Selected Abstracts from XXXV National Congress of the Italian Society of Hypertension (SIIA), Rome, 27–29 September 2018
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METABOLIC ASPECTS AND ASSOCIATED RISK FACTORS
1 THE “NEPHRO-DIABETOLOGICAL KEY” IN THE MANAGEMENT OF THE HYPERTENSIVE PATIENT: OUR EXPERIENCE
1.1 A. Bruzzese1, A.M. Bruzzese2, R. Cicciarello4, F. Nasso3, M. Pasquale3, V. Bruzzese4
1.1.1 1Istituto di Ematologia, Università La Sapienza, Roma, Italy, 2U.O. Medicina Interna Ospedaliera, A.O. Ferrara, Italy; 3U.O. Medicina Interna, Ospedale di Polistena (RC), 4U.O. Nefro-Dialisi, CAPT Taurianova (RC), Italy
INTRODUCTION: In the general population there is a notable prevalence of diabetic hypertensive subjects with CKD. For the better management of the pharmacological therapy of these subjects it is necessary to have multi-specialized, integrated and wide-ranging skills. Alongside the competences of cardio-vascular and endocrinological relevance, it is necessary to possess the competence to proceed first of all to the detection of Chronic Kidney Disease. In this context, the continuous introduction of new antidiabetic drugs should be exploited by carefully comparing it to the renal function of the subject. This implies the need to give priority to the hypertension specialists the refinement of nefro-diabetic skills, so that a “unifying” vision is guaranteed in the management of the “complexity” of “complicated” hypertensive subjects, for the best therapeutic choices.
AIM: To analyse the patient series in follow up at a clinic dedicated to Renal Diseases and Arterial Hypertension.
METHODS: We conducted a cross sectional study evaluating a cohort of 640 hypertensive subjects (317 M and 323 F, mean age 59 aa.). Detecting the prevalence between them of DMT2 and CKD and the type of hypoglycaemic pharmacological treatment in progress.
RESULTS: In our series of hypertensive subjects there were: CKD (Stage IIIa–IV K/DOQI) in 73% of cases—DMT2 in 37% of cases. Subjects with DMT2 had CKD in 96% of cases and among these about 30% had a conspicuous proteinuria. Very often the diagnostic-therapeutic path, despite the overlapping of multiple specialized interventions (diabetologist, cardiologist, endocrinologist, nephrologist, etc.). It was still dissonant with the possible advantages deriving from the use of “new” antidiabetic drugs.
CONCLUSIONS: We believe that the management of the “complexity” presented by the hypertensive subject with DMT2 and CKD, requires an integrated “generalized” approach in a nefro-diabetic way, for the improvement of the global outcomes of daily clinical practice, in relation to the great prevalence of arterial hypertension, DMT2 and CKD in the general population.
2 INCIDENCE OF CARDIOVASCULAR EVENTS IN PATIENTS IN TREATMENT WITH ALLOPURINOL OR FEBUXOSTAT: A META-ANALYSIS OF CONTROLLED CLINICAL STUDIES
2.1 A.F.G. Cicero1, E.R. Cosentino1, F. Fogacci1, M. Bove1, G. Magri1, C. Borghi1
2.1.1 1Dipartimento di Science Mediche e Chirurgiche, Alma Mater Studiorum Universitas Bononiensis, Bologna, Italy
INTRODUCTION: Hyperuricemia is now considered a cardiovascular risk factors, strongly and independently associated with risk of major cardiovascular diseases (CVEs).
AIM: To evaluate the incidence of CVEs (defined as coronary artery disease, acute coronary syndrome and myocardial infarction) in patients in treatment with allopurinol and febuxostat through a meta-analysis of the available controlled clinical studies.
METHODS: Literature search included SCOPUS, PubMed-Medline, ISI Web of Science and Google Scholar databases up to 20th May 2018. Meta-analysis was entirely conducted using Comprehensive Meta-Analysis (CMA) V3 software (Biostat, NJ, USA).
RESULTS: Data were pooled from 6 controlled clinical trials, which included 5139 subjects in the allopurinol arm and 7573 subjects in the febuxostat one. Included studies were published between 2005 and 2018. 336 subjects in treatment with allopurinol and 379 subjects in treatment with febuxostat experienced a CVEs. The incidence of CVEs was similar between the groups [OR = 1.041, 95% CI (0.888; 1.220), P = 0.619], and the present result persisted in the leave-one-out sensitivity analysis.
CONCLUSIONS: The present meta-analysis suggests the incidence of CVEs is similar among the subjects in treatment with allopurinol and in the ones in treatment with febuxostat.
3 BODY MASS INDEX AND ABDOMINAL CIRCUMFERENCE IN RELATION TO BLOOD PRESSURE IN A LARGE DATABASE OF POPULATION NOT ON ANTIHYPERTENSIVE THERAPY
3.1 L. Amendola1, R. Hernández2, M. Vera3, M. Guzmán4, A. Costantini4, J.A. Octavio5
3.1.1 1Department of Medicine, School of Medicine Luis Razetti. Universidad Central de Venezuela, Caracas, Venezuela, 2School of Medicine, Universidad Centro Occidental Lisandro Alvarado, Barquisimeto, Venezuela, 3School of Medicine, Universidad de Los Andes, Mérida, Venezuela, 4Farmatodo Group, Venezuela, 5Department of Experimental Cardiology, Tropical Medicine Institute, Universidad Central de Venezuela, Caracas, Venezuela
INTRODUCTION: Abdominal circumference (AC) and body mass index (BMI) are generally described as correlated with elevated values of blood pressure (BP). However, these studies have typically been performed in smaller samples of the population, and usually in subjects on antihypertensive therapy.
AIM: To analyze values of AC and BMI with BP in subjects not receiving antihypertensive drug therapy.
METHODS: BP was measured in a sample of 3317 (1196 men; 2121 women; age 18–99 years, mean 52.9 ± 15.45) consecutive (non-randomized) volunteer subjects. The BP were taken using a validated oscillometric device in 3 consecutive times and averaged; subjects previously were seated for 5 min. The BMI was calculated in the conventional manner and the AC was measured at the umbilicus level. Analysis was carried out using contingency analysis and Chi square test. The Spearman correlations between the AC and the BMI in relation to BP were calculated, also by sex.
Correlations between systolic/diastolic blood pressure and anthropometrics variables
Men (n = 1.196)
Women (n = 2.121)
SBP vs. AC
SBP vs. AC
DBP vs. AC
DBP vs. AC
SBP vs. BMI
SBP vs. BMI
DBP vs. BMI
DBP vs. BMI
CONCLUSIONS: There is a clear predominance of subjects with elevated AC and BMI in hypertensive individuals, and correlations demonstrate a clear relationship of BP to the studied anthropometric variables. Correlation values corresponding to the AC seem slightly higher than those related to the BMI.
4 PREVALENCE OF ARTERIAL HYPERTENSION RELATED WITH THE ABDOMINAL CIRCUMFERENCE AND THE BODY MASS INDEX IN A WIDE SAMPLE OF SUBJECTS IN CARACAS, VENEZUELA
4.1 L. Amendola1, R. Hernández2, M. Vera3, M. Guzmán4, A. Costantini4, J.A. Octavio5
4.1.1 1Department of Medicine, School of Medicine Luis Razetti, Universidad Central de Venezuela, Caracas, Venezuela, 2School of Medicine, Universidad Centro Occidental Lisandro Alvarado, Barquisimeto, Venezuela, 3School of Medicine, Universidad de Los Andes, Mérida, Venezuela, 4Farmatodo Group, Venezuela, 5Department of Experimental Cardiology, Tropical Medicine Institute, Universidad Central de Venezuela, Caracas, Venezuela
INTRODUCTION: The abdominal circumference (AC) and the body mass index (BMI) are reported to be positively related to blood pressure (BP) levels. However, it is not clearly established which percentage of the population, with abnormal anthropometric values, present arterial hypertension (AHT), when compare to subjects with normal AC and BMI.
AIM: To analyze the prevalence of AHT in a population of subjects related to abnormal BMI (peripheral obesity) or AC (central obesity).
METHODS: BP was measured in 6414 consecutives subjects (females 64.7%, age 18–101 years; mean 59.46 ± 15 years). BP was measured using a validated oscillometric device three-times sitting after 5-min rest, values were averaged; BMI was calculated in the conventional manner and subdivided into five categories, and the AC was measured at the level of umbilicus. Elevated BMI was defined as ≥ 25. Elevated AC was defined as ≥ 90 cm (women) and ≥ 100 cm (men) (Latino America cut-off points). Hypertension was defined in subjects with BP ≥ 140/90 mmHg and/or report of current antihypertensive drug therapy.
Prevalence of arterial hypertension according with anthropometric indices
Hypertensive pts (num)
Hypertensive pts (%)
Normotensive ind (num)
Normotensive ind (%)
CONCLUSIONS: The prevalence of AHT in this multiethnic population sample was related to the level of abnormal BMI (overweight and obesity) and AC. These results reinforce the relationship between AHT and abnormal levels of central and peripheral obesity.
5 PULSE WAVE VELOCITY PROGRESSION OVER A 3.7 YEARS FOLLOW-UP: FOCUS ON METABOLIC SYNDROME
5.1 A. Maloberti1,2, R. Facchetti2, L. Occhi1,2, F. Panzeri1,2, D. Sirico1,2, A. Buono1,2, D. Caroti2, S. Nava1, B. De Chiara1,2, M. Casati3, S. Besana4, C. Siracusa4, S. Signorini4, A. Moreo1, G. Grassi2, C. Giannattasio1,2
5.1.1 1Cardiology IV, ASST Niguarda Hospita, Milan, Italy, 2School of Medicine and Surgery, Milano Bicocca University, Milan, Italy, 3Biochemical Laboratory, San Gerardo Hospital, Monza, Italy, 4Biochemical Laboratory, Desio Hospital, Desio, Italy
INTRODUCTION: The role of classic cardiovascular risk factors on the progression of arterial stiffness has not yet been extensively evaluated particularly regarding Metabolic Syndrome (MS).
AIM: To evaluate the determinants of the pulse wave velocity (PWV) progression over a 3.7 years follow-up period in hypertensive subjects focusing on metabolic syndrome.
METHODS: We enrolled 448 consecutive hypertensive outpatients 18–80 aged, followed by the Hypertension Unit of St. Gerardo Hospital (Monza, Italy). At baseline anamnestic, Blood Pressure (BP) and laboratory data as well as cf-PWV were assessed. We performed PWV again at a follow-up examination with a median time amounting to 3.7 ± 0.5 years. NCPET-ATPIII criteria were used to define MS as the presence of three or more item. Data are reported as mean ± SE.
RESULTS: At T0 the mean age was 53.7 ± 1.1 years, SBP and DBP were 141.3 ± 1.7 and 86.4 ± 1.2 mmHg and PWV was 8.5 ± 0.15 m/s. 125 patients (27.9%) meet the criteria for MS. Those patients were older (56.3 ± 1.0 vs. 52.7 ± 0.7, p = 0.007) with superimposable baseline SBP and DBP values (141.4 ± 1/87.2 ± 0.6 vs. 142.4 ± 1.6/86 ± 1, p > 0.05 for both comparison) as well as PWV values (8.7 ± 0.18 vs. 8.58 ± 0.1, p = 0.43). At follow-up examination MS subjects showed a lower decrease in SBP/DBP (SBP: − 4.7 ± 1.7 vs. − 10.2 ± 1.1; DBP: − 5.1 ± 1.1 vs. − 8.3 ± 0.7, p < 0.01 for both comparison) with a higher increase in PWV values (1.1 ± 0.2 vs. 0.39 ± 0.1, p = 0.03). This difference remains significant also in a multivariate model with age, sex, smoking, baseline PWV and delta MBP as covariates.
CONCLUSIONS: Arterial aging and BP values in treated hypertensive subjects during a 3.7 year follow-up seems to be influenced by the presence of MS. In fact, subjects with MS showed a worse BP control and an increase in PWV values during the follow-up. PWV changes over time would probably give important information that need further future research studies.
6 RELATIONSHIP BETWEEN PSYCHO-SOCIAL FACTORS AND IDEAL CARDIOVASCULAR HEALTH IN ADOLESCENCE. THE MACISTE STUDY
6.1 G. Pucci, F. Battista, F. Anastasio, F. Papi, M.E. Crapa, L. Sanesi, L. Trioani, F. Desantis, G. Schillaci, G. Vaudo
6.1.1 Unit of Internal Medicine, Terni University Hospital, Department of Medicine, University of Perugia, Terni, Italy
INTRODUCTION: Social determinants of health, such as socio-economic status and psychosocial stress, are known to adversely influence the development of CV disease in adulthood. Ideal cardiovascular health (ICH) among adolescents is defined as the optimal levels of three CV risk factors (SBP/DBP < 90°percentile, fasting glucose < 100 mg/dL, total cholesterol < 170 mg/dL) and four behaviours (body mass index (BMI) < 85° percentile, not smoking, presence of ≥4 healthy components in diet, moderate or vigorous physical activity at least 1 h/day).
AIM: We aimed at defining personal and social determinants of ideal cardiovascular health among young individuals.
METHODS: 269 healthy subjects (mean age 17 ± 2 years, 56% boys, mean BP 124/67 mmHg) attending the Liceo Dontatelli High School, Terni, Italy; were evaluated. A 21-item interviewer-assisted questionnaire evaluating domains related to lifestyle, personal, social and behavioural factors, was undertaken. Through exploratory factor analysis, 4 principal components explaining more than 30% of total variance, were identified, as related to sleep behaviour (hours of sleep, restlessness, attention), family environment (parental educational level, family structure, parental overweight/obesity, parental smoking), social context (passive smoking exposure, frequency of alcohol consumption, binge drinking), and screen exposure. For each of these domains, a factor score, representing a weighted sum of the components, was calculated. Higher values represented negative factors.
Univariate analysis for cardiovascular risk factors and different determinants of cardiovascular health. P values are reported.
CONCLUSIONS: Negative personal, familial and psychosocial factors among healthy adolescents are inversely related to ICH metrics. Primordial CV prevention should aim at removing modifiable psychosocial negative influences on ICH.
7 PREVALENCE AND RELATION OF WEIGHT EXCESS AND BLOOD PRESSURE WITH ANTHROPOMETRIC MEASUREMENTS IN A SAMPLE OF ITALIAN CHILDREN
7.1 A. Tagetti1, S. Bonafini1, A. Giontella1, D. Marcon1 P. Minuz1, C. Maffeis2, F. Antoniazzi2, C. Fava1
7.1.1 1Department of Medicine, University of Verona, Verona, Italy, 2Pediatric Department, University of Verona, Verona, Italy
INTRODUCTION: Weight excess and hypertension represent an increasing epidemic not only in adults but even in children.
AIM: To assess the prevalence of weight excess and high blood pressure (BP) and their relation with other anthropometric measurements in a school-based study.
METHODS: 309 children attending the 3rd and 4th classes of 4 primary schools (mean age 8.64 ± 0.7 years) in Verona south district participated. All children underwent anthropometric and vascular measurements at school.
RESULTS: Based on the 85th and 95th percentiles of BMI, 19% of children were classified as overweight and 13% as obese, without significant gender differences. Waist/height ratio was below 0.5 in 93% of normal-weight children, 48% in overweight children and 12% in obese children. When considering the subgroup of children with weight excess (obese + overweight) in comparison to normal weight children, they showed higher systolic BP (including the z-score of systolic BP). Considering BP in the whole sample, 22% resulted above the 95th percentile and 17% between the 90th and 95th percentile whereas the prevalence of BP > 95th percentile in obese was 31%. After repetition of BP measurement in standard conditions in a subsample of 25 children with BP > 95th percentile at the first visit, only one child confirmed a BP > 95th percentile. Systolic and diastolic BP were directly correlated with BMI, waist circumference, hip circumference and waist/height ratio, but the latter showed a weaker correlation with BP in comparison to the other anthropometric characteristics. In obese children, most correlations were still significant and showed a higher correlation coefficient.
CONCLUSIONS: Excess weight and high BP is frequent also in Italian children attending the primary school. Measures of adiposity and BP associate calling for preventive actions. Epidemiological studies should pay attention to standardize the conditions of measurement when the exact prevalence of hypertension has to be estimated.
8 VISCERAL FAT QUANTIFICATION BY ECHOGRAPHY IN OVERWEIGHT HYPERTENSIVES AND CARDIOVASCULAR RISK ASSESSED BY ARTERIAL TONOMETRY AND NEUROPSYCHOLOGICAL ASSESSMENT
8.1 P. Nazzaro, F. Caradonna Moscatelli, A. Nardecchia, M. Contini, G. Schirosi, L. De Benedittis, A.M. Papagni
8.1.1 Department of Neurosciences, Hypertension Unit, University of Bari, Bari, Italia
INTRODUCTION: Visceral adiposity is recognized to be a well-established cardiovascular risk factor worsening the prognosis of hypertensives but, the evidence, is not determined in overweight patients in which the identification of fat distribution is critical.
AIM: To highlight the association between vascular damage and visceral fat distribution in overweight hypertensives, treated by monotherapy with ACEi or ARBs.
METHODS: Following the medical visit and anthropometric measures (BMI, abdominal circumference: CAD), ultrasound quantification of visceral (eVF), preperitoneal (ePF) and subcutaneal (eSF) fat and insulin resistance (HOMA), 370 normoglycemic (92 ± 7 mg/dl) grade 1–2 hypertensives, 95 with a normal weight (NW), 119 overweight (OW) and 156 obese (OB), with similar age and history of hypertension (eHISThtn), underwent arterial tonometry (PWVcf), ultrasound carotid intima-media thickness (IMT) and neuropsychological test, as multiple-choice (never-very often: 1–4) 18-item questionnaire, inspecting different neurocognitive abilities (CIS), with a good internal coherence index (alpha: 0.87) in pilot study in healthy and hypertensive subjects.
RESULTS: Ultrasound showed the association between vascular damage and visceral fat distribution.
General characteristics of the study population
56 ± 14
131 ± 9/81 ± 9
108 ± 83
23.9 ± 1.9
87.9 ± 7.2
1.6 ± 0.9
57 ± 11
132 ± 11/81 ± 7
111 ± 77
28.1 ± 0.9***
96.3 ± 7.8**
2.9 ± 1.4***
57 ± 11
133 ± 12/81 ± 9
99 ± 70
34.4 ± 4.1***^^^
109.5 ± 9.2***^^^
4.2 ± 2.6***^^^
30.7 ± 12.4
9.1 ± 3.2
19.1 ± 3.8
8.72 ± 1.98
0.88 ± 0.18
23.2 ± 4.7
50.7 ± 16.3***
10.8 ± 4.9
110.9 ± 4.9
9.71 ± 2.32**
0.88 ± 0.22
28.2 ± 8.5***
68.6 ± 18.3***^^^
12.1 ± 4.3***
113.2 ± 4.9***^
10.18 ± 1.53***
0.94 ± 0.21*^
31.3 ± 7.6***^^
CONCLUSIONS: The findings confirm that insulin resistance, higher in normoglycemic overweight hypertensives, is significantly associated to visceral fat, arterial stiffness and cognitive impairment, since the early phases of weight gain, independently by the hypertensive state, in patients treated by ARB o ACEi. The appropriate quantification of visceral fat, then, may be critical to highlight the cardiovascular risk in overweight patients.
9 THE ROLE OF ULTRASOUND TO QUANTIFY THE VISCERAL FAT IN OVERWEIGHT HYPERTENSIVES AND ITS RELATIONSHIP WITH THE CARDIOVASCULAR RISK
9.1 P. Nazzaro, F. Caradonna Moscatelli, A. Nardecchia, M. Contini, G. Schirosi, L. De Benedittis,, A.M. Papagni, I. Vitali, G. Laselva
9.1.1 Department of Neurosciences, Hypertension Unit, University of Bari, Bari, Italy
INTRODUCTION: The abdominal obesity is a well-established risk factor aggravating the cerebro-cardio-vascular prognosis in hypertensives. Then, the objective quantification of the visceral fat might be critical in overweight patients.
AIM: To highlight the association between the preclinical vascular damage indices and the abdominal fat in adult patients with hypertension, confirmed by ambulatory blood pressure monitoring, treated with ACEi or ARBs.
METHODS: Following the medical visit and the anthropometric measures (BMI, abdominal circumference: CAD), ultrasound quantification of visceral (eVF), preperitoneal (ePF) and subcutaneal (eSF) fat and insulin resistance (HOMA), 388 normoglycemic (91 ± 8 mg/dl) grade 1–2 hypertensives, with similar age and history of hypertension, 68 with normal weight (NW), 83 overweight with moderate (OWeVFL) and 89 con higher (OWeVFH) eVF and 148 obese (OB), underwent arterial tonometry (PWVcf), ultrasound carotid intima-media thickness (IMT) and neuropsychological test, as multiple-choice (never-very often: 1–4)18-item questionnaire, inspecting different neurocognitive abilities (CIS), with a good internal coherence index (alpha: 0.87) in pilot study in healthy and hypertensive subjects.
General characteristics of the study population
51 ± 16
130 ± 7/82 ± 10
22.9 ± 1.7
85.7 ± 6.8
1.4 ± 0.7
53 ± 11
129 ± 10/79 ± 8
27.1 ± 1.3***
95.4 ± 6.4***
2.3 ± 1.1***
54 ± 12
131 ± 10/81 ± 8
27.2 ± 1.3***
96.1 ± 10.7***
2.6 ± 1.3***
57 ± 11
131 ± 5/81 ± 9*^
34.4 ± 4.1***^^^°°°
105.8 ± 7.2***^^^°°°
4.1 ± 2.5***^^^°°°
30.7 ± 9.5
8.8 ± 3.7
9.7 ± 4.2
9.1 ± 2.4
0.83 ± .21
26.1 ± 7.7
50.6 ± 13.8***
10.3 ± 4.8
10.9 ± 4.3
9.3 ± 3.1
0.86 ± .12
26.7 ± 8.2
63.2 ± 15.1***^^^
12.1 ± 3.9**
11.2 ± 4.7
11.7 ± 5.8***^^^
1.03 ± .22***^^^
28.9 ± 8.2
70.6 ± 19.4***^^^
12.1 ± 3.7*
13.2 ± 4.9*
11.9 ± 9.9^
0.95 ± .21***^^^°°°
29.6 ± 9.4*
CONCLUSIONS: The findings confirm that insulin resistance characterizes the normoglycemic overweight hypertensives. In particular, the visceral fat, is associated to arterial stiffness and cognitive impairment since the early phases of weight gain preceding the obesity. Then, the visceral fat mass, particularly in overweight patients, should be objectively determined, because metabolically active and building up the cardiovascular risk in normoglycemic hypertensives.
10 FOOD OF SHORT SUPPLY CHAIN IMPACTS METABOLISM AND CARDIOVASCULAR RISK. A SURVEY IN SOUTHERN ITALY
10.1 R. Finelli, A.V. Pascale, I. Matula, M. De Rosa, V. Visco, M. Ciccarelli, M. Illario, G. Iaccarino
10.1.1 Department. of Medicine, Surgery and Dentistry, University of Salerno; Campania Region Health Department, Division of Health Innovation, Napoli, Italy
INTRODUCTION: Dietary habits influence not only body weight but also cardio-metabolic risk factors, including cholesterol, blood pressure (BP), glucose homeostasis, inflammation and visceral adiposity. In the past decades, the development of big retail distribution of food has favoured energy-dense and processed foods over than fresh ones, with high fat sugar and salt content. The so called “Western-style diet” played a key role in the spreading of diet-related chronic diseases such as obesity, type II diabetes, cardiovascular diseases. Recent studies showed that specific foods and overall dietary patterns, rather than single isolated nutrient removal from diet, are more relevant for cardio-metabolic health. Several public health interventions around the word advocate for locally grown fresh foods (Short Supply Chain-SSC-Reg. (EU) 1305/13) in order to improve general population dietary habits.
AIM: To evaluate whether food from SSC can influence metabolic outcomes and cardiovascular risk.
METHODS: We carried out body weight and blood pressure measurements and collected blood samples and information on dietary habits of 539 participants in the Salerno Area (Southern Italy) during the World Hypertension Day. All of them answered an 8 items-survey to calculate a dietary score (SSC-DS) that quantifies the tendency to purchase fresh and local foods rather than industrial ones. Blood glucose, insulin, HOMA-IR Index, lipid profile, markers of renal function were assessed as metabolic outcomes, while cardiovascular risk (CVR) was calculated according to the Framingham charts. Following data quality check, data from 365 subjects were analyzed. Pearson correlation and multivariate analysis were performed to explore the relationship between the SSC-DS and metabolic outcomes and cardiovascular risk.
RESULTS: The overall population mean age was 51.95 ± 0.7 and female sex was slightly prevalent (57.8%), while mean body mass index (BMI) was 27.08 ± 0.3. SSC-DS was inversely correlated with blood glucose (r = − 0.148, p < 0.01), insulin (r = − 0.291, p < 0.01), HOMA-IR index (r = − 0.325, p <0.01) and CVR score (r = − 0.113, p < 0.05). CVR score was correlated also with several other parameters, such as body weight, blood glucose, urea, triglycerides and diastolic blood pressure, not included in Framingham Risk Score calculation. After multivariate analysis which included all these parameters, SSC-DS confirmed its impact on CVR.
CONCLUSIONS: These data support the hypothesis that SSC can improve cardio-metabolic health. If confirmed in larger prospective studies, these results could promote public interventions to improve people’s lifestyle.
11 LOW SERUM LEVELS OF VITAMIN D ARE ASSOCIATED WITH POST-ORAL GLUCOSE LOAD GLUCOSE LEVELS IN NON DIABETIC HYPERTENSIVE PATIENTS
11.1 C. Catena, G. Colussi, G. Brosolo, F. Nait, L A. Palomba, G. Bolzan, L.A. Sechi
11.1.1 Clinica Medica, Department of Medicine, University of Udine, Udine, Italy
INTRODUCTION: A vitamin D deficiency is associated with the target organ damage hypertension-related with not completely clear mechanisms. A 25(OH)D deficiency could be implicated in insulin-resistance alterations in glucose homeostasis.
AIM: To investigate the relationships between serum 25(OH)D levels and glucose and insulin response in nondiabetic essential hypertensive (EH).
METHODS: In 187 EH patients (106 men, aged 50 ± 13 years) we evaluated levels of 25(OH)D, fasting glucose and insulin, and glucose and the area under the curve of glucose (G-AUC) and insulin (I-AUC) and the glucose level at 120 min of OGTT (G-120).
RESULTS: Patients with normal 25(OH)D level were younger and presented lower fasting glucose levels, G-AUC, G-120 than patients with deficient/insufficient 25(OH)D levels. In a logistic regression analysis, the presence of vitamin D deficiency/insufficiency was associated with higher age and G-AUC. G-AUC was significantly and directly related to age, BMI, systolic BP, duration of hypertension, alcohol intake, fasting insulin, C-peptide, I-AUC, PTH, triglycerides, and inversely related to 25(OH)D level. G-120 was significantly and directly related to age, BMI, systolic BP, duration of hypertension, fasting insulin, C-peptide, I-AUC, triglycerides, and inversely related to levels of 25(OH)D and HDL-cholesterol. At multivariate analyses G-AUC was independently associated with BMI, alcohol, I-AUC, 25(OH)D level and evaluation in summer/autumn. G-120 was independently associated with age, BMI, 25(OH)D and total calcium levels.
CONCLUSIONS: In hypertensive patients a high response of glucose at OGTT is independently associated with vitamin D depletion s. In hypertensive patients measurement of 25(OH)D could help physicians to better identify and prevent metabolic risk factors.
12 METABOLIC SYNDROME AND LONGITUDINAL CHANGES IN THE CLOCK DRAWING TEST IN A GROUP NON-DEMENTED HYPERTENSIVE GERIATRIC PATIENTS
12.1 E. Ettorre, A. Grassi, V. Leccese, C. Camellini, M. Cacciafesta
12.1.1 Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
INTRODUCTION: Cardiovascular risk factors play an important role in the onset of cognitive impairment.
AIM: To evaluate the role of the metabolic syndrome, and in particular of arterial hypertension, as an independent predictor of alterations in cognitive function at a distance of one year.
METHODS: Ninety-two patients belonging to a geriatric ambulatory with no history of dementia or stroke were recruited. The metabolic syndrome was investigated according to the NCEP ATP-III criteria. The cognitive function was evaluated by the Clock Drawing Test. Patients were also subjected to instrumental examinations, such as brain magnetic resonance. Changes in one-year cognitive function were expressed as changes in Clock Drawing Test.
RESULTS: Participants with metabolic syndrome showed greater cognitive decline than healthy subjects (− 1.78 ± 1.47 versus − 0.74 ± 1.44 CDT points, t = 3.348, df = 102, p < 0.001). The metabolic syndrome predicted cognitive decline (β = − 0.327, t = − 3.059, df = 96, p = 0.003) regardless of age, initial cognitive status and brain imaging findings. With the exception of systolic blood pressure, none of the components of the metabolic syndrome alone justified changes in performance at the one-year clock test.
CONCLUSIONS: The metabolic syndrome predicted the accelerated decline of one-year cognitive function in a sample of non-demented hypertensive geriatric patients
ATHEROSCLEROSIS AND INFLAMMATION
13 ECHOCARDIOGRAPHICS STRUCTURAL, CAROTID ECHO COLOR DOPPLER AND BRAIN COMPUTED TOMOGRAPHY OR MAGNETIC RESONANCE STRUCTURAL ISSUES IN PATIENTS WITH TRANSIENT ISCHEMIC ATTACKS (TIA)
13.1 C. Grasselli, E. Radighieri, A. Muoio, S. Davoli, A. Ghirarduzzi
13.1.1 Cardiovascular Medicine, Hypertension Unit, Santa Maria Nuova Hospital of Reggio Emilia, Reggio Emilia, Italy
INTRODUCTION: The transient ischemic attacks (TIA) is one of the complications of patients with arterial hypertension. In arterial hypertension there are modifications of left ventricular (LV) geometry, epiaortic parietal changes and cerebral vessels atherosclerosis, expression of hypertensive organ damage and associated with a higher incidence of cardio- and cerebrovascular accidents.
AIM: To evaluate whether some echocardiographic aspects, echo color Doppler and brain computed tomography (CT) or magnetic resonance (MR) aspects can identify patients at increased risk of TIA.
METHODS: From January 2016 to March 2018, we evaluated 1139 patients referred to our Hypertension Unit. Of these, 90 patients had a history of TIA (52 males and 38 females, median age 64 years). All patients underwent complete color Doppler echocardiography, carotid echo color Doppler and brain CT or MR as part of routine clinical and instrumental assessment at our ultrasound clinic. The evaluated parameters were: LV cavitary dimensions and wall thickness, volumes, mass and LV systolic function, in addition to the morphology of the interatrial septum, intima-media thickness, presence of atheromatous plaques and lacunar encephalopathy.
General characteristics of the study population
Median ± SD
Sex, male n (%)
Moderate to Severe Arterial Hypertension n (%)
Atrial Fibrillation n (%)
12.5 ± 0.71
10 ± 1.41
LV end-diastolic diameter(cm)
51 ± 4.24
51 ± 2.82
LV end-diastolic posterior wall (cm)
10.5 ± 0.71
9 ± 1.41
LV end-diastolic volume (ml)
83.3 ± 37.80
81.5 ± 40.31
LV end-systolic volume (ml)
28.4 ± 2.21
34.5 ± 17.68
Atrial septal aneurysm n (%)
240.5 ± 31.82
180 ± 26.87
LVM index (g/m2)
135.6 ± 50.20
93.2 ± 15.34
LA dimension (cm)
58.5 ± 2.12
42 ± 0
Normal epiaortic vessels n (%)
Increased IMT n (%)
Atheroma n (%)
Multilacunar encephalopathy n (%)
CONCLUSIONS: Among the LV structural echocardiographic aspects, a greater LV hypertrophy is associated with an increased risk of TIA, as well as the presence of AF, known risk factor for cerebral ischemic accidents. Among the carotid echo color Doppler structural aspects, both the increase of intima-media thickness and the presence of atheromatous plaques were associated whit an increased risk of TIA, as well as the presence of lacunar encephalopathy documented on brain CT or MR.
14 TEN-YEAR CHANGES IN AMBULATORY BLOOD PRESSURE PARAMETERS AND PROGNOSTIC ROLE OF AMBULATORY PULSE PRESSURE IN OLDER HYPERTENSIVES
14.1 F. Spannella1, P. Balietti1, F. Giulietti1, G. Rosettani1, B. Bernardi1, C. Di Pentima1, G. Cocci1, L. Landi1, L. Ristori1, R. Sarzani1
14.1.1 1Internal Medicine and Geriatrics, ESH Excellence Centre, IRCCS-INRCA, “Politecnica delle Marche” University, Ancona, Italy
INTRODUCTION: Age-related blood pressure (BP) changes and risk factors associated with pulse pressure (PP) increase in elderly have rarely been studied using ambulatory blood pressure monitoring (ABPM).
AIM: To evaluate ten-year ABP changes in older hypertensives, focusing on PP and its associations with mortality.
METHODS: Observational study on 119 consecutive older hypertensives evaluated at baseline (T0) and after 10 years (T1). We considered clinical parameters at T1 only in survivors (n = 87 patients). Patients with controlled ABP both at T0 and T1 were considered as having sustained BP control. Change in 24-h PP between T0 and T1 (Δ24-h PP) and a 24-h PP cut-off of 55 mmHg were considered for the analyses.
RESULTS: Mean age at T0: 69.4 ± 3.7 years. Females: 57.5%. Significant decrease in 24-h, daytime and night-time diastolic BP (all p < 0.05) coupled with an increase in 24-h, daytime and night-time PP (all p < 0.05) were observed at T1. Sustained daytime BP control was the only variable associated with Δ24-h PP (β = 0.29; p = 0.037). Non-sustained BP control was associated with higher risk of having 24-h PP ≥ 55 mmHg after 10 years (all p < 0.05). Patients who died during the 10-year period had higher 24-h, daytime and night-time PP at T0 compared to survivors (all p < 0.001). Fifty-five mmHg was the cut-off which best predicted mortality in our small sample of older hypertensives (AUC for 24-h PP = 0.78, p < 0.001).
CONCLUSIONS: ABPM reveals age-related BP changes and ABP control predicts ambulatory PP increase over 10 years, demonstrating the role of hypertension in the progression of vascular damage. Ambulatory PP ≥ 55 mmHg predicts mortality in our study.
15 AORTIC STIFFNESS IS INCREASED IN NORMOTENSIVE PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS
15.1 G. Mulè1, L. Lattuca1, M. Morreale1, C. Pugliares1, A. Savoia1, B. De Biasio1, A. Ferrante2, S. Cottone1
15.1.1 1Unit of Nephrology and Hypertension, ESH Excellence Center, DIBIMIS; University of Palermo, Palermo, Italy, 2Unit of Rheumatology, DIBIMIS, University of Palermo, Palermo, Italy
INTRODUCTION: Patients with systemic lupus erythematosus (SLE) have a 4- to 10-fold increased risk of developing cardiovascular (CV) events compared with the general population. The enhanced CV risk conferred by SLE may in part be mediated through preclinical CV damage. Large artery stiffness is usually assessed by measuring aortic pulse wave velocity (aPWV), a marker of early vascular aging (EVA) and an independent predictor of adverse CV prognosis. Several studies examined aortic stiffness in SLE with inconsistent results.
AIM: To evaluate aPWV and the prevalence of EVA in a group of normotensive patients with SLE and to compare these values with those obtained in age- and gender- matched control subjects.
METHODS: Aortic PWV was measured by a validated oscillometric device (Arteriograph). EVA was identified when the age-adjusted z-score of aPWV exceeded + 1.96 (EVA1). The aPWV z-score was calculated using the ratio “Observed PWV − Predicted PWV/SD Predicted”, where the predicted PWV values were computed using a regression equation obtained from the healthy cohort of the European study of The Reference Values for Arterial Stiffness’ Collaboration. We adopted also another definition of EVA (EVA2), wherein we included individuals with PWV values above the 90th percentile of aPWV distribution in the above mentioned population.
CONCLUSIONS: The impaired aortic distensibility we observed in patients with SLE may help to explain their increased CV risk.
16 CHARACTERIZATION OF MOLECULAR MECHANISMS ACTIVATED BY THE SPLENIC IMMUNE RESERVOIR TO ESTABLISH ADAPTIVE CARDIAC REMODELING TO PRESSURE OVERLOAD
16.1 S. Perrotta1, G. Cifelli2, R. Carnevale2, G. Lembo1,2, D. Carnevale1,2
16.1.1 1Department of Molecular Medicine, “Sapienza” University of Rome, Italy, 2Department of Angiocardioneurology and Translational Medicine, IRCCS Neuromed, Pozzilli (IS), ITALY
INTRODUCTION: Cardiac remodeling is a complex adaptive process of left ventricle (LV) to different stimuli, ranging from acute events, like myocardial infarction (MI), to chronic injuries, such as hypertension. Although immunity has been clearly shown to have a role in LV remodeling in MI, how immune response participates to chronic pressure overload is poorly understood. Typically, when LV is subjected to pressure overload, it induces a biphasic response with an initial adaptive hypertrophy and a later adverse remodeling with heart failure (HF).
AIM: To test the hypothesis that immune cells modulate these phases, we used transverse aortic coarctation (TAC) as model of pressure overload, and flow cytometry to characterize immune cells infiltrating LV.
METHODS AND RESULTS: We performed echocardiographic analysis at 1 week to TAC that showed an early adaptive response to pressure overload, characterized by heart failure with a preserved ejection fraction (HFpEF). Simultaneously, we found an early immune response mainly consisting of macrophages CD11b+-Ly6Clow-F4/80hi. Thus we sought to explore where the infiltrating macrophages originate to unravel the potential contribution of the spleen, an essential reservoir of myeloid cells. We performed TAC in splenectomized mice and then we investigated the response of LV with echocardiographic analysis and the activation of the immune response. Splenectomized mice didn’t develop compensatory hypertrophy and exhibited early HF. To investigate the role of adaptive/reparative macrophages, that enter tissues preferentially via CX3CR1 receptor, and of pro-inflammatory monocytes that accumulate through CCR2, we subjected CCR2 KO and CX3CR1 KO mice to TAC. While CCR2 KO behaved similarly to WT mice, CX3CR1 KO were unable to establish hypertrophy and, similarly to splenectomy, early developed HF.
CONCLUSIONS: These results suggest that the spleen responds to pressure overload by producing adaptive/reparative CX3CR1+ macrophages that sustain the hypertrophic adaption of LV to pressure overload.
17 THE PLACENTAL GROWTH FACTOR (PLGF) IS A NOVEL NEUROIMMUNE MODULATOR IN THE SPLEEN ACTIVATED BY DIFFERENT HYPERTENSIVE CHALLENGES THROUGH THE SYMPATHETIC INNERVATION
17.1 M.L. Perrotta1, L. Carnevale2, F. Pallante1, S. Fardella1, G. Lembo1,2, D. Carnevale1,2
17.1.1 1Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy, 2Department of Angiocardioneurology and Translational Medicine, IRCCS Neuromed, Pozzilli, Italy
INTRODUCTION: One of the most intriguing novel mechanism involved in hypertension is the pivotal role of immune system. Immune cells are recruited by different hypertensive stimuli and participate in modulating the typical mechanisms of blood pressure regulation in the cardiovascular system.
METHODS: Our group investigated the role of the splenic immune reservoir in sensing hypertensive challenges and priming immune cells that once deployed from the spleen, target and infiltrate kidneys and vasculature, contributing to blood pressure elevation.
RESULTS AND CONCLUSIONS: We found that several hypertensive stimuli, as Angiotensin-II (AngII), deoxycorticosterone acetate (DOCA)-salt and high fat diet (HFD), activated the expression of an angiogenic growth factor belonging to the Vascular Endothelial Growth Factor (VEGF) family. Among the VEGFs, we observed that the Placental Growth Factor (PlGF) was over activated in the spleen upon these different hypertensive challenges, where it is necessary for the co-stimulation of T cells and their subsequent egression towards typical target organs. Given the different nature of these hypertensive stimuli, we aimed at searching a common primer of PlGF in the spleen, where the expression was mainly confined to the stromal marginal zone. On this specific site of the spleen, many sympathetic fibres interconnected with immune cells. Interestingly, AngII, DOCA-salt and HFD are all known to promote a general increase of the sympathetic outflow. Thus, we investigated whether the expression of PlGF was dependent on the sympathetic innervation of the spleen, finding that upon surgical denervation, AngII, DOCA-salt and HFD were unable to induce the angiogenic growth factor. More important, the ablation of the neuroimmune pathway mediated by PlGF or the genetic deficiency of PlGF protected mice from the activation of T cells and their infiltration in target organs, as kidneys and vasculature, lastly resulting in hampering blood pressure increase.
18 SUBCLINICAL ATHEROSCLEROSIS, SERUM URIC ACID AND PLASMA ALDOSTERONE IN HYPERTENSIVE ADULTS
18.1 A. Concistrè, L. Petramala, V. Bisogni, F. Olmati, G. Oliviero, M. Bonvicini, M. Mezzadri, V. Saracino, G. Iannucci, C. Letizia
18.1.1 Department of Internal Medicine and Medical Specialities, Secondary Hypertension Unit, University of Rome “Sapienza”, Rome, Italy
INTRODUCTION: Aldosterone has long been classically considered to play a central role in the regulation of electrolyte and fluid volume and the maintenance of blood pressure (BP) homeostasis. Moreover, the aldosterone/mineralocorticoid system plays a key role in cardiovascular, metabolic and renal damage.
AIM: To assess the relationship between plasma aldosterone concentration (PAC) and some surrogate markers of subclinical atherosclerosis, such as carotid intima-media thickness (cIMT), ankle-brachial index (ABI) and biochemical parameters (i.e. serum uric acid—SUA) in subjects with essential hypertension (EH).
METHODS AND RESULTS: From January 2014 to December 2017 we consecutively enrolled 804 EH patients (407 males and 397 females, mean age 50 ± 14.5 years) without evident cardiovascular complications. Patients were divided in quartiles according to PAC levels. The relationship between PAC levels and obesity was also analyzed according to body mass index (166 obese patients, 79 males and 87 females, mean age 48.8 ± 14.1 years, and non-obese 638 patients, 328 males and 397 females, mean age 50.4 ± 13.9 years).
Compared to the first quartile, the highest PAC quartile was associated with the highest levels of SUA (5.3 ± 1.34 vs. 5.0 ± 1 mg/dl; p = 0.01) and cIMT (0.87 ± 0.22 mm vs. 0.8 ± 0.21 mm; p = 0.001). Patients of the fourth quartile also exhibited increased prevalence of carotid plaques, compared to the first quartile (26% vs. 16%; p < 0.005). Moreover, we found that in patients with PAC > 160 pg/ml ABI was significantly lower compared to those with PAC < 160 pg/ml (1.01 ± 0.09 vs. 1.1 ± 0.09; p < 0.022). No differences were found in PAC levels between obese and non-obese patients (158 ± 63 vs. 161 ± 72 pg/dl; p: 0.608).
CONCLUSIONS: These findings suggest that higher values of PAC are strongly associated with higher values of SUA, cIMT, and major prevalence of carotid plaques that, together with elevated BP values, are strictly correlated with higher risk of atherosclerosis.
19 AUTONOMIC DYSFUNCTION AND CARDIOVASCULAR RISK IN PATIENTS WITH ATHEROSCLEROTIC RENAL ARTERY STENOSIS: A PILOT STUDY
19.1 V. Zingaretti1, A. Mazzarella1, B. Barbano2, A. Gigante2, R. Cianci1
19.1.1 1UOD Nephrology Sapienza-University of Rome, Rome, Italy, 2Department of Clinical Medicine, Sapienza-University of Rome, Rome, Italy
INTRODUCTION: Atherosclerotic renal artery stenosis (ARAS) is a secondary cause of hypertension and is associated with ischemic nephropathy, congestive heart failure and accelerated cardiovascular disease (CVD). Autonomic dysfunction is a renowned risk factor for cardiovascular disease.
AIM: To evaluate if markers of increased cardiovascular risk, as autonomic dysfunction and QTc interval prolongation, can be detected in ARAS patients.
METHODS: We performed an observational study on 27 patients with ARAS compared to healthy controls (HC). All patients underwent clinical evaluation, renal Doppler ultrasound, electrocardiography, 24-h Holter monitoring and echocardiogram. Autonomic nervous activity was evaluated by heart rate variability (HRV).
CONCLUSIONS: Patients with ARAS present autonomic dysfunction and QTc interval prolongation. Analysis of HRV is a non-invasive tool to monitor autonomic control of the heart and should be included in the study of patients with ARAS to better stratify cardiovascular risk.
20 STATINS REDUCE LONG-TERM ALL-CAUSE MORTALITY IN ELDERLY PATIENTS THAT UNDERWENT CAROTID ANGIOPLASTY: A COHORT PROSPECTIVE STUDY
20.1 G. Colussi1, F. Zuttion1, A. Cavarape1, P. Dolso2, G.L. Gigli2, C. Catena1, L.A. Sechi1
20.1.1 1Clinica Medica, Department of Medicine, University of Udine, Udine, Italy, 2Clinica Neurologica, Department of Medicine, University of Udine, Udine, Italy
INTRODUCTION: Predictors of mortality of elderly patients that underwent percutaneous carotid angioplasty for a critical disease are unknown.
AIM: In this study, we have analyzed predictors of long-term mortality and the occurrence of major cardiovascular events (MACE) in a multi-state survival model.
METHODS AND RESULTS: We observed 171 consecutively patients (age 72 ± 8 years, 125 males, BMI 26.4 ± 3.8 kg/m2) with an elevated cardiovascular risk (146 hypertensives, 71 diabetics, 127 smokers, and 116 with an existing MACE at baseline) for a mean follow-up period of 87 ± 46 months. At the end of the study, all-cause mortality was 44%. New MACE occurred in 71 patients with a mean of 38 ± 44 months from enrollment and 13 patients developed a new carotid occlusion within 2 years from angioplasty. Among baseline variables, age of enrollment (74 ± 9 vs. 70 ± 8 years, P < 0.001) and prevalence of hypertension (92% vs. 80%, P = 0.048) and atrial fibrillation (16% vs. 4%, P = 0.015) were greater in deceased than in alive/lost at follow-up patients, whereas statins were used more in alive/lost at follow-up than deceased patients (67% vs. 45%, P = 0.008). Patients who used statins at baseline had lower hazard ratio of dead 55% (95% CI 34–86%, P = 0.010) and Cox proportional hazard analysis showed that this effect of statins was independent of sex, age, BMI, smoking history, prevalence of hypertension, diabetes, dyslipidemia, atrial fibrillation and new carotid occlusion, and occurrence of new MACE (P = 0.034). Baseline variables did not differ between patients that developed or not a new MACE during the follow-up.
CONCLUSIONS: In high cardiovascular risk elderly patients that underwent carotid angioplasty for a critical disease statins use is associated with a better long-term survival rate.
21 ASSOCIATION BETWEEN LIVER FIBROSIS AND ENDOTHELIAL DYSFUNCTION IN HCV PATIENTS
21.1 F. Crosta 1, C. Sanrocco 1, C. Marini1, C. Ferri1, G. Desideri1
21.1.1 Università degli studi dell’Aquila, Dipartimento MESV, L’Aquila, Italy
INTRODUCTION: Recent studies demonstrated that HCV infection was associated with a higher prevalence of atherosclerosis. However, it was not clarified whether HCV infection directly promoted endothelial dysfunction and whether there was an association between liver fibrosis and carotid intima-media thickness (c-IMT).
AIM: Evaluating endothelial dysfunction in a cohort of monoinfected HCV patients in order to clarify the role of HCV in the initiation and progression of atherosclerotic process.
METHODS: All patients with HCV infection for at least 20 years admitted in the Geriatric Unit of Avezzano’s Hospital from May to November 2016 were included in the study. All patients with HIV or HBV co-infection, history of alcohol abuse, coexistence of other chronic and/or autoimmune inflammatory diseases were excluded. Each patient underwent the same evaluation protocol: medical history with particular attention to cardiovascular risk factors, fibroscan for the evaluation of liver fibrosis (expressed in Kpa), liver ultrasound for the determination of steatosis, ultrasonographic study for the measurement of the c-IMT.
RESULTS: During the study period, 43 patients were enrolled, with mean age of 65.34 ± 12.22, of which 28 were women (see Table 1). Stepwise multiple regression analysis showed that c-IMT (dependent variable) was independently related with age (p < 0.001), female gender (p = 0.018), hypercholesterolemia (p = 0.012) and diabetes (p = 0.001). Moreover, our study points to a positive association between liver fibrosis and c-IMT (p = 0.006), which is independent from major cardiovascular risk factors (see Table 2).
CONCLUSIONS: The results of our study demonstrated that liver fibrosis represented an independent risk factor for the development of endothelial dysfunction. These findings suggested a pathogenic role to HCV infection in the genesis of the atherosclerotic process by means of the chronic inflammation and the development of liver fibrosis related to virus infection. Moreover, the importance of early detection of endothelial dysfunction was related to the reversibility of this pathological condition through appropriate therapies.
22 THE CHOLINERGIC INFLAMMATORY PATHWAY IS ACTIVATED BY HYPERTENSIVE STIMULI TO PRIME THE SPLENIC IMMUNE RESPONSE
22.1 L. Carnevale1, M.L. Perrotta2, F. Pallante1, D. Carnevale1,2, G. Lembo1,2
22.1.1 1Dipartimento di Angiocardioneurologia e Medicina Translazionale, IRCCS Neuromed, Pozzilli (IS), Italy, 2Dipartimento di Medicina Molecolare, “Sapienza” Università di Roma, Italy
INTRODUCTION: We previously described that hypertensive stimuli, such as Angiotensin-II (AngII) and deoxycorticosterone acetate salt (DOCA), need the spleen to raise the blood pressure (BP), being the immune reservoir responsible for the T cells egression toward organs of the cardiovascular system. It is known that, even though administered through peripheral routes, AngII and DOCA act through the brain to overactivate the sympathetic tone.
AIM: To explore how the brain is connected to the spleen, by developing a new way to examine the activity of the cholinergic inflammatory pathway (CIP), through a direct recording of the coeliac vagus nerve (CVN) and the splenic sympathetic nerve (SN) firing. Till now no direct approach of nerve activity recording has been implemented to explore role and characteristics of CIP in cardiovascular diseases.
METHODS: We registered CVN and SN in experimental models of hypertension, in the pre-hypertensive phase, thus avoiding interference of neural reflex activated by BP variations. Mice infused with AngII by subcutaneous osmotic pumps and mice stimulated with DOCA-salt pellet and high-salt in drinking water (and matched controls) underwent surgical exposure of CVN and nerve activity recording. Data have been analysed by implementation of an analysis tool of bursts of the integrated signal.
RESULTS: The analysis showed a significant increment of burst count both in AngII and DOCA. The enhanced activity of CVN was paralleled by a concomitant increase of SN activity, upon AngII or DOCA-salt stimuli.
CONCLUSIONS: By a selective CVN denervation during SN recording in AngII and DOCA-salt treated mice, we further demonstrated that hypertension recruits the CIP through the pathophysiological connection established between CVN and SN.
23 HIGH NEUTROPHIL AND BASOPHIL BLOOD COUNTS ARE ASSOCIATED WITH INCREASED FACTOR II PLASMA COAGULANT ACTIVITY AND MAY BE PREDICTORS OF MORTALITY IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE
23.1 F. Pizzolo1, V. Munerotto1, D. Girelli1, S, Friso1, F. Tosi1, A. Castagna, S. Udali1, V. Ceter2, G.B. Luciani2, G. Faggian2, O. Olivieri1, N. Martinelli1
23.1.1 1Department of Medicine, Unit of Internal Medicine, University of Verona, Verona, Italy, 2Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, Verona, ITALY
INTRODUCTION: White blood cell (WBC) count is widely available in clinical practice and has been proposed to provide prognostic information in coronary artery disease (CAD), with elevated levels of WBC predicting adverse cardiovascular outcomes. Recently, neutrophil extracellular traps (NETs) have been demonstrated to be a scaffold and stimulus for thrombus formation.
AIM: To investigate the correlation between WBC counts and factor II plasma coagulant activity (FII:c), and WBC prognostic significance in CAD patients.
METHODS: WBC count and FII:c were analyzed in 750 subjects (554 CAD and 196 CAD-free, 77.6% males, mean age 60.0 ± 10.5 years) not taking anticoagulant drugs within the angiographically-controlled Verona Heart Study. Moreover, WBC count was assessed as predictor of total and cardiovascular mortality in 823 stable CAD patients (80.2% males, mean age 61.8 ± 9.7 years). Subjects with overt leukocytosis (> 10,000/μL) or leukopenia (< 4000/μL) were excluded.
RESULTS: Neutrophils (β = 0.085; P = 0.021) and basophils (β = 0.073; P = 0.042) were significant predictor of FII:c variability in a linear regression model adjusted for all blood cell counts, age, sex, hs-CRP, and CAD diagnosis. In the longitudinal study, after a median follow-up of 61 months, 160 (19.4%) subjects died, 107 (13%) of whom for cardiovascular causes. High levels of neutrophils, monocytes, eosinophils, and basophils were associated with an increased mortality rate in the CAD population. However, in multi-adjusted Cox regression models only neutrophils and basophils remained predictors of total (the highest versus the lowest quartile HRs: 2.87 (1.54–5.34) and 1.71 (1.06–2.75), respectively) and cardiovascular mortality (HRs: 3.31 (1.42–7.71) and 1.85 (1.02–3.35), respectively).
CONCLUSIONS: High neutrophil and basophil blood counts are associated with an enhanced FII:c and may be independent predictors of total and cardiovascular mortality in patients with stable CAD.
24 CARDIOVASCULAR REMODELING IN MILD HYPERTENSION: ROLE OF SOLUBLE RECEPTOR FOR ADVANCED GLYCATION END PRODUCTS
24.1 R. Corso1, A. Grossi1, N. Tandurella1, S. Moretti1, G. Cavallaro1, L. Robustelli-Test1, M. Agostinis1, V. Pierobon1, L. Tavecchia1, V. Mancuso1, C. Mongiardi1, L. Montalbetti1, A.M. Grandi1, L. Guasti1, A.M. Maresca1
24.1.1 1Department of Medicine and Surgery, University of Insubria, Varese, Italy
AIM: To assess the correlation between soluble receptor for advanced glycation end products (sRAGE) and office, 24-h and central blood pressure (BP) and heart morpho-functional parameters in untreated mild hypertensive patients.
METHODS: We enrolled 74 patients, 35–55 years-old, with mild untreated hypertension, free from cardiovascular diseases or diabetes, not-smokers. 52 normotensives age, sex and anthropometric parameters-matched were enrolled in the control group. Each subject underwent office and 24 h BP measurement, arterial tonometry (central BP, pulse wave velocity—PWV), echocardiography (left ventricular mass—LVM, atrial size) and carotid ultrasonography (intima media thickness—IMT) and blood tests, with sRAGE dosage too.
RESULTS: sRAGE dosage was similar in hypertensives and normotensives (891 ± 697.9 pg/ml vs. 900 ± 560.4 pg/ml). There was no difference also between patients with normal glucose and with impaired fasting glucose, as well as between subjects with and without metabolic syndrome. In hypertensives, we found a negative correlation between sRAGE and LVM (r: − 0.24, p: 0.04), also confirmed by multivariate analysis (β: − 0.223, p: 0.04). A negative correlation was also observed between sRAGE and left atrial (LA) antero-posterior diameter (r: − 0.37, p: 0.002), LA volume (r: − 0.34, p: 0.004), confirmed by multivariate analysis β: − 0.214, p: 0.03 and BSA-indexed LA volume (r: − 0.30, p: 0.01). sRAGE correlated also with right atrial (RA) area (r: − 0.38, p: 0.001), but not with RA volume (r: − 0.24, p: 0.08). There was no correlation between sRAGE and office, 24 h and central BP, PVW, carotid-IMT, glycemia, HOMA-index and uric acid.
CONCLUSIONS: Correlations between sRAGE and LVM, LA and RA dimensions suggest how advanced glycation end products could play a role in cardiovascular remodeling. Mild hypertension and young age of our population may explain lack of differences between sRAGE dosage in hypertensives and normotensives. All the observed correlations were found in absence of drugs interference.
25 LATERAL MITRAL ANNULAR PLANE EXCURSION MEASURED USING CARDIAC MAGNETIC RESONANCE IMAGING IS AN INDEPENDENT PREDICTOR OF ALL CAUSE MORTALITY IN PATIENTS WITH HYPERTENSION: A MULTICENTER STUDY
25.1 S. Romano1, R. Judd2, R. Kim2, J. Heitner3, D. Shah4, R. Devereux5, P. Minuz1, A. Farzaneh-far6
25.1.1 1Università di Verona, Dipartimento di Medicina Interna, sezione di Medicina generale dell’ipertensione, Verona, Italy, 2Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA, Duke, USA, 3Department of Cardiology, New York Methodist Hospital, New York, NY, USA, 4Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA, 5Division of Cardiology, Weill Cornell Medical College, New York, NY, USA, 6Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
INTRODUCTION: In patients with hypertension, cardiac abnormalities including left ventricular hypertrophy and ventricular systolic dysfunction are powerful predictors of adverse outcomes. Over recent years it has become apparent that long axis mitral valve movement plays a fundamental role in cardiac mechanics and appears to be an early marker for a number of pathological states. Moreover, we have recently shown that lateral mitral annular plane systolic excursion (MAPSE), measured using cine cardiac magnetic resonance (CMR) imaging is a powerful independent predictor of mortality in patients with both preserved and reduced systolic dysfunction, incremental to common clinical and imaging risk factors. Given the important adverse consequences of cardiac involvement in hypertension, we hypothesized that lateral MAPSE may provide incremental prognostic information in these patients.
AIM: To evaluate the prognostic-value of CMR derived lateral MAPSE in a large multicenter-population of patients with hypertension.
METHODS: Consecutive-patients with hypertension at four US-medical-centers undergoing CMR were included in this study. Lateral MAPSE was measured in the 4-chamber cine view. Lateral MAPSE was defined as the distance between the lateral mitral annular position at the end of diastole to the lateral mitral annular position at the end of systole. The primary-endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the independent association between lateral MAPSE and death. The incremental prognostic value of lateral MAPSE was assessed in nested models.
CONCLUSIONS: CMR derived lateral MAPSE is a powerful independent-predictor of mortality in patients with hypertension, incremental to common clinical and CMR risk factors - including LV mass, ejection fraction and late-gadolinium-enhancement. Its measurement requires no specialized pulse-sequences or additional scanning time. These findings may have significant implications for management decisions based on risk stratification of patients with hypertension.
26 ASSOCIATION BETWEEN SLEEP QUESTIONNAIRES AND THE ONSET OF TARGET ORGAN DAMAGE IN ADULT HYPERTENSIVE PATIENTS
26.1 V. Bisogni1,3, M.F. Pengo2, G. Maiolino1, M. Cesari1, C. Berton1, S. Lerco1, G. Rossitto1, A. Concistrè3, L. Petramala3, C. Letizia3, G.P. Rossi3
26.1.1 1Clinica dell’Ipertensione Arteriosa, Department of Medicine – DIMED, University of Padua, Padua, Italy, 2Sleep Disorder Centre, Department of Cardiovascular, Neural and Metabolic Sciences IRCCS Istituto Auxologico Italiano, Milan, Italy, 3Department of Internal Medicine and Medical Specialties, Unit of Secondary Arterial Hypertension, “Sapienza” University of Rome, Rome, Italy
INTRODUCTION: Chronic poor sleep quality and duration are associated with arterial hypertension; moreover, while obstructive sleep apnoea aggravated target organ damage in hypertensive patients, it remains totally unknown if other common sleep disorders, as insomnia and restless legs syndrome (RLS), show such exacerbation of target organ damage.
METHODS: We used questionnaires to evaluate insomnia (Insomnia Severity Index), RLS (RLS Rating Scale) and OSA (STOP-Bang) and investigated their relationship with target organ damage, as assessed by transthoracic echocardiogram, microalbuminuria, and glomerular filtration rate, in 159 consecutive hypertensive patients [median age 47 (11) years, body mass index 25.5 (5.9) kg/m2, office systolic and diastolic blood pressure 144 (23)/92 (12) mmHg].
RESULTS: We found a direct significant correlation between cardiovascular damage and STOP-Bang score, but not with the other scores. Compared to patients with low-risk of OSA, those at high risk (STOP-Bang score ≥ 4) showed increased left ventricular mass index (LVMI) [51.4 (15.0) vs. 46.3 (11.1) g/m2.7, p = 0.001], left atrium volume index [26 (6) vs. 25 (4) ml/m2, p = 0.007] and aortic root dimension [35 (3) vs. 34 (5) mm, p < 0.0001]. Moreover, the STOP-Bang score was an independent predictor of LVMI at multivariate analysis, along with office systolic blood pressure values. No such relationship was seen for risk scores of insomnia and restless legs syndrome.
CONCLUSIONS: Thus, the STOP-Bang questionnaire, which has been validated for identifying high-risk obstructive sleep apnoea patients, allows pinpointing the hypertensive patients with more prominent cardiac damage. We would like to suggest that it may be an inexpensive tool useful for risk stratification purposes, particularly in municipalities with limited access to health care resources.
27 A RARE CASE OF HYPERTROPHIC CARDIOMYOPATHY INDUCED BY CATECHOLAMINE-PRODUCING TUMOR
27.1 F. Olmati1, L. Petramala1, A. Concistré1, V. Bisogni1, V. Saracino1, G. Oliviero1, M. Bonvicini1, A. Ciardi2, G. Iannucci1, G. de Toma2, A. Frustaci3, C. Letizia1
27.1.1 1Secondary Hypertension Unit, Department of Internal Medicine and Medical Specialties, University of Rome “La Sapienza” Rome, Italy, 2Department of Surgery “P. Valdoni”, University of Rome “La Sapienza” Rome, Italy, 3Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, University of Rome “La Sapienza” Rome, Italy
INTRODUCTION: Catecholamine-producing tumors are rare, occurring in less than 0.2% of patients with hypertension, but can have pervasive and profound effects on the cardiovascular system, translating into significant morbidity and mortality. It has been suggested that excessive levels of catecholamines induced cardiomyopathy.
AIM: We herein present a case of catecholamine-induced cardiomyopathy due to an adrenal adenoma mixed with nodules enriched in adrenalin-types secreting granules.
CONCLUSIONS: We report a rare case of CMH induced by catecholamine- producing tumor.
28 IMPACT OF THE USE OF LEFT VENTRICULAR MASS/END-DIASTOLIC VOLUME RATIO BY 3D- ECHOCARDIOGRAPHY ON 2D DERIVED GLOBAL LONGITUDINAL STRAIN AND DIASTOLIC FUNCTION IN NATIVE HYPERTENSIVE PATIENTS
28.1 M. Lembo, R. Esposito, R. Sorrentino, M. Petitto, C. Santoro, V. Fazio, B. Trimarco, G. de Simone, M. Galderisi
28.1.1 AOU Federico II, Napoli, Italy
INTRODUCTION: In patients with arterial hypertension, high left ventricular (LV) mass/end-diastolic volume ratio (LVM/EDV) has been related with a large evidence of myocardial impairment and fibrosis identified by cardiac magnetic resonance, a technique with limited availability.
AIM: We examined the ability of three-dimensional (3D) LVM/EDV ratio in detecting a phenotype of LV concentric geometry, possibly identifying early cardiac systolic and diastolic dysfunction in native hypertensive patients.
METHODS: We enrolled 144 native hypertensive patients (M/F = 92/52; age 43.4 ± 14.5 years, blood pressure (BP) = 143.3 ± 13.8/88.9 ± 8.8 mmHg), who underwent two-dimensional (2D) and 3D-echocardiography. 2D-Speckle tracking echocardiography was also assessed and LV global longitudinal strain (GLS) was computed. Exclusion criteria were diabetes mellitus, coronary artery disease, overt heart failure, valve heart disease, primary cardiomyopathies, atrial fibrillation or inadequate echocardiographic imaging. The population was divided into tertiles according to 3D-LVM/EDV ratio: the 1st tertile with LVM/EDV ratio < 1.01 (n = 42), the 2nd tertile with LVM/EDV ratio ≥ 1.01 and < 1.22 (n = 51), and the highest tertile (HT) with LVM/EDV ratio ≥ 1.22 (n = 51).
RESULTS: The three tertiles were comparable for heart rate, body mass index (BMI), systolic and diastolic blood pressure. The HT patients were older than patients in the 1st and 2nd tertiles (p < 0.0001 and p = 0.003 respectively). 2D-relative wall thickness was higher in the HT vs. 1st and 2nd tertiles (both p < 0.0001), whereas no significant difference was found in 2D LV mass index and ejection fraction. 2D-LVGLS was more impaired in the HT (− 20.3 ± 2.3%) vs. the 1st (− 21.6 ± 1.8%, p = 0.006) and 2nd tertiles (− 21.5 ± 1.8%, p = 0.007). Among diastolic parameters, E/A ratio was lower in HT (1.0 ± 0.29) vs. the 1st (1.32 ± 0.42, p < 0.001) and 2nd tertiles (1.23 ± 0.45, p = 0.014), average of septal and lateral mitral e′ velocity was lower in HT vs. the 1st tertile (9.6 ± 2.6 vs. 12.4 ± 3.7 cm/s, p < 0.0001), while no significant difference was found with the 2nd tertile. E/e′ ratio resulted higher in the HT only vs. the 1st tertile (7.9 ± 2.3 vs. 6.6 ± 1.7, p < 0.01). In the pooled population LVM/EDV ratio was positively related to GLS (considered in absolute value) (r = 0.29, p < 0.001) and with E/e′ ratio (r = 0.26, p < 0.02). By a multilinear regression analysis, after adjusting for sex, age, heart rate, mean BP and BMI, LVGLS (absolute value) was independently and positively associated to LVM/EDV ratio (β = 0.45, p < 0.0001) (R2 cumulative = 0.22, p < 0.0001).
CONCLUSIONS: In native-hypertensive patients, 3D-echo-derived elevated LVM/EDV ratio identifies a cardiac remodelling, which is associated to an early myocardial impairment, involving both systolic and diastolic function. GLS is independently and positively associated with LVM/EDV ratio. The combination of 3D echo and 2D STEL allows to identify a cluster of hypertensive patients with LV concentric geometry and myocardial longitudinal dysfunction.
29 INDEPENDENT ASSOCIATION BETWEEN LEFT VENTRICULAR MIDWALL MECHANICS AND GLOBAL LONGITUDINAL STRAIN IN NATIVE HYPERTENSIVE PATIENTS
29.1 M. Lembo, R. Esposito, C. Santoro, V. Fazio, A.M. De Roberto, B. Trimarco, G. de Simone, M. Galderisi
29.1.1 AOU Federico II, Napoli, Italy
INTRODUCTION: Midwall fractional shortening (MFS) is an index that studies midwall left ventricular (LV) circumferential fibres. In hypertensive patients, an impairment of this parameter was previously described in presence of LV concentric geometry. Evidence also showed LV subendocardial longitudinal dysfunction in the hypertensive setting, by determining global longitudinal strain (GLS).
AIM: Aim of our study was to evaluate longitudinal and circumferential systolic dysfunction and the correlations between these two components in native hypertensive patients.
AIM: We enrolled 150 newly-diagnosed, never treated hypertensive patients (M/F = 95/55; age 43.4 ± 14.6 years, blood pressure (BP) = 143.2 ± 13.5/88.7 ± 8.7 mmHg), who underwent standard two-dimensional echocardiography. Speckle tracking echocardiography was performed with calculation of LV GLS. MFS was also computed. Exclusion criteria were diabetes mellitus, coronary artery disease, overt heart failure, valve heart disease, primary cardiomyopathies, atrial fibrillation and inadequate echocardiographic-imaging. The pooled population was divided into two groups according to LV GLS cut-off of normalcy, considered in absolute value, as described in 2015 Chamber Quantification: patients with GLS > 20% (n = 104, normal GLS) and patients with GLS ≤ 20% (n = 46).
RESULTS: The two groups were comparable for age, heart rate, body mass index, systolic, diastolic and mean BP. Among echocardiographic data, no significant difference was found between the two groups in relative wall thickness, LV mass index for height powered at 2.7, LV ejection fraction and diastolic parameters. MFS was significantly lower in patients with GLS ≤ 20% (16.1 ± 3.0 vs. 17.8 ± 3.7%, p < 0.01) than in patients with GLS > 20%. In the pooled hypertensive population GLS resulted positively related to MFS (r = 0.23, p = 0.007) and negatively correlated with diastolic BP (r = − 0.17, p=0.03). By a multilinear regression analysis, after adjusting for sex, diastolic BP, E/e′ ratio and relative wall thickness, GLS was independently and positively associated with MFS (β = 0.28, p = 0.003).
CONCLUSIONS: In native-hypertensive patients, an early LV myocardial systolic dysfunction occurs. LV GLS is independently and positively associated with MFS. Both GLS and MFS express intrinsic wall mechanics on different planes. Their correlation suggest that these measures go beyond the simple determination of myocardial contraction in a specific direction. Thus, their use can identify a subgroup of hypertensive patients with early LV impairment and at high risk for progression to overt heart failure.
30 PRE-HYPERTENSION AND SUBCLINICAL CARDIAC DAMAGE: A META-ANALYSIS OF ECHOCARDIOGRAPHIC STUDIES
30.1 E. Gherbesi1, C. Cuspidi2,3, C. Sala1, M. Tadic4, G. Grassi2, G. Mancia2
30.1.1 1Department of Clinical Sciences and Community Health, University of Milan and Fondazione Ospedale Maggiore Policlinico of Milan, Milan, Italy, 2Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy, 3Istituto Auxologico Italiano, Milan, 4Department of Cardiology, Charité-University-Medicine Campus Virchow Klinikum, Berlin, Germany
INTRODUCTION: The association between pre-hypertension (pre-HTN) and subclinical cardiac damage remains undefined.
AIM: We performed a systematic meta-analysis of echocardiographic studies in order to provide a comprehensive information on structural and functional cardiac changes in untreated pre-HTN subjects.
METHODS: Studies were identified by crossing the following search terms: “pre-hypertension”, “high normal blood pressure”, “heart”, “left ventricular hypertrophy”, “left ventricular function”, “diastolic function”, “left atrial size”, “aortic root size”, “echocardiography.”
CONCLUSIONS: Our meta-analysis, for the first time, shows that alterations in cardiac structure and function in pre-HTN subjects are intermediate between normotensive and HTN individuals. These findings indicate that pre-HTN may not be a benign entity and should be addressed with early preventive strategies in order to prevent preclinical cardiac damage.
31 PREDICTIVE PARAMETERS FOR CARDIOVASCULAR EVENTS IN PATIENTS AFFECTED BY MULTIPLE MYELOMA TREATED WITH CARFILZOMIB
31.1 G. Bruno1, I. Maffei1, A. Iannaccone1, T. Crea1, M. Salvini2, F. Gay2, S. Bringhen2, F. Veglio1, A. Milan1
31.1.1 1Hypertension Unit, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy, 2Department of Haematology, Città della Salute e della Scienza, University of Turin, Turin, Italy
INTRODUCTION: Carfilzomib is a second-generation proteasome inhibitor approved for the treatment of multiple myeloma (MM). However, it seems to determine cardiovascular toxicity. So far, no predictive factors for cardiovascular events (CVE) are known in patients affected by MM treated with carfilzomib.
AIM: To determine parameters able to predict CVE in MM patients undergoing carfilzomib infusions.
METHODS: From March 2014 to March 2018, 70 patients affected by MM were prospectively enrolled. A comprehensive cardiovascular evaluation was performed in our EchoLab, where each patient underwent the measurement of office blood pressure values, an ambulatory blood pressure monitoring (ABPM), a transthoracic echocardiogram, the assessment of carotid-femoral pulse wave velocity (cf-PWV). All the patients were followed up to determine the incidence of CVE.
CONCLUSIONS: Blood pressure control, left ventricular mass and cf-PWV may predict CVE in MM patients treated with carfilzomib.
32 LEFT VENTRICULAR MECHANOENERGETIC EFFICIENCY INDEX (MEEI) IN PRIMARY ALDOSTERONISM
32.1 F. Bertacchini, A. Paini, D. Stassaldi, C. Agabiti Rosei, C. Aggiusti, M. Riviera, E. Agabiti-Rosei, M.L. Muiesan, M. Salvetti
32.1.1 Internal Medicine, University of Brescia, Brescia, Italy
INTRODUCTION: Available data indicate that patients with primary aldosteronism (PA) have an increased risk of cardiovascular (CV) events; furthermore, CV risk seems to be, at least in part, independent of blood pressure (BP) elevation. Previous studies have shown that patients with PA have a greater prevalence of left ventricular (LV) hypertrophy, which might contribute to the increase in CV risk. Recently, a non-invasive approach for the estimation of LV mechanical efficiency through the calculation of the ratio between stroke work (SW) and heart rate (HR)–pressure product has been proposed by de Simone and coworkers. This index, which expresses the amount of blood pumped in a single beat in 1 second by the heart, may be easily obtained by echocardiography.
AIM: To evaluate the determinants of myocardial mechanoenergetic efficiency index (MEEi), calculated as SV/HR and indexed to LV mass (MEEi = MEE/LVM) in a large group of patients with primary aldosteronism and in a control group of essential hypertensives (EH).
METHODS: PA was diagnosed in the presence of a positive aldosterone to renin ratio (> 30) and post saline aldosterone (> 100 ng/ml). Ninety-nine patients with PA were compared with 99 EH patients matched for age and BP values.
RESULTS: No differences between groups were observed for age, gender, BMI, BP values, glucose, lipid profile and renal function. LV mass index was greater in PA vs. EH (101 ± 34 vs. 84 ± 20, g/m2, p < 0.05); also relative wall thickness was greater in PA vs. EH (0.36 ± 0.1 vs. 0.32 ± 0.4, p < 0.05). Ejection fraction was not different between groups, while endocardial and midwall fractional shortening were lower in PA vs. EH (40 ± 7 vs. 43 ± 6, and 18 ± 3 vs. 21 ± 2 both p < 0.05). MEEI was lower in PA vs. EH (0.44 ± 0.14 vs. 0.52 ± 0.10, p < 0.05). A negative correlation was observed between MEEI and aldosterone levels (r = − 0.20, p < 0.05).
CONCLUSIONS: In patients with primary aldosteronism MEEI is lower as compared to EH. These findings may contribute to explain the increased risk of CV events in patients with PA.
33 INFLAMMATION AND VENTRICULAR-VASCULAR COUPLING IN PATIENTS WITH METABOLIC SYNDROME
33.1 L. Zanoli, S. Di Marca, A. Di Pino, A.M. Rabuazzo, S. Piro, R. Scicali, V. Ferrara, M. Pisano, R. Di Quattro, V. Terranova, L. La Malfa, R. Caruso, P. Fatuzzo, P. Castellino, F. Purrello, L. Malatino
33.1.1 Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
INTRODUCTION: Metabolic syndrome (MetS) is currently considered to raise the risk for type 2 diabetes and cardiovascular events. However, only part of this risk can be attributable to the individual risk factors that concur in defining the MetS. Therefore, it has been suggested that part of the risk excess detected in MetS may be attributed to a cluster of additional factors associated with it.
AIM: To investigate the role of inflammation on the ventricular-vascular coupling in patients with MetS.
METHODS: We enrolled a total of 227 patients (106 hypertensives with MetS and 121 hypertensives without MetS) matched for age and sex.
RESULTS: Aortic pulse wave velocity (PWV), intima-media thickness (IMT) and C-reactive protein (CRP) increased according to the number of MetS components. Compared to controls with hypertension, patients with MetS showed increased aortic PWV 11.5 ± 3.7 vs. 10.3 ± 2.5 m/s, P = 0.03). In a robust outlier multivariate linear regression analysis adjusted for age, sex, heart rate and mean blood pressure, aortic PWV resulted increased in patients with CKD (beta 1.29 m/s, 95% CI 0.61–1.96 m/s, P < 0.001) and MetS (beta 0.89 m/s, 95% CI 0.28–1.51 m/s, P = 0.005). After additional adjustment for C-reactive protein (CRP) and IMT, the slope of MetS was respectively reduced by 16% (beta 0.75 m/s, 95% CI 0.12–1.37 m/s, P = 0.02) and 62% (beta 0.34 m/s, 95% CI − 0.35 to 1.02 m/s, P = 0.33), suggesting that inflammation and intima-media thickening could contribute to aortic stiffening in patients with MetS. In these patients, aortic PWV was also associated with left-ventricular mass index (beta 0.79 g/m2.7, 95% CI 0.05–1.52 g/m2.7, P = 0.05).
CONCLUSIONS: MetS is characterized by an inflammation-dependent acceleration in cardiovascular ageing. This pattern of pathophysiological abnormalities may contribute to amplify the burden cardiovascular risk in patients with MetS.
34 HEPATITIS C VIRUS EFFECTS ON CARDIAC FUNCTION IN PATIENTS WITH HEPATIC FIBROSIS GRADE F0-2
34.1 A. Dalbeni1,2, S. Romano1, E. Imbalzano3, A. Tagetti1, A. Piccoli5, G. Torin1, A. Mantovani1, G. Cavallon2, V. Paon1,2, C. Fava1, L. Iogna Prat1,4, E. Tsochatzsis4, F. Capra2
34.1.1 1Division of General Medicine and Hypertension, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy, 2Division of Liver Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy, 3Division of Internal Medicine, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy, 4UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK, 5Division of Cardiology, Department of Cardiology, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
INTRODUCTION: Recent studies have reported that HCV-related chronic infection is associated with a higher incidence of cardiovascular (CV) diseases; the multifactorial pathogenetic mechanisms are have not yet been well understood and they are probably related to the high prevalence of cardiovascular risk factors in HCV-patients, to chronic inflammation and to the specific viral cytotoxicity on endothelium and myocardium. A reduced right and left ventricular function (both systolic and diastolic) has emerged in clinical trials.
METHODS: Fifty-nine HCV-patients (59.5 ± 12.0 years; males 52%) with Fibroscan-documented low-moderate liver fibrosis and eligible for virus eradication with DAAs (Direct-Acting Antivirals), were enrolled in this single-centre, prospective and observational study. Fifty-two subjects, matched for age, sex and CV risk factors, were evaluated as healthy controls. Obesity and diabetes were considered as exclusion criteria. A transthoracic echocardiography was performed in all participants.
RESULTS: Left ventricular function and left ventricular mass indexed by body surface (LVM/BSA) were similar in the two groups; there were no statistically significant differences in ejection fraction, MAPSE and E/A ratio between patients and controls. RWT (Relative-wall Thickness) was higher in HCV participants (0.39 ± 0.01 mm in controls vs. 0.47 ± 0.02 mm in HCV; p = 0.002). Left atrial morphology parameters were also comparable. As concern the right sections of heart, higher indexed atrial volumes (HCV 19.88 ± 1.83 mm3 vs. controls 13.99 ± 0.29 mm3, p < 0.001) and basal ventricular diameters were found in HCV participants compared to controls. When subdivided according to viral load (cut-off: 800,000 copies per millilitre) and liver fibrosis grade, patients did not show any echocardiographic differences.
CONCLUSIONS: The study reveals a concentric remodelling of left heart (normal indexed LVM and abnormal RWT) and structural modifications in right sections (higher atrial volumes and ventricular diameters) in HCV-related disease and low-moderate liver fibrosis.
35 NIGHT OXYGEN DESATURATION IS ASSOCIATED WITH MORPHO-FUNCTIONAL HEART PARAMETERS IN A GROUP OF OVERWEIGHT HYPERTENSIVE PATIENTS
35.1 G. Colussi1, M. Nardi1, C. Catena1, D. Darsiè1, F. Morselli1, V. Patruno2, A. Cavarape1, L.A. Sechi1
35.1.1 1Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy, 2Division of Pulmonary Rehabilitation, I.M.F.R., Udine, Italy
INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is an emergent risk factor for major cardiovascular events. We hypothesized that the severity of OSAS can be related to subclinical heart damages. At our Cardiovascular and Metabolic Unit, we consecutively enrolled 50 overweight high risk patients with treated hypertension (age 65 ± 10 years, 58% male), 68% of which with type 2 diabetes, 44% obese, and 54% active smokers.
METHODS: We measured anthropometric parameters, general clinical characteristics and major cardiovascular risk factors and performed cardiac echo-color and tissue-Doppler analysis and overnight cardiorespiratory monitoring.
RESULTS: Based on apnea/hypopnea index (AHI), OSAS severity in the study group was stratified as follows: 38% normal/minimal (AHI < 5 events/h), 30% mild (5 ≤ AHI < 15), 26% moderate (15 ≤ AHI < 30), and 6% severe (AHI ≥ 30). Hypertensive cardiomyopathy was observed in 62% of patients, whereas atrial volume enlargement in 16%. Patients with diabetes had more severe apnea/hypopnea index (AHI) (14.5 ± 13.4 vs. 6.8 ± 8.2 events/h, P = 0.011) than those without and this relationship was independent of body mass index, age, sex, and smoking history (P = 0.005). Diastolic LV internal diameter, indexed LV mass, and e/e′ ratio was positively associated with both AHI and night oxygen desaturation, whereas LA volume and ejection fraction was associated with night oxygen desaturation. No relationships were found between OSAS and right heart. Multivariate analysis showed that the relationship between indexed LV mass and AHI (P = 0.031) or between LV mass and night oxygen desaturation (P = 0.004) was independent of age, sex, prevalence of diabetes, and history of hypertension. An independent relationship was observed also between LA volume and average percentage of night oxygen desaturation (P = 0.002) independent of covariates.
CONCLUSIONS: OSAS severity as expressed by the averaged percentage of night oxygen desaturation, is associated with cardiac morpho-functional alterations. This observation might be causal for the increased incidence of cardiovascular events in these patients.
36 PROGNOSTIC IMPACT OF LEFT ATRIAL VOLUME IN PATIENTS WITH MILD-TO-MODERATE ASYMPTOMATIC AORTIC STENOSIS
36.1 C. Mancusi1, M. Losi1, E. Mitbo2, S. Saeed2, G. de Simone1, E. Gerdts2
36.1.1 1Hypertension Research Center, Federico II University, Naples, Italy, 2Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
INTRODUCTION: The prognostic impact of increased left atrial (LA) volume in mild-to-moderate aortic valve stenosis (AS) is unclear.
AIM: We investigated the association of estimated LA volume with prognosis in a large prospective study of patients with asymptomatic mild-to-moderate AS
CONCLUSIONS: Presence of enlarged LAVI based upon estimated LAVI by a validated equation in patients with mild-to-moderate asymptomatic AS was independently associated with increased risk of MACE.
37 MATERNAL ECHOCARDIOGRAPHIC AND VASCULAR MODIFICATIONS DURING PREGNANCY COMPLICATED BY HYPERTENSIVE DISORDERS
37.1 D. Degli Esposti1, C. Macrelli1, L. Moroni1, G. Nicolini1, R. Ricci1, S. Bacchelli1, A.F.G. Cicero1, F. Fogacci1, E.R. Cosentino1, E. Brunelli2, G. Salsi2, E. Montaguti2, A. Youssef2, T. Ghi2, N. Rizzo2, C. Borghi1
37.1.1 1Cardio-Thoracic-Vascular Department, Internal Medicine, S. Orsola-Malpighi Hospital, Bologna University, Bologna, Italy, 2Obstetric and Gynecology, S. Orsola-Malpighi Hospital, Bologna University; Bologna, Italy, 3Obstetric and Gynecology, Parma University, Parma, Italy
INTRODUCTION: Among hypertensive disorder in pregnancy, preeclampsia (PE) is the most ominous complication, without a real possibility of prevention and treatment. Chronic hypertension, twin pregnancy, previous PE, and immunological diseases are among risk factors for PE. Left ventricular echocardiographic structural and functional modifications are described in PE even in precocious phases of pregnancy. Scarce are the applications of vascular assessment by ViCorder in pregnancy.
AIM: To assess echocardiographic and vascular aspects during pregnancy and after delivery in high risk pregnancies, evaluating in particular if ViCorder assessment could help in predicting PE or other related complications.
METHODS: By ViCorder we evaluated arterial pressures and some vascular function index, such as Pulse Wave Velocity and Augmentation Index, whilst by echocardiography we assessed cardiac structural and functional aspects.
RESULTS: 81 women with PE high risk pregnancy (chronic hypertension, previous PE or gestational hypertension) and 10 women with physiological pregnancy were submitted to complete colour Doppler and tissue Doppler echocardiography, and ViCorder vascular evaluation in each gestational trimester and after delivery. 40 women reached delivery without any complication, whilst 41 women had complications such as PE or gestational hypertension, anticipated delivery, small-for-gestational age infants. We did not observe any difference between the two high risk group as regard as age, BMI parity, and blood pressure at entry, whilst controls showed lower blood pressure even at entry. High risk women with complicated pregnancy showed the worst echocardiographic and vascular aspects, while controls had the best cardiovascular aspects. In particular, among ViCorder parameters, women with complicated pregnancy showed higher systolic, diastolic and mean blood pressure, as well as end systolic pressure and augmentation index. They also showed higher left ventricular mass, more concentric geometry, and relatively worst left ventricular systolic and diastolic function. Moreover, a correlation was observed between Vicorder and echocardiographic aspects, with the worst Vicorder ones together with the worst echo ones, representing therefore a sort of validation of both examinations in pregnancy.
CONCLUSIONS: We observed differences even in the first trimester, suggesting that a simple exam, such as ViCorder, could be a valid tool to predict ominous evolution of high risk pregnancies.
38 ECHOCARDIOGRAPHIC ASPECTS IN WOMEN WITH RHEUMATIC DISEASES AND A HISTORY OF PREECLAMPSIA
38.1 D. Degli Esposti, L. Moroni, G. Nicolini, R. Ricci, C. Macrelli, R. Ricci, S. Bacchelli, A.F.G. Cicero, F. Fogacci, E.R. Cosentino, C. Borghi
38.1.1 Cardio-Thoracic-Vascular Department, Internal Medicine, S.Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
INTRODUCTION: Women with rheumatic diseases show a higher risk of preeclampsia (PE) and related obstetric complications. Both rheumatic diseases and PE represent risk factors or, at least a risk indicator for worse long-term cardiovascular prognosis.
AIM: To evaluate the link between rheumatic diseases and PE, and to assess if women with rheumatic diseases and a previous history of preeclampsia or pre-eclampic complications have echocardiographic modifications persistent in their long-term history respect to women without rheumatic diseases, and with a history of non-complicated pregnancies.
METHODS: We retrospectively studied 304 consecutive women of 40–70 years age, receiving routine complete echocardiography examination, evaluating pregnancy history, blood pressure, dyslipidaemia and diabetes history, and blood pressure measurement. Women were divided in two group according to the presence or not of rheumatic disease and among the two groups were divided in further two groups according to the presence or not of pre-eclamptic complications (PE or pregnancy induced hypertension, small-for-age infant, anticipated delivery) during previous pregnancies. Exclusion criteria were at least moderate valve disease or other cardiac diseases potentially causes of cardiac structural or functional modifications.
RESULTS: We confirmed the correlation between rheumatic diseases and PE (p = 0.032), and among women with rheumatic diseases, those with PE history showed higher relative wall thickness (0.43 ± 0.07 vs. 0.4 ± 0.06, p = 0.024), lower left ventricular diastolic dimensions (4.25 ± 0.25 cm vs. 4.44 ± 0.4 cm, p = 0.02) and volumes (81.58 ± 11.9 ml vs. 90.67 ± 21.39 ml, p = 0.025), and a not-significant trend toward a worsening in diastolic function. These aspects, already described in women with PE, and typical end organ damage of hypertension as well, were observed in the presence of similar prevalence of hypertension in the two group, suggesting a direct link between PE and long-term end organ damage. No significant differences were observed between PE history and normal pregnancies in the group of women without rheumatic diseases, suggesting a particular cluster of cardiovascular risk in women with rheumatic diseases and PE history.
CONCLUSIONS: It is not possible to define if PE is an indicator of cardiovascular risk or a proper cardiovascular risk factor.
39 THE RESULTS OF THE PARADIGM-HF TRIAL CAN BE APPLIED TO THE ELDERLY HYPERTENSIVE PATIENTS WITH COMORBIDITIES AND CHRONIC HEART FAILURE WITH REDUCED LEFT VENTRICULAR EJECTION FRACTION?
39.1 A. Mazza1, L. Schiavon2, G. Torin3, S. Lenti4
39.1.1 1ESH Excellence Hypertension Centre, Unit of Internal Medicine, S. Maria della Misericordia Hospital, AULSS 5 Polesana, Rovigo, Italy, 2Unit of Internal Medicine, S. Maria della Misericordia Hospital, AULSS 5 Polesana, Rovigo, Italy, 3Unit of Internal Medicine C, Department of Medicine, University of Verona, Verona, Italy, 4Internal Medicine Unit, S. Donato General Hospital, Arezzo, Italy
INTRODUCTION: The results of Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (Paradigm-HF) clinical trial have demonstrate that angiotensin receptor-neprilysin inhibitor (ARNI) in patients with chronic heart failure and reduced left ventricular ejection fraction are superior to enalapril in clinical outcomes. Despite this, there are little evidences about the efficacy of ARNI in elderly hypertensive patients with congestive heart failure (CHF) and comorbidities.
AIM: To evaluate the efficacy of ARNI to improve symptoms of HF and to explain the pathophysiological mechanisms by which they are achieved.
METHODS: Twenty-one hypertensive men (mean age 73.9 ± 11.8 years), having chronic CHF with reduced LVEF (29.4 ± 5.3%), in New York Heart Association (NYHA) class II to III symptoms and with a recent discharge for CHF were recruited. They were assigned to take ARNI twice daily according to the recommended dosage of 24/26, 49/51, 97/103 mg for 3 and 6 months. These patients were gender and age-matched with a control group of patients receiving standard therapy (ST) for HF and followed in our office. The office blood pressure (BP), NT-pro-BNP, estimated glomerular filtration rate (eGFR) values and NYHA class were evaluated at 6 months of follow-up during treatment with ARNIs; at the end of the follow-up (FW) left ventricular ejection fraction (EF) was performed by echocardiography. Difference of continuous variables at FW from baseline (B), were evaluated by the analysis of variance for repeated measures. Categorical variables were expressed as percentage rates and compared with the Pearson’s χ2 test.
CONCLUSIONS: In elderly patients with CHF and comorbidities ARNIs treatment seems effective and safe. The improvement of LVEF and of eGFR could be the mechanisms by which ARNIs plays their beneficial role on CHF.
40 CARDIOVASCULAR RISK AND HISTORY OF PREECLAMPSIA: LONG-TERM ANALYSIS OF ECHOCARDIOGRAPHIC ASPECTS
40.1 D. Degli Esposti, G. Nicolini, L, Moroni, C. Macrelli, R. Ricci, S. Bacchelli, A.F.G. Cicero, F. Fogacci, E.R. Cosentino, C. Borghi
40.1.1 Cardio-Thoracic-Vascular Department, Internal Medicine, S. Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
INTRODUCTION: Preeclampsia (PE) and related obstetric complications is a risk factor, or, at least a risk indicator for long-term cardiovascular prognosis.
AIM: Aim of the study was to assess if women with a previous history of preeclampsia or pre-eclampic complications have different echocardiographic aspects and a cluster of other cardiovascular risk factors respect to women with previous normal pregnancies.
METHODS: A retrospective study was conducted between March 2016 and April 2018 on consecutive women aged 40–80 years, receiving routine complete echocardiography examination, evaluating pregnancy history, blood pressure, dyslipidaemia and diabetes history, and blood pressure measurement. Women were divided in two group according to the presence or not of pre-eclamptic complications (PE or pregnancy induced hypertension, small-for-age infant, anticipated delivery) during their previous pregnancies.
RESULTS: Women with previous complicated pregnancies had higher prevalence of hypertension (OR 1.63, p = 0.042) and diabetes (OR 3.32, p = 0.005), they were less high (p = 0.000). As regard as echocardiographic aspects they had thicker left ventricular diastolic posterior wall (p = 0.021), suggesting a trend toward a more concentric left ventricular geometry, and lower tissue Doppler systolic waves both at mitralic anulus (septal p = 0.01, lateral 0.007), and at tricuspidalic anulus (p = 0.033), suggesting a certain degree of systolic function damage of both ventricles. Moreover, they showed lower uric acid values respect to controls (p = 0.21).
CONCLUSIONS: Women with a history of complicated pregnancies had a cluster of risk factors, such as hypertension and diabetes, and some cardiac structural and functional modifications, which can however be correlated with the presence of hypertension history.
41 ANALYSIS OF AORTIC REMODELING AND STIFFNESS IN HYPERTENSIVES WITH OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS)
41.1 S. Cicco1, G. Castellana2, L. Marra2, S. Dragonieri2, Prof. P. Carratù2, O. Resta2, A. Vacca1, G. Ranieri1
41.1.1 1Hypertension Center, Internal Medicine “G. Baccelli”, Department of Internal Medicine and Clinical Oncology, 2Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, University of Bari Aldo Moro Medical School, Bari, Italy
INTRODUCTION: Obstructive Sleep Apnea (OSA) is a well-known risk factor for cardiovascular diseases. Several studies have shown that OSA is associated with vessel remodeling. Few studies have examined ascending aorta in OSA.
AIM: To analyze the link between aortic root diameter (ARD) and severity of OSA or diurnal value of PaO2 and PaCO2.
METHODS: We studied 54 consecutive OSA patients (38 M/16 F, aged 58.5 ± 13.2 years). All patients underwent to a morning blood gas analysis, a full cardiorespiratory evaluation, including nocturnal polygraphy and echocardiography, with measurement of ARD and aortic stiffness index (ASI). Patients were grouped as follows: Group 1, non-severe OSA (Apnea-Hypopnea Index—AHI—< 30, 30 pts) and Group 2, severe OSA (AHI ≥ 30, 24 pts). Statistical significance: P ≤ 0.05.
RESULTS: No difference has been found between groups in ARD as absolute value (Group 1, 32.54 ± 3.99 mm; Group 2, 33.17 ± 3.61, P = ns) and normalized value for the body surface area—Aoi (Group 1, 16.20 ± 2.45 mm/m2; Group 2, 15.94 ± 1.75, P = ns). Moreover, no difference has been found in ASI (Group 1, 13.08 ± 7.39; Group 2, 12.08 ± 7.53, P = ns). Considering all OSA patients, AHI gave an inverse correlation with ASI (P = 0.047). Moreover, ASI was directly correlated with Aoi (P = 0.049) and to the number of drug assumed (P = 0.049) as well as a tendency of inverse correlation with oxygen desaturation index (ODI, P = 0.05).
CONCLUSIONS: No differences have been found between severe and not-severe OSA in ARD. Data have shown that severity of OSA correlates inversely with ASI. This result should not be a consequence of drugs assumed.
42 PLASMA CORTISOL LEVELS AFTER OVERNIGHT SUPPRESSION TEST WITH DEXAMETHASONE ARE ASSOCIATED WITH LEFT VENTRICULAR MASS AND GEOMETRIC CHANGES IN ESSENTIAL HYPERTENSION
42.1 C. Catena, G. Colussi, R. Abrusci, A. Palomba, F. Nait, G. Brosolo, L.A. Sechi
42.1.1 Clinica Medica, Department of Medicine, University of Udine, Udine, Italy
INTRODUCTION: Subclinical hypercortisolism and overt Cushing syndrome are associated with cardiovascular events. Few data are available on the relationship between cortisol production and LV geometry in essential hypertensive (EH) patients.
AIM: To evaluate the relationship between cortisol levels, the response of cortisol to the overnight dexamethasone suppression test (DMT) and LV mass and geometry in EH patients.
METHODS: In 103 EH subjects (age 50 ± 14 years, 58 males), we evaluated the circadian levels of plasma cortisol (8 AM, 5 PM, and 11 PM) with the area under the curve (C-AUC), 24-h urinary cortisol excretion, and the response of plasma cortisol to the DMT, and a standard echocardiography was performed.
RESULTS: A LV hypertrophy (LVH) was detected in 34 EH patients. Patients with LVH had a higher post-DMT cortisol level (P = 0.004) than patients without LVH. An eccentric LVH was present in 13 EH patients who showed greater post-DMT plasma cortisol levels than patients with other types of LV geometry. LV mass index (LVMI) was significantly and directly related to age, duration of hypertension, BMI, systolic blood pressure, plasma glucose, triglycerides, HOMA-index and post-DST plasma cortisol (r = 0.349, P = 0.002), whereas a borderline significant relationship was found with C-AUC (r = 0.201, P = 0.053). At multivariate analysis LVMI was independently associated with post-DMT cortisol (B = 0.245, P = 0.026) and C-AUC (B = 0.233, P = 0.018). At logistic regression analysis LVH was associated independently with BMI and post-DMT plasma cortisol (OR = 1.06, P = 0.045).
CONCLUSIONS: Subtle changes in the regulation of plasma cortisol secretion contribute to cardiac hypertrophy and LV geometric changes in patients with EH.
43 ACTIVATION OF THE PROTECTIVE ARM OF THE RENIN-ANGIOTENSIN SYSTEM PREVENTS THE DEVELOPMENT OF MYOCARDIAL FIBROSIS IN ANGIOTENSIN II-DEPENDENT HYPERTENSION
43.1 G. Castoldi1, C.R.T. di Gioia2, R. Carletti2, F. Roma1, M.G. Radaelli3, G. Manzoni3, A. Stella1, G.P. Zerbini4, G. Perseghin1,3
43.1.1 1Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Monza, Italy; 2Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo-patologiche, Istituto di Anatomia Patologica, Sapienza Universita’ di Roma, Rome, Italy; 3Dipartimento di Medicina Interna e Riabilitazione, Policlinico di Monza, Monza, Italy; 4Unita’ Complicanze del Diabete, Istituto Scientifico San Raffaele, Milano, Italy
INTRODUCTION: Angiotensin 1–7 (Ang 1–7), through Mas receptor, and Compound 21 (C21), AT2 receptor agonist, play an important role in the modulation of the protective arm of the renin-angiotensin system.
AIM: To investigate the effects of the activation of the protective arm of the renin-angiotensin system, through AT2 or Mas receptor stimulation, on the onset of myocardial fibrosis in an experimental model of angiotensin II-dependent hypertension.
METHODS: Sprague Dawley rats (n = 42) were treated for 4 weeks with: (a) Angiotensin II (Ang II, 200 ng/kg/min, osmotic minipumps s.c, n = 7); (b) Ang II + Ang 1–7 (576 μg/kg/day, i.p., n = 10); (c) Ang II + Compound 21 (C21, 0.3 mg/kg/day, i.p., n = 10); (d) Ang II + Losartan (50 mg/kg/die, p.o., n = 7); (e) control group (physiological saline, n = 8). Systolic blood pressure was measured by tail cuff method and, at the end of the experimental period, the rats were sacrificed and the heart was excised to evaluate interstitial fibrosis (Sirius red staining, histomorphometry, Image J software).
RESULTS: Ang II caused a significant increase of blood pressure (p < 0.0001) and myocardial interstitial fibrosis (p < 0.01) as compared to control group. C21 or Ang 1–7 administration did not modify the increase in blood pressure in Ang II treated rats, but prevented the development of interstitial myocardial fibrosis. Treatment with Losartan blocked the onset of hypertension and myocardial fibrosis in Ang II treated rats.
CONCLUSIONS: Activation of AT2 receptors or Mas receptors prevents the onset of myocardial fibrosis in Ang II-dependent hypertension. Unlike what happens with the treatment with Losartan, the antifibrotic effect obtained by activation of the AT2 or Mas receptors results to be independent of the modulation of blood pressure.
44 HIDDEN ENEMY: A RARE CASE OF MULTIPLE CARDIAC MASSES
44.1 F. Moscucci, S. Sciomer, G. Piccirillo, M. Cacciafesta
44.1.1 Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy.
45 AORTIC VISCOELASTIC PROPERTIES IN PATIENTS WITH CARDIAC AMYLOIDOSIS
45.1 L. Salvi1, F. Banfi1, P. Salvi2, A. Grillo2, G. Parati2, S. Perlini2
45.1.1 1Ospedale San Matteo, Pavia, Italy, 2Istituto Auxologico Italiano, Milano, Italy
INTRODUCTION: Cardiac amyloidosis (CA) is an infiltrative disorder primarily caused by deposition of amyloid fibrils in the myocardial extracellular matrix. It may be diagnosed as isolated disorder or as part as a systemic amyloidosis. Although there is a wide scientific literature regarding amyloid heart disease, no data about viscoelastic properties of the aorta in these patients are available.
METHODS: Outpatients attending the Pavia Amyloid Center either with suspected or already diagnosed cardiac amyloidosis were enrolled (mean age ± SD = 66 ± 12 years). 58 of them affected by cardiac amyloidosis. 57 patients have amyloidosis AL, 10 ATTRwt; 7 mATTR, 9 others different kinds of systemic amyloidosis. Arterial applanation tonometry (PulsePen, DiaTecne, Milan, Italy) was performed in carotid and femoral arteries to calculate carotid-to-femoral pulse wave velocity (PWV) as index of aortic stiffness. The variables were calculated by variance analysis. To identify factors affecting PPA a multivariate analysis was performed.
CONCLUSIONS: Although there were no significant differences in aortic stiffness evaluated by PWV in subjects with CA compared with controls, a reduced PPA was found. An altered electromechanical cardio-aortic connection, with preserved aortic properties, may be an explanation for this finding. In other words, amyloid cardiopathy strongly impairs cardiac function, without significantly alteration in aortic function. Significantly reduced central and peripheral pressure values could be caused by the inability of the diseased heart to develop a post load compared to that of subjects without cardiac involvement.
46 TROPONIN INCREASE AND SUBENDOCARDIAL OXYGEN SUPPLY AND DEMAND IMBALANCE IN CARDIAC AMYLOIDOSIS
46.1 L. Salvi1, F. Banfi1, P. Salvi2, A. Grillo2, G. Parati2, S. Perlini1
46.1.1 1Ospedale San Matteo, Pavia, Italy, 2Istituto Auxologico Italiano, Milano, Italy
INTRODUCTION: The increase in serum troponin is a known peculiarity of cardiac amyloidosis (CA). The most acclaimed hypothesis to explain this phenomenon is the toxicity of amyloid fibrils on cardiomyocytes. A possible subendocardial ischemia due to discrepancy between oxygen supply and demand imbalance has not been investigated yet.
METHODS: 113 outpatients (mean age ± SD: 66 ± 12 years), attending the Pavia Amyloid Center were enrolled. 58 of them were affected by CA. The subendocardial viability ratio (SEVR) was used to quantify non-invasively the relationship between subendocardial oxygen supply and demand. The SEVR was obtained by analysing the central pressure waveform obtained with a high-fidelity applanation tonometry (PulsePen, DiaTecne, Italy) and by calculating the ratio between the diastolic and systolic pressure-time indexes. Aortic stiffness was assessed measuring carotid-femoral pulse wave velocity (PWV). The SEVR was compared to plasmatic troponin I (TnI).
CONCLUSIONS: There is a close connection between the increase in troponin values and the reduction in SEVR. Our study highlights that ischemic suffering, with undamaged coronary arteries, may be a cause of cardiac myocytes damage in amyloidosis. The increase of left ventricular mass with the progression of the disease and the presence of amorphous amyloid mass altering the microcirculation may limit myocardial perfusion. Moreover, amyloid mass alters the macrostructural organization of myofibrils, thus heart may need an increased energy-metabolic supply.
EPIDEMIOLOGY AND CLINICAL ASPECTS
47 ASSESSMENT OF A NON-PHYSICIAN SCREENING PROGRAM FOR HYPERTENSION AND CARDIOVASCULAR RISKS IN COMMUNITY PHARMACIES
47.1 M. Pappaccogli1,*, L. Ravetto Enri2,*, E. Perlo1, S. Di Monaco1, C. Fulcheri1, I. Pignata2, F. Baratta2, F. Rabbia1, M. Mana3, F. Veglio1, P. Brusa2
47.1.1 1Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy, 2Department of Pharmaceutical Science and Technology, University of Turin, Turin, Italy, 3Federfarma Piemonte, Turin, Italy
INTRODUCTION: Hypertension is screened routinely by primary care physicians and no other non-physician screening programs are available.
AIM: To describe a population who underwent to a non-physician pharmacy based screening program for hypertension.
METHODS: 2731 costumers afferent to pharmacies answered to a questionnaire on personnel cardiovascular risk and measured their blood pressure with the support of trained community pharmacists. It does not exist a blood pressure target for diagnosing hypertension in the pharmacy setting, therefore we adopted 3 different cut-off values: ≥ 140/90, ≥ 135/85 and ≥ 130/80 mmHg. We evaluated the prevalence of hypertension according to these cut-off values and compared normotensives and hypertensives on major cardiovascular risk factors.
CONCLUSIONS: Our findings underline the usefulness of non-physician screening programs and other primary prevention strategies in order to increase blood pressure control, reduce cardiovascular risk and minimize the number of undiagnosed hypertensives, early detecting apparently healthy individuals, mostly among young adults in which a “wait and see” strategy may fail because of the difficulties to attend a practitioner visit.
48 CARDIOVASCULAR RISK PROFILE AND CLINICAL OUTCOMES OF HYPERTENSIVE PATIENTS COMPARED TO NORMOTENSIVE: ANALYSIS OF A LARGE DATABASE OF NOAC PRESCRIPTIONS FOR ATRIAL FIBRILLATION.
48.1 V. Presta1, I. Figliuzzi1, F. Miceli1, B. Citoni1, N. Attalla El Halabieh1, R. Coluccia2, A. Ferrucci1, M. Volpe1,2, G. Tocci1,2
48.1.1 1Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant’Andrea Hospital, Rome, Italy, 2 IRCCS Neuromed, Pozzilli (IS), Italy
INTRODUCTION: Hypertension substantially contributes to increased stroke risk in patients with atrial fibrillation (AF), being included in both CHA2DS2-VASc and HAS-BLED scores.
AIM: To evaluate cardiovascular (CV) risk profile and clinical outcomes in AF patients treated with novel oral anticoagulant agents (NOACs), who were stratified according to hypertension.
METHODS: From January 2013 to April 2018, we analysed adult outpatients with various forms of AF who received NOACs according to diagnostic criteria recommended by the Agenzia Italiana del Farmaco (AIFA). All candidate patients were consecutively included in the web-based AIFA database, which required demographic, clinical and therapeutic data for diagnostic and prescribing purposes. CHA2-VASC2 and HAS-BLEED scores were assessed in each patient included in the registry. Follow-up visits were scheduled every year. At each predefined time interval, blood samples were drawn for assessing haemoglobin, haematocrit, renal and liver functions. Incidence of drug-related side effects, major CV events and bleedings were periodically assessed. Diagnosis of hypertension was set according to ESH/ESC 2013 criteria.
RESULTS: Among a total sample of 850 adult patients with AF, 718 (84.5%) were hypertensive and 132 (15.5%) were normotensive individuals. No significant differences were found between groups for currently available NOACs. Hypertensive patients were older (75.1 ± 9.7 vs. 66.9 ± 14.3 years; P < 0.001), had higher serum creatinine levels (1.07 ± 0.35 vs. 0.91 ± 0.19 mg/dl; P = 0.024), and were more frequently affected by dyslipidaemia (43.3% vs. 18.4%; P = 0.004), diabetes (22.6% vs. 11.4%; P = 0.004), and coronary artery disease (29.9% vs. 12.1%; P < 0.001) compared to normotensive subjects. As expected, they also showed significantly higher CHA2-VASC2 (4.01 ± 1.5 vs. 2.39 ± 1.5; P < 0.001) and HAS-BLEED (2.51 ± 1.0 vs. 1.11 ± 0.9; P < 0.001) scores. Despite higher CV risk profile and higher scores, hypertension was not associated to an increased risk of major CV events [OR 4.335; 95% CI (0.580–32.381); P = 0.153], bleeding [OR 2.416; 95% CI (0.313–18.624); P = 0.397] or discontinuations [OR 0.753; 95% CI (0.513–1.106); P = 0.148] compared to normotension.
CONCLUSIONS: Hypertension was associated with increased CV risk profile, but not with adverse clinical outcomes in AF patients treated with NOACs compared with normotensive individuals.
49 ESTIMATION OF EUROPEAN SCORE RISK IN PATIENTS WITH SYSTEMIC HEMODYNAMIC ATHEROTHROMBOTIC SYNDROME (SHATS)
49.1 I. Figliuzzi1, V. Presta1, B. Citoni1, F. Miceli1, F. Simonelli1, A. Battistoni1, R. Coluccia2, A. Ferrucci1, M. Volpe1,2, G. Tocci1,2
49.1.1 Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant’Andrea Hospital, Rome, Italy, 2IRCCS Neuromed, Pozzilli (IS), Italy
INTRODUCTION: The Systemic Hemodynamic Atherothrombotic Syndrome (SHATS) is defined by the simultaneous presence of multi-organ alteration in single individuals. Cardiovascular (CV) risk estimation in SHATS patients has not been defined yet.
AIM: To evaluate prevalence and risk score profile according European SCORE equation in SHATS patients followed in a setting of real practice in Italy.
METHODS: Data extracted from a cross-sectional, national medical database were analysed for global CV risk assessment and rates of control of major CV risk factors, including hypertension, dyslipidaemia, diabetes, and obesity. CV risk profile characterization was based on European SCORE equation. The following markers of organ damage (OD) were considered: (1) cardiac OD: electrocardiographic or echocardiographic left ventricular hypertrophy; (2) vascular OD: carotid atherosclerotic plaque; (3) renal OD: reduced estimated glomerular filtration rate or microalbuminuria. SHATS was defined as their simultaneous presence in one individual.
RESULTS: We analysed data from a population sample of 2641 adult outpatients with valid OD data (age 57.9 ± 5.2 years, BMI 28.4 ± 5.1 kg/m2, clinic blood pressure 135.7 ± 14.5/82.0 ± 8.1 mmHg, total cholesterol 211.2 ± 39.8 mg/dl), who were predominantly followed by general practitioners (70.6%). In this sample, 25 (0.9%) patients had cardiac, 80 (3.0%) vascular, 541 (20.5%) renal OD, and 0.5% had SHATS. These patients showed significantly lower HDL cholesterol (41.8 ± 8.7 vs. 50.7 ± 13.0 mg/dl; P = 0.031) and higher levels of triglycerides (229.0 ± 101.7 vs. 161.1 ± 82.1 mg/dl; P = 0.006), systolic blood pressure (152.2 ± 14.2 vs. 135.8 ± 14.4 mmHg; P < 0.001), pulse pressure (70.2±11.3 vs. 53.7±11.3 mmHg; P < 0.001) and SCORE risk level (5.3 ± 3.8 vs. 3.0 ± 2.6%; P = 0.002) compared other ones. SHATS patients received more antiplatelet (76.9 vs. 43.6%; P = 0.016) and lipid-lowering (92.3% vs. 50.5%; P = 0.002) agents compared to other patients, whereas no difference was found for antidiabetic or antihypertensive drugs.
CONCLUSIONS: Although associated with impaired metabolic profile and high pulse pressure, thus suggesting a potentially higher susceptibility to developing major CV events, SHATS had relatively low prevalence in a setting of real practice of general medicine.
50 RELATION BETWEEN DIETARY HABITS AND ANTHROPOMETRIC AND VASCULAR PARAMETERS IN CHILDREN ATTENDING THE PRIMARY SCHOOL IN VERONA SOUTH
50.1 A. Giontella1, A. Tagetti1, S. Bonafini1, I. Bresadola2, L. Nicolussi Principe1, P. Minuz1, C. Maffeis2, F. Antoniazzi2, C. Fava1
50.1.1 1Dipartimento di medicina, Verona, Italy, 2Dipartimento di Scienze Chirurgiche Odontostomatologiche e Materno-Infantili, Verona, Italy
INTRODUCTION: Since childhood, unhealthy dietary habits could trigger the onset of cardiovascular risk factors, such as obesity and hypertension.
AIM: In this school-based study we aimed to identify the possible relation between dietary patterns, physical activity and anthropometric, hemodynamic [blood pressure (BP) and pulse wave velocity (PWV)] and gluco-lipid parameters.
METHODS: A validated Food Frequency Questionnaire (FFQ) and a validated questionnaire assessing the degree of physical activity (PAQ-C) were administered to children attending the 3rd and 4th class of four primary schools. Children responded with the aid of their parents and a dedicated dietitian. From FFQ, composed by 15 categories for a total of 61 foods, nutritional content in term of energy and macro-nutrients intake was extrapolated. Also dietary patterns obtained by Principal Component Analysis (PCA) were identified. Metabolic Equivalent of Task (MET) were computed for each child from IPAQ.
RESULTS: Three-hundred and nine children between 8 and 11 years participated (74.8% response rate) of whose 302 (97.7%) children compiled the FFQ. Significant correlations were found between: “junk food” intake and BMI (rs = 0.141, p < 0.05), diastolic BP (rs = 0.114, p < 0.05); PWV (rs = 0.155, p < 0.01), triglycerides (rs = 0.150, p < 0.05); meat intake and diastolic BP (rs = 0.124, p <0.05); vegetables intake and Z-score of diastolic BP (rs = − 0.115, p < 0.05);“animal fats” intake and cholesterol (rs = 0.165, p < 0.05). PCA identifies three dietary patterns: one characterized by junk food, meat, sweet, cereals and tubers; one composed by fruits, vegetables and fish and legumes and one characterized by eggs. No significant correlation was found between physical activity and the analyzed parameters.
CONCLUSIONS: The significant correlation between some categories of food and anthropometric, vascular and gluco-lipid parameters in 8–11 years children suggests that it is important to begin early with politics to prevent the onset of overt cardiovascular risk factors.
51 ANTIHYPERTENSIVE THERAPY DEPRESCRIBING IN OVER-EIGHTY-YEARS-OLD-PATIENTS: A TEN-YEAR EXPERIENCE
51.1 A. Grossi1, E. Cattaneo1, R. Corso1, N. Tandurella1, S. Moretti1, G. Cavallaro1, L. Robustelli-Test1, M. Agostinis1, V. Pierobon1, L. Tavecchia1, V. Mancuso1, C. Mongiardi1, L. Montalbetti1, A.M. Grandi1, L. Guasti1, A.M. Maresca1
51.1.1 1Department of Medicine and Surgery, University of Insubria, Varese, Italy
INTRODUCTION: Antihypertensive therapy deprescribing seems to reduce mortality in frail hospitalized elderly, whereas few evidences are available for fit elderly.
AIM: To investigate type and number of antihypertensive drugs in over-80-years-old-patients and 5-year follow-up changes in antihypertensive therapy.
METHODS: We enrolled 239 over-eighty-years-old-hypertensives (82.3 years) from 2007 to 2015. For each patient we assessed home and office-BP, other cardiovascular (CV) risk factors, target organ damage, comorbidities, antihypertensive-drugs. Follow-up consisted in interview to detect antihypertensive-therapy changes, CV-events and mortality.
RESULTS: At the first visit, BP-values were < 140/90 mmHg in 133 (55.6%) patients, systolic-BP > 140 mmHg in 87 (36.4%), diastolic-BP > 90 mmHg in 3 (1.3%), both systolic and diastolic-BP uncontrolled in 16 (6.7%). Forty-six (19.2%) patients had orthostatic hypotension, 133 (77.3%) left ventricular hypertrophy-LVH, 107 (70.9%) carotid-plaques. A history of heart failure was found in 16 (6.7%) patients, coronary-disease in 24 (10%), cerebrovascular-disease in 14 (5.8%), chronic renal failure in 46 (19.2%), diabetes and/or dyslipidaemia in 134 (56.1%). Among all patients, 52.3% of patients took 2–3 types of antihypertensive drugs, 32.7% ≥ 4, 12.6% followed monotherapy, 2.5% did not take antihypertensive drugs. Most used drugs were: calcium-antagonists (CA 66%), angiotensin-receptor-blockers (ARB 57%), beta-blockers (BB 42%), thiazide-diuretics (TD 47%), angiotensin-converting-enzyme-inhibitors (ACE-I 33%), sympatholytic (25%), loop-diuretics (LD 15%), mineralcorticoid-antagonists (MA 6%). After 4.9 ± 2.2 years, 51.7% of patients took 2–3 types of antihypertensive drugs, 25.3% ≥ 4, 16.7% followed monotherapy, 6.3% did not take antihypertensive drugs. The mean number of drugs passed from 2.96 ± 1.40 to 2.58 ± 1.34 (p: 0.006). The reduced pharmacological load was confirmed in males and females, in well-controlled and uncontrolled hypertensives. Particularly, CA (p: 0.04), TD (p: 0.001) and ARB (p: 0.01) were less used, whereas there was a rise of LD prescriptions (p: 0.004). Thirty-seven (15.5%) patients died: 54% for CV-events and 46% for other causes. Among the 174 (72.8%) alive-patients, 12 (6.9%) had CV-events.
CONCLUSIONS: Our data underlined deprescribing of hypertensives-drugs in an out-patient sample of fit over-80-year-old-hypertensives, especially for TD, ARB and CA. Due to the small sample size, it was not possible to evaluate the weight of deprescribing in terms of CV-morbidity and mortality.
52 INTERACTION BETWEEN LDL-CHOLESTEROLEMIA, SERUM URIC LEVEL AND SHORT-TERM INCIDENT HYPERTENSION: DATA FROM THE BRISIGHELLA HEART STUDY
52.1 A.F.G. Cicero, F. Fogacci, S. D’Addato, M. Giovannini, E. Grandi, E. Rizzoli, M. Rosticci, C. Borghi
52.1.1 Medicine and Surgery Sciences Dept., University of Bologna, Italy
AIM: To evaluate the short-term interaction between SUA, LDL-C and incident hypertension in a sample of overall healthy subjects.
METHODS: We selected from the general database of the Brisighella Heart Study four groups of age- and sex-matched non-hypertensive subjects with different levels of LDL-C and SUA level and examined during the 2008 population survey and re-evaluated in 2012. Incident hypertension was defined as the increase of systolic blood pressure values over 140 mmHg and/or of diastolic blood pressure over 90 mmHg and or the beginning of an antihypertensive treatment. The timing of hypertension diagnosis was estimated on the basis of what reported by the patient, the data reported on the electronic clinical forms provided by general physicians and of the beginning of the pharmacological treatment reported by the local pharmacy registries.
RESULTS: In a model adjusted for age, sex and baseline blood pressure Hazard Rations (HRs) for hypertension development compared to subjects with baseline normal LDL-C and SUA levels were 1.86 (95% CI 0.88–1.58, p = 0.243) for subjects with isolated high LDL-C level, 1.53 (95% CI 0.92–2.49, p = 0.061) for subjects with isolated high SUA level, and 1.61 (95% CI 1.18–2.11, p = 0.009) for subjects with both suboptimal LDL-C and SUA levels. In a model further adjusted for family history of hypertension, smoking status, Body Mass Index and physical activity intensity, HRs for hypertension development compared to subjects with baseline normal LDL-C and SUA levels were 1.14 (95% CI 0.87–1.55, p = 0.249) for subjects with isolated high LDL-C level, 1.55 (95% CI 0.96–2.48, p = 0.059) for subjects with isolated high SUA level, and 1.57 (95% CI 1.20–2.15, p = 0.015) with both suboptimal LDL-C and SUA levels.
CONCLUSIONS: In an overall healthy population sample, the contemporary presence of suboptimal LDL-C and SUA values are associated to an increased risk to develop hypertension.
53 GENDER-RELATED DIFFERENCES IN SERUM URIC ACID IN TREATED HYPERTENSIVES FROM CENTRAL AND EASTERN EUROPEAN COUNTRIES: FINDINGS FROM THE BP-CARE STUDY
53.1 A. Maloberti1,2, P. Redon3,4, R. Facchetti2, J. Redon4,5, E. Lurbe3,5, M. Bombelli2, G. Mancia2, G. Grassi2
53.1.1 1Cardiology IV, ASST Niguarda Hospital, Milan, Italy, 2School of Medicine and Surgery, Milano Bicocca University, Milan, Italy, 3 Pediatric Department of Consorcio Hospital General Universitario de Valencia, Valencia, Spain, 4CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Valencia, Spain, 5Hypertension Clinic, Hospital Clinico, INCLIVA, University of Valencia, Spain
INTRODUCTION: Hyperuricemia is frequent in hypertensives and have been associated to Blood Pressure (BP) values, Diabetes Mellitus (DM), Metabolic Syndrome (MS) and Chronic Kidney Disease (CKD).
AIM: To assess the relationship between Serum Uric Adic (SUA) and cardiometabolic variables in central and eastern Europe hypertensives.
METHODS: A total of 3222 with available SUA levels from the BP-care study were used for the present analysis. Correlation among SUA and BP values and control, DM, MS and CKD were assessed.
RESULTS: 25% of the whole population showed hyperuricemia (28% in females and 23% in males). Those subjects were older and showed a greater burden of CV risk factors (BP, BMI, glucose, total cholesterol and trigliceridemia). They also showed higher prevalence of MS, DM, uncontrolled BP, more than high CV risk and CKD. Hyperuricemic females didn’t showed differences in MS and uncontrolled BP while they present a higher prevalence of SM, high CV risk and CKD. In males a higher prevalence of MS, DM, high CV risk, uncontrolled BP and CKD but not polytherapy were showed. Logistic regression analysis showed that none of the evaluated cardio-metabolic variables, except for CKD, displayed SUA as a significant covariate.
CONCLUSIONS: Our findings provide evidence of a high prevalence of hyperuricemia among hypertensives from central and eastern Europe. Furthermore, we confirm that gender-related differences in the association between SUA and cardio-metabolic variables exist. Finally, a further confirmation of the independent role of SUA in development of CKD has been found in our population.
54 AMONG YOUNG ISOLATED SYSTOLIC HYPERTENSIVES THE RISK OF DEVELOPMENT HYPERTENSION NEEDING TREATMENT VARIES ACCORDING TO AMBULATORY BLOOD PRESSURE MONITORING LEVELS
54.1 F. Saladini 1, C. Fania 1, L. Mos 2, G. Garavelli 3, A. Mazzer 4, P. Palatini 1
54.1.1 1Dipartimento di Medicina, Università degli Studi di Padova, Padova, Italy, 2Unità Operativa di Cardiologia, Ospedale di San Daniele del Friuli, Udine, Italy, 3Unità Operativa di Cardiologia, Ospedale di Cremona, Cremona, Italy, 4Unità Operativa di Medicina, Ospedale di Vittorio Veneto, Treviso, Italy
INTRODUCTION: The clinical significance of isolated systolic hypertension (ISH) in youth and whether it should be treated is controversial. According to previous data, one of the main determinants of ISH is the white-coat effect.
AIM: To investigate the risk of hypertension needing pharmacological treatment in ISH identified with ambulatory 24 h blood pressure (ABPM).
METHODS: Among 1206, 18-to-45-year-old participants from the HARVEST study, 269 subjects were normotensive (NT), 209 had ISH, 277 had isolated diastolic hypertension (IDH), and 451 had systolic-diastolic hypertension (SDH). The cut-off value of 97 mmHg was used to distinguish those participants with normal and high 24 h mean BP. The predictive role of ISH for incident hypertension was evaluated in Cox survival analyses, adjusting for risk factors and confounders.
RESULTS: ISH participants were more frequently young males active in sports, with lower heart rate and cholesterol and higher stroke volume. During a 6.9-year follow-up, 61.1% of participants developed hypertension. ISH participants had a nonsignificant increase in risk of hypertension compared to NT (reference group) while IDH (1.44; 1.13–1.85) and SDH (2.04; 1.59–2.64) presented a significant increase in risk. When the ISH participants were divided according to whether 24 h mean BP was normal (< 97 mmHg) or high, ISH subjects with normal mean BP had no increase in risk (1.01; 0.73–1.40) whereas those with high mean BP had a significant increase in risk (1.70; 1.16–2.49). Similar results were observed for IDH, only those with high 24 h mean BP presented and increased risk (p < 0.001). Also when night-time BP was used to divide those with normal or high (< 87 or ≥ 87 mmHg) mean BP, only ISH and IDH with high night-time mean BP presented an unfavourable outcome.
CONCLUSIONS: Among young ISH subjects, only 24 h/night-time mean BP is a predictor of future hypertension needing treatment whereas the ISH status per se does not necessarily imply an increase in risk.
55 THE HAEMODYNAMIC PATTERN OF YOUNG ISOLATED SYSTOLIC HYPERTENSIVE SUBJECT DIFFERS ACCORDING TO THE LEVEL OF PHYSICAL ACTIVITY
55.1 F. Saladini, C. Fania, L. Mos, A. Mazzer, E. Casiglia, P. Palatini
55.1.1 1Dipartimento di Medicina, Università degli Studi di Padova, Padova, Italy, 2Unità Operativa di Cardiologia, Ospedale di San Daniele del Friuli, Udine, Italy, 3Unità Operativa di Medicina, Ospedale di Vittorio Veneto, Treviso, Italy
INTRODUCTION: Little is known about the clinical significance of isolated systolic hypertension in the young (ISHY). According to some authors ISHY is often associated with athletic participation and is considered at low cardiovascular risk, whereas according to others ISHY subjects are characterized by increased BMI and metabolic abnormalities.
AIM: To investigate whether ISHY athletes (ISHY-Athl) have different clinical characteristics and better long-term evolution than ISHY sedentary subjects (ISHY-Sed).
METHODS: We examined 35 male ISHY-Athl, with a mean age of 23.6 ± 7.0 years, 35 age-matched ISHY-Sed, 35 normotensives (NTs) and 35 subjects with systolic-diastolic hypertension (SDH). All these conditions were identified with ambulatory blood pressure (BP) monitoring. All data were re-measured after 8 years of follow-up.
RESULTS: At the baseline, ISHY-Athl had lower 24 h hear rate than the other three groups (p for ANOVA = 0.001). In addition, they had higher stroke volume (89.2 ± 16.2 ml, p ≤ 0.01 versus other 3 groups). Peripheral resistances were similar in ISHY-Athl and NT, whereas they were increased in the ISHY-Sed and SDH participants (p < 0.05). BMI and metabolic data at baseline, did not differ between the 4 groups. After 8 years, changes in 24h BP were similar in ISHY-Athl and ISHY-Sed, both ISHY groups presented lower 24 h diastolic BP compared to SDH (p < 0.001). Moreover, 24 h heart rate was lower in ISHY-Athl compared to the other groups (p < 0.022). Changes in metabolic data did not differ between the two ISHY groups, while BMI tended to be lower in ISHY-Athl (p = 0.089).
CONCLUSIONS: Athletes with ISHY exhibited a different hemodynamic pattern characterized by elevated stroke volume and normal peripheral resistance compared to ISHY-Sed, while baseline BMI and metabolic profile did not differ in the two ISHY groups. At the end of follow-up ISH-Athl maintained lower heart rate and BMI (even if the latter did not reach the level of clinical significance), while 24 h BP did not differ between the two ISHY groups, according to the level of physical activity.
56 PROGNOSTIC VALUE OF URIC ACID IN RELATION TO DIFFERENT AMBULATORY BLOOD PRESSURE COMPONENTS IN THE ABP-INTERNATIONAL STUDY
56.1 F. Saladini1, G. Reboldi2, P. Verdecchia3, F. Angeli3, L. Beilin4, K. Eguchi5, Y. Imai6, K. Kario7, T. Ohkubo8, P. Pierdomenico9, J. Schwartz10, L. Wing11, P. Palatini1
56.1.1 1Dipartimento di Medicina, Università degli studi di Padova, Padova, Italy, 2Università di Perugia, Perugia, Italy, 3Ospedale di Assisi, Assisi, Italy, 4University of Western Australia, Perth, Australia, 5Jichi University, Tochigi, Japan, 6Tohoku University, Sendai, Japan, 7Jichi University, Tochigi, Japan, 8Shiga University of Medical Science, Otsu, Japan, 9Università di Chieti, Chieti, Italy, 10Columbia University, New York, USA, 11Flinders University, Adelaide, Australia
INTRODUCTION: The intriguing relation between uric acid (UA) and cardiovascular events (CVE) and mortality is under active scrutiny. Increased UA levels have been associated with elevated BP and adverse prognosis. However, the extent to which UA maintains its prognostic value over and above specific ambulatory BP components is not well defined.
METHODS: We followed 5244 participants of the Ambulatory Blood Pressure International (ABP-I) study with UA determined at entry. We grouped participants by gender-specific UA quartiles (divisions: 4.6, 5.4, and 6.4 mg/dl in men; 3.4, 4.2 and 5.0 mg/dl in women). Cox models were used to estimate the magnitude and changes in UA hazard ratio (HR) for CVE and mortality in relation with different ambulatory BP (ABP) components. The Akaike and Bayes information criteria (AIC, BIC) were used to compare non-nested models.
RESULTS: The 24-h, daytime and night-time systolic BPs increased linearly (p < 0.001 for all) across the gender-specific UA quartiles. We found no evidence for significant relationships between increasing UA and diastolic ABPs. Participants in the top UA quartile were older (p < 0.001), with diabetes (p < 0.001), decreased renal function (p < 0.001), higher cholesterol (p < 0.001), and BMI (p < 0.001) than the others. During 35,087 person-years of follow-up there were 423 CVE (93 fatal, 330 nonfatal) and 185 deaths. The CVE rate per 100 person-years was 0.99, 0.95, 1.11, and 1.81, and mortality was 1.01, 0.55, 0.93, and 2.01, suggesting a possible non-linear relationship across UA quartiles. In fully adjusted survival models including different ABP components, the HR for CVE and mortality for the top UA quartile always remained significant (all p < 0.05 and p < 0.02 for CVE and mortality respectively) with no evidence for HRs heterogeneity (p = 0.965 CVE, p = 0.999 mortality). Based on AIC and BIC, CVE models including either the average 24-h or the night systolic BP were equally informative and better than those including daytime BP.
CONCLUSIONS: In ABP-I participants, UA is a powerful risk marker for subsequent cardiovascular events and mortality and adds prognostic value independently of specific ABP components.
57 HYPERTENSION IN GENERAL POPULATION: A SERIES REVIEW ACCORDING TO THE NEW AMERICAN GUIDELINES
57.1 G. Dognini1, F. Cagnoni2, S. Del Duca1, P. Pileri1, E. Bontempelli1, E. Oggionni3, M. Destro1
57.1.1 1U.O.C. Medicina Generale 1, Ospedale di Treviglio, ASST Bergamo Ovest, Treviglio, Italy, 2U.O.C. Medicina Generale, Ospedale di Lodi, ASST Lodi, Lodi, Italy, 3U.O.C. Servizio Farmaceutico, Ospedale di Treviglio, ASST Bergamo Ovest, Treviglio, Italy
INTRODUCTION: Guidelines (GL) for the diagnosis and management of hypertension (HTN) were reviewed in 2017 by the American College of Cardiology (ACC) and the American Heart Association (AHA), focusing on definition of grade 1 HTN (previously known as “pre-HTN”) and on the timing of treatment beginning.
METHODS: A series of 2069 subjects evaluated between May 17th 2011 and May 17th 2017during public events held out of hospital was reviewed according to the ACC/AHA 2017 GL. Each subject had undergone blood pressure (BP) measurement and evaluation of cardiovascular (CV) risk factors, comorbidities and ongoing therapies by fulfilling a questionnaire.
RESULTS: Among 2069 subjects (44% males, median age 60 years, 40% with HTN already diagnosed) BP measurement was ≥ 140/90 mmHg in 26%, but rose to 64% when adopting the ACC/AHA 2017 GL (BP ≥ 130/80 mmHg). According to the ACC/AHA 2017 GL 38% resulted affected by grade 1 HTN (i.e. pre-HTN according to the ESH/ESC 2013 GL) and 26% by grade 2 HTN (i.e. grade 1 according to the ESH/ESC 2013 GL). Moreover, 121 out of 785 subjects (= 9%) affected by grade 1 HTN according to the ACC/AHA 2017 GL (i.e. pre-HTN according to the ESC/ESH 2013 GL) had a ASCVD or a 10-years CV risk ≥ 10%. These subjects, if considered according to the ACC/AHA 2017 GL should receive a treatment.
CONCLUSIONS: This series review identified 9% of subjects who did not receive a treatment according to the ESC/ESH 2013 GL, but that should receive a treatment if considered according to the new ACC/AHA 2017 GL. Limits of this study are: BP measurement setting (during public events out of hospital) which does not allow a final diagnosis of HTN; the modality of data collection (questionnaire fulfilled by subjects) which does not allow a detailed definition of CV risk factors (i.e. lipid profile reported by subjects but not measured, weight not evaluated). New studies to better define the prevalence and management of HTN according to the new guidelines should be performed to better identify its optimal approach.
58 RISK OF FALL AND PHYSICAL EFFICIENCY IN ELDERLY PEOPLE AFFECTED BY HYPERTENSION
58.1 F. D’Amico1, R. Grasso1,2
58.1.1 1Department of Geriatrics and Long Term Care, Center of Hypertension, Hospital of Patti, Italy, 2School of Medicine, University of Messina, Italy
INTRODUCTION: Self-sufficient older subjects with reduced physical efficiency can be considered frail and at risk of disability.
AIM: To analyse physical efficiency and risk of fall in hypertensive elderly people.
METHODS: 33 women (mean age 78 ± 3) and 21 men (mean age 77 ± 4), already diagnosed Hypertension, therefore under specific treatment, have been included. The design of the study included: (1) Clinical Measurement of Blood Pressure (MBP); (2) Short Physical Performance Battery (SPPB); (3) Tinetti balance and gait Scale (TS). Controlled Blood Pressure resulted in BP values < 140/90 mmHg and < 130/80 mmHg for those patients affected by Diabetes Mellitus.
RESULTS: Among hypertensive subjects 12 women and 8 men had a mean 23 ± 4 Tinetti score showing a low risk of fall; 8 women and 6 men had a mean 14 ± 5 score indicating a high risk of fall. 9 women and 7 men in the control group scored 26 ± 3 showing a low risk of fall, while 4 women and 5 men scored average 16 ± 2 showing a high risk of fall. Those hypertensive subjects whose Tinetti score indicated a high risk of fall also showed significant relations between risk of fall and physical efficiency (p < 0.05). While subjects in the control group did not show such a relevant connection. We also detected that a reduced physical performance corresponds to a higher risk of fall (p < 0.01). Hypertensive patients who were also diagnosed a reduced efficiency through a mean score 6 at the SPPB in 87% cases scored an average value 12 at the TS, therefore showing a risk of fall (p < 0.5).
CONCLUSIONS: This study noticed the risk of fall incidence and the reduced muscular strength in hypertensive and non-hypertensive elderly people. Finally, it shows a significant connection among hypertension, high risk of fall and reduced physical efficiency.
59 BLOOD PRESSURE AND MORTALITY IN THE ELDERLY: RESULTS OF THE FIESOLE MISURATA FOLLOW-UP STUDY
59.1 G. Turrin1, M. Bulgaresi1, E. Lucenteforte2,3, G. Rivasi1, N. Nesti1, A. Giordano1, L. Martella1, C. Lorenzi1, M.F. D’andria1, V. Tortu’1, A. Vannacci2, A. Mugelli2, A. Ungar1
59.1.1 1Centro di riferimento regionale per l’ipertensione nell’anziano, Dipartimento di geriatria, AOU Careggi, Firenze, Italy, 2Dipartimento di Neurofarba, Università degli studi di Firenze, Firenze, Italy, 3Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
INTRODUCTION: Optimal blood pressure control is an important health care challenge, but target values are still controversial, especially in older patients with comorbidity and disability. This follow-up study aimed at evaluating the association of some information collected at baseline and mortality at 6 years.
AIM: To evaluate mortality according to blood pressure values in a cohort of elderly enrolled in the Fiesole Misurata Study, after a six-year follow-up.
METHODS: Vital status at December 31st 2016 was obtained in 385 subjects participating to the Fiesole Misurata study. Patients characteristics were analysed, to detect predictors of mortality. At baseline all patients had undergone office blood pressure measurement and a geriatric multidimensional assessment.
RESULTS: After a 6-year follow-up, 97 participants had died (25.2%). Mortality was higher in underweight (p = 0.04) and obese patients (p = 0.04), in those with diabetes (p = 0.002) and heart failure (p < 0.0001) and in patients treated with ACE-inhibitors (p = 0.003) or diuretics (p < 0.0001). Patients with systolic blood pressure (SBP) < 120 mmHg had the highest mortality rate; mortality was significantly lower in patients with SBP 140–159 mmHg as compared with SBP 120–139 mmHg (HR 0.54), particularly in those aged 75 or older (HR 0.49), with disability (HR 0.36) or taking antihypertensive drugs (HR 0.49).
CONCLUSIONS: After a 6-year follow-up, patients with SBP 140–159 mmHg had lower mortality as compared with SBP 120–139 mmHg; this was particularly evident for patients aged 75 or older, on antihypertensive treatment or with disability. particularly patients aged 75 or more, with disability or anti-hypertensive treatment. Conversely, SBP < 120 mmHg was associated with a higher mortality rate. Overweight showed a protective value in elderly patients.
60 REPRODUCIBILITY AND CONNECTIONS WITH PHARMACOLOGICAL THERAPY CHANGES OF AMBULATORY BLOOD PRESSURE MONITORING PHENONOTYPES IN VERY ELDERLY SUBJECTS
60.1 G. Ferraro, F. Colombo, A.M. Agrati
60.1.1 Internal Medicine Dept. and Hypertension Unit, Grande Ospedale Metropolitano Niguarda, Milano, Italy
INTRODUCTION: White coat hypertension (WCH) is a common condition that, especially in elderly, may lead to overtreatment with consequent hypotensions and side effects. Ambulatory blood pressure monitoring (ABPM) helps differentiating WCH subjects from those really needing therapeutic upgrading.
AIM: To evaluate reproducibility of ABPM phenonotypes in very elderly.
METHODS: 734 subjects > 75 years repeated 2 ABPMs within a year. Subjects were stratified in the 4 classic phenotypes (normotensives, hypertensives, WCH and masked). WCH was defined as the mean of the first and the last hour of recording > daytime mean pressure and masked effect if lower. In each group we evaluated phenotypic persistence or variation at the second recording, according to treatment and its modifications. A further sub-analysis was conducted in smokers, diabetics and for age groups.
RESULTS: The most represented phenotypes were hypertensives (40%) and normotensives (33%) followed by WCH (21%); negligible percentage (6%) were masked with a slight prevalence among smokers (11%) and diabetics (9%). Constant increase in WCH was identified with the increasing age. Second recordings showed normotension increase with therapy upgrading and a lower increase in hypertensives when therapy was downgraded. WCH seemed to be more independent from pharmacological therapy variations.
CONCLUSIONS: ABPM is an important tool to guide therapeutic strategies especially in elderly subjects, in consideration of the high prevalence of white coat patients among this age group.
61 BLOOD PRESSURE CONTROL IN PATIENTS WITH ATRIAL FIBRILLATION TREATED WITH ANTICOAGULANT THERAPY
61.1 G. Ferraro, F. Colombo, A.M. Agrati
61.1.1 Internal Medicine Department and Hypertension Unit, Grande Ospedale Metropolitano Niguarda, Milano, Italy
INTRODUCTION: Atrial fibrillation (AF) is very common in internal medicine patients and anticoagulation is necessary to reduce thromboembolic risk; hypertension increases the bleeding risk of these subjects.
AIM: We evaluated if blood pressure control could influence the choice of anti-coagulant strategy.
METHODS: 297 anti coagulated patients with one of the discharge diagnosis of AF in the first 6 months of 2017 were retrospectively evaluated. Age, sex, hospitalization timing, anti-coagulant therapy at home and at discharge, CHADS2-VASC, HASBLED, ATRIA, Hb, creatinine, blood pressure values, possible therapeutic interference with direct oral anti coagulants (DOAC) and in- and out-range INR values in subjects treated with vitamin K antagonists (AVK) were recorded.
RESULTS: Most patients (63%) with a new diagnosis of AF were discharged on DOAC, while only 36% admitted with an history of AF were on DOAC, even with no history of major bleeding and normal renal function. Only 33% of patients on AVK showed in-range INR values during hospitalization while 44% showed Hb values below normal range. 21% of patients showed blood pressure values > 140/90. Anti-coagulant strategy was not influenced by blood pressure control.
CONCLUSIONS: Even if DOAC proved to be superior to VKA in reducing thrombo-embolic events and major bleedings, there seems to be a relevant inertia in changing VKA therapy, even if INR proves to be often out of range in hospitalized patients. There is a greater favour in prescribing DOAC in newly diagnosed AF patients. Blood pressure control does not influence anti-coagulant strategy.
62 24-HOUR BLOOD PRESSURE CONTROL, AASI AND PULSE PRESSURE IN ELDERLY SUBJECTS
62.1 G. Ferraro, F. Colombo, A.M. Agrati
62.1.1 Internal Medicine Department and Hypertension Unit, Grande Ospedale Metropolitano Niguarda, Milano, Italy
INTRODUCTION: Elderly subjects show an increase in arterial stiffness that often reflects on pulse pressure (PP).
AIM: To evaluate if PP and ambulatory arterial stiffness index (AASI) could influence pressure control in elderly subjects undergoing ambulatory blood pressure monitoring (ABPM).
METHODS: We analysed 1196 ABPMs of subjects > 65 years (March 2006–December 2017). For each patient we recorded age, sex, BMI, smoking habits, anti-diabetic, cholesterol lowering, anti-platelet or anti-coagulant therapies. Antihypertensive treatments were also recorded. Patients were divided in normotensives (N) and hypertensives (H) according to a 24-h cut-off of 130/80 and these 2 groups further divided in resistant (R) and not-resistant (NR) if treated with more or less than 3 drugs (including a diuretic). We calculated: 24-h PP, daytime and night-time PP, 24 h AASI, daytime and night-time AASI and the dipper pattern.
RESULTS: 38% of patients were classified as NR, 13% as NNR, 33% as HNR and 16% as HR. N subjects (and especially NR) showed a significant increase in 24 h PP and AASI, while no significant differences were evident among the other groups. Dipper subjects showed a higher PP with no increase in AASI. No differences were observed when considering pressure control and day and night-time PP and AASI. On the contrary, daytime PP and AASI related with the number of anti-hypertensive drugs independently from blood pressure control.
CONCLUSIONS: In our study population subjects with increased arterial stiffness (as expressed by AASI and PP) seem to need a more aggressive anti-hypertensive drug treatment to reach a more adequate blood pressure control.
63 SYSTOLIC BLOOD PRESSURE PROFILE IN TREATED HYPERTENSIVE US ADULTS WITH AND WITHOUT PERIODONTITIS: RESULTS FROM NHANES 2009–2014
63.1 R. Del Pinto, D. Pietropaoli, M. Giannoni, A. Monaco, C. Ferri
63.1.1 Università dell’Aquila, Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell’Ambiente, L’Aquila, Italy
INTRODUCTION: Periodontal disease is a chronic inflammatory disorder of the tissues surrounding the teeth, with evidence of systemic effects. In fact, many cardiovascular risk factors and related diseases have been associated with periodontitis. Some evidence showed the benefit of periodontal therapy on blood pressure (BP), but the impact of periodontitis on BP control is unknown.
AIM: We examined systolic BP (SBP) profile in treated hypertensive patients with and without periodontitis using NHANES 2009–2014 data.
METHODS: Treated hypertensive adults ≥ 30 years with complete periodontal examination were included. The primary outcome was the effect of periodontitis on SBP response to antihypertensive treatment after adjustment for selected independent variables (periodontitis, age, gender, race/ethnicity, BMI) using generalized additive model. Secondary outcomes included the race/ethnicity-, gender-, age-, and disease severity-based analyses of the same effect. Significance was set at p < 0.01.
RESULTS: Adjusted mean SBP (± SD) was about 2.4 mmHg higher in treated hypertensive participants with (n. 1819, 133.44 ± 5.0 mmHg) than in those without (n. 1669, 131.08 ± 5.4 mmHg) periodontitis (p < 0.0001). Stratified analyses by age groups, race/ethnicity and gender confirmed the same finding. Moderate to severe periodontitis was associated with higher achieved SBP than the mild disease. No difference in serum C-reactive protein by periodontal status was observed, potentially due to fluctuations in inflammatory burden typical of periodontitis.
CONCLUSIONS: A good oral health is associated with greater efficacy of antihypertensive therapy by a magnitude of about 2.4 mmHg of SBP. Dedicated studies are needed to test the impact of periodontal therapy on BP and the long-term effects on cardiovascular outcomes of such a complementary approach to systemic health.
64 DIASTOLIC BLOOD PRESSURE AND INCIDENT OUTCOMES IN CARDIOVASCULAR AND KIDNEY DISEASE: EVIDENCE FROM SPRINT DATA
64.1 R. Del Pinto, D. Pietropaoli, C. Ferri
64.1.1 University of L’Aquila, Dep.t of Life, Health and Environmental Sciences, L’Aquila, Italy
INTRODUCTION: The SPRINT trial demonstrated the efficacy and safety of targeting a systolic blood pressure of < 120 mmHg compared to < 140 mmHg in selected hypertensive patients. Some evidence, however, suggests a J-curve for diastolic blood pressure (DBP) particularly in subjects with cardiovascular and chronic kidney disease.
AIM: We evaluated the risk of events in SPRINT with focus on these subgroups according to DBP levels.
METHODS: Mean DBP (± SD) throughout follow-up time was calculated for each patient. Patients were then categorized into five groups according to mean DBP (< 60 mmHg, 60–69 mmHg, 70–79 mmHg [reference], 80–89 mmHg, ≥ 90 mmHg); hazard ratio (HR) for outcomes was assessed overall and in the predefined subgroups.
RESULTS: A higher risk for cardiovascular events was observed in the lower DBP range overall (HR 1.46, CI 95% 1.1–1.95, P < .001), but not in the absence of pre-existing cardiovascular or renal disease. Indeed, such risk significantly increased above 80 mmHg in patients with cardiovascular disease and below 70 mmHg in those with chronic kidney disease for selected outcomes. DBP < 70 mmHg particularly affected renal outcomes irrespective of renal status.
CONCLUSIONS: Different risk profiles according to DBP ranges appear to be related to specific clinical characteristics in SPRINT. These findings require further testing in dedicated trials with appropriate follow-up.
65 THE INFLUENCE OF ILLNESS PERCEPTION ON ANXIETY AMONG HYPERTENSIVE PATIENTS: A 5 YEARS FOLLOW-UP
65.1 A.M. Annoni1, A. Greco2, A. Maloberti1,3, C. Giannattasio1,3
65.1.1 1Università degli studi di Milano-Bicocca, Milano, Italy, 2Università degli studi di Bergamo, Bergamo, Italy, 3Dipartimento cardiotoracovascolare Cardiologia 4, A. De Gasperis, Grande Ospedale Metropolitano Niguard. Milano, Italy
INTRODUCTION: Anxiety is a well-known risk factor in the genesis and evolution of hypertension (HT) and cardiovascular diseases, as well as a key factor in the development of illness perception. Illness perception consists in the way the patient thinks about his/her condition and it is defined by the set of the conceived disease representations. Besides this kind of studies, little is known about the influence of illness perception on anxiety levels among hypertensive patients.
AIM: To evaluate if illness perception dimensions and their variations over time could predict anxiety.
METHODS: A total of 345 (mean age 55.40 ± 11.2 years old) outpatients followed by the Hypertension Unit of S. Gerardo Hospital (Monza, Italy) affected by essential hypertension were recruited and assessed at the baseline and a total of 249 at a 5-years follow-up. Patients were asked to complete a battery of psychological questionnaires under the guidance of a psychologist; moreover, anamnestic and clinical data were evaluated. The associations between illness perception domains, their variations over time, cardiovascular risk factors and anxiety were explored using multivariate hierarchical regression analyses.
RESULTS: The results from hierarchical regression showed that the identity (β = 0.144, p < .05) and the variation over time of the HT consequences (β = 0.179, p < .05), of the treatment control (β = − 0.174, p < .05) and of the disease identity (β = 0.117, p < .05) were significantly and independently associated with anxiety at the follow-up. Furthermore, consequences (β = 0.152, p = .08) and the variation of the timeline (β = 0.157, p < .08) showed a trend that approached significance. These associations with anxiety were independent of cardiovascular risk factors and of the time elapsed since the HT diagnosis.
CONCLUSIONS: Current findings shed light to the reciprocal relationships among anxiety and illness perception. They may contribute to the development of interventions, targeted on specific domains of illness perception, against the risk of anxiety disorders in HT patients.
66 BLOOD PRESSURE TARGETS AND DIFFERENT GUIDELINES: THE MACRO- AND MICRO-VASCULAR DAMAGE IN HYPERTENSIVES TREATED BY ARB OR ACE-I MONOTHERAPY
66.1 P. Nazzaro, A. Nardecchia, G. Schirosi, F. Caradonna Moscatelli, M. Contini, L. De Benedittis, A.M. Papagni
66.1.1 Department of Neurosciences, Hypertension Unit, University of Bari “Aldo Moro”, Bari, Italy
INTRODUCTION: Recent studies (Sprint Study) and guidelines (AHA) suggest that, respectively, a drastic (< 120/80 mmHg, HRBP) or a further moderate (< 130/80 mmHg, MRBP) blood pressure reduction instead of the actual target (< 140–135/90–85 mmHg, ESGL) should be associated to an ameliorated cardiovascular prognosis.
AIM: To evaluate the association between the micro- e macro-vascular damage in adult grade 1–2 hypertensives, treated by ACEi or ARBs and the different obtained blood pressure reduction.
METHODS: Along the years 2014–2017, by medical visit (SBP/DBPoff), blood pressure level at the diagnosis (HISTsbp/dbp) and history of hypertension (HISThtn, months), 160 HRBP, 90 MRBP, 334 ESGL, with a similar follow-up, and 165 patients with a scarce blood pressure control (SCBP), underwent identification of the metabolic syndrome factors (nATPIII) and, in comparable groups, to measurements of arterial stiffness (PWVcf), carotid intima-media thickness (IMT) and, by videocapillaroscopy, capillary density of the medial and distal phalanx of the 2nd, 3rd and 4th finger of the non-dominant hand during baseline (CAP) and venous congestion (CVC), as indices of microvascular damage.
General characteristics of the study population
56 ± 13
116 ± 5/76 ± 6
119 ± 18/76 ± 9
151 ± 6/94 ± 5
65 ± 77
58 ± 12
127 ± 3/77 ± 3***
122 ± 10/75 ± 5
150 ± 9/93 ± 6
69 ± 80
57 ± 14
136 ± 4/82 ± 4***^^^
135 ± 11/86 ± 9***^^^
151 ± 9/93 ± 8
72 ± 97
59 ± 12
148 ± 9/88 ± 4***^^^°°°
141 ± 10/87 ± 9***^^^°°°
152 ± 7/94 ± 4
67 ± 86
9.2 ± 2.1
0.82 ± 0.23
47.8 ± 8.5
55.1 ± 10.2
9.3 ± 1.5
0.87 ± .17
48.1 ± 8.1
54.6 ± 9.8
9.9 ± 3.4*
0.89 ± .20***
44.4 ± 7.9***^^^
50.2 ± 9***^^^
10.8 ± 4.9***^°
0.94 ± .23***^°
41.1 ± 8.1***^^^
46.4 ± 8.6***^^^°
CONCLUSIONS: The findings highlight that a blood pressure scarce control is characterized by macro- and micro-vascular damage. Moreover, a moderate further blood pressure reduction (MRBP), compared to ESGL, might be associated to an additional restriction of the vascular damage comparable to that obtained by an extreme blood pressure decline which is largely characterized to potential contralateral side-effects. The findings, if confirmed by a longitudinal study, might substantiate the ameliorated cardiovascular prognosis found in hypertensives with a moderate further blood pressure control such as suggested by the AHA guidelines.
67 THE ANGER MANAGEMENT IN THE DIFFERENT FORM OF HYPERTENSION
67.1 F. Favieri1, I. Boncompagni1, A. Mingarelli2, G. Forte1, R. Germanò3, G. Germanò3, M. Casagrande1
67.1.1 1Dipartimento di Psicologia, Università di Roma “Sapienza”, Roma, Italy, 2Dipartimento di Psicologia Dinamica e Clinica, Università di Roma “Sapienza” Roma, Italy, 3Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche e Geriatriche, Università di Roma “Sapienza” Roma, Italy
INTRODUCTION: It is well-known that high levels of anger represent a significant risk factor for arterial hypertension (AH). However, no study has evaluated whether different forms of AH are associated with differences in the levels and the expression of anger.
METHODS: One-hundred and Sixty people, undergoing ABPM and clinical measurement of blood pressure, participated in the study. The participants were divided into four groups: Sustained Hypertension (SH; N = 41), Untreated Hypertension (UH; N = 44), Masked Hypertension (MH; N = 30), White Coat Hypertension (WCH; N = 45). All participants compiled STAXI for the assessment of anger.
RESULTS: There were no significant differences between the groups in the State and Trait Anger, in the Anger Control and the Anger Expression-Out. On the contrary, the levels of Expression of Anger (F1.155 = 4.16; p = 0.007; pn2 = 0.07) and Anger Expression-In (F1.155 = 3.28; p = 0.02; pn2 = 0.06) were lower in patients with ICB than in the other groups. The results showed a similar psychological pattern for some types of AH (SH, UH, MH), while the psychological profile was different in patients with WCH. In this group, we can see a reduced tendency to suppress and retain the anger, which is reflected in a reduction in the expression of the same.
CONCLUSIONS: According to previous studies that have highlighted a significant role of anger in the exacerbation of hypertensive symptoms, these findings suggest the importance of psychological interventions aimed at improving the anger management in patients with hypertension. Furthermore, the different control of anger observed in the four groups of hypertensive patients suggests how can be relevant to consider the type of hypertension to plan ad hoc psychological interventions for the different forms of AH.
68 REAL LIFE HYPERTENSION: A PROTOCOL FOR THE CLINICAL MANAGEMENT OF HYPERTENSIVE PATIENTS BY GENERAL PRACTITIONERS AND HYPERTENSION SPECIALISTS
68.1 G. Rigon1, F. Del Zotti1, G. Tebaldi2, C. Fava2, P. Minuz2
68.1.1 1General Practitioner, Centro Studi FIMMG Verona, Verona, Italy, 2Medicina Generale per lo Studio ed il Trattamento della Malattia Ipertensiva, University of Verona, Verona, Italy
INTRODUCTION: The prevalence of arterial hypertension in the Italian population is increasing, while antihypertensive treatment is not always adequate, thus generating an excess of preventable cardiovascular risk. Improved control of blood pressure and identification of secondary hypertension could improve the clinical outcome at population level.
AIM: The present project aims to create a warning system for general practitioners (GPs) endowed in clinical management program Millewin, that should allow: (1) identify subjects with inadequate blood pressure control, (2) establish parameters useful to recognize subjects with resistant hypertension, (3) identify among all these subjects those with possible secondary hypertension.
METHODS: The goal of the project is: (a) to create an effective Diagnostic and Therapeutic Protocol (PDT) for proper care of hypertensives, (b) to create an effective system of communication between GPS and specialists with a shared assessment of the clinical outcome. To this aim, the prevalence of hypertensive patients. will be identified from the clinical database of about 250 GPs (total estimated number: 100,000). Will be extrapolated data for age, sex, hypertension (ICD9), number of antihypertensive drugs, pressure, Comorbidities. Using a form containing information about clinical signs and laboratory data of possible secondary hypertension MMG will send the selected patient to a hypertension specialist for a diagnostic definition. A computer communication system between GPs and specialists will be implemented finalized to the creation of a PDT concerning secondary and resistant of arterial hypertension.
RESULTS: Results of the project are the software implementation and the creation of a local network of GPs and hypertension specialists who experience the PDT. Clinical outcomes will be assessed by comparison with historical data and cohorts of patients followed by other doctors who will initially not take advantage of the implemented software.
CONCLUSIONS: Large-scale utilization of computer systems that help to identify secondary or uncontrolled hypertension could reduce the burden of cardiovascular events in the population.
69 CHARACTERISTICS AND OUTCOMES OF PATIENTS PRESENTING WITH HYPERTENSIVE URGENCY IN THE OFFICE SETTING
69.1 G. Albano, G. De Stefano, M.I. Arnone, A. D’Amato, F. De Pisapia, A. Gaspardini, C. Mancusi, G. de Simone, B. Trimarco, N. De Luca
69.1.1 Hypertension Research Center, University Federico II of Naples, Italy
INTRODUCTION: Based on current clinical practice, hypertensive urgencies (HypUrg) are define as severe elevation in blood pressure (BP) without acute target organ damage (TOD), in otherwise stable patients. Those patients are frequently referred to emergency departments without clear indication. In the outpatient setting, treated, asymptomatic patients are often seen, with BP elevation meeting criteria for urgency.
AIM: Incident composite major and minor CV events (fatal and non-fatal stroke or acute myocardial infarction. TIA, coronary or carotid revascularization, atrial fibrillation) were evaluated in patients with HypUrg in an outpatient clinic setting.
METHODS: We analyzed the prevalence and characteristics of patients with HypUrg (systolic BP ≥ 180 mmHg and/or diastolic BP ≥ 110 mmHg) from the Campania Salute Network (CSN) Registry. Patients were older than 18 years old, with available cardiac and carotid ultrasound data, without prevalent CV disease and no more than stage III Chronic Kidney Disease. BP control was defined as the average BP during FU < 140/90 mmHg.
Baseline characteristics of patients presenting with or without hypertensive urgency
HypUrg (n = 491)
Non-HypUrg (n = 6898)
54 ± 11
54 ± 11
Average FU systolic BP (mmHg)
Average FU diastolic BP (mmHg)
Estimated creatinine clearance (ml/min/1.73 m2)
79.6 ± 15.9
81.1 ± 15.2
Number of antihypertensive drugs during FU
1.2 ± 1.2
1.1 ± 1.1
LV hypertrophy (%)
Carotid plaque (%)
CONCLUSIONS: Hypertensive urgencies, defined according to current clinical practice, present with high CV risk profile, reduced probability of good BP control during follow-up and greater prevalence of LVH and CP, but are not associated with increased risk of CV events independently of pre-existing TOD.
70 INCIDENT CARDIOVASCULAR EVENTS AMONG HYPERTENSIVE PATIENTS WITH OPTIMALLY CONTROLLED BLOOD PRESSURE: THE CAMPANIA SALUTE NETWORK
70.1 C. Mancusi, G. De Stefano, G. Albano, G. Canciello, N. De Luca, M. Losi, B. Trimarco, G. de Simone
70.1.1 Hypertension Research Center, University Federico II of Naples, ITALY
INTRODUCTION: Data from last decade indicate that the majority of incident cardiovascular (CV) events occur among individuals with systolic and diastolic blood pressure (BP) ≥ 140/90 mmHg. New American Guidelines suggest lower cut-point for definition and treatment threshold to < 130/80 mmHg. This change would highlight the need to focus CV prevention on further BP reduction among adults with BP < 140/90 mmHg.
AIM: We evaluated risk of incident CV events on the basis of clinical characteristics of hypertensive patients with controlled BP, focusing on follow-up BP values.
METHODS: From the Campania Salute Network 3933 patients exhibited controlled BP (defined as the average BP among the follow-up visits < 140/90 mmHg), and available information on cardiac and carotid ultrasound, to identify LV hypertrophy (LVH and carotid plaque (CP), as markers of target organ damage (TOD). A composite end-point of incident major and minor CV events was censored (fatal and non-fatal stroke or acute myocardial infarction. TIA, coronary or carotid revascularization, atrial fibrillation).
Cox regression model for combined cardiovascular endpoints
95,0% CI for HR
Baseline diastolic BP < 70 mmHg (n/y)
Average diastolic BP during FU < 70 mmHg (n/y)
Heart Rate (bpm)
LDL cholesterol (mg/dl)
LV hypertrophy (n/y)
Carotid Plaque (n/y)
Antihypertensive meds during FU (N of drugs)
CONCLUSIONS: In hypertensive patients with controlled BP during FU, risk of incident CV events is associated with diastolic BP during FU < 70 mmHg, independently of significant effect of older age and male sex, with no impact of baseline TOD.
71 THE IMPORTANCE OF PULSE PRESSURE ON CARDIOVASCULAR RISK AND TOTAL MORTALITY IN THE GENERAL POPULATION: IS GENDER RELEVANT?
71.1 A. Maloberti2, M. Tadic1, F. Quarti-Trevano2, M. Bombelli2, R. Facchetti2, C. Cuspidi3, G. Mancia2, G. Grassi2,4
71.1.1 1Charité, Universitätsmedizin Berlin, Department of Internal Medicine an Cardiology, Berlin, Germany, 2Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy, 3Department of Medicine and Surgery, University of Milan-Bicocca and Istituto Auxologico Italiano, Clinical Research Unit, Meda, Italy, 4IRCCS Multimedica, Sesto San Giovanni, Milano, Italy
AIM: To investigate the predictive value of pulse pressure (PP) assessed by different techniques (office, home, 24 h blood pressure monitoring) on cardiovascular events and all-cause mortality in general population and in both genders, separately.
METHODS: Study involved 2045 subjects from the Pressioni Monitorate E Loro Associazioni (PAMELA) study who underwent diagnostic tests including laboratory investigations and 24 h ambulatory blood pressure (BP) monitoring. Participants were followed from the initial medical visit for a time interval of 148 ± 27 months. CV events were defined as infarction, stroke or heart failure development.
RESULTS: Office, home and 24 h blood pressures (systolic BP, diastolic BP, mean BP and PP) were significantly higher in the individuals who experienced cardiovascular (CV) events or died during follow-up. Office, 24 h and daytime PP were independent predictors of CV events after adjustment for main demographic and clinical parameters in the whole study population. Nighttime PP was additional independent predictor in men. None of measured PP (office, home, 24 h, day- and nighttime) was predictor of CV events in women. Home PP was not predictor of CV events or all-cause mortality in general population or in women and men. Any of calculated PP was not predictor of all-cause mortality in general population and in both genders.
CONCLUSIONS: PP represents an important predictor of cardiovascular events in general population and particularly among men. Office and 24 h PP had similar predictive value in general population. Daytime and 24 h PP have greater predictive importance than nighttime PP in general population.
72 EFFECTS OF LIFESTYLE MODIFICATIONS ON ELEVATED BLOOD PRESSURE AND EXCESS WEIGHT IN A POPULATION OF ITALIAN CHILDREN AND ADOLESCENTS
72.1 S. Genovesi1,2, A. Orlando2, P. Rebora2, M. Giussani3, L. Antolini2, E. Nava2, M.G. Valsecchi2, G. Parati1,2
72.1.1 1Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy, 2Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy, 3Family Pediatrician, Milan, Italy
INTRODUCTION: Children excess weight is a common problem, due to low quality diet and poor physical activity and is a risk factor associated with hypertension.
AIM: To assess the effect of a non-pharmacological multidisciplinary intervention on blood pressure (BP) and body weight in a population of children with excess weight and/or elevated BP.
METHODS: Children consecutive referred to a Prevention of Cardiovascular Risk Clinic by the primary care pediatrician from 2009 to 2015, were assessed at baseline and followed up over time.
RESULTS: Out of 273 children (median age 11.4 years, 55% male), 61% were excess weight only, 7% had elevated BP only and 32% showed both conditions. The probability of reaching the clinical target (normal weight and BP values) at 1 year of follow-up was 19% (CI 14%; 24%) and increased up to 38% (CI 28%; 47%) at 3 years. At 1 year of follow-up, in the overall population both BMI and systolic BP z-scores decreased significantly from 1.77 to 1.47 and from 0.99 to 0.52, respectively (P < 0.0001). BP was significantly reduced in both children with elevated BP only (reduction = 0.91, P = 0.0157) and subjects with excess weight and elevated BP (reduction = 0.89, P < 0.0001). Variables significantly related with systolic BP z-score at 1 year of follow-up were baseline systolic BP z-score and BMI z-score reduction during follow-up (P < 0.001 and P = 0.0003, respectively).
CONCLUSIONS: Our data demonstrate the efficacy of lifestyles modification on weight and BP in children, both when elevated BP and excess weight were present as distinct clinical problems, and in the case of their association.
73 BETWEEN OLD AND NEW TARGETS: BLOOD PRESSURE CONTROL IN HYPERTENSIVE OUTPATIENTS
73.1 A. Del Giudice1, A. Fontana2, A. Cicchella1, C.C. Guida1, A. Gesuete1, R. Grifa1, A. Mangiacotti1, F. Miscio1, M. Piemontese1, M. Prencipe1, M. Vergura1, M. Copetti2, F. Aucella1
73.1.1 1IRCCS Casa Sollievo della Sofferenza, S.C. di Nefrologia e Dialisi, Centro per l’Ipertensione Arteriosa, San Giovanni Rotondo, Italy, 2IRCCS Casa Sollievo della Sofferenza, Unità di Biostatistica, San Giovanni Rotondo, Italy
INTRODUCTION: In developed countries, blood pressure (BP) control has increased over the past few decades and is now approaching 70% of patients.
AIM: We report the results of a cross-sectional study carried out on hypertensive outpatients.
METHODS: In a cohort of 1412 consecutive hypertensive outpatients (790 females, 622 males; mean age 60.3 ± 12.2 years) evaluated from January 2015 to December 2016, the following parameters were assessed: age, gender, body mass index (BMI), waist circumference (WC), smoking habits, BP in the sitting position, estimated glomerular filtration rate (eGFR), serum glucose, lipid profile, antihypertensive drugs prescribed. In agreement with the European guidelines, hypertension was defined as sitting BP equal or higher than 140/90 mmHg or use of antihypertensive drugs. Patients whose BP was lower than 140/90 mmHg were considered as having achieved BP control. Furthermore, in compliance with the redefinition of hypertension suggested by the American College of Cardiology/American Heart Association (ACC/AHA), a second level of BP control (BP < 130/80 mmHg) was evaluated.
RESULTS: Overall, 75.7% of hypertensive patients achieved BP levels lower than 140/90 mmHg, while 50.5% achieved BP levels lower than 130/80 mmHg. In both contexts, compared with patients whose BP was not controlled, those achieving the BP targets were mainly younger and females with a lower prevalence of obesity, diabetes and chronic kidney disease. Furthermore, they also had a lower WC and a higher eGFR.
CONCLUSIONS: Nearly 76% of patients achieved the BP target of lower than 140/90 mmHg, a result which is higher than the 70% achieved in Europe, and 50.6% achieved that of lower than 130/80 mmHg, a result which is slightly higher than the 47% recently reported in USA
GENETICS AND PHARMACOGENOMICS
74 NCC EXOSOMAL EXPRESSION IN HYPERTENSIVE PATIENTS IS MODULATED BY ALDOSTERONE STATUS
74.1 G. Sartori1, F. Pizzolo1, L. Bertolone1, A. Castagna1, F. Morandini1, C. Zaltron1, P. Pattini1, O. Olivieri1
74.1.1 1Dipartimento di Medicina Interna, UNIVR, Verona, Italy
INTRODUCTION: In Primary aldosteronism (PA), beside the classical aldosterone-mediated activation of the epithelial sodium-channel, the thiazide-sensitive sodium-chloride cotransporter (NCC) activation could contribute to sodium retention. In animal and human studies aldosterone was demonstrated to increase renal NCC. Urinary exosomes are small vesicles released by the tubular epithelium that carry constituents of their original cells, providing information about the tubular physiology in vivo.
Recently, in urinary exosomes NCC protein was found higher in PA, modulated by oral fludrocortisone.
AIM: To investigate the modulation of exosomal NCC mRNA in hypertensive patients, in relation to aldosterone variation.
METHODS: Urine samples were collected from patients with documented PA diagnosis, and patients with essential hypertension (EH). Patients positive for screening test were studied both before and after iv Salt Loading Test (ivSLT). In two PA patients with aldosterone producing adenoma (APA), urine was also collected after mineralocorticoid receptor antagonist (MRA) therapy and after adrenal surgery. Urinary exosomes were isolated from urine with a precipitating reagent and total RNA was extracted with a spin-column based kit. Relative abundance was quantified in RealTime PCR and expressed in -dCt.
RESULTS: Exosomal NCC mRNA was detectable in all patients. Patients with PA were characterized by higher median values of − dCt compared to EH patients (PA −4.9; EH − 10.43). In patients positive for PA screening, ivSLT induced a reduction in exosomal NCC mRNA (median − 9.3 before, − 16.7 after ivSLT) parallel to aldosterone inhibition. In two patients with APA, NCC mRNA decreased after ivSLT but increased above the basal level, both after MRA therapy and adrenal surgery.
CONCLUSIONS: In vivo exosomal NCC mRNA is modulated by aldosterone with reduction consensual to aldosterone inhibition, but it is induced after inhibition of MR activity. This suggests a complex modulation of aldosterone on sodium transporters activity.
75 RESISTANT HYPERTENSION: THE DRUGS WORK ONLY IF THEY ARE TAKEN. A DIFFICULT CASE OF RESISTANT HYPERTENSION
75.1 R. Pardeo, S. Quartuccio, E. Imbalzano
75.1.1 Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Messina, Messina, Italy
INTRODUCTION: Resistant hypertension is a condition that has been associated with augmented frequency of cardiovascular events and comorbidity. The treatment and the diagnosis of resistant hypertension are complicated and in some patients, the treatment is impossible with only medical drugs.
AIM: We report a case of a 56 years old male affected by uncontrolled blood pressure levels and a history of resistant hypertension, besides a previous renal denervation.
METHODS: We present a case of a 56-year-old white man. The patient was admitted to our unit for uncontrolled Hypertension. He was hypertensive and undergoing treatment since 2008. He was smoker and dyslipidemic. In November 2014, he underwent radiofrequency renal denervation without benefits. Since then the pressure was uncontrolled. Our echocardiography: hypertrophy was moderate. No other conditions to report. The routine blood tests were at the limit of normal values. Any form of secondary hypertension was excluded.
RESULTS: At the moment of medical examination, the patient presented an office BP 210/110 mmHg despite treatment with six antihypertensive agents (furosemide 50 mg, spironolactone 50 mg, olmesartan 40 mg, amlodipine 10 mg, doxazosin 4 mg, nebivolol 5 mg). We started a continuous intravenous infusion of urapidil at a dose of 8 mg/h and we suspended amlodipine. After 10 days the blood medium pressure level was lower, but it was not acceptable (178/101 mg). To complete the screening, we used therapeutic drug monitoring to characterize the drugs concentration measurement in patient urine (the patient was not informed of the type of test). In urine analysis were not detected drugs or drugs metabolites, except urapidil.
CONCLUSIONS: Our case report shows that the adherence at the drugs therapy is one of the most common causes of failed treatment. Therapeutic drug monitoring has revealed the non-adherence of the patient.
76 ROLE OF APPARENT TREATMENT RESISTANT HYPERTENSION AND TIME UPDATED BLOOD PRESSURE CONTROL ON THE PROGRESSION OF CHRONIC KIDNEY DISEASE IN PATIENTS WITH TYPE 2 DIABETES, RENAL IMPAIRMENT AND HYPERTENSION
76.1 F. Viazzi1, B. Bonino1, E. Greco2, P. Fioretto3, C. Giorda4, P. Guida5, G. Russo6, S. De Cosmo2, R. Pontremoli1 and the AMD-Annals Study Group^
76.1.1 1Università degli Studi and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy, 2Department of Medical Sciences, Scientific Institute “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG), Italy, 3Department of Medicine, University of Padua, Italy, 4Diabetes and Metabolism Unit ASL Turin 5 Chieri (TO), Italy, 5Associazione Medici Diabetologi, Rome, Italy, 6Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
INTRODUCTION: Apparent treatment resistant hypertension (aTRH) is highly prevalent in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). The impact of aTRH and achievement of recommended blood pressure (BP) values on the rate of glomerular filtration rate (eGFR) loss in CKD patients is poorly known.
AIM: To assess the role of aTRH and time-updated BP control (BPC) on the progression of CKD in patients with T2D and hypertension (HT) in real life clinical practice.
METHODS: Clinical records from a total of 2778 diabetic patients with HT and stage 3 CKD (i.e. baseline eGFR values between 30 and 60 ml/min) and regular visits during a four-year follow-up were analyzed. The association between BPC (i.e. 75% of visits with BP < 140/90 mmHg) and eGFR loss (i.e. a > 30% reduction from baseline) or worsening of albuminuria status over time was assessed.
RESULTS: At baseline 33% of patients had aTRH. Over the 4-year follow-up, 20% had a > 30% eGFR reduction. Patients with aTRH had an increased risk of eGFR loss > 30% (OR 1.31; P < 0.007). In patients with aTRH, BPC was associated with a 79% (P = 0.029) greater risk of eGFR reduction despite a 58% (P = 0.001) lower risk of albuminuria status worsening. In non-aTRH, no association was found between BPC and renal outcome.
CONCLUSIONS: In patients with stage 3 CKD the presence of aTRH entails a faster loss of eGFR. More effective prevention of aTRH should be implemented as this condition is associated with a burden of risk not modifiable by tight BP reduction.
77 PSYCHOLOGICAL FACTORS ASSOCIATED WITH NON-CONTROLLED HYPERTENSION
77.1 G. Forte1, A. Mingarelli2, I. Boncompagni1, F. Favieri1, R. Germanò3, G. Germanò3, M. Casagrande1
77.1.1 1Dipartimento di Psicologia, Università di Roma “Sapienza”, Roma, Italy, 2Dipartimento di Psicologia Dinamica e Clinica– Università di Roma “Sapienza”, Roma, Italy, 3Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche e Geriatriche, Università di Roma “Sapienza”, Roma, Italy
INTRODUCTION: The management of arterial Hypertension (AH) is one of the major public health challenges. In fact, despite the development of many specific medical drugs, many patients are unable to keep their blood pressure (BP) under control. Although the role of psychological aspects in the genesis and maintenance of AH is extensively studied, little is known about the role that these may have on BP control.
AIM: To analyse the relationship between anger expression, type D personality, and BP control.
METHODS: One-hundred and Fifty-five pharmacologically treated AH participants undergoing ABPM were divided into two groups: controlled hypertension (CH; N = 84) and non-controlled hypertension (NCH; N = 68). All compiled STAXI to evaluate anger and DS14 to analyse negative affectivity and social inhibition.
RESULTS: The State and Trait anger were not different in the two groups. On the contrary, significant differences were observed in the expression of anger (F1,150 = 18.31; p < 0.01; pn2 = 0.10) both internalized (F1.150 = 12.23; p < 0.001; pn2 = 0.07) that externalized (F1.150 = 8.28; p < 0.001; pn2 = 0.05), with higher scores in the NCH participants. Furthermore, a significant difference was found in the control of anger (F1,150 = 5.73; p < 0.05; pn2 = 0.04); which was lower in the NCH participants. NCH participants also showed higher levels of negative affectivity (F1.148 = 4.27; p < 0.05; pn2 = 0.03) and social inhibition (F1.148 = 8.95; p < 0.01; pn2 = 0.06).
CONCLUSIONS: It is well-known that a maladaptive expression of anger has an essential role in the genesis of AH. These findings it seems to play a role in the lack of control of BP in patients with AH. Furthermore, NCH patients would have higher levels of negative affectivity and social inhibition, typical traits of type D personality. Drug resistance in AH is a significant problem; in fact, NCH patients have a risk of developing cardiovascular complications comparable to that of untreated hypertensive subjects. Although the role of the psychological dimensions assessed in this study appears moderate, considering such individual traits may favour patient-care and help to provide more effective AH care.
78 OBSTRUCTIVE SLEEP APNEA SYNDROME IN PARKINSON’S DISEASE AND OTHER PARKINSONISMS
78.1 F. Crosta1, C. Marini1, G. Desideri1
78.1.1 1Università degli studi dell’Aquila, Dipartimento MESVA, L’Aquila, Italy
INTRODUCTION: The association of sleep-disordered breathing (SDB), in particular snoring and obstructive sleep apnea (OSAS), and daytime sleepiness with Parkinson’s disease (PD) has been reported by some small studies. However, the relative contribution of peripheral and central mechanisms is unclear.
AIM: We investigated the occurrence of OSAS and snoring in a large consecutive series of patients attending the outpatient clinic of our neurologic department.
METHODS: All patients admitted to the outpatient clinic of our department were systematically screened for daytime sleepiness, snoring and OSAS by means of sleep-wake history, including the bed partner and caregiver reports. Subjects unable to provide a reliable history, such as patients with dementia or aphasia, were excluded. Day-time sleepiness was evaluated through the Epworth Sleepiness Scale (ESS) in patients reporting either sleep abnormalities or daytime sleepiness or fatigue. Patients with an ESS score above 10 underwent to polysomnography. OSAS were diagnosed in patients with an apnoea-hypopnea index (AHI) of > 5/h, along with relatively low degrees of oxygen desaturation. Chi-square test was used to compare the occurrence of snoring and OSAS in subjects with PD or other parkinsonisms.
RESULTS: 3405 subjects were included in the study between January 2010 and April 2013. Two-hundred and eleven patients were excluded because they were affected by dementia or conditions related to a previous stroke. Therefore 3194 subjects were suitable for the present study. 271 subjects, 116 males and 155 females, mean age ± SD of 72.2 ± 11.7, were affected by PD or other parkinsonisms. Snoring was the most common SDB and was reported by 1040 subjects (32.5%), while OSAS was diagnosed in 72 (2.2%). Snoring, excessive daytime sleepiness and OSAS were more common in PD and in patients with Parkinsonisms (40.59%, 5.9% and 4.06%) than in controls (35.58%, 2.19% and 2.09%). SBD was also more frequent in PD and in patients Parkinsonisms than in controls (respectively 13.28% and 8.48%). These associations were confirmed by the multivariate analysis.
CONCLUSIONS: SDB represent an important group of non-motor symptoms of PD. Motor changes and central mechanisms may combine to precipitate nocturnal apneic attacks. However, frequency and clinical relevance of OSAS in PD are unclear. In our study, patients with PD or other parkinsonisms presented an association with both snoring and OSAS, suggesting that obstructing phenomena may represent the most important component in the pathophysiology of SDB. On the other hand, SDB may significantly contribute to disability of patients with PD, since daytime sleepiness and fatigue may worsen PD symptoms and interfere with treatment. Therefore, OSAS is associated with many other adverse health consequences, including an increased risk of all-cause mortality, stroke, hypertension, arrhythmias, myocardial infarction, insulin resistance, depression and cognitive impairment. For these regions, we suggest that OSAS should be systematically assessed in patients with PD. Our study suggests an increased frequency of snoring and OSAS in PD and in parkinsonisms. Early detection and management of these disorders may have a substantial impact on quality of life and survival in these patients.
79 HYPERTENSIVE PATIENTS SHOW A SIGNATURE OF WHITE MATTER ALTERATIONS EVIDENCED BY TRACTOGRAPHY MRI AND PREDICTIVE OF DEMENTIA
79.1 L. Carnevale1, V. D’Angelosante1, A. Landolfi1, G. Grillea2, M. Storto3, G. Selvetella1, G. Lembo1,4, D. Carnevale1,4
79.1.1 1Dipartimento di Angiocardioneurologia e Medicina Translazionale, IRCCS Neuromed, Pozzilli (IS), Italy, 2UOC di Neuroradiologia Diagnostica e Terapeutica, IRCCS Neuromed, Pozzilli (IS), Italy, 3Dipartimento di Diagnostica e Laboratorio Analisi, IRCCS Neuromed, Pozzilli (IS), Italy, 4Dipartimento di Medicina Molecolare, “Sapienza” Università di Roma, Italy
INTRODUCTION: Vascular dementia is a clinical condition typically linked to the exposure to risk factor such as hypertension. However we still don’t have predictive markers, probably because great part of research interests focused on gray matter damage. Currently, advanced neuroimaging techniques such as Diffusion Tensor Imaging (DTI) on MRI can provide important technological advances that enable the evaluation of prodromal alterations of white matter. Basically, by computer algorithms we can model the connections in the white matter, linked to specific cognitive functions, revealing alterations not evidenced by conventional neuroimaging.
AIM: We used that approach coupled with cognitive evaluations to identify a predictive dementia biomarker in hypertensive patients.
METHODS: 23 hypertensive vs. 19 normotensive subjects underwent DTI and cognitive evaluations. Moreover, patients have been characterized for end-organ damage by assessing cardiac and vascular remodelling, as well as renal damage. Hypertensive patients, despite showing controlled blood pressure levels, were characterized by mild end organ damage, representative of an intermediate stage of the pathology.
RESULTS: The cognitive evaluation showed an impaired performance in Montreal Cognitive Assessment (MoCA), a battery of tests specifically designed to evaluate multiple cognitive functions, validated for cerebrovascular pathologies. While no difference between brains of hypertensive and normotensive was evidenced by routine neuroimaging, at the advanced neuroimaging analysis, hypertensive patients showed a significant alteration in parameters characterizing white matter fiber tracts. Specifically, the impaired tracts were: projection fibers correlated to mnemonic functions (anterior-thalamic-radiation), association fibers involved in executive functions and emotions (superior-longitudinal-fasciculus) and corpus callosum fibers, associated to reaction readiness (forceps-minor).
CONCLUSIONS: Our data propose a new biomarker obtained by DTI and cognitive evaluations in hypertensive patients, capable of identify, with high sensitivity, prodromal signs of dementia.
HORMONAL MECHANISMS AND ENDOCRINE HYPERTENSION
80 ROLE OF CRY-1 AND CRY-2 IN ALDOSTERONE PRODUCING ADENOMAS AND ADRENOCORTICAL CELL FUNCTION
80.1 M. Tetti, I. Castellano, F. Veneziano, C. Magnino, F. Veglio, P. Mulatero, S. Monticone
80.1.1 Division of Internal Medicine and Hypertension (M.T., S.M., C.M., F.Veglio, P.M.) and Pathology (I.C., F.Veneziano), Department of Medical Sciences, University of Torino, Torino, Italy
INTRODUCTION: Mice lacking the core clock components, cryptochrome 1 (Cry1) and cryptochrome 2 (Cry2) display significant adrenal upregulation of type VI 3β-hydroxyl-steroid dehydrogenase (Hsd3b6), resulting in a clinical phenotype of hyperaldosteronism. Hsd3b6 is the murine counterpart to the human type I 3β-hydroxyl-steroid dehydrogenase (HSD3B1) gene.
AIM: To evaluate the role of CRY1 and CRY2 genes and their potential interplay with HSD3B isoforms, in human adrenal pathophysiology.
METHODS: Forty-six sporadic aldosterone producing adenomas (APAs) and 20 paired adrenal samples were included and the adrenocortical cells HAC15 used as in vitro model.
RESULTS: In our cohort of sporadic APAs, CRY1 expression was 1.7-fold [0.75–2.26] higher (p = 0.016), while CRY2 showed a 20% lower expression [0.80, 0.52–1.08] (p = 0.04) in APA compared with the corresponding adjacent adrenal cortex. Type II 3β-hydroxyl-steroid dehydrogenase (HSD3B2), 317-fold [200–573] more expressed than HSD3B1, is the main HSD3B isoform in APAs. Both the dehydrogenases are more expressed in the adrenal nodule compared with the paired adjacent cortex (5.7-fold and 3.5-fold, respectively p < 0.001 and p = 0.001) and HSD3B1 was significantly more expressed in APAs composed mainly of zona-glomerulosa like cells. Treatment with Angiotensin II (AngII) induced a significant up-regulation of CRY1 (1.7 ± 0.25 fold, p<0.001) at 6h and down-regulation of CRY2 at 12 h (of 1.6 ± 0.1-fold, p < 0.001), through activation of the AngII type 1 receptor. Independent silencing of CRY1 and CRY2 genes in HAC15 cells did not affect HSD3B1 expression, but resulted in a mild up-regulation of HSD3B2.
CONCLUSIONS: Our results support the hypothesis that CRY1 and CRY2, showing a differential expression in APAs compared to adjacent adrenal cortex and being AngII regulated, might play a role in the regulation of aldosterone production in man.
81 CARDIOVASCULAR EVENTS AND TARGET ORGAN DAMAGE IN PRIMARY ALDOSTERONISM: A META-ANALYSIS
81.1 S. Monticone1, F. D’Ascenzo2, C. Moretti2, T.A. Williams1, F. Veglio1, F. Gaita2, P. Mulatero1
81.1.1 1Division of Internal Medicine and Hypertension Unit, Torino, Italy, 2Division of Cardiology, Department of Medical Sciences, University of Torino, Torino, Italy
INTRODUCTION: Primary aldosteronism (PA), affecting around 6% of the general hypertensive population, is the most frequent form of secondary hypertension. There is conflicting evidence, based on heterogeneous studies, as to whether aldosterone excess results into an increased risk of cardio- and cerebrovascular complications in patients with PA.
AIM: To assess the relationship between PA and adverse cardiac and cerebrovascular events, target organ damage, diabetes and metabolic syndrome (MetS), compared with essential hypertension (EH), by integrating results of previous studies.
METHODS: We performed a meta-analysis of prospective and retrospective observational studies that compared patients with PA and EH, to investigate the association between PA and stroke, coronary artery disease (as co-primary endpoints), atrial fibrillation and heart failure, target organ damage, metabolic syndrome, and diabetes (as secondary endpoints). We also compared PA subtypes, aldosterone producing adenoma (APA) and bilateral adrenal hyperplasia (BAH).
RESULTS: We identified 31 studies including 3838 patients with PA and 9284 patients with EH. After 8.8 years [IQR 6.2–10.7] from the diagnosis of hypertension, patients with PA displayed an increased risk of stroke (OR 2.58 [IQR 1.93–3.45]), coronary artery disease (OR 1.77 [1.10–2.83]), atrial fibrillation and heart failure (OR 3.52 [2.06–5.99] and OR 2.05 [1.11–3.78]). These results were consistent for patients with APA and BAH, without difference between these two subgroups. Similarly, PA increased the risk of diabetes, metabolic syndrome (OR 1.33 [1.01–1.74] and OR 1.53 [1.22–1.91], respectively) and left ventricular hypertrophy (OR 2.29 [1.65–3.17]).
CONCLUSIONS: An early diagnosis of PA is of outmost importance because affected patients display an enhanced cardiovascular risk compared to patients with EH.
82 CIRCADIAN PRESSURE RHYTHM AND BLOOD PRESSURE VARIABILITY IN PHEOCHROMOCYTOMA
82.1 V. Bisogni, G. Oliviero, L. Petramala, F. Olmati, A. Concistrè, M. Bonvicini, M. Mezzadri, M. Celi, V. Saracino, G. Iannucci, G. De Toma, C. Letizia
82.1.1 Department of Internal Medicine and Medical Specialities, University of Rome “Sapienza”, Rome, Italy
INTRODUCTION: The variation of circadian pressure rhythm (dipping profile) and the increased blood pressure variability (BPV) are two independent cardiovascular risk factors and well-documented both in patients with primary hypertension and in those affected by secondary forms. However, pheochromocytoma is characterised by a highly variable pressure profile, so the studies carried out so far about the dipping profile and BPV in these patients showed conflicting results.
AIM: To analyse the dipping profile and the indices of short-term BPV in patients with diagnosis of pheochromocytoma, before and after surgical treatment.
METHODS AND RESULTS: 13 patients affected by pheochromocytoma (8 females and 5 males, mean age 48.4 ± 19.0 years), referred to our Centre for Secondary Hypertension, Policlinico Umberto I, Rome, were enrolled and evaluated at the baseline and after surgical treatment (mean follow-up of 39 ± 25 months). Data derived from 24 h-ambulatory blood pressure monitoring showed a reduction of mean number of antihypertensive drugs at follow-up; furthermore, comparing with baseline results, we have found a decrease, even thought non statistically significant, of BPV markers, such as standard deviation and average real variability (AVR) both for the systolic and diastolic component (systolic AVR 8.4 ± 1.8 vs. 7.6 ± 1.7 e diastolic AVR 7.8 ± 1.8 vs. 7.0 ± 1.9, respectively).
CONCLUSIONS: Our pilot study show as in patients affected by pheochromocytoma, after specific treatment, there is a decrease of short-term BPV markers, which are an independent cardiovascular risk factor. Further studies with largest group of patients will be necessary to confirm this preliminary data.
83 PAPILLEDEMA IN PATIENTS WITH PRIMARY ALDOSTERONISM: AN UNUSUAL CASE REPORT
83.1 F. Olmati1, A. Concistré1, L. Petramala1, V. Saracino1, F. Olmati1, V. Bisogni1, G. Oliviero1, M. Bonvicini1, A. Ciardi2, G. Iannucci1, G. De Toma2, C. Letizia1
83.1.1 1Secondary Hypertension Unit, Department of Internal Medicine and Medical Specialties, University of Rome “La Sapienza” Rome, Italy, 2Department of Surgery “P. Valdoni”, University of Rome “La Sapienza” Rome, Italy
INTRODUCTION: Primary aldosteronism (PA) is the most frequent form of secondary hypertension. A timely diagnosis, followed by a target treatment are important to reduce the risk of cardiovascular complications. Visual field defects and papilledema are rarely reported in PA patients.
CONCLUSIONS: We present an unusual case of PA due to adrenal adenoma presenting with papilledema. The prompt diagnosis after adrenalectomy restored mineralocorticoid hormone values and BP associated to disappearance of the papilledema.
84 LEFT VENTRICULAR MASS IN PRIMARY ALDOSTERONISM AND ESSENTIAL HYPERTENSION. A META-ANALYSIS
84.1 G. Pucci1, G. Bertarelli2, M. Tetti3, M.A. Ricci1, R. Sgariglia1, G. Vaudo1, S. Monticone3
84.1.1 1S.C. Medicina Interna, AOU S. Maria, Dipartimento di Medicina, Università di Perugia, Terni, Italy, 2Dipartimento di Economia e management, Università di Pisa, Pisa, Italy, 3Divisione di Medicina Interna, 4Centro Ipertensione Arteriosa, Dipartimento di Scienze Mediche, Università di Torino, Torino, Italy
INTRODUCTION: Primary aldosteronism (PA), as compared to essential hypertension (EH), is thought to be associated with an excess of left ventricular mass (LVM). However, results from previous studies were poorly informative due to low sample size.
AIM: To evaluate differences in LVM between PA and EH individuals in a meta-analysis with meta-regression.
METHODS: studies reporting LVM comparisons between PA and EH were selected. We searched Pubmed, Embase and Medline electronic databases before April 2018. Sixteen studies were retrieved, and comparisons were made within sub-groups according to LVM indexation (7 studies reported LVM indexed to g/m2, 6 to g/m2.7, 3 reported both indexations). A random-effect meta-regression model was used. Standardized values of LVM were subsequently introduced in a single multivariate linear model (all 16 studies included) as the dependent variable, with systolic BP (SBP), age and BMI as independent variables. The significance of the difference in the slope of the SBP/LVM relationship between PA and HT was tested.
RESULTS: 3395 patients (1198 PA, 2197 EH) were included. In the sub-group indexed to g/m2 (n = 10 comparisons), mean LVM was higher in PA (125.5 g/m2) than in EH (107.3 g/m2, p < 0.0001). The same was observed in the sub-group indexed to g/m2.7 (n = 9 comparisons, PA 52.0 g/m2.7, EH 47.2 g/m2.7, p < 0.0001). The standardized mean difference in LVM, considering all studies, showed a 51% increase in PA as compared to EH (p < 0.0001), and remained significant after adjustment for age, SBP and BMI (p < 0.0001). The standardized mean difference in LVM between PA and EH did not increase at increasing SBP values (b = − 0.01, seb = 0.01, p = 0.11). We found high heterogeneity in all the models.
CONCLUSIONS: individuals with PA showed consistently higher values of LVM than subjects with EH, which were independent from differences in age, BMI and SBP. Although limited by high heterogeneity, our results suggest that LVH increase in PA is independent from mechanisms associated to the degree of pressure overload. LVM excess in PA subjects could partially explain the associated increased risk of cardiac events.
85 HYPERTENSION ON ACROMEGALY: STUDY WITH ECHOCARDIOGRAPHY AND CARDIAC MAGNETIC RESONANCE
85.1 F. Dassie1, A. Casara1, G. Famoso2, L. Russo1, M. Parolin1, C. Martini1, R. Mioni1, E. De Carlo1, R. Vettor1, F. Tona2, F. Corbetti3, P. Maffei1, F. Fallo1
85.1.1 1DIMED, Padova University, Padova, Italy, 2DSCTV, Padova University, Padova, Italy, 3Cardiac magnetic resonance Unit, Albignasego, Italy
INTRODUCTION: Acromegaly is a rare chronic disease due to increased GH and IGF-1. Among comorbidities the most important mortality factors are hypertension, cardiac hypertrophy and diastolic and systolic hearth failure.
AIM: To analyse blood pressure values and cardiac hypertrophy in a group of acromegalic patients.
METHODS: We studied 25 patients (13 male), mean age 50.08 ± 11.95 years and mean IGF-1 10.88 ± 260.43 μg/L, 17 patients with active disease and 9 were naive patients. We collected clinical blood pressure (BP) values, echocardiographic data (ECO: FE, VTD, LVMI) and cardiac magnetic resonance results (MR: LVMI, E/A, fibrosis markers). On 12 patients we had also ambulatory blood pressure measurement (ABPM).
RESULTS: 16 (64%) patients had hypertension at clinical measurement and 9 (75%) patients at ABPM. 11 patients had left ventricular hypertrophy at ECO and 7 at MR (LVMi ECO: 143.44 ± 23.02 g/m2; LVMi RM: 115.61 ± 28.08 g/m2), 17 patients had a first grade diastolic dysfunction at MR (mean E/A = 0.81 ± 0.3). There was a positive correlation between IGF-1 and LVMi (r = 0.70, p < 0.001) and patients with active disease had a greater LVM at MR (active 76.99 ± 16.78 vs. controlled 56.56 ± 9.09, p < 0.01). There was also a positive correlation between ECO LVMI and MR LVMI (r = 0.5, p < 0.05). There were no differences on eco parameters, MR results and laboratory tests between hypertensive and normotensive patients.
CONCLUSIONS: This study confirmed that both ECO and MR are reliable technics for the study of cardiac mass and left ventricular function in acromegaly. Probably GH and IGF-1 play an important role on myocardial structure and cardiac function independently from blood pressure values.
86 PAPPHY (PROSPECTIVE APPRAISAL ON THE PREVALENCE OF PRIMARY ALDOSTERONISM IN HYPERTENSIVE PATIENTS PRESENTING WITH ATRIAL FLUTTER OR FIBRILLATION) STUDY: MAJOR RESULTS
86.1 T.M. Seccia1, S. Lerco1, C. Letizia2, M.L. Muiesan3, M. Cesari1, G. Maiolino1, V. Bisogni1, L. Petramala2, G.P. Rossi1
86.1.1 1Hypertension, Department of Medicine-DIMED, University of Padova, Padova, Italy, 2Department of Medicine, University La Sapienza, Rome, Italy, 3Department of Medicine, University of Brescia, Brescia, Italy
INTRODUCTION: The relationship between atrial fibrillation (AF) and primary aldosteronism (PA) remains unclear, despite excess aldosterone being suggested as predisposing to AF in patients with arterial hypertension.
AIM: The aim of the Prospective Appraisal on the Prevalence of Primary Aldosteronism in Hypertensive (PAPPHY Study) was to test the hypothesis that AF can be a presentation of unrecognized PA by screening for PA hypertensive patients presenting with “lone” AF.
METHODS AND RESULTS: Consecutive patients (n = 296) presenting with an unambiguous diagnosis of arterial hypertension, ECG-confirmed AF, and no obvious cause of arrhythmia were prospectively recruited in three European Society of Hypertension (ESH) centers of Excellence from 2015 to 2017. After appropriate pharmacological preparation and exclusion of those with at least one exclusion criterion, eligible patients (18.6% of the original cohort, age 76 ± 12 years; F/M %: 48/52) underwent a thorough diagnostic work-up aimed at identifying PA and its subtypes following the current guidelines. Among these patients we found a very high, e.g. 35%, prevalence of PA with surgically curable forms accounting for 42% of these cases.
CONCLUSIONS: Results of this prospective study provide compelling evidence that PA is highly prevalent in hypertensive patients with “lone” AF, thus underpinning the suggestion for a change in practice in that hypertensive patients should be screened for PA to identify those who can benefit markedly from adrenal vein sampling and either surgery or target medical treatment.
87 ALDOSTERONE AND ANGIOTENSIN II REGULATE PARATHYROID HORMONE SECRETION
87.1 S. Prisco1, L. Lenzini1, F. Torresan2, M. Iacobone2, G. Rossi1
87.1.1 1Department of Medicine, DIMED, University of Medicine of Padua, Padua, Italy, 2Endocrine Surgery Department of Surgical and Oncological Sciences, Department of Medicine, Padua, Italy
INTRODUCTION: We propose the existence of a pathophysiological link between the adrenocortical Zona Glomerulosa and the parathyroid glands.
AIM: To investigate: (1) in vivo effects of acute inhibition of angiotensin II (Ang II) signalling on parathormone(PTH) secretion in patients with primary aldosteronism (PA) and essential hypertension; (2) in vitro effects of ang II and aldosterone (ald) on PTH secretion in primary parathyroid cells.
METHODS: Referred hypertensive patients with PA (n = 34) and PH (n = 17) were prospectively investigated by assessing the acute effect of captopril on plasma PTH levels. Proteins expression for type 1 angiotensin receptor (AT1R) and 11HSDB2 were quantified in parathyroid tissues. Cultures of parathyroid primary cells characterized in terms of specific markers were developed and PTH production in response to ang II (100 nM) and ald (10-3M) was measured by ELISA kit.
RESULTS: Captopril lowered PTH in PA (from 36.9 ± 16.0 to 31.2 ± 13.2 ng/L, p = 0.0005) but not in PH (from 31.6 ± 9.0 ng/L to 29.7 ± 10.9 ng/L, p = 0.1024).Parathyroid tissues express both AT1R and 11HSDB2. Parathyroid primary cells cultured up to 7 days without losing their capability to produce PTH. Secretion of PTH was increased after cells stimulation with ald (10-3M) (%secretion of PTH vs. control 240 ± 52, p < 0.01)and Ang II (%secretion of PTH vs. control 168 ± 15, p < 0.01);this effect was abolished by canrenone (%secretion of PTH vs. control 135±35) and irbesartan (%secretion of PTH vs. control 102 ± 15).
CONCLUSIONS: These results show that acute lowering of Ang II formation lowers PTH secretion in vivo. The finding that parathyroid glands express AT1R and 11HSDB2, alongside that of the MR, and the response to Ang II and ald stimulation of primary parathyroid cells, provide further support for an involvement of the renin-angiotensin-aldosterone system in the regulation of parathyroid function.
88 AT1R AND GPER-1 RECEPTORS HETERODIMERIZATION POTENTIATES CYP11B2 GENE EXPRESSION IN ALDOSTERONE PRODUCING ADENOMA
88.1 B. Caroccia, M.T. Seccia, M. Piazza, G.P. Rossi
88.1.1 Università di Padova, Dipartimento di Medicina-DIMED, Padova, ITALY
INTRODUCTION: Aldosterone producing adenoma (APA) exhibits increased expression levels of G protein-coupled receptors (GPCRs). The GPCRs Angiotensin (Ang) II type 1 receptor (AT1R) and G protein-coupled estrogen receptor-1 (GPER-1) trigger aldosterone production by binding Ang II and 17-estradiol (or aldosterone).
AIM: Since functional crosstalk between GPCRs has been reported, we investigated if AT1R and GPER-1 form heterodimers to activate CYP11B2 gene expression in APA.
METHODS: APA strips and adrenocortical carcinoma cell line HAC15 were exposed to [100 nM] aldosterone alone or in presence of [100 nM] Ang II for 12 h, and/or after pre-treatment with the selective AT1R antagonist irbesartan and/or the selective GPER-1 antagonist G36. The experimental end-point was CYP11B2 gene expression change. HAC15 proteins were immunoprecipitated with an antibody for AT1R. and GPER-1 expression was revealed by immunoblot in immunoprecipitated proteins.
RESULTS: In APA strips both aldosterone and Ang II increased CYP11B2 gene expression (+ 220% and + 190%, respectively, p < 0.01 vs. untreated); aldosterone on top of Ang II potentiated the secretagogue effect of Ang II (+ 400%, p < 0.001 vs. untreated). The synergistic effect of aldosterone and Ang II was inhibited by either irbesartan or G36. Similarly, in HAC15 cells aldosterone potentiated the effect of Ang II (+ 800% vs. Ang II alone; + 1300% vs. aldosterone alone), and pre-treatment with irbesartan and/or G36 blunted the synergistic effect of aldosterone plus Ang II. After immunoprecipitation for AT1R, GPER-1 protein expression was detected by immunoblot.
CONCLUSIONS: Aldosterone and Ang II increase the expression of CYP11B2 through a cross-talk between GPER-1 and AT1R receptors. AT1R and GPER-1 heterodimers exist in HAC15 cells and the interaction between them contribute to the autonomous aldosterone production in APA.
BLOOD PRESSURE MEASUREMENT
89 RECLASSIFICATION OF HYPERTENSIVE OUTPATIENTS ACCORDING TO NEW UNITED STATES GUIDELINES ON HIGH BLOOD PRESSURE
89.1 V. Presta1, I. Figliuzzi1, F. Miceli1, B. Citoni1, N. Attalla El Halabieh1, R. Coluccia2, A. Ferrucci1, M. Volpe1,2, G. Tocci1,2
89.1.1 1Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant’Andrea Hospital, Rome, Italy, 2IRCCS Neuromed, Pozzilli (IS), Italy
INTRODUCTION: United States (US) guidelines on high blood pressure (BP) management and control have recently proposed a new BP stratification.
AIM: To evaluate the redistribution of adult outpatients according to previous (2003) and current (2017) US hypertension guidelines.
METHODS: We extracted data referred to adult individuals aged between 40–70 years with valid BP assessment from a national, cross-sectional database. All BP measurements were performed according to international guidelines, and the following systolic/diastolic BP strata were considered: (a) 2003 guidelines: 0 = normal (< 120/180 mmHg); 1 = prehypertension (≥ 120 and ≤ 139/≥ 80 and ≤ 89 mmHg); 2 = stage 1 (≥ 140 and ≤ 159/≥ 90 and ≤ 99 mmHg); 3 = stage 2 (≥ 160/≥ 100 mmHg); (b) 2017 guidelines: 0 = normal (< 120/80 mmHg); 1 = elevated (≥ 120 and ≤ 129/< 80 mmHg); 2 = stage 1 (≥ 130 and ≤ 139/≥ 80 and ≤ 89 mmHg); 3 = stage 2 (≥ 140/≥ 90 mmHg). CV risk profile characterization was based on Framingham risk score equation.
RESULTS: From an overall population sample of 10,012 adult individuals, we identified 8911 (89.0%) with valid clinic BP data (44.4% female, age 60.7 ± 6.6 years, BMI 28.2 ± 4.9 kg/m2, clinic BP 136.8 ± 14.5/82.1 ± 8.3 mmHg), among whom 339 (3.8%) were in the normal BP range. According to 2013 guidelines, 3,919 (44.0%) patients had pre-hypertension, 3698 (41.5%) had stage 1 and 955 (10.7%) had stage 2 hypertension. According to 2017 guidelines, 635 (3.8%) patients had elevated BP, 3284 (36.9%) had stage 1 and 4653 (52.2%) had stage 2 hypertension. New BP classification shifted 37% individuals from “pre-hypertension” to “stage 1” and 41% from “stage 1” to “stage 2” hypertension, respectively.
CONCLUSIONS: Redistribution of hypertensive patients may have relevant consequences on daily clinical management as well as socio-economic impact for health care systems, worldwide.
90 COMPARISON BETWEEN AOBP AND THE OTHER OFFICE AND OUT-OF-OFFICE BLOOD PRESSURE MEASUREMENT TECHNIQUES: A META-ANALYSIS
90.1 M. Pappaccogli1, E. Perlo1, S. Di Monaco1, C. Fulcheri1, E. Eula1, J. Burrello1, S. Monticone1, F. Rabbia1, F. Veglio1
90.1.1 1Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Italy
INTRODUCTION: AOBP, “Automated Office Blood Pressure”, is a blood pressure (BP) measurement technique, emerging as an integrative option to “office” measurements.
AIM: To compare AOBP BP values with those obtained with ambulatory (ABPM) and home blood pressure monitoring (HBPM) and those measured by physicians (Office BP) or non-medical health personnel such as nurses or technicians (non-physician BP).
METHODS: We conducted a systematic research in order to identify the studies comparing AOBP PB values with those measured by the other office or out-of-office BP measurement techniques already quoted. We only included studies performing AOBP measurements according with the modalities and the devices validated by previously published recommendations. BP mean differences and their standard errors were calculated; a random-effect model was used.
RESULTS: We included 24 studies, for a total of 7077 individuals. AOBP values were found significantly lower than those measured both by physician (n = 15; − 9.45 [− 11.49; − 6.81]/− 3.44 [− 5.33; − 1.55]) and non-medical health personnel (n = 8; − 7.50 [− 9.52; − 5.48]/− 4.23 [− 5.45; − 3.02]). When compared with daytime ABPM, only systolic AOBP values were significantly lower than those obtained with ABPM (n = 14; − 2.52 [− 4.80; − 0.24]/− 0.42 [− 1.55; 0.72]). On the contrary, the comparison between AOBP and HBPM showed no differences (n = 6; − 0.53 [− 6.34; 5.27]/− 1.37 [− 3.92; 1.18]).
CONCLUSIONS: Our results confirmed that AOBP BP values are significantly lower than those obtained with other office measurement techniques, likely due to the elimination of white-coat effect, while they not significantly differ from those measured with out-of-office measurement techniques.
91 24-HOUR AMBULATORY BLOOD PRESSURE LEVELS AND CONTROL IN A LARGE COHORT OF ADULT OUTPATIENTS WITH DIFFERENT GRADES OF OBESITY
91.1 I. Figliuzzi1, V. Presta1, B. Citoni1, F. Miceli1, F. Simonelli1, R. Coluccia2, G. Ceccarini3, G. Salvetti3, F. Santini3, A. Ferrucci1, M. Volpe1,2, G. Tocci1,2
91.1.1 1Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant’Andrea Hospital, Rome, Italy, 2IRCCS Neuromed, Pozzilli (IS), Italy, 3Obesity Centre at the Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
INTRODUCTION: Effective and sustained blood pressure (BP) control in hypertensive patients with moderate-to-severe obesity is often difficult to achieve in clinical practice.
AIM: To evaluate clinic, 24-h, day-time and night-time systolic/diastolic BP levels and control in a large cohort of adult outpatients with different grades of obesity.
METHODS: We retrospectively analysed data derived from a large cohort of individuals, who consecutively underwent home, clinic and ambulatory (24-h, day-time, night-time) BP assessment at our Hypertension Unit, Division of Cardiology, Sant’Andrea Hospital, Rome Italy. All BP measurements were performed and BP thresholds were set according to recommendations from European guidelines. Study population was stratified according to BMI.
RESULTS: We analysed 5,993 individuals (women 47.6%, age 60.3 ± 11.6 years, clinic BP 143.8 ± 18.4/90.9 ± 12.3 mmHg, 24-h BP 130.2 ± 13.3/79.0 ± 9.6 mmHg), among whom 31.3% had normal weight, 40.9% were overweight, 15.2% had grade I, and 4.9% grade II/III obesity. Obese outpatients had higher prevalence of risk factors, and were treated more frequently and with more drugs than those with normal body weight (P < 0.001 for all comparisons). They also showed higher systolic BP levels at all BP measurements, mostly 24-h and night-time periods, than those observed in normal weight outpatients. BMI was inversely related to 24-h SBP (r = 0.098; P < 0.001) and night-time SBP (r = 0.126; P < 0.001). BMI was also negatively and independently associated with predefined BP therapeutic goals.
CONCLUSIONS: Obesity was associated with high systolic BP levels during the entire 24-h period. These effects were independently observed, even after correction for major cardiovascular risk factors and comorbidities, as well as the number and type of antihypertensive drug classes.
92 PREVALENCE AND CLINICAL CHARACTERISTICS OF PATIENTS WITH UNTREATED MASKED HYPERTENSION COMPARED TO THOSE WITH MASKED UNCONTROLLED HYPERTENSION: ANALYSIS OF A LARGE DATABASE OF 24-H AMBULATORY BLOOD PRESSURE MONITORING
92.1 V. Presta1, I. Figliuzzi1, F. Miceli1, B. Citoni1, N. Attalla El Halabieh1, R. Coluccia2, A. Ferrucci1, M. Volpe1,2, G. Tocci1,2
92.1.1 1Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant’Andrea Hospital, Rome, Italy, 2IRCCS Neuromed, Pozzilli (IS), Italy
INTRODUCTION: Masked hypertension (MHT) is characterized by normal clinic and above normal 24-h ambulatory blood pressure (BP) levels.
AIM: To evaluate prevalence, clinical characteristics and cardiovascular (CV) outcomes of untreated MHT (unt-MHT) compared to treated uncontrolled MHT (unc-MHT).
METHODS: We analysed data derived from a large cohort of adult individuals, who consecutively underwent home, clinic and ambulatory BP monitoring at our Hypertension Unit, Division of Cardiology, Sant’Andrea Hospital, Rome Italy; for either diagnostic or therapeutic purposes between January 2007 and December 2017. MHT was defined as clinic BP < 140/90 mmHg and 24-h BP ≥ 130/80 mmHg, and stratified into 2 groups according to antihypertensive therapy.
RESULTS: From an overall sample of 4977 individuals with valid BP data, we identified 415 (8.3%) subjects with MHT, among whom 145 (34.9%) were untreated (unt-MHT) and 270 (65.1%) were treated (unc-MHT). Patients with unc-MHT were older (62.4 ± 12.6 vs. 59.3 ± 11.2 years; P = 0.012), were more frequently affected by obesity (42.2% vs. 19.0%; P = 0.039), dyslipidemia (16.9% vs. 2.7%; P < 0.001), diabetes (12.0% vs. 2.2%; P < 0.001), and coronary artery disease (2.7% vs. 0.2%; P = 0.050) compared to those with unt-MHT. Also, they showed higher home (140.8 ± 16.3 vs. 133.5 ± 14.1 mmHg; P = 0.004), 24-h (131.7 ± 7.8 vs. 129.7 ± 7.3 mmHg; P = 0.015) and night-time systolic BP levels (124.5 ± 11.7 vs. 121.5 ± 11.0 mmHg; P = 0.012), as well as lower clinic (80.9 ± 7.4 vs. 83.0 ± 5.7 mmHg; P = 0.004), 24-h (79.1 ± 6.7 vs. 80.6 ± 5.1 mmHg; P = 0.021) and day-time (81.8 ± 7.2 vs. 83.3 ± 6.0 mmHg; P = 0.034) diastolic BP levels compared to individuals with unt-MHT.
CONCLUSIONS: In our sample of adult outpatients, unc-MHT was associated with higher CV risk profile, higher systolic BP levels and lower diastolic BP levels compared to unt-MHT.
93 24-HOUR NIGHT-DAY BLOOD PRESSURE AND WAVE REFLECTIONS PATTERNS IN HEART TRANSPLANT AND HYPERTENSIVE INDIVIDUALS
93.1 A. Maloberti1,2, G. Masciocco3, M. Varrenti2, P. Meani2, A.D. Protogerou4, A. Argyris4, T. Weber5, P. Pecnik5, J. Sharman6, S. Wassertheurer7, B. Hametner7, M. Frigerio3, C. Giannattasio1,2
93.1.1 1Cardiology IV, ASST Niguarda Hospital, Milan, Italy, 2School of Medicine and Surgery, Milano Bicocca University, Milan, Italy, 3Cardiology II, ASST Niguarda Hospital, Milan, Italy, 4Cardiovascular Prevention and Research Unit, Department of Pathophysiology, Medical School, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece, 5Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria, 6Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Australia, 7Austrian Institute of Technology, Wien, Austria
INTRODUCTION: Heart denervation, a consequences of cardiac transplantation, results in increased resting heart rate (HR) with impact on blood pressure (BP) and on its 24 h pattern. A higher prevalence of non-dipping phenomenon has been reported in heart transplant recipients (HTX), but a specific analysis of night-day BP phenotypes is still lacking particularly regarding central hemodynamics.
AIM: To investigate 24 h changes of brachial and central BP, but also of 24 h steady state (stroke volume-SV, cardiac output-CO, peripheral resistance-PR) and pulsatile (antegrade and reflected waves) hemodynamics in HTX recipients, comparing them to treated hypertensive patients.
METHODS: We enrolled 25 HTX recipients and 25 hypertensives matched by age, sex and 24 h brachial BP. Ambulatory 24 h brachial and central BP, parameter were assessed with brachial oscillometry (Mobil-o-graph) and dedicated software for waveform analysis (ARCSolver).
RESULTS: The two groups were well matched for age (58.5 ± 12.1 vs. 58.5 ± 12.2 years, p = 0.9), sex (females 20% for group) and brachial and central 24 h BP (125/82 ± 11/8 vs. 127/81 ± 11/9 mmHg, p = ns). Mean time after HTX was 10.1 ± 9.5 years; and this group presented with higher 24 h (79.5 ± 10.3 vs. 71.4 ± 8.3 bpm) and daytime HR (82.7 ± 11.4 vs. 74.4 ± 8.5 bpm, p < 0.05 for both) compared to hypertensives. In both groups there were significant day/night decreases in systolic, diastolic and mean peripheral and central BP, as well as HR. In hypertensives CO decreased during night-time, and PR remained constant. Due to the decrease in HR, SV increased, with a parallel increase in antegrade and a more pronounced increase in reflected waves. In HTX, PR decreased during night-time, accompanied by an increase in SV and a stable CO. In turn, changes in wave reflections were less pronounced during night-time.
CONCLUSIONS: In treated hypertensives, the day-night pattern consists of a BP decrease with changes in wave reflections that increase during the night and are related to HR decrease, but also to postural and PR changes. In HTX, differences are observed regarding CO, PR and wave reflections. Differences are probably related to heart denervation and autonomic nervous system relative changes but further studies are needed.
94 ONLY TRONCO-CONICAL CUFFS CAN PROVIDE ACCURATE BLOOD PRESSURE MEASUREMENTS IN PEOPLE WITH SEVERE OBESITY
94.1 F. Saladini, E. Benetti, C. Fania, P. Palatini
94.1.1 Dipartimento di Medicina, Università degli Studi di Padova, Padova, Italy
INTRODUCTION: Rectangular (cylindrical) cuffs and bladders are currently used for blood pressure (BP) measurement at the upper arm. However, large arms have a tronco-conical shape which make cylindrical cuffs potentially unsuitable.
AIM: To investigate the effect of the shape of the cuff on BP measurement in very obese subjects.
METHODS: In 33 subjects with upper arm mid-circumference ≥ 42 cm and 33 subjects of control, cylindrical and tronco-conical cuffs of appropriate size were compared. In addition, in the obese participants, the pressure transmitted to the arm under the cuffs was measured at five cuff pressure levels using a paper-thin pressure sensor.
RESULTS: In all obese participants the upper arm shape was tronco-conical (mean ± SD slant angle, 84.1° ± 1.4°). In this group, systolic and diastolic BP differences between the tronco-conical and the cylindrical cuff were − 5.3 ± 4.0 and − 3.0 ± 4.3 mmHg, respectively (p < 0.001/= 0.01 versus controls). In the obese subjects of the top BP quintile the between-cuff systolic BP difference was − 9.1 ± 5.1 mmHg. Arm slant angle was an independent predictor of the between-cuff systolic BP discrepancy (p = 0.003). When the cylindrical cuff was used, measurement with the pressure sensor showed a marked disagreement between the pressure in the cuff and the pressure transmitted to the arm (mean difference, − 10.2 ± 5.2 mmHg) a difference which increased with increasing level of the pressure pumped in the cuff.
CONCLUSIONS: In very obese people, cylindrical cuffs overestimate BP chiefly in people with high systolic BP and thus only tronco-conical cuffs should be used.
95 AMBULATORY BLOOD PRESSURE MONITORING (ABPM): UTILITIES AND LIMITS
95.1 S. Agliata, P. Carpani, C. De Agostini, L. Benozzi, F. Rastelli, L. Scarpati, E. Ragazzoni, S. Cusinato
95.1.1 CS of Nephrology and Dialysis, S.S. Trinità Hospital of Borgomanero, ASL NO, Italy
INTRODUCTION: ABPM plays an important role in the control of the patient affected by arterial hypertension (AH).
AIM: We assess the use of ABPM in an hospital ambulatory of AH.
METHODS: From March 2016 to March 2018, we carried out the report of 1270 ABPM; then, 85 of them were referred from their general doctor to the follow up at the blood pressure ambulatory of our Complex Structure. Patients were given a survey to point out the degree of “tolerability” demonstrated by the examination, any observations, which was the reason of sending and the hypotensive therapy in progress.
RESULTS: Various reasons to conduct the examination (generic AH; occasional finding of AH, inadequate control of the arterial pressure; episodic AH; follow up of the blood pressure). 5/85 ABPM were incomplete because of some errors (3) or patient’s intolerant (2). 15/85 inadequate hypotensive therapy. 52/85 report with variability of the values. 63/85 showed a poor match between blood pressure levels (42 of them said the examination caused annoyance). 3 patients were diagnosed with masked hypertension.
CONCLUSIONS: These observations lead us to the conclusion that ABPM is a useful method to control blood pressure, but it is necessary also to make an adequate clinical evaluation of the patient, a blood pressure home diary, patient’s comments, and control of the hypotensive therapy in progress.
96 NURSE-OBP: A STANDARDISED NURSING METHOD FOR BLOOD PRESSURE MEASUREMENT
96.1 M. Pappaccogli1, F. Rabbia1, S. Di Monaco1, E. Perlo1, C. Maldarizzi1, E. Eula1, C. Fulcheri1, A. Milan1, P. Mulatero1, F. Veglio1
96.1.1 1Department of Medical Sciences, University of Turin, Hypertension Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
INTRODUCTION: In last few years a growing interest has been developing regarding Automated Office Blood Pressure (AOBP). This method has been recently adopted in controversial Systolic Blood Pressure Intervention Trial (SPRINT) in order to reduce the white-coat effect. The heterogeneity in the choice of methods for blood pressure measurement has been widely discussed.
AIM: To standardise a new method, the Nurse-OBP, and to compare it to AOBP.
METHODS: 118 hypertensive patients attending our Hypertension Unit were included in the study. They underwent an AOBP measurement and a Nurse-OBP one, which differs from the first in the presence of a nurse staying in the same room during blood pressure measurement. All subjects were randomized into two groups with a different order between the two modalities, with the aim of minimizing a potential effect on the measured BP values. At last, a conventional OBP measurement was performed during the medical examination.
RESULTS: Mean Nurse-OBP values (132 ± 19.4/73.3 ± 12.9) were significantly lower than OBP ones (141.3 ± 18.8/84.7 ± 10.7). When AOBP and Nurse-OBP were compared, no statistically significant differences between the two methods were found. The Bland–Altman analysis highlighted how the presence of the nurse could cause a minimum rise of BP values, (mean SBP and DBP difference respectively of 3.57 ± 12.23 mmHg and 2.25 ± 7.26 mmHg), not statistically significant; therefore, the two modalities, AOBP and Nurse-OBP, can be considered comparable.
CONCLUSIONS: Our study proposes a standardised nursing method for blood pressure measurement that could have practical implications when a dedicated room for AOBP is not available.
97 INTER-ARM BLOOD PRESSURE DIFFERENCE PREDICTS CARDIOVASCULAR EVENTS AND MORTALITY IN OLDER PATIENTS WITH TYPE 2 DIABETES MELLITUS
97.1 F. Spannella1, F. Giulietti1, G. Rosettani1, V. Bordoni1, M. Ricci1, F.E. Lombardi1, E. Borioni1, A. Filipponi1, S. Buscarini1, R. Sarzani1
97.1.1 1Internal Medicine and Geriatrics, ESH Excellence Centre, IRCCS-INRCA, “Politecnica delle Marche” University, Ancona, Italy
INTRODUCTION: Inter-arm difference (IAD) in blood pressure (BP) may affect the proper management of hypertension, leading to underestimation of the real BP values. IAD is highly prevalent in patients with type 2 diabetes mellitus (DM2). A systolic IAD ≥ 5 mmHg is associated with higher risk of all-cause mortality in the general population. The prognostic value of IAD in older patients with DM2 is still unclear.
AIM: Evaluate if a systolic IAD ≥5 mmHg could predict major cardiovascular events (MACE) in a sample of DM2 older patients.
METHODS: Five-year retrospective study on 506 DM2 patients aged ≥ 65 years, recruited in 2012 during an automatic simultaneous bilateral BP measurement in standard conditions. We considered the absolute value of the difference between systolic BP in dominant and non-dominant arm as IAD, choosing 5 mmHg as cut-off. We considered the cumulative incidence of the following MACE: acute myocardial infarction, transient ischemic attack (TIA)/stroke, cardiovascular death.
RESULTS: Mean age at recruitment: 75.1 ± 6.2 years; male sex: 53.6%; systolic IAD prevalence: 48%. No significant association was found in BP values between dominant and non-dominant arms. Patients with IAD had significantly worse metabolic and BP control and were taking more antiplatelet/antithrombotic drugs. IAD was associated with higher risk of myocardial infarction (OR 5.6, 95% CI 2.4–12.8, p < 0.001) and TIA/stroke (OR 5.5, 95% CI 2.7–11.2, p < 0.001). Cardiovascular death occurred in 6.3% of patients analyzed during the five-year period. IAD was associated with a higher risk of cardiovascular death (OR 2.5, 95% CI 1.2–5.4, p = 0.015). These association were confirmed even after adjusting for age, sex, smoke, BMI, diabetes control, systolic BP, LDL-cholesterol, eGFR.
CONCLUSIONS: A systolic IAD ≥ 5 mmHg is highly prevalent in older DM2 patients and is able to predict MACE. The prognostic role of systolic IAD confirms the importance of the simultaneous bilateral BP measurement.
98 DETECTING DIFFERENCES IN BLOOD PRESSURE VALUES BY DIFFERENT METHODS: ATTENDED AUTOMATED OFFICE BP, UNATTENDED AUTOMATED OFFICE BP AND ABPM
98.1 M. Crippa1, M. Bonavita2, S. Camanini3, G. Tovena4, C. Passeri5, G. Bianchi1, F. Zani1, R. Costa1
98.1.1 1U.O Medicina Interna P.O. Gardone VT, ASST Spedali Civili Brescia, Brescia, Italy, 2Polis Lombardia Corso di Formazione Specifica in Medicina Generale, Italy, 3Università degli Studi di Brescia Corso di Laurea in Medicina e Chirurgia, Brescia, Italy, 4ASST Spedali Civili di Brescia, Brescia, Italy, 5Università degli Studi di Brescia, Scuola di Specializzazione in Igiene e Medicina preventiva, Brescia, Italy
INTRODUCTION: Today auscultatory or oscillometric semiautomatic sphygmomanometers are used to measure blood pressure (BP). BP measured with these devices in an office setting without physician observers (unattended PA) could reduce the white coat effect.
AIM: To evaluate differences between automated office BP (aAOBP) versus unattended automated office BP (uAOBP) and ABPM.
METHODS: BP measurement was performed with semi-automatic oscillometric Microlife Afib in 450 hypertensive patients (238 M; 212 F) aged 59 ± 13, BMI 26.7 ± 5 kg/m2, in treatment (258) or not (192) who referred consecutively to our office. After 5-min rest in a seated position, 3 BP measurements were performed with and without a physician and the mean systolic BP (SBP), diastolic (DBP) and heart rate (HR) were recorded. Thereafter, ABPM was performed with Spacelabs 90217 device.
Systolic and diastolic blood pressure values in the overall population and in patients stratified for gender groups
CONCLUSIONS: Unattended BP was significantly lower compared to attended for both SBP (− 6 mmHg) and DBP (− 3 mmHg), consequently 134/87 mmHg could be the uAOBP value for the identification of hypertension in our population. This value is likely to the one indicated from guidelines for home BP. Unattended BP reduced the white coat effect in both genders. In female gender greater differences between methods of BP measurement where observed, in particular between clinical values and ABPM data.
99 BLOOD PRESSURE MEASUREMENT: ATTENDED VS. UNATTENDED, AVARAGE VALUES AND DIFFERENCE DETERMINANTS
99.1 M.L. Muiesan, A. Paini, F. Bertacchini, D. Stassaldi, G. Maruelli, C. Arnoldi, E. Agabiti-Rosei, M. Salvetti
99.1.1 Internal Medicine, University of Brescia, Brescia, Italy
INTRODUCTION: The results of the SPRINT study have called attention on the possible differences between blood pressure (BP) values obtained by health-care professionals in the office, during the visit (“attended BP”) as compared to those obtained in the office leaving the patient alone (“automated office BP” or “unattended BP”). Only few studies have compared the two techniques and none of them implemented the approach for unattended BP measurement used in SPRINT by the use of completely automated device for both attended and unattended BP and by the measurement of 3 values after 5 min of rest.
METHODS: In 261 consecutive outpatients attending the outpatient clinic at an ESH Excellence Centre, BP values were measured by the physician with an automated oscillometric device (Omron HEM 9000Ai, mean of 3 measurements), after 5 min of rest. After the measurement of BP by the physician, the patient was left alone in the room, and the device was programmed to automatically perform 3 BP measurements after 5 min.
RESULTS: Mean age was 61 ± 16 yrs, 60% ♀, BMI 26.1 ± 4.2, 88% with a previous diagnosis of hypertension (64% treated). Unattended systolic BP (SBP) and diastolic BP (DBP) were lower as compared to attended SBP (130.1 ± 15.7 vs. 138.6 ± 17.2 mmHg) and DBP (77.1 ± 11.7 vs. 78.9 ± 12.2 mmHg). The differences (Δ) between the values obtained using the two techniques were 8.5 ± 7.9 mmHg for SBP and 1.8 ± 5.6 mmHg for DBP. Δ SBP was directly correlated with age (r = 0.235 p < 0.0001) and with attended BP values (r = 0.407 p < 0.0001); Δ SBP was significantly lower in males than in females. At multivariate analysis Δ SBP remained independently correlated with age and attended SBP. Δ DBP was directly correlated with attended DBP (r = 0.322 p < 0.001) and was lower in males.
CONCLUSIONS: Our findings indicate that “unattended BP” measurement provides values significantly lower as compared to measurements obtained in the presence of the physician. Interestingly, the difference between the values obtained by the two approaches is not constant for all patients, being significantly affected by age, gender and BP values.
100 AORTIC PULSE WAVE VELOCITY ESTIMATED BY MOBIL-O-GRAPH IS UNRELIABLE IN THE CARDIOVASCULAR RISK ASSESSMENT OF MARFAN SYNDROME
100.1 G. Furlanis1, A. Grillo2, L. Salvi3, I. Pintassilgo4, E. Bungaro5, R. Gaetano6, S. Marelli7, B. Fabris1, R. Carretta1, A. Pini7, P. Salvi8, G. Parati2,8
100.1.1 1Università di Trieste, Trieste, Italy, 2Università di Milano-Bicocca, Milano, Italy, 3Università di Pavia, Pavia, Italy, 4Hospital Garcia de Orta, Almada, Saint Vincent and the Granadines, 5Università di Milano, Milano, Italy, 6IBIM CNR Istituto di Biomedicina e Immunologia Molecolare A. Morroy, Palermo, Italy, 7Ospedale L. Sacco, Milano, Italy, 8IRCCS Istituto Auxologico Italiano, Milano, Italy
INTRODUCTION: The measurement of aortic pulse wave velocity (PWV) by algorithms has been proposed for the evaluation of cardiovascular risk.
AIM: To evaluate the reliability of algorithm-based PWV estimated by the Mobil-O-Graph (IEM) compared to the standard non-invasive measurement of aortic PWV (carotid-femoral PWV by tonometry), in a population in which PWV measurement has a proven clinical utility: Marfan syndrome.
METHODS: In this study, 107 patients with confirmed Marfan syndrome in regular follow-up were enrolled (mean age 37.7 ± 15.1 years, males 50.4%, blood pressure 117.8 ± 13.6/69.0 ± 8.8 mmHg). PWV values estimated by Mobil-O-Graph (which uses an algorithm based mainly on age and pressure values, acquired by oscillometric method) were compared with carotid-femoral PWV measured by PulsePen tonometer (DiaTecne). For each method, two measurements were performed simultaneously, in a single session.
CONCLUSIONS: The Mobil-O-Graph provides PWV values of an ideal subject for a given age and pressure, but may not be able to assess the cardiovascular risk expressed by PWV in patients with specific alterations of aortic wall properties, as demonstrated in this population with Marfan syndrome. The use of algorithms for the evaluation of PWV should therefore be discouraged in particular categories of patients.
101 MULTIPLE OFFICE BLOOD PRESSURE MEASUREMENTS: A NOVEL APPROACH FOR BLOOD PRESSURE MEASUREMENT IN CHILDREN. DATA FROM THE SPA PROJECT
101.1 G. Ardissino2, S. Ghiglia1, M. Perrone3, S. Lava2, F. Tel2, A. Piantanida4, F. Letterio De Luca5, L. Filippucci6, E.R.A. Dardi7, T. Bollani7, P. Salice1 on behalf of the SPA Project
101.1.1 1Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Cardiologia Pediatrica, Milano, Italy; 2Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Nefrologia Pediatrica, Milano, Italy; 3Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Neonata Intensive Care Unit, Milano, Italy; 4Ospedale F del Ponte Cardiologia ad Indirizzo Pediatrico, Varese, Italy; 5Policlinico Universitario UOS Cardiologia Pediatrica, Messina, Italy; 6U.O. CARDIOLOGIA Riabilitativa e Sportiva-USLUmbria1, Perugia, Italy; 7ATS Città Metropolitana di Milano, Milano, Italy
INTRODUCTION: If blood pressure (BP) measurement still remains challenging in adults, it is even more so in children. Since 2010, we regularly perform unattended multiple OBPM (mOBPM) with a validated (OMRON M3) device: after 5 min rest, 10 automated readings are taken every 3 min on the non-dominant arm. Readings < 5th or > 95th centile and mOBPM with coefficient of variation (CV) > 15% are discarded.
CONCLUSIONS: Although most guidelines advice ≥ 2 BP readings, these findings suggest that mOBPM should include ideally ten, but at least four repeated measurements.
102 ANALYSIS OF BLOOD PRESSURE VARIABILITY WHEN IT IS MEASURED WITH DIFFERENT METHODS
102.1 E. Strocchi, I. Pareo, E. Fonte Basso, F. Muto, C. Borghi
102.1.1 Department of Medical and Surgical Sciences, University of Bologna, Bologna, ITALY
INTRODUCTION: Given the variability of blood pressure (BP), the way we measure it, is crucial to interpret the results as shown by the differences in the threshold for the diagnosis of hypertension between BP measured in the clinic (BP clinic) or with ambulatory blood pressure monitoring (ABPM) or at home (Home BP). The BP measured with an automatic device in the clinic with the patient left alone (AOBP), proposed by the Sprint study represents an additional method.
AIM: To compare the BP values obtained with the different methods and, above all, an analysis of the observed deviations.
METHODS: In all the patients who performed an ABPM, the BP was measured three times with traditional methods and subsequently with an automatic device with the patient left alone (AOBP); the waking period during ABPM was defined on the basis of the diary compiled by each patient and the mean of the lowest tertile of BP measured during this period was defined as “basal” BP.
RESULTS: After exclusion of patients with poor quality ABPM (% of successful measurements < 90%), 152 patients (77 M) were evaluated; as already observed in other studies, the average AOBP is lower than the BP clinic (− 13/6 mmHg) but also lower than ABPM during the day (− 10/3 mmHg); the difference between AOBP and “basal” BP of the ABPM is smaller. However, the most worrying aspect is that the deviations are widely dispersed (from − 41 to + 47 mmHg in the comparison between AOBP and ABPM during waking); similar results for the other comparisons.
CONCLUSIONS: To test the hypothesis that the difference between AOBP and clinic BP could represent a measure of stress-induced BP variability we compared this with the difference between “basal” BP at ABPM with the mean ABPM value without finding significant correlations.
103 EFFECT OF A COMBINED NUTRACEUTICAL CONTAINING MONACOLIN K ASSOCIATED TO ARTICHOKE EXTRACT OR BERBERINE ON LIPID PROFILE AND LIVER PARAMETERS IN PATIENTS AFFECTED BY POLYGENIC HYPERCHOLESTEROLEMIA: A DOUBLE-BLIND, PLACEBO-CONTROLLED, RCT
103.1 A.F. Cicero, A. Colletti, F. Fogacci, M. Bove, M. Veronesi, M. Giovannini, C. Borghi
103.1.1 Department of Medical and Surgical Sciences., University of Bologna, Bologna, ITALY
INTRODUCTION: Increasing evidence suggest that the combination of low-dosed lipid-lowering nutraceuticals is an effective and safe tool to improve LDL cholesterol (LDL-C) in subjects affected by mild-to-moderate hypercholesterolemia.
AIM: To test comparatively and versus placebo the lipid-lowering efficacy of berberine and artichoke extract in combination with low dose of monacolins from red yeast rice.
METHODS: A 3-arms, randomized, double-blind, placebo-controlled, parallel-groups clinical trial was carried out on 60 consecutively enrolled adult volunteers with a diagnosis of polygenic hypercholesterolemia. Enrolled subjects were randomized to be treated with monacolins 3 mg + artichoke 200 mg [ATC group], monacolins 3 mg + berberine 500 mg [BBR group] or placebo.
RESULTS: After 8 weeks of treatment, all patients experienced a significant improvement in baseline TC, LDL-C, apolipoprotein B (P < 0.01 always) (ATC group: TC = − 18.9%, LDL-C = − 26.7%, apoB = − 19.6%; BBR group: TC = − 18.4%, LDL-C = − 25.8%, apoB = − 23.2%; placebo: TC = − 6.2%, LDL-C = − 8%, apoB = − 8.4%). Observed LDL-C variations in actively treated subjects were statistically significant not only compared to baseline but also compared to placebo.
Subjects in ATC and BBR group respectively reached significantly lower body mass index and improved baseline HDL-C and triglycerides levels. Finally, baseline waist circumference and the hepatic steatosis index significantly decreased in both ATC and BBR.
CONCLUSIONS: In our short-term trial, subjects affected by polygenic hypercholesterolemia experienced a significant improvement in several cardiovascular risk factors in both monacolin-berberine and monacolin-artichoke treated patients.
104 EVALUATION OF THE EFFECTS OF MONACOLIN K ON LIPID PROFILE AND ARTERIAL FUNCTION IN DYSLIPIDEMIC PATIENTS
104.1 S. Castelnuovo1, R. Bosisio2, C. Pavanello2, A. Maloberti3,4, L. Giupponi3,4, A. Peretti3,4, L. Garatti3,4, M. Palazzini3,4, I. Bassi3,4, F. Pansera3,4, O. Belli3, F Casadei3, P. Sormani3, G.G. Mombelli5, L. Calabresi2, C. Giannattasio3,4
104.1.1 1Dyslipidemia Center, ASST Niguarda Hospital, Milan, Italy, 2Grossi-Paoletti Center, Farmacology and Biomolecular Department, Milan University, Milan, Italy, 3Cardiology IV, ASST Niguarda Hospital, Milan, Italy, 4School of Medicine and Surgery, Milano Bicocca University, Milan, Italy, 5Cardiology V, ASST Niguarda Hospital, Milan, Italy
INTRODUCTION: Dyslipidaemia is the major cardiovascular (CV) risk factor after hypertension. Some natural derivative molecules are able to improve the lipid profile, including monocolin K. This substance, which inhibits cholesterol synthesis, is produced by the fermentation of the red rice by a mycetes (Monascus purpureus). Monacolin K is also known as lovastatin, but recent data show that compared to classic lovastatin, monacolin K would have a higher bioavailability, a greater efficacy at the same dosage and a satisfactory tolerability. Its role as an hypolipidemic therapy is accounted in guidelines but, to date, the effect on arterial functional and structural parameters has never been evaluated.
METHODS: We evaluated 20 patients (11 females) with mild to moderate dyslipidaemia (LDL cholesterol between 100–160 mg/dL) before and after three months from monacolin therapy starting. Obesity, hypertension (defined as BP values > 140/90 mmHg or anti-hypertensive therapy) and impaired glycemic state Inclusion criteria were Patients were non-obese, normotensive and normoglycemic. Serum lipids, Blood Pressure (BP) and Pulse Wave Velocity (PWV—Complior).
RESULTS: At baseline mean age was 43.4 ± 10.2, BP 121 ± 14/76 ± 9.3 and heart rate (HR) 67.2 ± 7.6. Treatment lead to a significant reduction of total and LDL cholesterol (total: 258.4 ± 25.9 versus 228.5 ± 28.4 mg/dL after 3 months, p < 0.001; LDL 167.3 ± 31.2 versus 140.8 ± 25.2 mg/dL after 3 months, p < 0.001) and a significant improvement of arterial stiffness (PWV: 8.0 ± 1.4 versus 7.6 ± 1.2 m/s after 3 months, p = 0.02). No significant differences were seen for systolic BP (121 ± 14 versus 118.3 ± 15.5 mmHg after 3 months, p = ns) and HR (67.2 ± 7.6 vs. 69 ± 5.1 bpm after 3 months, p = ns) while a slight improvement for Diastolic BP (76 ± 9.3 vs. 72.8 ± 8.3 mmHg after 3 months, p = 0.004) was found.
CONCLUSIONS: The results of the present study confirm that the treatment with monacolin K reduces significantly the levels of total and LDL cholesterol. They also show that a so brief treatment course of only 3 months induces an improvement in arterial function as showed by the reduction in pulse wave velocity without changes in BP and HR.
105 PYCNOGENOL IS NOT EFFECTIVE IN LOWERING BLOOD PRESSURE: FINDINGS FROM A SYSTEMATIC REVIEW AND META-ANALYSIS
105.1 A.F.G. Cicero, F. Fogacci, M. Bove, M. Veronesi, C. Borghi
105.1.1 Department of Medical and Surgical Sciences, University of Bologna, Bologna, ITALY
INTRODUCTION: Results of previous clinical trials evaluating the effect of pycnogenol supplementation on blood pressure (BP) are controversial.
AIM: To assess the impact of pycnogenol on BP through a systematic review of literature and meta-analysis of available controlled clinical studies.
METHODS: Literature search included SCOPUS, PubMed-Medline, ISI Web of Science and Google Scholar databases up to 24th May 2018 to identify RCTs investigating the impact of pycnogenol on BP. Meta-analysis was entirely conducted using Comprehensive Meta-Analysis (CMA) V3 software (Biostat, NJ, USA).
RESULTS: Overall, the impact of pycnogenol on BP was reported in 4 trials. Meta-analysis did not suggest any significant change after pycnogenol supplementation neither in systolic blood pressure (SBP) [WMD − 0.19, 95% CI (− 0.44, 0.05) mmHg; p = 0.121] nor in diastolic blood pressure [WMD − 0.21 95% CI (− 0.45, 0.03) mmHg; p = 0.090] nor in mean arterial pressure (MAP) [WMD − 0.21 95% CI (− 0.45, 0.04) mmHg; p = 0.097] nor in pulse pressure [WMD − 0.06 95% CI (− 0.30, 0.19) mmHg; p = 0.653]. In the leave-one-out sensitivity analysis results persisted.
CONCLUSIONS: The present meta-analysis did not suggest any significant effect of pycnogenol on BP.
106 OPTIMIZING LIPID PATTERN BY ADDING A COMBINED NUTRACEUTICAL OR PRAVASTATIN TO FENOFIBRATE TREATMENT IN HYPERTRIGLYCERIDEMIC SUBJECTS
106.1 A.F.G. Cicero, F. Fogacci, M. Veronesi, E. Rizzoli, M. Giovannini, E. Grandi, C. Borghi
106.1.1 Department of Medical and Surgical Sciences., University of Bologna, Bologna, ITALY
INTRODUCTION: Fenofibrate is an effective and safe treatment for hypertriglyceridemia. However, after TG reduction a residual dyslipidemia could appear and require further treatment.
METHODS: We prospectively enrolled 40 patients well-tolerating treatment with micronized fenofibrate 145 mg/day and with residual dyslipidemia (LDL-C > 115 mg/dL and TG > 150 mg/dL). Exclusion criteria have been type 2 diabetes, Familial Hypercholesterolemia, previous cardiovascular diseases and severe chronic kidney disease (eGFR < 30 mL/min). Then, we have randomly assigned the patients to treatment with pravastatin 40 mg or a combined lipid-lowering nutraceutical (Armolipid Plus®, containing monacolin K 3 mg and berberin 500 mg per daily dose).
RESULTS: After 8 weeks of treatment, 80% of pravastatin treated patients (N. 16/20) and 75% of those treated with Armolipid Plus® (N. 15/20) reached the desired LDL-C target, while 50% of pravastatin treated patients (N. 10/20) and 80% of the Armolipid Plus® treated ones reached the desired TG target (N. 16/20). Non-HDL desired target was equally reached by both treatment groups in the 75% of cases (N. 15/20). No change in transaminases nor gamma-GT levels has been observed in both treatment group. No one adverse event has been registered during Armolipid Plus®, while 1 patient claimed moderate myalgia and 1 reported significant asymptomatic increase of CPK (> 3 ULN but < 5 ULN) during pravastatin treatment. Both patients were then treated with Armolipid Plus® with resolution of symptoms and CPK increase, respectively.
CONCLUSIONS: In hypertriglyceridemic patients with suboptimal control of lipid level despite effective treatment with fenofibrate, the association with a combined lipid lowering nutraceutical seem to be more efficacious in optimizing the lipid level and more safe than pravastatin 40 mg.
107 EFFECTS OF A NUTRACEUTICAL COMBINATION CONTAINING BERBERINE, RED YEAST RICE AND MORUS ALBA ON VASCULAR FUNCTION AND METABOLISM IN SMOKING AND NON-SMOKING SUBJECTS WITH DYSLIPIDEMIA
107.1 M. De Feo, S. Leone, F. Mai, I. Proietti, S. Abballe, C. Ferri, D. Grassi
107.1.1 Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
INTRODUCTION: Hypercholesterolemia and smoking are important risk factors for atherosclerotic disease. Cardiovascular prevention relies on the effective control of these modifiable conditions. Some nutraceuticals are prescribed as lipid-lowering substances. To date, only a few studies have focused on the effects of these compounds on vascular function and metabolism. Moreover, there are no studies in the literature that have specifically examined the possible effects of nutraceuticals in relation to cigarette smoking.
AIM: To investigate the acute effects of a nutraceutical combination (NC) containing berberine, red yeast rice and Morus alba on vascular function and metabolism in 33 dyslipidemic subjects (14 smokers and 19 non-smokers).
METHODS: Office blood pressure, flow mediated dilation (FMD), pulse wave velocity (PWV), Augmentation Index (AIx) and metabolism were evaluated at baseline and at 1, 2 and 3 h after the intervention. Non-smokers underwent only one visit, in which intervention consisted of NC administration. Smokers underwent two visits: in the first one, intervention consisted of cigarette without NC; in the second one, cigarette was followed by NC consumption.
RESULTS: In non-smokers group FMD increased after taking NC, reaching the statistical significance in the first and second hour (p < 0.05). In contrast, FMD showed a continuous decrease after cigarette consumption in smokers group; this decrease was less evident when also NC was administered. AIx showed a decreasing trend in all groups after the intervention; this reduction reached the statistical significance only with the association of cigarette with NC (p < 0.05). Metabolism showed a relative improvement in all groups. No substantial change was observed in PWV and office blood pressure.
CONCLUSIONS: Our study suggests that this NC may represent an effective tool for clinical management of cardiovascular risk factors. Moreover, it seems to exert some beneficial effects on vascular damage related to smoke. Further research on the long-term effects is needed.
108 THE EFFECT OF NUTRACEUTICAL COMPOUNDS IN HYPERTENSIVE AND HYPERCHOLESTEROLEMIC SUBJECTS WITH METABOLIC SYNDROME
108.1 G. Torin1, S. Lenti2, L. Schiavon3, E. Di Giacomo4, M. Tomasi3, R. Manunta5, A. Mazza6
108.1.1 1,6Unit of Internal Medicine C, Department of Medicine, University of Verona, Verona, Italy, 2Internal Medicine Unit, S. Donato General Hospital, Arezzo, Italy, 3Unit of Internal Medicine, S. Maria della Misericordia Hospital, AULSS 5 Polesana, Rovigo, Italy, 4Unit of Angiology, Department of Internal Medicine, Santa Maria della Misericordia General, AULSS 5 Polesana, Rovigo, Italy, 5Unit of Diabetology, S. Maria della Misericordia Hospital, AULSS 5 Polesana, Rovigo, Italy, 6ESH Excellence Hypertension Centre, Unit of Internal Medicine, S. Maria della Misericordia Hospital, AULSS 5 Polesana, Rovigo, Italy
INTRODUCTION: Treatment strategies of metabolic syndrome (MetS) include pharmacologic and non-pharmacologic interventions; among these ones, a relevant role has been shown for the nutraceutical compounds (NCs).
AIM: To investigate the efficacy and safety of NCs in lowering blood pressure (BP) values and improving lipid and glucose profile, in a group of hypertensives and hypercholesterolemic subjects with MetS.
METHODS: 52 subjects with MetS (mean age 57.4 ± 8.8 years, 51% males), defined according to NCEP ATP-III criteria and without history of CV diseases, were assigned to follow a treatment with a Mediterranean diet for two months and to take a NC once daily in the evening, containing red yeast rice equal to 10 mg of Monacolin K (MK) and Coenzyme Q10 (30 mg). These subjects were compared with a control group of 52 subjects with the same characteristics following a diet program. Clinic BP, serum total cholesterol (TC), low-density- and high-density-lipoprotein cholesterol (LDLC and HDLC), triglycerides (TG) and glucose were evaluated at baseline and at the 2 months of follow-up (FW). The safety profile was performed by monitoring serum transaminase (ALT, AST) and CPK. The difference between continuous variables was compared by analysis of variance.
CONCLUSIONS: In subjects with MetS, NCs were safe, well tolerated and effective in improving clinic BP, lipid and glucose profile.
109 ANTIHYPERTENSIVE EFFECT EVOKED BY “SPIRULINA PLATENSIS”: A NEW ALGAL MATRIX ABLE TO PROMOTE THE RELEASE OF NITRIC OXIDE
109.1 E. Sommella1, A. Damato2, M. De Lucia2, M.T. Ambrosio2, P. Campiglia1, C. Vecchione1,2, A. Carrizzo2
109.1.1 1University of Salerno, Baronissi-Fisciano (Salerno), Italy; 2I.R.C.C.S. Neuromed, Pozzilli, Italy
INTRODUCTION: The pharmacological properties of natural compounds have attracted more attention in the area of alternative therapeutic approaches to cardiovascular diseases. Currently, the food industry is focused on bioactive molecules contained in foods or natural matrices, which in addition to nutritional value, can exert beneficial effects in the treatment of chronic diseases. Among the natural sources, marine microalgae such as Spirulina (Arthrospira platensis) are considered the “superfood” of the future and an extraordinary source of bioactive compounds.
AIM: To characterize vascular effects evoked by the gastrointestinal digestion of Spirulina.
RESULTS: In this study, after a simulated gastrointestinal digestion (GID) process in vitro, we have shown, in mice mesenteric arteries, that Spirulina is able to exert a dose-dependent vasodilatation mediated by the recruitment of PI3k/Akt which converges on activation of nitric oxide endothelial synthase (eNOS). In vivo, administration of Spirulina is able to reduce the level of blood pressure in animal models of arterial hypertension. Moreover, using a detailed peptidomic approach, we have identified the single peptide (SP6), coming from the GID of Spirulina, able to exert the vascular and hemodynamic effects observed both in vitro and in vivo, by recruiting the same molecular pathway recruited by the whole composed. Finally, we demonstrated that the administration of bioactive peptide in eNOS knockout animals did not shown any vascular effects, thus confirming that the SP6 peptide acts through a dependent nitric oxide mechanism.
CONCLUSIONS: The identification of a single bioactive peptide, isolated from a complex Spirulina matrix, able to modulate the endothelial function and the pressure levels opens a new scenario for the development of combined therapeutic approaches, which integrate pharmacological and non-pharmacological treatment, aimed to improve endothelial function and control pressure levels.
110 AKP05: A NEW COMBINATION OF NUTRACEUTICALS ABLE TO REDUCE BLOOD PRESSURE LEVELS AND IMPROVE EXERCISE TOLERANCE IN HYPERTENSIVE PATIENTS
110.1 A. Carrizzo1, N. Virtuoso2, A. Strianese3, A. Damato1, M.T. Ambrosio1, V. Trimarco4,5, R. Izzo4,6, N. De Luca4,6, C. Vecchione1,3
110.1.1 1IRCCS Neuromed, Pozzilli (IS), Italy, 2Department of Cardiovascular Medicine, A.O.U. Federico II, 80131 Naples, Italy, 3Department of Medicine and Surgery, University of Salerno, Baronissi (SA), Italy, 4Hypertension Research Center, Federico II University Hospital, Naples, Italy, 5Department of Advanced Biomedical Science Federico II University Hospital, Naples, Italy, 6Department of Translational Medical Sciences Federico II University Hospital, Naples, Italy
INTRODUCTION: In recent decades the scientific community has shown considerable interest in nutraceuticals potential. Despite the numerous studies, the molecular mechanisms underlying vasculo-protective effects are still unknown.
AIM: To determine the vascular effects and molecular mechanisms evoked by a new combination of nutraceuticals composed by Bacopa monniera, Ginkgo biloba, phosphatidylserine and green tea leaf extract (AkP05, IzzeK).
METHODS AND RESULTS: AkP05 is able to induce a dose-dependent vasodilation of the mouse mesenteric artery through nitric oxide dependent mechanism. This action is mediated by the recruitment of PLC, PKC, Akt, since the pharmacological inhibition of these mediators blocks the vasodilating properties of AkP05. This compound is also able to reduce the activity of NADPH oxidase, reducing vascular oxidative stress. The analysis of the individual components showed that Bacopa monniera (BM) and phosphatidylserine (PS) are able to evoke a dose-dependent vasodilatation mediated by nitric oxide. While BM action was abolished by inhibition of Akt and PKC, the vascular action of PS persisted even in the presence of pharmacological inhibitors. Molecular analysis revealed the ability of PS to modulate the release of calcium from smooth muscle cells, favoring its vasodilatory capacity. In vivo administration of AkP05, but not of the individual components, was able to reduce the levels of arterial pressure, thus suggesting a synergistic action of the various compounds. Finally, a pilot study on a population of hypertensive subjects treated for 28 days with the AkP05 capsules, showed a reduction in systolic and diastolic blood pressure and an improvement in endothelial function measured with EndoPAT. Furthermore, the evaluation of physiological status and exercise capacity showed a strengthening of exercise tolerance.
CONCLUSIONS: On the basis of these results, AkP05 could represent a new therapeutic strategy adjuvant to the pharmacological one, to control and reduce the incidence of cardiovascular diseases.
111 CARDIAC REMODELLING IN RENAL TRANSPLANTED PATIENTS: A QUESTION OF GENDER?
111.1 F. Saladini, A. Polo, R. Verlato, N. Simioni, M. Nordio, R. Razzolini, P. Piovesana
111.1.1 1U.O. Cardiologia, P.O. Cittadella, Padova, Italy, 2U.O. Cardiologia, Ospedale di Bassano, Vicenza, Italy, 3U.O. Medicina, P.O. Cittadella, Padova, Italy, 4U.O. Nefrologia, P.O. Camposampiero, Padova, Italy, 5Clinica Cardiologia, Università degli Studi di Padova, Padova, Italy, 6U.O Cardiologia, Ospedale di Treviso, Treviso, Italy
INTRODUCTION: Cardiovascular diseases are the most common cause of morbidity and mortality among renal transplanted patients.
AIM: To explore clinical and echocardiographic characteristics of renal transplanted patients and to evaluate the role of elevated blood pressure (BP) in determining cardiac organ damage.
METHODS: We examine 44 patients, 15.4 ± 8.8 years after renal transplantation, who underwent to echocardiographic examination, including speckle tracking evaluation, and to ambulatory blood pressure monitoring (ABPM). Significant determinants of cardiac remodelling were explored with regression analysis adjusted for several clinical confounders
RESULTS: 86% of the study participants were hypertensives, 45% diabetics, 68% had lipid abnormalities and 47% high serum uric acid levels. Among hypertensive patients the majority (51%) were taken three pills and the most frequent treatment prescribed were β-blockers (79%). At echocardiographic evaluation 64% of the patients presented concentric hypertrophy, 27% concentric remodelling, 9% a normal morphology, none had eccentric hypertrophy. Mean longitudinal strain was − 21 ± 4% and 20% of the study participants had an impaired longitudinal function. Diastolic function was normal among 27% of the study participants, 68% had a diastolic dysfunction, 5% had a pseudo-normal pattern. According to ABPM data 27.3% had diurnal hypertension and 90.9% had nocturnal hypertension; the majority of the patients were risers (53%) or non-dippers (30%), only 17% had a normal dipping pattern. In multivariate regression analysis, adjusted for several clinical and biochemical analysis, none of the ABPM parameters was a significant determinant of left ventricular mass, diastolic function or global longitudinal strain, while gender resulted a significant determinant (p = 0.018 for left ventricle mass, p = 0.033 for GLS, p = 0.007 for diastolic function). Only serum calcium level presented a significant difference according to gender and was higher in females compared to males.
CONCLUSIONS: Renal transplanted patients presented an unfavourable cardiac remodelling and nocturnal hypertension, however none of ABPM indexes significantly correlated with cardiac organ damage. Gender and in particular male gender, is a significant determinant of cardiac remodelling, indicating that probably these patients should be treated more intensive.
112 PARA-PERIRENAL DISTRIBUTION OF BODY FAT IS ASSOCIATED WITH REDUCED GLOMERULAR FILTRATION RATE REGARDLESS OF OTHER INDICES OF ADIPOSITY IN HYPERTENSIVE SUBJECTS
112.1 G. Geraci, M.M. Zammuto, A. Mattina, C. Cusumano, V. Tranchida, C. Pugliares, S. Cottone, G. Mulè
112.1.1 Dipartimento Biomedico di Medicina Interna e Specialistica, Palermo, Italy
INTRODUCTION: Obesity is a well-known risk factor for the development and progression of chronic kidney disease. Recently, para-perirenal ultrasonographic fat thickness (PUFT) has shown to correlate with both total and visceral fat better than body mass index (BMI), waist circumference (WC) and other indices of obesity. Moreover, a local paracrine and mechanical action of the PUFT on kidney has been described in recent studies.
AIM: To assess the relationship between glomerular filtration rate (GFR) and PUFT in comparison to other anthropometric and ultrasonographic indices of adiposity.
METHODS: Two hundred ninety-six hypertensive patients were enrolled. PUFT, cutis-rectis thickness and rectis-aorta thickness were obtained by ultrasonography. Anthropometric measures of adiposity were also measured. Estimated GFR was calculated using the CKD-EPI equation.
RESULTS: Higher PUFT values were observed in patients with impaired renal function (p < 0.001), whereas no differences in BMI and WC were shown between groups divided by GFR. PUFT significantly correlated with GFR in all subjects (r = − 0.284; p < 0.001), with no differences in groups divided by gender, diabetes or BMI. This association held in multivariate analyses also after correction for confounding factors, including other adiposity indices (p < 0.001). When receiver-operating characteristic curves were built to detect a eGFR < 60 ml/min/1.73 m2, a PUFT value ≤ 3.725 cm showed a negative predictive value of 94.0%, with the largest area under the curve (AUC: 0.700) among the variables considered.
CONCLUSIONS: the relationship between PUFT and GFR seems to be more accurate and less influenced by the bias affecting traditional indices of adiposity.
113 PREDICTIVE ROLE OF CHANGES IN ALBUMINURIA ON THE LOSS OF RENAL FUNCTION UNDER ANTIHYPERTENSIVE TREATMENT IN PATIENTS WITH TYPE 2 DIABETES
113.1 F. Viazzi1, B. Bonino1, P. Fioretto2, C. Giorda3, P. Guida4, G. Russo5, E. Greco6, S. De Cosmo6, R. Pontremoli 1 and the AMD-Annals Study Group^
113.1.1 1Università degli Studi and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy, 2Department of Medicine, University of Padua, Padua, Italy, 3Diabetes and Metabolism Unit ASL Turin 5 Chieri (TO), Italy, 4Associazione Medici Diabetologi, Rome, Italy, 5Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy, 6Department of Medical Sciences, Scientific Institute “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG), Italy
AIM: To assess the predictive role of changes in albuminuria on the loss of renal function under antihypertensive treatment in patients with type 2 diabetes.
METHODS: Clinical records from a total of 12,611 patients with hypertension and type 2 diabetes, attending 100 antidiabetic Centers in Italy; with normal estimated glomerular filtration rate (eGFR) at baseline and regular visits during a four-year period were retrieved and analyzed. We assessed the association between changes in albuminuria status during a 1-year baseline period and time updated blood pressure and eGFR loss over the subsequent 4-year follow-up.
RESULTS: Mean age at baseline was 65 ± 9 years, known duration of diabetes 11 ± 8 years, eGFR 85 ± 13 ml/min and blood pressure 142 ± 17/81 ± 9 mmHg. Patients with persistent albuminuria showed the highest 4-year risk of eGFR loss > 30% from baseline or onset of stage 3 chronic kidney disease (eGFR < 60 ml/min) as compared to those with persistent normal albuminuria (OR 2.00, CI 1.71–2.34; P < 0.001). Female sex, age, disease duration, BMI, low baseline eGFR, lipid profile, the number of antihypertensive drugs, and variations in albuminuria status were associated to renal risk in the whole study population. Furthermore, lower time updated blood pressure values and the use of renin–angiotensin–aldosterone-system-inhibitors were related to the occurrence of renal endpoints only in the subgroup of patients without albuminuria.
CONCLUSIONS: In patients with hypertension and type 2 diabetes under real life clinical conditions, changes in albuminuria parallel changes of renal risk. Albuminuria status could be a guide to optimize therapeutic strategy.
114 THE IMPAIRED RENAL VASODILATION TO l-ARGININE (ARG) OF ESSENTIAL HYPERTENSIVE PATIENTS (EH) IS REVERSED TO NORMAL BY CALCIUM-CHANNEL ANTAGONISTS (CB)
114.1 A. Montanari, L. Musiari, A. Cabassi
114.1.1 Dipartimento di Medicina e Chirurgia, University of Parma, Parma, Italy
AIM: To investigate on the role of calcium channels (Cc) in the impaired renal vasodilation to ARG in EH.
METHODS: Mean arterial pressure (MAP), glomerular filtration rate (GFR, inulin), renal blood flow (RBF, p-aminohippurate) and urinary 8-isoprostane (U8-iso-PGF2αV) were measured in 15 normotensive volunteers (C) and 14 never-treated EH before (B) and during two 3-h infusions of 0.012 mmol kg min−1 ARG, each preceded for 3-days’ by either placebo (PL) or manidipine 10 mg (M).
RESULTS: With PL ± ARG, MAP and GFR, unchanged in C, fell (p < 0.05 vs. B) in EH (− 3.1% MAP, − 4.8% GFR). RBF rose (ΔRBF = + 23% C, + 13% EH, 0.001 vs. B), an increase, however, 43% lower in EH vs. C (ANOVA p < 0.001). U8-iso-PGF2αV decreased by 22% in C and increased by 24% in EH (p = NS vs. B for both, with ANOVA p < 0.05 between EH-PL + ARG and C-PL + ARG). With M±ARG, ΔRBF, slightly accentuated in C-M + ARG (+ 29% vs. B; ANOVA p < 0.05 vs. C-PL + ARG), was greatly enhanced in EH (+ 28% 0.001 vs. B; ANOVA p < 0.001 vs. EH-PL + ARG) and similar to that observed in C (ANOVA p = NS vs. C-M + ARG). MAP fell by 3% with unchanged GFR. U8-iso-PGF2αV decreased equally (p < 0.05 vs. B) in C (− 54%) and EH (− 45%, ANOVA p = NS vs. C). Renal hemodynamic response to ARG, impaired in HTN after PL, becomes essentially normal after short-term CB, which only slightly potentiates renal vasodilatation in C, thereby suggesting a substantial contribution of activated Cc to the lowered ΔRBF in EH.
CONCLUSIONS: Reduced ΔRBF was associated in EH with a slight increase in U8-iso-PGF2αV instead of the decrease seen in C, which also was reversed to normal after M. Therefore, the possible contribution to vasodilation of antioxidant effects of ARG could be limited in EH, the correction of which by CB may participate in the recovered renal hemodynamic response to ARG.
THERAPY, PHARMACOECONOMY AND PHARMACOSURVEILLANCE
115 THE “POLYPHARMACY” IN PATIENTS WITH HYPERTENSION, DISMETABOLISM, CKD IN STAGE IIIB–IV K/DOQI: OUR EXPERIENCE
115.1 A. Bruzzese1, A. Bruzzese2, R. Cicciarello4, F. Nasso3, M. Pasquale3, V. Bruzzese4
115.1.1 1Istituto di Ematologia, Università La Sapienza, Roma, Italy, 2U.O. Medicina Interna Ospedaliera, A.O. Ferrara, Italy, 3U.O. Medicina Interna, Ospedale di Polistena (RC), Italy, 4U.O. Nefro-Dialisi, CAPT Taurianova (RC), Italy
INTRODUCTION: In the general population there is a considerable prevalence of “primitively” and “contemporaneously” hypertensive and dismetabolic subjects who need treatment with many drugs. If they develop “organ damage”, the number of drugs increases. In this case it becomes necessary to correctly manage the same “polypharmacy”. The problem becomes particularly challenging in patients with dismetabolism, hypertension and CKD, where other needs of pharmacological treatment are added. The literature reports work on the potential inappropriateness of pharmacological prescriptions in elderly “hypertensive-dismetabolic” patients with CKD. We collected data on these aspects in a cohort of subjects with CKD related to a clinic for Renal Diseases and Arterial Hypertension, focusing attention on the pharmacological treatment of comorbidities.
METHODS: We conducted a cross sectional study evaluating a cohort of 432 hypertensive and dismetabolic subjects (207 M and 225 F, mean age 67 aa.) who presented with a CKD in Stage IIIb–IV K/DOQI, complicated by anemia, metabolic acidosis, disionia and alterations of calcium-phosphorus metabolism. For each subject we have analyzed the pharmacological therapy in several aspects: number of drugs, timing and methods of recruitment, type, dosages, timing and methods of prescription, interactions, and others.
RESULTS: We found that the subjects took on average 13 different drugs and often: (1) the molecules taken were prescribed by several “specialists” doctors without a prior comparison on possible interactions and dosage adjustments; (2) the treated subject was not able to correctly orientate himself in taking drugs without a “caregiver”; (3) it was evident the need for the attending physician to dedicate more time and pay more attention to the aspects concerning the pharmacological prescriptions: informational, motivational, educational, psycho-relational, and others, as to the “global” results of the treatment goals.
CONCLUSIONS: We believe that “polypharmacy” is worthy of greater attention and greater comparison between medical specialists for the improvement of the global outcomes of daily clinical practice.
116 PHARMACOLOGICAL TREATMENT OF ARTERIAL HYPERTENSION IN PEDIATRIC POPULATION: A NETWORK META-ANALYSIS
116.1 J. Burrello1, E.M. Erhardt2, G. Saint-Hilary2, F. Veglio1, F. Rabbia1, P. Mulatero1, S. Monticone1, F. D’Ascenzo3
116.1.1 1Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy, 2Department of Mathematical Sciences “G. L. Lagrange”, Polytechnic University of Turin, Turin, Italy, 3Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
INTRODUCTION: Pharmacological treatment of arterial hypertension in children and adolescents is indicated in all patients with symptomatic hypertension, target organ damage, secondary hypertension, diabetes or hypertension unresponsive to lifestyle modifications. The lack of head-to-head pharmacological trials does not allow to provide strong recommendations for any class of anti-hypertensive medications over the others.
AIM: We performed a network meta-analysis to evaluate the efficacy of different anti-hypertensive medication in the pediatric population.
METHODS: We searched MEDLINE and Cochrane Library for randomized-placebo controlled trials (RCTs) on treatment of pediatric hypertension, enrolling ≥ 50 patients and with a follow-up ≥ 4 weeks. The reduction of systolic (SBP) and diastolic (DBP) blood pressure after treatment were the co-primary endpoints.
RESULTS: Thirteen RCTs, including 2378 pediatric patients with a median age of 12 years, were included in the analysis. After a median follow-up of 35 days, lisinopril and enalapril were superior to placebo in reducing SBP and DBP whereas, only for DBP, losartan was superior to placebo and lisinopril and enalapril were superior to eplerenone. Angiotensin converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) were associated with a greater SBP and DBP reduction compared to placebo, likewise the mineralocorticoid receptor antagonist was inferior to ACE-Is in DBP reduction. The analysis was adjusted for age, gender, baseline blood pressure and weight: only the latter significantly affected DBP reduction. Lisinopril and enalapril confirmed their superiority versus placebo regardless of the considered confounding factors.
CONCLUSIONS: In this study we demonstrate that ACE-Is (in particular lisinopril and enalapril) and ARBs (in particular losartan) could represent the best choice as anti-hypertensive treatment for pediatric hypertension.
117 PREDICTORS OF ORTHOSTATIC HYPOTENSION IN HYPERTENSIVE PATIENTS: THE ROLE OF HYPOTENSIVE DRUGS
117.1 G. Rivasi, L. Martella, G. Turrin, A. Giordano, C. Lorenzi, V. Tortù, M.F. D’Andria, G. Casini, M. Rafanelli, A. Ungar
117.1.1 Referral Centre for Hypertension in the Elderly, Department of Geriatrics and Geriatric Intensive Care Unit, Careggi Hospital and University of Florence, Italy
INTRODUCTION: Orthostatic hypotension (OH) is a common finding in hypertensive patients. Different predictors of OH are reported in Literature, but the role of anti-hypertensive drugs is unclear; in addition, several drugs with a different indication may have hypotensive effects and favour OH.
AIM: To assess the prevalence and identify predictors of OH in hypertensive patients, with a particular focus on anti-hypertensive and hypotensive drugs.
METHODS: 386 consecutive patients referred to our Centre between January 2013 and March 2017 were enrolled and evaluated for OH. A comparison between patients with and without OH was carried out, analysing clinical features and pharmacological treatment.
RESULTS: The study population had a mean age of 61.8 years (range 33–92 years, 51% male). Patients were taking a mean of 2.1 ± 1.3 anti-hypertensive drugs, mainly calcium-antagonists (42.2%), angiotensin receptor blockers (ARB, 37.8%) and angiotensin-converting enzyme inhibitors (ACEi, 36.5%). OH was diagnosed in the 32.6% of patients and was associated with symptoms in 35.7% (45/126). Patients with OH were older (66.3 ± 12.1 vs. 59.6 ± 14.5 years, p < 0.001) and more frequently received treatment with ARB (p = 0.008), nitrates (p = 0.008), alpha-blockers (p = 0.05), benzodiazepine (p = 0001) and Levodopa (p = 0.01); ACEi therapy was more common in patients without OH (p = 0.02). At multivariate analysis, age (OR 1.03; p = 0.02) and therapy with nitrates (OR 9.95; p = 0.04), alpha-blockers (OR 2.58; p = 0.05) and benzodiazepine (OR 2.41; p = 0.01) were predictors of OH; ACEi (OR 0.53; p = 0.01) showed a protective role. If multivariate analysis was stratified by age, ARB were predictive of OH in patients aged 80 or older (OR 13.72; p = 0.007).
CONCLUSIONS: OH is common in hypertensive patients. Age, nitrates, alpha-blockers and benzodiazepine are predictive of OH, whereas ACEi have a protective role. ARB are associated with a higher risk of OH in patients aged 80 or older.
118 THE ROLE OF TRIPLED FIXED-DOSE COMBINATION WITH PERINDOPRIL/INDAPAMIDE/AMLODIPINE ON CARDIAC ORGAN DAMAGE REGRESSION. A 14-MONTH FOLLOW-UP STUDY
118.1 A. Mazza1, L. Schiavon2, G. Torin3, S. Lenti4, C. Rossetti2
118.1.1 1ESH Excellence Hypertension Centre, Unit of Internal Medicine, S. Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy, 2Unit of Internal Medicine, S. Maria della Misericordia Hospital, AULSS 5 Polesana, Rovigo, Italy, 3Unit of Internal Medicine C, Department of Medicine, University of Verona, Verona, Italy, 4Internal Medicine Unit, S. Donato General Hospital, Arezzo, Italy
INTRODUCTION: The increase of left ventricular mass index (LVMI) is a recognized marker of cardiac damage due to hypertension and also represents a strong risk factor for cardiovascular and cerebrovascular events. Most of the antihypertensive drugs used in mono- or in combination therapy are able to reduce LVMI. However little is known about the effects on LVMI of a tripled fixed-combination (TFC) therapy containing an angiotensin converting enzyme inhibitor (ACEI), a diuretic and a calcium channel blocker (CCB).
METHODS: These data, are taking part of a clinical prospective, open-label study1 performed in 2016, involved 92 HTs with essential hypertension randomized to 4-month treatment with the TFC of perindopril/indapamide/amlodipine at different doses (5/1.2/5, 10/2.5/5, 10/2.5/10 mg daily). These subjects were compared with an equal sample of HTs taking a free tripled combination therapy (FCT) with ACEI, diuretic and CCB. At baseline and at 14 months of follow-up, office BP, 24h-ABPM and echocardiography were performed. The BP variability (BPV) over the 24 h was calculated as ± standard deviation of the daytime systolic BP. Differences in office and monitored BP, and LVMI values were evaluated by analysis of variance for repeated measures.
CONCLUSIONS: A TFC of antihypertensive drugs is able to improve LVMI more effectively than FCT, probably for a better stability of BP control and it represents a new important tool in modulating the cardiovascular continuum from cardiac organ damage to cardiovascular events.
VESSELS AND ENDOTHELIUM
119 EVALUATION OF AORTIC STIFFNESS BY 2D SPECKLE TRACKING AORTIC STRAIN
119.1 L. Sabia, E. Avenatti, M. Cesareo, D. Leone, F. Tosello, M. Bollati, I. Maffei, G. Zocaro, L. Airale, F. Veglio, A. Milan
119.1.1 Internal and Hypertension Division, Department of Medical Sciences, AOU Citta’ Salute e Scienza, University of Turin, Turin, Italy
INTRODUCTION: Arterial stiffness is a marker of cardiovascular damage and an independent predictor of major cardiovascular events. It is usually assessed via Carotido-Femoral Pulse Wave Velocity (cfPWV). Strain analysis from cardiac resonance and computed tomography has been used to describe aortic stiffness.
AIM: To test the feasibility of aortic strain analysis using speckle tracking on transthoracic echocardiography (TTE), its association with cfPWV, and its behaviour in individuals with and without ascending aorta (aA) dilatation.
RESULTS: 17 controls were excluded for suboptimal TTE images. In the 43 analyzed individuals (male 58%, age 58 years), cfPWV was 8.0 ± 1.75 m/s and PaAS was 7.58 ± 4.82%, without significant differences between genders. Inter- and intra- observer variability were good for PaAs (Interclass correlation coefficient = 0.88 and 0.73, confidence intervals − 0.68 to + 0.81 and − 0.1 to 0.94 respectively). PaAS showed significant correlation with age (r = − 0.65, p < 0.001), aA diameter (r = − 0.42, p = 0.005), cfPWV (r = − 0.48, p = 0.004), stroke volume (r = 0.40, p = 0.008) and heart rate (r = − 0.50, p < 0.001). Only aA dimensions and cfPWV remained significantly and independently associated to PaAS in the multivariate regression analysis. PaAs was significant lower in patients with dilated aA (1.89 ± 1.84%, p < 0.001 vs. controls); logistic regression confirmed that PaAS but neither age nor gender were significant predictor of aA dilatation.
CONCLUSIONS: Speckle tracking TTE based strain analysis of the aA is feasible and reproducible. PaAS is associated with cfPWV, the gold standard measure of aortic stiffness, and is significantly reduced in patients with dilated aA.
120 PULSE WAVE VELOCITY PROGRESSION OVER A 3.7 YEARS FOLLOW-UP: FOCUS ON URIC ACID
120.1 A. Maloberti1,2, P. Vallerio1, N. Triglione1,2, E. Piccinelli1,2, A. Luongo2, E. Qalliu2, M. Milani2, G. Magni2, J. Zanoni2, F. Musca1, M. Casati3, S.C. Siracusa4, S. Signorini4, G. Grassi2, C. Giannattasio1,2
120.1.1 1Cardiology IV, ASST Niguarda Hospital, Milan, Italy, 2School of Medicine and Surgery, Milano Bicocca University, Milan, Italy, 3Biochemical Laboratory, San Gerardo Hospital, Monza, Italy, 4Biochemical Laboratory, Desio Hospital, Desio, Italy
INTRODUCTION: The role of Uric Acid (UA) on the arterial stiffness progression in prospective studies has been evaluated only in three studies.
AIM: To evaluate the role of UA as a possible determinants of the Pulse Wave Velocity (PWV) progression over a 3.7 ± 0.5 years of follow-up in hypertensive patients.
DESIGN AND METHODS: We enrolled 431 consecutive hypertensive outpatients 18–80 aged, followed by the Hypertension Unit of St. Gerardo Hospital (Monza, Italy). At baseline anamnestic, Blood Pressure (BP) and laboratory data as well as PWV were assessed. PWV was performed again at follow-up. We analysed data separately for gender with hyperuricemia defined as a UA > 6 mg/dL for women and > 7 mg/dL for men.
RESULTS: Baseline age was 53.2 ± 13.1 years, 43% were female, Systolic and Diastolic BP (SBP/DBP) 141.8/86.8 ± 17.5/10.8 mmHg, UA 5.2 ± 1.4 mg/dL and PWV 8.5 ± 2.0 m/s. At follow-up, despite better BP values (132.5/78.8 ± 17.4/10.7 mmHg, p < 0.001), PWV increases to 9.15 ± 2.3 m/s (p < 0.001) with mean deltaPWV of + 0.56 ± 2.2 m/s. 66 patients were hyperuricemic (15%) and when compared to normouricemic were older (58.3 ± 11.6 vs. 52.3 ± 13.1, p < 0.001) with superimposable baseline and follow-up BP whit a higher PWV baseline and follow-up (9.1 ± 2.7 vs. 8.4 ± 1.8 and 9.9 ± 3.2 vs. 9.0 ± 2.1, p < 0.05). Despite this, similar deltaPWV were found (0.8 ± 3.4 vs. 0.5 ± 1.9, p = ns). Hyperuricemic female (6.8%, 12 subjects) were older (63.1 ±10.6 vs. 53.1 ± 13.4, p < 0.001), with similar baseline and follow-up BP and, despite similar baseline PWV, a higher follow-up PWV (11.1 ± 2.5 vs. 8.7 ± 2.2, p < 0.001) and deltaPWV (2.1 ± 3.5 vs. 0.5 ± 1.9, p = 0.01) were showed. Contrariwise in males no differences were showed in arterial stiffness in hyperuricemic (21%, 54 subjects). UA correlate with age, sex and baseline and follow-up PWV (r = 0.13 and 0.19) in the whole population but not with deltaPWV. In females UA significantly correlate with age, follow-up PWV (r = 0.31) and deltaPWV (r = 0.26). Contrariwise in male no significant correlation was seen. At multivariate analysis UA were not a significant predictor of arterial stiffness parameter, also for gender analysis.
CONCLUSIONS: In HT, arterial stiffness showed some sign of correlation with UA particularly in women. Despite this it was not a significant predictor of arterial stiffness and its progression. A strong limitation of the present work is the low number of hyperuricemic female subjects.
121 REGRESSION OF RETINAL MICROVASCULAR ALTERATIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH ABATACEPT, AN INHIBITOR OF LYMPHOCYTIC CO-STIMULATION
121.1 S. Caletti1, S. Piantoni2, C. De Ciuceis1, M.A. Coschignano1, C. Rossini1, P. Airò2, A. Tincani2, C. Agabiti Rosei1, R. Kumar2, D. Rizzoni1,5
121.1.1 1Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Italy, 2Chair of Rheumathology, Department of Clinical and Experimental Sciences, University of Brescia, Italy, 3Istituto Clinico Città di Brescia, Division of Medicine, Brescia, Italy
INTRODUCTION: It has been previously demonstrated that T lymphocytes may be involved in the development of hypertension and microvascular remodeling, and that circulating T effector lymphocytes may be increased in hypertension. In particular, Th1 and Th 17 lymphocytes may contribute to the progression of hypertension and microvascular damage. Abatacept is a fusion protein composed of the Fc region of the immunoglobulin IgG1 fused to the extracellular domain of CTLA-4 that binds to the CD80 and CD86 molecule, and prevents activation of T cells, avoiding CD28 repetitive engagement. Abatacept is presently indicated for treatment of moderate to severe active rheumatoid arthritis in adults (aged 18 years or over) who have not had an adequate response to other drugs.
AIM: To non-invasively investigated morphological characteristics of retinal arterioles in patients with rheumatoid arthritis before and after treatment with abatacept.
METHODS: In the present study we enrolled 5 patients with rheumatoid arthritis. The wall to lumen ratio (WLR) of retinal arterioles was measured by adaptive optics (RTX-1, Imagine Eyes, Orsay, France), a recently validated technique for non-invasive assessment of retinal arteriolar morphology, providing also an estimation of internal and external diameters and wall cross-sectional area. Morphological evaluations were performed at baseline, after 6 months and after 12 months of treatment.
Main results of the analysis
0.31 ± 0.03
0.29 ± 0.05
0.26 ± 0.03*
Internal diameter (µm)
95.0 ± 9.36
95.7 ± 16.3
101 ± 14.4
External diameter (µm)
125 ± 11.0
123 ± 18.0
127 ± 16.7
Wall thickness (µm)
14.6 ± 1.55
13.6 ± 1.82
12.8 ± 1.84*
Wall cross-sectional area (µm2)
5073 ± 959
4708 ± 1128**
4631 ± 1107*
CONCLUSIONS: Our data suggest that a reduction in WLR, wall thickness and wall cross-sectional area was observed after treatment for 12 months with abatacept, thus suggesting the possibility to induce a regression of microvascular abnormalities through a modulation of the immune system.
122 THE ROLE OF SIRT 1 IN REGULATING MITOCHONDRIAL OXIDATIVE STRESS ASSOCIATED WITH ENDOTHELIAL DYSFUNCTION IN OBESITY
122.1 E. Duranti, M. Chiriacò, S. Masi, M. Anselmino*, M. Nannipieri, C. Blandizzi S. Taddei, A. Virdis
122.1.1 Department of Clinical and Experimental Medicine, University of Pisa, Department of General Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
INTRODUCTION: A high vascular oxidative stress is considered to be the main mechanism of endothelial dysfunction and reduced bioavailability of NO in obese subjects. Many regulatory mechanisms of oxidative stress in obese individuals are yet to be defined. Animal experiments suggest that Sirt-1 expression is reduced in conditions of excessive nutrients intake, leading to the increase of intracellular oxidative stress, especially of mitochondrial origin.
AIM: To verify the potential contribution of Sirt-1 to endothelial dysfunction in obese subjects and whether this influence is mediated, at least in part, by a dysregulation of mitochondrial reactive oxygen species production (mtROS).
METHODS AND RESULTS: Subcutaneous tissue biopsies of 20 subjects (10 obese, Ob; 10 normal weight controls, Ctrl) were obtained during laparoscopic surgery. After isolation, resistance arterioles were mounted on a pressure micromyograph to assess endothelium-dependent vasodilation (VDed) and its fraction due to NO production by dose-response curves to acetylcholine (Ach 0.001–100 μM), with and without l-NAME (100 μM). The Sirt-1 induced VDed and its reliance on NO was evaluated by pre-incubating the vessel with a selective agonist of Sirt-1 (SRT-1720, 1 μM), alone or in combination with l-NAME. The influence of mtROS on VDed was assessed by pre-incubating the vessel with MitoTEMPO (1 μM). Endothelial dysfunction mediated by Sirt-1 regulation of mtROS was assessed through co-incubation with mitoTEMPO and SRT-1720. The Ob group showed a reduced VDed response (P < 0.001) and less inhibition of l-NAME on VDed (Ob vs. CTRL: P < 0.001). Incubation with SRT-1720 enhanced VDed response (P < 0.001) in the Ob group. This improvement was lost after co-incubation with l-NAME. MitoTEMPO increased VDed (P < 0.001), with greater effect in the Ob group compared to the CTRL one. After pre-incubation with MitoTEMPO, SRT-1720 did not induce further VDed in Ob.
CONCLUSIONS: Stimulation of Sirt-1 improves endothelial function in resistance arteries of obese subjects by increasing the availability of NO, probably through the reduction in the production of mtROS.
123 NON-INVASIVE MEASUREMENT OF HEART-FEMORAL PULSE WAVE VELOCITY: CORRELATES, REPRODUCIBILITY AND COMPARISON WITH CAROTID-FEMORAL PULSE WAVE VELOCITY
123.1 C. Magistri, FUS Mattace-Raso, F. Battista, F. Anastasio, G. Pucci
123.1.1 Unit of internal Medicine, Terni University Hospital, Department of Medicine, University of Perugia, Terni, Italy, Division of Geriatrics, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
INTRODUCTION: Heart-femoral pulse wave velocity (hf-PWV), estimated from the Cardio-Ankle Vascular Index device (VaSera-1500) by combining phonocardiogram with pulse signals detected by thigh cuffs, as opposite to carotid-femoral pulse wave velocity (cf-PWV), includes the stiffness of the ascending aortic segment.
AIM: We sought to investigate the repeatability and main correlates of hf-PWV, and to compare the results with cf-PWV.
METHODS: hf-PWV and cf-PWV were obtained in 85 volunteers (n = 30 < 30 years, n = 30 30–60 years, n = 25 > 60 years), according to ARTERY society guidelines for validation of non-invasive devices (Artery Research 2010;4:34–40). Heart-femoral transit time was calculated as the time lag between aortic opening to pulse arrival to the thigh cuff. Distance was taken as 0.8 × direct distance between the carotid and femoral pulses. For comparison with cf-PWV, heart-femoral transit time was re-calculated after subtracting the transit times needed to travel: (1) the distance from the femoral pulse to the top of thigh cuff; (2) the distance from the aortic valve to the carotid pulse. These two transit times were derived from age- and sex-specific values published elsewhere.
CONCLUSIONS: Hf-PWV, measured through a semi-automated device which combines phonocardiogram with pulse detection with a thigh cuff, showed high reproducibility, was closely correlated with cf-PWV, and showed similar associations with variables traditionally associated with arterial stiffness. The non-invasive, operator-independent evaluation of hf-PWV could be of elevated impact in clinical practice.
124 PRE-HYPERTENSION AND SUBCLINICAL CAROTID DAMAGE: A META-ANALYSIS OF ULTRASONOGRAPHIC STUDIES
124.1 E. Gherbesi1, C. Cuspidi2,3, C. Sala1, M. Tadic4, G. Grassi2, G. Mancia2
124.1.1 1Department of Clinical Sciences and Community Health, University of Milan and Fondazione Ospedale Maggiore Policlinico of Milan, Milan, Italy, 2Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy, 3Istituto Auxologico Italiano, Milan, Italy, 4Department of Cardiology, Charité-University-Medicine Campus Virchow Klinikum, Berlin, Germany
INTRODUCTION: The association between pre-hypertension (pre-HTN) and subclinical carotid damage is poorly defined.
AIM: We performed a meta-analysis of ultrasonographic studies assessing carotid intima-media thickness (IMT) in untreated pre-HTN subjects.
METHODS: The OVID-MEDLINE, PubMed and Cochrane CENTRAL databases were searched for English-language articles without time restriction up to February 2018 through focused, high sensitive search strategies. Studies were identified by crossing the following search terms: “pre-hypertension”, “high normal blood pressure”, “carotid intima-media thickness”, “carotid atherosclerosis”, “ultrasonography”.
CONCLUSIONS: Our meta-analysis shows that carotid IMT in pre-HTN subjects is intermediate between normotensive and HTN individuals. These findings support the view that pre-HTN is an unfavourable condition that should be properly managed in order to prevent vascular damage.
125 IDENTIFICATION OF RADIAL VASCULAR WALL ABNORMALITIES BY VERY-HIGH FREQUENCY ULTRASOUND IN PATIENTS WITH FIBROMUSCULAR DYSPLASIA AND SPONTANEOUS CORONARY ARTERY DISSECTION: THE FUCHSIA STUDY
125.1 R.M. Bruno1, N. di Lascio2, A. Al Hussaini3, D. Guarino1, S: Vitali1, P. Rossi1, D. Caramella1, S. Taddei1, F. Faita2, L. Ghiadoni1, D. Adlam3, A. Persu, S. Laurent4, P. Boutouyrie4
125.1.1 1Università di Pisa, Pisa, Italy, 2Institute of Clinical Physiology, CNR, Pisa, Italy, 3University of Leicester, Leicester, UK, 4INSERM - U970; APHP, Paris, France
INTRODUCTION: Fibromuscular dysplasia (FMD) is an idiopathic disease of small-and medium-sized arteries. Subclinical alterations have been found also in non-affected districts, suggesting that FMD is a systemic disease. Spontaneous coronary dissection (SCAD) may represent a manifestation of FMD too.
AIM: This case–control study is aimed at identifying vascular wall abnormalities in the radial arteries in patients with FMD and SCAD by means of a novel ultrasound technique.
METHODS: Two 5′-clips from the left radial artery were obtained by Vevo MD (70 MHz probe, FUJIFILM, VisualSonics). Radial wall showed two echogenic interfaces: the 1st (lumen-media) and the 2nd (media-adventitia). Intima-media (IMT), adventitia (AT), and global thickness (IMAT) and wall cross-sectional area (WCSA) Measured. Vascular wall disarray was assessed calculating the root mean square error (RMSE) between 20 gray-level profiles crossing the two interfaces and the profile obtained averaging them, normalized for the maximum value of the corresponding mean profile (RMSE/mean).
CONCLUSIONS: The radial artery walls of FMD and SCAD patients present similar subclinical abnormalities, namely increased thickness and inhomogeneity, in comparison to controls. Fibromuscular dysplasia (FMD) is an idiopathic, systemic disease of small-and medium-sized arteries and spontaneous coronary dissection (SCAD) may represent a manifestation of FMD too. This case–control study is aimed at identifying vascular wall abnormalities in the radial arteries in patients with FMD and SCAD by means of a novel ultrasound technique.
126 ARTERIAL STIFFNESS AND CHRONIC STRESS: ROLE OF GENDER
126.1 R. Gherardini, R.M. Bruno, D. Guarino, E. Duranti, M. Nannipieri, L. Ghiadoni, S. Taddei
126.1.1 Department of Clinical and Experimental Medicine, University of Pisa, Pisa, ITALY
AIM: To evaluate whether exposure to chronic stress is associated with early vascular aging in hypertensive patients and possible gender differences in this relationship.
METHODS: Hypertensive patients were recruited in a Hypertension outpatient clinic during a visit for the evaluation of subclinical organ damage. Aortic stiffness was measured as carotid-femoral pulse wave velocity (PWV) by applanation tonometry; common carotid intima-media thickness (IMT) and distensibility were evaluated by automated analysis of carotid ultrasound clips. Chronic stress was assessed using three different standardized scales: Perceived Stress Score 4 (PSS4), Depression Anxiety Stress Scale (DASS) and Chronic Stress Burden (CSB).
RESULTS: Data from 125 patients (age 56.7 ± 12.5 years, 88.5% in antihypertensive therapy) were analyzed. No significant differences were found between men and women in terms of PWV [8.90 (1.9) vs. 8.55(1.8) m/s, p = 0.14], carotid distensibility (22.34 ± 8.79 vs. 21.17 ± 8.74 kPa−1, p = 0.545) and IMT (0.74 ± 0.12 vs. 0.70 ± 0.13 mm, p = 0.132). Women presented significantly higher scores of PSS4 (7 (3) vs. 5 (3), p = 0.007) and CSB (1.42 ± 1.24 vs. 0.59 ± 0.85, p = 0.004). In the linear multiple regression analysis, CBS was correlated with PWV in the general population (beta = , p = 0.050) being responsible for 4% of the variance of PWV, without significant gender differences. Among the components of CBS, difficulties in relationships with someone close to the participant were associated with increased PWV only in women (p = 0.01). In a multiple regression model, this variable tended to be an independent predictor of PWV (beta = 0.37, p = 0.057), responsible for 7% of the PWV variance. No significant relationships emerged between PWV and chronic stress assessed by PSS4 or DASS.
CONCLUSIONS: In hypertensive patients, chronic stress burden is associated with greater arterial stiffness; in particular, stress related to difficulties in relationships seems to be associated with greater vascular stiffness only in the female sex.
127 INFLUENCE OF HIV INFECTION AND ANTIRETROVIRAL THERAPY ON AORTIC STIFFNESS: A META-ANALYSIS
127.1 G. Mulè1, L. Lattuca1, G.J. Mulè2, E. Vicari1, M. Giambrone1, V. Tranchida1, A. Cascio2, S. Cottone1
127.1.1 1Unit of Nephrology and Hypertension, ESH Excellence Centre, DIBIMIS, University of Palermo, Palermo, Italy, 2 ip. di Scienze per la Promozione Della Salute e Materno-Infantile, University of Palermo, Palermo, Italy
INTRODUCTION: A growing body of evidence indicates that risk of CV events is higher in HIV-infected patients (HIV+) when compared to HIV-uninfected persons (HIV−). This enhanced risk may in part be mediated through preclinical CV damage. Large artery stiffness, a well-documented marker of arterial damage and predictor of adverse CV prognosis, is usually assessed by measuring aortic pulse wave velocity (PWV). Several studies examined arterial stiffness in HIV+ with inconsistent results. In a previous meta-analysis, showing increased arterial stiffness in HIV+ than in HIV- subjects, studies assessing aortic and peripheral PWV were pooled together. This may be misleading, because only the former has a demonstrated prognostic significance.
AIM: We performed a new meta-analysis with the aim to evaluate the influence of HIV-infection and its therapy only on aortic PWV (aPWV).
METHODS: A literature search was performed in PubMed, Google Scholar, Web of Science and Medline for articles, also in abstract form, concerning the effect of HIV infection and ART on aortic stiffness. The standardized mean difference (SMD) and corresponding 95% confidence intervals were calculated for aortic PWV in different comparison groups, which contained naive HIV+ versus HIV−, HIV+ receiving ART versus HIV- and HIV+ receiving ART versus naive HIV+. Statistical heterogeneity, assessed by Q test and I2 statistic, was observed in all these comparisons. Therefore, both the fixed and random effect models were implemented, even if only the results of the latter were presented.
RESULTS: In a total of 11 studies, naive HIV+ (n = 566) showed increased aPWV compared to HIV− (n = 816): SMD = 0.386 (0.197–0.575), p < 0.001. Nine studies were identified comparing HIV+ treated with ART (n = 631) to HIV− (n = 637) showing higher values of aPWV in the former than in latter: SMD = 0.681 (0.396–0.967), p < 0.001. In 8 studies HIV+ treated with ART (n = 599) exhibited greater aPWV values than those of naive HIV+ (n = 325): SMD = 0.259 (0.006–0.512), p < 0.04.
CONCLUSIONS: Our meta-analysis seems to suggest that HIV infection per se and even more ART may impair aortic distensibility.
128 THE RELATIONSHIP BETWEEN ENDOTHELIAL FUNCTION AND MICROVASCULAR REMODELLING
128.1 S. Masi1, G. Georgopoulos2, G. Grassi3, G. Seravalle4, C. Savoia5, D. Rizzoni6,7, A. Virdis1
128.1.1 1Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy, 2First Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece, 3Clinica Medica, University of Milano Bicocca, Milan, Italy, 4Cardiologia, Ospedale S. Luca, IRCCS Istituto Auxologico Italiano, Milan, Italy, 5Clinical and Molecular Medicine Department, Cardiology division, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy, 6Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, 7Istituto Clinico Città di Brescia, Division of Medicine, Brescia, Italy
INTRODUCTION: Several studies have showed that endothelial dysfunction can provide additional information on the severity of vascular remodelling in large vessels than common cardiovascular risk factor scores. Whether this is the case also in small resistance arteries remains unknown.
AIM: In this study, we assessed the relationship between cardiovascular risk scores and severity of microvascular remodelling as well as the influence of microvascular endothelial function on these relationships.
METHODS: Small resistance arteries of 188 patients isolated from biopsy of subcutaneous tissue obtained during laparoscopic procedures were mounted on a pressurised micromyograph. Severity of microvascular remodelling was assessed by meadia:lumen ratio (M/L) and media cross-sectional area (MCSA), while endothelial-dependent vasodilation (EDD) was assessed by dose-response curves to acetylcholine. The Framingham and Heart Scores (FRS and HS) were calculated to assess the cumulative cardiovascular risk factor burden.
CONCLUSIONS: Endothelial function completely explains the association between FRS or HS with indexes of microvascular remodelling, representing the strongest predictor of microvascular remodelling, particularly in subjects at low risk of cardiovascular disease.
129 COMPARISON BETWEEN INVASIVE AND NON-INVASIVE METHODS FOR THE ASSESSMENT OF AORTIC STIFFNESS
129.1 A. Grillo1, F. Moretti2, M. Rovina3, L Salvi2, F Scalise4, A Faini5, G Sorropago4, C Baldi3, G Furlanis3, R Carretta3, P Salvi5, G Parati1,5
129.1.1 1Università di Milano-Bicocca, Milano, Italy, 2Università di Pavia, Pavia, Italy, 3Università di Trieste, Trieste, Italy, 4Policlinico di Monza, Monza, Italy, 5IRCCS Istituto Auxologico Italiano, Milano, Italy
INTRODUCTION: Aortic pulse wave velocity (PWV) is the best indicator of aortic viscoelastic properties.
AIM: To investigate if invasively measured aortic PWV is accurately estimated by non-invasive methods which purport to assess it.
METHODS: One-hundred and two patients (30% female, mean age 65 ± 13 years) planned to undertake a cardiac catheterization were enrolled in the study. Different non-invasive methods were evaluated for each subject by randomly alternating the following devices: BPLab, Complior Analyse, Mobil-O-Graph, pOpmètre, PulsePen-ET, PulsePen-ETT and SphygmoCor. Immediately after, aortic PWV was evaluated by aortic catheterization and simultaneous measurement of pressure wave above the aortic valve and at the aortic bifurcation (FS-Stiffcath).
CONCLUSIONS: Devices measuring carotid-femoral PWV and the Mobil-O-Graph, which estimates aortic PWV from age and blood pressure values, present a good correlation with invasive aortic PWV in a large population with cardiovascular disease, while a less good agreement was found for other measuring devices (BPLab, pOpmètre). The underestimation of high PWV values may lead to erroneous estimation of cardiovascular risk by non-invasive devices.
130 EFFECT OF ANTIANGIOGENETIC DRUGS ON MICRO- AND MACROCIRCULATION IN PATIENTS WITH ADVANCED-STAGE RENAL CANCER
130.1 A. Dalbeni1, C. Ciccarese2, M. Bevilacqua1, F. Famà1, L. Ceritto1, A. Meneguzzi5, M. Benati4, M. Montagnana4, A. Mantovani1, C.Caimmi3, G. Orsolini3, G. Tortora2, P. Minuz1, O. Viapiana3, F. Massari2, R. Iacovelli2, C. Fava1
130.1.1 1Department of Medicine, General Medicine and Hypertension Unit, University of Verona, Verona, Italy, 2Department of Medicine, Oncology Unit, University of Verona, Verona, Italy, 3Department of Medicine, Rheumatology Unit, University of Verona, Verona, Italy, 4Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Biochemistry, University of Verona, Verona, Italy, 5Department of Medicine, Section of Internal Medicine, University Laboratory for Medical Research (LURM) and Regional Centre for the Study of Platelets, University of Verona, Verona, Italy
INTRODUCTION: Cardiovascular adverse effects including hypertension were described in patients with several types of cancer as treated with tyrosine kinase-inhibitors (TKI). The mechanism of TKI-related hypertension is still debated.
AIM: To study the effect of anti-angiogenic drugs on blood pressure (BP), searching for a relation with possible causative factors in patients with metastatic renal cell carcinoma.
METHODS: We included 29 patients with metastatic renal cell carcinoma in a single-center, prospective, observational study; twenty-two of them were treated with a first-line drug (Sunitinib) while 7 subjects participated during Axitinib (n = 3) or Cabozantinib (n = 4) second-line treatment. Patients were investigated at the beginning of anti-angiogenic therapy (T0), one month (T1), three months (T2) and six months (T3) later. Patients were evaluated by office BP measurement, by ultrasonography to measure Flow Mediated Dilatation (FMD) and carotid artery distensibility (DC), by echocardiography, by nailfold capillaroscopy (NC). Plasma Endothelin-1, urine nitrates and proteins were measured.
RESULTS: At T1, systolic BP along with urinary proteins and plasma ET-1 increased significantly. In patients with a clinically significant increase in BP (defined as either the need of an antihypertensive drug or SBP T1–T0 ≥ 10 and/(or SBP ≥ 140) mmHg and/or DBP T1–T0 ≥ 5 and/or DBP ≥ 90 mmHg); nitrate concentration in urine was lower at T0 (46.92 ± 23.14 µM/µmol of creatinine vs. 114.53 ± 89.3 µM/µmol of creatinine, p = 0.032) whereas there were no differences in ET-1 and proteinuria. Seventeen out of 29 participants (58.6%) showed changes in capillaroscopic pattern after 4 weeks without a clear relation with BP increase. We did not detect any difference in FMD, carotid distensibility and in the main echocardiographic parameters between different time-points.
CONCLUSIONS: Our findings are consistent with previous studies about BP increase by anti-angiogenetic drugs and suggest a role of nitric oxide in BP maintenance in this population.
131 MULTIPARAMETRIC EVALUATION IN PREGNANCY
131.1 R. Carbonara1, F. Giardinelli1, A. Zito1, I. Panettieri2, M.M. Ciccone1, V. Vulpis3
131.1.1 1Sezione di Malattie dell’Apparato Cardiovascolare, Dipartimento di Emergenza e Trapianti d’Organo (DETO), Università di Bari, Bari, Italy, 2U.O. Medicina Interna, Ospedali Riuniti di Foggia, Foggia, Italy, 3U.O. Medicina Interna Ospedaliera “Ferrarini-Pende”, Policlinico di Bari, Bari, Italy
INTRODUCTION: The most frequent cause of maternal and fetal morbidity and mortality in industrialized countries is gestational hypertension (PIH) which occurs in about 2% of women in the second trimester of pregnancy.
AIM: To compare vascular and pressure trends in borderline hypertensive pregnant with and without antihypertensive treatment. Vasoreactivity was compared in 4 different times (I, II, III trimester and I trimester postpartum) through the medial flow dilatation of the brachial artery (b-FMD). The temporal trend of the uterine resistance index (u-IR), of the carotid thickness (c-IMT) and of the ABPM in primipare with hypertension de novo treated pharmacologically and untreated was also compared.
METHODS: 93 hypertensive patients with and without pharmacological treatment were recruited. At each visit the ABPM was monitored within 24 h, the FMD and c-IMT were evaluated, the high sensitivity C-reactive protein (hs-PCR) was assayed.
Results: The 2 groups were homogeneous by age (p = 0.78). In the third trimester FMD was lower in untreated hypertensives (6.34 ± 1.23% vs. 12.65 ± 2.74%; p < 0.01). In pregnant women under treatment the FMD remained constant or increased slightly. In the non-treatment group the FMD in the III trimester was lower than the treated ones. In the postpartum, the FMD improved compared to the III trimester, although it was lower than the baseline (8.56 ± 1.71% vs. 10.5 ± 2.36%, p = 0.036). The IMT did not change significant in both groups. U-IR is reduced in the third trimester of pregnancy and correlates with FMD (r: 0.798).
CONCLUSIONS: Only in the hypertensive group under pharmacological treatment the FMD values remain constant without falling below reference values. FMD in the postpartum I trimester in women with untreated PIH improved compared to the third trimester of pregnancy, but remained below the baseline values.
132 EFFECTS OF AGALSIDASE-Β ADMINISTRATION ON VASCULAR FUNCTION AND BLOOD PRESSURE IN ANDERSON-FABRY DISEASE
132.1 M. De Feo, C.A. Stamerra, C. Ferri, D. Grassi
132.1.1 University of L’Aquila; Department of life, Health and Environmental Science, L’Aquila, Italy
INTRODUCTION: Anderson-Fabry disease is caused by the deficient activity of α-galactosidase A (α-Gal A), which leads to the lysosomal accumulation of globotriaosylceramide (GL-3) in various types of cells, in particular in the vascular endothelium. Endothelial dysfunction is probably one of the most important pathogenetic mechanisms in the development of multisystem complications of Fabry disease. Clinical studies have shown that enzyme replacement therapy (ERT) significantly removes the endothelial GL-3 deposits. However, only a few studies have yet focused on the effects of ERT on vascular function.
AIM: To investigate the effects of Agalsidase-β treatment on vascular function and blood pressure in 4 adult subjects affected by Fabry disease.
METHODS: Office blood pressure, flow mediated dilation (FMD), pulse wave analysis (PWA) and pulse wave velocity (PWV) were evaluated on the day before Agalsidase-β infusion, immediately after the infusion, and on days 4 and 8 after the infusion. Measurements were performed for three consecutive infusions (each dose administered 2 weeks apart) in the first month of treatment.
RESULTS: Agalsidase-β infusion resulted in a steady FMD increase immediately after the infusion and after 4 and 8 days, compared with baseline values. Moreover, there was a statistically significant increase of FMD after the first month of treatment (p < 0.05). Although an increase both in systolic blood pressure (SBP) and diastolic blood pressure (DBP) was detected immediately after each infusion, office blood pressure showed a decreasing trend. The reduction in DBP reached the statistical significance after a month of treatment (p < 0.05). PWV showed a progressive decrease throughout the follow-up period, not statistically significant. No substantial change was observed in PWA.
CONCLUSIONS: Our study showed that ERT with Agalsidase-β reduced blood pressure and improved FMD and arterial stiffness. These findings suggest that Agalsidase-β might represent a reasonable tool in cardiovascular prevention in subjects suffering from Fabry disease.
133 AN OPERATIONAL DEFINITION OF SHATS (SYSTEMIC HEMODYNAMIC ATHEROTHROMBOTIC SYNDROME): ROLE OF ARTERIAL STIFFNESS AND BLOOD PRESSURE VARIABILITY IN ELDERLY HYPERTENSIVE SUBJECTS
133.1 A. Scuteri1, V. Rovella2, D. Alunni Fegatelli3, M. Gabriele2, N. Di Daniele2
133.1.1 1Universita’ di Sassari, Sassari, Italy, 2Universita’ di Tor Vergata, Roma, Italy, 3Universita’ la Sapienza, Roma, Italy
INTRODUCTION: CV risk exponentially increases as the number of damaged organs increases The Systemic Hemodynamic Atherosclerotic Syndrome (SHATS) represents a novel conceptualization of the CV continuum focusing on simultaneous multi-organ alteration.
AIM: This is the first study operationally defining SHATS and aimed at identifying its determinants.
METHODS: Left ventricular hypertrophy (echocardiography), common carotid artery plaque and increased thickness (ultrasound), and chronic kidney disease (estimated glomerular filtration rate) indexed selective target organ damage. SHATS was operationally defined as their simultaneous presence in a patient. PWV was measured by Sphygmocor® and BP variability by 24 h ABPM.
RESULTS: SHATS affected 19.9% of the 367 studied subjects. Subjects with SHATS had a similar prevalence in diabetes mellitus, but a greater prevalence of very stiff artery (84.9 vs. 64.3%, p < 0.01) and use of antihypertensive medications. In the presence of similar office BP, SHATS was associated with higher 24 h SBP and lower 24h DBP (a greater pulsatile pressure!), reduced night-time SBP fall, and a twofold greater prevalence of reverse dipper status (48.2 vs. 20.2%, p < 0.001).
BMI (positive correlation) and DBP (negative correlation) were the only traditional CV risk factors significantly associated with the odds of having SHATS. Very stiff artery and BP variability were significant independent determinants of SHATS, with highly predictive accuracy.
CONCLUSIONS: SHATS, the simultaneous damage of multiple target organs, may easily operationally defined. Very stiff artery and BP variability represent key factors for SHATS. The present results support the hypothesis of SHATS as a systemic condition, needing further characterization.
134 RELATIONSHIP BETWEEN LIPOPROTEIN(A) LEVELS AND AORTIC STIFFNESS IN ESSENTIAL HYPERTENSIVE PATIENTS
134.1 C. Catena, G. Colussi, N. Bertin, A. Frangipane, A. Duratti, F. Spagnol, L.A. Sechi
134.1.1 Clinica Medica, Department of Medicine, University of Udine, Udine, Italy
INTRODUCTION: High serum Lp(a) concentration is an emergent cardiovascular risk factor. Arterial stiffness is associated with cardiovascular mortality and morbidity both in general population and in hypertension, and it can be evaluated by the augmentation index (AIx) and the carotid-femoral pulse wave velocity (cfPWV).
AIM: To investigate the relationships between serum Lp(a) levels and the AIx and cfPWV in a group of EH patients free of major cardiovascular complications.
METHODS: In 138 EH subjects (age 51 ± 14 years) we evaluated renal function, levels of Lp(a), lipids, glucose, AIx and cfPWV.
RESULTS: The AIx was significantly and directly related to age, levels of triglycerides, total cholesterol, LDL-cholesterol and Lp(a) (r = 0.490, P < 0.001). It was greater in women, in smokers, in subjects assuming beta-blockers or diuretics. The cfPWV was positively related to age, BMI, systolic blood pressure, duration of hypertension, fasting glucose, triglycerides, LDL-cholesterol, C-reactive protein, Lp(a) (r = 0.212, P = 0.013), and inversely related to HDL-cholesterol, and it was higher in anti-hypertensive treated than in naïve subjects, in subjects assuming calcium-antagonists or ACE-inhibitors/ATIIR. At multivariate analyses the AIx was independently associated with age, C-reactive protein and Lp(a) levels (B = 0.326, P < 0.001). Patients with AIx above the median value were older, more often females, had a higher prevalence of use of diuretics, and higher levels of total and LDL-cholesterol, Lp(a) and C-reactive protein, than subjects with AIx below the median value. A logistic regression analysis showed that high AIx was associated with age and serum Lp(a) concentration (OR = 1.026, P = 0.026).
CONCLUSIONS: Serum Lp(a) levels are significantly associated to arterial stiffness in EH patients. Reduction of Lp(a) concentrations might have a favorable effect on the atherosclerotic profile in these patients.
135 DICKKOPF3: A NEW MODULATOR OF ENDOTHELIAL FUNCTION AND ARTERIAL PRESSURE
135.1 A. Carrizzo1, C.L. Busceti1, P. Di Pietro3, A. Damato1, M. De Lucia1, M.T. Ambrosio1, F. Nicoletti1,2, C. Vecchione1,3
135.1.1 1I.R.C.C.S. Neuromed, Pozzilli, Italy, 2Dept. of Physiology and Pharmacology University Sapienza, Roma, Italy, 3Department of Medicine and Surgery, University of Salerno, Baronissi (Salerno), Italy
INTRODUCTION: Dickkopf3 (Dkk3) is a secreted glycoprotein widely characterized in tumor development and neurodegenerative diseases. The protein Dkk3, is expressed in various tissues, including heart, endothelium, muscle, and plays an important role in the development of the latter. Recently, DKK3 has been shown to act as a cardioprotective regulator and as a modulator of VEGF levels. The role of Dkk3 in the molecular mechanisms involved in regulating blood pressure is currently unknown.
AIM: To evaluate the possible vascular and hemodynamic effects evoked by Dkk3.
METHODS AND RESULTS: We have shown that Dkk3 KO animals exhibit an altered endothelium-mediated vasodilatation compared to control animals, and that treatment with hrDkk3 peptide is able to restore this dysfunction. This functional alteration was associated with a reduced phosphorylation state of the eNOS enzyme in serine 1177. The analysis of the vascular muscular component showed a physiological vasorelaxation, thus candidating endothelium as the target of the protein. We then focused on the receptor ALK1, important subunit of TGF-β receptor, which is involved in the angiogenetic mechanism regulated by Dkk3. Our studies of vascular reactivity conducted in murine resistance vessels from DKK3 KO animals, showed that treatment with the hrDkk3 peptide, in the presence of ALK1 inhibitor, was no longer able to restore endothelial vasodilation, thus suggesting ALK1 as the mediator of the vascular effect evoked by Dkk3. The analysis of hemodynamic parameters also revealed that the Dkk3 KO mice show an increased blood pressure, and that the intra-cerebro-ventricular treatment with the vector encoding Dkk3 was able to normalize the blood pressure levels, thus hypothesizing the double role of the protein, as modulator of cardiovascular system in the brain and in the peripheral vascular tissue.
CONCLUSIONS: Based on these results, Dkk3 could represent a new therapeutic target for the control of endothelial function and blood pressure levels.