Hypertensive Target Organ Damage Research Articles

A1790 Which is more correlated with hypertensive organ damage, sleep blood pressure assessed by self-measured at home or ambulatory blood pressure monitoring?

Objectives: To assess the associations with hypertensive target organ damage (TOD) of sleep SBP assessed by self-measured home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM) Methods: Data of 1008 participants in the J-HOP study who measured sleep BP using both HBPM, three times during sleep (2AM, 3AM and 4AM) and ABPM during sleep were analyzed. Study participants were classified into 4 groups according to sleep SBP values: group 1, HBPM <120 mmHg, ABPM<120 mmHg; group 2, HBPM <120 mmHg, ABPM>120 mmHg; group 3, HBPM >120 mmHg, ABPM<120 mmHg and group 4, HBPM >120 mmHg, ABPM>120 mmHg. Hypertensive TOD as indicated by B-type natriuretic peptide (BNP) levels, left ventricular mass index (LVMI) and carotid intima media thickness (IMT), assessed in 1008, 876 and 317 participants respectively, were compared among the 4 groups. Results: Mean age was 63 + 11 years. The percentage of male participants was 49.9. Thirty-four, 10, 20 and 36 percent of the participants were classified into groups 1, 2, 3 and 4. For groups 1,2, 3 and 4, respectively, BNP (median (25th Percentile, 75th Percentile)) levels were 14.6 (7.5, 30.9), 15.9 (6.5, 29.5), 17.9 (9.0, 44.9) and 22.1 (10.0, 41.7) pg/ml, LVMI were 91 + 23, 94 + 22, 101 + 26 and 101 + 28 g/m2, and IMT were 0.73 + 0.14, 0.72 + 0.18, 0.79 + 0.15 and 0.80 + 0.19 mm. After age, gender and office SBP were adjusted, the LVMI and IMT of groups 3 and 4 were significant higher than of group 1, and the BNP of group 4 was significantly higher than of group 1. In multivariate analyses, sleep SBP assessed by HBPM was an independent predictor of BNP, LVMI and IMT, but that assessed by ABPM was not. Conclusion: Sleep SBP measured by HBPM was more closely associated with BNP, LVMI and IMT than sleep SBP measured by ABPM.

A11075 Association of hypertensive target organ damage with serum uric acid in the community-dwelling elderly Chinese

Objectives: To survey the correlation between hypertensive target organ damage (TOD) and serum uric acid in the elderly. Methods: 1599 participants aged over 65 years (mean age 72.72 ± 5.97 years) were recruited in ten communities located in northern Shanghai from July 2014 and August 2015. Hypertensive TOD were assessed for each participant, including carotid-femoral pulse wave velocity (CF-PWV), carotid intima-media thickness (CIMT), left ventricular mass index (LVMI), estimated glomerular filtration rate (eGFR) and urinary microalbumin/creatinine (UMC). Results: Mean serum uric acid was 338.9 ± 84.6 μmol/L. sUA was positively correlated with age, body mass index and systolic blood pressure (BP) (p < 0.001). In the univariate linear regression, sUA was significantly associated with CF-PWV (r = 0.16, p < 0.001), UMC (r = 0.11, p < 0.05) and eGFR (r = −0.23, p < 0.001) in high sUA level. After adjustment for confounders, sUA in the high level also showed significant and negative association with eGFR (r = −0.22, p < 0.001) and CF-PWV (r = 0.13, p = 0.05). Conclusion: In the elderly, sUA is significantly correlated with renal function and arterial stiffening, especially in the high level.

A13994 Blood pressure variability and hypertensive target organ damage

Objectives: to investigate an impact of blood pressure variability (BPV) on heart and brain hypertensive damage in the middle-aged untreated patients with grade 1–2 essential arterial hypertension (EAH) without concomitant cardiovascular diseases. Methods: we examined 60 naive hypertensive patients (HP) with EAH and 44 sex- and age-matched healthy individuals. Comprehensive transthoracic echocardiography (Vivid 7 Dimension, GE) with 2D speckle tracking analysis and ambulatory blood pressure monitoring were performed in all participants. BPV was estimated as standard deviation. 41 HP underwent brain magnetic resonance imaging (MAGNETOM Skyra 3.0T, Siemens AG). Fazekas scale was used to quantify the amount of white matter hyperintensities (WMH). Results: nighttime systolic BPV (sBPV) and nighttime diastolic BPV (dBPV) were significantly (p < 0,001 for all) higher in HP (12,1 ± 0,1 vs. 9,3 ± 0,4 mmHg in controls and 9,8 ± 0,4 vs. 6,9 ± 0,3 mmHg in controls, respectively). Correlation analyses in HP revealed significant association of nighttime sBPV with left ventricular (LV) end-systolic elastance (r = −0,375; p < 0,01) and LV end-diastolic stiffness (r = −0,429; p < 0,01). Daytime dBPV significantly correlated with LV diastolic elastance (r = 0,265; p < 0,05), nighttime dBPV - with left atrial expansion index (r = −0,282; p < 0,05). WMH (Fazekas 1 and 2) were found in 53,7% HP patients. In HP with WMH 24 hours sBPV (19,7 ± 3,9 mmHg) and daytime sBPV (18,0 ± 4,5 mmHg) were significantly (p < 0,05 for all) higher compared to same parameters in HP without WMH (17,2 ± 3,3 and 15,7 ± 3,1 mmHg, respectively). Conclusion: middle-aged untreated patients with grade 1–2 uncomplicated EAH are different from the sex- and age-matched healthy individuals by higher nighttime BPV. BPV associated with heart and brain hypertensive organ damage.

A0812 Osteopontin associated with cardiac target organ damage in essential hypertension

A0812 Osteopontin associated with cardiac target organ damage in essential hypertension

A6321 Complement in Hypertension and Target Organ Damage

Objectives: Immunity and inflammation play pivotal roles in the development of hypertension, including innate and adaptive immunity. Complement system provides a bridge between innate and adaptive immune cells. We aim to elucidate the mechanism of complement activation in hypertension and related target organ damage. Methods: Complement C3, C3aR, C5aR knock out (KO) mice were utilized for performing hypertension model, including deoxycorticosterone acetate (DOCA)/salt and angiotensin II (Ang II)-induced hypertension. Macrophage and T cells were separated for stimulating with complement factors. Results: We firstly found that perivascular adipose tissue (PVAT) expressed abundant C3, which stimulated adventitial fibroblast migration and phenotype transdifferentiation. Subsequently, we showed that C5a regulated M1/M2 macrophage polarization and inhibited adiponectin production in the PVAT, which contributed to vascular inflammation in hypertension. More important, we demonstrated that double C3aR and C5aR KO (DKO) prevented Ang II-induced blood pressure elevation. Mechanically, DKO activated the immunosuppressive functio of regulatory T cells (Tregs). Adoptive transfer of DKO Tregs attenuated Ang II-induced hypertension and target organ damage. Conclusion: Our results demonstrate that complement activation-mediated immune cell infiltration is involved in the development of hypertension and target organ damage. Blockade of complement activation may be an alternative novel approach for hypertension treatment.

A13689 Novel markers of hypertensive target organ damage in the middle-aged untreated patients with uncomplicated essential arterial hypertension

A13689 Novel markers of hypertensive target organ damage in the middle-aged untreated patients with uncomplicated essential arterial hypertension

A3931 The Relationship between Urinary Magnesium Excretion and Subclinical Hypertensive Target Organ Damage

A3931 The Relationship between Urinary Magnesium Excretion and Subclinical Hypertensive Target Organ Damage

SHIP-AHOY (Study of High Blood Pressure in Pediatrics: Adult Hypertension Onset in Youth).

Although hypertension is identifiable in children and adolescents, there are many knowledge gaps on how to best define and manage high blood pressure in the young. SHIP-AHOY (Study of High Blood Pressure in Pediatrics: Adult Hypertension Onset in Youth) is being conducted to address these knowledge gaps. Five hundred adolescents will be recruited and will undergo ambulatory blood pressure monitoring, echocardiographic, vascular, and cognitive assessments, as well as epigenetic studies to identify mechanisms that underlie the development of hypertensive target organ damage. Details of the design and methods that will be utilized in SHIP-AHOY are presented here, as well as baseline characteristics of the first 264 study participants. The primary aim of the study is to develop a risk-based definition of hypertension in the young that will result in better understanding of the transition from blood pressure in youth to adult cardiovascular disease.

Abstract P391: Ambulatory Blood Pressure Phenotypes and Cardiovascular Target Organ Damage in Adolescents: The SHIP AHOY Study

Hypertensive target organ damage (TOD) is associated with increased risk for cardiovascular (CV) events. Ambulatory blood pressure (ABP) allows better prediction of TOD than clinic BP in adults, but data in youth are lacking. We aimed to determine if BP phenotype, based on a combination of clinic BP and ABP, predicts underlying CV TOD in otherwise healthy adolescents. We evaluated clinic BP (mean of 6 auscultatory BP’s), ABP (Spacelabs OnTrak), left ventricular mass index (LVMI), pulse wave velocity (PWV), diastolic function (E/e’), and systolic function (longitudinal strain) in 244 adolescents (median age 15.7 yrs, 63% white, 54% male). Clinic HTN was defined according to pediatric guidelines, and ambulatory HTN was defined as wake systolic BP &gt; 95 th percentile for sex and height. General linear models were used to evaluate associations between BP phenotype and TOD. Normal BP phenotype was found in 162 participants (66%), while 44 (18%), 16 (7%), and 22 (9%) had white coat (WCH), masked (MH), and ambulatory (AH) HTN, respectively. Participants with an abnormal BP phenotype had higher LVMI and PWV compared to those with normal BP (table). Participants with AH also had significantly higher PWV than those with WCH or MH. Adolescents with MH or AH had worse diastolic function (higher E/e’) compared to those with normal BP or WCH. Only participants with AH had significantly worse systolic function (less negative strain) compared to those with normal BP; there was no significant difference in strain among subjects with normal BP, WCH and MH. In conclusion, ABPM improves TOD risk stratification in adolescents evaluated for HTN.

P5368Biomarkers for prediction of target organ damage in hypertension

P5368Biomarkers for prediction of target organ damage in hypertension

Zalecenia Sekcji Pediatrycznej Polskiego Towarzystwa Nadciśnienia Tętniczego dotyczące postępowania diagnostycznego i terapeutycznego w nadciśnieniu tętniczym u dzieci i młodzieży

Presented recommendations are an extended and actualized version of paediatric recommendations of Polish Society of Hypertension published in 2015. Since then, new studies have appeared on this subject, introducing a new classification of hypertension, newly described principles of management in risk groups and methods of assessing hypertensive target organ damage. The presented updated recommendations included changes introduced in the 2016 European Society of Hypertension recommendation and Recommendations of Children’s Memorial Health Institute in Warsaw. Recently published guidelines of American Academy of Paediatrics have been discussed. In the presented issue of guidelines, epidemiological information on the occurrence and incidence of hypertension in developmental age was added and classification of blood pressure values was updated. Subchapters on diagnosis and organ damage assessment, principles of diagnosis and treatment of hypertension in children with diabetes, chronic kidney disease and a subsection discussing diagnostic and therapeutic difficulties with setting blood pressure targets were revised. In addition, the principles of early diagnosis of arterial hypertension in post-hospital care in children born before 33 weeks of gestation published in 2018 as recommendations of the Polish Neonatal Society have been also taken into account.

ALBUMIN-TO-CREATININE RATIO AND SUBCLINICAL ORGAN DAMAGE IN HYPERTENSIVES

Objective: Hypertension is associated with higher cardiovascular risk as well as several markers of subclinical target organ damage (TOD). Albumin to creatinine ratio (ACR) in urine has been recognised as an independent risk factor for cardiovascular events. We hypothesised that there is a relationship between ACR and markers of TOD in never-treated hypertensives. Design and method: We enrolled 924 consecutive essential hypertensives (mean age 53 ± 12 years, 486 males) without known cardiovascular disease (CVD). Markers of subclinical TOD [left ventricular mass index (LVMI), pulse wave velocity (PWV), ankle-brachial index (ABI) and estimated glomerular filtration rate (eGFR)] were evaluated in all patients. LVMI was assessed echocardiographically using the Devereux formula. Carotid-femoral PWV was estimated with the Complior device. eGFR was calculated by the Cockcroft-Gault formula. Wave reflections were assessed with aortic augmentation index corrected for heart rate ([email protected]). ABI was calculated by dividing the highest ankle systolic blood pressure by the highest brachial systolic blood pressure. In a 24-hour urine collection, ACR was measured. Results: ACR exhibited significant association with LVMI (r = 0.277, p < 0.001), PWV (r = 0.123, p < 0.001), ABI (r = −0.078, p = 0.018) and eGFR (r = −0.100, p = 0.002). In further analysis, ACR was associated with TOD as suggested by the 2013 European Guidelines for Hypertension [left ventricular hypertrophy (LVMI > 115 g/m2 in men and > 95 g/m2 in women), increased PWV (PWV > 10m/s), decreased. ABI (ABI < 0.9) and decreased renal function (eGFR < 60 ml/min)]. Specifically, ACR exhibited a significant association with the number of TOD and this association was independent of age and gender (p < 0.05, Figure).Conclusions: Our findings support the close relationship between ACR and TOD in hypertension, as well as, the predictive ability of ACR for TOD.

Clinical Implications

HomeHypertensionVol. 71, No. 6Clinical Implications Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBClinical Implications Originally published9 May 2018https://doi.org/10.1161/HYPERTENSIONAHA.118.11323Hypertension. 2018;71:955Biological Sex Modulates Aldosterone Levels (p 1083)Download figureDownload PowerPointSex differences in cardiovascular disease exist, with women being at greater risk than men for some hypertension-related cardiovascular diseases such as increased left ventricular hypertrophy. Salt sensitivity of blood pressure, the change in systolic blood pressure between high- and low-salt diet, is a risk factor for cardiovascular morbidity and mortality. In this study of 1592 normotensive and hypertensive individuals who participated in the Hypertensive Pathotype Consortium, women had increased salt sensitivity of blood pressure and increased blood pressure and aldosterone responses to angiotensin II as compared with men. In an animal model of aldosterone-dependent cardiovascular injury, female compared with male rodents had increased cardiovascular injury with increased aldosterone levels; mineralocorticoid receptor blockade was equally effective in both sexes in preventing the damage. These sex differences likely contribute to the increased salt sensitivity of blood pressure and to increased aldosterone-mediated cardiovascular disease in women compared with men. Thus, as compared with men, women are likely to receive a greater cardiovascular risk reduction from mineralocorticoid receptor blockade.MitoQ Treatment and Vascular Function With Aging (p 1056)Download figureDownload PowerPointAdvancing age is the primary risk factor for cardiovascular disease. The development of vascular dysfunction, including vascular endothelial dysfunction and stiffening of the large elastic arteries (aorta and carotid arteries), is a major mechanism of increased cardiovascular disease risk with aging. Excessive production of reactive oxygen species by mitochondria has emerged as a key driver of vascular dysfunction with aging. Results of preclinical studies from our laboratory demonstrate that 4 weeks of oral supplementation with the mitochondria-targeted antioxidant MitoQ ameliorates age-related endothelial dysfunction and aortic stiffening in mice. In this issue of Hypertension we report the successful translation of these preclinical findings to humans. We show that 6 weeks of supplementation with MitoQ is safe and well tolerated and improves vascular endothelial function in healthy late middle-aged and older adults. We present data from a unique functional bioassay suggesting that the mechanism of action for the improvement in endothelial function with MitoQ supplementation involves a reduction in mitochondrial reactive oxygen species-associated suppression of endothelium-dependent dilation. We also show that MitoQ treatment reduces aortic stiffness in individuals exhibiting age-related aortic stiffening and that MitoQ supplementation decreases plasma concentrations of oxidized low-density lipoprotein, a circulating marker of oxidative stress. Collectively, these findings indicate that mitochondria-targeted therapies such as MitoQ may hold promise for reducing mitochondrial-derived oxidative stress, improving vascular function and decreasing cardiovascular disease risk with aging.Media/Lumen Reference Values in Small Arteries (p 1193)Download figureDownload PowerPointSmall artery remodeling is an early feature of target organ damage in hypertension and retains a negative prognostic value. The gold standard for its assessment, media/lumen ratio (M/L), can be obtained by tissue biopsies. In this article, a cohort of 291 individuals with or without cardiovascular risk factors was pooled from 4 Italian centers to establish age- and sex-specific reference values and to explore M/L relationship with risk factors. M/L reference values obtained in a sufficiently large healthy population are useful in pathophysiological studies to establish the impact of classical and emerging risk factors on the microvasculature as well as the effect of treatment. Indeed, not only blood pressure, but also body mass index, cholesterol, smoking, and blood glucose were associated with increased M/L, highlighting especially the role of metabolic factors in inducing microvascular damage. From a clinical perspective, microvascular alterations are increasingly recognized as crucial mechanisms of cardiovascular and cerebrovascular disease, and they can be reversed by appropriate treatment. A better comprehension of microvascular damage accrual with age and risk factors may thus help identify novel treatment targets. Furthermore, the identification of a different impact of risk factors on M/L in the 2 sexes suggests a possible explanation for the well-known sex differences in the pathophysiology of cardiovascular disease, thus opening a novel pathway to personalized medicine. Previous Back to top Next FiguresReferencesRelatedDetails June 2018Vol 71, Issue 6 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.118.11323 Originally publishedMay 9, 2018 PDF download Advertisement

NEUTROPHIL TO LYMPHOCYTE RATIO AND PLATELET TO LYMPHOCYTE RATIO ARE INDEPENDENT PREDICTORS FOR BLOOD PRESSURE VARIABILITY

Objective: Hypertension is a major risk factor for cardiovascular diseases. Ambulatory blood pressure monitoring is used for detection, follow-up of hypertensive patients and also demonstrates the diurnal variability of the blood pressure. Decreased blood pressure variability is associated with hypertensive target organ damage and higher risk for cardiovascular events. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are also related to inflammation and increased cardiovascular risk. The purpose of the study is to investigate the relationship between NLR and PLR with non-dipper status of hypertensive and normotensive patients.Design and method: A total of 482 patients were evaluated retrospectively. Patients with previous hypertension diagnosis, acute coronary syndrome, serious valve regurgitation or stenosis, coronary artery disease, echocardiographic findings of reduced left ventricular ejection fraction (LVEF < 55%), congenital heart diseases, abnormal kidney function, chronic liver disorders, chronic inflammatory disease, patients who had a recent history of acute infection were excluded. Results: Mean age of the study population was 50.1 ± 15.5 years, 38.1% were male. Four groups were formed according to hypertension diagnosis, dipper and non-dipper patterns. Group 1 was consisted of 165 patients with hypertensive and non-dipper status; group 2 was consisted of 88 patients with hypertensive and dipper status; group 3 was consisted of 123 patients with normotensive and non-dipper status; and group 4 was consisted of 91 patients with normotensive and dipper status. Neutrophil lymphocyte ratio was statistically different among groups (p = 0.000). Group 1 had significantly higher values compared to Group 2 (p = 0.001), Group 3 (0.002) and Group 4 (p = 0.023). In hypertensive patient group, PLR values of Group 1 was significantly higher than Group 2 (p = 0.002). Pearson correlation analysis showed that NLR and PLR were correlated with BP variability between night and day (r = -0.188, p = 0.000 for NLR and r = -0.182 and p = 0.000 for PLR). Regression analysis showed NLR (p = 0.040), PLR (p = 0.021), age (p = 0.006) and hypertension (p = 0.000) were independent predictors of BP variability. Conclusions: In conclusion NLR and PLR can be used as easily accessible and inexpensive markers for non-dipper status especially in hypertensive patients.

ASSOCIATION OF ASYMPTOMATIC TARGET ORGAN DAMAGES WITH SECRETED FRIZZLED RELATED PROTEIN 5 IN THE ELDERLY

Objective: Secreted frizzled related protein 5 (SFRP5) is a novel anti-inflammatory adipokine which is implicated in metabolic and cardiovascular disease (CVD). However, little is known about the relevance of SFRP5 with asymptomatic hypertensive target organ damages (TOD). We aimed to investigate the association between SFRP5 and TOD in a large population study.Design and method: Associations between plasma SFRP5 and cardiovascular risk factors as well as TOD were investigated in 1745 participants from Northern Shanghai Study. Plasma SFRP5 level was measured by an enzyme-linked immunosorbent assay. Results: Plasma SFRP5 level was negatively associated with body mass index, waist/hip ratio and fasting blood glucose (all P < 0.001). Lower plasma SFRP5 level was observed in men than in women (4.19 vs 5.13 ng/ml, P < 0.001), in smokers than in nonsmokers (4.34 vs 4.78 ng/ml, P < 0.05). Additionally, plasma SFRP5 level was also lower in diabetes than those without diabetes (4.30 vs 4.81 ng/ml, P < 0.05). Further, an inverse association was observed between SFRP5 and pulse wave velocity as well as carotid intima-media thickness (both P < 0.05). Moreover, multivariate logistic regression analysis showed lower SFRP5 level was associated with increased arterial stiffness in the elderly (OR 0.83, 95% CI 0.71 to 0.99 per 1-SD increase, P < 0.05). Conclusions: Plasma SFRP5 level was inversely correlated with conventional cardiovascular risk factors and low plasma SFRP5 was also significantly associated with arterial stiffening in the elderly Chinese population.

EARLY MORNING SURGE BLOOD PRESSURE AND ISOLATED SYSTOLIC HYPERTENSION - A CLINICAL IMPORTANCE IN ELDERLY

Objective: In hypertensive patients treated with antihypertensive medication, even patients whose clinic blood pressure is well controlled, morning blood pressure prior taking medication remains high, and therefore morning hypertension is currently the blind spot in the clinical practice of hypertension. To objective is to asses now again on a wider group of patients whether an increased early morning blood pressure surge is related to more prominent target organ damage. Design and method: 623 treated hypertensive patients randomly attended the out-patient clinic of our hypertension centre from 6 October 2009 to 1 November 2014, and supplemented from 2 November 2014 to 31 October 2016. The Isolated Systolic Hypertension patients (n = 176, 78 ± 11 yrs) were divided into 2 groups (n = 176 {with morning hypertension [sleep > 120mmHg] n = 140 [nondippers] and those without n = 36 [dippers]}). Early Morning Blood Pressure Surge, was defined as peak Blood Pressure during morning period (4–6am, average of 5 values, mean = 124.19 mmHg, SD 21.91 mmHg) minus average BP during the sleep period (average of lowest 3 sleep values, mean = 145.49 mmHg, SD 22.14 mmHg). Early morning surge had a mean of 22.78 mmHg, SD 11.92 mmHg, (P < 0.01). Pulse Pressure was also used in this study as a direct predictor of hypertensive target organ damage. Results: Nondipping pattern is related to metabolic syndrome, masked hypertension and female gender. Pulse pressure mean was higher in Nondippers by 11mmHg. Higher cases of stroke and MI where reported in the Early Morning Surge group. Conclusions: Early Morning Surge is a predictor of hypertensive target organ damage.

Cardiac and Vascular Target Organ Damage in Pediatric Hypertension.

Atherosclerosis begins in youth and is associated with the presence of numerous modifiable cardiovascular (CV) risk factors, including hypertension. Pediatric hypertension has increased in prevalence since the 1980s but has plateaued in recent years. Elevated blood pressure levels are associated with impairments to cardiac and vascular structure and both systolic and diastolic function. Blood pressure-related increases in left ventricular mass (LVM) and abnormalities in cardiac function are associated with hard CV events in adulthood. In addition to cardiac changes, key vascular changes occur in hypertensive youth and adults. These include thickening of the arteries, increased arterial stiffness, and decreased endothelial function. This review summarizes the epidemiologic burden of pediatric hypertension, its associations with target organ damage (TOD) of the cardiac and vascular systems, and the impact of these adverse CV changes on morbidity and mortality in adulthood.

Familial clustering of hypertensive target organ damage in the community.

Prior studies suggest that hypertensive target organ damage (TOD) is a heritable trait. However, the risk that parental TOD confers on propensity for TOD in their offspring, and how hypertensive TOD clusters in the context of parental versus offspring hypertension status remain unclear. We studied 3238 Framingham Heart Study participants (mean age 39 ± 8 years, 53% women) with available parental data on TOD. Parents and offspring underwent measurements for left ventricular hypertrophy, increased relative wall thickness, albuminuria and conventional risk factors. Prevalence of any TOD (left ventricular hypertrophy or albuminuria) in participants with zero and at least one parents with any TOD was 7 and 13%, respectively (P < 0.001 for difference). Having at least one parent with TOD was associated with greater odds of TOD in offspring than individuals without parental TOD [multivariable-adjusted odds ratio (OR), 1.65; 95% confidence interval (95% CI), 1.27-2.14]. Similarly, parental left ventricular hypertrophy was associated with offspring left ventricular hypertrophy (OR, 2.73; 95% CI 1.92-3.89), parental increased relative wall thickness conferred increased odds of increased relative wall thickness in the offspring (OR, 1.54; 95% CI 1.16-2.04) and parental albuminuria was related to offspring albuminuria (OR, 1.49; 95% CI 1.03-2.16). These associations remained significant upon adjustment for other risk factors, including blood pressure, and in analyses of subgroups defined according to parental or offspring hypertension status. Overall, our data suggest that familial clustering of TOD in the community is independent of blood pressure. Additional studies are warranted to confirm our observations.

Role of Transforming Growth Factor-β in Hypertensive Living Kidney Donors

BackgroundTransforming growth factor-β (TGF-β) is involved in the pathogenesis of hypertension and the development of hypertensive target organ damage. TGF-β may promote blood pressure elevation through several mechanisms. The identification of risk factors of hypertension in living kidney donors may provide proper postoperative management. ObjectiveThe objective of the study was to determine the serum TGF-β concentration in living kidney donors after nephrectomy. Patients and MethodsA total of 66 living donor open nephrectomies were performed in the Department of General and Transplantation Surgery at the Medical University of Warsaw between 1995 and 2005. Forty living kidney donors reported for the follow-up. Physical examination, blood and urine tests, ECG, ambulatory blood pressure monitoring, cardiac sonography, and ophthalmoscopy were performed. Serum TGF-β concentration was measured by ELISA. Statistical analysis was performed using SPSS version 13.0. ResultsThe mean observation period was 65.6 months. The mean donor age at the time of donation and at the follow-up visit was 40.7 and 46.2, respectively. Hypertension was observed in 24% women and in 37% men after surgery. The significantly higher frequency of hypertension was observed after nephrectomy (P = .001). The strongest predictor of hypertension was age. The mean serum TGF-β concentration was 39.3 ng/mL. No significant differences were observed between hypertensive and normotensive donors (P = .061). A significantly higher TGF-β concentration was found 4 and 5 years after donation (P = .02). ConclusionsTGF-β is not associated with hypertension and glomerular filtration rate in living kidney donors after nephrectomy. Careful monitoring of hypertension in living kidney donors after nephrectomy is essential.

Age- and Sex-Specific Reference Values for Media/Lumen Ratio in Small Arteries and Relationship With Risk Factors.

Small-artery remodeling is an early feature of target organ damage in hypertension and retains a negative prognostic value. The aim of the study is to establish age- and sex-specific reference values for media/lumen in small arteries obtained in humans by biopsy. Data from 91 healthy individuals and 200 individuals with cardiovascular risk factors in primary prevention from 4 Italian centers were pooled. Sex-specific equations for media/lumen in the healthy subpopulation, with age as dependent variable, were calculated. These equations were used to calculate predicted media/lumen values in individuals with risk factors and Z scores. The association between classical risk factors and Z scores was then explored by multiple regression analysis. A second-degree polynomial equation model was chosen to obtain sex-specific equations for media/lumen, with age as dependent variable. In the population with risk factors (111 men, age 50.5±14.0 years, hypertension 80.5%), media/lumen Z scores were independently associated with body mass index (standardized β=0.293, P=0.0001), total cholesterol (β=0.191, P=0.031), current smoking (β=0.238, P=0.0005), fasting blood glucose (β=0.204, P=0.003), systolic blood pressure (β=0.233, P=0.023), and female sex (β=0.799, P=0.038). A significant interaction between female sex and total cholesterol was found (β=-0.979, P=0.014). Results were substantially similar in the hypertensive subgroup. A method to calculate individual values of remodeling and growth index based on reference values was also presented. Age- and sex-specific percentiles of media/lumen in a healthy population were estimated. In a predominantly hypertensive population, media/lumen Z scores were associated with major cardiovascular risk factors, including body mass index, cholesterol, smoking, glucose, and systolic blood pressure. Significant sex differences were observed.