Non-diabetic Hypertensive Patients Research Articles

Relation of short-term blood pressure variability to early renal effects in hypertensive patients with controlled blood pressure.

Microalbuminuria is a common early hypertension-mediated organ damage, which correlates with the overall cardiovascular risk and development of end-stage renal damage. Lately, blood pressure variability has shown an additive value over traditional BP measurement in prediction of cardiovascular and renal involvement. Investigate the relation between short-term blood pressure variability and microalbuminuria in controlled hypertensive patients. Ninety non-diabetic hypertensive patients with controlled blood pressure and normal estimated glomerular filtration rate had 24-hour ambulatory blood pressure monitoring with calculation of short-term blood pressure variability indices (SD, coefficient of variation and average reading variability of systolic and diastolic blood pressure for 24-hour, daytime and nighttime], and measurement of the albumin/creatinine ratio. Patients were classified into group 1 (61 patients without microalbuminuria) and group 2 (29 patients with microalbuminuria). No significant difference was observed between both groups regarding age, sex, body mass index, office blood pressure, average 24-hour ambulatory blood pressure monitoring readings and dipping status, but significantly longer duration of hypertension in group 2. All blood pressure variability indices were significantly higher in group 2, which showed strong positive correlations with microalbuminuria level. Multivariate analysis represented an average reading variability of 24-hour systolic blood pressure as the most powerful independent predictor for microalbuminuria (r = 0.516, P = 0.001). Receiver operating characteristic curve analysis revealed that average reading variability of 24-hour systolic blood pressure (>12.55) could predict microalbuminuria (sensitivity = 89.7%, specificity = 88.5%, area under curve = 0.949, P = 0.001). Short-term blood pressure variability correlated well with early renal effects in controlled hypertensive patients. Average reading variability of 24-hour systolic blood pressure was the strongest predictor for microalbuminuria in such patients.

Association of urinary sodium/potassium ratio with structural and functional vascular changes in non-diabetic hypertensive patients.

Studies aiming to associate the sodium/potassium (Na/K) ratio with hypertension use 24-hour urinary excretion as a daily marker of ingestion. The objective of this study was to evaluate the association between urinary Na/K ratio and structural and functional vascular alterations in non-diabetic hypertensive patients. In hypertensive patients (n=72), aged between 40 and 70years, both sexes (61% women), in use of hydrochlorothiazide, we measured blood pressure, 24-hour urine sample collection, assessment of carotid-femoral pulse wave velocity (cf-PWV, Complior), central hemodynamic parameters (SphygmoCor), and post-occlusive reactive hyperemia (PORH). The participants were divided according to the tertile of 24-hour urinary Na/K ratio. Each group contained 24 patients. Systolic blood pressure was higher in T2 (133±9 vs 140±9mmHg, P=.029). C-reactive protein (CRP) presented higher values in T3 as compared to T1 [0.20(0.10-0.34) vs 1.19 (0.96-1.42) mg/dL, P<.001]. Higher values in T3 were also observed for aortic systolic pressure (aoSP) [119(114-130) vs 135(125-147) mmHg, P=.002] and cf-PWV (9.2±1.6 vs 11.1±1.5m/s, P<.001). The urinary Na/K ratio presented significant correlations with proteinuria (r=.27, P=.023), CRP (r=.77, P<.001), cf-PWV (r=.41, P<.001), and post-occlusive reactive hyperemia on cutaneous vascular conductance (PORH CVC) (r=-.23, P=.047). By multivariate linear regression, it was detected an independent and significant association of cf-PWV with urinary Na/K ratio (R2 =0.17, P<.001) and PORH CVC with CRP (R2 =0.30, P=.010). Our data indicated that increased urinary Na/K ratio in non-diabetic hypertensive patients was associated with higher degree of inflammation, raised peripheral and central pressure levels, and changes suggestive of endothelial dysfunction and arterial stiffness.

Variations of oxidized ldl and adipocytokine during metabolic syndrome in hypertensive patients

Oxidative stress, obesity and metabolic syndrome (MS) are often combined in the pathophysiology of hypertension. The aim of this study was to quantify the plasma levels of leptin, adiponectin, and oxidized LDL in patients with essential hypertension, and to correlate these parameters with the metabolic disorders. Our prospective study was carried out in 160 non-diabetic hypertensive patients, age: 57 ± 8.49 years, 118 women and 42 men. Fasting biomarkers were measured: glycaemia, renal balance, total cholesterol, triglycerides, HDLc, LDLc, CRPus and insulinemia. Insulin resistance was assessed using the homeostasis model (HOMA-IR), coupled with anthropometric measurements (weight, BMI, waist circumference); ELISA assayed Leptin, adiponectin and oxidized LDL. Data on demographic characteristics, blood pressure and other variables were collected. The prevalence of metabolic syndrome (MS) in our series was 58%, 53% of patients were sedentary, 40% overweight and 39.25% of them obese. The insulin resistance evaluated by the HOMA-IR was 37%. The concentrations of leptin were 38.22 ± 24.31 ng/ml in MS patients and 33.34 ± 19.62 ng/ml in patients without MS and higher in obese patients. There was a statistically significant difference in adiponectin dosages between groups ( P = 0.046), 6.92 ± 3.18 ng/ml in for the MS group, and 8.74 ± 5.02 ng/ml in patients without MS. Oxidized LDL levels were 4.58 ± 3.74 μg/ml in MS patients and 2.16 ± 1.41 μg/ml in patients without MS ( P < 10 −5 ). In the MS group a positive correlation was found between leptin and waist circumference ( P < 0.0001), BMI ( P < 0.0001), TG ( P = 0.02) and HDLc ( P < 0.0001), no significant correlation was found between adiponectin and HOMA-IR. Our preliminary data revealed an elevation of oxidized LDL and leptin in hypertensive patients with metabolic syndrome. Adipo-cytokines have an important metabolic role; they interact directly with insulin signalling pathways.

Peripheral arterial disease of the lower limbs in Moroccan hypertensive non-diabetic patients

Peripheral arterial disease (PAD) of the lower limbs is only an aspect of a general vascular disease; PAD announces cardiovascular accidents. Thus, the early screening of PAD is a major issue. To evaluate the prevalence of PAD of the lower limbs in asymptomatic patients with hypertension and to determine the risk factors or associations of risk factors most frequently responsible of pathological (< 0.9) ankle-brachial index (ABI). We conducted a prospective survey including 273 patients from November 2016 to December 2017 in our department. The mean population's age was 62.09 years (27–88 years), with a male predominance gender (67,76%). The prevalence of PAD was 28.94%. Risk factors or association of risk factors that were significantly associated with PAD (Chi 2 Pearson test) were: the male gender (72%), tobacco use (56%), obesity (BMI ≥ 30) 15.8%, dyslipidemia and grade-3 hypertension (23.4%). PAD of the lower limbs is a particular location of the atheromatous process as well as a marker of its diffusion. As a result of this study, we recommend the screening of asymptomatic PAD in all hypertensive patients by measuring the ankle-brachial index.

CHANGES IN GLUCOSE METABOLISM PLAY A ROLE IN THE ASSOCIATION BETWEEN VITAMIN D INSUFFICIENCY AND SUBCLINICAL ORGAN DAMAGE IN HYPERTENSION

Objective: Recent studies have shown that low vitamin D levels are associated with greater subclinical target organ damage (TOD) in hypertension, but the mechanism has not been clarified. We previously reported that vitamin D (25OH-D) insufficiency is associated with a greater blood glucose response to an oral glucose load in non-diabetic patients with essential hypertension (EH). We therefore sought to investigate whether changes in glucose metabolism could play a role in the relationship between 25OH-D insufficiency and hypertensive TOD. Design and method: In 203 non-diabetic EH patients (age 50 ± 13 yr, 113 males, 85 never treated) we measured plasma levels of 25OH-D, fasting and post-glucose load (OGTT) glucose and insulin and calculated the HOMA index, and assessed renal function by measuring 24-h creatinine clearance (GFR) and urinary albumin excretion (UAE). We also performed conventional and tissue-Doppler echocardiography (TDI), carotid echo-Doppler ultrasound and renal ultrasound with measurement of intrarenal resistance indexes (IRI). Results: On univariate analysis, 25OH-D levels were inversely related with the area under the curve (G-AUC) of glucose response to OGTT (r = −0.244, P < 0.001) and also with age, left ventricular mass index (LVMI), E/A, E/e′ ratio, carotid intima-media thickness (IMT), and IRI. G-AUC was directly related with age, systolic blood pressure, body mass index, duration of hypertension, LVMI, E/A, E/e′, IMT, IRI, and inversely related to e′ velocity at TDI. Neither 25OH-D nor G-AUC were related to GFR or UAE. In multivariate models, we examined the relationship of different types of TOD that were included as dependent variables with 25OH-D levels and G-AUC that were included as independent variables together with other confounders identified in the univariate analysis. In these analyses, LVMI (B = 0.197, P = 0.008), E/A (B = −0.188, P = 0.005), and E/e′ ratio were independently related with G-AUC but not 25OH-D levels. Conversely, the IMT was independently related with 25OH-D levels (B = −0.177, P = 0.023) but not with G-AUC, and only IRI was independently related with both 25OH-D levels and G-AUC. Conclusions: These results suggest that the interaction between vitamin D and glucose metabolism might have a role in the development of subclinical organ damage in nondiabetic hypertensive patients

Calcium channel blocker monotherapy versus combination with renin-angiotensin system inhibitors on the development of new-onset diabetes mellitus in hypertensive Korean patients.

BackgroundIn real practice, two or more antihypertensive drugs are needed to achieve target blood pressure. We investigated the comparative beneficial actions of combination therapy of renin-angiotensin system inhibitors (RASI), with calcium channel blockers (CCB) over CCB monotherapy on the development of new-onset diabetes mellitus (NODM) in Korean patients during four-year follow-up periods.MethodsA total of 3208 consecutive hypertensive patients without a history of diabetes mellitus who had been prescribed CCB were retrospectively enrolled from January 2004 to December 2012. These patients were divided into the two groups according to the additional use of RASI (the RASI group, n = 1221 and the no RASI group, n = 1987). Primary endpoint was NODM, defined as a fasting blood glucose ≥ 126 mg/dL or hemoglobin A1c ≥ 6.5%. Secondary endpoint was major adverse cardiac events (MACE) defined as total death, myocardial infarction (MI) and percutaneous coronary intervention (PCI).ResultsAfter propensity score-matched (PSM) analysis, two propensity-matched groups (939 pairs, n = 1878, C-statistic = 0.743) were generated. The incidences of NODM (HR = 1.009, 95% CI: 0.700–1.452, P = 0.962), MACE (HR = 0.877, 95% CI: 0.544–1.413, P = 0.589), total death, MI, PCI were similar between the two groups after PSM during four years.ConclusionsThe use of RASI in addition to CCB showed comparable incidences of NODM and MACE compared to CCB monotherapy in non-diabetic hypertensive Korean patients during four-year follow-up period. However, large-scaled randomized controlled clinical trials will be required for a more definitive conclusion.

Hypertensive retinopathy and associated factors among nondiabetic chronic kidney disease patients seen at a tertiary hospital in Tanzania: a cross-sectional study.

Background: Hypertensive retinopathy is a known marker of cardiovascular disease, and among unselected patients with chronic kidney disease (CKD) more severe retinopathy has been associated with lower estimated glomerular filtration rate (eGFR). This association has, however, not been widely studied among nondiabetic hypertensive patients with CKD, especially in sub-Saharan Africa. We aimed to determine the prevalence and severity of hypertensive retinopathy and its relationship with eGFR among nondiabetic CKD patients seen at Muhimbili National Hospital in Dar es Salaam, Tanzania.Methods: A hospital-based cross-sectional study was conducted among nondiabetic CKD adult (≥18 years) patients with hypertension. A structured questionnaire was used to record patients’ demographic characteristics and their cardiovascular risk profile. eGFR was calculated using the Modification of Diet in the Renal Disease (MDRD) equation and only patients with CKD stage 3 or more were enrolled in the study. Grading of retinopathy was done using the Keith–Wagener classification.Results: In total, 224 patients fulfilled the inclusion criteria and were enrolled. Their mean age was 45.8±14.1 years, and 59.4% were men. The proportions of patients with stage 3, 4, and 5 CKD were 21.4%, 19.6%, and 58.9%, respectively. Hypertensive retinopathy was present in 157 (70.1%) patients and the proportions with grade I, grade II, grade III, and grade IV retinopathy were 17.9%, 18.8%, 19.6%, and 13.8%, respectively. The severity of retinopathy increased with decreasing levels of eGFR, and in multivariate logistic regression analysis, factors found to be independently associated with ≥grade II hypertensive retinopathy were more severe CKD, higher hypertension grades, and alcohol use, all p<0.05.Conclusion: The prevalence of hypertensive retinopathy is high among nondiabetic CKD patients seen at a tertiary hospital in Tanzania and is independently associated with CKD severity. Retinopathy grade can be used as a marker of CKD severity among these patients.

Serum uric acid concentration is associated with ascending aortic dilatation in newly diagnosed nondiabetic hypertensive patients

ABSTRACTObjectives: Recently, serum uric acid (UA) has emerged as an important independent risk factor for adverse outcomes in hypertension. The aim of the study was to evaluate the relationship between UA levels and ascending aortic dilatation (AAD) in newly diagnosed nondiabetic hypertensive subjects.Methods: A total of 818 patients with a new diagnosis of hypertension for which they had never received treatment were enrolled in this cross-sectional study. All patients underwent comprehensive transthoracic echocardiography measurement. AAD was defined as a diameter of ascending aorta equal to or more than 35 mm.Results: There were 302 patients with AAD (mean age 69 ± 11 years; 157 male) and 516 subjects with normal ascending aorta diameters (mean age 64 ± 12 years; 158 male). The correlation analysis pointed out positive correlations between ascending aorta size and serum UA levels (r = 0.30, P<0.001). In multiple logistic regression analysis, the OR of a 1 mg/dL increase in serum UA was 1.29(95% CI, 1.18 to 1.43; P < 0.001) for AAD. In reference to the first quartile, the prevalence of AAD increased such that the OR for the fourth quartile was 4.03 (95% CI, 2.38 to 6.82; P for trend < 0.001) of the serum UA concentration. The optimal UA cutoff value for detecting AAD was 6.45 mg/dL, based on receiver operating characteristic curve analysis with a sensitivity of 68.0% and a specificity of 70.0%.Conclusion: Serum UA concentration was significantly associated with AAD prevalence in newly diagnosed nondiabetic hypertensive patients.

Mineralocorticoid receptor blockade suppresses dietary salt-induced ACEI/ARB-resistant albuminuria in non-diabetic hypertension: a sub-analysis of evaluate study.

Excessive dietary salt intake can counteract the renoprotective effects of renin-angiotensin system (RAS) blockade in hypertensive patients with chronic kidney disease (CKD). In rodents, salt loading induces hypertension and renal damage by activating the mineralocorticoid receptor (MR) independently of plasma aldosterone levels. Thus, high salt-induced resistance to RAS blockade may be mediated by MR activation. To test this, a post hoc analysis of the Eplerenone Combination Versus Conventional Agents to Lower Blood Pressure on Urinary Antialbuminuric Treatment Effect (EVALUATE) trial was conducted. Thus, 304 non-diabetic hypertensive patients on RAS-blocking therapy were divided into tertiles according to salt intake (estimated 24-h urinary sodium excretion at baseline) and compared in terms of percent reduction in urinary albumin-to-creatinine ratio (UACR) at 52 weeks relative to baseline. The eplerenone-treated patients in the highest sodium excretion tertile exhibited significantly greater reduction in UACR than the placebo subjects in the same tertile (-22.5% vs. +21.8%, p = 0.02). This disparity was not observed in the lowest (-10.2% vs. -0.84%, p = 0.65) or middle (-19.5% vs. +9.5%, p = 0.22) tertiles. Similar systolic blood pressure changes were observed. In the whole cohort, reduction in UACR correlated positively with reduction in systolic blood pressure (r2 = 0.04, p = 0.02). These results support the hypothesis that excessive salt intake can enhance resistance to RAS blockade by activating MR. They also suggest that eplerenone plus RAS blockade may be effective for CKD in hypertensive patients, especially those with excessive salt intake.

The relation between insulin resistance and left ventricular mass in hypertensive nondiabetic patients

Background: Patients with essential hypertension (EH) are often associated with left ventricular (LV) hypertrophy (LVH) and insulin resistance (IR). Insulin may have a direct growth-promoting effect on cardiomyocytes. Hence, the aim of this work was to study the effect of IR on LV geometry in newly diagnosed arterial hypertensive nondiabetic patients not taking any antihypertensive medication. Methods: One hundred and eight patients were included in our study including 88 newly diagnosed hypertensive nondiabetic patients and 20 healthy controls. Fasting glucose, insulin levels, total cholesterol, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol, and triglyceride levels were measured. Homeostasis Model Assessment (HOMA) index was calculated for the assessment of IR. Echocardiography measurements of LV dimensions such as LV mass (LVM) and LVM index (LVMI) were calculated. Results: Fasting blood insulin and HOMA index were significantly higher in patients with LVH than patients with normal LV dimensions and controls. We found highly significant positive correlations between insulin levels, LVM, and LVMI. In addition, we found highly significant positive correlations between HOMA index, LVM, and LVMI. Conclusion: We conclude that cardiac changes in hypertensive patients including those with increased wall thickness, LVM, and LVMI are mediated, at least in part, by increased insulin levels and the HOMA index.

Long-Term Effects of Intensive Low-Salt Diet Education on Deterioration of Glomerular Filtration Rate among Non-Diabetic Hypertensive Patients with Chronic Kidney Disease

Background: Diet modification, especially a decrease in salt intake, might be an important non-pharmacological strategy to improve chronic kidney disease (CKD) prognosis. Objectives: We conducted a prospective cohort study to investigate whether an intensive low-salt diet education program effectively attenuated the rate of renal function decline in hypertensive patients with CKD. Methods: This cohort study recruited 171 participants from a previous open-labelled, case-controlled, randomized clinical trial that originally consisted of 245 hypertensive CKD patients who were assigned to two groups, intensive low-salt diet or conventional education. We evaluated the renal outcomes, which included the rate of change in estimated glomerular filtration rate (eGFR) per year, the increase in serum creatinine ≥50%, the decrease in eGFR ≥30%, and the percent change in albuminuria throughout the entire study period. Results: The baseline characteristics of the cohort participants between the two groups were similar at the time of trial phase randomization. During the whole study period, the rate of renal function decline was significantly faster in the conventional group (0.11 ± 4.63 vs. –1.53 ± 3.04 mL/min/1.73 m2/year, p = 0.01). The percent of incremental change in serum creatinine ≥50% was 1.1% in the intensive group and 8.2% in the conventional group (p = 0.025), and the percent of decremental change in eGFR ≥30% was 3.3% in the intensive group and 11.1% in the conventional group (p= 0.048). With logistic regression analysis adjusted for related factors, we found that the conventional group showed a higher risk for deterioration in serum creatinine and eGFR during the entire study period. Especially, we found that the intensive education program preserved eGFR in participants with one, several, or all of the following characteristics at the time of randomization: older age, female, obese, had higher protein intake, higher amounts of albuminuria, higher salt intake. Conclusion: This cohort study demonstrated that an intensive low-salt diet education program attenuated the rate of renal function decline in hypertensive CKD patients independent of its effect on lowering salt intake or albuminuria during the 36 months of follow-up.

Determinants of pulse pressure amplification in hypertensive and diabetic patients

Hypertensive diabetic patients remain at high cardiovascular risk despite adequate blood pressure and glycemic control. Pulse pressure amplification (PPA) is expressed as the peripheral-to-central PP ratio and provides complementary information for use in assessing cardiovascular risk. The aim of our study was to determine the clinical and biological determinants of PPA in hypertensive and diabetic patients. A cross-sectional study was conducted in 624 patients. Applanation tonometry was used to determine hemodynamic parameters. Age, gender, and the association between hypertension and diabetes were the independent factors of PPA in our population (N = 624). A threshold of 55 years of age was chosen because of its link with menopause in our analysis. Multivariate regression analyses were performed to evaluate the independent determinants of PPA for hypertensive diabetic and hypertensive nondiabetic male and female patients. HbA1c level is the main factor of increased PPA regardless of age and gender (P < 0.05). Mean BP negatively regulates PPA in the overall study: men > 55 years (P = 0.0001) and women > 55 years (P = 0.03). The threshold calculated glomerular filtration rate (cGFR) < 60 mL/min/1.73 m2 was an independent and negative factor of PPA in hypertensive diabetic men regardless of age (P < 0.05) and in women > 55 years (P = 0.04). Mean BP negatively regulates PPA in hypertensive nondiabetic patients (P < 0.04) regardless of age and gender, except in women > 55 years, where cGFR < 60 (P = 0.04) negatively regulates the modulation of PPA. HbA1c and threshold cGFR < 60 have highly significant impacts on PPA in hypertensive diabetic patients, whereas mean BP appears as the main factor of PPA in hypertensive nondiabetic patients.

GW29-e0337 Relationship between Adiponectin, Insulin Resistance and Atherosclerosis in non-diabetic Hypertensive Patients and Healthy Adults

GW29-e0337 Relationship between Adiponectin, Insulin Resistance and Atherosclerosis in non-diabetic Hypertensive Patients and Healthy Adults

A1635 Relationship among adiponectin, insulin resistance and atherosclerosis in non-diabetic hypertensive patients and healthy adults

A1635 Relationship among adiponectin, insulin resistance and atherosclerosis in non-diabetic hypertensive patients and healthy adults

Abstract P270: Increase of Total Peripheral Vascular Resistance and Arterial Stiffness in Non-Diabetic Hypertensive Patients With Overweight, Compared With Hypertensive Patients of the Same Age With Normal Body Mass Index

Introduction: it is known that obese hypertensive patients (HTAO) have more difficulties for the better control of blood pressure, being involved many factors that try to explain this situation. However, little has been said regarding total vascular resistance and arterial stiffness (AS) in overweight patients (OWHTA), so we present this work that could provide data of interest in these Objectives: to assess the relationship between adequate control of blood pressure, AS and TPR in patients with OWHTA compared with hypertensive patients with a normal body mass index (BMI). Material and Method: cross-sectional and prospective study of a cohort of 1700 male patients (P) with hypertension, we have 290 P divided into two groups: OWHTA Group 190 P with BMI between 25 and 29 (65 ± 8 years) and Group HTA: 100 P with BMI &lt;25 (66 ± 6 years) who have received treatment from their GP, to keep the BP below 140/80 and apparently were well controlled. A 24 hours blood pressure holter (ABPM) was performed in all patients, and augmentation index (AI) ,pulse wave velocity (PWV) as well as the TPR were measured. The results were compared in both groups and are presented in the following table: Results: Table of results: *means p value less than 0.05. Conclusions: according to our data, in hypertensive males with overweight there are already aggravating factors such as the difficulty for better hypertension control , increase in AS and a significant increase in the TPR that has been seen in obese patients. All of these factors make the cardiovascular risk of these patients much greater, and forces the physician to be more demanding with the therapeutic measures.

Albuminuria during treatment with angiotensin type II receptor blocker is a predictor for GFR decline among non-diabetic hypertensive CKD patients

BackgroundAlbuminuria is a predictor of disease progression in patients with chronic kidney disease (CKD). However, the ability of proteinuria parameters measured at various time periods to predict renal outcomes is unclear.MethodThis observational cohort study included 165 non-diabetic hypertensive CKD patients who took olmesartan medoxomil. We measured the albuminuria at five different time points (0, 2, 4, 26, and 38 months) and the mean levels. The mean albuminuria levels were calculated during 0–4 months, 0–26 months, and 0–38 months. The renal outcome was defined as a decline in eGFR ≥ 40% during the entire study period.ResultThe albuminuria at five different time points and the mean albuminuria levels were independent risk factors for a worse renal outcome after adjusting for age, sex, and estimated glomerular filtration rate (eGFR) at enrollment and were able to predict the renal outcome, although the performance of the estimation tended to be more effective using the mean albuminuria level at the 38-month follow-up time point. The risk of a decline in eGFR ≥ 40% was increased by 1.690-folds [95% CI 1.110–2.572, P = 0.014] per 500 mg/day increase in the mean albuminuria at 38 months. With a cut-off value of 897 mg/day for mean albuminuria at 38 months after treatment, a decline in eGFR ≥ 40% was predicted with a sensitivity of 88.9% and specificity of 81.3%. The ability of albuminuria to predict a renal event at different measurement points does not differ in CKD patients.ConclusionThe time-averaged albuminuria cut-off of 900 mg/day during the 3-year follow-up period showed high sensitivity and specificity for predicting a decline in eGFR ≥ 40% in CKD patients, although the albuminuria at different measurement points did not predict a worse renal outcome.

Optimal Blood Pressure Target in Diabetic and Nondiabetic Hypertensive Patients.

Optimal Blood Pressure Target in Diabetic and Nondiabetic Hypertensive Patients.

Short-Term Effects of a Sodium-Glucose Linked Transporter 2 Inhibitor on Left Ventricular Relaxation in Nondiabetic Hypertensive Patients

Background: The rapid beneficial effects of Empagliflozin on cardiovascular mortality and hospitalization rate for heart failure in subjects with type 2 diabetes Mellitus raised some questions related to a potential intrinsic effect on the heart. We conducted this study in a population of nondiabetic hypertensive patients in order to look out for short-term effects on left ventricular relaxation. Methods: We carried out a single arm non-randomized clinical trial. Each patient received 25mg of empagliflozin as add-on therapy once daily for six weeks. We included nondiabetic hypertensive patients on stable anti-hypertensive medication for at least 12weeks with diastolic dysfunction haven given their informed consent. The outcome measures were to evaluate the left ventricular relaxation, to determine changes in the nycthemeral blood pressure profile and to evaluate the electrocardiographic profile before and after the treatment. The primary endpoint was the increase in velocity of the lateral mitral annulus e’ at Doppler echocardiography. Results: A total of 11 patients were treated. Nine patients had significant improvement of their mitral profiles E/A from 0.71 [0.58-0.75] to 0.82 [0.79-0.93] cm/s (p= 0.008). The velocity e’ that was impaired in 5 patients improved by 22% in 4 patients. The effect of empagliflozin was non-significant on blood pressure at ABPM. On the electrocardiogram we observed a significant decrease in the PR interval from 200 [157-200] to 160 [143-186] ms, p= 0.04. Conclusion: Daily intake of 25mg Empagliflozin is associated with an early improvement of the left ventricular relaxation in nondiabetic hypertensive patients without significant reduction in blood pressure. This suggests an intrinsic myocardial action of Empagliflozin to investigate. Disclosure E. Krystel Kelly: None. J. Mbanya: Advisory Panel; Self; GlaxoSmithKline plc.. Speaker's Bureau; Self; Novo Nordisk A/S, Sanofi, Servier. E. Sobngwi: None. M. Liliane: None.

Microalbuminuria and Retinopathy among Hypertensive Nondiabetic Patients at a Large Public Outpatient Clinic in Southwestern Uganda.

Background Routine testing of microalbuminuria and retinopathy is not done among patients with high blood pressure in resource-limited settings. We determined the prevalence of microalbuminuria and retinopathy and their risk factors among hypertensive patients at a large hospital in western Uganda. Methods We consecutively recruited nondiabetic patients with hypertension at the outpatients' clinic over a period of 3 months. Spot urine samples were tested for urine albumin. Direct fundoscopy was done to assess retinal vasculature and optic disc for signs of hypertensive retinopathy. Logistic regression was done with retinopathy and microalbuminuria as primary outcomes. ResultsWe enrolled 334 patients and, of these, 208 (62.3%) were females, with median age of 55 years (range: 25–90). The prevalence of microalbuminuria was 59.3% (95% CI: 50.1–72.2) and that of retinopathy was 66.8% (95% CI: 58.6–76.5). The independent correlates of retinopathy and microalbuminuria were systolic blood pressure (SBP) > 140 mmHg (OR = 2.76, 95% CI: 1.29–5.93) and treatment with beta-blockers (OR = 2.16, 95% CI: 1.05–4.44). Use of ACEIs was unrelated to the study outcomes. ConclusionThe prevalence of retinopathy and microalbuminuria is high. Clinicians should aim for better control of blood pressure and routinely perform fundoscopy and urine albumin, especially for patients with poorly controlled blood pressure.

The relationship of all-cause mortality to average on-treatment systolic blood pressure is significantly related to baseline systolic blood pressure: implications for interpretation of the Systolic Blood Pressure Intervention Trial study.

The SPRINT study demonstrated that targeting systolic blood pressure (SBP) less than 120 mmHg was associated with lower cardiovascular event and mortality rates. In the LIFE study, however, a lower achieved SBP was associated with increased mortality. Mean baseline SBP in SPRINT was 140 mmHg and a third of the population had a baseline SBP 132 mmHg or less, raising the question of whether the lower baseline SBP in SPRINT could in part account for these differences. All-cause mortality during 4.8 ± 0.9 years follow-up was examined in relation to tertiles of achieved on-treatment average SBP in patients with baseline SBP of 25th percentile or less versus greater than 25th percentile value of 164 mmHg in 7998 nondiabetic hypertensive patients with ECG left ventricular hypertrophy randomly assigned to losartan-based or atenolol-based treatment. Average on-treatment SBP less than 142 mmHg (lowest tertile) and average SBP 142 mmHg to less than 152 mmHg (middle tertile) were compared with average SBP at least 152 mmHg (highest tertile and reference group). In the overall population, there was a significant interaction between baseline SBP 164 mmHg or less and average on-treatment SBP less than 142 mmHg in Cox analysis (χ = 15.48, P < 0.001). Among patients with baseline SBP greater than 164 mmHg, in multivariate Cox analyses adjusting for other potential predictors of mortality and a propensity score for having baseline SBP 164 mmHg or less and compared with average on-treatment SBP at least 152 mmHg, average on-treatment SBP less than 142 mmHg was associated with 32% higher mortality (hazard ratio 1.32, 95% CI 1.01-1.65), whereas average SBP of 142 mmHg to less than 152 mmHg was associated with 24% lower mortality (hazard ratio 0.76, 95% CI 0.59-0.98). In contrast, among patients with baseline SBP 164 mmHg or less, both average on-treatment SBP less than 142 mmHg (hazard ratio 0.60, 95% CI 0.36-0.99) and average SBP of 142 mmHg to less than 152 mmHg (hazard ratio 0.51, 95% CI 0.30-0.89) were associated with significantly lower mortality compared with average SBP of at least 152 mmHg. Achievement of an average SBP less than 142 mmHg was associated with reduced mortality in patients with baseline SBP 164 mmHg or less but with increased mortality in those with higher baseline SBP in LIFE. These findings suggest that the lower mortality associated with a lower targeted SBP in SPRINT may not be applicable to patients with considerably higher baseline SBP than SPRINT patients. Further study is necessary to better understand these findings. http://clinicaltrials.gov/ct/show/NCT00338260?order=1.