Asymptomatic Hypertensive Patients Research Articles

Cardiotrophin-1 in Asymptomatic Hypertensive Patients With Mild Diastolic Dysfunction: Potential Prognostic Value in Early Stages of Hypertensive Heart Disease.

Regardless of the advancements in modern technology and treatment options, heart failure (HF) exhibits impervious mortality and morbidity rates. Arterial hypertension poses one of the greatest risks for developing HF, yet the exact pathophysiological path and changes that lead from isolated hypertension to HF are still unclear. Cardiotrophin-1 (CT-1) serves as a promising prognostic biomarker for the onset of HF in hypertensive patients. The aim of this study was to investigate whether CT-1 levels are elevated in a selected group of asymptomatic hypertensive patients. In a selected cohort of 40 asymptomatic patients with early diastolic dysfunction (grade I), without any signs of increased filling pressures in the left ventricle, as well as 20 healthy individuals, the levels of CT-1 brain natriuretic peptide (BNP)along with various echocardiographic parameters were evaluated. The mean age of the hypertensive patients was 56 ± 5 years and 52± 3.5 years for the normotensive controls. The hypertensive group exhibited higher levels of CT-1, which was not affected by left ventricular hypertrophy. Notably, in patients with normal E/E' < 8 (n = 30), CT-1 levels were 1165 ± 471 pg/mlcompared to 2069 ± 576 pg/ml in patients with marginal E/E' > 8 and <14 (n = 10), p = 0.001. Our study demonstrated elevated CT-1 levels in a cohort of asymptomatic hypertensive patients, exhibiting mild diastolic dysfunction. These findings are suggestive of the potentially prognostic value of this particular biomarker in the early stages of hypertensive heart disease.

Factors and sex differences associated with intermediate probability of heart failure with preserved ejection fraction in asymptomatic patients working in the Arctic

Aim. To determine additional factors and sex differences associated with the intermediate probability of heart failure (HF) with preserved ejection fraction (HFpEF) in asymptomatic patients working in the Arctic on a rotating basis.Material and methods. In the polar village of Yamburg (68° 21' 40 "N), 99 men and 81 women with grade 1 and 2 hypertension (HTN) and normal blood pressure, comparable by age (p=0,450), length of service in the north (p=0,956), office systolic blood pressure (BP) (p=0,251), diastolic BP (p=0,579) were simultaneously examined. We performed echocardiography and assessed the risk of HFpEF by H2FPEF score (Heavy; Hypertensive; Atrial Fibrillation; Pulmonary Hypertension; Elder; Filling Pressure). A treadmill test, Baevsky index, 24-hour BP monitoring, and biochemical blood tests were performed.Results. Depending on H2FPEF score, participants were divided into groups: from 0 to 1 (group 1 — normal), from 2 to 5 (group 2 — intermediate probability of HFpEF). In men with intermediate probability of HFpEF, the Baevsky index (p=0,0048) and the incidence of resting body reserve dysaptation (p=0,0394) were higher, as well as a rapid BP increase during dosed exercise (p=0,0058) and a decrease in chronotropic reserve (p&lt;0,0001) were noted. The presence of HTN in men increased the intermediate probability of HFpEF by 3,6 times, dyspnea at dosed exercise by 10 times, dysaptation to exercise by 5 times, the presence of left ventricular concentric remodeling by 8-10 times. In females with intermediate probability of HFpEF, dysaptation to exercise at rest (p=0,0120) and lower level of oxygen consumption during dosed exercise was more often determined (p=0,0485). The intermediate probability of HFpEF in women increased with autonomic nervous system dysfunction, an increase in the mean 24-hour systolic BP variability, the presence of dyspnea during dosed exercise (10 times), concentric left ventricular remodeling, and an increase in nonspecific inflammation markers (high-sensitivity C-reactive protein, IL-1β, IL-6).Conclusion. Early identification of additional risk factors for intermediate probability of HFpEF in asymptomatic hypertensive patients has the potential to reduce the risk of subsequent clinical heart failure, allowing focus on prevention and intervention strategies in this group of patients.

Prognostic implications of machine learning-derived echocardiographic phenotypes in community hypertensive patients

ABSTRACT Background Echocardiogram is commonly used to evaluate cardiac remodeling in hypertension (HTN). However, study on echocardiographic phenotypes and their prognostic implications in HTN is limited. Objective We aimed to evaluate the prognostic implications echocardiographic phenotypes in community hypertensive patients. Method A total of 1881 community hypertensive patients without overt cardiovascular disease and severe renal disease (mean age 62.8 years, women 57.9%) were included. Using Two-Step cluster analysis with four conventional echocardiographic variables, two clusters with distinct echocardiographic phenotypes were identified. Result The Cluster 1 (namely “mild-remodeling” HTN; n = 1492) had low prevalence of enlarged left atrium (LA; 0.9%) and left ventricular hypertrophy (LVH; 16.2%) and better LV diastolic function. They were younger and more likely to be men and had lower comorbid burden. The Cluster 2 (namely “severe-remodeling” HTN; n = 389) had higher prevalence of enlarged LA (26.0%) and LVH (83.0%) and worse LV diastolic function. They were older and more likely to be women and had higher comorbid burden. After a median follow-up of 4.2 years, compared to the Cluster 1, the Cluster 2 had higher incidence of cardiovascular (4.1% vs 1.7%; P = .006) and all-cause (9.8% vs 4.8%; P < .001) death, with adjusted hazard ratio of 2.80 (95% CI 1.39–5.62; P = .004) and 2.04 (95% CI 1.32–3.14; P < .001) respectively. Conclusion These findings indicate that the conventional echocardiographic variables-based algorithm could help identify asymptomatic community hypertensive patients at risk for cardiovascular and all-cause death. Further studies are needed to develop and validate phenotype-specific prevention and intervention strategies in HTN.

Asymptomatic left ventricular systolic dysfunction in hypertensive patients with disturbed ventriculo arterial coupling

Abstract Funding Acknowledgements Type of funding sources: None. Background Left ventricular (LV) ejection fraction (LVEF) is most commonly used validated echocardiographic parameter of systolic function estimation, but left ventricular (LV) global longitudinal strain (GLS) is an early indicator of subclinical cardiac dysfunction, even when LVEF is normal. Purpose To investigate ventriculo – arterial coupling (VAC) and LV function in asymptomatic hypertensive patients without target organ damage to compare different echocardiographic parameters for systolic function. Methods A total 110 patients (56 ± 14 years) with hypertension, were separated in two groups: 32(men, ( 59 %)) patients with normal AE/Ees ratio (Arterial elastance (AE) and ventricular elastance (Ees)) and 78 (men, ( 64%)) hypertensive patients with decrease AE/Ees ratio, marker for ventriculo – arterial coupling. All patients underwent standard two – dimentional echocardiography with Speckle tracking analysis for LV - GLS. End – systolic pressure was determined from the brachial pulse wave. Arterial elastance (AE) and ventricular elastance (Ees) were calculated as and – systolic pressure/stroke volume and end – systolic pressure/end – systolic volume. Results Patients with disturbed VAC had concentric hypertrophy whereas patients with normal VAC had concentric remodeling. There were no significant differences in EF, but GLS in all patients was reduced. There were no statistically significant differences in LV diastolic function parameters. Statistically significant differences in echocardiographic parameters were found in patients with normal VAC in comparison with disturbed VAC (TABL. 1), There are negative correlation between LV - GLS and AE/Ees (r = -0.327, p = 0.001) and positive with Ees (r=0.250, p = 0.015). Conclusion LV - GLS is a more sensitive parameter of LV systolic function than LVEF, when LV concentric hypertrophy is present in hypertensive patients. Further investigation are needed to confirm the superiority of GLS over LVEF in LV systolic function estimation and its implementation in clinical practice.

PS-C13-1: PREVALENCE AND ASSOCIATED FACTORS OF LEFT VENTRICULAR HYPERTROPHY IN ASYMPTOMATIC HYPERTENSIVE PATIENTS

Introduction: Left ventricular hypertrophy (LVH) is a major target organ impairment in hypertensive patients, LVH is an independent cardiovascular risk factor. The objective of our work is to detect and analyze the factors associated with electrical left ventricular hypertrophy in asymptomatic hypertensive patients. Method: Prospective study of a cohort of asymptomatic hypertensive patients, aged over 35, seen in consultation. All patients had undergone a 12 lead ECG examination looking for left ventricular hypertrophy defined by Sokolow Lyon index &gt; 3.5 mV and/or RaVL&gt; 1.1 mV and/or Cornell voltage duration product &gt; 244 mV ms Results: 263 patients evaluated during the study period, 151 women or 57% and 112 men or 43%, the average age of the population is 59.78 years ± 10.67 [36 to 87 years]. Left ventricular hypertrophy is observed in 52 patients, i.e. 19.7% of asymptomatic hypertensives. These are 31 women (20.3% of women) and 21 men (18.75% of men). The analysis of the subgroups finds a high prevalence of electrical LVH between 45 and 55 years and between 55 and 65 years with ORs at 7.80 [0.97, 62.37] p = 0.0528 and at 7.76 [0.99, 60.82] p = 0.0511. Regarding the blood pressure profile, LVH is strongly associated with systolic blood pressure levels. The analysis of the subgroups of the seniority of hypertension finds an increase in the OR to 2.95 in the group of 1 to 5 years of seniority with significant p at 0.02. After the multivariate analysis, the two independent risk factors associated with the development of electrical left ventricular hypertrophy are: Systolic Blood Pressure level between 140 and 179 mmHg and Total Cholesterol level greater than 2 g/l. The p is very significant (0.016 and 0.025 respectively) Conclusion: LVH is common in our series, it affects 19.7% of our asymptomatic hypertensive patients. The most affected age group is from 45 to 65 years old whose seniority from the time of diagnosis is less than 5 years. The two factors associated with LVH are systolic blood pressure and total cholesterol level. In the light of these results, the prevention of LVH must associate; Early screening by ECG at the time of diagnosis and during the first 5 years, management of hypertension with a target SBP of less than 140 and a cholesterol level of less than 2 g/l

PS-BPC01-5: PROGNOSTIC IMPLICATIONS OF MACHINE LEARNING-DERIVED ECHOCARDIOGRAPHIC PHENOTYPES IN ASYMPTOMATIC COMMUNITY HYPERTENSIVE POPULATIONS

Objective: Echocardiogram is commonly used to evaluate cardiac remodeling in hypertension (HTN). However, study on echocardiographic phenotypes and their prognostic implications in HTN is limited. This study aimed to elucidate these aspects. Method: A total of 1881 community hypertensive patients without overt cardiovascular disease and severe renal disease (mean age 62.8 years, women 57.9%) were included. Using Two-Step cluster analysis with four conventional echocardiographic variables, two clusters with distinct echocardiographic phenotypes were identified. Result: The Cluster 1 (namely mild-remodeling HTN; n = 1492) had low prevalence of enlarged left atrium (LA; 0.9%) and left ventricular hypertrophy (LVH; 16.2%) and better LV diastolic function. They were younger and more likely to be men and had lower comorbid burden. The Cluster 2 (namely severe-remodeling HTN; n = 389) had higher prevalence of enlarged LA (26.0%) and LVH (83.0%) and worse LV diastolic function. They were older and more likely to be women and had higher comorbid burden. After a median follow-up of 4.2 years, compared to the Cluster 1, the Cluster 2 had higher incidence of cardiovascular (4.1% vs 1.7%; P = 0.006) and all-cause (9.8% vs 4.8%; P &lt; 0.001) death, with adjusted hazard ratio (HR) of 2.80 (95% confidence interval [CI] 1.39–5.62; P = 0.004) and 2.04 (95% CI 1.32–3.14; P &lt; 0.001) respectively. Kaplan-Meier curve plotted the cumulative incidence of cardiovascular and all-cause mortality in the Figure 1 Panel A and B. Conclusion: In conclusion, these findings indicate that the conventional echocardiographic variables-based algorithm could be helpful to identify asymptomatic community hypertensive patients at risk for cardiovascular and all-cause death. Further studies are needed to develop and validate phenotype-specific prevention and intervention strategies in HTN.

OUES from submaximal cardiopulmonary exercise

Abstract Introduction Cardiopulmonary exercise testing (CPEX) provides valuable diagnostic and prognostic cardiopulmonary function data. However, in clinical setting a maximal test is not always achievable. The Oxygen Efficiency Uptake Slope (OUES) has been proposed as a possible submaximal measure of cardiopulmonary function as it remains relatively stable during the final quartile of the exercise test. This study explored the validity of OUES as a surrogate marker for cardiopulmonary function in the event of a submaximal test. Methods Four groups of subjects [128 healthy controls (73 M), 44 asymptomatic hypertensive (HT) patients (26 M), 67 adult cardiac congenital heart disease (ACHD) patients (44 M) and 35 Heart Failure with preserved Ejection Fraction (HFpEF) (10M) patients] were recruited after informed consent. All subjects underwent clinical assessment, resting ECG, blood pressure and spirometry prior to a treadmill CPEX to volitional exhaustion and a respiratory exchange ratio (RER) of at least 1.1 using the same testing protocol. Peak VO2 (ml/min) was recorded from the last 5s of the maximal test (RER=1.1) and OUES was calculated from complete (RER=1.1) and truncated (RER=0.9) gas exchange data. The linear relationships between absolute peak VO2 and OUES from complete and truncated gas exchange data were assessed using Pearson's correlation coefficient. Subsequently, the two correlations obtained in each patient group were compared. Statistical significance was set at p&amp;lt;0.01. Results Mean and 95% confidence intervals of the peak VO2 for males and females in each decile of life examined in the 4 subject groups are shown in the Figure. Peak VO2 values achieved in each of the patient groups were significantly lower when matched for age and sex compared to healthy participants (HT p=0.006, ACHD patients p&amp;lt;0.001 and HFpEF patients p&amp;lt;0.001). In all 4 groups there was a good correlation between absolute peak VO2 and the OUES at RER 1.1 (healthy volunteers r=0.910, p&amp;lt;0.001, HT r=0.899, p&amp;lt;0.001, ACHD r=0.816, p&amp;lt;0.001 and HFpEF r=0.846, p&amp;lt;0.001). Correlations were inferior for absolute peak VO2 and OUES at RER 0.9 (healthy volunteers r=0.74, p&amp;lt;0.001, HT r=0.780, p&amp;lt;0.001, ACHD r=0.651, p&amp;lt;0.001 and HFpEF r=0.817, p&amp;lt;0.001). Correlations between absolute peak VO2 vs OUES at RER of 1.1 and 0.9 were significantly different only for healthy controls (p=0.001, Z-score = −4.649), but not for HT (p=0.05, Z-score = −1.909), ACHD (p=0.04, Z-score = −2.080) or HFpEF (p=0.7, Z-score = −0.377) patients. Conclusion Our data support the use of submaximal OUES at an RER of 0.9 as a surrogate marker for absolute peak VO2 obtained at an RER of 1.1, especially in patients, in whom it can often be difficult to achieve maximal exercise. Funding Acknowledgement Type of funding sources: None.

CARDIOVASCULAR RISK RECLASSIFICATION BY PULSE WAVE VELOCITY IN BRAZILIAN HYPERTENSIVE PATIENTS

Objective: Objetive: The number of asymptomatic hypertensive patients who already have subclinical injuries in the early stages of hypertensive disease is high and, generally, they are not identified by the traditional evaluation model. The use of Pulse Wave Velocity (PWV) in addition to traditional cardiovascular risk factors can improve risk stratification. The present study intends to perform the reclassification of cardiovascular risk according to the median Pulse Wave Velocity (PWV) and correlate PWV with the intima-media thickness, with the left ventricular (LV) mass indexed and with microalbuminuria. Design and method: Design and method: Multicenter analytical cross-sectional study of patients undergoing measurement of central and peripheral blood pressure parameters between October/2018 and March/2019. Intima-media thickness (IMT) and presence of carotid plaque, left ventricular mass indexed and microalbuminuria were also evaluated. Fisher’s test was applied to verify the association of cardiovascular risk reclassification by median PWV. Spearman’s correlation was used to correlate PWV with intima-media thickness, presence or absence of carotid plaque, microalbuminuria and indexed left ventricular mass. A significance level of 5% was adopted. Results: Results: 126 patients were evaluated, with a mean age of 60.58 ± 10.51 years and 87 (69.95%) are women. When reclassified, there was an increase in the frequency of patients who moved from medium to high risk (p&lt;0.001). A weak and positive correlation was identified between PWV and LV mass indexed (r = 0.304, p &lt; 0.001) and with IMT (r = 0.30, p &lt; 0.001). Conclusions: Conclusions: The application of median PWV values is a simple and effective tool to reclassify intermediate-risk individuals to high-risk.

INTEREST OF MEASURING THE INTIMA MEDIA THICKNESS IN THE EVALUATION OF HYPERTENSIVE

Objective: The measurement of the Intima Media Thickness (IMT) allows the diagnosis of the early stages of atherothrombosis. There is a direct correlation between the intima media thickness and CVRF in particular hypertension. The objective of our study is to describe the profile of IMT in hypertensive patients and to analyze the correlations with subclinical damage to target organs. Design and method: Descriptive and analytical prospective study of a cohort of asymptomatic hypertensive patients aged over 35 received in consultation. All the patients had benefited from a measurement of the intima media thickness. An intima-media thickness &gt; 0.9 mm is considered pathological. At the same time, patients benefit from a systematic assessment in search of other target organ damage, namely cardiac, neurological, renal and ophthalmological damage. Results: 252 patients included in our work, it is 146 women or 58%. The average age of our series is 59.5 years. The EIM is pathological in 34.9% of patients. In multivariate analysis, the two independent factors associated with pathological ADR are age &gt; 55 years and smoking. Chi-square correlation analysis shows us a highly significant correlation between pathological IMT and LVH on ultrasound, carotid plaques and stenosing plaques, and urinary albumin excretion and kidney disease chronic. Intima Media thickness values are positively correlated with indexed left ventricular mass values (pearson 0.190**, p = 0.004), pulse pressure values (pearson = 0.226**[0.123, 0.344] p = 0.000), to the values of the Sokolow index (0.145*[0.032, 0.261] p = 0.029) and to the values of proteinuria and particularly to microalbuminuria (0.187**[0.013, 0.369] p = 0.008) The values of the media intima thickness are negatively correlated with MDRD clearance values (-0.140* [-0.250, -0.019] p = 0.037) Conclusions: Carotid intima media thickness is an excellent screening test for target organ damage in hypertensive patients. It is a simple and non-invasive measure, it reflects early lesions of atherosclerosis. Our study clearly shows the strong correlation between the values of the intima media thickness and the values of all the screening tests for target organ damage.

Asemptomatik Hipertansif Hastalarda Parçalanmış QRS Kompleksi ile Arteryel Komplians Arasındaki İlişki

Objective: Decreased arterial compliance is among the earliest detectable findings of adverse structural and functional changes in the vessel wall and it results in stiffened arteries. The goal of this study was to explore the relationship between fragmented QRS in electocardiogram and arterial compliance.Material and Methods: Eighty asymptomatic hypertensive patients with fragmented QRS (40 male, mean age: 58±8/years) and 80 age-gender matched control subjects without fragmented QRS (39 male, mean age: 57±9/years) were enrolled. Arterial compliance was calculated as stroke volume to pulse pressure ratio and adjusted to body surface area to calculate the stroke volume to pulse pressure index. The fragmented QRS complexes were investigated in the 12-lead electrocardiogram.Results: Patients wih fragmented QRS had significantly lower arterial compliance (0.71±0.29 mL/m2/mmHg versus 0.93±0.32 mL/m2/mmHg; p&amp;lt;0.001). A univariate analysis showed a significant correlation between decreased arterial compliance and fragmented QRS, age, and calcium channel blocker use. Multivariable analysis demonstrated age (95%CI): 0697-0.830; p&amp;lt;0.001) and fragmented QRS (95%CI): 0.06-0.536; p=0.002) as independent determinants of reduced arterial compliance.Conclusion: The avaliability of fragmented QRS in electrocardiogram may have significant predictive information of arterial compliance in hypertensive subjects.

State of intra- and extracranial arteries, white matter and cerebral cortex in asymptomatic hypertensive patients

Aim. To assess the state of intra- and extracranial arteries, white matter and cerebral cortex in asymptomatic hypertensive (HTN) patients according to multimodal examination.Material and methods. The study included data from 147 asymptomatic individuals (without prior ischemic stroke) with an established HTN (n=43; 29,3%) and without it. All participants underwent extracranial duplex ultrasound, transcranial duplex sonography, detection of middle cerebral artery microembolism, and brain magnetic resonance imaging. We performed a statistical analysis of the data obtained, adjusted for age and body mass index.Results. In patients with HTN, atherosclerotic plaques were more often detected — 37,2 vs 14,4% on the right (p=0,027) and 41,9 vs 13,5% on the left (p=0,001). In these patients, intima-media abnormalities and common carotid artery narrowing were also more common. Regional temporal lobe atrophy (p=0,044 on the right and p=0,046 on the left), central atrophy (p=0,045), focal periventricular white matter abnormalities (p=0,004) were more pronounced in hypertensive patients. There was no association between HTN and the presence of cerebral microbleeds, as well as the Montreal Cognitive Assessment (MoCA) score.Conclusion. In asymptomatic hypertensive patients relative to those without HTN, with comparable body mass index and age, head arterial abnormalities are more pronounced, but this regards only large ones — the common carotid artery. In these patients, more pronounced white matter and cerebral cortex changes were revealed.

NT-pro BNP versus E/E’ Ratio after ECG Treadmill Test in Asymptomatic Hypertensive Patients with Exercise-Induced Diastolic Dysfunction

Abstract Left ventricle dysfunction is the link between the heart morphological changes and the overt heart failure. Hypertension is one of the main cardio-vascular conditions which can lead to development of left ventricle failure. The study was conducted at outpatient Clinic – Medlife, Memorial Hospital. It intended to compare NT-pro BNP and the ratio E/E’ as markers of diastolic dysfunction in hypertensive patients and normal ejection fraction (EF) and no signs or symptoms of heart failure. Both indexes proved to reflect independently diastolic dysfunction in symptomatic patients with different cardiac diseases but not in asymptomatic hypertensive patients. It was a single-center observational study recruiting 40 participants (20 F 52–70 age, and 20 M 56–67 age). Natriuretic peptides are widely accepted as biomarkers in heart failure with reduced ejection fraction. NT-pro BNP proved to be a very good means of diagnosing exercise-related left ventricular dysfunction (LVD) showing that it could unveil a subclinical LVD, especially in patient with myocardial remodeling. The main goal of this study was to compare the values of NT-pro BNP and E/E’. We have found no correlation between NT-pro BNP and E/E’, both pre-exercise and post-exercise, demonstrating that the later was not a reliable means of diagnosing LVD at effort in aymptomatic hypertensive patients.

ATRIAL FIBRILLATION INFLUENCE ON LEFT VENTRICULAR FUNCTION IN HYPERTENSIVE PATIENTS WITH PRESERVED EJECTION FRACTION

Objective: Atrial fibrillation(AF) may affect left ventricular function, causing abnormal diastolic filling and variable degrees of systolic abnormality. We tried to find the influence of AF on left ventricular function in a group of hypertensive patients with preserved ejection fraction. Design and method: 108 subjects were prospectively enrolled. All had a history of essential hypertension(HTN), without any other important comorbidity and with preserved ejection fraction(LVEF&gt;50%). 67 patients without any history of arrhythmia formed group one(group HTN) and 41 subjects with a recent AF episode, but in sinus rhythm at the enrollment, group two(group HTN and AF). By performing a standard echocardiography, we evaluated LV mass, LV ejection fraction, diastolic function and LA maximal volume. Also, global longitudinal strain of left ventricle(GLS) was analyzed, using the current recommendations of speckle tracking method. Results: In arrhythmia group, we observed a longer history of HTN diagnosis(62.2 versus 40.4months, p = 0.04) and a more severe form of HTN(grade 3 HTN for 48.8 % patients). LV ejection fraction, though normal, was lower in group2 (58.44% versus 60.75% in HTN group, p = 0.02). Also, GLS was more affected in group2 in comparison with group1, suggestive for a mild myocardial dysfunction(-16.71% in group 2 versus -18.85% in group1, p = 0.02). We found a greater diastolic dysfunction in AF patients based on mitral E/A ratio(p = 0.04) and smaller values of A’ septal and lateral velocity(p &lt; 0.0001 and p = 0.002) in this group. Conclusions: Even paroxysmal or persistent types of AF can cause an incipient form of LV systolic dysfunction and diastolic dysfunction in asymptomatic hypertensive patients with preserved left ventricular ejection fraction.

SUB-CLINICAL DAMAGE TO THE TARGET ORGANS (TOD) IN HYPERTENSIVE PATIENTS, ABOUT 300 PATIENTS

Objective: HTA is considered to be a silent killer. TOD is an indicator of cardiovascular risk in people with hypertension. The main objective of our study is to describe the sub-clinical TOD in hypertensive patients. Design and method: This is a descriptive study, conducted between October 2016 and October 2019. It included all asymptomatic hypertensive patients over the age of 35 of both sexes. Screening for infraclinical cardiac, vascular and renal damage is carried out with; the evaluation of the left ventricular hypertrophy (LVH) ultrasound and electric. Intima media thickness measurement by 2D carotid ultrasound and screening and evaluation of plaques. The measurement of pulsed pressure. Measuring the ABI for obliterating arterial disease. And finally, the estimate of urinary albumin excretion (UEA) and creatinine clearance according to MDRD. Results: 300 patients included in our series, these are 120 men and 180 women. The average age is 59.75 years. The prevalence of TOD is estimated at 72.3%, the prevalence of electrical LVH is 17.3%, the ultrasound LVH is 29%. Carotid hypertrophy is observed in 34.9% and the presence of stenotic plaques affect 9.1% of patients AOMI is found in 9%. Pathological pulsed pressure is found in 34.3%. UAE is pathological in 23.30% of our patients for A2 and 5.7% for A3. The creatinine clearance is less than 60 ml / min in 11%. The main independent risk factors associated with TOD are the value of SBP and Age. Pulse pressure&gt; 60 mmHg is associated with all TOD and the IMT is correlated with all screening tests for TOD. The SCORE score is predictive only for carotid lesions, it is not predictive for LVH or albuminuria. The SCORE score is not very predictive for AOMI and renal failure. Conclusions: Subclinical TOD is frequent in our series. The major modifiable independent risk factor is the value of SBP. Special attention to pulse pressure as a cardiovascular risk factor and marker of arterial stiffness A strategy for screening for target organ damage coupled with effective therapy targeting SBP is the only way to prevent cardiovascular, neurovascular and renal complications.

Cardio-ankle vascular index represents the best surrogate for 10-year ASCVD risk estimation in patients with primary hypertension

ABSTRACT Background: Identification of target organ damage and/or risk-enhancing factors help treatment decisions in hypertensive and hyperlipidaemic patients who reside in borderline to an intermediate risk category based on 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimates. Aim: In the present study, we aimed to investigate the comparative efficacy of certain hypertension-mediated organ damage markers (HMOD) for the prediction of 10-year ASCVD risk ≥10%, in patients with primary hypertension without established CVD. Methods: One-hundred thirty-seven asymptomatic hypertensive patients ≥40 years of age were enrolled in the present study. Ten-year ASCVD risks were estimated by Pooled Cohort Equations. The following HMOD markers; pulse pressure (PP), left ventricular mass index (LVMI), carotid intima-media thickness (CIMT), ankle-brachial index (ABI), cardio-ankle vascular index (CAVI) and estimated glomerular filtration rate (eGFR) were evaluated with respect to efficacy for predicting ≥10% ASCVD risk with ROC analysis. Results: CAVI gave the greatest Area Under Curve (AUC = 0.736, p < .000), and followed by CIMT (AUC = 0.727, p < .000), LVMI (AUC = O.630, p = .01), and PP (AUC = 0.623, p = .02). ABI and eGFR were not found to be predictive. CAVI correlated best with estimated 10-year ASCVD risk (r = 0.460, p < .000). A CAVI value ≥8 was found 71% sensitive and 72% specific for predicting ≥10% risk in 10-year ASCVD risk scale. CAVI gave the best graded response to increments in 10-year ASCVD risk categories. Conclusion: We suggest that CAVI is the best surrogate for 10-year ASCVD risk, among several HMOD markers.

The remodelling index risk stratifies patients with hypertensive left ventricular hypertrophy.

Aims Hypertensive left ventricular hypertrophy (LVH) is associated with increased cardiovascular events. We previously developed the remodelling index (RI) that incorporated left ventricular (LV) volume and wall-thickness in a single measure of advanced hypertrophy in hypertensive patients. This study examined the prognostic potential of the RI in reference to contemporary LVH classifications.Methods and results Cardiovascular magnetic resonance was performed in 400 asymptomatic hypertensive patients. The newly derived RI (, where EDV is LV end-diastolic volume and t is the maximal wall thickness across 16 myocardial segments) stratified hypertensive patients: no LVH, LVH with normal RI (LVHNormal-RI), and LVH with low RI (LVHLow-RI). The primary outcome was a composite of all-cause mortality, acute coronary syndromes, strokes, and decompensated heart failure. LVHLow-RI was associated with increased LV mass index, fibrosis burden, impaired myocardial function and elevated biochemical markers of myocardial injury (high-sensitive cardiac troponin I), and wall stress. Over 18.3 ± 7.0 months (601.3 patient-years), 14 adverse events occurred (2.2 events/100 patient-years). Patients with LVHLow-RI had more than a five-fold increase in adverse events compared to those with LVHNormal-RI (11.6 events/100 patient-years vs. 2.0 events/100 patient-years, respectively; log-rank P < 0.001). The RI provided incremental prognostic value over and above a model consisting of clinical variables, LVH and concentricity; and predicted adverse events independent of clinical variables, LVH, and other prognostic markers. Concentric and eccentric LVH were associated with adverse prognosis (log-rank P = 0.62) that was similar to the natural history of hypertensive LVH (5.1 events/100 patient-years).Conclusion The RI provides prognostic value that improves risk stratification of hypertensive LVH.

Usefulness of Stress-Derived E/e’ Ratio in Asymptomatic Hypertensive Patients

Purpose: We sought to investigate the usefulness of stress echocardiography-derived E/e’ in predicting subclinical atherosclerosis in asymptomatic hypertensive patients. Materials and Methods: 71 newly diagnosed untreated hypertensive patients (48 ± 13 years, 65% males) and 30 age- and sex-matched healthy controls were recruited. Resting and exercise echocardiography was performed to assess resting diastolic blood pressure and the diastolic stress parameters. Coronary flow reserve (CFR) was evaluated as well. Results: Based on CFR values, newly diagnosed, untreated hypertensives were stratified into hypertensives with microvascular dysfunction (MVD; 34 patients had CFR <2.0) and those without MVD (37 patients had CFR ≥2.0). Patients with MVD had a significantly higher C-reactive protein level (p < 0.05) and lower metabolic equivalent values (p < 0.05). With resting echocardiography, only the left atrial volume index (LAVI) was significantly increased in those with MVD compared with those without MVD and controls (p < 0.05). With exercise echo, the E/e’ was significantly increased in MVD patients compared with those without MVD and controls (p < 0.001). Importantly, the percentage of subjects with exercise E/e’ ≥15 was 76.5% (26 patients in the group with MVD), 4.1% (3 patients in the group without MVD), and 0% in controls. At univariate analysis, high-sensitivity C-reactive protein (p < 0.05), LAVI (p < 0.05), and exercise E/e’ (p < 0.001) were independently associated with reduced CFR. On the other hand, at multivariate analysis, only exercise E/e’ was the independent predictor of reduced CFR in newly diagnosed hypertensives. Conclusion: We have demonstrated significant associations between exercise-derived raised left ventricular pressure and coronary MVD in newly diagnosed untreated hypertensive patients. Herein, we supposed that exercise-derived E/e’ could predict subclinical atherosclerosis and might be a risk parameter for newly diagnosed untreated hypertensive patients.

P1419 Sex-related differences in cardiac remodeling in health and hypertension

Abstract Funding Acknowledgements National Medical Research Council OnBehalf National Heart Centre Singapore BACKGROUND Adverse cardiac remodelling is associated with worse cardiovascular outcomes. Development of left ventricular hypertrophy (defined as increased myocardial mass) is a complex process mediated by myocardial wall thickening and/or ventricular dilatation. Sex-related differences in the relationship between myocardial mass and wall thickening/ventricular dilatation have not been well-described. PURPOSE We examine differences in determinants and patterns of cardiac remodeling between males and females. METHODS Comprehensive cardiovascular magnetic resonance imaging was performed in 1006 participants: 316 healthy volunteers (50% males, 46 ± 14 years) and 690 asymptomatic hypertensive patients (60% males, 57 ± 11 years). Myocardial mass, ventricular volumes and maximal myocardial wall thickness (across 16 myocardial segments) were measured using standardized contouring techniques. Clinically relevant variables (age, weight, height, and adiposity) that demonstrated significant univariate association with myocardial mass (P &amp;lt; 0.05) were selected in the multivariable linear regression model using the forward approach. RESULTS Increased body weight, lower body fat composition and higher systolic blood pressures were independently associated with increased myocardial mass in healthy volunteers (males and females) and hypertensive females. In hypertensive males, only increased body weight and elevated systolic blood pressure were independently associated with increased myocardial mass. The association between myocardial mass and ventricular volumes was almost identical between males and females (P = 0.65 for interaction; Figure). Conversely, there was a significant gender-related difference in the association between wall thickness and myocardial mass after adjusting for potential confounders (P &amp;lt; 0.001 for interaction). Concentric remodeling was initially more evident in males; but further with increase, myocardial mass was associated with greater concentric remodeling in females (Figure). Similar results were observed when analyses were performed separately in healthy volunteers and hypertensive patients. CONCLUSION There were sex-related differences in concentric remodeling at progressive stages of myocardial hypertrophy that may explain the higher prevalence of heart failure with preserved ejection fraction reported in females. Abstract P1419 Figure

P962 The Remodeling Index risk stratifies patients with hypertensive left ventricular hypertrophy

Abstract Funding Acknowledgements National Medical Research Council BACKGROUND Hypertensive left ventricular hypertrophy (LVH) is associated with increased cardiovascular events. The authors previously developed the Remodeling Index (RI) that incorporated LV volume and wall-thickness in a single measure of advanced hypertrophy in hypertensive patients. PURPOSE This study examined the mechanisms and prognostic potential of the RI in reference with current LVH classifications. METHODS Cardiovascular magnetic resonance (CMR) was performed in 400 asymptomatic hypertensive patients. The newly derived RI ([(EDV)^1/3]/t; where EDV is LV end-diastolic volume and t is the maximal wall thickness across 16 myocardial segments) stratified hypertensive patients into 3 groups: without LVH, LVH with normal RI (LVH_Normal-RI) and LVH with low RI (LVH_Low-RI). The primary outcome was a composite of all-cause mortality, acute coronary syndromes, strokes and decompensated heart failure. RESULTS LVH_Low-RI was associated with increased LV mass index, fibrosis burden, impaired myocardial function and elevated biochemical markers of myocardial injury and wall stress. Over 18.3 ± 7.0 months (601.3 patient-years), patients with LVH_Low-RI had more than a 5-fold increase in adverse events compared to those with LVH_Normal-RI (11.6 events/100patient-years versus 2.0 events/100 patient-years, respectively; log-rank P &amp;lt; 0.001; Figure A). The RI provided incremental prognostic value over and above a model consisting of clinical variables and LVH (P = 0.02). Conversely concentric and eccentric LVH were associated with adverse prognosis (4.5 events/100patient-years versus 6.0 events/100patient-years, respectively; log-rank P = 0.62) that was similar as the natural history of hypertensive LVH (5.1 events/100patient-years). CONCLUSIONS The RI provides mechanistic insights and prognostic value that improves risk-stratification of hypertensive LVH. Abstract P962 Figure.

P1822Pocket-size mobile echocardiographic device screening for thoracic aortic aneurysm in asymptomatic hypertensive patients

Abstract Background Patients with hypertension may develop thoracic aortic aneurysm (TAA) that can be asymptomatic but potentially life-threatening. We sought to assess the prevalence of asymptomatic TAA among hypertensive patients and define the effectiveness of a TAA point-of-care screening program using pocket-size mobile echocardiographic (PME) devices. Methods We prospectively performed transthoracic echocardiography for TAA screening using a PME device on 1529 hypertensive patients (age, 62y [30y to 85y], 824 men) who attended our hypertension specialist clinic between June 2016 and July 2018. Measurement of the dimensions of the aortic sinus, sinotubular junction, ascending aorta, aortic arch, and descending thoracic aorta were obtained through multiple standard echo views. Results The prevalence of TAA (defined as maximum aortic diameter of ≥4.5cm and/or &gt;50% diameter of the adjacent aorta) in our study population was 7.3% (111/1529), with distal ascending aorta as the most frequent location (Figure). Multiple logistic regression analysis identified male gender, older age, and presence of heart valve disease as independent factors associated with TAA (all p&lt;0.05). Figure 1 Conclusions Asymptomatic TAA is common among asymptomatic hypertensive patients. Point-of-care use of PME device is effective in detecting TAA in a clinic setting. Such approach may be useful for early detection of TAA among at-risk patients allowing aggressive blood pressure control and early surgical intervention to prevent catastrophic complications such as aortic dissection or rupture. Acknowledgement/Funding Health and Medical Research Fund of the Hong Kong Government