mean Arterial Pressure (104.9/107.2 - 101.8/112.7), and specifi cally the AIx (34.1/34.7 - 24.6 - 17) were highest than normal levels. The differences between the observed values and the normal values of the AIx in PS/Female - RA/Male (6/6.5 - 9.1/5.8) comparing each gender with the other had no statistical signifi cance.

Conclusions: Systemic diseases as psoriasis and rheumatoid arthritis produce similar harmful effect on central haemodynamic parameters, mainly the increase of AIx, in both gender, and could be the contributing cause of endothelial dysfunc-tion with a high probability to develop arterial hypertension and increase a risk of cardiovascular events.

PP.10.10 EARLY VASCULAR AGING SYNDROME

PREVALENCE IN RUSSIAN POPULATION

A. Orlov, M. Boyarinova, O. Rotar, A. Alieva, E. Moguchaya, V. Solntsev, A. Konradi. Federal Almazov North-West Medical Research Centre, Saint-petersburg, Russia

Objective: Vascular age is the apparent age of the arteries that can be affected by lifestyle risk and genetic factors. Subjects whose vascular age is older than chronological age might have higher cardiovascular risk. The aim of our study was to estimate early vascular aging (EVA) syndrome prevalence in population-based sample of Saint-Petersburg inhabitants according to pulse wave velocity (PWV) and cardio-ankle vascular index (CAVI) assessment.

Design and method: As a part of all-Russian epidemiology survey ESSE-RF random sampling of 1600 Saint-Petersburg inhabitants (25–65 years) stratifi ed by age and sex was involved. In 452 randomly selected subjects simultaneously cardio-ankle vascular index (CAVI) was measured by VaSera VS-1500 (Fuku-da, Japan) and carotid-femoral pulse wave velocity (cfPWV) was measured by SphygmoCor (Atcor, Australia). We used 2 defi nitions of EVA syndrome - if vas-cular age calculated from pressure independent stiffness index (CAVI) exceeded the biological age> = 4 years (EVAcavi); and if cfPWV exceeded 2SD for cor-responding age group (EVApwv). Hypertension was considered if BP> = 140/90 mmHg or antihypertensive treatment, diabetes type 2 was considered as fasting glucose> = 7.0 mmol/l or treatment.

Results: EVAcavi prevalence is much higher, than EVApwv (table 1). According to both criteria, there is an increase of EVA with age. Kappa index of criteria agreement was low – 0,09.

Conclusions: Prevalence of EVA syndrome detected by applanational tonometry or volume sphygmography has low agreement. It seems that carotid-femoral PWV criteria do not sensitive to detect EVA even in the oldest age group. At the same time, CAVI is a weak instrument to measure vascular stiffness.

PP.10.11 ENDOTHELIAL (DYS)FUNCTION IN PATIENTS WITH

HYPERTENSION AND RESISTANT HYPERTENSION

- PROFOUND VASOCONSTRICTION OR IMPROPER

VASODILATION? PILOT RESULTS

J. Novák1, P. Kruzliak2, M. Blaha1, J. Spac1, I. Rihacek1, J. Tomandl3, K. Budinskaya4, J. Svacinova4, Z. Novakova4, M. Soucek1. 1Second Depart-ment of Internal Medicine, St. Anne´s University Hospital in Brno and Faculty of Medicine, Masaryk Univ., Brno, Czech Republic, 2Department of Chemi-cal Drugs, Faculty of Pharmacy, University of Veterinary and Pharmaceuti-cal Sciences, Brno, Czech Republic, 3Department of Biochemistry, Faculty of Medicine, Masaryk University, Brno, Czech Republic, 4Department of Physi-ology, Faculty of Medicine, Masaryk University, Brno, Czech Republic

Objective: Endothelial dysfunction (ED), one of the fi rst steps in the pathophysi-ology of hypertension, is highly complex process that is still not fully understood. The aim of the current study was to test various modalities refl ecting the endo-thelial function or damage in newly identifi ed hypertensive patients compared to healthy individuals and compared to patients with resistant hypertension in order to shed more light on the pathophysiology of hypertension.

Design and method: Study is conducted as prospective single-center study. 56 patients (44 males) have already been enrolled: 28 newly identifi ed untreated hy-pertensive patients (group H), 18 healthy individuals (group C) and 10 patients with resistant hypertension (group RH). All the hypertensive patients underwent 24-ABPM and echocardiography followed by examination of pulse wave veloc-ity (PWV), CAVI and augmentation index and carotid intima media thickness. Levels of vasoactive factors were determined by ELISA from the peripheral blood including nitric oxide (NO), endothelin, oxidized LDL and osteopontin. Statistical analysis was performed in the STATISTICA software using appropriate statisti-cal tests.

Results: Selected echocardiography parameters describing heart structure dif-fered signifi cantly between H and RH group, refl ecting structural remodelling of

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Abstracts e161

the heart. Statistically signifi cant differences have been observed among individ-ual groups in the levels of NO (C vs. H vs. RH: 30,93 ± 22,36 vs. 17,76 ± 10,53 vs. 14,36 ± 7,19 [mM]; p = 0,005), differences of borderline signifi cance have been observed for the levels of oxidized LDL (C vs. H vs. RH: 12,13 ± 3,03 vs. 12,71 ± 2,84 vs. 10,40 ± 1,66 [U/ml]; p = 0,069). No statistically signifi cant dif-ferences have been observed for endothelin and osteopontin. Values of pulse ware velocity, augmentation or CAVI index and cIMT did not differ between H and RH groups. Various correlations among the levels of the plasmatic factors with the paraclinical examination methods results have been observed.

Conclusions: Production of NO is signifi cantly decreased in newly identifi ed hy-pertensive individuals and further decreases in patients with RH; the levels of vasoconstrictive endothelin and other factors do not show this trend. It can be suggested that the impossibility of proper vasodilation contributes signifi cantly to the development and progression of hypertension.Supported by MUNI/A/0949/2016 and MUNI/A/1356/2016 grants.

PP.10.13 FREQUENT EXACERBATIONS OF CHRONIC

OBSTRUCTIVE PULMONARY DISEASE AND

ATHEROSCLEROSIS: WHAT RELATIONSHIP?

A. Namitokov1, H. Kosmacheva2, V. Zafi raki3, V. Porhanov4. 1Research Institute - Regional Clinical Hospital #1, Krasnodar, Russia, 2Research Institute - Regional Clinical Hospital #1, Krasnodar, Russia, 3Kuban State Medical University, Kras-nodar, Russia, 4Research Institute - Regional Clinical Hospital #1, Krasnodar, Russia

Objective: To determine angiographic features of coronary atherosclerosis in pa-tients with frequent COPD exacerbations

Design and method: There was 110 patients with acute coronary syndrome and COPD included in observation, 24 of which (study group) had frequent COPD exacerbations (FE). Selection criteria were: COPD diagnosis; age > = 40 years; smoking history > = 10 pack-years; acute coronary syndrome at the presenta-tion to hospital; > = 1 stent implantation; > = COPD exacerbations during last year, diagnosed accordingly to GOLD criteria. Control group had < 2 COPD exacerbations per last year, other including criteria were the same. Detail «seg-ment by segment» analysis was used to describe all lesions. > = 50% lesions were considered as major, and <50% as minor. We also monitored long-term outcomes of PCI

Results: Follow-up median consist 19 months. There was no signifi cant difference between the groups in regards of age, gender, cholesterol levels, myocardial in-farction history, left ventricular ejection fraction, as well as arterial hypertension, diabetic mellitus, chronic kidneys disease.We have found more severe atheroscle-rotic lesions in group with FE of COPD. The row of features in atherosclerotic lesion distribution and frequency were founded: 1) patient with FE of COPD had higher total number of lesions, major lesions in main arteries and total occlu-sions in main and collateral arteries; 2) there was no statistically signifi cant differ-ences in frequency of total lesion number in left main artery, proximal, medium and distal segments in both groups, however the number of proximal and distal major lesions was signifi cantly higher in group with FE of COPD; 4) extended (>20 mm) stenosis (no depends of localisation) are more specifi c for the patients with FE of COPD. The frequency of occurrence of cardiac events such as cardiac death, myocardial infarction, stroke, coronary artery bypass grafting did not differ individually. However, the frequency of MACE the differences were statistically signifi cant (2.31 (95% CI 1,45–3,68).

Conclusions: COPD with FE determines a high risk of major cardiovascular and earlier their onset in the late period after PCI

PP.10.15 URIC ACID AND PRO-INFLAMMATORY/PRO-

THROMBOTIC STATE IN HYPERTENSIVE PATIENTS.

DIFFERENCES BETWEEN MEN AND WOMEN

STRATIFIED BY THE MENOPAUSAL STATUS

C. Liakos1, E. Karpanou2, C. Grassos3, M. Markou4, G. Vyssoulis1, D. Tousoulis1. 11st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece, 21st Cardiology Clinic, Antihypertension Center, Onassis Cardiosurgery Center, Athens, Greece, 3ESH Center of Excellence for Hypertension, Cardiology Department, KAT General Hospital of Attica, Athens, Greece, 4Cardiology Department, Hippokration Hos-pital, Athens, Greece

Objective: Uric acid (UA) levels in serum have been previously correlated with serum biomarkers of pro-infl ammatory and pro-thrombotic state in patients with arterial hypertension. The aim of the present study was to examine whether these correlations differ between men and women. Possible differences were also exam-ined within women’s group according to their menopausal status.

Design and method: The study comprised all hypertensives referred to our hy-pertensive units from 1985 to 2016 (n = 20450, 57.9 ± 13.9 years, 53.5% men). Menopausal status of female patients (pre-menopause, post-menopause, hyster-ectomy) was recorded. Levels of UA, pro-infl ammatory (c-reactive protein, CRP; serum amyloid A, SAA; homocysteine) and pro-thrombotic (fi brinogen; plasmin-ogen activator inhibitor-1, PAI-1; D-Dimer) biomarkers were measured in serum. Correlations adjusted for age were performed with the use of Pearson coeffi cient r.

Results: Statistically signifi cant positive correlations (adjusted for age) were found between UA and pro-infl ammatory/pro-thrombotic biomarkers in all groups (p < 0.001). In the whole cohort, r values for the correlations of UA with CRP, SAA, homocysteine, fi brinogen, PAI-1 and D-Dimer were 0.159, 0.244, 0.319, 0.256, 0.249 and 0.159, respectively. In women (n = 9501, 59.0 ± 13.3 years) correlations were stronger than in men (n = 10949, 56.9 ± 14.4 years): r values 0.300, 0.268, 0.302, 0.251, 0.257 and 0.194 versus 0.102, 0.209, 0.232, 0.218, 0.183 and 0.117, respectively. Within women’s group, correlations were by far stronger in those with hysterectomy (n = 1150; 61.1 ± 9.8 years; r values 0.380, 0.373, 0.367, 0.359, 0.325 and 0.316) compared to post-menopause (n = 5923; 65.3 ± 9.8 years; r values 0.291, 0.248, 0.291, 0.237, 0.254 and 0.185) and pre-menopause individuals (n = 2428; 42.8 ± 7.6 years; r values 0.273, 0.269, 0.296, 0.234, 0.231 and 0.142). Correlations were also clearly stronger in post-menopause compared to pre-menopause women when adjustment for age was not performed: r values 0.319, 0.280, 0.329, 0.274, 0.288 and 0.186 versus 0.282, 0.279, 0.306, 0.247, 0.246 and 0.143, respectively.

Conclusions: Possible pro-infl ammatory and pro-thrombotic effect of UA in hy-pertensive patients is affected by gender, menopausal status and age.

PP.10.16 RHEUMATOID ARTHRITIS PATIENTS WITH

ARTERIAL HYPERTENSION HAVE HIGH

PREVALENCE OF CARDIOVASCULAR RISK

FACTORS

L. Krougly1, O. Fomicheva1, Yu Karpov1, T. Popkova2, E. Nasonov2. 1Institute of Clinical Cardiology of Russian Research and Production Complex, Moscow, Russia, 2V. A. Nasonova Institute of Rheumatology Federal Agency of Scientifi c Research, Moscow, Russia

Objective: Tight control of disease activity, management of traditional CV risk factors such as arterial hypertension (AH), smoking, obesity, blood lipids level, diabetes mellitus (DM) are the most important steps in improving CV disease outcomes in Rheumatoid arthritis (RA) pts. We have studied prevalence of CV risk factors in RA pts with AH and management of risk factors.

Design and method: A total of 124 pts with RA on the ACR/EULAR criteria 2010 and suspected coronary artery disease (CAD) underwent clinical, laboratory and instrumental evaluation and treatment assignment. Pts were included in the study based on the clinical signs of CAD (chest pain) and CV risk factors evaluation. All pts underwent laboratory tests included blood total cholesterol (TC), LDL, HDL, TG, erythrocyte sedimentation rates (ESR), C-reactive protein (CRP), rheumatoid factor (RF), antibodies against citrullinated circular peptides (anti-CCP).We evaluated CV risk factors (AH, dyslipidemia, smoking, obesity), infl ammation markers, anti-rheumatic treatment and treatment reduces CV risk.

Results: Mean age was 59.0 years, men 29%, 25% smokers. AH had 98 pts (77%). Mean ESR was 24.9 mm/h, CRP 2.5 mg/dl, RF+ in 74%, anti-CCP+ in 66%. 83% had the very high CV risk according to the SCORE stratifi cation or cardiovascular diseases. Methotrexate was prescribed in 52%, lefl unomide 13%, hydroxychloroquine 5%,

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sulfasalazine 7%, biological anti-rheumatic drugs 26%, methylprednisolone in 51% (n = 63). RA remission (DAS28 < 3,2 in 17%, 3,2–5,1 in 50%, >5,1 in 33%).Pts with AH had mean blood pressure 127/69 mm Hg, pts without AH 123/72 mm Hg. 64% had treated by the combination of 3 antihypertensive drugs. Target level of blood pressure (<140/90 mm Hg) was achieved in 82%. Target level of LDL (<1.8 mmol/l) was achieved only in 18% of high CV risk pts). Statin (Atorvas-tatin, mean dose 13.7 mg/d) treatment was administrated in 73%. Age, sex, smok-ing status, infl ammation markers didn’t show any signifi cantly differences.

Conclusions: We found high prevalence of AH (77%) in RA which correlates with CV risk factors prevalence (obesity, DM, higher LDL). Pts achieved the tar-get level of blood pressure more often than the target level of lipids.

PP.10.19 VALIDITY AND REPEATABILITY OF A NEW

REACTIVE HYPEREMIA INDEX USING CALIBRATED

PULSE-VOLUME RECORDING IN EVALUATION OF

ENDOTHELIAL FUNCTION

S. Kim, J.B. Park. Cheil general hospital and women’s healthcare center, Dankook University, Seoul, South Korea

Objective: Endothelial function is clinically important for evaluation of cardio-vascular risk and its prediction, but its evaluating method is impractical for to use in the clinic. We aimed to assess the volume changes of brachial artery using cali-brated pulse-volume recording with MultiLab Series II LHS (Unetixs Vascular, Inc. USA) as an alternative to evaluate endothelial function and compared with fl ow mediated dilation (FMD) measured by ultrasound.

Design and method: Reactive hyperemia volume index (RHVI) was calculated as (average amplitude during reactive hyperemia / average amplitude at baseline -1) x 100. There were outliers, defi ned as <Q1–1.5 x (Q3-Q1) or > Q3+1.5 x (Q3-Q1) by Turkey’s outlier rule, three from RHVI and two from FMD and excluded from analy-sis. And Thirty seven subjects (mean age: 39.04 ± 10.10 years, male 5) were recruited.

Results: Mean systolic and diastolic blood pressures were 120.40 ± 15.27 and 75.22 ± 9.57mmHg. Endothelial function (FMD) by ultrasound was 14.97 ± 6.13% and RHVI by plethysmography was 68.53 ± 64.77%, with the correlation coeffi cient of 0.3182 (p-value = 0.0229) between them. The regres-sion was remained signifi cant after adjustment with age, sex and body mass index (b = 3.555 (se = 1.749), p-value = 0.0481). Short-term (15-minute interval) and longer-term (1-week interval) reproducibility was tested. Intra-class correlation coeffi cient was 0.620 (95% confi dence interval -0.080 to 0.910) with correlation of 0.6429 for short term and 0.693 (95% confi dence interval 0.156 to 0.914) with correlation of 0.5879 for longer-term.

Conclusions: This method may provide a simple and repeatable alternative for evaluating endothelial function, but need further studies in large volumes for its potential use in clinic.

PP.10.20 IMBALANCE BETWEEN T REGULATORY AND

TH17 LYMPHOCYTE SUBSETS IN PATIENTS WITH

RESISTANT HYPERTENSION AND PRIMARY

ALDOSTERONISM

A. Kaszuba1, A. Konior2, T. Mikolajczyk2, A. Prejbisz1, A. Januszewicz1, T. Guzik3. 1Institute of Cardiology, Warsaw, Poland, 2CM Jagiellonian University, Cracow, Poland, 3Univerity of Glasgow, Glasgow, United Kingdom

Objective: In the past several years, it has become evident that infl ammation con-tributes to the elevation of blood pressure. Evidence from experimental models of hypertension and hypertensive patients suggests imbalance of T effector and regulatory subsets in hypertension. In our study we aimed to quantify blood T lymphocyte subsets in subjects with secondary hypertension- resistant hyperten-sion (RHT) and primary aldosteronism (PA) characterized by increased BP levels, augmented cardiovascular risk in comparison to control subjects matched for age, sex and BMI (CG).

Design and method: In an ongoing study we included 29 patients (20 M, 9F, mean age 54.9 ± 11.5) with RHT, 26 patients with PA (14 M,12F, mean age 54.8 ± 12.6) and 30 CG patients (15 M, 15F, mean age 50.4 ± 11.2). T cells characteristics from peripheral blood samples were studied by multicolour fl ow cytometry with intracellular staining for foxp3. The concentration of the an-giotensin II in patients’ blood samples was determined by radioimmunoassay method. Data were analyzed using T test with Bonferroni correction for mul-tiple comparisons.

Results: Patients with RHT and PA were characterized by signifi cantly higher BP values on ambulatory blood pressure monitoring as compared with CG. In comparison to CG, patients with RHT and PA had lower per-centage of CD4+25+foxp3+ T cells (Tregs): consecutively RHT 5.5 ± 3.2%; PA 5.8 ± 4.3% vs CG 9.9 ± 10.6%; p = 0.01, p = 0.084. However, the per-centage of CD3+CD4+IL-17+ T cells was higher in RHT 19 ± 20% and PA 12.9 ± 16.2%, vs CG 3.7 ± 2.4%; p < 0.01, p = 0.04. In patients with PA, in comparison to CG and RHT, lower angiotensin II concentration and higher aldosterone to renin ratio was observed.

Conclusions: Our results indicate, that dysregulation of T cell activation with very signifi cant increase of proinfl ammatory T cells and decrease in Tregs may play a role in the pathogenesis of RHT and PA, regardless of the renin-angioten-sin-aldosterone activation.

PP.10.21 GALECTIN-3 AND THE RISK OF

ATHEROSCLEROTIC LESIONS OF CAROTID

ARTERIES IN PATIENTS WITH METABOLIC

SYNDROME

V. Ionin1, E. Baranova1,2, E. Zaslavskaya1, E. Bazhenova1,2, E. Polyakova1,2,I. Ma1, O. Belyaeva1,2, E. Shlyakhto1,2. 1Pavlov First Saint-Petersburg State Medi-cal University, Saint-Petersburg, Russia, 2Federal Almazov North-West Medical Research Centre, Saint-Petersburg, Russia

Objective: The carotid intima-media thickness (cIMT) is parameter of early atherosclerotic lesions of arterial wall, which associated with increased risk of cardiovascular complications. Galectin 3 (Gal-3) - substance with profi brogenic and proinfl ammatory effects on cardiovascular system. The objective of this study was to compare the level of Gal-3 in patients with metabolic syndrome (MetS) and healthy individuals and to identify the relationship between this substance, lipids and cIMT.

Design and method: 190 persons (97 female and 93 males, 52,2 ± 8,1 years old) were examined and divided into 2 groups: MetS (n = 100) with 3 or more components (IDF, 2005) and healthy control (n = 90) without metabolic disorders and cardiovascular diseases. Groups did not differ signifi cantly by gender and age (p>0,05). The examination included: medical history, anthropometry, lipids (Cobas Integra 400/700/800) and Gal-3 (Enzyme Immunoassay) levels in serum. The assessment of carotid intima-media thickness was performed with ultrasound scanning.

Results: Gal-3 in patients with MetS was higher than in healthy individuals (480,2 [420,1;1240,4] and 270,1 [240,3;320,4] pg/ml; p < 0,001), also as cIMT (0,93 ± 0,21 and 0,61 ± 0,12 mm; p < 0,001). The Gal-3 was positive correlated with waist circumference (r = 0,74, p < 0,001), systolic blood pressure (r = 0,66, p < 0,001), triglycerides (r = 0,54, p < 0,001) and fast-ing glucose (r = 0,53, p < 0,001), total cholesterol (r = 0,315, p = 0,04) and negative correlated with HDL-cholesterol (r = - 0,474, p < 0,001). Strong positive correlation between Gal-3 and cIMT (r = 0,761, p < 0,001) was re-vealed. The multivariate regression analysis demonstrated that the Gal-3 is an independent predictor of increasing the carotid intima-media thickness more than 0,9 mm in patients with MetS (OR = 15,2, 95% CI 7,59–30,5, p = 0,001).

Conclusions: The carotid intima-media thickness and level of galectin 3 were higher in metabolic syndrome patients, than in healthy persons. We propose that profi brogenic and proinfl ammatory effects of galectin 3 can induce morphologi-cal changes in arterial wall, because we revealed strong signifi cant relationship between these parameters.

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Abstracts e163

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved

SATURDAY

POSTERS

POSTER SESSION

LATE-BREAKERS POSTER’S SESSION LB01:

SESSION 1 - POSTER

LB.01.02 ASSESSMENT OF ANTICOAGULATION

TREATMENT IN PATIENTS DIAGNOSED WITH

ATRIAL FIBRILLATION IN A BASIC HEALTH AREA.

ACAP STUDY

B. Aguilera-Alcaraz1, J. Abellan-Huerta2, C. Ariza-Copado1, J. Carbayo-Herencia3,J.J. Martínez-Díaz3, F. Hernández-Menárguez3, J. Mroz1, J. Abellan-Alemán3.1Centro de Salud Isaac Peral, Cartagena, Spain, 2Hospital General Almansa, Albacete, Spain, 3Cátedra de Riesgo Cardiovascular, Universidad Católica deMurcia, Murcia, Spain

Objective: Atrial fi brillation (AF) is the most common cardiac arrhythmia. It is present in 1–2% of the population. To assess the need for anticoagulation is essen-tial for its management. Our objective was to investigate whether the indication of anticoagulation was adequate in patients diagnosed with atrial fi brillation, given the CHA2-DS2-VASc scale, measuring the International Normalizad Ratio range (INR) in patients treated with anti-vitamin K drugs.

Design and method: This is an observational and cross sectional study. 271 pa-tients with atrial fi brillation were included. We analyzed demographic, the CHA2-DS2-VASc and HAS-BLED variables, the treatment and INR values for 6 conse-quentive months. The confrontation of variables was performed using chi-square and Mantel-Haenzel tests.

Results: The prevalence of AF was 1,2%. The mean age was 74,9 ± 11,4. 90,4% had hypertension, 37,6% diabetes mellitus and 16,2% presented history of bleed-ing. The 89,3% had CHA2-DS2-VASc > 1. The 73,8% were taking anticoagu-lants, of which 61,3% were under antivitamin k. The 44,8% of patients taking an-tivitamin K, presented inadequate range of INR, although 93,3% of them followed up the monitoring properly. There was a greater prescription of anticoagulants in patients with persistent or permanent AF compared to the paroxysmal form.

Conclusions: The level of anticoagulation with antivitamin K was inadequate in our sample, despite a proper follow up and adherence to treatment. Patients diag-nosed with paroxysmal AF were less anticoagulated than those diagnosed with persistent or permanent AF.

LB.01.03 COMPARISON OF THE SPHYGMOCOR XCEL

WITH APPLANATION TONOMETRY FOR CENTRAL

PRESSURE ASSESSMENT IN CHILDREN AND

ADOLESCENTS

S. Stabouli1, C. Zervas1, N. Printza1, J. Dotis1, K. Chrysaidou1, O. Maliachova1,C. Antza2, V. Kotsis2, F. Papachristou1. 11st Department Pediatrics, Aristotle Uni-versity Thessaloniki, Thessaloniki, Greece, 23rd Department Medicine, Aristotle University Thessaloniki, Hypertension-24 h ABPM ESH Center Excellence, Thes-saloniki, Greece

Objective: Over the last few years assessment of central systolic BP (cSP) has been increasing used in adults and seems to be superior to peripheral blood pres-sure (pBP) to predict cardiovascular events. The gold-standard technique is to-nometry, but this technique can be challenging, especially when used on children. The purpose of this study was to validate cBP assessment with novel oscillometric SphygmoCor XCEL device for use in children and adolescents.

Design and method: Children and adolescents aged 6–20 years were recruited subsequently and were equally distributed in two age groups (pre-adolescent chil-dren and adolescents). Central systolic BP (cSPton) was measured by applana-tion tonometry with the “convetional’’ Sphygmocor device and by SphygmoCor XCEL device (cSPosc). For each patient, the average of the three recordings taken with each device was calculated. Bland-Altman plots were generated for compari-son of the tonometer- to oscillometric-based method. The ANSI/AAMI/ISO 2013 criteria were used to assess the accuracy of agreement between devices.

Results: Five participants were excluded from the analysis due to low quality of recordings, four with tonometric technique and one with both devices. The remaining 67 participants had mean age 11.5 ± 3.7 years, were 31 (46.3%) male,

and presented even distribution of sex in both age groups. cSPosc was strongly correlated with cSPton (R2 = 0.87, P < 0.001). Mean cSPton was 103.23 ± 9.43 mmHg and mean cSPosc 103.54 ± 8.87 mmHg. The mean cSP difference between the two devices was -0.30 ± 3.34 mmHg (P = NS), and fulfi lled the AAMI criteri-on 1 (difference < 5.0 ± 8.0 mmHg). The estimated s.d. (inter-subject variability) was 2.17 mmHg. Bland-Altman analysis showed good agreement with LoA -6.24 to 6.84. No proportional bias was detected by linear regression analysis with de-pendent variable the mean differences between devices and independent variable mean cSP of the two devices (B = 0.06, P = NS).

Conclusions: The new oscillometric SphygmoCor XCEL device provides equiva-lent results for cSP values to those obtained by tonometry in children and adoles-cents. Thus, the SphygmoCor XCEL device is appropriate for assessing cSP in the pediatric population.

LB.01.06 INVESTIGATION OF FACTORS IMPACTING BLOOD

PRESSURE ON THE SHORT TERM, BASED ON A

COHORT OF USERS OF CONNECTED DEVICES

A. Chieh1, E. Roitmann1, O. Bellahsen1, E. Helander2. 1Withings - Nokia Health Division, Nokia, Paris, France, 2Signal Processing Department, Tampere Univer-sity of Technology, Tampere, Finland

Objective: According to literature, blood pressure is impacted by stress, emotion-al state, and tiredness. The objective of this research is to analyze the short-term effect of these factors on blood pressure.

Design and method: A questionnaire enquiring about mood and tiredness was sent to users of Withings connected blood pressure monitors, through the With-ings application. Only participants who had a blood pressure (BP) measurement in the last seven days and who declared to remember the conditions of their last measurement were eligible to the study. To analyze the effect of the studied factors on BP, questionnaire answers were associated with the difference between the last systolic blood pressure (SBP) reading and a baseline computed as the mean SBP in the six preceding months. All SBP measurements were collected automatically by the connected BP monitors.

Results: In total, 3,412 participants (16% women, mean age 52.0, sd 12.2 years) from 111 countries were eligible. The mean baseline SBP was 127.3 (sd 11.8) mmHg, the mean SBP at the last measurement was 125.3 (sd 13.9) mmHg, and 1589 (47%) participants declared to take medication for high blood pressure.The difference between the last measurement and the baseline was fi tted to a lin-ear model depending on the mood, and controlled for the hour of measurement. Compared to feeling neutral, feeling angry during the last measurement increased the difference to baseline by 4.0 mmHg (sd 1.2, p = 0.005), feeling stressed by 2.0 mmHg (sd 0.6, p < 0.001), and feeling sad by 0.7 mmHg (sd 1.2, not signifi -cant with p = 0.5). Feeling happy compared to neutral decreased the difference to baseline by 1.0 mmHg (sd 0.4, p = 0.01). Lastly, being tired increased the differ-ence to baseline by 1.1 mmHg (sd 0.3, p = 0.001) compared to not being tired.

Conclusions: These results indicate a short-term effect of emotional state and tiredness on blood pressure. This effect needs to be further investigated in a lon-gitudinal study, in which several data points for mood would be collected for each participant.

LB.01.07 ALLIANCE STUDY: EVALUATION OF THE

EFFICIENCY FOR IMPLEMENTATION FIXED

ANTIHYPERTENSIVE DRUG COMBINATION OF

LISINOPRIL/AMLODIPINE IN PATIENTS WITH

ESSENTIAL ARTERIAL HYPERTENSION

S. Siarkevych, M. Dolzhenko, O. Nudchenko, S. Bondarchuk. P. L. Shupik National Medical Academy of Postgraduate Education, Cardiology Department, Kiev, Ukraine

Objective: The aim of study was to evaluate the effi ciency and safety of fi xed combination of lisinopril 10/20 mg + amlodipine 5/10 mg usage in patients with essential arterial hypertension.

Design and method: the study included male and female patients over 18 years with a new onset or previous treatment uncontrolled hypertension (blood pres-sure> 140/90 mm Hg). Offi ce blood pressure (BP) was measured and biochemical blood assay was done to all patients on baseline and in the follow-up periods. At

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e164 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

the beginning of the study all previous antihypertensive therapy was cancelled. After randomization lisinopril/amlodipine has been administered to patients in accordance to their blood pressure levels. If the patient was newly diagnosed with blood pressure or had previously untreated hypertension and blood pressure in the range 140–179/90–109 mm Hg, lisinopril/amlodipine were administered at a dose of 5/10 mg per day. Patients who previously had an antihypertensive therapy but blood pressure kept to a level 140–179/90–109 mm Hg, lisinopril/amldipine were administered at an initial dose of 20/10 mg per day. If blood pressure was higher than 180/110 mm Hg, betablockers, diuretics and statins were administered according to indications. The study lasted over 60 days.

Results: 6069 patients were involved to the study. According to data gained from the offi ce of blood pressure monitoring essential reduction of blood pressure lev-els (from 169.3 ± 0.2/98.1 ± 0.1 mm Hg at baseline to 131.9 ± 0.1/81.1 ± 0.1 mm Hg at the end of the study) was achieved through lisinopril/amlodipine treatment. 57.1% of patients achieved targeted blood pressure levels. Patients who were treat-ed with lisinopril/amlodipine without statins had demonstrated signifi cant reduc-tion in plasma cholesterol levels from 5.75 ± 0.02 mmol/l to 5.09 ± 0.1 mmol/l. In the end of study was observed a signifi cant decrease of number of patients with proteinuria/microalbuminuria who followed lisinopril/amlodipine therapy— from 667 persons (11.0%) to 244 persons (4.0%). Lisinopril/amlodipine therapy was well tolerated by patients. Serious adverse events were not observed.

Conclusions: Results of the study proved the effectiveness of the strategy to pre-scribe fi xed combination lisinopril + amlodipine for the patients with hyperten-sion in daily clinical practice in Ukraine for the prevention of cardiovascular and cerebrovascular complications.

LB.01.08 VALIDATION OF THE SUNTECH® CT40™ BLOOD

PRESSURE MEASUREMENT DEVICE BY THE

BHS PROTOCOL AND THE AAMI/ISO 8160–2:2013

STANDARD

H. Polo Friz, V. Punzi, F. Petri, R. Orlandi, D. Maggiolini, L. Primitz,G. Vighi. Internal Medicine, Vimercate Hospital, Vimercate, Italy

Objective: To perform a simultaneous, independent validation of the oscillomet-ric CT40 device for BP measurement, produced by SunTech®, according to the 1993 protocol of the British Hypertension Society (BHS) and the standard of the Association for the Advancement of Medical Instrumentation (AAMI)/the Inter-national Organization for Standardization (ISO) 8160–2:2013.

Design and method: Study participants were aged > 18 years old and written informed consent was obtained from each subject. The study was approved by the institutional review board. Subjects recruitment conditions (sex, arm circumfer-ence, BP readings) as long as procedures and data analysis fulfi lled the require-ments stated by BHS protocol and AAMI/ISO8160–2:2013 standard.

Results: A total of 94 participants were included, 52 females (55.3%), mean age (years ± SD) 63.1 ± 18.0, mean arm circumference (cm ± SD) 35.0 ± 9.0. The average of observers entry BPs were 146.9 ± 37.2 mmHg for systolic (SBP) and 82.2 ± 22.1 mmHg for diastolic BP (DBP), Table 1. As for the BHS protocol, differences between standard measurement and test de-vice within 5, 10, and 15 mmHg, for the better observer (A), were 79.4, 95.4 and 100.0 %, respectively for SBP, and 82.6, 97.2 and 100.0 % for DBP, Table 2. Fig-ures in the low, medium and high pressure ranges are shown in Table 3. Scatter plots of differences between the test device and the better observer (A) against the average of the device and observer pressure values are shown for SBP (Figure 1) and DBP (Figure 2). The mean difference between the readings obtained by using the test device and those obtained by the observers (AAMI/ISO8160–2:2013 standard criteria 1) were 0.3 ± 5.0 mmHg (SBP) and -0.8 ± 4.3 mmHg (DBP), and the mean differences between the aver-age of three readings of the test device and the average of the observers, for each par-ticipant (criteria 2), were 0.3 ± 3.9 and -0.8 ± 3.5 mmHg for SBP and DBP, respectively.

Conclusions: The CT 40 blood pressure device achieved A/A grade of the BHS protocol and fulfi lled the requirements (criteria 1 and 2) of the AAMI/ISO stan-dard. CT 40 can be recommended for BP measurement in adults.

LB.01.09 ISOLATED NOCTURNAL HYPERTENSION AND

NON DIPPING BLOOD PRESSURE: FREQUENT

SITUATIONS, STILL UNDER-DIAGNOSED

D. Ouail, M. Tebbani, O. Terra, S. Kheyar, L. Benzaid, D. Si Ahmed, F. Bouali. Faculty of Medicine, CHU, Béjaia, Algeria

Objective: Nocturnal hypertension is associated with an increased risk of major cardiovascular events. Patients with Isolated nocturnal hypertension (INH) had more severe target-organ damage. A ‘non-dipping’ Blood Pressure profi le is as-sociated with a high cardiovascular risk. The diagnosis of these two entities is easy by ambulatory blood pressure monitoring(ABPM). The aim of this study is to describe the prevalence of nocturnal hypertension and to study the dipping profi le in hypertensive patients

Design and method: Our study is retrospective, it includes all patients referred for diagnosis of hypertension; Before high blood pressure levels or high normal tension in whom the diagnosis is confi rmed by ABPM, and the known hyper-tensives oriented for evaluation.A Schiller MT-300 with BR-102 plus program was used for the ABPM. 46 mea-sures required to validate the ABPM. We studied the mean of the blood pressure over the 24 hours, the mean pressure night and day and the profi le dipping in all the patients. Nocturnal hypertension and dipping profi le values are those defi ned by ESC/ ESH 2013 and AHA/ASA 2015.

Results: Twenty seven patients included in our series. It is 15 men (55%) and 12 women (45%). Mean age is 54 years [35–80 years]. Twenty fi ve patients (93%) had nocturnal hypertension, Six (22%) of whom had isolated nocturnal hyperten-sion. Patients with INH are six, they are 3 men and 3 women, mean age 50.5 years (43 - 59) years. Hypertension is systolic-diastolic in three patients, diastolic isolated in two patients and systolic isolated in one. The dipping profi le in our se-ries, it is normal in nine patients, 12 patients (44%) are non dippers, four Reverse dipping (15%) and two extrem dipping.

Conclusions: The prevalence of isolated nocturnal hypertension is high in our series (22% of patients) and The non dipping Blood pressure is also very com-mon (60%), together, these entities are regarded as important harbingers of poor cardiovascular prognosis. The ambulatory blood pressure monitoring(ABPM) in hypertensive patients at diagnosis and during progression is the only non-invasive way to detect nocturnal hypertension and to analyse dipping profi le.

LB.01.13 THE USE OF CARDIOVASCULAR PREVENTIVE

DRUGS IN SUBJECTS AFTER MYOCARDIAL

INFARCTION. A POPULATION BASED STUDY

J. Redon1, J. Sanchis1, R. Uso1, J. L. Trillo1, A. Fernandez2, F. Morales3,D. Orozco4, V. Gil4. 1INCLIVA Research Institute, Valencia, Spain, 2SICCRO,Valencia, Spain, 3University of Valencia, Valencia, Spain, 4University MiguelHernandez, Alicante, Alicante, Spain

Objective: Drug treatment for secondary prevention of cardiovascular disease is an established strategy recommended by guidelines. However, a wide gap exists between what the guidelines say and the real life in terms of number of drugs. The objective of the SATURNO study was to assess what is the gap in subjects after myocardial infarction (MI) based on Electronic Health Records (EHR).

Design and method: Patients with a diagnosis of MI before to January 1st, 2012 were selected from the EHR of the Valencia Community which contain all drug prescriptions. In the present study, three groups of therapy usually recommended for secondary prevention or for control of main cardiovascular risk factors were selected: aspirin, SRA blockers (ACEi, ARB), beta-blcokers and statins. Assess-ment of treatment was performed after 6.1+3.5 yr of the event.

Results: A total of 72784 patients (76% men, mean age 63 yr) were included. Among them, 14484 (20%) were not taking drug of the three groups, 3023 (4%) one, 9100 (13%) two and 45774 (63%) three. Concerning the kind of drugs, as-pirin was present in 70%, followed by 70% SRA blockers and 68% statins. The beta-blockers were included in the treatment of 42824 (59_%) subjects. The beta-blockers when administrated in more than 80% of the cases were combined with statins, aspirin or SRA blockers.

Conclusions: The proportion of patients taking cardiovascular preventive drugs after a MI is low in the general population. Several factors can contribute to it, but physician inertia and low patient compliance requires action in order to improve the secondary prevention.

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Abstracts e165

LB.01.14 PHYSIOLOGICAL AND MOLECULAR STUDIES

OF RABBIT HEART FED ON CHOLESTEROL

REACH DIET

C. Revnic1, F. Revnic2, S. Voinea1, B. Paltineanu4. 1UMF. Carol Davila Inter-nal Medicine, Bucharest, Romania, 2NIGGAna Aslan Biology of Aging, Bucha-rest, Romania, 3UMFCarol Davila Oncology, Bucharest, Romania, 4UMF Targu Mures, Targu Mures, Romania

Objective: Hypertension and atherosclerosis are among the most common causes of death in the world.

Aim of study: To examine the direct effects of hypercholesterolemia (HC) on rabbit myocardiial structure,physiology and biochemistry.

Design and method: 10 adult rabbits divided into 2 groups of 5 rabbits each:Control(C) fed on normal chow, and (HC) fed on 2% cholesterol(Iard mixed with chow) for 16 weeks. After tretment,rabbits from (C) and (HC) groups were sacrifi ced and hearts were quicky removed,and perfused with standard Krebs Han-seleit buffer, 10 ml/minute at 37°C, pH 74 in Langendorff retrograde perfusion system at a constant pressure.45 minutes ischemia was followed by 120 minutes reperfusion and parameters of cardiac function: coronary fl ow(HC),Heart rate (H.R.) and left ventricle developed pressure(LVDP) of hearts from (C) and (HC) groups were measured. TACS DNA laddering kit was used to assess left ventricle cardiomyocytes from group (HC) for apoptosis, also fragments of left ventricle from (HC) were processed for Electron Microscopy (EM)

Results: Evaluation of (C.F.), (H.R.) and (LVDP) in (C) and (HC)groups have pointed out a 50% reduction in (C.F). in (HC) group versus(C) during stabiliza-tion period. In (HC) group, LVDP was depressed during the whole experiment, while in (C)group it was almost constant .Protection of myocardium against oxi-dative stress was signifi cantly depressed following (HC) treatment, synthesis and utilization of GSH was limited versus (C).Cardiac hypertrophy experimentally induced with (HC) was related with a decrease in(C.F.) and LVDP associated with an increase in lipid peroxidase, in LDH and CK as markers of myocardial lesion and GGT activity in myocardial tissue. Myocyte apoptosis was present in (HC) group, pointed out by DNA laddering pattern on gel electrophoresis.(E.M.) stud-ies have pointed out dilated sarcoplasmic reticulum, perinuclear edema of myo-cytes and swollen mitochondria.

Conclusions: High cholesterol diet in (HC) rabbits induces cardiac hypertrophy and changes in physiological parameters of heart with a negative impact upon syn-thesis of antioxidant enzymes as well as changes in ultrastructure of heart muscle and at the molecular level(DNA laddering is present as a sign of apoptosis in ventricular myocytes)

LB.01.15 DECREASE OF CARDIOVASCULAR RISK

IN HYPERTENSIVE AND HYPERTENSIVE-

DIABETIC PATIENTS AFTER A PROGRAM OF

PHARMACEUTICAL INTERVENTION

M. Sánchez Macarro1, J.J. Martínez Diaz2, J. Abellán Huerta3, F.G. Clavel Ruiperez2,P. Ramos Ruiz2, P. Gómez Jara1, M. Léalo Hernandez1, J. Abellán Aleman1.1Cátedra de Riesgo Cardiovascular UCAM, Murcia, Spain, 2Hospital General Uni-versitario Santa Lucia, Cartagena, Spain, 3Hospital de Almansa, Albacete, Spain

Objective: To determine the effectiveness of a pharmaceutical care plan by re-ducing CVR in a sample with moderate-high or high CVR in a rural community pharmacy.

Design and method: Clinical trial with an intervention group and a control group with a previous non-probabilistic sampling of consecutive cases followed by a probabilistic one by simple randomization in 2 groups stratifi ed by age and sex. Were included patients who came to the pharmacy offi ce with cardiovas-cular prescriptions and moderate-high or high CVR. The pharmaceutical care plan includes group talk about CVR and an individual strategy through a plan of modifi cation of lifestyles, all through interviews and follow-ups allowing to detect non-compliances, safety problems or problems of effectiveness. The Framingham score was determined and, on the other hand, CVR in percentage at the beginning and at the end of the study, calculated with the D ‘Agostino formula.

Results: Comparison of Framingham (%) CVR and score between groups at base-line in hypertensive patients with and without diabetes is presented. No compari-son showed statistically signifi cant differences. We also present a comparison of Framingham VR (%) and score between groups at the end of follow-up in hyper-tensive patients with and without diabetes. There was a decrease in CVR and score in each of the variables, with a signifi cant reduction in the mean of the Framing-ham score in hypertensive patients with diabetes. The mean score decreased 2.3 points (17.8 vs 20.1, P < 0.05) in the range of 23.9% and 26.5% probability of having a cardiovascular event in the next 10 years. We present the measure of the

percentage change in the CVR or its score at the end of the study, between groups in hypertensive patients with and without diabetes. The mean score decreased by 10.1% (-3.7% vs +6.4%, p < 0.05) in diabetic hypertensive patients, a similar tendency presents the CVR data with a tendency to signifi cance.

Conclusions: The application of a pharmaceutical care plan has a positive infl u-ence on the decrease of the CVR in the hypertensive population with and without diabetes, showing a statistically signifi cant decrease in the diabetic-hypertensive population.

LB.01.16 FACTORS RELATED TO LEFT VENTRICULAR

HYPERTROPHY IN ONE YEAR FOLLOW-UP OF

HEMODIALYSIS PATIENTS

A. Laucyte-Cibulskiene1,2, M. Petrylaityte2, M. Gudynaite1, D. Sukackiene1,2, M. Petraviciute3, L. Rimsevicius1,2, L. Ryliskyte4, M. Miglinas1,2, K. Strupas2,5. 1Centre of Nephrology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania, 2Faculty of Medicine, Vilnius University, Vilnius, Lithuania, 3Centre of Endocrinology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithua-nia, 4Centre of Cardiology and Angiology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania, 5Centre of Abdominal Surgery, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania

Objective: The phenomenon of cardiac remodeling in dialysis population which leads to high prevalence of cardiovascular disease is every day burden for ne-phrologists. We aimed to analyze which factors could better indicate the presence of left ventricular hypertrophy in dialysis population.

Design and method: 60 stable hemodialysis patients were screened for a prospec-tive study. 45 patients had all data and met the inclusion criteria (no previous car-diovascular events, no cerebrovascular events). The calculated effect size for this population is 0.4052 (a 0.05, b 0.90). Blood tests (including beta2-microglobulin, cystatin C), carotid femoral pulse wave velocity (cfPWV), left ventricular mass (LVM) and index, left ventricular end diastolic diameter, relative wall thickness, mean wall thickness and left ventricular ejection fraction were evaluated twice, average 1 year apart was also tested.

Results: LVM and LVM index correlated with cystatin C level (r = 0.5141, p = 0.0085 and r = 0.4381, p = 0.0284 respectively), beta2-microglobulin concen-tration (r = 0.5759, p = 0.0025 and r = 0.5136, p = 0.0086 respectively). Change in LVM and LVM index within one year follow-up correlated with change in cf-PWV (r = 0.5201, p = 0.0468 and r = 0.5518, p = 0.0266 respectively). Left ven-tricular end diastolic diameter, and MWT also strongly correlated with beta2-mi-croglobulin and cystatinC. The strongest relationship revealed by linear regression indicated that for an increase of 1 m/s in cfPWV the expected increase in LVM index is 5.505 g/m2 (r-squared 0.3695, p = 0.3244, 95%CI [1.38;9.62]). During one year follow up the reverse cardiac remodeling was observed in some patients.

Conclusions: Change in carotid-femoral pulse wave velocity within 1 year in di-alysis population without previous cardiovascular or cerebrovascular events is as-sociated with change in LVM index and has better descriptive value than cystatin C or beta2-microglobulin.

LB.01.17 SEASONAL ARTERIAL STIFFNESS CHANGES

IN TREATED HYPERTENSIVE PATIENTS WITH

DIFFERENT BLOOD PRESSURE PHENOTYPES

Y. Koshelyaevskaya1, M. Smirnova1, V. Gorbunov1, D. Volkov1, A. Deev1,S. Boytsov1, N. Furman2, P. Dolotovskaia2, M. Shamiunov2. 1National Research Center for Preventive Medicine, Moscow, Russia, 2Saratov State Medical Univer-sity, Institute of Cardiology, Saratov, Russia

Objective: It is known that blood pressure (BP) is generally higher in winter (W) than in summer (S). But the studying of seasonal BP changes mechanisms is incomplete. Some scientists supposed that one of the mechanisms is seasonal dynamics of arterial stiffness (AS). The seasonal BP and AS changes are probably interrelated with seasonal dynamics of cardiovascular morbidity and mortality. We supposed, the relation between ambulatory BP (ABP) and clinical BP (CBP) [BP phenotypes; BPPh] might also depend on the season and AS. The aim of our study was to estimate the seasonal differences in AS parameters in treated hyper-tensive patients (THP) with different BPPh.

Design and method: The ambulatory patients from the ABP monitoring data-base were selected according with criteria: antihypertensive treatment (>2 weeks; AHT), CBP and ABPM records in W and S. ABPM was performed by the device with algorithm for AS calculation. BPPh defi nitions: normotension (NT), masked uncontrolled hypertension (MUH), uncontrolled hypertension (UH). AS param-eters (mean for 24 h): pulse wave velocity (PWV), maximum rate of BP increase (Dp(dt)), central augmentation index (AIxao) and peripheral (AIx).

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Results: 469 patients were selected. The main characteristics of BPPh are pre-sented in the Table1. The antihypertensive therapy did not differ signifi cantly in 3 groups. The seasonal dynamics of mean AS parameters with sex and age adjustment in BPPh differed slightly. We compared AS parameters (in quintiles from min to max) between BPPh. The upper (3–5th) quintiles of the most AS indices (Dp(dt), AIx, AIxao) in MUH and UH were signifi cantly higher than in NT(p < 0.05). But this pattern was found for the S only. The 4th quintiles of PWV was higher in UH vs. NT in W and S (p < 0.005). We found no substantial differ-ences in AS parameters in UH vs. MUH

Conclusions: Our study confi rms seasonal changes in some of AS parameters in THP with different BPPh. The signifi cant differences of AS parameters in NT vs. MUH and the absence of these AS differences in most of the parameters in MUH vs. UH may be one of the confi rmations of the high cardiovascular risk in MH.

LB.01.20 ASSOCIATION BETWEEN HYPERTENSION AND

HEART FAILURE IN PATIENTS WITH CANCER

J. Díaz-Peromingo, A. Hermida-Ameijeiras, J. López-Paz, A. González-Quintela.Department of Internal Medicine. University Clinical Hospital, Santiago de Compostela, Spain

Objective: The incidence of cancer is constantly increasing and the mortality de-creasing in the last several decades. The improve in survival is related to the in-troduction of new anticancer drugs that, sometimes, revealed a large spectrum of cardiotoxicity manifestations. Our aim is to study the prevalence of hypertension, ischemic cardiac disease, heart failure in these patients and the possible relation with the presence of metastatic disease or not.

Design and method: Patients with known cancer with or without metastasis were included. Hematologic malignancies were excluded. Variables like age, sex, smoking habit, hypertension, heart failure or ischemic heart disease were includ-ed. A descriptive analysis was performed. To compare non-continuous variables, we used the Chi-square test.

Results: A total of 316 patients were included. Middle age: 72 years old (range 36–99; SD 15.085). Men: 220 (69.6%); women: 96 (30.4%). Currently smokers: 71 (22.5%), former smokers 89 (28.2%), and non-smokers 156 (49.4%). The prev-alence of hypertension was 55.1%, heart failure 27.5% and ischemic heart disease 23.4%. Regarding to the cancer status, 176 patients (55.7%) had tumours without metastasis, and 140 (44.3%) had metastatic disease. Chi-square analysis showed that patients without metastasis had more frequently heart failure (p = 0.015) and hypertension (p = 0.021). No differences were found regarding to sex, smoking habit or known ischemic heart disease.

Conclusions: 1.- In our population, most patients were men with a middle age around 70 years-old. 2.- The lack of metastatic disease was associated to the fact of having hypertension of previous heart failure. 3.- We do not found statistical asso-ciation between the presence of metastasis and known ischemic heart disease prob-ably, at least in part, because of the great proportion of non-smokers (half patients) in our study. 4.- Due to the potential cardiotoxicity of various new anticancer drugs, an adequate assessment of cardiovascular risk should be performed in these patients.

LB.01.21 ANALYSIS OF THE INFLUENCE OF THE CLASSICAL

CARDIOVASCULAR RISK FACTORS IN THE TIMES

AND QUALITY INDICATORS IN THE INTRAHOSPITAL

CARE FOR ACUTE ISCHEMIC STROKE

E.J. Martínez-Lerma1, B. Palazón1, J. Abellán-Huerta1,2, F.G. Clavel-Ruipérez1,3, P. Gómez1, A. Morales1, E. Carreón1, C. Sánchez-Vizcaino1, M. Leal-Hernández1, J. Abellán-Alemán1. 1Cátedra Riesgo Cardiovascular, Universidad Católica

UCAM, Murcia, Spain, 2Servicio de Cardiología. Hospital General de Almansa, Albacete, Spain, 3Servicio de Cardiología. Hospital Universitario Santa Lucía, Cartagena, Spain

Objective: To analyze and to know the prevalence of cardiovascular risk factors (CVRF) and their infl uence on the time and indicators of the intrahospital process of the stroke code.

Design and method: Descriptive cross-sectional study of patients with acute ischemic stroke treated with reperfusion therapies in a tertiary hospital between 2009–2016. Intrahospital times, quality indicators and the infl uence of CVRF were analyzed.

Results: We analyzed 376 patients with acute ischemic stroke treated with reper-fusion therapies, with a mean age of 68.42 years (Confi dence interval - CI - 95%: 67.08, 69.83) and a range of 13 years to 89 years; of which 18.4% were older than 80 years, and 9.6% were <or=50 years (stroke in young). 55.1% were males. Hy-pertension was the most prevalent CVRF (67.3% of patients), followed by atrial fi brillation (AF), 43.1%. Only 0.1% did not present any CVRF. Age and chronic enolism conditioned an extended hospital time. Age and diabetes were identifi ed as negative conditioning factors of the door-neuroimaging indicator <or =25 min-utes. No statistically signifi cant differences were found based on sex, hyperten-sion, hypercholesterolemia, AF or tobacco consumption.

Conclusions: Although the majority of patients with acute ischemic stroke pre-sented some CVRF and this fact poses an increased risk of suffering a cerebrovas-cular event, it has been objectifi ed that, in general, they do not receive a different in-hospital care in the acute phase of the stroke compared to those without CVRF.

PP.01.22 COMPARISON OF THE SPHYGMOCOR XCEL

DEVICE WITH APPLANATION TONOMETRY

FOR PULSE WAVE VELOCITY ASSESSMENT IN

CHILDREN AND ADOLESCENTS

S. Stabouli1, N. Printza1, J. Dotis1, C. Zervas1, K Chrysaidou1, O. Maliachova1,C. Antza2, V. Kotsis2, F. Papachristou1. 11st Department Pediatrics, Aristotle Uni-versity Thessaloniki, Thessaloniki, Greece, 23rd Department Medicine, Aristotle University Thessaloniki, Hypertension-24 h ABPM ESH Center Excellence, Thes-saloniki, Greece

Objective: Pulse wave velocity (PWV) is a well-recognized marker of arterial stiffness. Although the clinical value in children is not yet established its use is increasing in children and adolescents with cardiovascular risk factors. The gold-standard technique is tonometry, but this technique can be challenging, especially when used on children. The purpose of this study was to validate PWV assess-ment with novel oscillometric device (SphygmoCor XCEL) for use in children and adolescents.

Design and method: Children and adolescents aged 5–20 years were recruited subsequently. Carotid-femoral PWV (PWVton) was measured by applanation to-nometry with the “classic’’ Sphygmocor device and by SphygmoCor XCEL device (PWVosc). Regression analysis and Bland-Altman plots were used for comparison of the tonometer- to oscillometric-based method. ARTERY Society guidelines cri-teria were used to assess the performance of the oscillometric device.

Results: Sixty-eight children and adolescents with mean age 11.5 ± 3.6 years, 32 (47.1%) male were included in the analysis. Mean pulse transit time was 81.48 ± 12.55 sec by the tonometric method, and 81.63 ± 12.24 sec by the os-cillometric method (P = NS). Mean PWVton was 4.85 ± 0.81 m/sec and mean PWVosc 4.75 ± 0.81 m/sec. The mean difference between the two devices was 0.09 ± 0.47 m/sec (P = NS) and the accuracy of the oscillometric device was rated “excellent’’ according to the ARTERY Society guidelines (mean difference less than 0.5 m/s, SD of difference less than 0.8 m/s). Bland-Altman analysis showed good agreement with LoA ranging from -0.83 to 1.01. No proportional bias was detected by linear regression analysis with dependent variable the mean differ-ence between devices and independent variable mean PWV of the two devices (B = 0.005, P = NS). In ANCOVA analysis, age and systolic blood pressure had no statistically signifi cant effect on the mean difference between devices.

Conclusions: The new oscillometric SphygmoCor XCEL device provides equiva-lent results for PWV values to those obtained by tonometry in children and ado-lescents. Thus, the SphygmoCor XCEL device is appropriate for assessing PWV in studies in the pediatric population.

LB.01.23 BLOOD PRESSURE AND VASCULAR PHENOTYPE

IN CHILDREN AND ADOLESCENTS WITH SICKLE/

BETA-THALASSEMIA

S. Stabouli1, M. Economou1, N. Printza1, A. Teli1, J. Dotis1, E. Papadopoulou1, C. Antza2, V. Kotsis2, F. Papachristou1, D. Zafeiriou1. 11st Department Pediatrics,

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Aristotle University Thessaloniki, Thessaloniki, Greece, 23rd Department Medi-cine, Aristotle University Thessaloniki, Hypertension-24 h ABPM ESH Center Excellence, Thessaloniki, Greece

Objective: Blood pressure (BP) in patients with sickle cell disease has been re-ported to be lower than in the general population. Despite low BP, sickle cell disease is associated with increased risk of cardiovascular disease. The aim of the present study was to investigate the prevalence of BP phenotypes and possible differences in arterial stiffness in pediatric patients with sickle/beta thalassemia (S/b-thal) compared with matched controls.

Design and method: We included in the study 16 pediatric S/b-thal patients and 16 controls matched for age and sex. Controls were otherwise healthy children and adolescents visiting our hypertension center for suspected hypertension. All patients underwent ambulatory BP monitoring and measurement of carotid-femo-ral pulse wave velocity (cf-PWV).

Results: Mean age of the study population was 13.30 ± 4.63 years (34.4% boys). Despite lower offi ce systolic BP levels (115.43 ± 10.03 vs. 123.37 ± 11.92 mmHg, S/b-thal vs. controls, P = 0.05), there was no statistical signifi cant dif-ference in 24 h, daytime and nighttime BP. Twenty fi ve % of the S/b-thal patients and 43.8% of the controls presented offi ce hypertension (P = NS), while 18.8% of the S/b-thal patients and 25% of the controls presented hypertension by ambula-tory BP levels (P = NS). All S/b-thal patients with offi ce hypertension presented normal ambulatory BP values (white-coat hypertension). None of the S/b-thal patients had daytime hypertension, while all 18.8% presented nighttime hyperten-sion with offi ce normotension < 90th percentile (masked hypertension). S/b-thal patients and controls presented equal prevalence of masked hypertension (19%). S/b-thal patients presented also similar levels of cf-PWV with controls (7.1 ± 1.25 vs. 7.25 ± 1.43 m/sec, P = NS) and an 18.8% of the patients presented cf-PWV levels above the 95th pc for age and sex.

Conclusions: Children and adolescents with S/b-thal present similar prevalence of BP phenotypes and levels of cf-PWV with pediatric population referred for suspected hypertension. A signifi cant number of children and adolescents with S/b-thal may have nighttime hypertension despite normal offi ce BP levels.

LB.01.24 HOME BLOOD PRESSURE NORMALCY IN NON-

EUROPEAN ADOLESCENTS

T. Jardim, C. Carneiro, P. Morais, K. Mendonça, T. Povoa, W. Roriz,F. Nascente, W. Barroso, A. Sousa, P. Jardim. Hypertension League, Federal Uni-versity of Goias, Goiania, Brazil

Objective: Evidence on normal range of home blood pressure (BP) in adolescents relies on only one European study. This study aims to investigate the normal range of home BP in a healthy non-European population of adolescents.

Design and method: Cross-sectional study with a representative sample of secondary school students (12–17 years) from a Brazilian capital. Adolescents’ heights were classifi ed in percentiles according to age and gender. Height percen-tiles were divided in <= 50th or >50th percentile. The home BP protocol included two day-time and two evening-time measurements over 6 days. Exams were con-sidered valid with at least 12 measurements.

Results: A total of 1024 adolescents were included, mean age 14.68 ± 1.61 years, predominantly female (52.4%), from public schools (68.4%) and non-white (51.3%). The 50th (midpoint of distribution) and the 95th percentile (upper normal limit) for systolic and diastolic home BP in adolescents are provided by gender, age and height percentiles. There was a marked increase in the estimated 95th percentile for systolic home BP with increasing age in males for both height percentiles examined (16mmHg for <= 50th percentile and 14.5 mmHg for >50th percentile) and less so for diastolic home BP (1mmHg and 5mmHg, respectively). In females the 95th percentile increase with age was less signifi cant for systolic and similar for diastolic BP when compared to males in the two height percentiles evaluated (6/2 mmHg for <= 50th percentile and 4/4 mmHg for >50th percentile).

Conclusions: Reference values for home BP by height percentiles for age and sex in a non-European population of adolescents are provided.

LB.01.25 ESTIMATION OF DIETARY SALT INTAKE BY 24-H

URINE AND ITS ASSOCIATION WITH BLOOD

PRESSURE IN CHINESE URBAN CHILDREN

J. Dong1, J. Mi2. 1Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China, 2Capital Institute of Pediatrics, Department of Epidemi-ology, Beijing, China

Objective: High salt intake is recognized as a risk factor for hypertension in children and adults. However, limited data on dietary salt intake of Chinese chil-dren were available. Hence, this study aimed to estimate the dietary salt intake of

Chinese urban children aged 9–17 years by 24 h urinary sodium excretion and its association with blood pressure.

Design and method: Our study was a multi-center, cross-sectional survey. Us-ing a multi-stage clustered sampling method, three cities in the northern region (Changchun, Beijing and Jinan) and two cities in the southern region (Shanghai and Chengdu) were selected. Our study consisted of 1 076 participants with col-lections of 24-h urine samples and three measurements of blood pressure. Linear regression model and binary logistic regression analysis was used to examine the association between sodium excretion and blood pressure. Prehypertension/hypertension was diagnosed by Chinese Children Blood Pressure References, as blood pressure equal or more than 90th percentile by age and gender.

Results: The average of urinary sodium excretion of Chinese urban children was 4.7 ± 2.8 g/day, with an estimation of dietary salt intake 11.9 ± 2.8 g/day, and 86.5% of children had excessive salt intake according to WHO recommendation (equal or less than 5.0 g/day for salt intake). Boys had a slightly higher sodium excretion than that of girls (p = 0.011). No signifi cant difference of sodium ex-cretion was found between the northern and southern regions. Urinary excretion of sodium was signifi cantly correlated with systolic blood pressure (� = 0.272, p = 0.024) but not with diastolic blood pressure (� = 0.125, p = 0.195) after ad-justment of age, gender and body mass index. Children who took in high salt had a mildly higher risk of getting prehypertension/ hypertension (odds ratio = 1.108, 95% confi dence interval: 1.058–1.161).

Conclusions: It is alarming that the majority of China urban children aged 9–17 years old had excessive salt intake. Sound policies must be taken to reduce the sodium content in children’s diet to decrease cardiovascular risk in the future.

LB.01.26 RECLASSIFICATION OF ELEVATED BLOOD

PRESSURE SUBTYPES AND STAGES BASED ON

REPEATED MEASUREMENTS AMONG CHINESE

SCHOOLCHILDREN

H. Dong1, Y. Yan2, H. Fan1, J. Liu2, H. Cheng2, X. Zhao2, G. Huang2, J. Mi2. 1Peking Union Medical College; Capital Institute of Pediatrics, Beijing, China, 2Capital Institute of Pediatrics, Beijing, China

Objective: Due to the variability of childhood blood pressure(BP), several guidelines recommend that elevated BP (EBP) in children and adolescents should be deter-mined based on at least three separate visits. However, data regarding the subtypes and their fl uctuations during this process is limited. In this study, we sought to assess the proportion and change of EBP classifi cations over repeated measurements.

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Design and method: Oscillometric BP measurements were obtained from a gen-eral population, comprising 44,328 children and adolescents aged 6–17 years old from six urban cities in mainland China. Those with EBP (at least 95th centile) were screened a second or third time at a month interval. In addition, EBP at each screening was further classifi ed according to BP stages (stage 1 and stage 2) and BP subtypes (isolated systolic EBP, isolated diastolic EBP, and systolic-diastolic EBP).

Results: After 3 separate consecutive visits, isolated systolic EBP and stage 1 EBP sustained to be the major type of EBP subtypes and stages. Meanwhile, there were increases in the relative proportion of isolated systolic EBP, systolic-diastol-ic EBP and stage 2 EBP, and concurrent decreases in isolated diastolic EBP and stage1 EBP. In the last two visits, approximately 50% of subjects diagnosed with EBP at a former visit had their BP normalized, which was mostly found among those with isolated diastolic EBP and those with stage 1 EBP. Apart from that, subjects with isolated diastolic EBP and those with stage 2 EBP exhibited higher proportion of reclassifi cation within EBP subtypes and stages; they were more likely to shift to isolated systolic EBP and stage 1 EBP, respectively. Compared with normotensives, subjects that changed their BP classifi cation were younger, with higher proportion of boys and higher levels of heart rate, body mass index, and triglyceride.

Conclusions: After 3 repeated measurements, less than half of the population di-agnosed with EBP at the fi rst visit maintained their classifi cation, which was even less in the group of isolated diastolic EBP. Repeated measurements in obese chil-dren (<12 years) may lead to more accurate classifi cation of BP types and stages.

LB.01.27 THE IMPACT OF THE ECONOMIC CRISIS ON

HYPERTENSION IN CHILDREN

X. Florou, M. Chania. General Hospital, Sparta, Greece

Objective: In recent years, Greece has been going through a period of economic crisis with social and economic implications, changes in the family budget and infl uences on the eating habits of children, resulting in child obesity in Greece being in the fi rst place globally whereas in other countries it has started to show a decline. The latest report from the Organisation for Economic Co-operation and Development (OECD) shows that 44% of schoolboys and 38% of schoolgirls in Greece are obese or overweight.

Design and method: The purpose of the study is to determine the existence of an inverse relationship between childhood obesity, and by extension of childhood hypertension, and the economic crisis plaguing Greek households.This is a systematic review study. The relationship between economic household data and childhood hypertension during the last 5 years of the economic crisis was researched in Greek and international literature found in electronic databases (MEDLINE, PUBMED).

Results: It is striking that, the more the annual family income decreases, the greater the rate of childhood obesity is. According to research, the economic crisis being experienced by Greece and the reduction of income leads to cheap calorifi c diet resulting in weight gain in children and adolescents, thus putting the health of Greek children at risk. Numerous studies have shown that 9–13% of overweight children have elevated blood pressure, as do 30% of obese children. Also, 65% of fi ve to ten-year-old obese children, exhibit at least one of the main cardiovascular risk factors, i.e., hypertension and hyperlipidaemia.

Conclusions: The economic conditions have affected the diet and lifestyle of Greek people. So, the frequency of hypertension in children has increased in families with low income, mainly due to changes in eating habits, rendering it necessary to educate children and parents on the value of a healthy and balanced diet, and more specifi cally of the Mediterranean diet.

LB.01.28 PREVALENCE OF HYPERTENSION AMONG

CHINESE CHILDREN: A CROSS-SECTIONAL

SURVEY

H. Fan1, Y. Yan2, J. Mi2. 1Graduate School of Peking Union Medical College,Beijing, China, 2Department of Epidemiology, Capital Institute of Pediatrics,Beijing, China

Objective: It was recommended that the diagnosis of childhood hypertension should be established on three separate occasions. The prevalence of childhood hypertension remains unknown in China. The goal of our study was to determine the prevalence of childhood hypertension in China, and examined the association between weight status and hypertension.

Design and method: Data were obtained from a sample of 45262 Chinese chil-dren aged 6–17 years. Initial measurements included three oscillometric blood pressure (BP) readings. Children with elevated BP were screened a second or

third time at 10-week intervals. Hypertension was defi ned as persistently elevated BP on all three occasions. Normal weight, overweight and obesity were evaluated based on age- and sex-specifi c BMI percentiles as recommended by the Inter-national Obesity Task Force. Logistical regression model was used to assess the association between weight status and hypertension after controlling for sex, age and other covariates.

Results: The prevalence of elevated BP decreased across visits, from 16.9% during the fi rst visit to 4.2% during the third visit. The prevalence of childhood hyperten-sion was also 4.2%. Isolated systolic hypertension was the most frequent subtype of childhood hypertension. In addition, compared to children with normal weight, children with overweight or obesity were more likely to have hypertension.

Conclusions: Childhood hypertension has been an emerging public-health prob-lem in China. Our fi ndings emphasized the importance of maintaining healthy weight in the prevention of childhood hypertension.

LB.01.29 THE INFLUENCE OF ARTERIAL HYPERTENSION ON

LEFT VENTRICULAR REMODELING IN PATIENTS

WITH ST-ELEVATED MYOCARDIAL INFARCTION

S. Tadic, A. Stojsic-Milosavljevic, A. Ilic, R. Jung, S. Stojsic, M. Stefanovic, M. Sladojevic, A. Milovancev. Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia

Objective: Patients with ST-elevated myocardial infarction (STEMI) treated by primary angioplasty (pPCI) will develop postinfarctial remodeling (PIR) in one third of the cases. The purpose of this study is to determine infl uence of arterial hypertension (AHT) as predictor.

Design and method: 210 patients with a fi rst acute anterior STEMI underwent echocardiography in the fi rst 24hrs and again after 6 months, after which they were divided into: remodeling (RM, n = 55; 26%) and non-remodeling (NRM, n = 155; 74%) groups. The criteria for remodeling was increasing of left ventricu-lar end-diastolic volume >20% after 6 months.

Results: There were no statistical signifi cant difference in prior AHT (47,3% vs. 56,1%, p = 0,258), AHT at admission (45,5% vs. 51%, p = 0,069) or aver-age mean arterial pressure (102,09 vs. 104,83 mmHg, p = 0,323) between groups (RM vs. NRM). Patients with prior AHT had increase LV mass (59,3% vs. 33,3%, p = 0,021), but no difference in RM vs. NRM group (56,4% vs. 50,3%, p = 0,443). Left ventricular remodeling (determined by LV mass and relative wall thickness) on early echocardiography were similar in both groups (RM vs. NRM, p = 0,447): normal (16,4% vs. 11%), concentric hypertrophy (45,5% vs. 43,2%), concentric remodeling (27,3% vs. 37,4%) and eccentric hypertrophy (10,9% vs. 8,4%). The independent early predictors were: no-refl ow phenomenon after pPCI (OR = 27.7 95% CI, p < 0.0001) and at admission Killip class 2–4 (OR = 3.4 95% CI, p = 0.003). Also, strong predictors were Wall motion score index >2 (OR 21.6 95% CI, p < 0.0001) and incomplete ST-resolution (OR 2.0 95% CI, p = 0,024). RM group had more frequent MACE during one year follow-up: re-peated hospitalizations (61.8% vs. 22.6%; p < 0,0001), re-infarctions (20% vs. 7.1%; p = 0.007), repeated coronary angiography (45.5% vs. 18.1%; p < 0,0001), re-PCI ((30.9% vs 11%; p = 0.001) and mostly, re-hospitalizations due to heart failure (40% vs 2.6%; p < 0.0001). Mortality rate in RM group was 5.5%.

Conclusions: For the patients with a fi rst acute anterior STEMI, treated by pPCI, development of PIR is absolutely independent of arterial hypertension. Remodel-ing patients will have a more frequent incidence of MACE and mortality.

LB.01.32 URINARY METABOLIC SIGNATURE OF PRIMARY

ALDOSTERONISM: GENDER AND SUBTYPE

SPECIFIC ALTERATIONS

A. D’Alessandro1, A. Lana2, F. Morandini3, F. Pizzolo3, F. Zorzi3, P. Mulatero4, L. Zolla2, O. Olivieri3. 1Departments of Biochemistry and Molecular Genetic, University of Colorado Denver, Anschutz Medical Campus, Aurora, USA, 2De-partment of Ecological and Biological Sciences, Tuscia University, Viterbo, Italy, 3Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy, 4Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy

Objective: Current work up for primary aldosteronism diagnosis requires, from the initial suspicious to the fi nal subtype classifi cation, complex and expensive tests which include invasive approaches performed by highly skilled personnel; appropriate markers for the defi nition of subtype are thus greatly desirable. Re-cently we demonstrated that an aldosterone excess was associated with subtype-specifi c features in urinary proteome.

Design and method: We performed a mass spectrometry-based metabolomics analysis looking for specifi c urinary molecular signatures of primary aldosteronism.

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Abstracts e169

We studied patients affected by essential hypertension and primary aldosteronism and matched-healthy subjects. The study was planned to take into account gender-related differences, while adopting advanced UHPLC-MS metabolomics analyses.

Results: As general results, we recognized statistically signifi cant changes (p < 0.05 ANOVA, Fc>1.5) of metabolites involved in central carbon, energy and nitrogen metabolism, especially purine and pyrimidine nucleosides and precur-sors, and free amino acids. Partial least squares discriminant analysis interpre-tation provided strong evidence about a disease-specifi c metabolic pattern with dAMP, diiodothyronine and 5-methoxytryptophan as leading factors, and a sex-specifi c metabolic pattern, associated with orotidine 5-phosphate, N-acetylala-nine, hydroxyproline and cysteine.

Conclusions: Despite the exploratory nature of this study, preliminary results highlight for the fi rst time specifi c urinary metabolic signatures that can discrimi-nate gender- and PA-subtype phenotypes.

LB.01.33 DRUG ADHERENCE AND CLINICAL OUTCOME

IN RESPONSE TO PERINDOPRIL/AMLODIPINE

FIXED DOSE COMBINATION IN AN ITALIAN

CLINICAL PRACTICE SETTING. THE AMLODIPINE-

PERINDOPRIL IN REAL SETTINGS (AMPERES)

STUDY

C. Borghi1, L. Degli Esposti2, V. Perrone2, S. Buda1. 1Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy, 2Clicon S. r. l. Health Economics and Outcomes Research, Ravenna, Italy

Objective: The purpose of this study was to assess in real practice the effect on adherence of a switch from a single- or two-pills therapy (SPT/FC) of perindopril and/or amlodipine to fi xed-dose combination (FDC) of the same drugs.

Methods: This was a retrospective cohort study, performed in 3 Italian Local Health Units. We selected all subjects ? 18 years, who received at least one pre-scription of antihypertensive drugs between 01/01/2010 and 31/12/2014. For each patient we evaluated the adherence to different schedule of perindopril/amlodip-ine administration schedule during the two 12-month periods preceding and fol-lowing the index date. We also evaluated the rate of major CV events, the changes in concomitant treatment and the economic implications of drugs switch. Changes in adherence level had been compared in subjects who shifted to the FDC of perin-dopril/amlodipine after the ID as well as in patients who did not.

Design and method: A total of 24,020 subjects were analyzed. Subjects treated with the free dose combination switched more frequently to FDC of to perindo-pril/amlodipine than subjects treated with SPT (p < 0.001). Adherence to treat-ment was higher in the 3,597 subjects who switched to the perindopril/amlodipine FDC therapy, than in the 20,423 subjects who did not. The rate of major CV events was lower in patients with adherence > 80% who also showed a higher rate of concomitant treatment reduction (36.5% vs. 21.3%; p = 0.005). No differences have been observed in the drug costs after switch.

Results: Our results show that, the real-world use of perindopril/amlodipine as FDC increases the rate of stay-on-therapy, improves the antihypertensive drug schedule and reduces the rate of major CV events in subjects previously treated with the same drugs as a two pills combination or as SPT.

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e170 Abstracts

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved

SATURDAY

POSTERS

POSTER SESSION

ORAL PRESENTATIONS IN POSTER AREA BP01:

COMPLICATIONS AND COMORBIDITIES

BP.01.01 COMBINED MONITORING OF CARDIAC

FUNCTION AND SLEEP PARAMETERS: FUTURE

PERSPECTIVES

L. Korostovtseva1, M. Bochkarev1, A. Tataraidze2, V. Gumenniy3, E. Yakushenko3, V. Tikhonenko3, Y. Sviryaev1, A. Konradi1. 1V. A. Almazov Federal North-West Medical Research Centre - Hypertension Department, St Petersburg, Russia, 2Bauman Moscow State Technical University, Moscow, Russia, 3Closed Corpora-tion INKART, St Petersburg, Russia

Objective: Background. Timely verifi cation and treatment of sleep disorders are crucial for the prevention and control of cardiovascular diseases, above all hyper-tension. However, specialized sleep diagnostics is accessible only for a minority of patients. The development of various diagnostic approaches and screening tools appears to be helpful. In particular, routinely used long-term electrocardiogram (ECG) and blood pressure (BP) monitoring is promising for simultaneous assess-ment of both cardiovascular and sleep parameters. The aim of our study was to develop an objective approach for the identifi cation of sleep structure and sleep-wake cycle based on the cardiorespiratory and activity parameters recorded during the long-term ECG and BP monitoring.

Design and method: We recorded simultaneously 24-h cardiovascular (12-lead ECG and BP; three axis accelerometer fi xed on the right V intercostal space; im-pedance pneumography) monitoring (Kardiotekhnika, Inkart, Russia) and noc-turnal PSG (Embla N7000, Natus, USA) in 23 subjects (aged 17–75 years, 13 males). Based on PSG analysis, hypnograms (sleep structure) were verifi ed by an experienced specialist. From ECG/BP monitoring the data from accelerometer, ECG and respiratory pattern were obtained. Based on diurnal activity sleep and wake periods were identifi ed (modifi ed Koele and Kripke’s algorithm). Based on the analysis of heart rate variability and respiration variability a specifi ed classifi -cation of sleep stages was developed (Fig.). The accuracy, sensitivity and specifi c-ity of the developed algorithms were evaluated.

Results: Our approach based on actigraphy analysis enabled classifi cation of sleep and wakefulness with specifi city of 80% and sensitivity of 86%. The combined analysis of both heart rate variability and respiratory signals allowed a 3-stage sleep classifi cation (light, deep and rapid-eye-movement sleep) with the accuracy of 71.4% and comparatively high inter-rater agreement (Cohen’s kappa 0.58 ± 0.16). Sleep effi ciency error was 6.7 ± 6.6 %, total sleep time error - 33.2 ± 45.3 min, sleep onset latency error - 22.3 ± 35.8 min.

Conclusions: The implementation of the proposed combined analysis of activity, heart rate variability and respiration pattern in the ECG/BP monitoring systems is a promising alternative to specialized sleep diagnostic studies to be used in routine cardiovascular medicine practice.

BP.01.02 URIC ACID AND NEW ONSET LEFT VENTRICULAR

HYPERTROPHY: FINDINGS FROM THE PAMELA

POPULATION

C. Cuspidi1, R. Facchetti1, M. Bombelli1, C. Sala1, M. Tadic2, G. Grassi1, G. Mancia1.1Department of Medicine and Surgery, University of Milano-Bicocca, Milan,Italy, 2Department of Medicine and Surgery, University of Milano-Bicocca,Milan, Italy, 3Department of Medicine and Surgery, University of Milano-Bicocca,

Milan, Italy, 4Department of Clinical Sciences and Community Health University of Milano and Fondazione Ospedale Maggiore Policlinico, Milan, Italy, 5Depart-ment of Cardiology, Charité-University-Medicine Berlin Campus Virchow Klinikum (CVK) Augustenburger Platz1, 1335, Berlin, Germany, 6Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy, 7Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

Objective: The association between serum uric acid (SUA) and left ventricular hypertrophy (LVH) is controversial and the ability of SUA in predicting incident LVH remains unsettled. Thus, we evaluated the relationship of SUA with new-onset echocardiographic LVH over a 10-year period in subjects of the general population enrolled in the PAMELA study.

Design and method: The study included 960 subjects with normal LV mass index (LVMI) at baseline echocardiographic evaluation and a readable echocardiogram at the end of follow-up. Cut-points for LVH were derived from reference values of the healthy fraction of the PAMELA population.

Results: Over a 10-year period 258 participants (26.9%) progressed to LVH. The incidence of new onset LVH increased from the lowest (23%) to intermediate (25%) and the highest baseline SUA tertile (32%). After adjusting for confound-ers (not including body mass index), each 1 mg/dl increase in SUA entailed a 26% higher risk of incident LVH. Adjusted odd ratio of LVH risk in the high-est SUA tertile was 96% higher than in the lowest tertile (OR = 1.966, 95% CI 1.158–3.339, p = 0.0123). Correction for body mass index reduced the magnitude and statistical signifi cance of ORs.

Conclusions: The study shows that SUA is a predictor of long-term echocar-diographic changes from normal LVMI to LVH in a community sample. Thus, life-style and pharmacologic measures aimed to reduce SUA levels may concur to preventing LVH development in the general population.

BP.01.03 ASSOCIATION OF INTER-ARM BLOOD PRESSURE

WITH AYSMPTOMATIC INTRACRANIAL AND

EXTRACRANIAL ARTERIAL STENOSIS IN

HYPERTENSION PATIENTS

Y. Wang1, J. Zhang1, Y. Qian1, X. Tang1, H. Ling2, K. Chen2, Y. Li1, P. Gao1,D. Zhu1. 1Research Center for Hypertension Management and Prevention in Community, Shanghai Key Laboratory of Hypertension, Shanghai, China,2Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

Objective: Inter-arm blood pressure (BP) difference has been associated with ischemic stroke. Local atherosclerosis of stroke differ among vulnerable indi-viduals, whereas intracranial arterial stenosis (ICAS) is more frequently affected Asians, and extracranial arterial stenosis (ECAS) is more prevalent among whites.

Design and method: We hereby sought to explore the association of inter-arm BP difference with ICAS and ECAS in stroke-free hypertensive patients in Chinese population. All the 885 subjects were evaluated for the presence and severity of ICAS and ECAS through computerized tomographic angiography. Both arm BP was measured simultaneously by the Vascular profi ler 1000 device.

Results: In the continuous study, ICAS was associated with age, male, aver-age arm SBP, diabetes, anti-hypertensive treatment and inter-arm DBP difference. ECAS was associated with age, inter-arm SBP and LDL. In the categorical study,

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the subjects with the top quartile of inter-arm DBP difference (>4 mmHg) showed signifi cantly higher risk of ICAS (OR = 2.038; 95% CI, 1.347~4.177). The risk of ICAS in patients with inter-arm DBP difference > = 5mmHg was 103% higher (P = 0.009). And the participants with the top quartile of inter-arm SBP difference (>6 mmHg) showed higher risk of ECAS (OR = 2.031; 95% CI, 1.195~3.452). The risk of ECAS in patients with inter-arm SBP difference > = 10 mmHg was 225% higher.

Conclusions: In conclusion, we here reported a diverse association of inter-arm SBP/DBP difference with the ICAS/ECAS. Inter-arm DBP difference might be the early symbol of ICAS in Chinese population, which need further verifi cation in long-term cohort study.

BP.01.04 THE ROLE OF ARTERIAL HYPERTENSION IN THE

DEVELOPMENT OF CHRONIC HEART FAILURE

(ACCORDING TO THE RUSSIAN CHF REGISTRY)

N. Lazareva1, E. Oshchepkova2, S. Tereschenko3. 1Cardiology Reseach Complex, Moscow, Russia, 2Cardiology Reseach Complex, Moscow, Russia, 3Cardiology Reseach Complex, Moscow, Russia

Objective: to study the frequency of arterial hypertension (AH) in the develop-ment of CHF and gender peculiarities in patients with AH suffering from CHF

Design and method: The analysis includes medical data for 6465 patients with CHF (average age 65 ± 7 ys old), of which 58% (n = 3774) were m, of I-IY class NYHA undergone examination and treatment in 6 polyclinics and 5 hospitals between 2010–2015. The data was analysed using statistical software STATISTICA 10

Results: AH was observed at the time of examination in 40% of patients (n = 2164) in the selection of patients with CHF, of which 32% (n = 1734) had I stage hypertension, 6% (n = 328) – II stage and 2% (n = 102) III stage hypertension. 56% of patients with CHF (n = 3124) at the moment of ex-amination had BP < 140/90 mm Hg (average SBP was 123 ± 5.6 and DBP - 78 ± 4.7 mm Hg). Arterial hypotonia was observed in 2% (n = 136) patients with CHF. F were suffering from hypertension certainly more often – 87% (n = 2333), 6% registered stroke,TIA (n = 171), 11% (n = 291) – according to the ECG data atrial f ibrillation (permanent). M had CHD among etio-logical factors with certainly higher registered old MI in medical history in 54% (n = 2036) and in 26% of cases for f. According to the ECG data 37% of f suffered from LVH certainly more often with the figure equal to 30% for m. According to the ECG data 30% of m (n = 1156) suffered from Q heart attack certainly more often, 21% (n = 804) suffered from non-Q heart attack with the figures equal to 10% and 3% respectively for f. F patients more often register II and III stage (45% and 39% respectively) of CKD with glomerular filtration rate calculated according to MDRD formula (ml/min/1.73), while in m patients I and II stages of CKD (30% and 55% respec-tively) is more often.

Conclusions: In female patients arterial hypertension is observed more often in CHF ethiology; TIA, atrial fi brillation (ECG), left ventricular hypertrophy – in medical history. In male patients CHF-CHD is orbserved in ethiology and an old MI – in medical history.

BP.01.05 IMPACT OF 24-H BLOOD PRESSURE MONITORING

ON OBJECTIVE SLEEP DURATION AND

FRAGMENTATION IN RESISTANT HYPERTENSIVE

PATIENTS

R.M. Bruno1, M. Di Galante2, T. Banfi 3, M. Di Pilla1, S. Taddei1, U. Faraguna1,2,3. 1University of Pisa, Pisa, Italy, 2Fondazione Stella Maris, Pisa, Italy, 3Scuola Superiore Sant’Anna, Pisa, Italy

Objective: 24-h ambulatory blood pressure monitoring (ABPM) is crucial for diagnosis of treatment-resistant hypertension (RH). However, repetitive cuff in-fl ations during night might induce sleep deprivation and hamper physiological nocturnal BP fall. The study was aimed at investigating the impact of the ABPM on sleep duration and fragmentation in RH patients.

Design and method: 20 RH patients and 13 healthy controls (HC) were recruited and underwent 7-day actigraphy and ABPM. The following parameters were cal-culated on the whole week and separately for the ABPM night: total sleep time (TSTtot and TSTABPM), wake after sleep onset (WASOtot and WASOABPM) and sleep effi ciency (SEtot and SEABPM).

Results: RH patients were older (63 ± 11 vs 27 ± 4 years, p < 0.001), had higher 24-h (135 ± 16/78 ± 16 vs 122 ± 11/74 ± 5mmHg, p = 0.01 and p = 0.42) and nighttime BP (130 ± 17/72 ± 14 vs 106 ± 11/62 ± 7 mmHg, p < 0.001 for both) and a reduced dipping (6 ± 6 vs 18 ± 5%, p < 0.001) than HC.

RH had a lower TSTtot than HC (6.4 ± 1.1 vs 7.5 ± 0.9 h, p < 0.01). TSTABPM was not reduced during the ABPM night in both groups (6.8 ± 1.3 and 7.7 ± 1.4, p = ns vs TSTtot for both). However, WASOABPM tended to be longer than WA-SOtot in RH (RH: 73 ± 34 vs 61 ± 29 min, p = 0.07; HC 30 ± 24 vs 27 ± 17 min, p = ns), and SEABPM thus tended to be reduced in RH (84.4 ± 7.2 vs 86.2 ± 7.2%, p = 0.09) but not in HC (93.7 ± 3.2 vs 93.9 ± 5.0 p = 0.88). None of the consid-ered sleep parameters were correlated with 24h-BP in HC and RH.

Conclusions: ABPM did not signifi cantly infl uence objective sleep duration and only marginally induce sleep fragmentation, thus can be safely used for diagnosis of resistant hypertension.

BP.01.06 SLEEVE GASTRECTOMY VS ROUX-EN-Y GASTRIC

BYPASS. EFFECT ON METABOLIC COMORBIDITIES

I. Papadakis1, K. Stavroulakis2, V. Tzikoulis2, J. Melissas2. 1University Hospital of Heraklion - Hypertension Unit, Department of Internal Medicine, Heraklion,Greece, 2University Hospital of Heraklion - Bariatric Unit, Department ofSurgery, Heraklion, Greece

Objective: Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGBP) are the most commonly used operations to treat morbid obesity worldwide. The pur-pose of this study is to compare the effect on metabolic comorbidities of SG vs RYGBP.

Design and method: We studied 17,035 morbid obese patients (12,540 females), of median age 43 (range: 14–75) years, who had a bariatric procedure (6,413 SGs and 10,622 RYGBPs) from January 2010 till December 2015, with at least 12 months follow-up.

Results: Patients with SG were heavier pre-operatively (BMI: 43.43 vs 42.46 kg/m2, p < 0.0001). However, signifi cantly better % excess weight loss were seen following GBP in all post-operative years. Weight loss was peaked at the 18th month after surgery for both procedures. Six thousands one hundred eighty seven (36.3%) patients were hypertensives, 4,125 (24.2%) had diabetes mellitus or impair glucose tolerance, and 5,214 (30.8%) dyslipidemia. Signifi -cantly more patients have their hypertension resolved or improved following RYGBP than after SG in the fi rst (48% vs 44%, p = 0.018) and second (55% vs 49%, p = 0.023) post-operative year. However, in the subsequent years, there were no differences in hypertension resolution following either procedure. Bet-ter glycemic control was observed in 60.1% of patients after RYGBP, as com-pared to 54.2% following SG, in the fi rst post-operative year (p = 0.005). No differences were observed in glycemic control in the subsequent years follow-ing the two studied procedures. Similar results were observed for dyslipidemia. RYGBP patients showed higher remission rate during the fi rst post-operative year (57% vs 37% p = 0.0001), although equal rate for dyslipidemia remission, with the SG patients, in the subsequent 5 post-operative years.

Conclusions: Both procedures had a considerable high remission rate of meta-bolic comorbidities in morbid obese patients. RYGBP had better results than SG after the fi rst post-operative year; however after that, both procedures had equal remission rates, in the subsequent 5 post-operative years.

BP.01.07 SEVERITY OF HEMODYNAMIC AND METABOLIC

DISORDERS IN PATIENTS WITH ESSENTIAL

HYPERTENSION AND TYPE 2 DIABETES

DEPENDING ON GENETIC POLYMORPHISM OF

AGTR1 GENE

A. Shalimova, O. Bilovol, L. Bobronnikova. Kharkiv National Medical University,Kharkiv, Ukraine

Objective: The aim of the study was to investigate the severity of hemodynamic and metabolic disorders in patients with essential hypertension (EH) and type 2 diabetes (DM2) in A1166C polymorphism of angiotensin II receptor type 1 (AGTR1) gene in Ukrainian population.

Design and method: The main group consisted of 320 patients with EH and DM2; the comparison group consisted of 90 patients with EH without DM2; the control group consisted of 31 healthy individuals. We determined carbohydrate and lipid profi les, levels of adiponectin and leptin, conducted genotyping of A1166C polymorphism of angiotensin II receptor type 1 gene.

Results: It was established that 61.6% of patients with EH and DM2 and 57.8% with EH without DM2 had A/C and C/C genotypes of AGTR1. As to the spectrum of these genotypes the main group and the comparison group signifi cantly differed from the control group (p < 0.01). The patients with EH and DM2 in presence of A/C and C/C genotypes of AGTR1 gene had signifi cantly higher blood pressure (p < 0.001), higher levels of glucose, HbA1c, insulin, HOMA-IR, leptin (p < 0.01) and signifi cantly lower levels of

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high-density lipoprotein cholesterol (p < 0.001) and adiponectin (p < 0.01) as compared to A/A genotype. The difference of adypokines levels can be explained by the infl uence of angiotensin II activation to the change of ex-pression of gene encoding adypokines. However in patients with EH without DM2 polymorphism of AGTR1 gene was associated with the difference blood pressure (p < 0.001), carbohydrate (p < 0.01) and lipid (p < 0.001) spectra but did not affect adipokines levels. The absence of differences adypokines levels in the comparison group depending on AGTR1 polymorphism, unlike

the main group, can indicate that the association of metabolic parameters with polymorphism of AGTR1 gene is more pronounced in presence of DM2.

Conclusions: In Ukrainian population of patients with EH polymorphism of AGTR1 gene was associated with the severity of hemodynamic and metabolic disorders. In comorbidity of EH and DM2 A/C and C/C genotypes of AGTR1 gene were associated with more pronounced adypokines disbalance as compared to A/A genotype of AGTR1 gene.

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Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved

SATURDAY

POSTERS

POSTER SESSION

ORAL PRESENTATIONS IN POSTER AREA BP02:

DIAGNOSIS AND TREATMENT

BP.02.01 TREATMENT WITH ESAXERENONE (CS-3150)

IS ASSOCIATED WITH A SIGNIFICANT DOSE-

DEPENDENT ANTIHYPERTENSIVE EFFECT IN

ESSENTIAL HYPERTENSIVE PATIENTS

S. Ito1, H. Ito2, H. Rakugi3, Y. Okuda4, S. Yamakawa4. 1Tohoku University School of Medicine, Sendai, Japan, 2Keio University School of Medicine, Tokyo, Japan, 3Osaka University Graduate School of Medicine, Osaka, Japan, 4Daiichi Sankyo Co., Ltd., Tokyo, Japan

Objective: To evaluate the antihypertensive effects and safety of esaxerenone (CS-3150), a novel non-steroidal mineralocorticoid receptor antagonist, to de-termine the optimal dose for reducing blood pressure in patients with essential hypertension.

Design and method: Four hundred subjects with essential hypertension (sitting systolic blood pressure (SBP): 140 to < 180 mmHg, diastolic blood pressure (SBP): 90 to < 110 mmHg, 24-h blood pressure by ABPM: >130/80 mmHg) from 19 sites in Japan were enrolled in a randomized, double-blind, placebo-controlled, open-label comparator Phase II study. Patients were assigned to one of fi ve groups (n = 80/group), and received 1.25, 2.5, or 5 mg/day CS-3150, placebo, or 50 to 100 mg/day eplerenone. Treatment was for 12 weeks following a 4-week washout period. Effi cacy was assessed by monitoring sitting SBP and DBP changes from baseline to weeks 10 and 12 of treatment, and 24-h BP from baseline to the end of treatment. Safety was assessed by monitoring serum potassium changes from baseline, and the occurrence of adverse events.

Results: A dose-dependent response in effi cacy was observed, with analysis of covariance showing a signifi cant lowering of sitting SBP and DBP in the 2.5 and 5 mg/day CS-3150 groups compared with placebo (all p < 0.001). CS-3150 1.25 mg/day signifi cantly lowered sitting SBP (p = 0.0412). Target BP achieve-ment was also dose dependent. Similarly, 24-h BP changes showed a clear dose relationship, and all CS-3150 doses signifi cantly lowered 24-h BP compared with placebo (1.25 mg/day: p = 0.0038 and 0.0154 for 24-h SBP and DBP, respective-ly; 2.5 and 5 mg/day: all p < 0.0001). Compared with placebo, all CS-3150 doses were well tolerated. Hyperkalemia (> = 5.5 mEq/L) was briefl y detected in the 2.5 and 5 mg/day groups, but it was transient and recovered without treatment.

Conclusions: A novel non-steroidal mineralocorticoid receptor antagonist CS-3150 had a dose-dependent antihypertensive effect on sitting SBP and DBP as well as 24-h BP. CS-3150 showed good effi cacy and safety profi les in essential hypertensive patients.

BP.02.02 RATE OF MORNING BLOOD PRESSURE SURGE

IS A BETTER PREDICTOR THAN AMPLITUDE FOR

20-YEAR ALL-CAUSE AND CARDIOVASCULAR

MORTALITIES: RESULTS OF A COMMUNITY-BASED

STUDY

H. Cheng1, S. Sung1, C. Wu1, J. Lee1, K. Kario2, C. Chiang1, P. Hsu1,S. Chuang3, W. Wang1, E. Lakatta4, F. Yin5, P. Chou6, C. Chen6. 1Taipei Veter-ans General Hospital, Taipei, Taiwan, Taipei, Taiwan, 2Jichi Medical University School of Medicine, Jichi, Japan, 3National Health Research Institutes, Miaoli, Taiwan, 4National Institute on Aging Intramural Research Program, Baltimore, MD, USA, 5Washington University, St Louis, MO, USA, 6National Yang-Ming Uni-versity, Taipei, Taiwan

Objective: Morning blood pressure (BP) surge (MS) is recognized as an impor-tant predictor of cardiovascular outcomes. We compared the prognostic values of MS amplitude and rate of BP rise for predicting long-term mortality in a popula-tion-based cohort.

Design and method: We enrolled 2,025 participants (984 females, 1,041 males, aged 30–79 years) with complete demographic and 24-h ambulatory blood pres-sure monitoring data. During a median 19.7-year follow-up, 607 deaths (119 by cardiovascular causes) were confi rmed from the National Death Registry. The am-plitude of sleep-trough MS (STMS) was derived from the difference between the

morning systolic blood pressure (SBP) and the lowest nighttime SBP. In addition, the rate of MS was derived as the slope of linear regression of sequential SBP measures on time intervals within the STMS period.

Results: Thresholds for high MS amplitude and rate were determined by the 95th percentiles (43.7 mmHg and 11.3 mmHg/h, respectively). Multivariable Cox models adjusting for age, sex, body mass index, smoking, alcohol consumption, low-density lipoprotein cholesterol, 24-h SBP, night:day SBP ratio, and anti-hy-pertensive treatment revealed that a high STMS rate (HR 1.601; 95% CI 1.145–2.237) but not STMS amplitude (1.281 95% CI 0.944–1.737) as signifi cantly as-sociated with greater risk of mortality. Similarly, STMS rate (HR 2.287, 95% CI 1.177–4.444) but not STMS amplitude was signifi cantly associated with the risk of cardiovascular mortality (HR 0.954, 95% CI 0.466–1.951).

Conclusions: The STMS rate may be a more sensitive and reliable predictor of mortality than the STMS amplitude. Appropriate management for a rapid STMS should be further investigated.

BP.02.03 ACCURACY OF AUTOMATED BLOOD PRESSURE

MONITORS IN CHILDREN: A SYSTEMATIC REVIEW

A. Kollias, N. Boubouchairopoulou, A. Ntineri, G.S. Stergiou. Hypertension Center STRIDE-7, University of Athens, Third Department of Medicine, Sotiria Hospital, Athens, Greece

Objective: For the accurate diagnosis of hypertension in children current guide-lines recommend the use of out-of-offi ce blood pressure (BP) monitoring, which is based almost exclusively on automated BP monitors. This study reviewed the evidence on the accuracy of automated BP monitors in children.

Design and method: A systematic review of validation studies of electronic BP monitors in children (age 3–12 years) according to established validation proto-cols was performed. Medline and EMBASE databases were searched via Dialog ProQuest.

Results: The initial literature search retrieved 4,156 articles and 28 were analyzed (31 validation studies of 29 devices; n = 3,067 including 1,450 children). 13 arti-cles (42%) were published a decade ago or longer. Sixteen studies (52%) included children and also adolescents and 5 (16%) also adults. 11 studies that included children and older subjects did not report the number of children. From the 29 devices validated, 16 (55%) were designed for professional offi ce BP measure-ment, 7 (24%) for ambulatory BP monitoring and 6 (21%) for home monitoring. Fourteen studies (45%) applied validation criteria of more than one protocols. The Association for the Advancement of Medical Instrumentation and/or International Organization for Standardization protocol was used in 20 studies (65%), the Brit-ish Hypertension Society protocol in 18 (58%) and the European Society of Hy-pertension International protocol in 6 (19%). Korotkov K5 was used for reference diastolic BP in 14 studies, K4 in one study, and 4 studies used K4 or K5 depending on the subject (not reported in 12 studies). Results from children were reported together with those of older subjects (adolescents or adolescents and adults) in 26

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studies (84%). Twenty-two studies (71%) passed the validation protocol require-ments, and 9 (29%) failed (6 for systolic and diastolic BP, and 3 for diastolic only).

Conclusions: The published evidence on the accuracy of electronic BP monitors in children is limited and with considerable heterogeneity. There is need for: (i) more automated devices to be tested in children; (ii) a universal protocol that meets the specifi c issues of children to be developed, (ii) the review process for publishing validation studies to follow a detailed checklist.

BP.02.04 THE ANTIHYPERTENSIVE EFFECT OF

EMPAGLIFLOZIN IN RATS WITH NON-DIABETIC

NEPHROSIS

G. Kim, C. Jo, S. Kim, J. Park. Division of Nephrology, Hanyang University Hos-pital, Seoul, South Korea

Objective: The effects of sodium-glucose cotransporter-2 (SGLT2) inhibiton on low-ering blood pressure are well characterized in diabetic animals and humans. However, it is unclear whether SGLT2 inhibitors may have antihypertensive effects in non-dia-betic kidney disease. This study was undertaken to investigate whether the hyperten-sion in non-diabetic proteinuric kidney disease may be controlled by empaglifl ozin.

Design and method: Male Sprague-Dawley rats were randomly divided into uni-nephrectomized controls (NX, n = 5), uni-nephrectomy plus doxorubicin-treated rats (NXD, n = 5), and uni-nephrectomy plus doxorubicin/empaglifl ozin-cotreat-ed rats (NXDE, n = 5). Doxorubicin was administered via femoral vein in a single bolus (5 mg/kg) after 7 days of right nephrectomy. Empaglifl ozin (20 mg/kg/d) was daily given in food slurry. After 5 weeks of empaglifl ozin administration, kidneys were harvested for immunoblotting of sodium transporters.

Results: At baseline (Day 0, immediately before doxorubicin treatment), sys-tolic blood pressures were not different between group: NX, 120 ± 1; NXD, 120 ± 1; and NXDE, 119 ± 3 mmHg. From Day 7 (NX, 127 ± 1; NXD, 163 ± 3; and NXDE, 155 ± 1 mmHg) through Day 35 (NX, 130 ± 1; NXD, 172 ± 1; and NXDE, 160 ± 1 mmHg), remarkable hypertension was induced by doxorubicin and signifi cantly relieved by empaglifl ozin cotreatment (P < 0.01). Signifi cant proteinuria was produced from Day 14 and increased thereafter by doxorubicin but not decreased by empaglifl ozin cotreatment. Osmotic diuresis was evidently induced by empaglifl ozin administration from Day 7 (NXDE 40.7 ± 1.3 vs. NXD 21.7 ± 1.1 mosmoles/d, P < 0.01) through Day 35 (NXDE 52.3 ± 4.0 vs. NXD 27.9 ± 1.7 mosmoles/d, P < 0.01), in parallel with natriuresis and glycosuria. Im-munoblot analysis from the kidney showed that compared with NXD, NXDE had decreased protein abundance of Na-K-2Cl cotransporter-2 (100 ± 31 vs. 40 ± 8%, P < 0.05) and Na-K-ATPase alpha1 subunit (100 ± 13 vs. 51 ± 13%, P < 0.05) but no change in Na/H exchanger-3.

Conclusions: In our uni-nephrectomized rat model, doxorubicin-induced hyper-tension was signifi cantly ameliorated by empaglifl ozin administration. This an-tihypertensive effect was associated with decreased expression of renal sodium transporters and resultant increased natriuresis, but not with proteinuria reduction.

BP.02.05 FEASIBILITY AND EFFICACY OF RENAL

DENERVATION THERAPY IN HEMODIALYSIS

PATIENTS WITH RESISTANT HYPERTENSION

F. Scalise, G. Sorropago, C. Auguadro, C. Ballabeni, A. Sorropago, F. Maccario, G. Mancia. Policlinico di Monza, Monza, Italy

Objective: AIM: Nephrectomy has been considered for patients with malignant hypertension on dialysis to remove the pressor effects refl exly induced by afferent fi bers originating in the renal structure and still active in nonfunctioning kidneys. Because the morbidity and mortality associated with the surgical procedures has limited its adoption, endovascular procedures that might denervate the native nonfunctioning kidney much less invasively has been proposed as an alternative therapeutic strategy.

Design and method: We enrolled 5 consecutive dialised patients affected by re-sistant hypertension (RH,4 men, 1 women, mean age 50 years). The average dura-tion of dialysis was of 5,4 years and the average number of antihypertensive drugs for each patient was 3.5. The renal arteries average diameter was 3.96 mm. The cohort underwent bilateral percutaneous trans-catheter renal denervation (RDT) with the EnligHTN System (St. Jude Medical, St Paul, MN, USA).Measurements included intra-arterial Systolic blood pressure (SBP), diastolic (D) BP, mean (M) BP and heart rate (HR).

Results: The small basket device of the EnligHTN was used in all patients. RDT was performed without complications, with an average number of ablations of 33,8. SBP was reduced by the procedure from 162,7 to 130,4 mmHg (p-value

0.02) with also a reduction of DBP (from 97,6 to 83,6 mmHg,p-value 0.04) and MBP (from 119,3 to 99,2 mmHg,p-value 0.03) and no signifi cant HR changes (from 78 to 72 bpm,p-value 0.74).

Conclusions: the bilateral RDT procedure in dialised patients with RH was feasi-ble without complications and produced an acute statistically signifi cant decrease in BP.. Diseased kidneys might be the source of a persistently elevated activity of afferent signals to the central sympathetic nervous system, the interruption of which may favour BP reduction.This may be obtain by renal denervation with no need of surgical kidney removal.

BP.02.06 MATRIX METALLOPROTEINASE 2 AND 9

POLYMORPHISMS ARE ASSOCIATED WITH

TARGET ORGAN DAMAGE IN OBESE RESISTANT

HYPERTENSIVE SUBJECTS

A. Ritter, A. De Faria, A. Sabbatini, N. Barbaro, N. Correa, V. Brunelli,A. Almeida, N. Pires, R. Modolo, H. Moreno. University of Campinas - Unicamp, Campinas, Brazil

Objective: The aim of this study is to analyze the infl uence of MMP-2 and -9 SNPs in obese hypertensive (HTN) and resistant hypertensive (RH) subjects, as well as their association with MMP-2 and 9 levels and target organ damage (TOD).

Design and method: Two thousand and fi fty six hypertensive subjects were divided in obese [body mass index (BMI higher than 30 kg/m2) and non-obese (BMI lower than 30 kg/m2). Genotypes were obtained by allelic discrimination assay using real time polymerase chain reaction. We compare clinical and labo-ratorial characteristics according to genotypes/haplotypes for MMP-2 (rs243865, rs243866 and rs2285053) and for MMP-9 SNPs (rs17577, rs17576 and rs391824) in obese HTN and RH subjects.

Results: No difference in allele, genotype and haplotype frequencies for all poly-morphisms between obese and non-obese HTN and RH were found. MMP-2, MMP-9 and their TIMPs levels were similar in obese HTN and RH according to MMP-2 and MMP-9 genotypes for all SNPs assessed. The same happened for clinical and biochemical characteristics among the genotypes in obese HTN and RH subjects except for some parameters: diastolic ambulatory blood pres-sure (BP) monitoring was higher in AG+AA compared to GG genotype for both rs243866 and rs243865 MMP-2 SNPs and the offi ce diastolic BP was higher in AA than AG+GG genotype for rs17576 MMP-9 polymorphism in obese RH. However, when we compared the TOD according to genotype in obese RH we found that PWV was higher in CC genotype than CT for rs2285053 MMP-2 poly-morphism [8.8 (8 – 11) vs 7.8 (6 – 8), p = 0.04]. Also, the AG+AA genotype for rs243866 and rs243865 MMP-2 polymorphisms have the same levels of LVMI and they are higher than GG genotype [116 ± 37 vs 138 ± 40, p = 0.04]. Finally, the microalbuminuria level was higher in AG+GG compared to AA genotype for rs17576 MMP-9 polymorphism. A multiple linear regression showed that only rs243866 and rs243865 are an independent predictor for LVMI levels after ad-justed by gender, age, offi ce BP, aldosterone and glucose levels.

Conclusions: Therefore, the MMP-2 and -9 polymorphisms are associated with TOD in obese RH subjects.

BP.02.07 LOSARTAN/HCTZ COMBINATION THERAPY IS

SAFE AND USEFUL IN CONTROLLING MORNING

HYPERTENSION IN VERY ELDERLY PATIENTS

H. Kai1, H. Uchiwa2, Y. Iwamoto2, K. Fukuda2, T. Imaizumi3. 1Kurume Univer-sity Medical Center, Cardiology, Kurume, Japan, 2Kurume University, Cardio-vascular Medicine, Kurume, Japan, 3Fukuoka International College of Health and Welfare, Fukuoka, Japan

Objective: Morning hypertension is an independent risk for cerebrovascular and cardiovascular events. Although the incidence of morning hypertension increases with age, treatment of morning hypertension has not been established particu-larly in late-elderly patients. Among various combinations, ARB combined with a small dose of thiazide diuretic is desirable because the two drugs have comple-mentary mechanisms of action, and effectively reduce BP. Thus, we investigated the safety and effi cacy of ARB/hydrochlorothiazide (HCTZ) combination in con-trolling morning hypertension in the very elderly.

Design and method: This is a subanalysis of the Morning Hypertension and An-giotensin Receptor Blocker/Hydrochlorothiazide Combination Therapy (MAPPY) study, which compared the effects of a combination of 50-mg losartan/12.5-mgHCTZ (Combination) and 100-mg losartan (High ARB) on morning SBP levels after 3-month treatment in on-treatment hypertensive patients with morning SBP greater than 135/85 mmHg on home BP self-measurement. Patients were allo-cated to very elderly group (more than 75 years) and young/elderly group (below 75 years).

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Results: Effects of 3-month Combination therapy and High ARB therapy were summarized in Table (*P < 0.05 and **P < 0.01 vs. baseline; #P < 0.05 and ##P < 0.01 vs. High ARB group). More than 98% of patients in all groups showed the adherence to medications of 80% or more. The incidence of adverse events of both treatments was similar in both groups.

Conclusions: In the elderly patients, ARB/HTCZ combination induced further morning SBP reduction and greater target achievement ratio of morning BP (<135/85 mmHg), than high-dose ARB, to the similar levels seen in the young/elderly patients. And, ARB/HTCZ combination was safe and tolerable in either age group.

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e176 Abstracts

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved

SATURDAY

POSTERS

POSTER SESSION

ORAL PRESENTATIONS IN POSTER AREA BP03:

EPIDEMIOLOGY AND MANAGEMENT

BP.03.01 EFFECT OF ACETYLSALICYLIC ACID ON THE

MARKERS OF ENDOTHELIAL CELL DYSFUNCTION

IN WOMEN WITH GESTATIONAL HYPERTENSION

D. Xydakis1, E. Antonaki1, K. Kostakis1, M. Tzanakakis1, A. Papadaki2,A. Papadogiannakis1. 1Nephrology Department, Venizeleio Hospital, Iraklio, Crete, Greece, 2Nephrology Department, CHANIA Hospital, Chania, Crete, Greece

Objective: The target organ of preeclampsia (PE) is the maternal endothelium. Clinical manifestations are associated with its dysfunction. A case control study was designed to analyze markers of endothelial dysfunction in women with gesta-tional hypertension (GH), preeclamptic women and to compare these levels to the disease state as well as investigate if acetylsalicylic acid (ASA) can infl uence the endothelial function in women with GH.

Design and method: 64 pregnant women with gestational hypertension (GH) (group A), 50 healthy pregnant women (group B) and 45 non-pregnant women (con-trol group C) were enrolled. Exclusion criteria were chronic hypertension, diabetes mellitus,renal disease and antiphospholipid syndrome. Levels of vonWillebrand factor, soluble adhesion molecules-intercellular adhesion molecule-1(ICAM-1), vascular cell adhesion molecule-1(VCAM-1), were compared in all groups. Groups were matched. Low dose (80 mg q.d.) of ASA was prescribed in group A at the time of the diagnosis of GH. Levels of vWF, ICAM-1, VCAM-1 were measured 60 days after ASA began. Multivariate logistic regression models were used.

Results: ICAM-1 and VCAM-1 were signifi cantly elevated in women with GH com-pared to group B and C (296 ± 86,222 ± 79 and 219 ± 89 ng/ml-p < 0.005, 633 ± 101 – 505 ± 87 and 489 ± 98 ng/ml, p = 0.02), whereas vWF was not associated. Eleven women (group A) and 3 (groupB), developed preeclampsia. vWF,VCAM-1 and ICAM-1 levels were signifi cantly higher in preeclamptic patients than in GH women (172% vs 129%, 784 ± 82 vs. 633 ± 109 ng/mL, p < 0.05 and 405 ± 67 vs. 296 ± 57 ng/mL, p < 0.05, respectively). Multivariate logistic regression model showed that levels of ICAM-1, VCAM-1 and vWF have a signifi cant infl uence on the occurrence of PE (p = 0.04, p = 0.05 and p = 0.006, respectively). VCAM-1, ICAM-1 were signifi cantly lower after ASA was prescribed in group A (633 ± 101 ng/ml vs 410 ± 116 –p < 0.005 and 296 ± 86 vs 188 ± 76 ng/ml, p < 0.005) but not for group B and C.

Conclusions: Our data indicate that vWF,VCAM-1 and ICAM-1 levels were sig-nifi cantly higher in preeclamptic patients and are correlated with the development of PE. These data suggest that these molecules may be sensitive infl ammatory biomarkers for preeclampsia. The use of ASA reduces adhesion molecules levels in women with gestational hypertension.

BP.03.02 ON THE ORIGIN AND DISAPPEARANCE OF SFLT-1

AND PLGF IN PREECLAMPSIA

L. Saleh1, A. H. Van Den Meiracker2, R. Geensen1, J. E. Roeters Van Lennep2, J. J. Duvekot1, K. Verdonk2, E. A. P. Steegers1, H. Russcher3, A. H. J. Danser2, W. Visser2. 1Erasmus Medical Centre - Department of Obstetrics and Gynecol-ogy, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands, 2Erasmus Medical Centre - Department of Internal Medicine, Division of Vascu-lar Medicine and Pharmacology, Rotterdam, The Netherlands, 3Erasmus Medical Centre - Department of Clinical Chemistry, Rotterdam, The Netherlands

Objective: To assess the changes in the anti-angiogenic, PlGF-sequestering solu-ble receptor (sFlt-1) and the pro-angiogenic placental growth factor (PlGF) levels in preeclamptic women after delivery.

Design and method: In this exploratory study, serum sFlt-1 and PlGF levels were measured in 23 women aged 20 to 41 years with a median duration of labor of 27 weeks (range 24–32 weeks) using the automated Elecsys system. The women were randomly chosen from a big preeclampsia/HELLP cohort, and blood samples were drawn before and after delivery. Concentrations after delivery were expressed as a percentage of the concentration in the sample that was taken at the fi nal stage of pregnancy. The half-life (t1/2) over the fi rst week was calculated on the basis of the formula Ct = C0 x e-kt, where C0 is the concentration in the last sample taken during pregnancy, Ct the concentration at day t after delivery, and k = ln2/t1/2.

Results: Median sFlt-1 and PlGF concentrations of pregnancy were 10578 (4505, 85000) and 26 (6 – 237) pg/mL, respectively, and the ratio was 569 (83, 1034). sFlt-1 decreased with a half-life of 1.4 ± 0.0 days, and then stabilized at levels corresponding with < 1% of the levels before delivery. PlGF decreased with a half-life of 3.7 ± 4.3 days and then stabilized at levels corresponding with ~30% of the levels before delivery. Changes in the ratio paralleled those in sFlt-1; the half-life was 0.6 ± 0.7 days.

Conclusions: The rapid and pronounced decline of sFlt-1 values, unlike PlGF, in patients with preeclampsia/HELLP suggests that sFlt-1 almost exclusively (>99%) originates in the placenta, thus allowing a quick normalization of the sFlt-1/PlGF ratio.

BP.03.03 CARDIOVASCULAR RISK AND HYPERTENSION

CONTROL IN ITALY. DATA FROM THE 2015 WORLD

HYPERTENSION DAY

C. Torlasco1, A. Faini1, E. Makil1,2, C. Ferri3, C. Borghi4, G. Schillaci5, F. Veglio6,G. Desideri3, E. Agabiti Rosei7, L. Ghiadoni8, P. Pauletto9, R. Pontremoli10, M. Stornello11, G. Tocci12, B. Trimarco13, G. Parati14. 1Department of Cardio-vascular, Neural and Metabolic Sciences, IRCCS Auxologico, San Luca Hospital,Milan, Italy, 2Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy, 3Department of Medicine, Life and Environmental Sciences, L’Aquila University, Coppito, Italy, 4Chair of Internal Medicine, Department of Medical and Surgical Sciences, Faculty of Medicine, University of Bologna, Bologna, Italy, 5University of Perugia, Department of Medicine, Perugia, Italy, 6Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, Uni-versity of Turin, Turin, Italy, 7Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, 8Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy, 9Department of Medicine, Universityof Padova, Padova, Italy, 10Università degli Studi di Genova, Genova, Italy,11Ospedale Umberto I, Siracusa, Italy, 12Div. Cardiology, Dpt. Clinical Molecular Medicine, Fac. Medicine and Psychology, Univ. Sapienza, Sant’ Andrea Hospital, Rome, Italy, 13Federico II University, Naples, Italy, 14Dept. of Cardiology, Istituto Auxologico Italiano and Dept. of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

Objective: Cardiovascular diseases (CVD) are the fi rst cause of death and dis-ability in western countries. Despite therapeutic advances, their prevalence is constantly increasing. Detailed assessment of modifi able CV risk factors could improve CVD prevention and management. Aim of this study is to assess CV risk and BP control in a sample of the Italian population.

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Design and method: To assess CV risk and hypertension control in a sample of the Italian population, individuals participating to the 2015 “World Hypertension Day’’ were interviewed in 62sites all over Italy. Blood pressure was measured with a validated auscultatory or oscillometric device and information on demography and prevalence of CVD risk factors was collected by an anonymous question-naire. An ad-hoc modifi ed version of the Systematic COronary Risk Evaluation (SCORE) system was then applied.

Results: 8657 recruited individuals (43%women, aged 56.68 ± 16years) were subdivided into 3 age groups (40–49y, 50–59y, 60–69y) for analysis. CV risk was low in 62.4%, 18.0% and 0%; moderate in 26.0%, 66.0% and 62.5%; high/very high in 11.6%, 16% and 37.4%, respectively. Smoking was mainly responsible for increased CV risk among those aged 40–49y (26%smokers), while hypertension was the main factor in the whole sample and in subjects over 50y (36% and 42% respectively). Overall, BP control was unsatisfactory in 36% of individuals (28%, 48% and 31% of those who declared to be normotensive, hypertensive on treat-ment or unaware of their BP condition, respectively).

Conclusions: In this sample of the Italian population CV risk was alarmingly high, irrespectively of age, mostly due to presence of modifi able risk factors, in-cluding hypertension, which should thus be better addressed, especially in the youngsters.

BP.03.04 LONG-TERM IMPACT OF ELEVATED BLOOD

PRESSURE IN CHILDHOOD ON ADULT

SUBCLINICAL CARDIOVASCULAR DISEASES:

EVIDENCE FROM CHINA

Y. Yan, J. Liu, D. Hou, X. Zhao, H. Cheng, J. Mi. Capital Institute of Pediatrics, Beijing, China

Objective: Hypertension is the main risk factor for cardiovascular disease. The association between childhood elevated blood pressure and adult subclinical car-diovascular diseases has been reported in several longitudinal studies from Eu-rope, US and Australia. We aimed to examine the long-term impact of elevated blood pressure (BP) from childhood on subclinical cardiovascular diseases and chronic kidney disease in a China population.

Design and method: Data were obtained from a school-based prospective study, which consisted of 1256 adults aged 27–42 years who had 2–10 measurements of body mass index (BMI) and blood pressure from childhood in 1987. The total area under the growth curve (AUC) and incremental AUC from childhood to adulthood were calculated to characterize the cumulative risk burden and long-term trends of BMI and BP during the follow-up duration. In the fi nal survey (2010), we measured multiple markers of subclinical cardiovascular diseases and chronic kidney disease, including carotid intima-media thickness (cIMT), carotid-femoral pulse wave veloci-ty (cfPWV), left ventricular mass (LVM), and microalbumin (MAU) were measured.

Results: Pearson correlation analyses showed that BP in childhood and adulthood, as well as cumulative and incremental values from childhood to adulthood, were all signifi cantly associated with adult cIMT, cfPWV, LVM, and MAU in males and in females (all P < 0.05). In the multivariate logistical analyses, for both genders, childhood SBP predicted hypertension, high cIMT, high cfPWV, high LVM and high MAU in adulthood. However, the associations for high Cimt, high cfWV, high LVM and high MAU were largely attenuated and became non-signifi cant af-ter additional adjustment for adult BP and other risk factors, except that childhood BP showed a borderline signifi cant association with high cfPWV in adulthood for males. In addition, for both genders, incremental BP from childhood to adulthood predicted high cIMT, high cfPWV, high LVM and high MAU in adulthood inde-pendent of childhood values.

Conclusions: Both elevated BP from childhood and incremental BP from child-hood to adulthood play important roles in the development of subclinical cardio-vascular diseases and chronic kidney disease in adulthood.

BP.03.05 THE ADDED VALUE OF THE BIOMARKERS SFLT-

1, PLGF AND THEIR RATIO ON PREDICTION OF

PROLONGATION OF PREGNANCY AND MATERNAL

AND FOETAL COMPLICATIONS IN (SUSPECTED)

PREECLAMPSIA

L. Saleh1, Y. Vergouwe2, A. H. J. Danser3, K. Verdonk3, E. A. P. Steegers1,H. Russcher4, A. H. Van den Meiracker3, W. Visser3. 1Erasmus Medical Cen-tre, Department of Obstetrics and Gynecology, Rotterdam, The Netherlands,2Centre for Medical Decision Sciences, Department of Public Health, Rotterdam, The Netherlands, 3Erasmus Medical Centre, Department of Internal Medicine, Division of Vascular Medicine and Pharmacology, Rotterdam, The Netherlands, 4Erasmus Medical Center, Department of Clinical Chemistry, Rotterdam, The Netherlands

Objective: To assess whether a single determination of the serum values of sFlt-1, PlGF and their ratio improves prediction of delivery and maternal and foetal com-plications in women with suspected or clinically confi rmed preeclampsia.

Design and method: In this prospective, multicentre, observational study the plasma levels of antiangiogenic soluble fms-like tyrosine kinase 1 (sFlt-1) and proangiogenic placental growth factor (PlGF) were measured in women with (suspected) preeclampsia. Multivariable logistic regression analysis was used to assess the added value of sFlt-1, PlGF and their ratio to the traditional criteria, in-cluding gestational age, parity, blood pressure, proteinuria, uric acid, alanine ami-notransferase and platelets, to estimate the risk of delivery and maternal and foetal complications. Models were compared using concordance (C)-statistic and R2.

Results: Six hundredtwenty women (age 18 to 48 yrs., singleton pregnancies, median pregnancy duration 34 weeks (range 20–41 weeks) were included. Com-plications occurred in 118 (19%) of the women and in 248 (40%) of the neonates. Adding PlGF or the sFlt-1/PlGF ratio to the traditional criteria strongly predicted faster delivery, both resulting in R2 increases of 40%, whereas sFlt-1 alone in-creased the R2 by only 17%. The predictive value of maternal complications im-proved by adding sFlt-1, PlGF or the ratio to the traditional criteria, resulting in an increase of the C-statistic by respectively 0.080, 0.065 and 0.090 (from 0.746 to 0.826, 0.811 and 0.836, respectively). The incorporation of sFlt-1, PlGF and their ratio to the traditional criteria also resulted in an increase of the c-statistic for the foetal complications, by respectively 0.032, 0.053 and 0.04 (from 0.764 to 0.796, 0.817 and 0.812).

Conclusions: sFlt-1, PlGF and their ratio have additive predictive value on top of the traditional criteria for both maternal and foetal complications, while PlGF and the ratio, but not sFlt-1 alone, help to predict faster delivery.

BP.03.06 EFFECT OF COMBINED HORMONAL

REPLACEMENT THERAPY ON THE ALDOSTERONE/

RENIN RATIO IN POSTMENOPAUSAL WOMEN

A. Ahmed1, R. D. Gordon1, G. Ward2, M. Wolley1, B. Mcwhinney3, J. Ungerer4, M. Stowasser1. 1Endocrine Hypertension Research Centre, Univ of Qld School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia, 2Sullivan & Nicolaides Pathology, Brisbane, Australia, 3Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women’s Hospital, Bris-bane, Australia

Objective: Plasma aldosterone/renin ratio (ARR) is the most popular screening test for primary aldosteronism (PA) is. Because both estrogen and progesterone affect aldosterone and renin levels, we studied effects of combined hormonal re-placement therapy (HRT) on ARR, measuring renin as both direct renin concen-tration (DRC) and plasma renin activity (PRA).

Design and method: 15 normotensive, healthy postmenopausal women under-went measurement (seated, midmorning) of plasma aldosterone, DRC, PRA, electrolytes and creatinine and urinary aldosterone, cortisol, electrolytes and cre-atinine at baseline and after 2 weeks and six weeks treatment with combined HRT (Premia 2.5 continuous).

Results: Treatment with combined HRT was associated with signifi cant increases in aldosterone [baseline median (range) 150 (85–600), 2 weeks 230 (129–790), 6 weeks 434 (200–1200) pmol/L (P < 0.001 Friedman Test)] and PRA [2.3 (1.2–4.3), 3.8 (1.4–7.0), 5.1 (1.4–10.8), P < 0.001]; but decreases in DRC [21 (10–31), 21 (10–39), 14 (8.0–30) mU/L, P < 0.01] leading to increases in ARR calculated by DRC [7.8 (3.6–34.8), 11.4 (5.4–48.5), 30.4 (10.5–90.2), P < 0.001]. The ARR calculated by DRC exceeded the cut off value (70) in two patients after 6 weeks. There were no signifi cant changes in ARR calculated by PRA [79 (26–184), 91 (23–166), 88 (50–230),P = 0.282], plasma electrolytes and creatinine, and all uri-nary measurements.

Conclusions: The combined oral HRT used in this study is capable of signifi -cantly increasing ARR with risk of false positive results during screening for PA, but only if DRC is used to calculate the ratio.

BP.03.07 ENDOTHELIN RECEPTOR TYPE B-DEFICIENT

PREGNANT RATS HAVE EXAGGERATED

PLACENTAL ISCHEMIA-INDUCED HYPERTENSION

F. Spradley. University of Mississippi Medical Center, Jackson, MS, USA

Objective: Preeclampsia (PE) is a pregnancy-specifi c disorder of new-onset hy-pertension. While its pathogenesis is unclear, studies have implicated placental ischemia. Indeed, reduced uterine perfusion pressure (RUPP)-induced placental ischemia in experimental animals stimulates the release of factors into the ma-ternal circulation where they cause vascular dysfunction and hypertension. Phar-macological blockade of the vasoconstrictive endothelin type A receptor (ETA)

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e178 Journal of Hypertension Vol 35, e-Supplement 2, September 2017

abolishes RUPP-induced hypertension. Although blockade of vasodilatory ETB receptors increases blood pressure during late pregnancy in rodents, and placental ischemia has been shown to reduce ETB receptor expression, the importance of the ET/ETB receptor pathway in blood pressure regulation during pregnancy or in response to placental ischemia is unclear. The hypothesis was tested that ETB defi ciency results in exaggerated placental ischemia-induced hypertension.

Design and method: At eighteen weeks old, ETB defi cient (def) and transgenic control (Tg) timed-pregnant rats were generated using Wistar Hannover males. Rats underwent RUPP or Sham surgeries at gestational day 14, with assessment of mean arterial blood pressure (MAP, carotid catheter) and fetal weights and plasma collection at day 19. This resulted in 4 groups: Sham Tg (N = 13); RUPP TG (N = 10); Sham ETB def (N = 11); and RUPP ETB def (N = 6).

Results: MAP was greater in Sham ETB def over Sham Tg (109 ± 3 vs. 79 ± 3 mmHg, P < 0.05). MAP levels were increased by RUPP in both Tg (99 ± 3 mmHg, P < 0.05) and ETB def (139 ± 6 mmHg, P < 0.05), but the degree of this hypertension was exaggerated in ETB def rats (30 vs. 20 mmHg). Circulating levels of cGMP, a surrogate measure of bioavailability of the vasodilator nitric oxide (NO), were reduced in Sham ETB def compared to Sham Tg (43 ± 5 vs. 178 ± 18 pg/mL, P < 0.05), which were reduced by RUPP in Tg (18 ± 3 pg/mL), but not further reduced in RUPP ETB def (35 ± 11 pg/mL).

Conclusions: These data not only suggest an important role for ETB in blood pressure regulation during normal pregnancy but also in buffering the response to placental ischemia-induced hypertension.

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Abstracts e179

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved

SATURDAY

POSTERS

POSTER SESSION

ORAL PRESENTATIONS IN POSTER AREA BP04:

MECHANISMS OF HYPERTENSION

BP.04.01 PLASMA MIR-LET7 EXPRESSION LEVEL IS

POSITIVELY RELATED TO CAROTID INTIMA-MEDIA

THICKNESS IN ESSENTIAL HYPERTENSION

PATIENTS

Y. Huang, J. Chen, Y. Feng. Department of Cardiology, Guangdong Cardiovas-cular Institute, Guangdong Provincial Key Laboratory of Coronary Disease, Guangzhou, China

Objective: MicroRNAs (miR) play a critical role in the pathophysiology of arte-rial remodeling in essential hypertension, and are emerging as potential biomark-ers and therapeutic targets in cardiovascular disease. The aim of this study was to assess the relationship of plasma miR-let7 expression level with subclinical atherosclerosis in untreated patients with newly diagnosed essential hypertension.

Design and method: We assessed the expression level of miR-let7 in atheroscle-rosis patients and age-sex matched healthy individuals. All patients underwent measurements of CIMT and ambulatory blood pressure (BP) monitoring. Plasma miR-let7 expression was quantifi ed by real-time reverse transcription polymerase chain reaction. Correlations between miR-let7 expression and BP parameters and CIMT were assessed using the Spearman correlation coeffi cient and multiple lin-ear regression analysis.

Results: There were 240 participants including 60 healthy volunteers with normal carotid intima-media thickness (nCIMT), 60 healthy volunteers with increased CIMT (iCIMT), 60 hypertension patients with nCIMT and 60 hypertension pa-tients with iCIMT. We observed the lowest miR-let7 expression (21.70 ± 1.45vs29.33 ± 2.58vs31.50 ± 1.80vs35.49 ± 2.33; P < 0.001) in healthy controls with nCIMT, followed by healthy controls with iCIMT, then hypertension patients with nCIMT and highest expression in hypertension patients with iCIMT. MiR-let7 was independently correlated with CIMT(r = 0.587, P < 0.001).

Conclusions: Our fi ndings present signifi cant evidence that plasma miR-let7 rep-resents a potential non-invasive atherosclerosis marker in essential hypertensive patients and provide new perspectives on the development of a new generation of biomarkers for the better monitoring of end-organ damage in hypertension.

BP.04.02 TUMOR NECROSIS FACTOR-RELATED

APOPTOSIS-INDUCING LIGAND (TRAIL) IS

ASSOCIATED WITH INFLAMMATION IN YOUNG

ADULT SURVIVORS OF CHILDHOOD CANCER

J. Sulicka-Grodzicka1, A. Surdacki2, K. Rewiuk3, T. Grodzicki3. 1Jagiellonian University Medical College, Department of Rheumatology, Krakow, Poland,2Jagiellonian University Medical College, 2nd Department of Cardiology,Krakow, Poland, 3Jagiellonian University Medical College, Department ofInternal Medicine and Gerontology, Krakow, Poland

Objective: Cancer survivors previously treated with cardiotoxic therapies (an-thracycline, chest and neck radiotherapy) are at risk for early atherosclerosis sec-ondary to infl ammation and endothelial dysfunction. The aim of the study was to assess markers of infl ammation and subclinical atherosclerosis in young adult survivors of childhood cancer.

Design and method: We evaluated cardiovascular risk factors and assessed bio-chemical markers of infl ammation and intima-media thickness (IMT) in 50 fi ve-year survivors of childhood cancer (CCS) and in 29 healthy controls.

Results: Cancer survivors (age 23.6 ± 2.8 years, 10.4 ± 4.1 years since the end of treatment, 94% with hematologic malignancies) had higher total cholesterol level (4.7 ± 1 versus 4.3 ± 0.6 mmol/l; p = 0.03) and LDL cholesterol (2.6 ± 0.9 versus 2.2 ± 0.6 mmol/l; p = 0.03) but were comparable with controls for other tradition-al cardiovascular risk factors. IMT was similar in both groups (0.43 ± 0.05 mm in CCS and 0.41 ± 0.05 mm in controls; p = 0.13). Infl ammatory markers: hsCRP and fi brinogen were increased in CCS compared to controls (0.79 [0.33–2.42] versus 0.30 [0.17–0.57] mg/l; p = 0.006 and 2.8 [2.5–3.3] versus 2.2 [1.9–2.4] g/l; p < 0.001, respectively). Serum TRAIL levels were lower in CCS than in controls (97.6 ± 38.7 versus 127.8 ± 37.6 pg/ml; p = 0.001) and correlated negatively with PTX3 (r = -0.64; p < 0.001). IMT was not associated with infl ammatory markers in CCS.

Conclusions: Young childhood cancer survivors 10 years after treatment had increased cholesterol level and infl ammatory markers but no signs of subclini-cal atherosclerosis. Low serum TRAIL levels were signifi cantly associated with higher PTX3. It may suggest possible role of TRAIL in the control of chronic infl ammatory activation and refl ect a dysregulation of apoptosis in patients previ-ously treated for cancer. (The study was supported by the Research Grant No. DEC-2012/7/N/NZ5/0080.)

BP.04.03 SHORT-TERM AND LONG TERM RELATIONSHIP

BETWEEN HEART RATE AND AUGMENTATION

INDEX IN YOUNG TO MIDDLE AGE SUBJECTS

F. Saladini1, C. Fania1, L. Mos2, A. Mazzer3, R. Garbelotto3, D. Ovan3, D. Longo1, D. Perkovic1, O. Vriz2, P. Palatini1. 1Medicine Department, University of Padua, Padua, Italy, 2Town Hospital of San Daniele del Friuli, Udine, Italy, 3Town Hospi-tal of Vittorio Veneto, Treviso, Italy

Objective: Several studies have shown that the augmentation index (AIx), the primary outcome derived from pulse wave analysis, is negatively correlated with heart rate (HR). This led some authors to claim that the use of HR-lowering drugs may be detrimental in hypertension. The aim of this study was to assess the acute and chronic relationships of HR with AIx in a sample of normotensive and hyper-tensive adults younger than 45 years.

Design and method: We studied 347 subjects (259 men) from the HARVEST study (mean age 37.3 ± 10.1 years). Central blood pressure and AIx were evalu-ated with Specaway DAT system and small artery compliance (SAC) with HDI Pulse Wave device. HR was measured at baseline in the offi ce (mean of 6 read-ings) and with 24 h ambulatory recording. The arterial elasticity assessment was performed after a mean of 6.7 years from baseline. In multivariate regression analyses, AIx and central systolic BP were used as dependent variables and offi ce HR or night-time HR as predictors adjusting for age, sex, BMI, height, mean BP, smoking, alcohol, physical activity habits, SAC, and pulse wave velocity.

Results: Adjusted offi ce HR measured at the time of arterial elasticity assessment was inversely correlated with AIx (p = 0.001) a relationship which was attenuated after physical activity (p = 0.004) and ejection duration (p = 0.015) were taken into account. In addition, offi ce HR was inversely correlated with central BP (p = 0.039) a relationship which was no longer signifi cant after physical activity (p = 0.14)

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or ejection duration (p = 0.58) were accounted for. In contrast, in fully adjusted models baseline average night-time HR was a signifi cant positive predictor of AIx (p < 0.001) and central BP (p = 0.014) measured 6.7 years later. Adjusted AIx was 20.0 ± 3.0% in the top night-time HR quintile, 14.9 ± 1.4% in the 3 intermediate quintiles, and 6.5 ± 2.8% in the bottom quintile. Baseline offi ce HR was unrelated to both AIx and central BP.

Conclusions: These data confi rm that HR is negatively related to AIx when mea-sured at the time of arterial elasticity assessment. However, HR measured with ambulatory monitoring is an independent positive long-term predictor of AIx and central BP.

BP.04.04 ATP2B1 VARIANT RS2854371 G/A GENOTYPE

ASSOCIATED WITH ASYMPTOMATIC

INTRACRANIAL ATHEROSCLEROTIC STENOSIS IN

STROKE-FREE HYPERTENSIVE CHINESE

D. An, Y. Wang, P. Gao, D. Zhu. Shanghai Institute of Hypertension,Shanghai, China

Objective: Intracranial atherosclerotic stenosis (ICAS) is considered as a risk fac-tor of ischemic stroke, especially in those with hypertension. Meanwhile, ATP2B1 gene has been associated with hypertension and vascular stiffness by several stud-ies. We hereby aim to test the association of ATP2B1 common variants with ICAS in stroke-free hypertensive Chinese.

Design and method: A Total of 881 consecutive hypertensive patients without stroke were included. They were 50 years or older, without severe cardiovascular disease and able to receive CTA examination. Patients were divided into ICAS and Non-ICAS(NICAS) group according to CTA results. 11 tag SNPs were selected, which covered the ATP2B1 gene and 20 kb of fl anking sequences to either side.

Results: There were 330 patients in ICAS group and 551 in NICAS group. Rs2854371showed signifi cant association with ICAS. The patients with G/A genotype had increased ICAS prevalence (OR:1.59; 95%CI: 1.17–2.16) after adjusted for age, sex, BMI, antihypertensive treatment, systolic blood pressure, LDL, HDL, smoking status, and diabetes. A-allele of Rs2854371was associated

with an increased susceptibility to ICAS (OR 1.42; 95% CI: 1.06–1.91). In the subgroup analysis, G/A genotype remained signifi cant in females (OR:2.2; 95% CI:1.39–3.46), non-diabetes (OR: 1.68; 95% CI: 1.17–2.39) and non-smokers (OR:1.55; 95% CI: 1.11–2.17, p = 0.022). Compared with the G/G carriers, pa-tients with G/A genotype were found to have more intracranial atherosclerotic lesions (P = 0.013).

Conclusions: In conclusion, rs2854371 G/A genotype of ATP2B1 gene was as-sociated with increased susceptibility of asymptomatic ICAS in a hypertensive Chinese population, especially in females, non-diabetes and non-smokers.

BP.04.05 PREVALENCE AND CLINICAL PHENOTYPE OF

PRIMARY ALDOSTERONISM IN PRIMARY CARE

HYPERTENSIVES

S. Monticone1, J. Burrello1, D. Tizzani1, C. Bertello1, A. Viola1, F. Buffolo1,T. A. Williams1,2, F. Rabbia1, F. Veglio1, P. Mulatero1. 1Department of Medical Sciences, Univerisity of Turin, Turin, Italy, 2Medizinische Klinik und Poliklinik IV, Klinikum der Universitat Munchen, Ludwig-Maximilians-Universitat Munchen, Munich, Germany

Objective: Despite being widely recognized as the most common form of second-ary hypertension, the true prevalence of primary aldosteronism (PA) and its main subtypes, aldosterone-producing adenoma (APA) and bilateral adrenal hyperpla-sia (BAH), among the general hypertensive population remains a matter of debate. The present study was undertaken to determine the prevalence and clinical phe-notype of PA in a large cohort of unselected hypertensive patients, consecutively referred to our Hypertension Unit, by 19 general practitioners.

Design and method: Patients were screened for PA using the serum aldosterone to plasma renin activity ratio after withdrawal from all interfering medications and PA was diagnosed according to the Endocrine Society guidelines. The diagnosis was confi rmed/excluded by an i.v. saline infusion test or captopril challenge test and subtype differentiation was performed by adrenal CT scanning and adrenal vein sampling (AVS) using strict criteria to defi ne both successful cannulation and lateralization of aldosterone production.

Results: A total of 1,672 primary care hypertensive patients, 569 newly diagnosed hypertensives and 1,103 patients already diagnosed with arterial hypertension, were included in the study. A total of 99 patients (5.9%) were diagnosed with PA and conclusive subtype differentiation by AVS was made in 91 patients (27 patients with an APA and 64 patients with BAH). The overall prevalence of PA increased with the severity of hypertension, from 3.9% in hypertensives stage I to 11.8% in hypertensives stage III. Patients with PA more frequently displayed tar-get organ damage and cardiovascular events compared to non-PA hypertensives, independent of confounding variables.

Conclusions: The results from the present study demonstrated that PA is a frequent cause of secondary hypertension even in the general hypertensive population and indicates that the majority of hypertensive patients should be screened for PA.

BP.04.06 CIRCULATING ENDOTHELIAL-DERIVED

APOPTOTIC MICROPARTICLES TO MONONUCLEAR

PROGENITOR CELLS RATIO AS A PREDICTOR OF

THROMBOEMBOLIC EVENTS IN PATIENTS WITH

ACUTELY DECOMPENSATED HEART

A. Berezin1, A. Kremzer1, T. Berezina2. 1Medical University, Zaporozhye, Ukraine, 2VitaCenter, Zaporozhye, Ukraine

Objective: The objective of the study was to examine prognostic value ofcirculating endothelial-derived apoptotic microparticles (EMPs) to endothelial origin mononuclear progenitor cells (MPCs) ratio for post-discharged patients after acutely decompensated heart failure (ADHF).

Design and method: Methods: We have been consecutively enrolled 118 clini-cally stable HF patients (72 male) admitted with a primary diagnosis of ADHF. All the patients have given their written informed consent for participation in the study. At baseline all enrolled patients were hemodynamically stable and they had NYHA III/IV classes of chronic HF. Observation period was up to 3 years. Flow cytometry analysis for quantifying the number of EMPs and angiogenic MPCs was used. The fl ow cytometric technique was used for predictably distinguishing circulating cell subsets depending on expression of CD45, CD34, CD14, Tie-2, and CD309 antigens and determining endothelial cell-derived microparticles. CD31+/annexin V+ was defi ned as apoptotic endothelial cell-derived MPs, MPs labeled for CD105+ or CD62E+ were determined as MPs produced due to activa-tion of endothelial cells.

Results: Results: Thirty six thromboembolic events (TEE) were determined with-in 3 years. Calculated EMPs to MPCs ratios in patients without and with TEE

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Abstracts e181

were 7.9 (95% CI = 7.4 – 9.0) and 66.5 (95% CI = 47.0 – 110.4) respectively (P = 0.001). MPCs to EMPs ration, NYHA class, galectin-3 and NT-pro-BNP at discharge, increased NT-pro-BNP > 30% within hospitalization period were found as independent predictors of TTE rate. All these predictors were compounded into predictive Model 1. However, adding of EPMs to MPCs ratio to the Model 1 has improved the relative IDI by 17.4% for TTE rate, by 20.1% for fatal TTE, and by 18.1% for TTE-related re-admission.

Conclusions: Conclusion: We demonstrated that EMPs to MPCs ratio might considered a tremendous predictor of TTE and HF-related outcomes in post-dis-charged clinically stabilized HF patients.

BP.04.07 EFFECTS OF A NOVEL INTERACTING MOLECULE

WITH AT1 RECEPTOR, ATRAP, ON ANG II-INDUCED

PROLIFERATIVE ACTIVITY AND OXIDATIVE STRESS

IN VASCULAR SMOOTH MUSCLE CELLS

K. Azuma1, K. Tamura2, T. Taira3. 1Asamizo Jin Clinic, Sagamihara, Japan,2Dept of Cardiorenal Med, Yokohama City Univ. Sch of Med, Yokohama, Japan, 3Aobadai Jin Clinic, Yokohama, Japan

Objective: Superoxide anions are recognized as mediators of intracellular sig-naling cascades and are known to participate in cardiovascular diseases such as arteriosclerosis and hypertension. The NADPH oxidase complex in the vascular

smooth muscle cells consists of p22phox, Rac1, and Nox1. We previousy 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-hy-brid strategy. In this study, we tested the hypothesis that vascular smooth muscle cells express ATRAP and that ATRAP modulates Ang II-induced proliferative ac-tivity and oxidative stress in vascular smooth muscle ells.

Design and method: We identifi ed that the ATRAP mRNA and protein were endogenously expressed in VSMC, and found a substantial co-localization of ATRAP and AT1R in intracellular compartments in Ang II-stimulated VSMC. Overexpression of ATRAP by adenoviral gene transfer signifi cantly inhibited Ang II-mediated increases in TGF-bmRNA expression (p < 0.05, n = 6) and TGF-b production into the medium (p < 0.05, n = 6). Furthermore, this phenomenon was accompanied by inhibition of Ang II-induced activation of BrdU incorporation (p < 0.05, n = 6).

Results: The results of gain-of-function studies by adenoviral gene transfer dem-onstrated that overexpression of ATRAP signifi cantly inhibited Ang II-mediated increases in c-fos gene transcription, BrdU incorpoaration, and mRNAs expres-sion of NADPH oxidase complex (p < 0.05, n = 6).

Conclusions: These results indicate that ATRAP signifi cantly attenuates Ang II-mediated proliferative activity and oxidativestress in vascular smooth muscle cells, and may suggest a novel strategy to inhibit cardiovascular disease such as arteriosclerosis and hypertension.