Prevalence Of Target Organ Damage Research Articles

Differences in target organ damage between captopril challenge test-defined definitive-positive and borderline-range groups among patients with primary aldosteronism.

The new Japanese guidelines for primary aldosteronism introduce a category in the judgment of functional confirmatory tests that is called the "borderline range," which is rare in the other international guidelines. The clinical characteristics of this borderline group are not yet understood. To investigate whether this borderline group has any significant differences in terms of target organ damage, we used data from a Japanese nationwide registry (JPAS-II) of individuals with primary aldosteronism or essential hypertension to compare the borderline group with the definitive-positive group and the negative group. We analyzed the cases of 1785 patients based on their captopril-challenge test results. Since the JPAS-II database contains plasma aldosterone concentration values obtained based on both radioimmunoassay (n = 1555) and chemiluminescent enzyme immunoassay (n = 230) principles, we converted these values to their equivalents as if measured by chemiluminescent enzyme immunoassay and conducted all analyses under the simulated condition. Multicovariate-adjusted models revealed significant prevalance odds ratios for chronic kidney disease (2.01, 95% confidence interval: 1.13 to 3.61), electrocardiographic abnormalities (1.66, 95% confidence interval: 1.16 to 2.37). No significant difference was observed between the borderline and negative groups in these assessments (odds ratio [95% confidence interval] for chronic kidney disease: 0.73 [0.26 to 2.02] and electrocardiographic abnormalities: 1.01 [0.60 to 1.70]). We confirmed that the prevalence of target organ damage increases linearly as the aldosterone-to-renin ratio rises following the captopril challenge test. These results provide material to consider regarding the significance of the provisionally established borderline group.

Association between short-term blood pressure variability and target organ damage in non-dialysis patients with chronic kidney disease

BackgroundIt is unclear whether short-term blood pressure variability (BPV) is associated with target organ damage in patients with non-dialysis chronic kidney disease (CKD).MethodsA cross-sectional, single-center study was conducted among 3442 non-dialysis CKD patients hospitalized in the department of Nephrology of the Fifth Affiliated Hospital of Sun Yat-sen University from November 2017 to July 2022 and collected the demographic, laboratory, clinic blood pressure, ambulatory blood pressure data, and short-term BPV assessed by the weighted standard deviation (wSD) derived from ambulatory blood pressure monitoring (ABPM). Multivariate logistic analyses were used to evaluate the independent effects between short-term BPV and subclinical target organ damage, including left ventricular hypertrophy (LVH), abnormal carotid intima-media thickness (CIMT), low estimated glomerular filtration rate (eGFR), and albuminuria.ResultsThe average age of the participants was 47.53 ± 14.06 years and 56% of participants were male. The baseline eGFR was 69 mL/min/1.73 m2. Based on the tertile distribution of wSD according to equal numbers, patients were divided into three categories with T1(< 9.66 mmHg), T2(9.66–12.23 mmHg), and T3(> 12.23 mmHg) of SBPV; T1(< 8.17 mmHg), T2(8.17–9.93 mmHg), and T3(> 9.93 mmHg) of DBPV. The participants with the higher wSD group had a higher prevalence of target organ damage than their counterparts (P-trend < 0.05). An increasing trend in short-term variability was present with advancing CKD stages (P-trend < 0.001). Multivariate logistic analyses results showed that the odds ratio (OR) of SBP wSD was (1.07 [1.03,1.11], P < 0.001) for LVH, (1.04 [1.01,1.07, P = 0.029) for abnormal CIMT, (1.05 [1.02,1.08], P = 0.002) for low eGFR, and (1.06 [1.02,1.09], P = 0.002) for albuminuria; The OR of DBP wSD was (1.07 [1.02,1.12], P = 0.005) for LVH, (1.05 [1.01,1.09], P = 0.028) for abnormal CIMT, (1.05 [1.01,1.09], P = 0.022) for low eGFR, and (1.05 [1.01,1.10], P = 0.025) for albuminuria when adjusted for confounding factors and mean BP.ConclusionsIn conclusion, short-term BPV is associated with target organ damage, and irresponsible of average blood pressure levels, in Chinese non-dialysis CKD participants.

Incidence and determinants of hypertensive retinopathy in hypertension patients at a teaching hospital in North Western Karnataka

Persistently raised blood pressure not only leads to retinal vascular damage but also leads to systemic diseases. The retinal vasculature observation by fundoscopy offers a great opportunity to explore the association of systemic microvascular disease caused by hypertension. Hypertensive retinopathy (HR) is considered to be a marker for vascular disease and death. The aim of the present study was to find out the prevalence of hypertensive retinopathy among hypertensive subjects and assess the pattern of retinopathy and associated risk factors. This was a hospital based cross-sectional study conducted among hypertensive patients at a teaching hospital, for a period of 3 months.A total of 300 hypertensive patients formed the study population. The prevalence of the hypertensive retinopathy in the present study was 49.33%. Hypertensive retinopathy was more prevalent in men 62% than women 38%. The prevalence of grade 1 and grade 2 hypertensive retinopathies was 43.24% and 33.11% respectively and 20.95% and 2.7% had grade 3 and 4 respectively. The prevalence of retinopathy was found to be statistically higher in patients who had h/o hypertension for more than 5 years. The prevalence of hypertensive retinopathy was more common in age group &amp;#62;60yrs. The prevalence of target organ damage was higher in those having retinopathy.The prevalence of hypertensive retinopathy is high in the present study which reflects lack of awareness, patient compliance, sub optimal measures to control blood pressure and even lack of prompt follow up with ophthalmologists. There is need to spread awareness and take adequate measures to reduce the burden of hypertensive retinopathy.

Arterial stiffness assessment in patients with resistant hypertension using pulse wave analysis

Abstract Introduction People living with resistant hypertension (RH) have a higher prevalence of target organ damage, and demonstrate increased risk of cardiovascular (CV) morbidity and mortality. There are distinctive vascular structural and functional changes associated with hypertension. Among these, endothelial dysfunction and increased arterial stiffness are prevalent. Increased aortic augmentation index (AIx) is a non-invasive hemodynamic indicator of systemic arterial stiffness, which has been associated with hypertension; however, there are less data in RH patients. Purpose To test the hypothesis that people living with RH have increased AIx compared to those with controlled essential hypertension (CH) and normotensive controls (NC); and to explore demographic and clinical variables related to AIx. Methods In our observational study, 54 participants: 17 with RH (mean age 60.5±12.4 years), 18 with CH (57.7±12.2 years), and 19 NC (54.7±11.9 years) were recruited. Anthropometric and resting office blood pressure (BP) measurements were obtained. Pulse wave analysis was performed using a commercially available device (Vicorder) to measure central BP, aortic pulse pressure, mean arterial pressure (MAP), aortic augmentation pressure and AIx. Results The study groups were matched for age, sex, ethnicity, height, body surface area and heart rate (P&amp;gt;0.05) (Table 1). Both office and central BP readings were elevated in RH group compared to CH and NC (162/102mmHg vs 126/86mmHg and 118/80mmHg, P&amp;lt;0.001) and (163/83mmHg vs 131/73mmHg and 120/67mmHg, P&amp;lt;0.05). Aortic pulse pressure, MAP and aortic augmentation pressure were significantly increased in patients with RH compared to other groups (P&amp;lt;0.001). AIx was markedly increased in RH compared to CH and NC (31±7% vs 23±8% and 21±9%, P=0.001, respectively). Antihypertensive medications were similar between both hypertensive groups, except for diuretics and beta-blockers which were more prevalent in the RH group (100% vs 28% and 47% vs 6%, P&amp;lt;0.05, respectively). In stepwise regression analysis, elevated AIx was significantly and independently associated with the presence of RH (β=6.4, P=0.005), age (β=.23, P=0.005), female sex (β=6.3, P=0.003) and body mass index (β=.71, P=0.038). Conclusion AIx is increased in RH patients and independently related to the presence of RH, age, female sex and body mass index. Increased arterial stiffness and reduced arterial compliance in patients with RH may play an important role in the progression of serious CV complications seen in these patients. The non-invasive assessment of arterial stiffness indices such as AIx in RH patients may be valuable to provide prognostic and therapeutic insights.Table 1

Assessment of the prevalence of target organ damage at various stages of the cardiometabolic continuum. According to the ESSE RF study

Objective: to assess the prevalence of target organ damage (TOD) at various stages of the cardiometabolic continuum, including abdominal obesity (AO) without metabolic syndrome (MS), MS, and type 2 diabetes mellitus (DM).Materials and methods: this study presents an analysis of data from a sample of residents of Tomsk (1,104 examined from an unorganized adult population of 25-64 years), performed within the framework of the ESSAY RF-2012 project (Epidemiology of Cardiovascular Diseases in the Regions of the Russian Federation). The analysis included the presence of LV hypertrophy (LVH), a decrease in glomerular filtration rate (GFR), an increase in the thickness of the intima-media complex (TIM), the presence of atherosclerotic plaques (ASP) in the common carotid arteries (CCA).Results: TODs were already reported among individuals with isolated AO (without MS), whose prevalence was statistically significantly higher compared to those with normal body weight. Atherosclerosis of CCA turned out to be the most frequent TOD phenotype, ASP was detected in 22% of individuals with isolated AO, in 33% patients with MS and 35% patients with type 2 DM, the second most common was LVH, which was detected in 0.8%, 4,7% and 17,5% of cases, respectively, the least common was a decrease in GFR – in 1,37%, 3,7% and 6,7% of patients, respectively. Differences in the frequency of TOD in all groups were statistically significant (p &lt; 0,01).Conclusions: Thus, the prevalence of TODs detected already at the stage of isolated AO progressively increased from group to group, as they moved along the cardiometabolic continuum.

Prevalence and clinical characteristics of primary aldosteronism in a tertiary-care center in Korea.

Approximately 29% of Korean adults have hypertension; however, the prevalence of primary aldosteronism among the hypertensive population is largely unknown. The aim of our study was to evaluate the prevalence and clinical characteristics of primary aldosteronism in a tertiary-care center in Korea. We retrospectively analyzed 1173 patients with newly diagnosed or preexisting hypertension who were referred to our tertiary-care hospital between January 2013 and December 2018. Patients were screened for primary aldosteronism with the aldosterone-renin ratio and underwent a saline infusion test for diagnostic confirmation. Adrenal computed tomography and adrenal venous sampling were performed for subtype classification for primary aldosteronism. Among the 1173 patients (mean age, 51.8 years; women, 53.2%), 360 (30.7%) had positive screening-test results, of whom 71 (6.1%) were finally diagnosed with primary aldosteronism. Conclusive subtype differentiation was made in 55 patients, of whom 15 (27%) had an aldosterone-producing adenoma, 4 (7%) had unilateral adrenal hyperplasia, and 36 (66%) had bilateral adrenal hyperplasia. Patients with primary aldosteronism had a higher ambulatory blood pressure, left ventricular mass index, and urinary albumin-to-creatinine ratio than those without. Moreover, the primary aldosteronism group had a higher prevalence of left ventricular hypertrophy and albuminuria than the non-primary aldosteronism group. Primary aldosteronism may be more common (6.1%) among Korean patients with hypertension than generally recognized. Primary aldosteronism was associated with a higher degree and prevalence of target organ damage and a higher blood pressure level. Wide application of screening tests for primary aldosteronism may be beneficial in detecting this potentially curable cause of hypertension.

PREVALENCE OF TARGET ORGAN DAMAGE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN IBERICAN STUDY

Objective: The general aim of IBERICAN study is to know the prevalence and incidence of cardiovascular risk factors and cardiovascular and renal disease in Spain. The aim of this abstract is to know the prevalence of subclinical target organ damage (TOD) and type 2 of Diabetes mellitus (T2DM) in population of the IBERICAN Study. Design and method: The IBERICAN Study is a longitudinal, observational, and multicentric study with subjects between 18 to 85 years of age, recruited in Primary Care (PC) and who will be follow up at least 10 years. The final sample size is estimated in 8,066 patients. We show the baseline characteristics of the patients in the first visit (n = 8,066). To define the TOD, we consider the ESH 2013 Guide criteria: pressure pulse in aged &gt; 60 mmHg, ankle/brachial index &lt; 0.9, microalbuminuria: albumin/creatinine ratio (between 30 - 299 mg/g), glomerular filtration (CDK-EPI &lt; 60 ml/min), left ventricular hypertrophy (electrocardiogram or ECHO). Results: 1,434 patients had T2DM (20.1%), 56.4% men. 44.8% of patients with T2DM had TOD. Of the patients with TOD, the mean BMI was 31.7 ± 9.6 Kg/m2. By type of TOD: pulse pressure at &gt; 60 mmHg: 29.2%; ankle/brachial index &lt; 0.9: 3.0%; microalbuminuria: 17.0%; left ventricular hypertrophy: 7.0%. The prevalence of cardiovascular risk factors in patients with T2DM and TOD compared to non-TOD was: Hypertension 84.8% vs 68.4%, p&lt; 0.001; dyslipidemia 78.2% vs 71.6%, p &lt; 0.01; obesity 52.0% vs 49.7% p = 0.376; alcohol consumption 17.0% vs 15.2% p = 0.369; smoking 12.4% vs 14.7%, p = 0.202; sedentary lifestyle 38.5% vs 33.7%, p = 0.061. Conclusions: The prevalence of TOD in patients with T2DM in primary care is high, half of the patients. By type of TOD, elevated pulse pressure in the elderly and microalbuminuria were the most prevalent. Arterial hypertension and dyslipidemia were more prevalent in patients with TOD.

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

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

Prevalence of target organ damage in subjects with high-normal blood pressure without known cardiovascular and kidney disease

Abstract Background Heterogeneous results have been obtained regarding the presence of Target Organe Damage (TOD) in subjects with high-normal Blood Pressure (BP) value (sistoly 130–139, diastolic 85–89 mmHg). Purpose Aim of our study was to assess the prevalence of TOD in healthy subjects with high-normal BP comparing them with subjects with BP values that are considered normal (&amp;lt;130/85 mmHg) or indicative of hypertension (≥140/90 mmHg). Methods 755 otherwise healthy subjects participated at the present analysis. TOD was evaluated as Pulse Wave Velocity (PWV), Left Ventricular Mass Index (LVMI) and carotid Intima-Media Thickness (IMT) and plaque. Results When subjects were classified according to BP levels we found that high-normal BP group showed intermediate values of PWV and LMVI with higher value of IMT. This corresponds to intermediate prevalence of arterial stiffness (PWV&amp;gt;10 m/s: 3.4% vs 2.3% for normal and 9.6% for high BP groups, p=0.0014), Left Ventricular Hypertrophy – LVH (32.4% vs 25.7% for normal and 46.6% for high BP groups, p=0.0001) while there were no differences for IMT&amp;gt;0.9 or carotid plaque. At multivariable analysis the odds of having a PWV&amp;gt;10 m/s (OR=1.75, 95% C.I. 0.59–5.16), an IMT&amp;gt;0.9 mm (OR=1.81, 95% C.I. 0.60–5.00) or a LVH (OR=1.1, 95% C.I. 0.72–1.67) in the high-normal group resulted not different to the normal group. Conclusions In our otherwise healthy population, high-normal BP values were not related to aortic, carotid or cardiac TOD. Funding Acknowledgement Type of funding sources: None.

THE RELATIONSHIP AMONG BRACHIAL SYSTOLIC BLOOD PRESSURE, MICROALBUMINURIA, AND 24-H URINARY EXCRETION ON CENTRAL SYSTOLIC PRESSURE IN RESISTANT HYPERTENSIVE PATIENTS

Objective: Resistant hypertensive patients have a high prevalence of target organ damage. Increased central systolic blood pressure (cSBP) is more relevant than the peripheral one in these patients, because heart, brain and kidneys are directly exposed to high cSBP levels. Moreover, it is directly related to left ventricular hypertrophy, left atrial size, ischemic heart disease, brain injury, and kidney dysfunction. Currently, assessing cSBP and Augmentation Index (Aix) can be helpful to stratify cardiovascular risk and there is evidence that an improvement on cSBP leads to reduction of cardiovascular events and guides the antihypertensive treatment with drugs that more effective on cSBP reduction.An open prospective study was conducted, to identify markers associated with high cSBP values in resistant hypertensive patients on antihypertensive treatment. Design and method: Seventy-two hypertensive patients were recruited in the Hypertension Outpatient Clinic of FAMERP (44 women/ 28 men). Clinical characteristics and biochemical data collected are shown in the Table 1. The central systolic arterial pressure (cSBP) and the augmentation index (AIx) were measured using Tonometry HEM 9000-A validated OMRON equipment (JAPAN). Results: Multiple regression (cSBP) showed positive correlation between cSBP and brachial SBP (p = 0,0243) and microalbuminuria (p = 0,0325) and negative correlation with 24-h urinary sodium (p = 0,0277). Table2 and Figures. Conclusions: In Resistant hypertensive patientes the microalbuminuria can be useful as a marker to Increased central systolic blood pressure (cSBP)

Evolution of isolated systolic hypertension with normal central blood pressure in adolescents\u2014prospective study

BackgroundThe clinical significance of isolated systolic hypertension with normal central blood pressure known as spurious hypertension (sHT) in adolescents and its evolution over time is not known.MethodsThe aim of this study was to analyze changes in office, ambulatory blood pressure (ABPM), central systolic blood pressure (cSBP), hemodynamic parameters, and target organ damage (TOD) over a 1-year follow-up in a group of non-obese children with sHT.ResultsOf 294 patients referred for primary hypertension, 138 patients (31 girls; 22%) had hypertension confirmed by ABPM. 48/138 (35%) patients (7 girls; 15%) were diagnosed with sHT (elevated office and ambulatory systolic BP, but normal cSBP); 43 of them (6 girls; 14%) were followed for 12 ± 3 months during non-pharmacological therapy. At baseline 7 (16%) patients had borderline values of cIMT or LVMi indicating mild TOD. After 12 months, 10/43 (3 girls; 23%) patients developed sustained HT (elevated office, ambulatory BP and cSBP), 11/43 (1 girl; 26%) maintained sHT, and 22/43 (2 girls; 51%) evolved to white coat hypertension or normotension. The cSBP values increased in 27 patients (4 girls; 63%), but the group average remained in the normal range. Prevalence of TOD did not change during observation. The multivariate regression analysis showed that the only predictor of cSBP change over time was a change in serum uric acid level.ConclusionsIn conclusion, after 1 year of non-pharmacological treatment, 23% of adolescents with sHT developed sustained hypertension, with the main predictor of cSBP change being the change in serum uric acid.

Abstract MP42: Do Adult Ambulatory BP Cut-points Predict Target Organ Damage Better Than Pediatric ABP Percentiles?

Ambulatory hypertension (HT) is more strongly related to cardiac target organ damage (TOD) than clinic BP. Therefore, correct classification of ambulatory blood pressure (ABP) phenotype is needed to determine which patients to refer for imaging. Pediatric ABPM interpretation is based on percentiles of ABP while adult ABPM interpretation is based on static cut-points. We sought to determine which ABP classification system was the best predictor of TOD in adolescents. We measured adiposity, LV mass index (LVMI), systolic and diastolic function (strain, E/e’ ratio) in 315 adolescents (15.9 + 1.4 years, 64% white, 59% male). BP phenotype was determined by mean of 6 casual aneroid SBPs, and 24-hour SBP on ABP (Spacelabs Inc., Snoqualmie, WA) 1) by age, sex and height specific pediatric cut-points and 2) by adult ABPM cut-points (day &lt;130, night &lt; 110, 24-hour &lt; 125 mmHg). We evaluated concordance in classification and prevalence of TOD with Chi square and kappa statistic for agreement. For daytime SBP, 5% of all subjects (16 of 315) reclassified from normotensive (NT) to masked hypertension (MH) and 8% (24 of 315) reclassified from white coat (WC) to HT. Results were similar for night and 24-hour ABP. Fewer NT and WC subjects had any form of TOD by adult vs pediatric cut-point (NT 32 vs 36%, WC 8 vs 13%; chi square &lt; 0.0001, kappa 0.73). The only significant differences in cardiac TOD by ABP phenotype were found using adult ABP cut-points (LVMI higher and strain lower HT vs NT, diastolic E/e’ higher HT and MH vs NT all p &lt;=0.05). We conclude that classification of ABP by adult cut-points is superior in identifying adolescents at risk for cardiac TOD. These findings may inform future pediatric ABP guidelines.

Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting: The Campania Salute Network.

Hypertensive urgencies (HypUrg) are defined as severe elevation in blood pressure (BP) without acute target organ damage. In the office setting, treated asymptomatic patients, with severe BP elevation meeting criteria for urgency are often seen. We evaluate incident Cardiovascular (CV) events (n = 311) during follow-up (FU) in patients with HypUrg at first outpatient visit. HypUrg was defined by systolic BP ≥180 mm Hg and/or diastolic BP ≥110 mm Hg. Patients were >18 years old, with available ultrasound data, without prevalent CV disease, and no more than stage III Chronic Kidney Disease. BP control was defined as the average BP during FU <140/90 mm Hg. Four hundred and sixty-nine of 6,929 patients presented with HypUrg at first visit. Patients with HypUrg were more likely to be women, obese and diabetic and with higher prevalence of left ventricle (LV) hypertrophy and carotid plaque (all P < 0.05). During FU patients with HypUrg had 5-fold higher risk of uncontrolled BP (95% confidence interval (CI) 4.1-6.8, P < 0.0001). In Cox regression presenting with HypUrg was not associated with increased CV risk after adjusting for significant covariates, including age, sex, BP control, LV hypertrophy, and carotid plaque (hazard ratio (HR) 1.42, 95% CI (0.96-2.11), P = 0.08). Patients with HypUrg have worst CV risk profile, reduced probability of BP control during FU and greater prevalence of target organ damage, but the excess CV event risk appears to be mediated through BP control, non-BP cardio-vascular disease risk factors, and demographic attributes. NCT02211365.

Endothelial dysfunction in hypertension: cause or effect?

Hypertension remains a pandemic of the 21st century, being a major factor of premature death. The introduction of imaging methods into clinical practice revealed a high prevalence of target organ damage mediated by hypertension. One of the systemic target organs in hypertension is endothelium. Its damage plays an important role in the initiation of the cardiovascular disease continuum. On the other hand, structure and function defects of the endothelium is considered as a possible reason for the increase in blood pressure. This literature review systematizes data on a causal relationship between hypertension and endothelial dysfunction, and discusses the direction of further study of vascular endothelium function.

Childhood obesity and early target organ damage

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

Prevalence of Target Organ Damage in Chinese Hypertensive Children and Adolescents

Background: Subclinical target organ damage (TOD) has been common in hypertensive children, but there is limited data in the Chinese pediatric population. This study aimed to investigate the prevalence of subclinical TOD in the Chinese hypertensive children and adolescents.Methods: A cross-sectional study was performed in children and adolescents from four schools in Jinan, China between September 2012 and September 2014. The hypertensive status was confirmed based on elevated blood pressure across three different occasions. Those with hypertension were invited to participate in the evaluation of TOD (including heart, arteries, and kidney) and metabolic disorders. A total of 7,840 children and adolescents aged 6–17 years were recruited at baseline, of whom 373 were diagnosed as hypertensive after three separate visits, and 333 (89%) participated in evaluation of TOD.Results: Among 333 hypertensive children, 47.4% had elevated carotid intima-media thickness, 32.4% had left ventricular hypertrophy, 29.2% had dyslipidemia, 7.6% had liver dysfunction, and 4.1% had microalbuminuria. Cardiovascular damages were more prevalent in children aged 9–14 years than the other age groups (i.e., 6–8 and 15–17 years). Girls had higher proportion of microalbuminuria than boys (8.2 vs. 2.6%). No significant sex and age differences were observed for the prevalence of other TODs. Nearly all subclinical TODs were much more prevalent in hypertensive children who were overweight and obese than those with normal weight, except microalbuminuria.Conclusions: The subclinical TOD is prevalent in Chinese hypertensive children and adolescents. Effective measures should be taken to fight against subclinical TOD.

A9497 Prevalence of target organ damage in Chinese hypertensive children and adolescents

Objectives: The aim of our study was to investigate the prevalence of subclinical target organ damage (TOD) in Chinese hypertensive children and adolescents. Methods: A cross-sectional study was performed in children and adolescents from four schools in Jinan of China between September 2012 and September 2014. The hypertensive status was confirmed based on blood pressure measured on three different occasions. Those with hypertension were invited to participate in the evaluation of TOD (including heart, arteries, and kidney) and metabolic disorders. A total of 7840 children aged 6–17 years were recruited at baseline, of whom 373 were diagnosed as hypertension after three separate visits, and 333 (89%) participated in evaluation of TOD. Results: Among 333 hypertensive children, 32.4% had left ventricular hypertrophy, 47.4% had elevated carotid intima-media thickness, 7.6% had liver dysfunction, 4.1% had microalbuminuria, and 29.2% had dyslipidemia. Cardiovascular damages were more prevalent in children aged 9–14 years than the other age groups (i.e., 6–8 and 15–17 years). Girls had higher proportion of renal damages than boys (8.2% vs. 2.6%). No significant gender and age differences were observed for other indicators. Conclusion: The subclinical TOD is prevalent in Chinese hypertensive children and adolescents. Effective measures should be taken to fight against the subclinical TOD.

Abstract P399: Abnormal Ankle-Brachial Index Values are Associated With a Greater Prevalence of Left Ventricular Hypertrophy, Renal Impairment and Relevant Vascular Findings in Diabetic Hypertensive Patients

Few studies have examined the correlation between the presence of peripheral artery disease diagnosed by ankle-brachial-index (ABI) and cumulative target organ damage (kidney, heart and vessels) in hypertensive patients with diabetes. For this purpose, we evaluated the prevalence of target organ damage as evidenced by an echocardiogram, Doppler carotid scan, retinography and glomerular filtration rate according to ABI values in 99 hypertensive diabetic patients. The patients were classified into a normal ABI group (1.4 ≥ ABI &gt; 0.9) and abnormal ABI group (ABI ≤ 0.9 or ABI&gt;1.4). From the data obtained, we analysed cumulative number, mean and frequency (mean) of lesions in target organs. The mean age of the patients was 65.4 ±7 years, and 61.6% were women. There were no differences concerning age, gender, race, body mass index, and metabolic profile between the normal (49 patients) and abnormal ABI group (50 patients), but higher levels of systolic blood pressure were observed in abnormal ABI group compared to normal ABI group (170.3 ± 26 vs. 153.3 ± 18; p = 0.002). In patients with abnormal ABI, it was observed a higher prevalence of left ventricular hipertrophy (56% vs. 26,5%, p = 0,003), internal carotid stenosis &gt; 50% (13,7% vs. 3,2%, p = 0,009) and glomerular filtration rate &lt; 60ml/1,73m 2 /min (33,3% vs. 12,8%, p = 0,018). Abnormal ABI group has a higher frequency of 2 or more lesions (54% vs. 20.4%, p &lt; 0.001), a greater mean number of lesions (2.37 ± 1 vs. 0.71 ± 0.7, p &lt; 0.001), as well as a higher frequency of target organs damage (0.36 ± 0.31 vs. 0.19 ± 0.19, p = 0.001). Multiple linear regression analysis revealed abnormal ABI as an independent factor related to the higher frequency of target organ damage (OR = 13.22; 95% CI = 1.81-24.63; p = 0.024). In conclusion, hypertensive diabetic patients with abnormal ABI values had a higher prevalence of single and cumulative target organ damage.

Cardiovascular risk factors: Is the metabolic syndrome related to aging? Epidemiology in a Portuguese population

AimsThe primary objective of our study is to determine the prevalence of the metabolic syndrome in the population. The secondary objective is to determine the prevalence of cardiovascular risk factors, anthropometric alterations and the prevalence of target organ damage and their relationship with aging. Material and MethodsThe sample for the study was obtained by means of a consecutive population-based demonstration in 803 adults over 18 years of age belonging to the labor force of the company Grupo Delta SA. The study was carried out according to the guidelines of the Declaration of Helsinki. The individuals included in the study voluntarily participated, once informed of the purpose of the study, giving their prior verbal consent, to the company's human resources department, in the case of Delta Group workers. Results23.8% of the population has metabolic syndrome more prevalent in males, no smoking, no significant alcohol consumption, sedentary, with a high Body mass index (BMI). Its prevalence increases with age. ConclusionWe found that the prevalence of metabolic syndrome increases with age and is present in people of working age, increasing the risk of cardiovascular diseases, work-related absences, and socio-economic costs.

Prevalence and Clinical Characteristics of Refractory Hypertension.

BackgroundWe aimed to estimate the prevalence of refractory hypertension (RfH) and to determine the clinical differences between these patients and resistant hypertensives (RH). Secondly, we assessed the prevalence of white‐coat RfH and clinical differences between true‐ and white‐coat RfH patients.Methods and ResultsThe present analysis was conducted on the Spanish Ambulatory Blood Pressure Monitoring Registry database containing 70 997 treated hypertensive patients. RH and RfH were defined by the presence of elevated office blood pressure (≥140 and/or 90 mm Hg) in patients treated with at least 3 (RH) and 5 (RfH) antihypertensive drugs. White‐coat RfH was defined by RfH with normal (<130/80 mm Hg) 24‐hour blood pressure. A total of 11.972 (16.9%) patients fulfilled the standard criteria of RH, and 955 (1.4%) were considered as having RfH. Compared with RH patients, those with RfH were younger, more frequently male, and after adjusting for age and sex, had increased prevalence of target organ damage, and previous cardiovascular disease. The prevalence of white coat RfH was lower than white‐coat RH (26.7% versus 37.1%, P<0.001). White‐coat RfH, in comparison with those with true RfH, showed a lower prevalence of both left ventricular hypertrophy (22% versus 29.7%; P=0.018) and microalbuminuria (28.3% versus 42.9%; P=0.047).ConclusionsThe prevalence of RfH was low and these patients had a greater cardiovascular risk profile compared with RH. One out of 4 patients with RfH have normal 24‐hour blood pressure and less target organ damage, thus indicating the important role of ambulatory blood pressure monitoring in guiding antihypertensive therapy in difficult‐to‐treat patients.