Essential Hypertensive Individuals Research Articles

Volume overload is a major characteristic in primary aldosteronism: a 3-year follow-up study.

We examined haemodynamics, focusing on volume balance and forward and backward wave amplitudes, before and after 2.8 years of targeted treatment of primary aldosteronism. Patients with essential hypertension and normotensive individuals were examined for comparison ( n = 40 in each group). Recordings were performed using radial artery pulse wave analysis and whole-body impedance cardiography. Unilateral aldosteronism was treated with adrenalectomy ( n = 20), bilateral aldosteronism with spironolactone-based medication ( n = 20), and essential hypertension with standard antihypertensive agents. Aortic SBP and DBP, forward and backward wave amplitudes, and systemic vascular resistance were equally elevated in primary aldosteronism and essential hypertension. All these haemodynamic variables were similarly reduced by the treatments. Primary aldosteronism presented with 1 litre (∼10%) extracellular water excess ( P < 0.001) versus the other groups, and this excess was normalized by treatment. Initial pulse wave velocity (PWV) was similarly increased in primary aldosteronism and essential hypertension, but final values remained higher in primary aldosteronism ( P < 0.001). In regression analyses, significant explanatory factors for treatment-induced forward wave amplitude reduction were decreased systemic vascular resistance ( β = 0.380) and reduced extracellular water volume ( β = 0.183). Explanatory factors for backward wave amplitude reduction were changes in forward wave amplitude ( β = 0.599), heart rate ( β = -0.427), and PWV ( β = 0.252). Compared with essential hypertension, the principal haemodynamic difference in primary aldosteronism was higher volume load. Volume excess elevated forward wave amplitude, which was subsequently reduced by targeted treatment of primary aldosteronism, along with normalization of volume load. We propose that incorporating extracellular water evaluation alongside routine diagnostics could enhance the identification and diagnosis of primary aldosteronism.

Physiological reactivity to acute mental stress in essential hypertension-a systematic review.

Exaggerated physiological reactions to acute mental stress (AMS) are associated with hypertension (development) and have been proposed to play an important role in mediating the cardiovascular disease risk with hypertension. A variety of studies compared physiological reactivity to AMS between essential hypertensive (HT) and normotensive (NT) individuals. However, a systematic review of studies across stress-reactive physiological systems including intermediate biological risk factors for cardiovascular diseases is lacking. We conducted a systematic literature search (PubMed) for original articles and short reports, published in English language in peer-reviewed journals in November and December 2022. We targeted studies comparing the reactivity between essential HT and NT to AMS in terms of cognitive tasks, public speaking tasks, or the combination of both, in at least one of the predefined stress-reactive physiological systems. We included a total of 58 publications. The majority of studies investigated physiological reactivity to mental stressors of mild or moderate intensity. Whereas HT seem to exhibit increased reactivity in response to mild or moderate AMS only under certain conditions (i.e., in response to mild mental stressors with specific characteristics, in an early hyperkinetic stage of HT, or with respect to certain stress systems), increased physiological reactivity in HT as compared to NT to AMS of strong intensity was observed across all investigated stress-reactive physiological systems. Overall, this systematic review supports the proposed and expected generalized physiological hyperreactivity to AMS with essential hypertension, in particular to strong mental stress. Moreover, we discuss potential underlying mechanisms and highlight open questions for future research of importance for the comprehensive understanding of the observed hyperreactivity to AMS in essential hypertension.

A STUDY OF 24HOUR CENTRAL BLOOD PRESSURE VARIABILITY WITH MEASURES OF MACRO- AND MICROVASCULAR FUNCTION IN A POPULATION OF UNTREATED HYPERTENSIVE AND NORMOTENSIVE INDIVIDUALS

Objective: Central blood pressure (cBP) has been more closely associated with target-organ damage compared with brachial BP, although a bidirectional interplay between central and peripheral arteries exists. Brachial short term BP variability (BPV) has been increasingly related to impaired macro- and microvascular function. However, scarce data exists regarding 24hour central BPV (cBPV) and its impact on organ damage. This study aimed to measure 24h cBPV in a population of untreated essential hypertensive (UHTs) and normotensive (NTs) individuals and evaluate its association with measures of macro- and microvascular function. Design and method: Newly-diagnosed UHTs and NTs were enrolled. 24hour cBP and 24h pulse wave velocity (PWV) were measured with the Mobil-O-Graph device. BPV including average real variability (ARV) of 24h central systolic BP (cSBP) and diastolic BP (cDBP) was calculated according to a standardized formula based on the ambulatory BP monitoring (ABPM) measurements. Urine albumin excretion (UAE) was measured in 24h samples. Results: We recruited 119 individuals including 79 UHTs and 40 NTs that didn’t differ in baseline characteristics. As expected, PWV was increased in UHTs compared to NTs [7.7 (1.5) vs 6.7 (1.2) m/s, p&lt;0.001]. Similarly, in a subset of 60 individuals, UAE was increased [12.1 (9.7) vs 6.4 (4.5) mg/24h, p = 0.008]. UHTs presented higher ARV of 24h, daytime and nighttime cSBP/cDBP compared to NTs (p&lt;0.05 for all comparisons). In total population, 24h PWV positively correlated with ARV of 24h cSBP (r = 0.353, p&lt;0.001) and cDBP (r = 0.235, p = 0.010), ARV of daytime cSBP (r = 0.342, p&lt;0.001) and cDBP (r = 0.235, p = 0.010), and nighttime cSBP (r = 0.297, p = 0.007). Furthermore, UAE correlated with ARV of nighttime cDBP (r = 0.372, p = 0.017). In multivariate analysis after adjusting for age, sex, and hypertension, ARV of 24h cSBP remained an independent predictor of PWV (beta = 0.109, p&lt;0.001). Likewise, ARV of nighttime cDBP independently predicted UAE (beta = 0.480, p = 0.002). Conclusions: In a population of untreated hypertensives and normotensives, cARV indices are significantly and independently associated with measures of macro- and microvascular function including PWV and UAE, respectively. Further studies are warranted to ascertain the clinical value of cARV in terms of risk stratification and management.

The effect of age, sex and BMI on the aldosterone-to-renin ratio in essential hypertensive individuals.

The aldosterone-to-renin ratio (ARR) is widely used as a screening test for primary aldosteronism, but its determinants in patients with essential hypertension are not fully known. The purpose of the present investigation is to identify the impact of age, sex and BMI on renin, aldosterone and the ARR when measured under strict, standardized conditions in hypertensive patients without primary aldosteronism. We analysed the data of 423 consecutive hypertensive patients with no concomitant cardiac or renal disorders from two different hospitals (Rotterdam and Maastricht) who had been referred for evaluation of their hypertension. Those who were diagnosed with secondary causes of hypertension, including primary aldosteronism, were excluded from analysis. Patients who used oral contraceptives or had hormonal replacement therapy were excluded as well. Plasma aldosterone concentration (PAC), active plasma renin concentration (APRC) and the ARR were measured under standardized conditions. All measurements were taken in the supine position at 10.00 h in the morning, with one subgroup of patients adhering to a sodium-restricted diet (55 mmol/day) for no less than 3 weeks, and the other subgroup maintaining an ad libitum diet. In those who were receiving antihypertensive treatment, all medications were discontinued at least 3 weeks before testing. In neither group did aldosterone correlate with age. Renin, however, was inversely related to age both during low-salt diet ( P < 0.001) and during ad lib salt intake ( P = 0.05). This resulted in a significant positive correlation between age and the ARR in both groups. Although on both dietary regimens, PAC and APRC were significantly higher in men when compared with women, the ARR was not significantly different between the two sexes. The age-relationships of renin and the ARR were comparable in men and women on both diets, albeit with greater variability in women. There was an upward trend between BMI and the ARR, which reached statistical significance only in men on low-salt diet. In multivariable regression analysis, age remained the only independent determinant of the ARR. In our essential hypertensive population, the ARR increased significantly with age but was not affected by sex or BMI.

Alpha-Adrenergic Mechanisms in the Cardiovascular Hyperreactivity to Norepinephrine-Infusion in Essential Hypertension.

AimsEssential hypertension (EHT) is characterized by cardiovascular hyperreactivity to stress but underlying mechanism are not fully understood. Here, we investigated the role of α-adrenergic receptors (α-AR) in the cardiovascular reactivity to a norepinephrine (NE)-stress reactivity-mimicking NE-infusion in essential hypertensive individuals (HT) as compared to normotensive individuals (NT).Methods24 male HT and 24 male NT participated in three experimental trials on three separate days with a 1-min infusion followed by a 15-min infusion. Trials varied in infusion-substances: placebo saline (Sal)-infusions (trial-1:Sal+Sal), NE-infusion without (trial-2:Sal+NE) or with non-selective α-AR blockade by phentolamine (PHE) (trial-3:PHE+NE). NE-infusion dosage (5µg/ml/min) and duration were chosen to mimic duration and physiological effects of NE-release in reaction to established stress induction protocols. We repeatedly measured systolic (SBP) and diastolic blood pressure (DBP) as well as heart rate before, during, and after infusions.ResultsSBP and DBP reactivity to the three infusion-trials differed between HT and NT (p’s≤.014). HT exhibited greater BP reactivity to NE-infusion alone compared to NT (trial-2-vs-trial-1: p’s≤.033). Group differences in DBP reactivity to NE disappeared with prior PHE blockade (trial-3: p=.26), while SBP reactivity differences remained (trial-3: p=.016). Heart rate reactivity to infusion-trials did not differ between HT and NT (p=.73).ConclusionOur findings suggest a mediating role of α-AR in DBP hyperreactivity to NE-infusion in EHT. However, in SBP hyperreactivity to NE-infusion in EHT, the functioning of α-AR seems impaired suggesting that the SBP hyperreactivity in hypertension is not mediated by α-AR.

The Relationship of Modifiable Risk Factors with Indicators of Arterial Stiffness and Vascular Age in Patients with Arterial Hypertension

Aim. To study the relationship of modifiable risk factors (RF) with indicators of arterial stiffness and vascular age based on the contour analysis of the pulse wave velocity in hypertensive patients.Material and methods. The material of the study was the data from a survey of patients undergoing clinical observation at the polyclinic of MMC SOGAZ. A total of 107 patients were examined, in which 70 were men and 37 were women. The average age was 52.3±18.29. Photoplethysmography was used as a special research method, performed using the AngioScan-01 diagnostic complex. The main indicators used to evaluate the stiffness of large vessels were: stiffness index (SI), reflection index (RI), augmentation index (Alp75), age index (AGI), pulse wave types (PV) and vascular age (VA).Results. The mean values of arterial stiffness indices in patients with essential arterial hypertension (AH) and healthy individuals (control) had significant differences. The mean SI, Alp75, and VA values in the group of patients with AH were 7.8±1.03, 7.0±14.44 and 50.8±15.93 versus 7.2±1.73, 0.5±18.02 and 43.8±16.94, respectively (p&lt; 0.05). In both groups, a strong inverse correlation of passport age with C-type PV was revealed (r=0.74, p&lt; 0.01), which reflected the dynamics of a gradual age-dependent decrease in vascular compliance. The average VA value in the control group was 63.1±16.99 years with an average passport age of 59.5±8.79 years, which significantly differed from VA in hypertensive patients (p&lt; 0,05). Overweight, hypercholesterolemia, elevated low-density lipoprotein levels, lack of adequate antihypertensive control, and left ventricular diastolic dysfunction were significantly associated with early vascular (arterial) aging.Conclusion. Patients with hypertension, in addition to high blood pressure, significantly differ from normotensive control in terms of arterial stiffness. The lack of control over modifiable RF of patients with hypertension is associated with early vascular aging.

Protective Effect of Mitochondrial ND2 C5178A Gene Mutation on Cell and Mitochondrial Functions.

Background Mitochondrial NADH dehydrogenase subunit 2 (MT-ND2) m. 5178C>A gene mutation has protective effects against various diseases, but the molecular mechanism is still unclear. In previous study, we found a heteroplasmy level of MT-ND2 m. 5178C>A mutation in normotensive controls. Peripheral blood samples were obtained from essential hypertension individuals carrying the mutation and healthy controls without gene mutation to establish immortalized lymphocyte lines. To investigate the effect of the MT-ND2 m. 5178C>A gene mutation, comparative analyses of the two group cell lines were performed, including measurements of cell proliferation, viability, ATP synthesis, mitochondrial oxidative stress, and oxidative phosphorylation. Results The cell proliferation rate and viability of the MT-ND2 m. 5178C>A mutant lymphocyte line were higher than those of the control group. Mitochondrial functions of the MT-ND2 m. 5178C>A mutant lymphocyte were increased, including increased ATP synthesis, decreased ROS production, increased mitochondrial membrane potential and Bcl-2 gene transcription and protein translation, decreased Caspase 3/7 activity, and decreased early apoptosis and late apoptosis. The oxygen consumption rate (OCR) of the mutant lymphocyte line was higher than that of the control group, including basal OCR, ATP-linked OCR, maximal OCR, proton leak OCR, and reserve OCR, and there was no significant difference in nonmitochondrial OCR. The activity of Mitochondrial Complex I of the mutant group was increased than that of the control group. Conclusions The MT-ND2 m. 5178C>A mutation is a protective mutation that may be related to improvement of mitochondrial functions and decrease in apoptosis.

Correlation between serum vitamin D3 levels and blood pressure in patients with essential hypertension and normotensive individuals

Background: Vitamin D, a fat-soluble vitamin is produced when ultraviolet rays from sunlight strike the skin. Literature data supports, there is a relationship between low vitamin D and pathogenesis of cardiovascular diseases and arterial hypertension. It had been seen that lower circulating 25(OH)D levels were associated with higher blood pressures. Aim was to study the correlation between serum vitamin D3 levels and blood pressure in patients with essential hypertension and normotensive individuals.Methods: An observational study was conducted on 60 individuals in the OPD at MGMCRI between January 2018 and December 2018. Based on history and blood pressure values (JNC 7), the population was divided into cases and controls in accordance with the age and sex. Serum Vitamin D levels were measured by chemiluminescence assay and classified into deficiency (&lt;20ng/ml), insufficiency (20-30ng/ml) and sufficiency (30-100ng/ml). Statistical analysis was done using independent t test, one way ANOVA and correlation.Results: Among the hypertensive individuals, 90% were Vitamin D deficient and 10% had insufficiency. The mean Serum Vitamin D level in essential hypertension was 14.6±4.401 (p value &lt;0.001). Serum Vitamin D levels were affected significantly by increasing BMI (p value &lt;0.001) and less sunlight exposure (p value &lt;0.001) among both cases and controls. There was also a significant negative correlation between serum vitamin D levels and systolic blood pressure (p &lt;0.001).Conclusions: Isolated systolic hypertension was associated with lower serum Vitamin D levels. Obesity and reduced sunlight exposure are factors associated with lower serum Vitamin D levels.

Subclinical atherosclerosis due to increase of plasma aldosterone concentrations in essential hypertensive individuals.

The adrenal mineralocorticoid system plays a key role in cardiovascular, metabolic and renal damage. This study aimed to assess the relationship between plasma aldosterone concentration (PAC) and some surrogate markers of subclinical atherosclerosis, such as carotid intima-media thickness (cIMT), ankle-brachial index (ABI) and biochemical parameters in patients with essential hypertension. From January 2014 to December 2017, we consecutively enrolled 804 essential hypertensive patients (407 men and 397 women, mean age 50 ± 14 years) without cardiovascular complications, distinguishing patients in quartiles according to PAC. Compared with the first quartile, the highest PAC quartile was associated with the highest levels of serum uric acid (SUA) (5.3 ± 1.3 vs. 5.0 ± 1.0 mg/dl; P = 0.01), triglycerides (117.5 ± 15.7 vs. 106.8 ± 10.5 mg/dl; P < 0.05), 24-h urinary albumin excretion (UAE) (38.8 ± vs. 7.6 ± mg/24 h; P < 0.05), cIMT (0.87 ± 0.22 vs. 0.80 ± 0.21 mm; P = 0.001) and increased prevalence of carotid plaques (26 vs. 16%; P < 0.005). Moreover, we found that in patients with PAC more than 150 pg/ml, the ABI was significantly lower than those with PAC < 150 pg/ml (1.01 ± 0.09 vs. 1.10 ± 0.09; P < 0.022). PAC was also found to be an independent predictor of the presence of carotid plaques and pathological ABI (<0.9) in essential hypertensive individuals. Our results revealed that higher PAC values are strongly associated with some metabolic variables, as triglycerides, UAE, cIMT, worse ABI and major prevalence of carotid plaques that, together with elevated blood pressure values, are strictly correlated with higher risk of atherosclerosis and cardiovascular complications.

The effect of short-term exposure to red and blue light on the autonomic tone of the individuals with newly diagnosed essential hypertension.

The research study aimed to study the effect of short term exposure to light basically red, blue and white on the autonomic tone of essential hypertensive individuals. The objective was to find out the baseline cardiac autonomic function along with the effect of these lights on the cardiac autonomic function among them. Till date few if any study have been conducted upon the individuals with certain disorder as common as essential hypertension. This was a cross sectional observational study conducted in the institute itself that included 77 newly diagnosed hypertensive subjects who willingly participated in the study. After written informed consent, brief history taking with the help of self-made questionnaire and clinical examination, they were randomized to different intervention groups (IG) namely IG I (red) IG II (blue) and IG III (white). HRV analysis of the last 5-6 minutes of both the baseline and color exposure was finally analyzed using MS Excel version 13 and Graph Pad Prism version 7.05. Different HRV parameters have been found to be affected differently on different color exposures. Red has shown to have an impact, mainly on the sympathetic system whereas white showed a dominant vagal component thus acting as a parasympathetic regulator. On one hand, where no conclusive result was found on blue light exposure, white light showed the most prominent results affecting various time and frequency components of HRV like SDRR, TP, LF etc. The present study, both, contradicts as well as supports various other works done on the similar area of interest. One reason of such high variation in different results is because HRV is itself a very dynamic function affected by even a slight change in both the internal and external environment of the subject. As artificial lights of various colors are part and parcel of the aesthetics and designing of most of the work environment all over world, it is very pertinent to study its impact upon human health status. The outcome of the study may play a decisive role in the diagnostics and therapeutics of essential hypertension in days to come. Furthermore, on the basis of the present findings, a future study could be undertaken with bigger data base addressing the limitations of the present study to find some conclusive evidence in the area highlighted.

Factors associated with high probability of target blood pressure non-achievement in hypertensive patients

One of the topic issue of modern cardiology is factors of target blood pressure level non-achievement clarifying due to a better understanding how we can reduce cardiovascular complications. The aim of the study is to determine the factors of poor blood pressure control using the ambulatory blood pressure monitoring parameters and adenosine 5'-diphosphate-induced platelet aggregation parameters in patients with arterial hypertension. Material and methods. The study involved 153 patients with essential hypertension (EH) stage II, II degree. The ambulatory blood pressure monitoring (ABPM) was performed in patients during at least two of first-line antihypertensive drugs in optimal daily doses usage by the ABPM bifunctional device (Incart, S.-P., R.F.). Platelet aggregation was carried out using light transmittance aggregation by optical analyzer (Solar, R.B.) with adenosine 5'-diphosphate (Sigma-Aldrich) at final concentration of 10.0 × 10 -6 mol / L. The first group were inadequately controlled essential hypertensive individuals with high systolic or/and diastolic BP level according to the ABPM results, and the second one were patients with adequately controlled EH. Groups of patients were comparable in age (60.39 ± 10.74 years vs. 62.80 ± 9.63; p = 0.181, respectively). In the group of EH patients who reached the target level of blood pressure, women predominated (60% vs. 39.81%; p = 0.021, respectively). We used the binary logistic regression analysis to determine the predictors of target blood pressure level poor reaching using ABPM and platelet aggregation parameters. Results According to the univariate logistic regression analysis, the dependent factors influencing the target blood pressure level poor reaching are the average diurnal diastolic blood pressure (DBP) (OR = 44.8); diurnal variability of systolic blood pressure (SBP) (OR = 4.4); square index of hypertension for diurnal periods SBP (OR = 318.9); square index of hypertension for diurnal periods DBP (HS = 36,6); the average pulse blood pressure (OR = 65.9), the rate of morning rise of SBP (OR = 3.6), and the maximum aggregation time of 5-minute ADP-induced platelet aggregation (OR = 3.5). Independent factors influencing the target blood pressure level pure reaching are the average diurnal DBP (OR = 47.8); variability of diurnal SBP (HS = 4.6); the maximum aggregation time of ADP-induced platelet aggregation (OR = 3.4). Female sex is associated with the best prognosis for the target level of BP reaching (OR = 0.4; 95% CI = 0.2‒0.8; p = 0.012). Conclusions . The independent factors influencing the target blood pressure level poor reaching in patients with EH are two ABPM parameters (the average diurnal diastolic blood pressure of more than 76 mm Hg and the variability of SBP diurnal more than 17 mm Hg); and one ADP-induced platelet aggregation parameter (the maximum aggregation time more than 143 seconds). The female sex is associated with better prediction of achieving the target level of blood pressure.

Preliminary analysis of the association between methylation of the ACE2 promoter and essential hypertension.

The aim of the present study was to investigate whether methylation of the angiotensin I converting enzyme2 (ACE2) promoter increases the risk of essential hypertension (EH). A total of 96patients with EH were recruited and 96 sex‑ and age‑matched healthy controls. Methylation of 5 CpG dinucleotides in the ACE2 promoter was quantified using bisulfite pyrosequencing. Logistic regression and multiple linear regression were used to adjust for confounding factors and the generalized multifactor dimensionality reduction (GMDR) method was applied to investigate high‑order interactions. Methylation of CpG4 (adjusted P=0.020) and CpG5 (adjusted P=0.036) was significantly higher in patients with EH, with frequency 97.56±5.65% and 12.75±4.15% in EH individuals and 95.73±9.11% and 11.47±3.67% in healthy controls. GMDR detected significant interaction among the 5 CpG sites (odds ratio=7.33, adjusted P=0.01). Furthermore, receiver operating characteristic curves identified that CpG5 methylation was a significant predictor of EH. Notably, CpG2 methylation was significantly higher in males than in females (adjusted P=0.018). Conversely, CpG5 methylation was significantly lower in males (adjusted P=0.032). These results indicated that aberrant methylation of the ACE2 promoter may be associated with EH risk. In addition, sex may significantly influence ACE2 methylation.

FACTORS INFLUENCING THE FORMATION OF BURNOUT SYNDROME IN PATIENTS WITH WORKPLACE HYPERTENSION

Aim. To study the relationship of psychological factors (perfectionism and mechanisms of psychological defense), with the presence and qualitative characteristics of the syndrome in patients with workplace (WPH), in comparison with other patients with essential hypertension (HT) and healthy individuals. Material and methods. 170 untreated patients with stage II HT (mean age 46.7±4.1 years) were examined. 85 patients with WPH were included into group 1 (46 men; mean age 44.7±4.3 years) and 85 patients without WPH – into group 2 (42 men; mean age 47.4±4.5 years). The control group consisted of 82 healthy individuals (45 men; mean age 44.9±3.1 years). The Russian version of Maslach Burnout Inventory (MBI), the Multidimensional scale of by Hewitt and Flett (MPS), The Life Style Index (LSI) were used for “burnout syndrome” diagnose. Results. The relationship between and burnout was found in all studied groups. The factor socially prescribed perfectionism was most associated with the burnout parameters in both groups of HT patients. In the WPH-group this relationship was more pronounced. The structure of in WPH-patients is the most disharmonious in comparison with patients of the group 2 and healthy persons. The socially prescribed perfectionism was significantly more prevalent (76.6±3.9) compared with other indicators (62.1±4.3 and 61.5±3.6 for oriented to others and to themselves, respectively). In the structure of the protective processes in HT patients of both groups with the maximal degree of excess of the values of healthy individuals two most archaic mechanisms [projection (69.1% and 40.8%) and (51.8% and 40.9%) in groups I and II, respectively] as well as one of the most mature protective processes (intellectualization - 53% and 47.9%, respectively) were revealed. Taken together, this shows a general tension of the system of protective processes. Statistically significant correlations between the high representation of the protective processes negation and projection with high values of the score according to MBI scales were found. Conclusion. Perfectionism and the tension of the mechanisms of psychological defense can be considered as the most important personal characteristics predisposing to the development of syndrome in WPH-patients.

Ambulatory blood pressure monitoring in essential hypertensive patients with acute ischaemic stroke

Blood pressure (BP) has been identified as a risk factor for various health disorders, including stroke onsets. Hypertension is one of the crucial health problem among adult Ukrainian. Due to the importance of elevated BP in stroke causality, BP measurement remains critical. However, it is limited information about value in clinical practice of ambulatory blood pressure monitoring (ABPM) data in hypertensive patients with inadequately controlled BP with acute stroke compared with those individuals who has no vascular onset. The aim of the study was to determine ABPM parameters in essential hypertensive patients with ischaemic hemisphere stroke. Materials and methods. A total of 114 study participants were analyzed (mean age 62 (56;72) years, 40 % women). We divided them into two groups according to the level of 24-h systolic BP (SBP) and diastolic BP (DBP), and the results of clinical examination. The first group (n=83) were inadequately controlled essential hypertensive individuals with high systolic or/and diastolic BP level according to the ABMP results, and the second one (n=31) were EH patients with an acute hemispheric ischaemic stroke (IS). Diagnosis of stroke was confirmed with clinical examination and computed tomography scan or magnetic resonance imaging results, and ABPM was conducted in 4.2±2.3 days after the stroke onset. Results. We had statistician difference (p<0.001) between groups of such parameters, as average SBP (diurnal, daytime, nighttime); diurnal pulse BP; SBP load (p<0.05); the diurnal AASI (p<0.05); circadian rhythm of DBP (p<0.05). No differences were found between the groups in morning surge calculated as speed and amplitude of the BP climbed in morning hours both for SBP (P=0.422 and P=0.395, respectively) and DBP (P=0.860 and P=0.337, respectively). Conclusion . In the present study, we evaluated the ABPM parameters in inadequately controlled essential hypertensive individuals with and without acute ischaemic hemispheric stroke. There was no statistical difference in ABPM parameters as for diastolic BP (averages, BP load) and for systolic BP (some parameters of BP load, variability). Meanwhile, there was statistician difference in systolic BP profile (averages, BP load, and the circadian index), pulse BP and the diurnal AASI.

The relationship between blood pressure dipping status and carotid plaque in senior essential hypertensive individuals of different sexes: a cross-sectional study.

To investigate the associations of the blood pressure (BP) dipping status with carotid plaque in senior essential hypertensive patients of different sexes. A total of 512 patients (275 men and 237 women) with essential hypertension who underwent ambulatory BP monitoring and carotid ultrasound assessment were recruited in our study. Binary logistic regression was used to analyze the associations of multiple risk factors with carotid plaque. Abnormal dipping [odds ratio (OR)=2.138, 95% confidence interval (CI) 1.170-3.908, P<0.05] and circadian decline rate of systolic BP (SBP) (OR=0.925, 95% CI 0.884-0.968, P<0.01) were found to be associated with carotid plaque in men. The level of night-time SBP (OR=1.022, 95% CI 1.003-1.042, P<0.05) and carotid plaque were associated with each other in women. In addition, as for all the patients in our study, abnormal dipping (OR=1.743, 95% CI 1.114-2.725, P<0.05), circadian decline rate of SBP (OR=0.950, 95% CI 0.922-0.980, P<0.01), the level of night-time SBP (OR=1.030, 95% CI 1.014-1.047, P<0.001), and the level of daytime diastolic BP (OR=0.971, 95% CI 0.946-0.998, P<0.05) were associated with carotid plaque, respectively. Our results suggested that the abnormal dipping status of BP and circadian decline rate of SBP might serve as independent risk factors for carotid plaque, respectively, in men, as does night-time SBP in women. Therefore, personalized BP management may be necessary for hypertensive patients.

Waist circumference compared with other obesity parameters as determinants of coronary artery disease in essential hypertension: a 6-year follow-up study.

This study aimed to assess the predictive role of body mass index (BMI), waist circumference (WC) and the waist-to-hip ratio (WHR) for the incidence of coronary artery disease (CAD) in a cohort of essential hypertensive patients. We followed up 2266 essential hypertensive individuals (mean age, 57.8 years; males, 1083; office blood pressure (BP), 143/89 mm Hg) who were free of cardiovascular disease for a mean period of 6 years. All subjects had at least one annual visit and, at baseline, underwent blood sampling and a complete echocardiographic study to determine the left ventricular (LV) mass index. CAD was defined as a history of myocardial infarction or significant coronary artery stenosis that was revealed by angiography or a coronary revascularization procedure. The incidence of CAD throughout the follow-up period was 2.33%. Hypertensive individuals who developed CAD (n=53) had a greater baseline WC (101.1±11.7 vs. 96.4±12 cm, P=0.005), WHR (0.94±0.07 vs. 0.89±0.08 cm, P<0.0001) and LV mass index (117±26.8 vs. 103.3±27 g m(-)(2), P<0.0001) compared with those without CAD at follow-up (n=2213), whereas no difference was observed compared with the baseline office BP and BMI values (P=NS for all). Using a multivariate Cox regression model, WC (hazard ratio (HR) 1.037, P=0.002) and LV mass index (HR 1.010, P=0.044) were found to be independent predictors of CAD. In essential hypertensive patients, WC could predict the future development of CAD, whereas BMI and WHR showed no independent prognostic value. These findings suggest that WC constitutes an easy clinical tool to assess risk in hypertension among individuals with obesity.

Serum Aldosterone Levels In Hypertension

Aims: Hypertension affects around 30% of the adult population. It is related to cardiovascular complications, especially on account of atherosclerosis. Resistant hypertension (RH) occurs when blood pressure remains above target value despite the use of three antihypertensive medications with synergistic actions at maximum recommended doses or whenever the patient makes use of four or more antihypertensive drugs even when blood pressure is controlled. Hyperaldosteronism is an important cause of RH. The study aims to evaluate the association of aldosterone concentrations not only in essential hypertensive individuals but with RH correlating also with inflammatory levels. Methods: A total of 44 EH patients and 32 RH patients were selected. All of them were submitted to serum analysis of urea, creatinine, potassium, aldosterone, fasting glycemia, glycated hemoglobin (HbA1C), complete blood count, usCRP, homocysteine and beta-2 microglobulin (B2M). Results: No significant difference could be observed among the groups regarding the inflammatory markers TNF-alpha, IL-6, usCRP, homocysteine and B2M. As to aldosterone and the ratio of albumin to creatinine (ACR), there was an expressive difference; however, no correlation between ACR and aldosterone could be found.Conclusions: In this sample of hypertensive individuals, aldosterone levels are relatively higher in RH when compared with those with EH.

PP.42.07

Objective: Analyzing 25-hydroxyvitaminD (25[OH]D) serum levels and common carotid intima-media thickness (IMT) relationship, and evaluating the association of FokI and BsmI vitamin D receptor (VDR) gene polymorphisms with IMT in essential hypertensive patients were our study aims. Design and method: We enrolled seventy-one essential hypertensive patients, 18–75 years old. Patients underwent clinical blood pressure (BP) measurement, 24 hour ambulatory blood pressure monitoring, routine blood test, 25[OH]D assay and common carotid IMT evaluation. FokI and BsmI VDR polymorphisms were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: We did not find significant correlation between 25[OH]D and IMT. IMT was correlated with 24 h systolic BP, 24 h pulse BP, age, body mass index, glomerular filtration rate estimated by CKD-EPI equation, and HDL cholesterol in the univariate analysis, but not in the multivariate model. When we divided patients in accordance to FokI or BsmI VDR genotypes, there were not differences in IMT among the groups. No association between a specific genotype or allele and IMT greater than 0.9 mm was pointed out (Figure 2).Conclusions: Our results seem to exclude any association between either 25[OH]D concentrations or VDR FokI and BmsI polymorphisms and common carotid IMT in essential hypertensive individuals.

PP.10.06

Objective: Aortic pulse wave velocity (aPWV), is one of the most important markers of vascular aging. It is well known that connective tissue diseases are associated with accelerated atherosclerosis, but only a few data are available about aPWV in patients with systemic lupus erythematosus (SLE). The aim of this study was to evaluate early vascular aging, assessed by measuring aPWV, in a group of normotensive patients with SLE and to compare these subjects with a group of young essential hypertensive (EH) individuals Design and method: Cross-sectional study.We have enrolled 39 normotensive SLE subjects (mean age: 38.7 ± 8.3 years) matched for age with a group of essential hypertensive patients (mean age 38.7 ± 9.8 years). Each patient has been underwent aPWV measurement through an oscillometric device (Arteriograph). Results: As for selection, systolic and diastolic blood pressure values were significantly lower (121/71 ± 14/9 mmHg) in the SLE patients when compared to those of the hypertensive subjects (151/98 ± 14/8 mmHg; p < 0.001). Despite this difference regarding BP, aPWV was similar in the two groups, being 9.1 ± 2,9m/sec in SLE subjects and 9.05 ± 2 m/sec in the group of young essential hypertensive patients (p = ns). In both groups aPWV was greater than that of the normal population in the same age category (6.5 m/s). Conclusions: Our results seem to suggest that SLE has the same deleterious impact on vascular aging as well as high blood pressure. It is very likely that this unfavourable effect of SLE is mediated by chronic inflammation.

Characteristics of salt intake in essential hypertensive patients regarding socio-demographic factors

Background: High sodium intake is a well-known and important environmental factor for the development of hypertension and cardiovascular events. A reduction in dietary sodium intake reduces blood pressure and the long-term risk of cardiovascular events. Objectives: This study was to evaluate relationship between salt intake and blood pressure in a representative group ofhypertensive patients in National Cardiovascular Center of Harapan Kita, Jakarta. Methods: The enrolled essential hypertensive individuals (n = 114) completed a questionnaire including demographics, dietary habits, hypertension awareness and drug usage from April to December 2014. Blood pressure was measured, 48 hours dietary recall and to estimate salt consumption, 24-h urine samples were collected. Results: The daily urinary sodium excretion was 410.2 ± 136.5mmol/dayequals to a salt intake of 23.98 g/day. Eighteen (15.8%) patients consume 2 antihypertensive therapy, sixty seven (58.8%) patients with 3 antihypertensive therapy, twenty nine (39.4%) patients with more than 3 antihypertensive therapy. Salt intake was higher in male, lower education levels, lower monthly income and elderly. No differences were observed between salt intake among hypertensive patients with associated diabetes or hyperlipidemia, this is the same of previously study. Conclusion: This data revealed that patients who administered antihypertensive therapy still consume high salt intake and consumption of high salt in essential hypertensive patients interfered by many socio-demographic factors.