Indices Of Target Organ Damage Research Articles

Prediction of the left ventricular mass index in hypertensive patients using the product of red cell distribution width and mean corpuscular volume.

The product of red cell distribution width (RDW) and mean corpuscular volume (MCV) has been identified as an indicator of target organ damage in cases of hypertension. However, the role of the RDW-MCV product in assessing carotid alteration, renal damage, and left ventricular hypertrophy in patients with hypertension has not been elucidated. In this cross-sectional study, a total of 1115 participants with hypertension were included. The RDW and MCV at admission were measured using an automated hematology analyzer. Organ damage was determined by the left ventricular mass index (LVMI), carotid intima-media thickness, and estimated glomerular filtration rate. The prevalence rates of carotid alteration and left ventricular hypertrophy were 57.0% and 18.0%, respectively. A higher RDW-MCV product and RDW were observed in hypertensive patients who developed carotid alteration. After adjusting for potential confounding factors, the correlations of the RDW-MCV product (P = .285) and RDW (P = .346) with carotid alteration were not significant. Moreover, the analysis of variance showed no significant correlation between RDW and LVMI (P = .186). However, the RDW-MCV product was higher in individuals with a high LVMI compared to those with a normal LVMI. Multivariable linear regression analysis revealed that the RDW-MCV product was independently associated with the LVMI (β = 2.519, 95% CI: 0.921-4.116; P = .002), but not the estimated glomerular filtration rate (β = -0.260, 95% CI: -2.031-1.511; P = .773). An elevated RDW-MCV product may be a predictor for left ventricular hypertrophy in patients with hypertension.

STUDY OF LEFT VENTRICLE MASS AT THE TIME OF DIAGNOSIS IN HYPERTENSIVE PATIENTS

Background: Hypertension is a significant public health issue that affects people all over the world.In India, hypertension affects 5-15 percent of the adult population. In this study we aim at recording incidence of LVH at the time of diagnosis in a tertiary hospital. Aims & Objectives: To monitor Left Ventricular Geometry in newly diagnosed hypertensives, and to study if there is a link between LVH & other indices of target organ damage. Materials & Methods: Hospital based Prospective Analytical study was done in 100 Patients selected by random sampling procedure matching the inclusion criteria. A pretested pro forma was used Follow up was done on inpatient admission and on outpatient department basis. Results: 78 OP & 22 IP patients were studied of which 68 were male and 32 were female LVH was seen in 27% study sample,In the present study, it was observed that there is significant correlation between the prevalence of microalbuminuria and the presence of LVH (P < 0.001) and LV dysfunction (P < 0.002) in hypertensive patients. Hypertensive patients with microalbuminuria were 9.4 times more likely to develop LVH than patients with normal UAE (95% CI: 4.2 - 21.6). ? Conclusion: LVH at the time of diagnosis of hypertension has higher risk of presence of other target organ damages, hence can be used as indicator for prognosis and need for strict monitoring and control of blood pressure recordings with regular follow ups.

NOCTURNAL BLOOD PRESSURE DIPPING AND PRECLINICAL TARGET ORGAN DAMAGE IN YOUNG INDIVIDUALS

Objective: A blunted nighttime blood pressure (BP) decrease (non-dipping) has been linked to increased cardiovascular risk. Relevant research data in children and adolescents are scarce with most studies conducted in young individuals with medical conditions, e.g., diabetes. This study investigated the relationship of nighttime dipping with indices of preclinical target organ damage (TOD) in young individuals. Design and method: Individuals referred for suspected hypertension and healthy volunteers aged 6-25 years were evaluated with 24h ambulatory BP (ABP) monitoring. The nighttime BP dip was quantified as the percentage BP decline as compared to the daytime value. Non-dippers were defined as those with systolic and/or diastolic nighttime dip <10%. TOD was assessed by echocardiographic left ventricular mass index (LVMI) and ultrasonographic determination of intima-media thickness of the common carotid artery (IMT). Results: 276 individuals were included (13.8±3.8 years, 67% males, 31.2% children, 56.1% adolescents, 12.7% adults, 3.3% healthy volunteers, BMI z-score 1.18±0.96, 37.4% obese, 25.7% with elevated 24h ABP, 27.9% with elevated nighttime BP). LVMI measurements were available in 257 and IMT in 205. The average systolic/diastolic dip was 12.1±4.7/19.6±6.3% and 30.4% of participants were classified as non-dippers. TOD indices were higher in non-dippers than in dippers (LVMI 30.5±8.2 versus 28.4±5.9 g/m2.7; IMT 0.517±0.054 versus 0.500±0.053 mm, p<0.05 for both). In linear regression analysis, non-dipping was independently associated with LVMI (↓ = 2.14, p = 0.01) and IMT (↓ = 0.02, p = 0.02), after adjustment for sex, age, BMI z-score and 24h systolic ABP. However, after adjustment for the nighttime BP levels (instead of 24h ABP) this association lost its statistical significance. Conclusions: These data suggest that in young individuals nocturnal non-dipping is associated with TOD, but not after accounting for the nighttime BP levels.

NIGHT-TIME BLOOD PRESSURE IN DIABETES TYPE-1 ASSESSED BY HOME VS. AMBULATORY MONITORING: A PILOT STUDY

Objective: To compare night-time (asleep) blood pressure (BP) evaluated by home monitoring (HBPM) vs. ambulatory monitoring (ABPM) in adolescents and young adults with diabetes type-1 (DM1) and examine their association with indices of preclinical target organ damage (TOD). Design and method: Individuals aged 12–30 years with DM1 were subjected to 24-hour ABPM (every 20 min, Microlife WatchBP O3) and 7-day HBPM (daytime: duplicate morning and evening measurements; night-time: 3 measurements per night for 3 nights; Microlife WatchBP Home-N), as well as TOD assessment (left ventricular mass index, carotid intima media thickness, urine albumin excretion). Results: Data from 24 individuals were analysed (mean age 19.8 ± 5.3 [SD] years, men 62.5%, BMI 25.6 ± 4.1 kg/m2, 13% with elevated 24-hour ABPM]. The number of valid ABPM readings was 45.7 ± 1.4/22.4 ± 4.8 (awake/asleep, mean ± SD) and HBPM 26.3 ± 2.1/8.3 ± 2.0 respectively (p < 0.001/ < 0.001). Daytime HBPM was lower than ABPM (by 2.7 ± 0.1/1.9 ± 0.7 mmHg, systolic/diastolic, p < 0.05/ < 0.05), but night-time was higher (difference 5.0 ± 0.6/3.2 ± 0 mmHg, p < 0.01/ < 0.05). There was a strong association between HBPM and ABPM (daytime r = 0.85/0.88, night-time r = 0.68/0.49, systolic/diastolic). There was fair agreement (88%; kappa = 0.33) between ABPM and HBPM in diagnosing nocturnal hypertension (age > = 16 years > = 120/70 mmHg; < 16 years > = 95th centile;) and poor agreement in detecting non-dippers (38%, kappa = 0.032). No significant association of night-time ABPM or HBPM and indices of TOD was found, probably due to small sample size and low prevalence of TOD. Conclusions: These preliminary data in young individuals with DM1 show that nocturnal HBPM is feasible and provides values similar to ABPM. Further research is needed to extend these finding and investigate their clinical relevance in DM1.

OFFICE VERSUS HOME BLOOD PRESSURE VARIABILITY IN YOUNG INDIVIDUALS: COMPARISON AND ASSOCIATION WITH PRECLINICAL ORGAN DAMAGE

Objective: Studies in adults showed that blood pressure (BP) variability has independent prognostic value for cardiovascular outcome. This study investigated the relationship between office and home BP variability with indices of preclinical target organ damage in young individuals. Design and method: Healthy individuals aged 6–25 years referred for elevated BP and healthy volunteers were subjected to BP measurements in the office (2–3 visits, triplicate measurements, mercury sphygmomanometer) and at home (6–7 school/work days, duplicate morning and evening measurements, validated oscillometric arm-cuff devices) within 4 weeks. BP variability was quantified as the standard deviation and coefficient of variation of visit-to-visit office BP and day-to day home BP. Preclinical organ damage was assessed with ultrasonographic evaluation of left ventricular mass index (LVMI), determination of common carotid intima-media thickness (cIMT) and pulse wave velocity (PWV, piezoelectronic principle). Results: 233 individuals were analyzed (age 14.1 ± 4.0 years, 72% males, 32% children, 53% adolescents, 15% young adults, 4.3% healthy volunteers, 29.6% with office and 25.3% with home hypertension). All participants had office and home BP measurements and evaluation of at least one index of target organ damage (LVMI 189, cIMT 123, PWV 73). The variability of systolic office BP was higher than home (p < 0.05) whereas there was not such a difference for diastolic BP variability (Table). None of the office and home BP variability indexes exhibited a statistically significant association with LVMI, cIMT or PWV. Conclusions: This study in healthy children, adolescents and young adults showed higher systolic office than home BP variability, but none of them was associated with preclinical organ damage. The clinical relevance of BP variability, and the optimal index and method for its evaluation remain undefined and require further investigation.

NIGHT-TIME BLOOD PRESSURE ASSESSED BY HOME VS. AMBULATORY MONITORING IN ADULTS WITH TYPE 2 DIABETES: ASSOCIATION WITH PRECLINICAL TARGET ORGAN DAMAGE

Objective: To evaluate the relationship of night-time blood pressure (BP) assessed by home (HBP) or ambulatory BP (ABP) monitoring with preclinical target organ damage in adults with type 2 diabetes (DM2). Design and method: Hypertensive adults with DM2 or pre-diabetes on stable treatment were subjected to (i) 24 h ABP monitoring (20 min intervals, Microlife WatchBP O3), (ii) HBP monitoring (7 days with duplicate morning/evening measurements and 3 nights with 3 measurements/night, Microlife WatchBP Home-N), and measurement of (iii) echocardiographic left ventricular mass index (LVMI), (iv) carotid intima-media thickness (cIMT), (v) aortic pulse wave velocity (PWV) and ankle-brachial index (ABI), (Microlife PWV/ABI), (vi) urine albumin-creatinine ratio (ACR) in 2 different morning samples. Results: Seventy individuals were analyzed (mean age 65.2 ± 9.7 years, 47 males, body mass index 31.6 ± 4.8 kg/m2, 59 with DM2 and 11 with pre-DM). Daytime HBP was slightly higher than daytime ABP (mean difference 2.4 ± 9.3/0.5 ± 4.9 mmHg, systolic/diastolic, p < 0.05/NS). Similarly, night-time HBP was slightly higher than night-time ABP (2.1 ± 6.5/0.8 ± 5.0 mmHg, p < 0.05/NS). There was strong correlation between ABP and HBP (daytime r = 0.77/0.77 and night-time 0.88/0.80, systolic/diastolic) (all p < 0.05). Night-time ambulatory/home pulse pressure presented the following correlation coefficients with indices of target organ damage: LVMI r = 0.23/0.15; cIMT 0.28/0.28; ABI -0.21/-0.23; PWV 0.04/0.05; ACR 0.57/0.50 (p = NS for HBP-ABP comparisons). The agreement between night-time HBP and ABP in identifying individuals with nocturnal hypertension was 81% (kappa statistic = 0.63) and in detection of non-dippers 73% (kappa = 0.44). Conclusions: Night-time HBP monitoring in hypertensive adults with DM2 is feasible, strongly associated with night-time ABP and gives similar correlations with preclinical target organ damage. These methods also present substantial agreement in identifying individuals with nocturnal hypertension.

HYPERTENSION PHENOTYPES IN YOUNG INDIVIDUALS BASED ON COMBINED OR ISOLATED ELEVATION OF OFFICE, HOME AND AMBULATORY BLOOD PRESSURE MEASUREMENTS AND ASSOCIATION WITH ORGAN DAMAGE

Objective: To assess the prevalence of white-coat (WCH) and masked (MH) hypertension detected by only ambulatory or only home blood pressure (BP) monitoring (isolated), or both (dual), and their association with preclinical target organ damage (TOD). Design and method: Young individuals referred for elevated BP and healthy volunteers aged 6–25 years were evaluated with office (2–3 visits; triplicate measurements), home (7 days, duplicate morning and evening measurements) and 24-hour ambulatory BP monitoring. TOD assessment included echocardiographic left ventricular mass index (LVMI), carotid intima-media thickness (IMT) and pulse wave velocity (PWV; Complior). Normotension (NT) was defined as normal office, home and ambulatory BP and sustained hypertension (SH) as all measurements being elevated. WCH and MH phenotypes were identified based on isolated or combined (dual) home and ambulatory BP values. Results: Analysis included 320 individuals (mean age 13.8 ± 3.8 years, 66.6% males, 32.2% children, 55.9% adolescents, 11.9% young adults, BMI 24.1 ± 4.8 kg/m2), of whom 276 had LVMI, 212 IMT and 168 PWV assessment. 182 (56.9%) participants had NT and 39 (12.2%) SH. Among 54 (16.9%) participants with WCH, 35 had dual WCH (64.8%) and 19 (35.2%) isolated ambulatory or home WCH. Among 45 (14.1%) with MH, 17 had dual MH (37.8%) and 28 isolated ambulatory or home MH (62.2%). Participants with dual and isolated intermediate phenotypes didn’t differ according to age, sex and BMI. Individuals with SH had higher LVMI, IMT and PWV than NT (all P < 0.05; Figure). Intermediate phenotypes based on selective or combined elevation of out-of-office BP presented intermediate values of indices of TOD between NT and SH. Isolated ambulatory or home WCH was associated with higher LVMI values than NT (P < 0.05), whereas dual MH was associated with higher IMT than NT (all P < 0.05). Conclusions: These findings suggest that in young individuals intermediate hypertension phenotypes with selective (isolated WCH) or combined elevation of BP (dual MH) in out-of-office measurement methods appear to carry an increased risk of preclinical TOD compared with NT.

Left ventricular hypertrophy and incident cognitive impairment in elderly hypertensive patients: Hypertension in the Very Elderly Trial

AbstractBackgroundWe assessed whether left ventricular hypertrophy (LVH), as an indicator of hypertensive target organ damage, was associated with subsequent cognitive decline.MethodWe used data collected in the Hypertension in the Very Elderly Trial (HYVET). HYVET was a double‐blind placebo‐controlled trial of antihypertensives in hypertensive older adults (≥80 years). Trial treatment was not associated with cognitive decline, allowing us to analyze the trial data as a cohort. The baseline characteristics of the analytical sample and those who were excluded due to missing electrocardiography (ECG) values or cognitive outcomes were compared. LVH was assessed using a 12‐lead ECG based on Cornell product criterion. The Mini‐Mental State Examination (MMSE) was used to assess cognitive function at baseline and annually. A fall in MMSE to ≤24 or an annual fall of ≥three points was defined as cognitive decline. Proportional hazard regression, including a competing risk Fine‐Gray model to account for competing outcomes (stroke, heart failure, myocardial infarction, other fatal cardiovascular disease), was used to examine the relationship between baseline LVH and cognitive outcomes. Sensitivity analyses were run in those with baseline MMSE ≥24, considered unlikely to have pre‐existing cognitive decline. To evaluate attrition bias, we ran inverse probability weighting (IPW) models.ResultThere were 1944 in the analytical sample, 164 with LVH. Mean follow‐up was 3.9 or 4.2 years accounting or not accounting for competing outcomes. The analytical sample differed from those excluded, e.g. they had higher diastolic blood pressures and were more likely to be female (Table 1). LVH was associated with increased risk of 1) cognitive decline (Table 2), hazard ratio (HR)1.44 (95%confidence interval (CI)1.12:1.84), 2) combined cardiovascular events and cognitive decline, HR1.51 (95% CI 1.2:1.91), and 3) cognitive decline using the Fine‐Gray model, HR1.41 (95%CI 1.08:1.84). Sensitivity and IPW analyses yielded similar results.ConclusionCP criterion defined LVH was associated with an increased risk of cognitive decline in older adults with hypertension. The potential for selection bias and healthy individual bias (trial participants) should be noted. Further work should explore the potential for LVH as an indicator of target organ damage beyond the heart.

Left ventricular mass index unveils differences in sympathetic nervous system activity between patients with MINOCA and Takotsubo syndrome

Abstract Background/Introduction Left ventricular mass index (LVMI) has been long established as an index of target organ damage. It has demonstrated a prognostic role in cardiovascular morbidity and mortality assessed using either echocardiography or cardiac magnetic resonance (CMR) under the prism of coronary artery disease, hypertension, diabetes mellitus, chronic kidney disease. On the other hand, it has shown a strong association with indices of sympathetic nervous system (SNS) activity. Purpose The aim of our study is to investigate for potential associations between LVMI and indices of SNS among patients with a working diagnosis of MINOCA. Methods Our study population consists of 50 patients [32% male; mean age: 61±12 years old; 50% hypertensives (HTN), 16% with history of diabetes mellitus (DM), 22% smokers] admitted with acute coronary syndrome (ACS) fulfilling the diagnostic criteria of MINOCA. A subsequent CMR demonstrated an ischemic pattern of late gadolinium enhancement (LGE) in 15 cases (27.8%), findings indicative of Takotsubo syndrome (TTS) in 19 patients (35.2%), whereas failed to reveal any abnormalities in 16 cases (29.8%). LVMI was estimated using left ventricular mass per body surface area (LV mass/BSA) as derived from CMR. SNS activity was assessed using muscle sympathetic nerve activity (MSNA) during the first 30 days of patient discharge. Results Univariate analysis failed to demonstrate an association between LVMI and indices of SNS in the total population. This was found to be driven by the TTS group. However, for all other MINOCA cases (n=31; including both LGE CMR and clear CMR cases) LVMI demonstrated a significant positive association with MSNA measured as bursts/min (OR, 0.558; CI 95%, 0.200–0.915; p=0.004). A multivariate analysis was conducted in the same group in which LVMI retained its statistical significance independently of age, gender, ejection fraction derived from CMR, history of HTN and DM (OR, 0.518; CI 95%, 0.030 - 0.952; p=0.038). TTS group did not show any association between LVMI and MSNA. Conclusions These preliminary results may imply an underlying mechanism of reverse negative feedback on systematic SNS activity after the acute phase of sympathetic overdrive during a TTS event. Further investigation is warranted to confirm our research findings. Funding Acknowledgement Type of funding sources: None.

CARDIOVASCULAR STATUS REFERENCE VALUES OF RECENTLY DIAGNOSED AND NAÏVE TO TREATMENT HUMAN IMMUNODEFICIENCY VIRUS (HIV) PATIENTS. A PILOT STUDY

Abstract Objective: HIV infection is a well recognized risk factor for cardiovascular (CV) disease. Virus induced chronic inflammation plays a key role in the development of early CV disease. The aim of this study is to explore the baseline CV status of recently diagnosed and naïve to treatment HIV patients regarding arterial blood pressure parameters, target organ damage indices as well as aerobic capacity (AC). Design and method: Forty two (42) recently diagnosed and naïve HIV patients were evaluated regarding office and central blood pressure (SBP/DBP), carotid-femoral aortic stiffness estimated by PWV and endothelial function measured by endothelial glycocalyx integrity. Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranged from 5–9 micrometers) Using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non-invasive accurate index of reduced EG thickness. Finally AC status was evaluated after a maximal cardiopulmonary exercise test (CPET). No one patient had ever received any treatment for HIV or any cardiovascular disease. Results: HIV patients were mostly males (38 men, 90%), young (mean age = 37 + 10 years), smokers (21, 42%) and normotensives (office SBP/DBP = 124 + 13/76 + 10 mmHg and central SBP/DBP = 116 + 12/77 + 10 mmHg). PWV was estimated as 9.2 + 1.7 m/sec. Endothelial glycocalyx intergrity was measured as PBR5–9 = 1.2 + 0.2 micrometers. During maximum aerobic CPET, HIV patients achieved 8 + 2 METS and 28 + 6 ml/kg/min peak VO2 which corresponds to 80 + 14% of peak VO2 predicted. Their SBP was measured as 112 + 10 mmHg at exercise initiation and 169 + 22 mmHg at peak exercise. Two male patients (5%) had a hypertensive response during CPET defined as SBP > 210 mmHg. Conclusions: It seems that recently diagnosed naïve HIV patients have a CV status similar to which corresponds to their age. We are going to re-evaluate those patients, one and three years after HIV treatment initiation, in order to explore any early differences regarding their CV status.

NOCTURNAL HOME VERSUS AMBULATORY BLOOD PRESSURE MONITORING IN CHILDREN AND ADOLESCENTS: ASSOCIATION WITH PRECLINICAL TARGET-ORGAN DAMAGE

Abstract Objective: To evaluate the relationship between nighttime blood pressure (BP) assessed by home (HBP) or ambulatory (ABP) monitoring with preclinical damage in children and adolescents. Design and method: Apparently healthy children and adolescents (age 6–18 yeas) referred for elevated BP were subjected to (i) 24 h ABP monitoring (Microlife WatchBP O3), (ii) 7-day HBP monitoring during daytime (duplicate morning and evening measurements) and nighttime (3 nights, 3 readings/night) (Microlife WatchBP Home-N), and measurement of (iii) carotid intima-media thickness (cIMT) and carotid distensibility coefficient (cDC), (iv) carotid-femoral pulse wave velocity (PWV; Complior device), and (v) echocardiographic left ventricular mass index (LVMI). Results: 94 individuals were analyzed (mean age 13.2 ± 2.8 years, 54 males, BMI 24.8 ± 5.2 kg/m2, 18 with 24 h ABP > 95th centile). Daytime HBP was slightly lower than daytime ABP (difference -2.0 ± 6.4/-0.8 ± 5.0 mmHg, systolic/diastolic, p < 0.01/NS), whereas nighttime HBP was slightly higher than nighttime ABP (2.5 ± 7.1/2.1 ± 6.2 mmHg, p < 0.01/ < 0.01). There was a strong association between ABP and HBP (daytime r = 0.83/0.79 and nighttime 0.79/0.60, systolic/diastolic) (all p < 0.05). Nighttime systolic ABP and HBP were associated with all indices of target-organ damage (LVMI r = 0.36/0.30 for ABP/HBP; cIMT 0.47/0.49; cCD -0.31/-0.25; PWV 0.50/0.56 (p = NS for HBP-ABP comparisons). The agreement between nighttime HBP and ABP in identifying: (i) subjects with asleep ABP > 90th percentile was 73% (kappa 0.38, p < 0.01) and (ii) non-dippers 55% (kappa 0.16). Conclusions: These results suggest that in children and adolescents nocturnal HBP monitoring is feasible, is strongly correlated with nighttime ABP and gives similar correlations with preclinical target-organ damage. The agreement between these methods in identifying individuals with nocturnal hypertension is satisfactory, whereas for non-dippers it is moderate.

P804The significance of 24h blood pressure variability improvement regarding target organ damage indices three years after medical treatment initiation in essential hypertension

Abstract Background Blood pressure variability (BPV) has been associated with development, progression and severity of cardiac and vascular organ damage and with an increased risk of cardiovascular events and mortality, independently adding to cardiovascular risk, over and above the contribution of elevated mean BP levels. We aimed to explore any correlation between differences in BPV and target organ damage indices (TOD) in hypertensive patients three years after medical treatment initiation. Methods At baseline and before medical treatment initiation, we measured 24h average SBP and DBP as well as 24h systolic BPV after 24h ambulatory blood pressure monitoring (ABPM) in newly diagnosed and never treated hypertensive patients (n=171, mean age=52+12 years, 110 males, 24h average SBP/DBP=138+10/87+9 mmHg, 24h systolic BPV=15+3) who were also subjected to arterial stiffness by carotid-femoral pulse wave velocity (PWV), left ventricular hypertrophy by left ventricular mass index (LVMI) and coronary flow reserve (CFR) estimations. All the above tests were repeated approximately three years later after treatment initiation. Results Patients were characterized as controlled (n=113, mean age=54+12 years, 62 males, 24h average SBP/DBP=118+6/71+6 mmHg) or non-controlled hyperensives (n=58, mean age=48+11 years, 48 males, 24h average SBP/DBP=133+8/83+7 mmHg) based on ABPM results three years later (controlled BP=24h average BP<130/80 mmHg). In the whole population, 24h average SBP/DBP, systolic BPV (p<0.001) and LVMI (p=0.01) were decreased while systolic BPV difference was related with LVMI difference (r=0.27, p<0.001). In controlled hypertensives, 24h average SBP/DBP, systolic BPV (p<0.001) and LVMI (p=0.02) were decreased while systolic BPV difference was related with LVMI difference (r=0.35, p<0.001). In non-controlled hypertensives, 24h average SBP (p=0.001), DBP p<0.001) and systolic BPV (p=0.04) were decreased while PWV was increased (p=0.03) and no correlations were found between systolic BPV and TOD. Correlation between BPV and LVMI Conclusions It seems that antihypertensive-induced systolic BPV improvement relate with cardiovascular risk decrease occur only in the setting of blood pressure treated within normal limits and confirmed by ABPM. Our study confirms that left ventricular mass between other TOD primarily improves due to successful antihypertensive treatment.

P5470Studying target organ damage indices in newly diagnosed and never treated extreme dipper patients with essential hypertension

Abstract Background Cardiovascular risk estimation in arterial hypertension includes the investigation for target organ damage indices (TOD). 24h ambulatory blood pressure monitoring (ABPM) represents the gold standard method for the confirmation of the arterial hypertension disease. Dipping phenomenon, defined as blood pressure decrease >10% during night-time measurements, leads to hypertension burden reduce during night and carries a positive prognostic significance. However, there are doubts regarding its prognosis when it becomes augmented (extreme dipping defined as blood pressure decrease >20% during night-time measurements). Aim of our study is to explore TOD existence between extreme dipper and dipper hypertensive patients with newly diagnosed and never treated arterial hypertension. Methods From the 480 total patients with newly diagnosed and never treated arterial hypertension who subjected to ABPM, we excluded 190 non-dipper patients and we divided the rest 290 hypertensives (mean age 49±11 years, 193 males) in normal dippers (n=245, mean age 49±11 years, 160 males) and extreme dippers (n=45, mean age 49±10 years, 33 males). Both groups were subjected to the following measurements: arterial stiffness (PWV), 24h microalbumin levels (MAU), carotid intima-media thickness (IMT), diastolic dysfunction (E/Ea), left ventricular mass index (LVMI) and coronary flow reserve (CFR). Results We did not find any differences within groups regarding age, sex distribution, BMI, office SBP/DBP, cenrtal SBP/DBP and daytime average SBP/DBP as well as PWV, MAU, IMT, E/Ea and CFR. We noticed that extreme dippers had reduced 24h average SBP/DBP (p=0.001 and p=0.02, respectively) and increased LVMI (86±18 vs. 79±20 gr/m2, p=0.04) compared to normal dippers. Differences in LVMI Conclusions Extreme dipper hypertensive patients have an increased LVMI, probably as a result of myocardial hypoxia due to severe blood pressure reduction over night. Our results point to the possible increased cardiovascular risk in this group of hypertensive patients.

P1680High density lipoprotein cholesterol (HDL-C) levels and endothelial glycocalyx integrity in treated hypertensive patients

Abstract Background Endothelial dysfunction indicates target organ damage in hypertensive patients. The integrity of endothelial glycocalyx (EG) plays a vital role in vascular permeability, inflammation and elasticity and finally to cardiovascular disease. We aimed to investigate the role of increased HDL cholesterol levels (HDL-C), which usually are considered protective against cardiovascular disease, in EG integrity in older hypertensive patients. Methods We studied 120 treated hypertensive patients older than 50 years were divided regarding HDL-C tertiles in group HDLH, (HDL-C >71 mg/dl, upper HDL-C tertile) and group HDLL, (HDL-C <71 mg/dl, two lower HDL-C tertiles). Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranged from 5–9 micrometers) using Sideview Darkfield imaging was measured as a non-invasive accurate index of reduced EG thickness. Results PBR 5–9 was significantly decreased in group HDLH (p=0.04). In the whole population, HDL-C was inversely but moderately related with PBR 5–9 (r=−0.22, p=0.01). In a multiple linear regression analysis model, using age, BMI, smoking habit, HDL-C, LDL-C and office SBP, as independent variables, we found that BMI (β=0.25, p=0.006) independently predicted PBR 5–9 in the whole population. Differences in PBR5-9 between HDL groups Conclusions In older hypertensive patients, HDL-C ranged between 71–101 mg/dl might moderately protect EG and subsequently endothelial function. Future studies in several groups of low or high risk hypertensives are needed in order to evaluate the beneficial role of extremely elevated HDL-C regarding cardiovascular risk evaluation as well as endothelial glycocalyx as a novel index of target organ damage in essential hypertension.

AMBULATORY ARTERIAL STIFFNESS INDEX AS PREDICTOR OF IN-HOSPITAL RENAL DYSFUNCTION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective: The ambulatory arterial stiffness index (AASI) is a marker of arterial stiffness, predicts cardiovascular morbidity and mortality in hypertensive patients and is associated with indices of target organ damage. However, data is scarce regarding the prognostic role of AASI for renal dysfunction in patients with myocardial infarction (MI).We therefore evaluated the relationship between AASI and worsening of renal function (WRF)in patients suffering a MI. Design and method: We studied 197 patients [78.7% male; mean age 62.44 years; 68.5% hypertensives; 27.9% with diabetes mellitus (DM)] who were hospitalized because of ST-elevation myocardial infarction (STEMI, 50.3%) and NonST–elevation myocardial infarction (NSTEMI). All patients underwent baseline estimation of clinical and laboratory parameters during their hospitalization. Moreover, patients underwent 24-h ambulatory BP monitoring during the third day of hospital stay. AASI was measured according to established methodology. WRF was defined as a reduction of GFR > or = 25% according to the RIFLE criteria using MDRD formula. Results: AASI demonstrated a prognostic role for WRF in the entire population (HR, 0.094; CI, 0.026–0.161; p = 0.007). After separate analysis for STEMI and NSTEMI groups, AASI was a significant predictor for WRF in the STEMI group(HR, 0.087; CI, 0.004–0.170; p = 0.04) with a tendency in the NSTEMI one (p = 0.08). Therefore, a model of multivariate regression analysis was conducted for the entire population and STEMI group, where AASI retained its significant role as a predictor of WRF (OR, 0.097; CI, 0.034–0.157; p = 0.003 and OR, 0.104; CI, 0.020–0.187; p = 0.016 respectively), independently of age, gender, history of hypertension, history of DM and low density lipoprotein (LDL-C). Conclusions: According to our study AASI is an independent predictor of in-hospital renal dysfunction in patients with MI. More data and research are required to determine the usefulness of this non-invasive tool in clinical practice in general population and in patients with MI.

STUDYING TARGET ORGAN DAMAGE INDICES IN NEWLY DIAGNOSED AND NEVER TREATED EXTREME DIPPER PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: Cardiovascular risk estimation in arterial hypertension includes the investigation for target organ damage indices (TOD). 24 h ambulatory blood pressure monitoring (ABPM) represents the gold standard method for the confirmation of the arterial hypertension disease. Dipping phenomenon, defined as blood pressure decrease >10% during night-time measurements, leads to hypertension burden reduce during night and carries a positive prognostic significance. However, there are doubts regarding its prognosis when it becomes augmented (extreme dipping defined as blood pressure decrease >20% during night-time measurements). Aim of our study is to explore TOD existence between extreme dipper and dipper hypertensive patients with newly diagnosed and never treated arterial hypertension. Design and method: From the 480 total patients with newly diagnosed and never treated arterial hypertension who subjected to ABPM, we excluded 190 non-dipper patients and we divided the rest 290 hypertensives (mean age 49+11 years, 193 males) in dippers (n = 245, mean age 49+11 years, 160 males) and extreme dippers (n = 45, mean age 49+10 years, 33 males). Both groups were subjected to the following measurements: arterial stiffness (PWV), 24 h microalbumin levels (MAU), carotid intima-media thickness (IMT), diastolic dysfunction (E/Ea), left ventricular mass index (LVMI) and coronary flow reserve (CFR). Results: We did not find any differences within groups regarding age, sex distribution, BMI, office SBP/DBP, cenrtal SBP/DBP and daytime average SBP/DBP as well as PWV, MAU, IMT, E/Ea and CFR. We noticed that extreme dippers had reduced 24 h average SBP/DBP (p = 0.001 and p = 0.02, respectively) and increased LVMI (86+18 vs. 79+20 gr/m2, p = 0.04) compared to dippers. Conclusions: Extreme dipper hypertensive patients have an increased LVMI, probably as a result of myocardial hypoxia due to severe blood pressure reduction over night. Our results point to the possible increased cardiovascular risk in this group of hypertensive patients.

HDL cholesterol levels and endothelial glycocalyx integrity in treated hypertensive patients.

Endothelial dysfunction indicates target organ damage in hypertensive patients. The integrity of endothelial glycocalyx (EG) plays a vital role in vascular permeability, inflammation and elasticity, and finally to cardiovascular disease. The authors aimed to investigate the role of increased HDL cholesterol (HDL-C) levels, which usually are considered protective against cardiovascular disease, in EG integrity in older hypertensive patients. The authors studied 120 treated hypertensive patients older than 50years were divided regarding HDL-C tertiles in group HDLH (HDL-C≥71mg/dL, upper HDL-C tertile) and group HDLL (HDL-C<71mg/dL, two lower HDL-C tertiles). Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranging from 5 to 9µm) using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non-invasive accurate index of reduced EG thickness. PBR 5-9 was significantly decreased in group HDLH (P=0.04). In the whole population, HDL-C was inversely but moderately related to PBR 5-9 (r=-0.22, P=0.01). In a multiple linear regression analysis model, using age, BMI, smoking habit, HDL-C, LDL-C, and office SBP, as independent variables, the authors found that BMI (β=0.25, P=0.006) independently predicted PBR 5-9 in the whole population. In older hypertensive patients, HDL-C ranging between 71 and 101mg/dL might moderately protect EG and subsequently endothelial function. Future studies in several groups of low- or high-risk hypertensives are needed in order to evaluate the beneficial role of extremely elevated HDL-C regarding cardiovascular risk evaluation as well as endothelial glycocalyx as a novel index of target organ damage in essential hypertension.

Comparison of various lipid parameters in association of target organ damage: a cohort study

BackgroundRecommendations of non-HDL amplification varied from different guidelines. We aim to test the relationships between various lipid parameters and target organ damage (TOD) including aortic stiffness, peripheral arterial disease and chronic kidney disease in a community-based elderly cohort.Methods1599 (aged 71.4 ± 6.1 years) participants were recruited. Eight lipid parameters, including total cholesterol (TC), triglycerides (TG), LDL-C, HDL-C, non-HDL-C, TC/HDL ratio, TG/HDL ratio and LDL/HDL ratio, together with other plasma biomarkers like creatinine were measured. Pulse wave velocity (PWV) was measured by the SphygmoCor device, and ankle-brachial index (ABI) was assessed by Omron VP-1000 device.ResultsFour individual lipid parameters (TC, TG, LDL-C and HDL-C) significantly correlated with most, but not all, TOD indices. Meanwhile, 4 combined lipid parameters, namely non-HDL-C, TC/HDL, TG/HDL and LCL/HDL, significantly correlated with all TOD (P ≤ 0.033). In multiple linear regression analyses, 4 combined lipid parameters also significantly associated with TOD (P ≤ 0.027), while none of individual lipid parameters significantly associated with all TOD indices. In multiple logistic regression analyses, only non-HDLC and TC/HDL significantly associated with TOD (P ≤ 0.039), and other lipid parameters did not significantly associate with TOD.ConclusionIn an elderly community sample, non-HDLC and TC/HDLC were better associated with TOD than other lipid parameters. This finding should be considered in future clinical lipid-lowing therapy.Trial registrationThis trial was retrospectively registered in ClinicalTrials.gov (No. NCT02368938, registered on 15 Feb 2015).

Left atrial diameter is associated with target organ damage in patients with type 2 diabetes mellitus

This paper aims to investigate whether there is a relationship between left atrial diameter (LAD) and target organ damage (TOD) in patients with type 2 diabetes mellitus (DM). Two-hundred-and-eleven patients with type 2 DM were recruited. Data on left ventricular mass index (LVMI), diabetic retinopathy, carotid intima–media thickness/carotid plaque, micro-albuminuria, and serum creatinine levels were collected to determine whether TOD occurred in patients with type 2 DM. Age, body mass index, waist-hip ratio, a history of DM, Framingham Score, and 10-year risk were used to assess cardiovascular disease risk. Patients were divided into four groups: zero TOD (group I, n = 50), one TOD marker (group II, n = 76), two TOD markers (group III, n = 51), and at least three TOD markers (group IV, n = 34). Using multivariate regression analyses, age, body mass index, waist-hip ratio, a history of DM, Framingham Score, and 10-year risk were significantly associated with LAD. LAD was associated with an increased number of markers for TOD. Univariate analyses demonstrated significant relationships between LAD and TOD in the context of serum creatinine and urinary albumin creatinine ratio (r = 0.292, p < 0.001), creatinine (r = 0.346, p < 0.001), carotid intima–media thickness (r = 0.128, p = 0.032), and LVMI (r = 0.399, p < 0.001). Multivariate regression analyses also determined that LVMI and creatinine were independent predictors of LAD enlargement. LAD may be associated with cardiovascular disease risk. LAD enlargement could be an effective indicator of TOD, particularly renal impairment and left ventricular hypertrophy. Screening for LAD may offer a new and rapid approach for evaluating the severity of DM.

4917Global longitudinal strain to pulse wave velocity ratio (VA coupling) is a better indicator of target organ damage than the arterial elastance to LV elastance ratio in hypertensives

4917Global longitudinal strain to pulse wave velocity ratio (VA coupling) is a better indicator of target organ damage than the arterial elastance to LV elastance ratio in hypertensives