Philip Zager 1 2 6 7 8 9 0 10 12 13 14 17 18 20 21 22 23 24 25 27 28 29 30 31 32 33 35 36
Dana Miskulin 0 8 5 9 10 11 13 16 19 20 23 26 29 30 33 34
Jennifer Gassman 5 8 9 10 3 13 15 20 23 29 30 33
Cynthia Kendrick 5 8 9 10 3 13 15 20 23 29 30 33
David Ploth 4 8 9 10 13 20 23 29 30 33
Manisha Jhamb 3 8 9 10 13 20 23 29 30 33
0 Tufts Medical Center , Boston, MA
1 Dialysis Clinic, Inc. , Albuquerque, NM
2 University of New Mexico , Albuquerque, NM
3 University of Pittsburgh , Pittsburgh, PA
4 Medical University of South Carolina , Charleston, SC
5 The Cleveland Clinic Foundation , Cleveland, OH
6 University of Glasgow , Galsgow , United Kingdom
7 Charite , Berlin , Germany
8 Vera Jankowski
9 Philip Zager
10 Georgios Koutroumpas
11 Laboratory of Pharmacology & Experimental Therapeutics, IBILI, Faculty of Medicine, University of Coimbra , Coimbra , Portugal
12 Institute for Molecular and Cell Biology, University of Porto , Porto , Portugal
13 Pantelis A. Sarafidis
14 Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto , Porto , Portugal
15 Esav and Educational, Technologies and Health Study Center, Polytechnic Institute of Viseu , Viseu , Portugal
16 Hypertension Unit & Cardiovascular Research Laboratory, “laiko” Hospital, Medical School , National and Kapodistrian
17 Medical School, Aristotetle University , Thessaloniki , Greece
18 Achillopoulion General Hospital of Volos , Volos , Greece
19 Medical University of Gdan ́ Sk, Department of Therapy Monitoring and Pharmacogenetics , Gdansk , Poland
20 Dimitris Evangelou
21 Mossakowski Medical Research Center Polish Academy of Sciences Laboratory of Molecular and Cellular Nephrology , Gdansk , Poland
22 University Hospital of Ioannina , Ioannina , Greece
23 Maciej Jankowski
24 Konya Numune Hospital Department of Nephrology , Konya , Turkey
25 Selcuk University Faculty of Medicine , Konya , Turkey
26 University of Colorado , Colorado, CO
27 C.I. Parhon University , Iasi , Romania
28 Istanbul Medeniyet University School of Medicine , Istanbul , Turkey
29 Mehmet Kanbay
30 Chieh Kai Chan
31 Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital , Taipei , Taiwan
32 Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital , Taipei , Taiwan
33 Ines Baotic ́
34 Radboud University Nijmegen Medical Center , Nijmegen , Netherlands
35 Julius Center for Health Sciences and Primary Care , Utrecht , Netherlands
36 University Medical Center Utrecht , Utrecht , Netherlands
Introduction and Aims: Both increased albuminuria and reduced kidney function predict blood pressure (BP) progression in the community, and exacerbate each other's effects. We investigated associations and interactions between these two risk factors, BP changes and hypertension incidence in community-dwelling elderly men. Methods: Cross-sectional and longitudinal observational study in the Uppsala Longitudinal Study of Adult Men. 1051 men (all aged 71 years) with assessments on urinary albumin excretion rate (UAER, performed on an overnight urine collection.), 24-hour ambulatory BP monitoring (ABPM) and cystatin-C estimated glomerular filtration rate (eGFR). Of these, 574 men attended re-examination after 6 years, and ABPM measurements were again recorded. Results: UAER associated with ABPM measurements both at baseline and longitudinally. In longitudinal analysis, there were significant interactions between UAER and kidney function in their associations with changes of systolic BP, mean arterial pressure, and pulse pressure. After stratification for renal function state, UAER independently predicted BP changes only in those who had eGFR<60 mL/min/1.73m2. At re-examination, 71 new cases of hypertension were recorded. In multivariable logistic models of hypertension incidence, similar interactions were observed: UAER was an independent predictor of incident hypertension only in those with reduced renal function. These associations were evident also in the subpopulation of participants with normal range UAER (<20ug/min). Conclusions: UAER, even within the normal range, associates with BP progression and hypertension incidence in community-dwelling elderly men but only in those with concurrent reduction of renal function.
A SINGLE MEASUREMENT OF ELEVATED BLOOD PRESSURE
TAKEN AT AGE 17 IS ASSOCIATED WITH AN INCREASED
RISK OF ESRD- A COHORT STUDY OF 914,616 HEALTHY
Introduction and Aims: Few data are available on the long term outcomes of
adolescents with persistent hypertension. Moreover, the outcome of healthy
adolescents, without known hypertension at age 17, but with a single elevated blood
pressure measurement detected during routine medical screening is unclear.
Methods: We conducted a nationwide, population based cohort study using medical
data from 1,260,919 seventeen year old boys and girls examined for fitness for military
PULSE PRESSURE SUPERIOR TO SYSTOLIC OR DIASTOLIC
BLOOD PRESSURE IN PREDICTING MORTALITY IN
Introduction and Aims: Recent studies concerning patients on hemodialysis have not
been conclusive regarding the best blood pressure measurement in relation to
predicting long term outcome. Currently, there is uncertainty whether pulse pressure,
stystolic or diastolic should be preferred.
Methods: The AURORA study was a randomized controlled trial evaluating rosuvastin
in hemodialysis patients. We performed a post-hoc analysis for the outcome of all
cause mortality. Pulse pressure, systolic blood pressure and diastolic blood pressure
were evaluated in separate Cox regressions. These were adjusted for age, gender, BMI,
current smoking, phosphate, albumin, high-sensitive CRP, dialysis vintage, diabetes,
coronary heart disease and dialysis adequacy. Explanatory value was assessed by
calculation of Wald statistic and its corresponding p-value.
Results: A total of 2773 patients were included. During a median follow-up time of 3.8
years there were 1296 events. Mean age was 64 years and 62% were men. Mean systolic
blood pressure was 137.0 mmHg, and diastolic blood pressure was 75.8 mmHg. In
adjusted analyses, the measure of blood pressure with the highest explanatory value for
the outcome of all cause mortality was pulse pressure (Wald 5.1, p=0.02), followed by
systolic blood pressure (Wald 3.4, p=0.07), and diastolic blood pressure (Wald 0.001,
Conclusions: Pulse pressure is superior to systolic or diastolic blood pressure in
predicting mortality in dialysis patients.
BLOOD PRESSURE IN DIALYSIS (BID) STUDY
Introduction and Aims: The optimal blood pressure target for hypertensive
hemodialysis patients is unknown. Current KDOQI and KDIGO guidelines were
derived from data obtained in the general population. Previous studies of blood
pressure in hemodialysis patients were observational and did not adjust for baseline
cardiac structure and function. Most blood pressure measurements made in the dialysis
unit are not standardized and may be relatively poor predictors of clinical outcomes
(Agarwal, Hypertension 2010). Therefore, it is unknown, which blood pressure
measure e.g., in-center routine, in-center standardized (SDUBPM), standardized home
(HBPM) or ambulatory blood pressure monitoring (ABPM) should guide
management. Although the ability of HBPM and ABPM to predict clinical outcomes
may be superior to dialysis unit measurements, the adherence with longitudinal, out of
unit, measurements is unknown. We are conducting the Blood Pressure in Dialysis
(BID) Study to assess feasibility and inform the design of a full-scale, randomized,
clinical trial of intensive versus usual control of hypertension.
Methods: The BID Study is sponsored jointly by NIH and Dialysis Clinic Inc.
Hypertensive hemodialysis patients are randomized to a pre-dialysis SDUBPM of
110-140 mm Hg versus 155-165 mm Hg during a 1-year intervention. We assessed
adherence with prescribed in-center SDUBPM, HBPM and ABPM. Pre-dialysis
SDUBPM is obtained at each treatment after a 5 minute rest, 3 readings per sitting, in
accord with American Heart Association guidelines. HBPM is performed in the
morning and evening on the day following the mid-week dialysis. ABPM is performed
during one 44-hour interdialytic period per quarter. To compare the distributions of
SDUBPM across study arms we constructed boxplots of SDUBPM to depict the
interquartile ranges, mean, median, minimum and maximum values. To assess the
relationship of cardiac structure and function to blood pressure we obtain a cardiac
MRI at the beginning and end of the 12-month intervention period.
Results: To date we have randomized 102 patients and 58 have completed the
12-month intervention period. Adherence with prescribed pre-dialysis SDUSBPM was
excellent with over 75% of scheduled measurements successfully completed. Each
week, 66% (weekly range 57-74%) of patients performed HBPM, with 79% (range
67-85%) doing at least one HBPM per month. All patients completed ABPM during
the baseline period. However, follow-up adherence was poor, with 46%, 17%, 31% and
58% completing scheduled ABPM in quarters 1, 2, 3 and 4 respectively. Overall, 68% of
patients completed at least one follow-up ABPM. Boxplots of SDUBPM readings across
treatment arms in weeks 14 to 32 is shown in Figure 1. Adherence with prescribed
cardiac MRI was high.
Conclusions: It is feasible to obtain pre-dialysis SDUBPM in busy dialysis units.
Adherence with prescribed HBPM was modest. However, long-term adherence with
prescribed ABPM was poor. It is possible to obtain adequate separation in pre-dialysis
SDUBPM between treatment arms. It is feasible to conduct a full-scale randomized
clinical trial of intensive versus usual control of hypertension.
THE ENZYMATIC ACTIVITY OF THE VEGFR2-RECEPTOR FOR
THE BIOSYNTHESIS OF DINUCLEOSIDE POLYPHOSPHATES
Introduction and Aims: The group of dinucleoside polyphosphates encompasses a
large number of molecules consist-ing of two nucleosides which are connected by a
phosphate chain of variable length. While the receptors activated by dinucleoside
polyphosphates as well as their degradation have been studied in detail, its biosynthesis
has not been elucidated so far.
Methods: Since endothelial cells released the dinucleoside polyphosphate uridine
adenosine tetraphos-phate (Up4A), we tested cytosolic proteins of human endothelial
cells obtained from dermal vessels elicited for enzymatic activity.
Results: When incubated with ADP and UDP these cells showed increasing
concentrations of Up4A. The underlying enzyme was isolated by chromatography and
the mass-spectrometric analysis revealed that the enzymatic activity was caused by the
vascular endothelial growth factor re-ceptor 2 (VEGFR2). Since VEGFR2 but neither
VEGFR1 nor VEGFR3 were capable to syn-thesise dinucleoside polyphosphates,
Tyr-1175 of VEGFR2 is most likely essential for the enzymatic activity of interest.
Further VEGFR2-containing cells like HepG2, THP-1 and RAW264.7 were capable of
synthesizing dinucleoside polyphosphates. VEGFR2-transfected HEK 293T/17 but not
native HEK 293T/17 cells synthesised dinucleoside polyphosphates in vivo too. The
simultaneous biosynthesis of dinucleoside polyphosphates could amplify the response
to VEGF, since dinucleoside polyphosphates induce cellular growth via P2Y purinergic
receptors. Thus the biosynthesis of dinucleoside polyphosphates by VEGFR2 may
enhance the proliferative response to VEGF. Given that VEGFR2 is primarily expressed
in endothelial cells, the biosynthesis of dinucleoside polyphosphates is mainly located
in the vascular system. Since the vasculature is also the main site of action of
dinucleoside poly-phosphates, activating vascular purinoceptors, blood vessels appear
as an autocrine system with respect to dinucleoside polyphosphates.
Conclusions: We conclude that VEGFR2-receptor is capable of synthesizing
dinucleoside polyphosphates. These mediators may modulate the effects of VEGFR2
due to their proliferative effects.
CENTRAL BLOOD PRESSURE PREDICTS THE CHANGES
OF LEFT VENTRICULAR REMODELING IN MAINTENANCE
Younhg-Ki Lee1, Ajin Cho1, Jwa-Kyung Kim1, Myung-Jin Choi1, Soo Jin Kim1,
Jong-Woo Yoon1, Ja-Ryong Koo1, Hyung Jik Kim1 and Jung-Woo Noh1
1Hallym University College of Medicine, Seoul, Republic of Korea
Introduction and Aims: Brachial blood pressure is predictive of cardiovascular
outcome; however central blood pressure may better represent the load imposed on the
coronary and cerebral arteries and thereby bear a stronger relationship to vascular
damage and prognosis. The present study was undertaken to examine the relations of
central and conduit arterial stiffness to the changes of left ventricular (LV) remodeling
in patients with end-stage renal disease.
Methods: We conducted a prospective observational study of 75 patients (47 women;
54.8 ± 12.4 years) receiving maintenance dialysis. At baseline and 12 months, we
measured brachial blood pressure, brachial-ankle pulse wave velocity (PWV),
abdominal aorta calcification, and echocardiography of each patient. Central blood
pressure was monitored using radial applanation tonometry (HEM-9000AI), and the
interrelationships among the measured parameters and their contributions to the
changes of left ventricular remodeling were evaluated.
Results: Central pulse pressure and systolic pressure was strongly related to PWV,
abdominal aorta calcification, LV mass index, and pulmonary artery pressure (all P
<0.001). Our study provides evidence that patients had a prevalence of abnormal LV
geometry in 80%. The concentric LV hypertrophy (LVH) and eccentric LVH groups
had significantly higher central pulse pressure and systolic blood pressure compared
with the normal geometry and concentric remodeling groups. After 12 months,
progression of LV remodeling was observed in 24%. Central pulse pressure and
diabetes were significant predictors of the changes of LV remodeling.
Conclusions: These data suggest that central pulse pressure is more important in
stimulating left ventricular hypertrophy and remodeling. Central blood pressure is
closely associated with aortic calcification and cardiac hypertrophy in maintenance
dialysis patients, and could be a useful marker for management of these patients.
THE EFFECT OF AZELNIZIPINE ON TISSUE/PLASMA RENIN
ACTIVITY IN MICE WITH DIABETIC NEPHROPATHY
Seiji Itano1, Minoru Satoh1, Kengo Kidokoro1, Tamaki Sasaki1
and Naoki Kashihara1
1Kawasaki Medical School, Kurashiki, Japan
Introduction and Aims: Azelnidipine, one of the calcium channel blocker, has organ
protective effect through suppression central sympathetic nerve activity. In the previous
study, we showed that Azelnidipine has anti-oxidative effect and inhibitory effect of
sympathetic nerve. Acceleration of sympathetic nerve promotes renin-isolation from
renal juxtaglomerular cell and angiotensin II production, consequently exacerbates
kidney injury. Therefore, we hypothesized and investigated that Azelnidipine
suppresses renin activity by inhibition of sympathetic nerve, and exerts renal protective
Methods: We used C57BL/6 mice and KKAy mice (type 2 diabetic model), then made
groups; (1) C57BL/6 control group (WT), (2) Azelnidipine group (WT+Azel: 1mg/kg/
day), (3) KKAy group, (4) KKAy+ Azelnidipine group (KKAy+Azel: 1mg/kg/day), (5)
KKAy+Nifedipine group (KKAy+Nife: 1mg/kg/day). We administrated these drugs by
gavage for 4 weeks. Physiological data (body weight, systolic blood pressure, blood
glucose, urinary albumin excretion, plasma renin activity) were compared between
groups. Noradrenaline content of kidney was examined by ELISA using renal extracted
protein. To visualize plasma/tissue renin activity, we used in vivo imaging method of
using renin fluorescence resonance energy transfer (FRET) peptide. Glomerular
endothelial surface (ESL) layer related to glomerular permeability was detected by
lycopersicon esculentum lectin (LEL) staining. Glomerular permeability of
macromolecules was visualized using in vivo fluorescence microscopy with 70-kDa
Results: Body weight, blood pressure, and blood glucose were increased in KKAy,
KKAy+Azel, KKAy+Nife compared to WT and WT+Azel. Furthermore, urinary
albumin excretion, plasma renin activity, and noradrenaline content of kidney were
increased in KKAy group than WT group. They were also ameliorated in KKAy+Azel.
iii | Abstracts
However, they were not decreased in KKAy+Nife. Renin activity in renal tissue assessed
by FRET method was markedly enhanced in KKAy and KKAy+Nife, but was strongly
suppressed in KKAy+Azel. ESL detected by LEL lectin staining diminished in KKAy
group. Glomerular permeability of the macromolecules was visually observed in the
KKAy group. But both changes were ameliorated in the KKAy+Azel groups, not in the
Conclusions: These data indicated that Azelnidipine attenuated urinary albumin
excretion by inhibiting plasma/tissue renin activity via inhibition of sympathetic nerve
activity in diabetic model mice.
SP036 Table 1. Physiological data
BW; body weight, SBP; systolic blood pressure, BG; blood glucose, UAE; urinary
albumin excretion, PRA; plasma renin activity, RFU; relative fluorescent units.
AMBULATORY RECORDING OF WAVE REFLECTION AND
ARTERIAL STIFFNESS PARAMETERS DURING THE LONG
INTERDIALYTIC INTERVAL IN PATIENTS RECEIVING
Introduction and Aims: Vascular remodeling in hemodialysis (HD) patients is
characterized by accelerated arterial stiffening, which represents strong and
independent predictor of mortality. Recent cohort studies have demonstrated that long
interdialytic interval is associated with heightened risk of cardiovascular death in
patients receiving conventional thrice weekly HD. The aim of this study was to
investigate for first time potential variations between Day 1, Day 2 and Day 3 of a
72-hour interdialytic period in HD patients.
Methods: A total of 32 end-stage renal disease patients receiving conventional HD
underwent a brachial and aortic Ambulatory Blood Pressure Monitoring (ABPM) with
the newly-introduced Mobil-O-Graph device (IEM, Stolberg, Germany). ABPM
covered a whole 72-hour interdialytic period prior to the first HD session of the week.
Mobil-O-Graph is a validated brachial cuff-based automatic oscillometric device that
records blood pressure (BP) and pulse waveforms at brachial artery and calculates
augmentation index (AIx), total vascular resistance (TVR) and pulse wave velocity
(PWV) in ambulatory conditions. Mean day-time and night-time values of the above
parameters were compared between Day 1, 2 and 3 of the long interdialytic interval.
Results: No significant differences in day-time AIx were evident between Day 1, Day 2 and
Day 3 of the long interdialytic interval, whereas night-time AIx at Day 1 was significantly
lower than night-time AIx at Day 3 (28.8±8.6 vs 32±9.5%, P<0.05). In contrast, a gradual
increase in TVR was observed between Day 1 and Day 3 at both day-time (1.27±0.1 vs 1.29
±0.2 vs 1.34±0.2 s*mmHg/ml, P<0.01) and night-time periods (1.32±0.2 vs 1.35±0.2 vs
1.42±0.2 s*mmHg/ml, P<0.001). Similarly, PWV was also elevated from Day 1 to Day 3, a
trend that was consistent in both day-time (9.5±2.5 vs 9.6±2.5 vs 9.8±2.5 m/s, P<0.001)
and night-time periods (9.4±2.7 vs 9.7±2.7 vs 9.9±2.6 m/s, P<0.001).
Conclusions: This study showed for first time a gradual increase in arterial stiffness
parameters during the 72-hour interdialytic period. The significantly higher TVR and
PWV at Day 3 of the long interdialytic interval may represent a mechanism possibly
involved in the increased risk of death of HD patients at this time-period.
VARIABILITY IN STANDARDIZED, ROUTINE AND HOME
SYSTOLIC BLOOD PRESSURE MEASUREMENTS IN THE
BLOOD PRESSURE IN DIALYSIS STUDY; A RANDOMIZED
CLINICAL TRIAL OF INTENSIVE VERSUS USUAL CONTROL
OF SYSTOLIC BLOOD PRESSURE
However, these were retrospective observational studies, which used thrice weekly
routine dialysis unit blood pressures. The Blood Pressure in Dialysis (BID) study is a
pilot randomized control trial, assessing intensive (110 to 140 mm Hg) versus usual
(155 to 165 mm Hg) control of pre-dialysis systolic blood pressure (SBP) measured in
accord with American Heart Association guidelines.
Methods: We examined six months of mid-week SBP in 68 consecutive randomized
BID patients, 33 in the intensive arm and 35 in the usual arm, who were followed from
month 5 to month 10, post randomization. We examined variability in mid-week
standardized pre-dialysis SBP, mid-week routine SBP measured 60 minutes after the
start of hemodialysis and home SBP measured the day after the midweek hemodialysis.
We also assessed variability of standardized pre-dialysis SBP using data from all
treatments. Data are expressed as untransformed and natural log transformed
coefficients of variation. To identify clinical characteristics associated with variability
we compared patient characteristics across tertiles of variability in the standardized
dialysis unit measurements of SBP.
Results: The untransformed and natural log transformed coefficients of variability for
the three measurements of SBP, stratified by treatment arm are shown in Table 1.
The coefficients of variation for the three midweek measurements of SBP were similar.
Moreover, the variability in the standardized pre-dialysis SBP in the analysis that
examined three treatments a week was similar to that which examined only the
midweek pre-dialysis SBP. Variability in all measures of SBP was similar across
treatment arms. Baseline participant characteristics associated with increased
variability included Black race, large interdialytic weight gains (IDWG), and a history
of congestive heart failure (CHF)(Table 2).
Conclusions: Although our sample size was limited, variability was similar in all
measures of SBP. Variability in SBP did not differ across treatment arms but did differ
by race, IDWG, vintage and cardiac history.
SP038 Table 1. Coefficients of Variation
Black Race (%)
Hx of CHF (%)
SP038 Table 2. Baseline Characteristics by Coefficient of Variation Tertile (CVT) of
Introduction and Aims: Blood pressure variability is associated with increased
mortality among hemodialysis patients (Chang et al., J. Human Hypertension 2014).
RENAL DENERVATION DOES NOT CHANGE RENAL
OXYGENATION DETERMINED BY BOLD-MRI
Introduction and Aims: Renal denervation (RDN) is a promising therapy for
hypertension. RDN is postulated to decrease sympathetic activity, resulting in altered sodium
handling by the kidneys and a decrease in peripheral vascular resistance. Consequently, we
hypothesize that renal oxygenation will increase after RDN. Blood oxygen level dependent
MRI (BOLD-MRI) provides a non-invasive tool to determine renal oxygenation in humans.
Increased R2*-levels imply decreased renal oxygen levels. The aim of current study was to
investigate the effect of RDN on renal oxygenation determined by BOLD-MRI.
Methods: Patients with a SBP ≥160mmHg despite the use of ≥3 antihypertensive drugs or
the inability to follow a stable drug regimen due to unacceptable side-effects, meeting
inand exclusion criteria for RDN were included. BOLD MRI was performed before and 12
months after RDN. 20 patients were imaged on 3.0T and 18 on 1.5T clinical MRI systems.
Since most drugs influence BOLD MRI, anti-hypertensive medication was temporarily
stopped before MRI when considered safe. MRIs were analyzed using the compartmental
method proposed by Ebrahimi et al. using Matlab. R2* histograms were calculated and
fitted to a Gaussian function (cortex) and a gamma function (medulla) (figure).
Results: At the moment of submission, 37 patients (21 female, mean age 57) were
included. Mean daytime BP changed from 168 (±23)/ 101 (±16)mmHg at baseline to 158
(±23)/ 96 (±13)mmHg ( p=0.005). 24 patients (65%) stopped medication twice. In this
subgroup the BP-lowering effect of RDN was comparable to the total group. eGFR did not
change after RDN (77(±18) to 80(±18) mL/min/1.73m2).
Inter- and intra- reader reproducibility of R2* values was good. From 4 patients both the
coronal and transverse scans were excluded from analysis because of artifacts. In 6 patients
only the coronal or transverse scan was excluded. R2* levels of the muscle did not change,
implicating good reproducibility of BOLD-MRI. Table 1 shows that RDN did change renal
oxygenation. Subanalysis of patients who stopped medication twice showed the same
results. In the subgroup of responders (decrease in daytime SBP ≥ 5mmHg), renal
oxygenation also did not change.
Conclusions: The current study shows that RDN does not change renal oxygenation
determined by BOLD-MRI.
SP039 Table 1. R2* levels at baseline and 12 months after RDN
COMPARISON OF PULSE WAVE VELOCITY, AUGMENTATION
INDEX AND AORTIC SYSTOLIC BLOOD PRESSURE
MEASURED IN STATIC CONDITIONS BY THE MOBILOGRAPH
AND THE SPHYGMOCOR DEVICES IN END-STAGE RENAL
Introduction and Aims: A novel automatic oscillometric brachial cuff-based device
(Mobil-o-Graph, IEM, Stolberg, Germany) provides the ability to assess non-invasively
aortic systolic blood pressure (aSBP), aortic augmentation index (AIx) and pulse wave
velocity (PWV), in ambulatory conditions. Previous studies comparing the validity of
this device with the currently most widely applied non-invasive tonometry-based
device (Sphygmocor, ArtCor, Sydney, Australia) showed acceptable agreement between
the 2 devices for aSBP and AIx measured in static conditions in healthy volunteers and
hypertensive individuals and slight underestimation of PWV by the Mobil-O-Graph
device. The aim of this study was to investigate for first time the agreement between
these 2 devices in end-stage renal disease (ESRD) patients undergoing dialysis.
Methods: In 49 consecutive ESRD patients (30 male and 19 female) with a mean age of
59.6±15.7 years aSBP, AIx adjusted for 75 heart beats/min (heart rate-adjusted AIx)
and PWV were measured with both devices (order: Sphygmocor then Mobilagraph)
after 10 min of rest in the supine position, according to the manufacturer’s operational
Results: Mean aSBP, heart rate-adjusted AIx and PWV measured with the Sphygmocor
device did not significantly differ from the relevant measurements obtained with the
Mobil-O-Graph device Νο significant differences were observed between the 2 device for
all 3 hemodynamic parameters (aSBP: 136.3±20.5 vs 132.7±19.1 mmHg, P=0.113; heart
rate-adjusted AIx: 28.7±9.9 vs 30.0±12.2%, P=0.477; PWV: 9.7±2.8 vs 9.3±2.0 m/sec,
n=42, P=0.344, for Sphygmocor vs Mobil-O-Graph respectively). The difference for aSBP
was similar to and explained by the difference in the peripheral SBP used for waveform’s
calibration (147.1±21.5 vs 144.2±20.4 mmHg, P=0.274, for Sphygmocor vs
Mobil-O-Graph respectively). In addition, measurements of all 3 hemodynamic
parameters obtained with the Sphygmocor device exhibited strong significant associations
with the relevant measurements taken with the Mobil-O-Graph device (r=0.697, P<0.001
for aSBP, r=0.347, P<0.05 for heart rate-adjusted AIx and r=0.613, P<0.001 for PWV,
respectively). The Bland-Altman Plots for aSBP, heart rate-adjusted AIx and PWV
showed acceptable agreement between the 2 devices without evidence of systemic bias.
Conclusions: Acceptable agreement between the 2 devices was evident for aSBP, AIx and
PWV, the latter being slightly underestimated by the Mobil-O-Graph device compared to
RHUEPO INDUCED-HYPERTENSION LEADS TO EARLY
Sandra Ribeiro1,2, João Fernandes2,3, Patrícia Garrido3, José Sereno3,
Helena Vala4, Elsa Bronze Da Rocha1,2, Luís Belo1,2, Elísio Costa1,2, Flávio Reis3
and Alice Santos-Silva1,2
Introduction and Aims: The introduction of recombinant human erythropoietin
(rHuEpo) improved the treatment of anemia in chronic kidney disease patients.
However, in the recent years, some concerns were raised about this therapy, namely the
development of cardiovascular complications, one of the major causes of death in these
patients. Hypertension development is closely associated with renal deterioration and
is one of the most described side effects associated with rHuEpo therapy. The aim of
this study was to assess the effect of rhEPO-induced hypertension on renal function
and lesions, using an animal model.
Methods: Male Wistar rats (12 weeks old) were divided in 4 groups (n=7-8); each
group was administrated with different rHuEPO doses (100, 200, 600 UI/kg/week bw),
three times a week, by subcutaneous injections, during 3 weeks, and a Control group
with the vehicle (saline 0.9%). At starting and at the end of the protocol, blood samples
were collected to assess renal function and hematological data. Urine samples were also
collected to assess renal function. Blood pressure and heart rate were also measured. At
the end of the protocol, tissues were collected for histological and qPCR studies.
Statistical analysis with ANOVA and post-hoc tests were performed (SPSS version
21.0); p<0.05 was considered as significant.
Results: rHuEpo administration to healthy rats caused a dose-dependent increase in
systolic blood pressure, erythrocyte count, hemoglobin concentration and hematocrit,
and all groups presented higher values, as compared to control group. No significant
changes in blood and urine levels of urea, nitrogen, creatinine and uric acid, were
observed, and the GFR presented also similar values. qPCR studies showed no
significant changes for 100rHuEPO; a significant increase in HIF-2alpha, VCAM-1
and TGF-beta1 gene expression was only found in the 200rHuEPO group. This group
also showed kidney arterio and arteriolosclerosis, arteriolar vacuolization and tubular
damage characterized by hidropic and vacuolar tubular degeneration, interstitial
inflammatory infiltration and IFTA; these histological changes were even more
pronounced in the 600rHuEPO group.
Conclusions: rHuEpo-induced hypertension did not impair renal function, as showed
by the traditional blood and urinary markers of renal function; however, histological
and genetic expression studies suggested that there is already kidney damage.
Hypertension, by increasing the tone of renal blood vessels, compromises blood flow,
leading to renal hypoxia, which activates the HIF pathway (observed in the
200rHuEPO group), to face hypoxic damage; nevertheless, the increase in TGF-beta 1
and VCAM-1 suggest kidney damage. Using a higher rHuEPO dose (600rHuEPO), the
higher hematocrit, probably, blunts the HIF pathway activation, explaining the
enhancement of cellular damage. In conclusion, rHuEpo-induced hypertension alters
vascular and metabolic kidney pathways that will lead to early renal injury, even before
significant changes in the traditional blood and urinary biomarkers of renal function.
iii | Abstracts
TYPE D PERSONALITY AMONG SUBJECTS
Rigas Kalaitzidis1, Petros Skapinakis1, Vasilis Karathanos1,
Despina Karasavvidou1, Giorgos Katatsis1, Kosmas Pappas1, Stelios Hatzidakis1
and Kostas Siamopoulos1
1University Hospital of Ioannina, Ioannina, Greece
Introduction and Aims: Type D personality has been associated in the past with
increased cardiovascular mortality among subjects with established coronary heart
disease. Hypertension is a risk factor for coronary heart disease and chronic kidney
disease. In this study, we assessed potential associations between type D personality
and hypertension and we examined the hypothesis that patients with hypertension and
deteriorating renal function would have a higher prevalence of type D personality.
Methods: Patients with hypertension attending an outpatient clinic in the University
Hospital of Ioannina were included in the study. A previously historical control group
without hypertension from the same hospital was used. Type D personality was
assessed with the DS-14 scale. Multivariate regression techniques were used to
investigate the association between personality and hypertension adjusting for a
number of medical and psychiatric confounders.
Results: The hypertension group consisted of 176 patients (61% male, mean age 55
years old, range 21-86) while the control group consisted of 134 patients (48% male,
mean age 49, range 22-82). The prevalence of type D personality was significantly
higher in the hypertensive group as compared to the control group (41% versus 14%,
respectively, p<0.001). In multivariate logistic regression analysis the presence of Type
D personality was significantly associated with hypertension independently of other
clinical factors, sociodemographic factors and depressive symptoms (odds ratio 4.96,
95% Confidence Interval: 2.68-9.17). In the hypertensive subjects, a lower CKD-EPI
was not more likely to meet criteria for type D personality compared to those with a
higher CKD-EPI (odds ratio1.17, 95% CI 0.56-2.44).
Conclusions: Personality traits should be taken into account for the diagnostic aspects
and treatment strategies in hypertension.
URIC ACID AND SODIUM OVERLOAD PLUS ALLOPURINOL
IN NORMOTENSIVE SUBJECTS
Fernando Margulis1, Roberto Sabbatiello1, Claudia Castro1, Silvia Ramallo1,
Miriam Martinez1 and Ruben Schiavelli1
1Htal Argerich, Buenos Aires, Argentina
Introduction and Aims: Short-term sodium loading has minimal effect on the blood
pressure of normotensive individual. However, sodium loading led to substantial
increases in BP of individuals who are salt sensitive. Serum uric acid (SUA) is a marker
of salt sensitivity (SS). It has been reported that allopurinol (Al) prevents the increase
of BP induced by hyperuricemia. The aim of this study was to evaluate BP behavior
after sodium overload (SO) in people with (SOAI) and without Al
Methods: Data from 25 living kidney donors that participated in the donor screening
protocol with subsequent donation were included in the present analysis. None had a
history of kidney disease, diabetes, cardiovascular events or hypertension.
The subjects were placed the first on a high-salt diet containing 300 mmol Na by 7
days, then, on a low-salt diet containing 30 mmol Na in the following 7 days, and
finally, on a high-salt diet plus Al 300 mg/day for 7 days.
Salt-sensitivity was defined by a significant decrease ( p<0.05) of 24-hour mean
ambulatory blood pressure (MABP) from high to low salt intake. The last day of each
week office BP (OBP), ABP and laboratory tests were performed (SUA, 24hs CrCl and
24-hours urinary Na excretion). Data were expressed as mean ± standard deviation.
Student t test and Wicoxon test were used for data with normal and nonparametric
distribution respectively, p values < 0.05 were considered to be statistically significant.
Results: No statistical differences between SO and SOAl subjects in mean OBP (96 ± 10 vs
95 ± 12 mmHg), 24 MABP (88 ± 7 vs 89 ± 8 mmHg) and 24 hs Urine Na (238 ± 100 vs 200
± 84 mmol/d) were found. SUA was significantly reduced in SOAl subjects (4,8 ± 1,1 vs 3,1 ±
0,8 mg/dl p< 0,001). When the outcomes were evaluated in the context of SS, no differences
were found. Normal and overweight people had the similar pattern.
Conclusions: Contrary to reported in hypertensive-hyperuricemic patients, the action of Al
on OMBP and 24 AMBP was not observed in SS normotensive subjects and in those with
RENAL ARTERY DENERVATION IN PATIENTS WITH CHRONIC
KIDNEY DISEASE &HEMODIALYSIS, WITH RESISTANT
ARTERIAL HYPERTENSION- NORTH ISRAELI CENTER
Diab Ganem1,2, Farid Nakhoul3, Ana Roth1 and Evgeny Farber1
1Baruch Padeh Poriya Medical Center, Lower Galilee, Israel, 2Cardiology, Lower
Galilee, Israel, 3Baruch Padeh Poriya Medical Center, Shefa-Amre, Israel
Introduction and Aims: Hypertension is highly prevalent and one of the most
frequent chronic disease worldwide. A number of cardiovascular diseases have been
shown to be characterized by a marked increase in sympathetic drive to the heart and
peripheral circulation as in essential hypertension (EHT), chronic kidney disease
(CKD) and Hemodialysis (HD). CKD patients show sympathetic hyperactivity, with
aggravation of EHT. In CKD and HD patients is difficult to control, and need multiple
drugs use. We report our first experience on renal sympathetic nerve ablation for
treatment of severe resistant hypertension in CKD patients.
Methods: 33 patients- aged average between 40-79 yrs old, were treated with RAD:
66% of them were with diabetes mellitus, 64% with LVH. 22 Patients were with follow
up to 3 months (Range 1-12 months) 9 patients with CKD (Two of them were on
Hemodialysis and two with RAS). All patients were with systolic BP≥160 mmHg under
three drugs. Mean number of antihypertensive drugs per patient were 4.5. In patients
with CKD: Plasma Creatinine range was 2-3.6 mg/dl.
Results: At Baseline: Mean systolic blood pressure of the whole group = 179±19 mmHg
and Mean diastolic blood pressure = 83±17 mmHg. Three months after RAD: Mean
systolic BP = 142±16 mmHg and Mean diastolic blood pressure = 77±11 mmHg. There
was a significant reduction of the systolic blood pressure in the whole group by an
average of 36 mmHg with (P <0.0001). Significant reduction in the diastolic BP by an
average of 6 mmHg (P= 0.038). Baseline (Subgroup analysis of patients with CKD):
Mean SBP: 183±20 mmHg and Mean DBP: 79±12 mmHg. Three months after RAD:
Mean SBP = 147±17 mmHg and Mean DBP = 75±10 mmHg. CKD patients had
significant reduction of 36 mmHg in the systolic blood pressure (P=0.005). There was
no significant reduction in the diastolic blood pressure. During follow-up, renal
function estimated by eGFR remained unchanged.
Conclusions: 1. Bilateral renal arteries denervation is associated with significant
reduction in systolic and diastolic blood pressure in hypertensive patients resistant to
multiple drug therapy.
2. CRF patients had significant reduction in systolic BP but no significant reduction in
diastolic BP and with no short term kidney injury.
SP044 Patients Characteristics
ASSOCIATION OF PULSE WAVE VELOCITY AND PULSE
PRESSURE WITH DECLINE IN KIDNEY FUNCTION
Chang Seong Kim1, Ha Yeon Kim1, Yong Un Kang1, Joon Seok Choi1,
Eun Hui Bae1, Seong Kwon Ma1 and Soo Wan Kim1
1Chonnam National University Hospital, Gwangju, Republic of Korea
Introduction and Aims: The association of arterial stiffness and kidney function
decline in patients with mild-to-moderate chronic kidney disease (CKD) is not well
established. This study investigated whether pulse wave velocity (PWV) and pulse
pressure (PP) are independently associated with glomerular filtration rate (GFR) and
rapid kidney function decline in early CKD.
Methods: A cohort of 913 patients (mean age, 63 ± 10 years; baseline estimated GFR,
84 ± 18 ml/min/1.73 m2) underwent tests for measuring carotid femoral PWV
(cfPWV), brachial-ankle PWV (baPWV), and PP. Estimated GFR was measured at
baseline and at follow-up. The renal outcome examined was rapid kidney function
decline (estimated GFR loss of >3 ml/min/1.73 m2 per year).
Results: The median follow-up duration was 3.2 years. Multivariable adjusted linear
regression model indicated that arterial PWV (both cfPWV and baPWV) and PP
increased as estimated GFR declined, but neither was associated with kidney function
after adjustment for various covariates. Multivariable logistic regression analysis found
that cfPWV and baPWV were not associated with rapid kidney function decline (odds
ratio [OR] = 1.39, 95% confidence interval [CI] = 0.41-4.65; OR = 2.51, 95% CI =
0.66-9.46, respectively), but PP was (OR = 1.22, 95% CI = 1.01-1.48, P = 0.045).
Conclusions: Arterial stiffness assessed using cfPWV and baPWV was not correlated with
lower estimated GFR and rapid kidney function decline after adjustment for various
confounders. PP was an independent risk factor of rapid kidney function decline in
population with relatively preserved kidney function (estimated GFR ≥ 30 ml/min/1.73 m2).
COMPARISON OF AMBULATORY CENTRAL AND
PERIPHERAL BLOOD PRESSURE BETWEEN THE SECOND
AND THIRD DAY OF THE LONG INTERDIALYTIC INTERVAL
IN HEMODIALYSIS PATIENTS
University of Athens, Athens, Greece, 4Alexandroupolis University Hospital,
Introduction and Aims: The conventional thrice-weekly hemodialysis schedule
includes two regular (about 2 days) and one long (about 3 days) interdialytic interval
periods. During the long interval patients have to deal with a larger amount of
metabolic products and volume accumulation and recent data suggest that the end of
the 3-day period associates with the highest cardiovascular risk. This study compared
for the first time ambulatory central blood pressure between Day 2 and Day 3 of a long
Methods: Thirty-two end-stage renal disease patients receiving conventional
hemodialysis (mean age 64.3±14 years and median time on renal replacement therapy
37.6 months) were included in the study. All underwent a 72-hour Ambulatory Blood
Pressure Monitoring covering the large interdialytic interval, with the novel
Mobil-O-Graph device (IEM, Stolberg, Germany). Mobil-O-Graph is a validated
brachial cuff-based automatic oscillometric device that records brachial BP and pulse
waveforms and calculates central BP through mathematical transformation. Daytime
and night-time ambulatory BPs of Day 3 vs Day 2 were compared.
Results: Ambulatory central aortic SBP and DBP on Day 3 were significantly higher
than on Day 2 (daytime, 124.3±17.8 vs 118.03±17.7 and 81.8±10.9 vs 77.4±11.3
mmHg, p<0.001; night-time 126.1±21.8 vs 120.2±23.1 and 80.8±14.5 vs 76.5±12.8
mmHg, p<0.001, respectively). Ambulatory brachial SBP and DBP followed the same
pattern (daytime 136±22.1 vs 129.3±21.7 and 80.2±10.8 vs 75.5±11 mmHg, p<0.001;
night-time 138.5±26.3 vs 131.4±26.4 and 79.4±13.7 vs 74.8±12.5 mmHg, p<0.001,
respectively). Central and peripheral pulse pressures were also significantly higher in
Day 3 vs Day 2 and heart rate significantly lower, during daytime but not during
night-time. Fourteen patients needed increase at their antihypertensive drugs
specifically for Day 3.
Conclusions: This is the first study evaluating central BP during a 72-hour interval in
hemodialysis patients. The significant increase in central BP during Day 3 follows the
same pattern with that of peripheral BP and may be a major mechanism of elevated
cardiovascular risk at the final hours of the week in this population.
MODIFICATION OF GLOMERULAR ALBUMIN PERMEABILITY
IN RAT ISOLATED GLOMERULUS BY
Introduction and Aims: Glomerular filter consisting of endothelial cells, basement
membrane and podocytes prevents plasma proteins e.g. albumin from entering the
urinary space, an independent risk factor for the progression of renal failure. Activity of
these cells is under control of renin-angiotensin-aldosteron system (RAAS), thus
pharmacological inhibition of RAAS may affect properties of glomerular filter.
Methods: Experiments were performed on Wistar rats maintained on normal/low sodium
diet (NSD, LSD, 5 days ) and RAAS inhibitors (7 days, p.o): aliskiren (4.3 mg/kg/24h),
enalapril (0.14 mg/kg/24h), telmisartan (0.6 mg/kg/24h), eplerenore (0.36 mg/kg/24h).
Glomeruli were isolated and single affixed glomerulus was continuously observed with use of
video-microscopy (Olympus IX51). Changes in the glomerular volume due by oncopressive
medium eliciting transglomerular fluid flux were used to calculate convectional albumin
permeability (Palb). Nephrin and albumin in urine were measured by ELISA.
Results: Palb on NSD was 0.13±0.02 and increased to 0.34±0.05. This effect was significantly
(P<0.05) decreased by aliskiren (0.26±0.03), enalapril (0.20±0.03) and telmisartan (0.17
±0.04), however eplerenore did not affect Palb on LSD. RAAS blockade did not affect Palb
on NSD. RASS blockade with enalapril, telmisartan or eplerenore but not with aliskiren
decreased urinary albumin execration in urine. Used pharmacological tools did not affect
urinary nephrin excretion.
Conclusions: These results suggest that RAAS blockade affects glomerular permeability for
protein but its final urinary excretion may be modulated by postglomerular processes.
DETERMINANTS OF EARLY CHANGES IN LEFT
VENTRICULAR SYSTOLIC FUNCTION IN PATIENTS WITH
ESSENTIAL HYPERTENSION AND NORMAL EJECTION
echocardiography even in the presence of normal ejection fraction (EF). The aim of the
study was to investigate the association of 2DSTE indices of longitudinal and rotational
myocardial function with risk factors, arterial stiffness and coronary microvascular
function in hypertensive patients with normal EF.
Methods: Forty-one male patients (mean age 57±9 years) with normal EF and without
left ventricular (LV) hypertrophy were enrolled. Conventional, tissue Doppler (TD)
and 2DST echocardiography was used to assess cardiac function. Coronary flow reserve
(CFR) in the left anterior descending artery using dipyridamole and arterial stiffness by
measurement of carotid femoral pulse wave velocity and central augmentation index
Results: Global circumferential strain was not associated with any of the studied
parameters. Global longitudinal strain (GLS) was associated with conventional
echocardiographic indices of systolic function: velocity-time-integral of LV outflow
tract (r=-0.452, p=0.006) and MAPSE (r=-0.329, p=0.05), as well as systolic (r=0.500,
p=0.003) and diastolic (r=0.377, p=0.028) blood pressure (BP), heart rate (r=0.435,
p=0.009), glomerular filtration rate (r=-0.335, p=0.05), and LV mass index (r=0.437,
p=0.011). Systolic BP (B 0.079, p=0.005) was the sole independent predictor of GLS in
multivariate analysis (R2 0.241). Apical twist was associated with LV EF (r=0.415,
p=0.023), velocity-time-integral of LV outflow tract (r=0.401, p=0.028) and LV mass
index (r=-0.476, p=0.010). Indices of arterial stiffness and CFR did not correlate with
global circumferential strain or GLS or apical twist.
Conclusions: In conclusion, in healthy hypertensive patients with normal EF,
longitudinal and rotational myocardial function were inversely associated with systolic
BP and LV mass respectively, but not with indices of arterial stiffness or coronary
microvascular function. Further research is needed to assess the potential
pathophysiological and prognostic role of these echocardiographic indices in patients
CIRCULATING RENALASE AND CATECHOLAMINES
IN HYPERTENSIVE PATIENTS
Dominika Maciorkowska1, Edyta Zbroch1, Ewa Koc-Zorawska1
and Jolanta Malyszko1
1Medical University, Bialystok, Poland
Introduction and Aims: Hypertension is an important risk factor for cardiovascular
mortality. Sympathetic activity plays an important role in its multifactorial
pathophysiology. Renalase, a new hormone, secreted from the kidney to the blood, may
degradate the circulating catecholamines and down-regulate the sympathetic activity.
The aim of the study was to estimate circulating levels of renalase, dopamine and
noradrenaline in 121 patients with primary hypertension and proper renal function
and to correlate the renalase concentration with circulating catecholamines as also with
some laboratory and clinical parameters.
Methods: The renalase concentration was estimated in 121 hypertensive patients (median
age 56 min-19, max-85). The medical history, office blood pressure measurements, 24
hour ambulatory blood pressure measurement (ABPM), laboratory tests and the
echocardiography were taken, the medical therapy was analyzed. The correlation between
renalase levels and catecholamine concentration in blood, blood pressure control,
laboratory tests, type of pharmacological therapy and medical history were analyzed.
Results: The median office blood pressure was 145,5/86 mmHg and was significantly
higher than the median home blood pressure measurements, which was 135/80 mmHg,
p<0,05. The most patients were treated with hypotensive drugs from 3 different groups.
The main used drugs were diuretics -65,8% and ACEI (angiotensin converting enzyme
inhibitor) -65%. Circulating renalase level was significantly higher in patients with
hypertension comparing to healthy individuals (Me 9,57 vs 3,83 ug/ml, p=0,0001). The
correlation between renalase and noradrenalin concentration in blood was observed
(r=0,549; p<0,05). Renalase was higher in patients treated with ARB (angiotensin receptor
blocker) than without (Me 12,05 vs 8,2 ug/ml, p<0,05). It was higher in patient without
proper blood pressure control in office measurements and in ABPM. It was also higher in
patients with coronary artery disease and correlated with decreased ejection fraction.
Noradrenaline concentration correlated with the interventricular septum and posterior
wall diameter of left ventricle (r=0,289; r=0,314, p<0,05) as also with decreased ejection
fraction (r=-0,411, p<0,05). Noradrenaline concentration was higher in patients treated
with calcium channel blockers than without (Me 1,08 vs 0,85 ng/ml). Noradrenaline
concentration was also higher in patients with estimated glomerular filtration rate (eGFR)
lower than 60 ml/min per 1.73 m2 compared with patients with eGFR 60 and over (Me
1,75 vs 0,93 ng/ml).
Conclusions: Renalase elevated circulating level in patients with poor blood pressure
control as also its correlation with noradrenalin concentration needs further studies to
find out the role of renalase in pathogenesis and treatment of hypertension.
INVESTIGATION OF HYPERTENSION WITH AMBULATORY
BLOOD PRESSURE MONITORING IN CHILDREN WITH
HYDRONEPHROSIS CAUSED BY UNILATERAL PARTIAL
URETEROPELVIC JUNCTION OBSTUCTION
Aysun Karabay Bayazit1, Ihsan Yuksekkaya1, Sercan Aynaci1 and Ali Anarat1
1Cukurova University, Adana, Turkey
Introduction and Aims: Hypertension is associated with early reduction in
myocardial systolic function as assessed by novel 2D speckle tracking (2DST)
Introduction and Aims: To investigate the tendency to hypertension in children with
hydronephrosis caused by unilateral partial ureteropelvic junction obstuction and to
iii | Abstracts
examine the effects of isolated ureteropelvic junction obstruction on blood pressure.
Methods: Patient group consisted of 19 children with unilateral partial ureteropelvic
junction obstuction. They had normal renal function, had not been operated and had
no additional renal pathology and systemic disease. Control group consisted of 19
healthy children who had no any known disease. Renal pelvis anteroposterior
diameters were measured with ultrasonography. Clinic blood pressure measurements
and 24 hour ambulatory blood pressure monitoring were performed to all children.
Z scores were calculated with LMS method. Blood pressure loads and nocturnal
dipping were examined.
Results: Z scores for night diastolic blood pressure (0,553 ± 0,833 in patient group,
0,132 ± 0,638 in control group) and night mean arterial pressure (0,804 ± 0,753 in
patient group, 0,389 ± 0,688 in control group) were higher in patient group. Number of
cases whose blood pressure loads for ≥90th and ≥95th percentiles exceed 30% and 40%
were higher statistically in patient group (9 cases ≥30%, 6 cases ≥40% for loads ≥90th
percentile and 8 cases ≥30%, 4 cases ≥40% for loads ≥95th percentile in patient
group. 3 cases ≥30%, 1 cases ≥40% for loads ≥90th percentile and 2 cases ≥30%, no
cases ≥40% for loads ≥95th percentile in control group). In patient group, the
percentage of non-dipper cases was higher than the expected values in normal
Conclusions: There was a tendency to hypertension in children with hydronephrosis
caused by unilateral partial ureteropelvic junction obstuction. Although the patients
were suitable for conservative management with normal renal function, their blood
pressures were higher than the control group. The long term physiopathologic
consequences should be evaluated in these patients who are preferably managed
NOCTURNAL BLOOD PRESSURE RISE ASSOCIATED WITH
DIABETES AND BRAIN NATRIURETIC PEPTIDE LEVELS IN
PATIENTS WITH CHRONIC KIDNEY DISEASE
Kentaro Nakai1, Hideki Fujii1, Risa Ishida1, Chie Utaka1, Rie Awata1,
Shunsuke Goto1, Jun Ito1 and Shinichi Nishi1
1Kobe University Graduate School of Medicine, Kobe, Japan
Introduction and Aims: Hypertension is a crucial risk factor for mortality,
cardiovascular events, and decline of kidney function in patients with and without
chronic kidney disease (CKD). However, the patterns concerning 24 hour-monitoring
of hypertension were not fully evaluated in patients with moderate to severe CKD. The
aim of our study was to assess the circadian variation of blood pressure in patients with
Methods: Among patients who were hospitalized in our unit from 2009 to 2012, those
who had a 24 hour ambulatory blood pressure monitoring (ABPM) and an estimated
glomerular filtration rates (eGFR) under 45ml/min/1.73m2 were enrolled and observed
for a median period of 249 days. Patients with the following characteristics were
excluded from the present study: 1) rapidly progressive glomerulonephritis, 2) acute
kidney injury, 3) kidney transplantation.
Results: Consequently, 125 patients were enrolled in our study. Their average ages were
64 years, 58% were male, and 43% had diabetes. The results of ABPM revealed that
46% of patients had non-dipper pattern, 34% had riser pattern, 19% had dipper
pattern, and 1% had extreme-dipper pattern. Compared to patients with non-riser
pattern (non-dipper, dipper, and extreme-dipper), eGFR were significantly lower, and
the prevalence of diabetes and plasma levels of brain natriuretic peptide (BNP) were
significantly higher in patients with riser pattern. Age and a percentage of male gender
were comparable between the two groups, riser and non-riser patterns. Kidney survival
rates were significantly worse in patients with riser pattern than in those with non-riser
pattern (log-rank test; p=0.016).
Conclusions: The results of our study suggested that diabetes, low eGFR and high BNP
were related to nocturnal blood pressure rise. The riser pattern may be a strong
predictor of decline of kidney function in patients with CKD.
SERUM URIC ACID AND ARTERIAL STIFFNESS IN
HYPERTENSIVE CHRONIC KIDNEY DISEASE PATIENTS:
Rengin Elsurer1 and Baris Afsar2
Introduction and Aims: Hyperuricemia and arterial stiffness are associated with
increased cardiovascular risk. Specific relationship between arterial stiffness and serum
uric acid (SUA) in chronic kidney disease (CKD) patients has not been investigated.
We investigated whether SUA level is associated with arterial stiffness in hypertensive
Methods: Study had a single-center, cross-sectional design. 339 hypertensive CKD
patients (female/male; 192/147, mean age; 57.9±13.9 years) were recruited. Arterial
stiffness was assessed by pulse wave velocity (PWV) and augmentation index adjusted
for heart rate (AIx@75).
Results: SUA was negatively correlated nighttime wave reflection magnitude (P:0.015),
24-hour AIx@75 (P<0.0001), daytime AIx@75 (P<0.0001) and nighttime AIx@75
(P:0.014), and was positively correlated with 24-hour PWV (P<0.0001), daytime PWV
(P<0.0001) and nighttime PWV (P<0.0001). SUA was negatively correlated with
24-hour AIx@75 (P:0.024), daytime AIx@75 (P:0.023) and nighttime AIx@75 (P:
0.047) in males, whereas SUA was positively correlated with 24-hour PWV (P<0.0001),
daytime PWV (P<0.0001) and nighttime PWV (P<0.0001) in females. In adjusted
analysis, SUA was independently associated with AIx@75, but not with PWV. In
gender-specific unadjusted analysis, SUA was significantly associated with PWV only
in females, which lost significance in adjusted analysis. SUA was significantly
associated with AIx@75 in only males, which remained significant after adjustment for
Conclusions: In hypertensive CKD patients, SUA was correlated with the two indices
of arterial stiffness, PWV and AIx@75, with gender-specific variations. However, SUA
was independently associated with only AIx@75, but not with PWV, in the whole
patient population and only in males.
SODIUM SUPPLEMENTS IN HYPERTENSIVE CKD PATIENTS
Zoe Lepar1, Daniela Radulescu1, Cristiana David1, Ileana Peride1, Andrei Niculae1,
Ionel Alexandru Checherita1 and Alexandru Ciocalteu1
1“Carol Davila” University of Medicine and Pharmacy Bucharest, Bucharest,
Introduction and Aims: Although sodium retention is considered a pattern feature of
hypertension pathogenesis in CKD patients, in clinical practice, hyponatremia and
hypovolemia is often noticed, and sodium supplementation may be required to correct
high BP and hemodynamic disturbance. The aim of the study is to emphasize the
importance of appreciating the frequency of hyponatremia associated with
hypovolemia in CKD subjects with hypertensive crises, and defining the optimal
treatment protocol in order to decrease BP ≤160mmHg, restore volemia and correct
Methods: During 3 years, we conducted an exhaustive research evaluating the first
24 hours after hospital admission of 681 patients with CKD stages 3 or 4 and
hypertensive crises. A 10 minutes protocol including measuring of hemodynamic
status (with transthoracic vascular bioimpedance) and serum sodium was performed
before treatment intervention. 4 groups of water and sodium imbalances were
identified: hypervolemia - 478 patients (70.2%), hypovolemia associated with
normoor hypernatremia - 86 patients (12.6%), hypovolemia with hyponatremia - 58 patients
(8.5%), normovolemia and normonatremia - 59 patients (8.7%). The present study
focused on individuals presenting hypovolemia who received oral antihypertensive
drugs and concomitant volume expansion - in the group with
hypovolemia + hyponatremia, intravenous isotonic dextrose 5% was compared with
intravenous normal saline; in the group with hypovolemia + hyper- or normonatremia,
free oral fluid intake was compared with intravenous isotonic dextrose 5%.
Results: In patients with concomitant hypovolemia + hyponatremia, target BP,
correction of natremia and volemia were significantly ( p = 28.51; p = 2.67 respectively
p = 14.87) more rapidly achieved after sodium supplementation versus those with low
sodium diet. In patients with normo- or hypernatremia associating hypovolemia, our
treatment goals were significantly faster obtained after parenteral route of volume
expansion versus free oral liquid intake (target BP, p = 9.21; volemia, p = 4.43;
natremia, p = 10.55).
Conclusions: Hypovolemia is frequently observed in non-dialyzed CKD patients with
hypertensive crises, and the treatment of concomitant hypertension and hypovolemia
imposes antihypertensive drugs administration and immediate restoring of plasma
volume. Therefore, in cases with hyponatremia and hypovolemia, sodium chloride
solution infusion ( producing RAAS inhibition and peripheral resistance decrease) by
parenteral route is required to correct hypertension.
PREVALENCE OF HYPERTENSIVE OCTOGENARIANS WITH
REDUCED GFR AND HYPERKALEMIA ON ARB+HCTZ
Cem I Sungur1
1Medicana Ankara Hospital, Ankara, Turkey
Introduction and Aims: Prevalence of hypertension is increased in elderly population.
Although most of the randomized controlled trials have excluded elderly patients,
several hypertension guidelines recommend thiazide diuretics(HCTZ) and angiotensin
receptor blockers (ARBs) as first line therapy for the elderly hypertensive patient. On
the other hand elderly patients have increased prevalence of renal artery disease,
reduced GFR, diminished potassium excretion and reduced aldosterone secretion,
rendering them to be susceptible to unwanted effects of ARBs and hydrochlorotiazide.
In this cross-sectional study we analyzed the rate of octogenarians on ARB+ HCTZ
fixed dose combinations despite having high serum potassium and creatinine levels.
Methods: Fifty hypertensive octogenarians receiving fixed dose ARB+HCTZ
combinations referred to nephrology outpatient clinics were evaluated for diminished
GFR and hyperkalemia. Their mean age was 82 years. Thirty five (%70) were female
and 15 (30%) were male. 15 patients (%30) were diabetic. Blood samples were drawn in
the morning after 10 hours of fasting. Serum potassium levels were measured by a
flame photometer and serum creatinine by AbbottC8000. Estimated GFR values were
calculated according to CKD-EPI formula. Twenty five percent of the patients were
receiving 25 mg of HCTZ daily while 75% were on 12.5 mg HCTZ combinations. The
daily doses and types of ARBs were as follows: Losartan 100 mg 36%, Telmisartan
80 mg 24%, Valsartan 80 mg 8%, Valsartan 160 mg 12%, Irbesartan 300 mg 20%,
Candesartan 16 mg 10%. The mean duration of treatment with these combinations was
Results: Mean blood pressure was 132 mm Hg systolic and 84 mm Hg diastolic. 32
patients (64%) were receiving another hypertensive agent; 12 patients (24%) a beta
blocker, 14 patients (28%) a calcium channel blocker and 6 patients (12%) an alpha
blocker. Mean serum potassium level was 4.4 mEq/L and serum creatinine level was
1.1 mg/dL. 16 patients (32%) had serum potassium levels above 5.0 mEq/L. Mean
serum potassium level among hyperkalemic patients were 5.4 mEq/L (Range 5.1-6.2
mEq/L). 28 patients (56%) had eGFR above 60 ml/min. CKD Stage in the remaining 22
patients (44%) were: CKD Stage IV in 2 patients (4%), Stage IIIb in 8 (16%) and Stage
IIIa in 12 (24%) patients.
Conclusions: Elderly patients have a high prevalence of hypertension most requiring
more than two antihypertensive agents. ARB+HCTZ combinations are among the first
line antihypertensive agents in most of the guidelines and are among the commonly
prescribed agents. Renal vascular disease and a tendency to develop hyperkalemia pose
elderly patients to adverse effects of these combinations. This study shows that one in
three octogenarians treated with these combinations have hyperkalemia and reduced
GFR. Additionally despite these adverse effects, these patients were re-prescribed these
combinations for a mean duration of 18 months. These findings provides additional
support for the ongoing efforts for developing special hypertension guidelines for the
URIC ACID, ALLOPURINOL AND ENDOTHELIAL
Introduction and Aims: Several studies have assessed the effect of allopurinol on
endothelial function, but these studies were relatively small in size and used different
methods of evaluating endothelial function. We conducted a meta-analysis to
investigate this effect on both endothelial dependent and independent vasodilatation.
Methods: Electronic databases, Medline, PubMed, EMBASE, SCOPUS, EBSCO and
the Cochrane Library for Central Register of Clinical Trials were searched from January
1985 to July 2013 on clinical trials (randomized and non-randomized) which assessed
the effect of allopurinol on endothelial function. We conducted a sensitivity analysis to
assess the contribution of each study to the pooled treatment effect by excluding each
study one at a time and recalculating the pooled treatment effect for the remaining
studies. Treatment effect was significant if p 50%).
Results: We included in our final analysis 11 studies (2 observational and 9
randomized). For the endothelial dependent vasodilatation there were six studies,
including 257 patients, that evaluated flow-mediated dilatation and 5 studies with 87
patients that reported data on forearm blood flow (FBF) response to acetylcholine or
flow-dependent vasodilatation. Overall, there was a significant increase in the
endothelium dependent vasodilatation with allopurinol treatment (MD 2.69%, 95% CI
2.49, 2.89%, P<0.001; heterogeneity χ2=319.1, I2=96%, P<0.001). In regard with
endothelial independent vasodilatation there was only one study (100 patients)
assessing nitrate mediated dilatation (NMD) and 4 studies (73 patients) evaluating FBF
response to sodium nitroprusside. The overall analysis (MD -0.08, 95% CI -0.50, 0.34,
P=0.70; heterogeneity χ2=9.0, I2=44%, P=0.11) showed no effect of allopurinol
treatment on endothelium independent vasodilatation
Conclusions: We found that allopurinol use was associated with an improvement in
the endothelial dependent, but not in the endothelial independent vasodilatation,
suggesting that this effect is not related to correcting a generally abnormal
responsiveness to vasodilator stimuli.
PULSE WAVE VELOCITY HAS DIFFERENT PATTERNS OF
ASSOCIATION WITH SUBCLINICAL CARDIAC DAMAGE IN
HYPERTENSIVE PATIENTS WITH OR WITHOUT CHRONIC
Simone Vettoretti1, Enrico Gallazzi1, Roberto Meazza1, Valentina Gagliardi1,
Anna Villarini1,2, Carlo Maria Alfieri1, Riccardo Floreani1 and Piergiorgio Messa1
1Fondazione IRCCS Ca Granda Ospedale Policlinico Maggiore Milano, Milan, Italy,
2Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
Introduction and Aims: Different patterns of left ventricular mass index (LVMI) are
associated with a variable cardio-vascular risk profile. In essential hypertensives (EH)
as well as among hypertensives with chronic kidney diseases (CKD-H) arterial stiffness
(AS) is associated with LV hypertrophy and stiffening . We investigated the correlations
between pulse wave velocity (PWV), an index of AS, LVMI and left ventricular
geometry in EH and CKD-H individuals.
Methods: 84 patients were evaluated, 40 with established CKD stage 2-4 (CKD-H,
mean age 67,55 ± 7,54, mean eGFR 33±17,52 ml/min) and 44 without evidence of
CKD (EH, mean age 64,1± 9,3, mean eGFR 74 ± 16,82). Each patient underwent
physical examination, anthropometric, biochemical measurements, office and 24h
iii | Abstracts
ambulatory blood pressure (BP) measurement in order to estimate their cardiovascular
risk using SCORE chart. Pulse Wave Velocity (PWV) and central BP values were
assessed by applanation tonometry. Left ventricular geometry and function was
assessed by 2D color Doppler echocardiography.
Results: General anthropometrics, bio-humoral charachteristics (except eGFR) and
overall CV risk (CKD-H SCORE 7±3,1%, EH SCORE 6,7±2,3%, p=ns) were not
statistically different in the two groups. CKD-H showed higher PWV respect to
EH (12,660±4,83 m/s vs. 10,165±3,7, p<0,001) . Despite similar blood pressure
control CKD-H had higher LVMI (105,58±19,3 g/mq vs. 17,77 g/mq, p<0,05)
respect to EH. Furthermore, CKD-H showed a stronger correlation beteween
indices of arterial stiffness and several parameters of ventricular dysfunction
(shown in Table).
Conclusions: Our results suggest that among CKD-H individuals arterial stiffness
is associated with worse left ventricular patterns than among patients with EH.
Moreover, our results suggest a greater stiffening of LV and vessels in CKD
patients, with greater correlation between AS parameters and LVM in this
population. Therefore we suggest that AS should be routinely evaluated among
CKD-H in order to stratify their CV risk profile.
LVMI and PWV
RWT and PWV
LVMI and AIx
E/A and PWV
RESISTANT HYPERTENSION SUBTYPES, ARTERIAL
STIFFNESS AND CHRONIC KIDNEY DISEASE
Simone Vettoretti1, Carlo Maria Alfieri1, Enrico Gallazzi1, Valentina Gagliardi1,
Anna Villarini1,2, Roberto Meazza1, Riccardo Floreani1 and Piergiorgio Messa1
1Fondazione IRCCS Ca Granda Ospedale Policlinico Maggiore Milano, Milan, Italy,
2Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
Introduction and Aims: Resistant hypertension (RH), particularly in the form of
isolated systolic hypertension (ISH), is associated with high cardiovascular morbidity
and mortality, both in chronic kidney disease (CKD) patients and essential
hypertensives (EH). Increased arterial stiffness (AS) is thought to be an important
contributor to RH and ISH development. Aim of this study is to evaluate the role
of increased AS in generating RH subtype in patients with and without established
Methods: 84 patients were evaluated, 40 with established CKD stage 2-4 (mean age
67,55 ± 7,54, mean eGFR 33±17,52 ml/min) and 44 without evidence of CKD (EH,
mean age 64,1± 9,3, mean eGFR 74 ± 16,82). Each patient underwent physical
examination, anthropometric, biochemical measurements, and office and 24h
ambulatory blood pressure (BP). Pulse Wave Velocity (PWV) and central BP values
were assessed by applanation tonometry. On the basis of ABPM measurements
patients were classified into six groups: normotensives (NT) with CKD (n=19) and
without CKD (n=16) with systolic blood pressure (SBP) <135 mmHg and diastolic
blood pressure (DBP) or =135 mmHg and DBP or =135 mmHg and DBP > or
= 85 mmHg.
Results: Clinical, biochemical and tonometric characteristics of different groups are
showed in Table 1. PWV in ISH with CKD group was significantly higher when
compared with any other group ( p< 0,05). Moreover, both in patients with and
without CKD, pooled PWV in ISH and SDH was significantly higher when compared
with NT ( p<0,05)
Conclusions: This study shows that both in CKD patients and EH, RH is associated
with increased arterial stiffness. Furthermore arterial stiffness is higher in CKD patients
with ISH when compared with any other group, suggesting a greater influence of AS on
RH subtype in this population.
ARTERIAL STIFFNESS IS ASSOCIATED WITH GLOMERULAR
FILTRATION RATE IN UNTREATED HYPERTENSIVE PATIENTS
Yulia Kotovskaya1, Svetlana Villevalde1 and Zhanna Kobalava1
1Peoples Friendship University of Russia, Moscow, Russian Federation
Introduction and Aims: The relationship between arterial stiffness and kidney
function in middle-aged patients with uncomplicated hypertension is not well studied.
Accordingly the aim of the study was to investigate the association between estimated
glomerular filtration rate (eGFR) and arterial stiffness in middle-aged patients with
untreated arterial hypertension
Methods: A cross-sectional study included 101 non-diabetic patients (age 53,5±12,3
years, 48,5% males) with untreated arterial hypertension without target organ damage
on routine examination with estimated glomerular filtration rate by CKD-EPI formula
(eGFR) >60 ml/min/1,73m2 and albumin/creatinine ratio<30mg/g in a morning
urinary spot. Arterial stiffness was evaluated by central pulse wave analysis and and
pulse wave velocity measurement (SphygmoCOr, AtCor, Australia). Linear regression
analyses were used to assess the cross-sectional associations between arterial stiffness
parameters and eGFR. A two-sided p-value of < 0.05 was regarded as significant.
Results: PWV >12 m/s was found in 54 (53,5%) patients. In multivariate analysis
decrease of eGFR<90,6 ml/min/1,73m2 was a strong independent predictor (χ2=7,6,
p 94 ml/min/1,73m2 , II 91-94 ml/min/1,73m2, III 79-91 ml/min/1,73m2 , IV 61-79 ml/
min/1,73m2. There was a progressive increase from I to IV quartile of PWV (9,9±3,8,
11,5±2,6, 12,6±3,3 ( p<0,05 compared to I quartile), 12,7±2,5 ( p<0,05 compared to I
quartile) m/s), augmentation index@75 bpm (AIx) 14,8±13,5%, 24,9±10,5%, 26,3
±13,0% ( p<0,05 compared to I quartile), 31,5±5,9% ( p<0,05 compared to I quartile).
Central systolic BP, AIx and PWV were significant independent predictors of eGFR:
respectively, β= -0,47, p<0,01 β= -6,2, p<0,01, β= -2,33, p<0,01.
Conclusions: There is strong association between increased arterial stiffness assessed
by direct and indirect measures and decrease in eGFR in hypertensive subjects with
normal kidney function.
ASSESSING CARDIOVASCULAR REMODELING THROUGH
ABPM, TNFα, IL-6 AND PROTEINURIA IN CHRONIC KIDNEY
Alexandra Circiumaru1, Elena Rusu2, Diana Zilisteanu2, Teodora Atasie2, Flavia Cirstea2,
Monica Ecobici2, Mihai Voiculescu2, Monica Rosca3 and Cristiana Tanase4
1UMF Carol Davila Bucharest, Bucharest, Romania, 2Fundeni Clinic of Internal
Medicine and Nephrology, “Carol Davila” University of Medicine and Pharmacy,
Bucharest, Romania, 3Cardiology, “Prof. Dr. CC. Iliescu” Cardiovascular Diseases
Institute, Bucharest, Romania, 4“Victor Babes” National Institute for Research and
Development In Pathology and Biomedical Sciences, Bucharest, Romania
Introduction and Aims: Ambulatory blood pressure monitoring (ABPM) is
considered to be an important tool in evaluating cardiovascular prognosis.
Furthermore, the study of pro-inflammatory markers may be beneficial in assessing
cardiovascular outcomes through remodeling of the cardiovascular tree. Our study tries
to assess the role of ABPM and the importance of proteinuria and inflammatory
markers, TNFα and IL-6, in the process of cardiac and vascular remodeling.
Methods: 35 patients were enrolled in the study, mean age 67.4 y/o, 18 male patients.
TNFα, IL-6 and proteinuria were assessed. All patients underwent 24 hour ABPM.
Cardiac modifications were evaluated through cardiac ultrasonography, both anatomical
through left ventricle mass index, posterior wall thickness (PWT) and functional through
left ventricle systolic ejection fraction (EF). Vascular modifications were assessed by
carotid ultrasonography and evaluation of the intima-media thickness (IMT), considering
an atherosclerotic plaque or an IMT>0.9 mm as being a significant finding. Arterial
stiffness measurements, aortic systolic pressure (AoSP), aortic pulse pressure (AoPP) and
pulse wave velocity (PWV), were performed using SphygmoCor (AtCor Medical, Sydney,
Australia). Statistical analysis was performed using IBM SPSS Statistics Version 19.
Results: There were 4 patients with CKD stage 2, 21 patients with stage 3 and 10 patients
with stage 4. 19 patients (54.2%) had a non-dipper pattern. Carotid ultrasonography
showed 26 (74.3%) patients with an IMT>0.9 mm or an atherosclerotic plaque. Dipper
status was associated with the IMT ( p= 0.02). TNFα levels significantly correlated with
IMT ( p=0.05), EF ( p=0.04) and AoPP ( p=0.03). We found correlations between IL-6
levels and AoSP ( p=0.02), PWV ( p=0.02) and the stage of the CKD ( p=0.001). The
amount of proteinuria was linked to PWT value ( p=0.01).
Conclusions: Cardiovascular function and anatomic modifications can be easily assessed
through little or non-invasive methods. ABPM and TNFα are strong predictors of vascular
remodeling in CKD patients. Moreover TNFα is strongly correlated to cardiac function
and proteinuria is a reliable marker of cardiac muscle modifications in these patients.
LIMITED EFFECTS OF RENAL DENERVATION IN RESISTANT
Introduction and Aims: Renal Denervation (RDN), an endovascular catheter-based
intervention, is being applied as a novel concomitant treatment of drug-resistant
hypertension (rHT). However, with underpowered efficacy and safety data currently
available. The aim of this study was to evaluate the duration of the blood pressure (BP)
lowering effect of RDN and reduction of antihypertensive drug classes needed after
Methods: Office BP measurements at 1, 3 and 6 months follow-up visits were
compared to baseline values in 7 patients with rHT. Also, the number of
antihypertensive drug classes before and 6 months after RDN were evaluated. We used
STATISTICA 10, 2011 software (Stat Soft Inc., Tulsa, OK, USA). Values are mean ± SD
and considered statistically significant if P < 0.001.
Results: At baseline, values were 62 ± 6 years for age, 184 ± 21 mmHg and 106 ± 26
mmHg for systolic and diastolic BP, respectively; and 6.7 ± 1 for number of
antihypertensive drug classes. One, 3 and 6 months after RDN, office SBP values were
significantly lower (144 ± 13 mmHg, 140 ± 17 mmHg and 141 ± 15 mmHg,
respectively; P < 0.001). However, no significant reduction in DBP values at 1, 3 and 6
months after RDN was observed (81 ± 6 mmHg, 82 ± 9 mmHg and 79 ± 9 mmHg,
respectively; P > 0.05). Six months after RDN the number of antihypertensive drug
classes required was 6.5 ± 1 which was not statistically different from baseline.
Conclusions: The sustained reduction of office SBP was observed during 6 months
after the RDN. For better understanding the efficacy and safety of RDN we need well
structured randomized clinical trials in patients with rHT and various co-morbidities.
Also, further meta-analysis to evaluate the optimal target population and importance
of RSD as rHT treatment.
ESTIMATION OF THE PULSE WAVE VELOCITY THROUGH
SOME CARDIOVASCULAR RISK FACTORS
Erol Arslan1, Hakan Sarlak1, Mustafa Cakar2, Seref Demirbas1, Muharrem Akhan1,
Omer Kurt3, Sevket Balta2, Sirzat Yesilkaya2 and Fatih Bulucu1
1Gulhane Military Medical Academy, Ankara, Turkey, 2Eskisehir Military Hospital,
Eskisehir, Turkey, 3SarıKamıS Military Hospital, Kars, Turkey, 4Etimesgut Military
Hospital, Ankara, Turkey
Introduction and Aims: Increased arterial stiffness is an independent predictor of
cardiovascular disease. Arterial stiffness can be easily and noninvasively assessed by
measuring the pulse wave velocity (PWV) as the present gold standard measurement of
regional arterial stiffness. Arterial stiffness increases with age, hypertension,
dyslipidemia, smoking, obesity, increased plasma glucose, elevated heart rate and
endothelial dysfunction. In this study, we aimed to perform calculations based on
estimating the arterial stiffness measurement indirectly via some other cardiovascular
Methods: In this study, we recruited 1054 patients. 469 of them were females (44.5%)
and the mean ages of the female and male subjects were 48.3±13.5 and 42.4±16.2 years,
respectively. The subjects were patients having arterial stiffness measurements applied
in the internal medicine outpatient clinics.
Results: The mean body mass index (BMI), pulse wave velocity (PWV), augmentation
index (Aix) and central aortic pressure (CAP) measurements of the patients were 27.7
±5 kg/m2; 8.5±1.8 m/sec; 22.3±16.5 % and 127.4±22.6 mmHg, respectively. Among the
cardiovascular risk factors and laboratory measurements, only seven (age, gender,
smoking, body mass index, systolic and diastolic blood pressures, heart rate) were
found associated with pulse wave velocity measurements. A linear regression analysis
was performed to estimate pulse wave velocity measurements through these factors.
The final equation of the estimated PWV was formulated below (Formula).
(Smoking*0,2507576021845)(Blood pressures: mmHg, Age: years, BMI: kg/m2, Heart
rate: beats per minute, Gender: 1 male, 0 female; Smoking: 1 yes, 0 no)
Conclusions: PWV measurement is important in representing the cardiovascular risk.
We think that estimation of the PWV via this formula where there is no real availability
of PWV measurement, may be useful for clinicians to determine the future
CYSTATIN C VERSE CREATININE IN DERTERMING
ALBUMINURIA WITH PRIMARY ALDOSTERONISM
Introduction and Aims: Using cystatin C to determine the estimated glomerular
filtration rate (eGFR) strengthens the association of eGFR and the outcome risk
stratification, however this effect on predicting albuminiuira in primary aldosteronism
(PA), with high cardiovascular events has not been determined.
Methods: We collected 327 PA patients who have standardized measurements of
serum creatinine and cystatin C. Albuminuria was defined by urine
albumin-to-creatinine ratio (ACR). We compared the association of the eGFR, as
calculated by creatinine (CKD-EPI), Cystatin C formula and creatinine-cystatin C
formula with albuminuria.
Results: eGFR calculated by Cystatin C have the highest result (100±27) followed by
Cre-Cystatin C (94±26) and then CKD-Epi (84±24mL/min/1.73 m2). To determine the
presence of albuminuira, the area under the curve (AUC) describes that
creatinine-cystatin C formula (AUC:0.600) and Cystatin C based formula(AUC:0.597)
had the larger value than CKD-EPI (AUC:0.594). The association between albuminuria
severity (separated at urine ACR 30mg/g) and patients’ characteristics shows that
underlining disease(diabetes mellitus and coronary artery disease), PA severity
(hypertension diagnosed duration, aldosterone level and blood pressure level) and
baseline renal function(creatinine and cystatin C level) have significant difference to
albuminuria severity in univariable analysis. However, only creatinine level has
significant difference in multivariable analysis.
Conclusions: In PA patients, the combined creatinine-cystatin C equation strengthens
the association of eGFR and the risk of albuminuia.
PREVALENCE OF THERAPY RESISTANT HYPERTENSION
AND ITS IMPACT ON OUTCOME IN CKD PATIENTS
Introduction and Aims: Renal denervation has been suggested as a promising therapy
in particular in those with impaired kidney function. Estimates of the prevalence of
therapy resistant hypertension and its consequences in these patients are therefore
becoming increasingly important.Aim of this study was to study the prevalence and the
impact on outcome of therapy resistant hypertension, defined as a blood pressure (BP)
above 140/90 mmHg despite treatment with three or more BP lowering drugs, in a
cohort of CKD patients under nephrology care.
Methods: We used data from the MASTERPLAN trial, a multicenter RCT
investigating an integrated multifactorial approach delivered by nurse practitioners vs.
usual care according to current guidelines on cardiovascular risk in CKD patients.
Blood pressure was measured at baseline as office BP and during 30 minutes using a
non-invasive automated oscillometric device. Use of BP lowering drugs was recorded.
Participants were followed for the occurrence of myocardial infarction, stroke or
cardiovascular mortality (composite endpoint) and ESRD.
Results: 788 CKD patients (mean eGFR 36 ±14 ml/min/1.73m2) were included. Office
BP was above 140 mmHg systolic and/or above 90 mmHg diastolic in 49%. Automated
measurements were >140/90 mmHg in 41%. Resistant hypertension was found in 26%
based on office BP and in 23% based on automated measurement. Kidney transplant
recipients (n=110) had similar control of blood pressure: resistant hypertension 25%
(office) and 23% (automated measurement). During 4.6 years of follow-up, 16% of the
therapy resistant group reached the composite endpoint and 22% reached ESRD.
Conclusions: Therapy resistant hypertension is common in CKD patients and
associated with a high cardiovascular risk. Moreover, treatment of hypertension is
suboptimal in many CKD patients.
IMPACT OF COUNSELING FOLLOWING SEVERE
PREECLAMPSIA ON CARDIOVASCULAR RISK CONTROL
Markus Mohaupt1, Kim Straessle1, Marc Baumann1, Luigi Raio1
and Daniel Sirbek1
1University of Bern, Berne, Switzerland
Introduction and Aims: Hypertensive pregnancies and established preeclampsia have
severe long-term consequences for both mothers and children by increasing
cardiovascular risk, compromising renal function and causing premature death. As a
consequence, we established counseling early after severe preeclampsia without
objective criteria for its sustainability. We hypothesized that these young women will
follow a healthy lifestyle and have careful follow-up visits with their general
practitioner given their high risk status.
Methods: We identified 354 consecutive women attending our post-preeclampsia
outpatient clinics in between 2003 and 2011 1 to 8 y after the index pregnancies. Of
these, 189 were accessible for a telephone consultation. Information on medical
contacts, further pregnancies and cardiovascular risk control were obtained. Medical
records were reviewed to characterize the cardiovascular risk profile at initial
Results: During the initial work-up, sufficient information on family history of diseases
with enhanced cardiovascular risk was obtained in 86% of the patients and positive in
55%. A family history for preeclampsia was present in 19%. At counseling, the personal
history revealed obesity, diabetes mellitus, smoking, chronic hypertension, prior
cardiovascular disease, and pregnancy-induced hypertension in 47%, 1%, 9%, 5%, 0%,
and 6%, respectively. Clinical chemistry revealed elevated total cholesterol,
LDL-cholesterol, HbA1c, and microalbuminuria in 52, 53%, 3%, and 38%, respectively.
During follow-up blood pressure and dyslipidemia was controlled in 44% and 35%,
obesity persisted in 37%, 13% continued to smoke, and 4% of the women suffered from
diabetes or manifest cardiovascular disease. During the follow-up 44% of the women
had at least one additional pregnancy with 33% of the completed pregnancies again
developing preeclampsia irrespective of the use of low-dose aspirin and calcium.
Conclusions: Despite intense counseling, the renal and cardiovascular high risk disease
preeclampsia does motivate neither the patients nor the medical care-givers to provide
appropriate health protection. The unexpected high rate of recurrent disease further
exposes the women to future life-threatening health hazards such as chronic kidney
disease. Further studies closely involving the patients and their doctors are urgently
EFFECTS OF ORAL L-ARGININE SUPPLEMENTATION
AND ACUTE RESISTANCE EXERCISE ON BLOOD PRESSURE
AND NITRIC OXIDE IN HYPERTENSIVE PATIENTS
Marcos A. Nascimento1, Margaret G. Mouro1, Giovana R. Punaro1,
Marco T. Mello1, Sérgio Tufik1 and Elisa M.S. Higa1
1UNIFESP, Sao Paulo, Brazil
Introduction and Aims: High blood pressure (BP) is a world health problem and a
risk factor to cardiovascular disease. L-arginine (L-arg) is a conditionally essential
amino acid in the human diet that serves as substrate for nitric oxide synthases (NOS)
to synthesize nitric oxide (NO). Dietary L-arg supplementation can improve the
functional properties of the cardiovascular system. This study examined the effects of
oral L-arg supplementation and acute resistance exercise on blood pressure and NO in
Methods: Sixteen hypertensive men (45±7 yrs, 92.5±13.0 kg, body weight and 31.0±3.8
kg/m2 , body mass index) volunteered to be in this randomised, double-blind, and
repeated-measure study: control placebo (starch, CTL-PLA), control L-arg
(CTL-ARG), exercise placebo (EXE-PLA) and exercise L-arg (EXE-ARG).The
supplementation (6 g/day of placebo or L-arg for 7 days) was separated by a 7-day
washout. The acute resistance exercise (ARE) comprised 8 exercises (chest press, leg
press, handle back, leg extension, shoulder press, leg curl, biceps curl, and triceps
pulley), with an intensity of 60% of 1 maximum repetition. An execution speed of 2:2
was used, with recovery intervals of 60 seconds between sets and two minutes between
exercises. Each session was performed at the beginning and at the end of the
supplementation with L-arg or placebo. The systolic blood pressure (SBP, mmHg),
iii | Abstracts
diastolic blood pressure (DBP, mmHg), mean blood pressure (MBP, mmHg), heart rate
(HR, bpm) and double product (DP=SBPxHR) were determined at rest, immediately
after ARE and 5, 10, 15, 30, 45 and 60 minutes after ARE. Serum NO (µM) was
determined at rest, immediately after ARE and 1 hour after ARE by chemiluminescence,
utilizing the NO Analyzer (NOA™, a gold standard method for NO).
Results: SBP decreased at all periods after ARE in the EXE-PLA and EXE-ARG when
compared to CTL-PLA or CTL-ARG, but not significantly P>0.05; DBP decreased at 45'
after ARE in the groups EXE-PLA (76±2.2) and EXE-ARG (75±1.25), when compared to
CTL-PLA (85±2.7) or CTL-ARG (83±2.31) P<0.05, and at 60' after ARE in the groups
EXE-PLA ( 79 ±1.87) and EXE-ARG ( 78 ±1.09) compared to CTL-PLA ( 85 ±2.90) or CTL -ARG ( 83 ±1.85), P<0.05. DP was increased immediately after ARE , and at 5 , 10, 15 , 30 , 45 and 60' comparing exercise to control groups , with P< 0 .05.