Early Target Organ Damage Research Articles

Hypertension: smoking or quit. Clinical difficulties

The review describes the combination of hypertension (HTN) and smoking in the same person. The prevalence of this combination in the Russian population is high due to the widespread prevalence of both HTN and smoking. There are following unidirectional negative impact of both factors on vascular system: endothelium, microcirculation, large vessel stiffness, contributes to higher blood pressure among such patients and leads to early target organ damage, increased cardiovascular and death risk. Smoking cessation is the main effective measure of primary and secondary prevention among smoking patients with HTN. The review provides links to well-known articles and the results of studies showing the benefits of smoking cessation. However, it is not easy for smoking patients with hypertension to quit smoking: on the one hand, nicotine addiction, similar to drugs, through central nervous system exposure, makes the habit stable, while on the other hand, the low motivation of such patients due to young age and the absence of current smoking consequences, which complicates working with such patients. Knowledge of algorithms for working with smoking patients and methods of non-drug support can help practitioners supporting such patients at the stage of smoking cessation.

Associations of brachial-ankle pulse wave velocity with left atrial stiffness and left atrial phasic function in inpatients with hypertension.

Hypertension induces left atrial (LA) and left ventricular (LV) dysfunction, and an increase in arterial stiffness. This study aimed to investigate the associations of brachial-ankle pulse wave velocity (baPWV) with LA stiffness and LA phasic function in hypertension. A total of 305 hypertensive inpatients enrolled and were divided into two groups based on baPWV [Group I, baPWV ≤ 1515 (cm/s), n = 153; Group II, baPWV > 1515 (cm/s), n = 152]. Two-dimensional speckle tracking echocardiography (2D-STE) based LA phasic strains (LAS-S, LAS-E, LAS-A) and LV global longitudinal strain (LVGLS) were evaluated. LA stiffness index (LASI) was defined as the ratio of E/e' to LAS-S. Multivariate linear regression modeling was used to analyze the associations of baPWV with LASI and LA phasic function in all patients as well as age-specific and sex-specific subgroups. LASI was significantly higher in Group II [0.35(0.26, 0.52)] compared with Group I [0.26(0.20, 0.36)] (P < 0.001). After adjusting cardiovascular risk factors, medication, and LV structural and functional parameters (LVEF, LVMI, E/A ratio, and LVGLS), baPWV remained significantly correlated with LASI (P < 0.05). We also evaluated the predictive value of baPWV for LASI, the area under the curve (AUC) was 0.663 (95% CI: 0.607-0.716, P < 0.001). In conclusion, BaPWV was independently associated with LA stiffness in hypertensive inpatients. BaPWV also exhibited a certain predictive value for LA stiffness in these inpatients. Measuring arterial stiffness can provide clinicians clues for early cardiac target organ damage (TOD) in addition to vascular TOD.

DIFFERENCIAL HEMODYNAMIC CHARACTERISTICS OF TRUE SYSTOLIC HYPERTENSION AND SPURIUS HYPERTENSION IN THE YOUTH

Objective: In adolescents, isolated systolic hypertension (ISHT) could be associated with normal central blood pressure (cBP). This is called spurious hypertension (Sp-HT), typically occurs more in young males, and does not lead to organ damage compared to true ISHT (t-ISHT. Recently, the possibility to measure non-invasively cBP seems to be a tool able to discriminate Sp-HT from t-ISHT. Design and method: To evaluate in ISHT youths the ability of cBP to discriminate both diagnosis, t-ISHT and Sp-HT and to analyze hemodynamic and arterial stiffness parameters in both group of patients (n = 58) Methods: From 75 young subjects, no receiving antihypertensive drugs, 58 (25±4 years, 32 male) of them were identified having ISHT by 24hs ABPM. Afterwards, cBP was evaluated through a validated Mobil-O-Graph device. vs intraarterial cBP measurements, performed by our group. By this way, 28 of them were considered having t-ISHT and the 30 remaining having Sp-HT. In all of them, left ventricular mass index (LVMI, Echocardiography), Cardiac Index (CI), Pulse Wave Velocity (PWV) and microalbuminuria (mAlb) were recorded. Results: As Shown in Table 1, in t-ISHT, cBP, Heart Rate (HR), mAlb and CI were higher, compared to subjects with Sp-HT. The remaining parameters evaluated failed to show any statistical difference. Conclusions: In this cohort of youths, cBP was able to discriminate ISHT from Sp-HT. In addition, t-HT youths showed a hyperkinetic cardiac behavior (high Heart Rate and CI) and early target organ damage (increased LVMI and mAlb), thus suggesting and increased cardiovascular risk in these t-HT patients.

S-28-5: CIRCULATING ANGIOTENSIN CONVERTING ENZYME 2 ACTIVITY AS A CARDIOVASCULAR RISK MARKER IN A YOUNG HEALTHY POPULATION: THE AFRICAN-PREDICT STUDY

Objective: Cardiovascular disease (CVD) remains the major contributor to premature death globally, with black populations presenting with a disproportionate burden of CVD and early target organ damage. Renin angiotensin system dysregulation is a key factor involved in hypertension development and organ damage in black populations. Angiotensin converting enzyme 2 (ACE2) counteracts the deleterious effects of angiotensin II, and increased circulating ACE2 predicts cardiovascular events and mortality in the general population, and in patients with CVD. However, the role of ACE2 activity as a cardiovascular risk marker in young healthy individuals remains largely unclear. We explored ethnic and sex differences in ACE2 activity and associations between blood pressure (BP), left ventricular mass index (LVMi) and ACE2 activity in young healthy black and white adults. Design and method: We included 1134 black (men, N = 280; women, N = 285) and white (men, N = 277; women, N = 292) participants aged 20–30 years. The participants were normotensive at screening (BP≦140/90 mmHg) with no known CVD. Ambulatory systolic and diastolic BP were recorded and LVMi (m2.7) was obtained from echocardiography and plasma ACE2 activity measured using a validated assay. Results: Overall, mean plasma ACE2 activity was higher in black [1.33 pmol/min/ml (0.02; 19.6)] than in white [0.73 pmol/min/ml (0.02; 12.5)] participants, and higher in men [3.63 pmol/min/ml (0.02; 20.5)] than in women [0.28 pmol/min/ml (0.02; 9.87)] (both P &lt; 0.001). When comparing ethnic groups according to sex, ACE2 activity was higher in black men and women than in white men and women (both P ≦ 0.012). After adjustments for covariates (ethnicity, sex, age, body mass index, socioeconomic status, physical activity, glucose, low density lipoprotein cholesterol, C-reactive protein, alcohol intake and smoking), 24-hour systolic BP was positively associated with ACE2 activity in the total group (R2 = 0.43; β=0.07; P = 0.019) and black men (R2 = 0.19; β=0.18; P = 0.007). There were no independent associations of diastolic BP and LVMi with ACE2 activity in any of the groups. Conclusions: 24-hour systolic BP was independently and positively associated with ACE2 activity in the total group. When stratifying the group according to ethnicity and sex, a similar association was evident in black men, a group previously identified to be at high cardiovascular risk. The observed ethnic and sex differences in ACE2 activity and associations with BP suggest that ACE2 may be a useful biomarker in cardiovascular risk profiling in young populations.

Evaluation of Arterial Stiffness and Carotid Intima-Media Thickness in Children with Primary and Renal Hypertension.

Hypertension is an increasing disease in children and the risk of endothelial damage and target organ damage increases in the presence of additional risk factors such as obesity. In our study, the effect of hypertension on early atherosclerotic changes and target organ damage in children was investigated. Twenty four-hour ambulatory pulse wave analysis was performed by oscillometric method in 71 children aged 8-18years, 17 of whom were diagnosed with primary hypertension without obesity, 18 had both primary hypertension and obesity, and 16 had renal hypertension. Twenty healthy normotensive children were included as the control group. Carotid intima-media thickness (CIMT) and Left Ventricular Mass Index were measured. Central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in the primary hypertension group compared to controls (p = 0.001, p = 0.005, p = 0.001, p = 0.009, respectively), cSBP was higher in the renal hypertension group than the control group (p = 0.018). There was no difference between the groups in terms of pulse wave analysis parameters, CIMT, or left ventricular mass index (p > 0.05). Pulse wave velocity was positively correlated with SBP, DBP, cSBP, cDBP (p < 0.001). Augmentation index was positively correlated with DBP and cDBP (p = 0.01, p = 0.002, respectively). Our findings show that high blood pressure is associated with arterial stiffness and target organ damage beginning in childhood. The detection of early atherosclerotic vascular changes using pulse wave analysis allows to take necessary precautions such as lifestyle changes to prevent target organ damage in hypertensive children.

DIABETIC STATUS AND NIGHT-TIME SYSTOLIC BLOOD PRESSURE PREDICT EARLY MYOCARDIAL DAMAGE IN NEWLY DIAGNOSED DIABETES MELLITUS TYPE 2 PATIENTS AS THIS IS DEPICTED BY GALECTIN-3 LEVELS

Objective: Long standing Diabetes Mellitus Type 2 (T2DM) shows a high frequency of cardiovascular events. However, it is not known if newly diagnosed patients with T2DM present early signs of cardiovascular dysfunction. On the other hand, galectin has been introduced as a novel biomarker of myocardial fibrosis. The aim of the study was to evaluate levels of galectin-3 in patients with a very recent diagnosis of T2DM without established cardiovascular disease. In addition, hemodynamic parameters as well as their possible correlation with galactin-3 levels were studied. Design and method: Patients with a recent diagnosis of T2DM (&lt;6 months) and non-T2DM volunteers were studied. A thorough medical history with emphasis on hypertension and relevant comorbidities, somatometric measurements and blood tests was obtained from all participants. Serum levels of galectin-3 were determined by ELISA. Myocardial function and hemodynamic profile were noninvasively assessed with impedance cardiography. Furthermore, Atherosclerotic Cardiovascular Disease Risk (ASCVD) was calculated. Results: We studied 135 subjects, 79 T2DM patients with a median disease duration of 1 month (IR: 5) and 56 controls matched by age, sex and hypertension. T2DM patients had significantly higher values of galectin-3 (90 ± 88ng/dl vs 32.92 ± 6.32ng/dl, p &lt; 0.001), Cardiac Output (CO), ASCVD Risk compared to controls. Galectin-3 was associated with T2DM (p &lt; 0.001), fasting glucose (p &lt; 0.001), glycosylated hemoglobin (p &lt; 0.001). Furthermore, galectin-3 was associated with CO (p = 0.023), nighttime systolic blood pressure (SBP) (p = 0.03) and ASCVD Risk (p = 0.001). In multiple linear regression analysis, T2DM (Beta: 0.406, p &lt; 0.001) and nighttime SBP (Beta: 0.196, p = 0.028), were identified as independent predictors of galectin-3, after adjustment for age, sex, Body Mass Index and CO. Conclusions: Galectin-3 is elevated in patients with early stage T2DM even in the absence of established cardiovascular disease, and is independently correlated with T2DM and nighttime SBP. In this group of patients galectin may be used as a biomarker of early myocardial damage. Nighttime SBP emerge as an important mediator in early target organ damage in cardiovascular diseases.

STUDY OF EARLY RETINAL CHANGES IN PATIENTS WITH NEWLY DIAGNOSED TYPE 2 DIABETES MELLITUS

Objective: Retina and endothelium constitute fields in which the hyperglycemia’s pathological effects of type 2 diabetes mellitus (T2DM) can be detected. However, the precise time of these lesions’ appearance and factors contributing to it are still under investigation. Thus, we studied the early retinal lesions and endothelial function in patients with a recent diagnosis of T2DM (&lt;6 months) and their association with adverse prognostic factors. Design and method: Patients with a recent diagnosis of T2DM receiving no other diabetic medication except from Metformin, and volunteers matched for age and blood pressure (BP) participated in the study. Somatometric data, BP measurements (ambulatory and office) and hematological parameters (lipids, renal function, fasting glucose, glycosylated hemoglobin) were recorded. Endothelial function was assessed by Asymmetric Dimethylarginine (ADMA). Retinal vessel diameters (central retinal arteriolar equivalent-CRAE / central retinal venular equivalent-CRVE) and their ratio (arteriovenous ratio-AVR) were assessed with a non-mydriatic fundus camera using special software. Results: We studied 165 participants, 81 T2DM patients and 84 non-T2DM volunteers. No differences were found between the 2 groups in retinopathy and ADMA measurements. ADMA was associated with female sex (p = 0.037), Body Mass Index (p = 0.033) and AVR (p = 0.047). AVR was significantly associated with age, male sex, ADMA, estimated Glomerular Filtration Rate (eGFR), smoking, office, day and nighttime diastolic, 24-hour, and nighttime systolic BP. Linear regression analysis showed the independent correlation of AVR with nighttime systolic blood pressure (p = 0.002) and age (p = 0.019) taking into consideration gender, smoking, eGFR, ADMA and T2DM. Conclusions: In patients with a very recent diagnosis of Type 2 Diabetes Mellitus, the retinal vessels diameters do not differ compared with individuals of similar age and blood pressure. However, the AVR index correlates with age and nighttime BP, highlighting the important contribution of the latter in early target organ damage in this population.

STUDY ON HYPERTENSION-RELATED TARGET ORGAN DAMAGE IN ESSENTIAL HYPERTENSION PATIENTS WITH HYPOKALEMIA

Objective: To explore the early target organ damage in essential hypertension patients with hypokalemia,we nalysed ambulatory blood pressure, cardiac structure and function, early renal function, neck blood vessels and head imaging in patients with essential hypertension. Design and method: 590 patients with hypertension who were nalysedsed from January 2015 to June 2021 were selected, including 257 cases with hypokalemia and 76 cases have primary aldosteronism.Collect patients’ general information, biochemistry, urine routine, office blood pressure, 24 h ambulatory blood pressure monitoring.The results were statistically nalysed by SPSS. Results: Compared with the essential hypertension group,average systolic blood pressure during the day, average diastolic blood pressure during the day, average systolic blood pressure at night, and average diastolic blood pressure at night, 24 h average systolic blood pressure, 24 h average diastolic blood pressure, daytime systolic blood pressure load rate, night diastolic blood pressure load rate, 24 h systolic blood pressure load rate, and 24 h diastolic blood pressure load rate were significantly higher in both the hypokalemia group and the essential hyperaldosteronism group (P &lt; 0.05). Urinary microalbumin in the primary hypertension with hypokalemia group and primary aldosteronism group was significantly higher than that in the primary hypertension group (P &lt; 0.05).The 24 h average diastolic blood pressure, night systolic blood pressure load rate, and 24 h systolic blood pressure load rate were all positively correlated with urine microalbumin(P &lt; 0.05); they were negatively correlated with serum potassium ion (P &lt; 0.05). The nighttime mean systolic blood pressure and nighttime systolic pressure load rate were independently positively correlated with urine microalbumin (P &lt; 0.05), and serum potassium ions were independently negatively correlated with urine microalbumin by Multiple linear regression analysis (P &lt; 0.05). Conclusions: Essential hypertension patients with hypokalemia have higher 24 h blood pressure and blood pressure load rate, and have more serious early renal damage than patients with normal potassiumic Otherwise, Serum potassium concentration was an independent risk factor for urinary microalbumin in essential hypertension patients with hypokalemia

Association of Cerebral Oxygenation During Exercise With Target Organ Damage in Middle-Aged Hypertensive and Normotensive Individuals.

The brain is one of the main target organs affected by hypertension. Impaired cerebral oxygenation during exercise is an indicator of cerebral dysfunction. We aimed to investigate whether cerebral oxygenation during exercise correlates with subclinical markers of early target organ damage in a population of middle-aged, newly diagnosed hypertensive and healthy individuals. Carotid intima-media thickness (cIMT) was measured using ultrasound, arterial stiffness was estimated measuring the augmentation index and pulse wave velocity, and retinal vessel diameter was assessed via the central retinal-arteriolar and vein equivalent and retinal-arteriovenous ratio. Participants (n = 93) performed a 3-minute isometric handgrip exercise. Cerebral prefrontal oxygenation was measured continuously using near infrared spectroscopy. The average exercise responses in oxygenated hemoglobin (O2Hb), deoxygenated hemoglobin (HHb), and total hemoglobin (tHb) were assessed. Univariate analyses were performed; partial correlation was used to account for traditional cardiovascular risk factors to identify independent associations between cerebral-oxygenation indices and early markers of target organ damage. Mean cIMT was negatively correlated with the average exercise response in cerebral oxygenation (rhoO2Hb = -0.348, PO2Hb = 0.001; rhotHb = -0.253, Pthb = 0.02). Augmentation index was negatively correlated with cerebral oxygenation during exercise (rhoO2Hb = -0.374, P < 0.001; rhotHb = -0.332, P = 0.02), whereas no significant correlation was observed between pulse wave velocity and cerebral-oxygenation indices. In the adjusted analysis, cerebral oxygenation was correlated with central retinal arteriolar diameter (CRAE r = 0.233, P = 0.043). Our novel findings suggest that indices of lower cerebral oxygenation during a submaximal physical task are associated with markers of early, subclinical target organ damage, namely increased cIMT, arterial stiffness, and arteriolar retinal narrowing in newly diagnosed, untreated, hypertensive individuals.

Isolated Nocturnal Hypertension in Children.

Isolated nocturnal hypertension (INH) is attracting attention because it has been shown to correlate with target organ damage as well as cardiovascular events in adults. INH has also been reported in children especially in those with underlying diseases including chronic kidney disease and some studies reported association with markers of early target organ damage. INH occupies the majority of nocturnal hypertension. On the other hand, masked hypertension is largely attributed to INH. INH is usually diagnosed by ambulatory blood pressure monitoring. Recently, it became possible to monitor sleep blood pressure by an automated home blood pressure device feasible also in children. The epidemiology, methodology and reproducibility, pathophysiology, relation to target organ damage, and treatment of INH in children will be reviewed here along with adult data.

Abstract P119: Cardiovascular Risk And Subclinical Target Organ Damage In A Young Adult Population Provided By A Primary Healthcare Center In Brazil (Laparc Study)

Background: In this young and apparently healthy population, it is important to identify early CV risk factors and subclinical target organ damage (TOD) with low complexity procedures, aiming regression, control and primary prevention with future reduction of CV morbidity and mortality. Objectives: To evaluate subclinical TOD using Ankle-Brachial Index (ABI), Office and Home Pulse Pressure (PP), identifying arterial stiffness. Methods: A cross-sectional population study for CV risk assessment in adults aged 20-50 years old provided by a Primary Healthcare Center in Brazil. A total of 632 individuals were evaluated (40% male; mean age 36 ± 9 years). Socio-demographic, anthropometric data, and lifestyle evaluation were recorded. All underwent Office Blood Pressure (OBP) measurements in the 4 limbs to calculate the ABI and office PP. All received the Home Blood Pressure Monitoring (HBPM) device (7 days protocol) and the mean of the general BP and the calculation of the PP were evaluated. They also performed an ECG to calculate Sokolow-Lyon Index (SLI) and Cornell Voltage Index (CVI). Results: The prevalence of hypertension according to OBP was 16% and 18% according to HBPM, but with a low agreement between diagnoses (kappa = 0.385). HBPM identified 4 phenotypes: normotension (74%), sustained hypertension (8%), masked hypertension (10%), and white coat hypertension (8%). The median of office PP was 46 [39-52] mmHg and of Home PP was 45 [41-50] mmHg. Elevated Office PP and Home PP (&gt; 60 mmHg) were identified in 64 and 28 participants, respectively. High office PP was more frequent in men, obese, with increased neck circumference and lower ABI. It was also associated with higher SLI and CVI. High Home PP was also more frequent in men, obese, with increased neck circumference and higher CVI. The median of the ABI was 1.14 [1.08-1.22], which is the cutoff point we used to define early changes in the ABI. Individuals with decreased ABI are more obese, with smaller neck circumference and lower OBP control. They also had higher systolic BP values and office PP (49 vs 43 mmHg, p&lt;0.001). Conclusion: In this young population, early changes in subclinical TOD already identify a higher CV risk profile, indicating the importance of implementing prevention measures to reduce this risk.

Could arterial stiffness be early reversible target organ damage test in childhood hypertension?

The recommended treatment for hypertension (HTN) in children has been revised recently. This study aimed to present the changes in target organ damage (TOD) and arterial stiffness parameters after treatment in children with primary HTN who were managed in accordance with the 2016 European Society of Hypertension Guidelines. Patients with primary HTN included in this study were newly diagnosed, untreated, and were followed-up for a minimum of 6 months. HTN was confirmed by 24-h ambulatory blood pressure monitoring (ABPM). All patients underwent the following assessments: anthropometrical measurements of body mass index (BMI), carotid intima-media thickness (cIMT), left ventricular mass index (LVMI), plasma creatinine, urea, electrolytes, uric acid, fasting plasma glucose, blood lipids, urinalysis, urine culture, and first morning urine albumin tocreatinine ratio. The ABPM device performed measurements such as central blood pressure (cBP) and pulse wave velocity (PWV). Thirty-two of 104 patients were enrolled. Seventeen patients were male, and 53% were obese. Compared with pretreatment, creatinine, urea, systolic BP (SBP), diastolic BP (DBP), systolic load, diastolic load, central SBP (cSBP), cSBP z score, cDBP, and PWV z score decreased, whereas LVMI and BMI z scores were unchanged. After BP improvement, while LVMI did not regress, the cSBP, cSBP z, and PWV z score values, which are markers of arterial stiffness, regressed. This supports the corrective effect of BP control on the cardiovascular system even in a short-term follow-up. Further longitudinal studies are needed for the assessment of BP control on arterial stiffness in childhood.

Intensity of Glycemic Exposure in Early Adulthood and Target Organ Damage in Middle Age: The CARDIA Study.

AimTo determine whether long-term intensity of glycemic exposure (IGE) during young adulthood is associated with multiple target organs function at midlife independent of single fasting glucose (FG) measurement.MethodsWe included 2,859 participants, aged 18–30 years at Y0, in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. IGE was calculated as the sum of (average FG of two consecutive examinations × years between the examinations) over 25 years. Target organs function was indicated by cardiac structure, left ventricular (LV) systolic function, LV diastolic function, coronary artery calcium (CAC), and urine albumin-to-creatinine ratio (UACR) at Y25. We evaluated the associations between IGE with target organs function using linear regression models and estimated the associations between IGE with numbers of organs involved (0, 1, or ≥ 2 organs) using multinomial logistic regression models.ResultsA 1-SD increment of IGE was significantly associated with worse target organs function after multivariable adjustment: left ventricular mass (β [SE], 5.468 [1.175]); global longitudinal strain (β [SE], 0.161 [0.071]); E/e’ ratio (β[SE], 0.192 [0.071]); CAC score (β [SE], 27.948 [6.116]); and log UACR (β [SE], 0.076 [0.010]). Besides, IGE was independently associated with having ≥ 2 organs involved in both overall population (OR [95% CI], 1.48 [1.23, 1.41], P < 0.001) and subgroups stratified by diabetes at Y25.ConclusionHigher intensity of glycemic exposure during young adulthood was independently associated with subclinical alterations of target organs function at midlife. Our findings highlight the importance of early screening and management of IGE in youth.

EXCESS ALDOSTERONE RELATIVE TO PLASMA RENIN AND ANGIOTENSIN II ASSOCIATES POSITIVELY WITH CENTRAL SYSTOLIC BLOOD PRESSURE IN YOUNG BLACK AFRICANS

Objective: Populations of African ancestry usually present with a suppressed renin-angiotensin-aldosterone system (RAAS) attributed to excessive sodium retention and subsequently experience early and severe forms of hypertension-mediated organ damage. Central systolic blood pressure (cSBP) was previously found to be higher in young black adults as compared to their white counterparts. In the current study, we investigated associations of cSBP with a detailed RAAS profile in a healthy young population stratified according to ethnicity and sex. Design and method: This study included apparently healthy black men (N = 285) and women (N = 304), white men (N = 278) and women (N = 305) aged 20–30 years old. The SphygmoCor XCEL was used to derive cSBP. Aldosterone and equilibrium angiotensin levels were measured by LC-MS/MS and used for calculating angiotensin derived markers for plasma renin activity (PRA-S, Angiotensin I + Angiotensin II), angiotensin-converting enzyme (ACE-S, Angiotensin II/Angiotensin I), and two markers for adrenal effects of angiotensin II, the aldosterone-to-renin ratio (ARR-S, Aldosterone/PRA-S) and the aldosterone-to-angiotensin II-ratio (AA2-R, Aldosterone/Angiotensin II). Sodium and potassium were determined from 24-hour urine and then used to calculate sodium-to-potassium ratio. Results: Young black men and women presented with lower RAAS components and higher cSBP and urinary sodium-to-potassium ratio as compared to their white counterparts (all P &lt; = 0.001). In forward stepwise multiple regression analyses, we observed the following associations: In black women, cSBP associated positively with ARR-S (β=0.269; P = 0.001) and AA2-R (β=0.263; P = 0.001), and negatively with PRA-S (β=-0.311; P &lt; 0.001) and angiotensin II (β=-0.311; P &lt; 0.001). In black men we observed a negative association between cSBP and PRA-S (β=-0.181; P = 0.047). None of the associations were present in white men and women. Conclusions: Positive associations of cSBP with the ratio of aldosterone to both PRA-S and angiotensin II in healthy young black women suggest that excess aldosterone may have deleterious effects on central blood pressure in this population group, which may lead to early target organ damage. The absence of any association between cSBP and RAAS components in white adults indicates an ethnic disparity in central pressure regulation.

Comparing the associations of clinic vs. ambulatory blood pressure with subclinical organ damage in young healthy adults: the African-PREDICT study.

Raised blood pressure (BP) causes pathophysiological cardiovascular changes resulting in target organ damage. Although ambulatory and central BP relate more strongly to outcomes than clinical brachial BP in the elderly population, it is unknown which measure of BP is most strongly associated with markers of organ damage in younger populations. We compared the strength of associations between different BPs and measures of subclinical organ damage and investigated whether ethnic differences exist between these associations. The design was a cross-sectional analysis of the African-PREDICT study, including young black and white men and women (aged 20-30, N = 1202). We obtained clinic, ambulatory, and central BP readings, as well as measures of subclinical organ damage: central retinal arteriolar equivalent (CRAE) from fundus images, echocardiography to determine left ventricular mass index (LVMi), carotid intima media thickness (CIMT), carotid-femoral pulse wave velocity (PWV), and albumin-to-creatinine ratio (ACR) determined from spot urine samples. Overall, weak correlations were evident between CIMT, ACR, and BP, whereas CRAE, LVMi, and PWV correlated strongly with BP. In the total group, clinic brachial BP had stronger associations with CRAE, LVMi, and PWV (all p < 0.001) than ambulatory and central BP. Although the ethnic groups showed similar correlations between CRAE, LVMi, CIMT, and the various BPs, PWV correlated more strongly with ambulatory systolic BP (p < 0.001) in white participants. In young healthy adults, clinic brachial BP correlated more strongly with measures of early target organ damage than central or ambulatory BP. No differences were observed between correlations of BP and measures of target organ damage in the two ethnic groups.

Resistant hypertension: Prevalence and profile of patients followed in a university ambulatory.

Background:Hypertension affects about 36 million Brazilians. It is estimated that 10%–20% of these have resistant hypertension. These patients are at an increased risk of early target organ damage, as well as cardiovascular and renal events.Objective:To estimate the prevalence of resistant hypertension in a specialized outpatient clinic, to describe the sociodemographic and clinical characteristics of these patients, and to identify possible factors associated with resistant hypertension.Methods:Data collection from medical records of hypertensive patients treated using oral antihypertensive drugs in optimized doses at a specialized university clinic from March 2014 to December 2014, after ethical approval statement. All patients were using appropriate antihypertensive drugs in optimized doses and assisted at a teaching-assistance clinic of internal medicine of the Bahiana School of Medicine and Public Health in Brazil.Results:A total of 104 patients were enrolled and 31.7% (n = 33) had criteria for resistant hypertension. Of the total participants, 75.7% were female and 54.8% were black or brown. The average age was 61.7 years (SD ± 10.1). In the resistant hypertension group, 63.6% had diabetes, compared to 32.4% in the hypertension group. Among resistant hypertensive patients, 51.5% had dyslipidemia. Regarding drug treatment, 75.8% of the resistant hypertension group and 51.4% of the hypertension group used statins. Among patients with resistant hypertension, 90.9% used angiotensin II receptor blockers and 66.7%, dihydropyridine calcium channel blockers. In the resistant hypertension group, 75.8% used beta-blockers, against 25.4% in the hypertension group.Conclusion:The prevalence of hypertension was higher than that described in the global literature, which may be associated with the high percentage of black and brown (“pardos”) patients in the population studied, and also because the study was performed in a specialized outpatient clinic.

Left atrial stiffness index as a marker of early target organ damage in hypertension.

This study aimed to evaluate left atrial (LA) mechanics using two-dimensional speckle-tracking echocardiography (2DSTE) and investigate their correlations with measures of target organ damage (TOD) in hypertension. We enrolled 42 healthy controls (Group I) and 286 hypertension patients: Group II (n = 79) had an LA volume index (LAVI) <28 ml/m2; Group III (n = 92) had an LAVI ≥28 ml/m2; and Group IV (n = 115) had hypertension with left ventricular hypertrophy (LVH). We measured the following parameters: LA reservoir strain and strain rate (LAS-S, LASR-S), LA conduit strain and strain rate (LAS-E and LASR-E), and LA booster strain and strain rate (LAS-A and LASR-A). The LA stiffness index (LASI) was defined as the ratio of early diastolic transmitral flow velocity/lateral mitral annulus myocardial velocity (E/e') to LAS-S. We performed correlation and regression analyses of individual TOD with LA phasic functions, the LASI, and cardiovascular risk factors. Our findings showed that there was a trend toward a gradual increase in the LASI from controls to normal LA and enlarged LA patients and finally to hypertrophic LV patients. The LASI was significantly higher in Group III [0.28 (0.20, 0.38)] than in Group I [0.20 (0.16, 0.23)] and Group II [0.22 (0.18, 0.27)] and was the highest in Group IV [0.33 (0.26, 0.43)]. The LA reservoir and conduit function gradually decreased from Group I to Group IV. Multivariate regression analysis revealed that the LASI was independently correlated with individual TOD. In conclusion, abnormal LA mechanics precede LA enlargement and LVH, and an increased LASI can be used as a marker of early TOD in hypertension.

4-8CENTRAL AORTIC SYSTOLIC PRESSURE MEASUREMENT IN PATIENTS WITH REFRACTORY HYPERTENSION

Background: Aortic systolic pressure is regarded more reliable due to elastic properties of the central arterial walls, than the peripheral blood pressure (BP) brachial arteries being more muscular. The arterial distensibilty is an important factor in determining the vascular age and predicting future acute aortic events. The non-invasive central blood pressure can aid in early detection and harmonising treatment in patients with Refractory hypertension (RH). Aim: To assess the Central aortic systolic pressure (CASP) in RH patients. Methods and materials: We identified 111 patients with refractory hypertension (uncontrolled BP despite use of 3 or more anti-hypertensives) at the outpatient clinic of Kasturba Medical College Hospital, Mangalore in the period of July-August 2018. The non-invasive CASP, Average systolic, diastolic and pulse (AvgS, AvgD, AvgP) measured with A-PULSE CASPal® Monitoring Device. Statistical analysis using SPSS software and parameters like Independent t-test, descriptive statistics (mean, standard deviation) were calculated. Results: The average age of the patients was 58 ± 14.95; 39 (35.1%) were females(F) and 72 (64.9%) were males (M). There was a significant difference in the CASP in F 146.6 ± 29.34 and 139.6 ± 21.8 in M; AvgS in F and M was 157.9 ± 28 and 152.4 ± 21.8 respectively. AvgD and AvgP in F and M were 92.9 ± 17.1, 92.5 ± 13.3 and 83.87 ± 13.9, 79.2 ± 13.6 respectively. Conditions age and CASP p = 0.324; age and AvgS p = 0.338; CASP and AvgS p = 0.919 were significant at p &lt; 0.01. Conclusions: In patients with refractory hypertension, chrono-modulation with centrally acting anti-hypertensive drugs and synchronous CASP monitoring non-invasively can predict early target organ damage and helps improve the quality of life.

Childhood obesity and early target organ damage

Childhood obesity has been an important public health issue worldwide. We searched PubMed, CNKI, and Wanfang databases to perform a systematic review of how to identify early target organ (including heart, vessel, kidney and liver etc) damage in children, the effects of obesity on early target organ damage (including left ventricular hypertrophy, left ventricular diastolic dysfunction, increased carotid intima-media thickness, increased arterial stiffness, impaired glomerular filtration rate, and non-alcoholic fatty liver disease, etc), the possible biological mechanisms (including hemodynamic changes, abnormal metabolic indices, and effects of cytokines and inflammatory factors, etc), and the effects of exercise training and dietary interventions on target organ damage in obese children. Thus, it is important to take effective measures to prevent and control childhood obesity, and finally to reduce the prevalence of target organ damage.

RISK OF BLOOD PRESSURE MISCLASSIFICATION IN TALL BOYS ACROSS DEVELOPMENTAL PERIODS

Objective: Screening for hypertension in childhood and adolescence represents a key strategy for prevention of early vascular aging and consequent target organ damage later in life. Regarding the effect of anthropometric characteristics, emphasis is presently placed on elevated blood pressure (BP) in overweight/obese children. The effect of height on BP is often underestimated, despite its incorporation into normative BP data. The risk of misclassification of hypertensive vs. normotensive individuals seems to be particularly expressed in boys. Therefore, we aimed to study the relationship between height, measures of adiposity, and BP in healthy normal-weight boys in distinct developmental age periods. Design and method: 250 healthy normal-weight boys in age groups of 7–10 (n = 73), 11–14 (n = 85), and 15–19 years (n = 92) were examined under standard conditions. Weight, height, and waist circumference were measured, and two indices of adiposity were calculated: body mass index (BMI; kg.m-2) and body roundness index (BRI; -). Right brachial BP was measured oscillometrically, and mean BP was used for statistical analyses. Results: In multiple linear regression analysis, out of the three anthropometric parameters (height, BMI, and BRI), BP in adolescents aged 15–19 years was best predicted by height (regression coefficient 25.198 mmHg/m, p = 0.013), compared to BMI and BRI (p = 0.102, p = 0.921, respectively). Linear regression analyses showed significant effects of height and BMI, but not BRI, on mean BP in adolescents aged 15–19 years (height: 29.039 mmHg/m, p = 0.004; BMI: 0.847 mmHg/kg.m2, p = 0.014; BRI: p = 0.252). No significant linear relationship between the anthropometric parameters (height, BMI, and BRI) and mean BP was detected in boys aged 7–10 and 11–14 years. Conclusions: The effect of height on BP was most expressed in adolescent boys aged 15–19 years. BP should be evaluated with caution in this paediatric population due to increased risk of misclassification of normotensive individuals as hypertensive. These findings may be related to both physiological adaptation to greater height and a previously described “spurious” peripheral hypertension resulting from specific alteration of peripheral wave reflection in young tall boys with greater elasticity of the arterial wall.