Damage In Hypertensive Patients Research Articles

Daytime plasma cortisol and cortisol response to dexamethasone suppression are associated with a prothrombotic state in hypertension.

A prothrombotic state was demonstrated in patients with Cushing's syndrome and is involved in the development and progression of cardiovascular and renal damage in hypertensive patients. This study was designed to examine the relationships between cortisol secretion and the hemostatic and fibrinolytic systems in hypertension. In 149 middle-aged, nondiabetic, essential hypertensive patients free of cardiovascular and renal complications, we measured hemostatic markers that express the spontaneous activation of the coagulation and fibrinolytic systems and assessed daily cortisol levels (8 AM, 3 PM, 12 AM; area under the curve, AUC-cortisol) together with the cortisol response to dexamethasone overnight suppression (DST-cortisol). Plasma levels of D-dimer (D-dim), prothrombin fragment 1+2 (F1+2), and von Willebrand factor (vWF) were progressively and significantly higher across tertiles of AUC-cortisol and DST-cortisol, whereas no differences were observed in fibrinogen, tissue plasminogen activator, plasminogen activator inhibitor-1, antithrombin III, protein C, and protein S. D-dim, F1+2, and vWF were significantly and directly correlated with age and both AUC-cortisol and DST-cortisol. Multivariate regression analysis showed that both AUC-cortisol and DST-cortisol were related to plasma D-dim, F1+2, and vWF independently of age, body mass index, blood pressure, and renal function. Greater daily cortisol profile and cortisol response to overnight suppression are independently associated with a prothrombotic state in hypertensive patients and might contribute to the development of organ damage and higher risk of cardiovascular complications.

End-Organ Damage in Hypertension: An Insight on a Differentiated Outpatient Consultation.

The objective of this study was to determine the prevalence of end-organ damage in hypertensive patients attending an outpatient consultation. Patients were selected from an outpatient consultation at a tertiary hospital care center. All patients who consulted between July 2022 and March 2023 were included. Data on demographic characteristics, blood pressure records, hypertension etiology, medication use, and the presence of target organ damage were collected. A total of 73 patients were included in the study, with 34 patients being male (46.6%) and 39 patients being female (53.4%). The mean age of the patients was 49.8 years. Among the cases of hypertension, 14 (19.2%) were classified as secondary arterial hypertension (AH). The most common cause of secondary AH was obstructive sleep apnea (OSA) (42.9%). Approximately 23.2% of patients had documented end-organ damage potentially related to hypertension, with kidney disease being the most frequent (n = 10, 13.7%). The most commonly prescribed pharmacological classes were angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists (n = 46, 63%). Despite numerous studies and trials on arterial hypertension, it remains a significant contributor to morbidity and mortality, necessitating the continued awareness of its long-term implications.

Study of coronary artery lesions in hypertensive patients with and without diabetes

Objectives: To investigate the imaging characteristics of coronary artery lesions in hypertensive patients with or without diabetes by percutaneous coronary angiography. Determining the relationship between cardiovascular risk factors and levels of coronary artery damage in patients with hypertension. Methods: A cross - sectional description was carried out in 185 hypertensive patients (49 with diabetes; 136 without diabetes) underwent percutaneous coronary angiography to assess lesion images at the Emergency - Interventional Cardiology Department - Hue Central Hospital and the Cardiology Department - International Medical Center, Hue Central Hospital from April 2020 to July 2021. Results: Characteristics of coronary artery damage in hypertensive patients by percutaneous coronary angiography: the proportion of patients with significant coronary artery stenosis accounted for 64.90%. Significant lesions in the LAD: 63.20%; RCA: 45.40%, LCx: 35.70% and LM: 1.10%. The coronary artery lesions in patients with diabetes were diffuse, complex, and more severe than in the non - diabetic group, with an average number of obstructive branches over 50% and over 70% in two groups with and without diabetes, respectively. 39 ± 1.81; 1.90 ± 1.57 and 1.71 ± 1.60; 1.40 ± 1.33. The degree of atherosclerosis was more diffuse with a higher Gensini index of 34.22 ± 25.73; 29.59 ± 27.76. The average Syntax score was 10.82 ± 9.00; in the group of patients with diabetes and without diabetes, respectively, 14.32 ± 10.12; 8.67 ± 8.24. Significant coronary artery damage was not related to age, sex, obesity, hypertension class, smoking. Patients with dyslipidemia had a rate of coronary artery stenosis of more than 2.78. Hypertensive patients with diabetes had a higher rate of coronary artery damage 4.72 times. In multivariate analysis with two risk factors, both dyslipidemia and diabetes were independent risk factors for coronary stenosis greater than 70%. Conclusions: Coronary lesions in patients with diabetes were characterized by diffuse, multi - branch, and complex effects. Dyslipidemia and diabetes were two risk factors that independently affect the degree of significant coronary artery injury.

EARLY INDICES OF SUBCLINICAL CARDIOVASCULAR DAMAGE IN PATIENTS WITH ESSENTIAL HYPERTENSION AND PRIMARY ALDOSTERONISM. A PRELIMINARY OBSERVATIONAL STUDY

Objective: In hypertensive patients, the activation of the renin-angiotensin-aldosterone system is associated with an increase of subclinical vascular and cardiac damage. Our study aimed to compare some early markers of cardiovascular organ damage between patients with essential hypertension and patients with secondary hypertension, in particular primary aldosteronism. Design and method: Fifty-seven hypertensive patients (mean age: 44,4±13,6 years, 60.7% males) were included, 47 with essential hypertension and 10 with primary hyperaldosteronism. Peripheral blood pressure (pBP), central blood pressure (cBP) and pulse wave velocity (PWV) were assessed by the SphygmoCorXCEL. The carotid Intima-Media Thickness (cIMT) and the carotid Distensibility Coefficient (cCD) were measured by a scanner connected with an image acquisition and analysis system (CardiovascularSuite). Left ventricular mass index (LVMI) and relative wall thickness (RWT) were evaluated by transthoracic echocardiography. Results: Patients with primary aldosteronism have higher cIMT and PWV values compared to patients with essential hypertension (0.7±0.1mm vs. 0.6±0.1 mm, p = 0.02 and 8.6±2.5 m/s vs. 7.2±1.5 m/s, p = 0.02; respectively). By linear regression, age was the only variable independently associated with cIMT. On the other hand, various factors such as age, the diagnosis of primary aldosteronism, pSBP and cSBP were independently associated with PWV. Although not statistically significant, LVMI and RWT tended to be higher in the group with primary aldosteronism in comparison to patients with essential hypertension (14.3% vs. 0% exhibited concentric hypertrophy and 42.8% vs. 28.1% showed findings consistent with concentric cardiac remodelling). No differences were found in cDC values between the two groups. Conclusions: The results of this study confirm a possible deleterious impact of aldosteronism on cardiovascular damage in hypertensive patients, more evident for PWV than for cIMT or DC. This fact could suggest a possible different effect of the abnormal hormone secretion at different vascular districts.

Association of arterial stiffness with a prothrombotic state in uncomplicated nondiabetic hypertensive patients.

Past studies reported a significant contribution of a prothrombotic state to the development and progression of target organ damage in hypertensive patients. Stiffening of arterial vessels is associated with aging and hypertension, and additional factors could contribute to this process. This study was designed to examine the relationships between arterial stiffening and the hemostatic and fibrinolytic system. In 128 middle-aged, nondiabetic, essential hypertensive patients without major cardiovascular and renal complications, we measured coagulation markers that express the spontaneous activation of the hemostatic and fibrinolytic system and assessed stiffness of the arterial tree by measurement of the carotid/femoral pulse wave velocity (cfPWV) and pulse wave analysis with calculation of the brachial augmentation index (AIx). Levels of fibrinogen (FBG), D-dimer (D-d), and plasminogen activator-inhibitor 1 (PAI-1) were significantly higher in patients with PWV and AIx above the median of the distribution. FBG, D-d, and PAI-1 were significantly and directly related with both cfPWV and AIx, and multivariate regression analysis indicated that the relationships of D-d and PAI-1 with both cfPWV and AIx and of FBG with AIx, were independent of age, body mass index, severity and duration of hypertension, use of antihypertensive drugs, blood glucose, and plasma lipids. In middle-aged, uncomplicated, nondiabetic patients with essential hypertension, spontaneous activation of plasma hemostatic cascade and impaired fibrinolysis is significantly and independently associated with stiffening of the arterial tree.

PS-C36-5: SUPEROXIDE DISMUTASE AS A PROTECTIVE FACTOR FOR EARLY RENAL DAMAGE IN HYPERTENSIVE PATIENTS

Background: Hypertension is a primary risk factor for chronic kidney disease (CKD), which is a highly prevalent condition that contributes to a substantial proportion of disease burden globally. However, CKD can be reversed in the early stage of renal damage. As a result, for a better prognosis, early detection and treatment are crucial for a better prognosis. Oxidative stress had been linked to hypertensive renal impairment in previous investigations. Superoxide dismutase (SOD) was a clinically available oxidative stress biomarker that had yet to be linked to early kidney damage in hypertension. The association between SOD and the early renal damage (ERD) of hypertension has not been established. The aim of the study was to investigate the relationship between SOD and ERD, hoping to provide a new direction to prevent and treat hypertension with ERD. Methods: This was a retrospective observational study. Clinical data were collected from patients with essential hypertension (EH) in Shandong Provincial Qianfoshan Hospital from January 2017 to December 2018. ERD was defined as urine microablumin/ creatinine ratio (UACR) greater than 30 mg/g but less than 300 mg/g. Patients were divided into hypertension with ERD group and hypertension without early renal damage (NRD) group. Clinical data from patients were collected and compared between the two groups. Spearman and Pearson correlation analysis were used to analyze the correlation between UACR and SOD. Moreover, univariate and multivariate logistic regression analyses were used to screen for the risk factors for ERD. Results: According to our analysis, SOD was protective factors (P < 0.05). Multivariate logistic regression analysis showed that SOD was an independent protective factor for hypertension with ERD. Both Spearman and Pearson correlation analysis showed negative correlation between SOD and UACR (P < 0.05). Conclusion: SOD was an independent protective factor for early renal damage in hypertensive patients, providing a new direction for the treatment of early renal damage in hypertensive patients.

PS-R02-1: THE HIDDEN HAND BEHIND AN AORTIC DISSECTION CASE

According to the data of WHO, more than 1.1 billion people worldwide suffer from hypertension, which leads to complications such as aortic dissection, acute myocardial infarction, and heart failure seriously threaten human health. Previously, we believed that primary hypertension accounted for 80%-90% of all hypertension, but with the gradual increase in understanding and improvement of detection methods, the understanding of secondary hypertension factors is becoming clearer. Among the secondary hypertension, primary aldosteronism is receiving more and more attention. It is thought that the actual prevalence of primary aldosteronism may account for 30%-50% of hypertension. The dangers of primary aldosteronism are not only in the damage to target organs from blood pressure, but the damage to organs from elevated aldosterone appears much earlier. Early recognition of primary aldosteronism is important to reduce the emergence of complications. We report a case of a patient with aortic dissection with a previous history of thirty years of hypertension, regular medication and stable blood pressure control, who, after a sudden aortic dissection, had laboratory tests suggesting intractable hypokalemia and poor results with potassium supplementation. We further examined aldosterone and renin levels and found that renin levels were significantly lower, with an aldosterone/renin ratio of 72 (reference value: 0–38). Although the patient was not able to standardize medications at the time of examination due to his condition, the ARB, CCB and hydrochlorothiazide medications the patient was on were all elevated for renin. In this case, renin levels remained low and we have reason to believe that the patient could be diagnosed with primary aldosteronism. With this history, we recognize that screening for secondary hypertension is far from adequate, and some scholars believe that less than 1% of hypertensive patients worldwide are currently screened for secondary factors. We believe that screening for secondary hypertensive factors should be performed in all patients with aortic dissection, even whenever there is combined target organ damage in hypertensive patients, regardless of blood pressure values.

To Estimate the Prevalence of Microalbuminuria and to Determine its Corelation with Left Ventricular Mass Index in Hypertensive Patients - A Cross-Sectional Study

Background: Microalbuminuria (MA) is a sign of renal impairment that can predict cardiovascular disease independently. Left ventricular hypertrophy (LVH) is a prelude to cardiac symptoms of target organ damage in hypertensive patients. Aim: This study aims to determine the relationship between left ventricular mass index (LVMI) and MA in hypertensive patients. Materials and Methods: This cross-sectional study was done from January 2020 to January 2021. In this study, 100 patients aged 18–60 years with hypertension were enrolled. MA was assessed by urine albumin creatinine ratio and LVMI was calculated by two-dimensional echocardiography using the Devereux and Reichek “cube” formula. Results: Mean age was 52.04 ± 9.96 years in study population with male: female of 0.96. The mean systolic blood pressure was 163.80 ± 18.13 mmHg and the mean diastolic blood pressure was 94.90 ± 8.93 mmHg with mean duration of hypertension being 2.49 ± 3.93 years. LVH was present in significant number of patients with MA as compared to those without MA (87.5% vs. 50%, P < 0.001). The LVH was independently associated with MA, albumin-creatinine ratio, and serum creatinine. Out of 77 patients with LVH, 49.4% had high LVMI with a P = 0.002 suggesting a significant correlation between LVH with LVMI. A significant correlation between raised LVMI and presence of MA was seen and the odds of having raised LVMI was 3.46 times in the presence of MA as compared to without MA. Interpretations and Conclusions: This study shows that MA and LVMI are independently correlated, and as a result, MA stands alone as a risk factor for higher cardiovascular morbidity and mortality.

S-40-1: INFLAMMATION AND IMMUNITY IN HYPERTENSION

Over the past almost 30 years the roles of inflammation and later of specific immune cells in the mechanisms of hypertension have increasingly been demonstrated. Initially it was shown that immune cells infiltrated perivascular tissue in the heart and kidney. Later, the demonstration that macrophages and shortly after T lymphocytes were critical for angiotensin II and DOCA-salt-induced hypertension consolidated the idea that immune mechanisms played a role in cardiovascular and renal injury in hypertension. As well, the anti-inflammatory role of T regulatory lymphocytes, the participation of dendritic cells, of gamma/delta T lymphocytes, of neutrophils through the formation of neutrophil extracellular traps (NETs), has become evident. The role of antigen presentation and intracellular mechanisms leading to activation of innate and adaptive immunity in hypertension have offered additional opportunities for eventually targeting the immune system to control inflammation-mediated damage in hypertension. Interferon-gamma and interleukin-17 appear to be important pro-inflammatory cytokines, whereas interleukin-10 plays an anti-inflammatory role in hypertension. Recent application of single cell RNA sequencing has opened novel vistas of the landscape of immune cells participating in cardiovascular and renal injury in hypertension, which can lead to new therapeutic options to control blood pressure and target organ damage in hypertensive patients.

Ventricular-arterial coupling assessed by PWV/GLS ratio in hypertensive patients.

The physiological interaction between the left ventricle (LV) and the arterial system, defined as ventricular-arterial coupling (VAC), facilitates the optimal volume of cardiac work and cardiovascular performance. The aim of this study was to evaluate the benefit of PWV/GLS ratio associated with other vascular and cardiac performance parameters in hypertensive patients compared to age-matched healthy controls. We calculated the ratio of pulse wave velocity (PWV), as a marker of arterial stiffness, to global longitudinal strain (GLS), as a marker of left ventricular function in 135 patients divided in 3 groups, as follows: group 1 (HT + CAD) enrolled 54 hypertensive patients with coronary artery disease, group 2 (HT) enrolled 43 hypertensive patients and group 3 (CON) represented the control group consisting of 38 age-matched healthy subjects. GLS values were significantly reduced in HT+CAD (-17.50±7.2) vs. HT (-17.95±5.3) vs. control (-20.13±4.6) (p-value <0.001). PWV values were higher in HT+CAD (9.90±3.1) and HT (9.70±2.5) vs. control (7.85±3.2) (p-value <0.001). VA coupling measured by the PWV/GLS ratio showed significantly lower values in HT+CAD and HT vs. control (p-value <0.001). The ROC curve identified a threshold of -0.054 of the PWV/GLS ratio to detect altered ventricular-arterial coupling AUROC = 0.836, 95% CI [0.762; 0.909]. This study demonstrated that assessment of the PWV/GLS ratio represents a useful tool to detect altered ventricular-arterial coupling in hypertensive patients. The perspectives of future use could include monitoring of earlier development of multiple organ damage in hypertensive patients and the efficacy of the different hypertensive medications. Extensive prospective studies are needed to confirm this hypothesis.

A CROSS SECTIONAL STUDY; COMPARISON OF DIAGNOSTIC PARAMETERS AND COMORBID CONDITIONS IN HYPERTENSION ALONE AND HYPERTENSION PLUS DIABETES

Comorbidities such as hypertension and type 2 diabetes are widespread. Hypertension is twice as common in diabetic individuals as it is in non-diabetics. The purpose of this research was to better understand the clinical profile, laboratory features, and vulnerability to end organ damage in hypertensive patients with and without diabetes. Method: This was a cross-sectional observational study conducted in the outpatient and inpatient departments of Medicine. Study participants were divided into two groups according to their presence of hypertension or diabetes mellitus. Patients were examined clinically and the data was further analysed using statistical methods. We observed th Results: e mean age of 53.08 years (±11.48) and 55.96 years (±11.23) with no associations between the age group and gender of the hypertensive patient group (p&lt;0.344) and the hypertensive diabetic group (p&lt;0.597). The most frequent symptom of presentation in both groups was a headache. There was a significant statistical difference in mean systolic blood pressure between hypertensive and hypertensive-diabetic group t (165.8) =4.643, p&lt;0.001. Our study shows a higher value of mean HbA1c, mean postprandial glucose levels, and mean fasting blood glucose levels in the hypertensive diabetic group as compared to the hypertensive group. Our study demonstrated that end organ damage Conclusion: was more prevalent in hypertensive diabetic individuals, indicating the effect of diabetes-hypertension co-morbidity on target organs.

Research on early warning of renal damage in hypertensive patients based on the stacking strategy

BackgroundAmong the problems caused by hypertension, early renal damage is often ignored. It can not be diagnosed until the condition is severe and irreversible damage occurs. So we decided to screen and explore related risk factors for hypertensive patients with early renal damage and establish the early-warning model of renal damage based on the data-mining method to achieve an early diagnosis for hypertensive patients with renal damage.MethodsWith the aid of an electronic information management system for hypertensive out-patients, we collected 513 cases of original, untreated hypertensive patients. We recorded their demographic data, ambulatory blood pressure parameters, blood routine index, and blood biochemical index to establish the clinical database. Then we screen risk factors for early renal damage through feature engineering and use Random Forest, Extra-Trees, and XGBoost to build an early-warning model, respectively. Finally, we build a new model by model fusion based on the Stacking strategy. We use cross-validation to evaluate the stability and reliability of each model to determine the best risk assessment model.ResultsAccording to the degree of importance, the descending order of features selected by feature engineering is the drop rate of systolic blood pressure at night, the red blood cell distribution width, blood pressure circadian rhythm, the average diastolic blood pressure at daytime, body surface area, smoking, age, and HDL. The average precision of the two-dimensional fusion model with full features based on the Stacking strategy is 0.89685, and selected features are 0.93824, which is greatly improved.ConclusionsThrough feature engineering and risk factor analysis, we select the drop rate of systolic blood pressure at night, the red blood cell distribution width, blood pressure circadian rhythm, and the average diastolic blood pressure at daytime as early-warning factors of early renal damage in patients with hypertension. On this basis, the two-dimensional fusion model based on the Stacking strategy has a better effect than the single model, which can be used for risk assessment of early renal damage in hypertensive patients.

Phenotyping the hypertensive heart.

Arterial hypertension remains the most frequent cardiovascular (CV) risk factor, and is responsible for a huge global burden of disease. Echocardiography is the first-line imaging method for the evaluation of cardiac damage in hypertensive patients and novel techniques, such as 2D and D speckle tracking and myocardial work, provide insight in subclinical left ventricular (LV) impairment that would not be possible to detect with conventional echocardiography. The structural, functional, and mechanical cardiac remodelling that are detected with imaging are intermediate stages in the genesis of CV events, and initiation or intensification of antihypertensive therapy in response to these findings may prevent or delay progressive remodelling and CV events. However, LV remodelling-especially LV hypertrophy-is not specific to hypertensive heart disease (HHD) and there are circumstances when other causes of hypertrophy such as athlete heart, aortic stenosis, or different cardiomyopathies need exclusion. Tissue characterization obtained by LV strain, cardiac magnetic resonance, or computed tomography might significantly help in the distinction of different LV phenotypes, as well as being sensitive to subclinical disease. Selective use of multimodality imaging may therefore improve the detection of HHD and guide treatment to avoid disease progression. The current review summarizes the advanced imaging tests that provide morphological and functional data about the hypertensive cardiac injury.

Electrocardiography in Hypertensive Patients without Cardiovascular Events: A Valuable Predictor Tool?

Background Hypertension is an important risk factor of cardiovascular (CV) disease. An early diagnosis of target organ damage could prevent major CV events. Electrocardiography (ECG) is a valuable clinical technique, with wide availability and high specificity, used in evaluation of hypertensive patients. However, the use of ECG as a predictor tool is controversial given its low sensitivity. This study aims to characterise ECG features in a hypertensive population and identify ECG abnormalities that could predict CV events. Methods We studied 175 hypertensive patients without previous CV events during a follow-up mean of 4.0 ± 2.20 years. ECGs and pulse wave velocity were performed in all patients. Clinical characteristics and ECG abnormalities were evaluated and compared between the patients as they presented CV events. Results Considering the 175 patients (53.14% male), the median age was 62 years. Median systolic blood pressure was 140 mmHg and diastolic blood pressure was 78 mmHg. Median PWV was 9.8 m/s. Of the patients, 39.4% were diabetic, 78.3% had hyperlipidaemia, and 16.0% had smoking habits. ECG identified left ventricular (LV) hypertrophy in 29.71% of the patients, and a LV strain pattern was present in 9.7% of the patients. Twenty-nine patients (16.57%) had a CV event. Comparative analyses showed statistical significance for the presence of a LV strain pattern in patients with CV events (p=0.01). Univariate and multivariate analysis confirmed that a LV strain pattern was an independent predictor of CV event (HR 2.66, 95% IC 1.01–7.00). In the survival analysis, the Kaplan–Meier curve showed a worse prognosis for CV events in patients with a LV strain pattern (p=0.014). Conclusion ECG is a useful daily method to identify end-organ damage in hypertensive patients. In our study, we also observed that it may be a valuable tool for the prediction of CV events.

Total White Blood Cell Count is Associated with Arterial Stiffness Among Hypertensive Patients.

The association between white blood cell (WBC) count and arterial stiffness in patients with hypertension is not well-documented. We aimed to examine the relationships of total WBC count with arterial stiffness and risk of macrovascular damage in hypertensive patients. A total of 631 hypertensive adults (mean age: 65.6years) were included in the present study. Arterial stiffness was determined by brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI). Macrovascular damage was defined as baPWV >1.8m/s or ABI <.9. The dose-response associations were assessed by multivariate linear or logistic regression models. After multivariate adjustments, we observed a dose-response relationship between increasing total WBC count and arterial stiffness. Participants in the highest tertile of total WBC count showed a significantly elevated baPWV (β = .088; 95% CI: .021, .154; Ptrend = .010) and reduced ABI (β = -.027; 95% CI: -.046, -.008; Ptrend = .005), as compared with those in the first tertile. The association was similar in different subgroups. In addition, elevated total WBC count was related to a greater risk of macrovascular damage, as indicated by baPWV >1.8m/s (OR = 1.86; 95% CI: 1.15, 2.99, comparing the extreme tertiles). Our data suggest that elevated total WBC count was related to arterial stiffness among individuals with hypertension.

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.

Prevalence of target organ damage in hypertensive patients with coexisting obstructive sleep apnea.

Obstructive sleep apnea (OSA) is associated with cardiovascular risk and higher mortality. Assessment of subclinical organ lesions is significant for prevention of clinically manifested complications which might result in death. The aim of the study was to assess the prevalence of subclinical target organ damage in hypertensive patients with OSA, and to establish whether these lesions are dependent on the intensity of sleep-disordered breathing. The study covered 67 patients with OSA diagnosed on the basis of polygraphy. Depending on the apnea/hypopnea index (AHI), the patients were divided into two groups: G1 (n=32; AHI=5-30) and G2 (n=35; AHI>30). The control group C consisted of 31 hypertensive subjects with OSA risk estimated as low based on the Berlin Questionnaire (BQ). Each patient had the following parameters measured: intima-media thickness (IMT), ankle-brachial index (ABI), left ventricular mass index (LVMI), and estimated glomerular filtration rate (eGFR). The patients with severe OSA had significantly higher LVMI compared to the control group (130.99±44.6 g/m2 versus 106.61±27.86 g/m2; p=0.0332). The G2 group had higher eGFR than C (104.7±17.96 ml/min/1.73m2, 88.85±17.68 ml/min/1.73m2; p=0.0058). Similar results of eGFR were observed between G1 and C (104.35±21.06 ml/min/1.73m2, 88.85±17.68 ml/min/1.73m2; p=0.0081). G1 and G2 did not differ significantly in terms of eGFR. The other measured parameters, such as IMT and ABI, did not differ significantly between OSA and controls. Patients with severe OSA demonstrate signs of left ventricular hypertrophy, while early atherosclerotic lesions (ABI and IMT) were not more intense than in the control group. High eGFR levels may indicate hyperfiltration, which does not correlate with OSA intensity level.

Higher plasma renin activity is associated with increased kidney damage risk in patients with hypertension and glucose metabolic disorders.

The impact of renin on kidney remain unclear among hypertensives with glucose metabolic disorders (GMD). We aimed to evaluate the association between plasma renin activity (PRA) and kidney damage in hypertensive patients with GMD. Overall, 2033 inpatients with hypertension and GMD free of chronic kidney disease (CKD) at baseline were included. CKD was defined using estimated glomerular filtration rate (eGFR) and urine protein. PRA was treated as continuous variable, and also dichotomized as high (≥0.65) or low (< 0.65) groups. The association of PRA with incident CKD was evaluated using multivariable Cox model controlling for antihypertensive medications and baseline aldosterone, and traditional parameters. Subgroup and interaction analyses were performed to evaluate heterogeneity. During a median follow‐up of 31 months, 291 participants developed CKD. The incidence was higher in high‐renin group than that in low‐renin group (54.6 vs 36.6/1000 person‐years). Significant association was observed between PRA and incident CKD, and the association was mainly driven by an increased risk for proteinuria. Each standard deviation increment in log‐transformed PRA was associated with 16.7% increased risk of proteinuria (hazard ratio = 1.167, P = .03); compared with low‐renin group, there was 78.4% increased risk for high‐renin group (hazard ratio = 1.784, P = .001). Nonlinear associations were observed between PRA and kidney damage. Higher PRA is associated with greater risk of incident kidney damage, especially for positive proteinuria, in patients with coexistence of hypertension and diabetes, independent of aldosterone. In this patient population with high risk for kidney damage, PRA may serve as an important predictor.

A study to identify obstructive sleep apnea syndrome based on 24 h ambulatory blood pressure data

Sleep apnea causes cardiac arrest, sleep rhythm disorders, nocturnal hypoxia and abnormal blood pressure fluctuations in patients, which eventually lead to nocturnal target organ damage in hypertensive patients. The incidence of obstructive sleep apnea hypopnea syndrome (OSAHS) is extremely high, which seriously affects the physical and mental health of patients. This study attempts to extract features associated with OSAHS from 24-hour ambulatory blood pressure data and identify OSAHS by machine learning models for the differential diagnosis of this disease. The study data were obtained from ambulatory blood pressure examination data of 339 patients collected in outpatient clinics of the Chinese PLA General Hospital from December 2018 to December 2019, including 115 patients with OSAHS diagnosed by polysomnography (PSG) and 224 patients with non-OSAHS. Based on the characteristics of clinical changes of blood pressure in OSAHS patients, feature extraction rules were defined and algorithms were developed to extract features, while logistic regression and lightGBM models were then used to classify and predict the disease. The results showed that the identification accuracy of the lightGBM model trained in this study was 80.0%, precision was 82.9%, recall was 72.5%, and the area under the working characteristic curve (AUC) of the subjects was 0.906. The defined ambulatory blood pressure features could be effectively used for identifying OSAHS. This study provides a new idea and method for OSAHS screening.

Abstract 9: Pervasive White Matter Microstructure Dysintegrity Related To High Blood Pressure Among Asymptomatic Population

Background: Blood pressure is the strongest contributor to clinically evident cerebrovascular disease. We investigated the role of blood pressure on white matter (WM) microstructure among asymptomatic individuals without clinically evident cerebrovascular disease. Methods: We conducted a nested study within the UK Biobank, restricting our analysis to participants without cerebrovascular disease or dementia and with available brain diffusion tensor imaging (DTI). We tested for association between systolic blood pressure (SBP) and six different DTI metrics: fractional anisotropy (FA), mean diffusivity (MD), tensor mode (MO), intra-cellular volume fraction (ICVF), isotropic or free water volume fraction (ISOVF), and orientation dispersion index (OD) across 48 WM tracts using multivariable linear regression adjusted for potential confounders. We used Bonferroni-corrected p-values (0.05/48) for statistical significance. Results: We analyzed 33,440 participants. Mean age was 63.0 (SD 7.7), and 17,688 (53%) were female. Higher SBP is independently associated with pervasive decrease in FA and ICVF and increase in MD (Figure), after adjustment for vascular risk-factors. SBP was also associated with lower neurite OD (a more specific metric of axonal damage) in bilateral posterior corona radiata, external capsule, medial lemniscus, and corticospinal tracs. FA and OD of external capsule and posterior corona radiata had the largest drop per 10 mmHg increase of SBP (steepest slope). Conclusions: Higher SBP is associated with pervasive WM microstructure dysintegrity in asymptomatic individuals without evident cerebrovascular disease. DTI metrics of the posterior corona radiata and external capsule are most reflective of variations in SBP and may provide a potential biomarker to assess subtle WM microstructural damage in hypertensive patients or monitor treatment response in clinical trials.