HYPERTENSION

Nephrology Dialysis Transplantation, May 2014

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. View larger version: In this window In a new window Download as PowerPoint Slide

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HYPERTENSION

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 YOUNG ADULTS 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 HEMODIALYSIS PATIENTS 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, p=0.98). 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 DIALYSIS PATIENTS 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 effect. 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 dextran. 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 KKAy+Nife group. 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 CONVENTIONAL HEMODIALYSIS 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 (%) IDWG (kg) Hx of CHF (%) Vintage (yrs) SP038 Table 2. Baseline Characteristics by Coefficient of Variation Tertile (CVT) of SDUSBPM 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 DISEASE PATIENTS 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 recommendations. 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 Sphygmocor device. RHUEPO INDUCED-HYPERTENSION LEADS TO EARLY RENAL DAMAGE 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 WITH HYPERTENSION 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 obesity. RENAL ARTERY DENERVATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE &HEMODIALYSIS, WITH RESISTANT ARTERIAL HYPERTENSION- NORTH ISRAELI CENTER EXPERIENCE 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 Number 15 17 16 5 4 0.52 4 14 10 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, Alexandroupolis, Greece 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 interdialytic interval. 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 RENIN-ANGIOTENSIN-ALDOSTERON BLOCKADE 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 FRACTION 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 were assessed. 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 with hypertension. 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 children. 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 conservatively 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 CKD. 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: GENDER-SPECIFIC VARIATIONS 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 CKD patients. 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 confounders. 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, Romania 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 natremia. 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 COMBINATIONS 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 18 months. 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 elderly. URIC ACID, ALLOPURINOL AND ENDOTHELIAL DYSFUNCTION 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 KIDNEY DISEASE 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 CKD. 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. Serum Creatinine 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 DISEASE PATIENTS 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 HYPERTENSION 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 intervention. 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 risk factors. 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). PWVestim=-112,91446217+0,0211937383703*(Age0,173930194946) +45,87673631727*(BMI1,02939903956456)+49,38948049469* (Systolic1,01661333628177)+5,652578136932*(Diastolic1,1699440306161)+ 0,07210998120011*(HR1,8905313062488)+(Gender*0,03561363100352)+ (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 cardiovascular risk. 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 counseling. 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 warranted. 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 hypertensive men. 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.


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Hong Xu, Xiaoyan Huang, Ulf Risérus, Tommy Cederholm, Bengt Lindholm, Johan Ärnlöv, Juan Jesús Carrero, Adi Leiba, Asaf Vivante, Yulia Bulednikov, Eliezer Golan, Karl Skorecki, Tamar Shohat, Geir Mjoen, Faiez Zannad, Alan Jardine, Roland Schmieder, Bengt Fellstrøm, Hallvard Holdaas, On Behalf Of The AURORA Study Group, Philip Zager, Dana Miskulin, Jennifer Gassman, Cynthia Kendrick, David Ploth, Manisha Jhamb, Vera Jankowski, Anna Schulz, Harald Mischak, Walter Zidek, Joachim Jankowski, Younhg-Ki Lee, Ajin Cho, Jwa-Kyung Kim, Myung-Jin Choi, Soo Jin Kim, Jong-Woo Yoon, Ja-Ryong Koo, Hyung Jik Kim, Jung-Woo Noh, Seiji Itano, Minoru Satoh, Kengo Kidokoro, Tamaki Sasaki, Naoki Kashihara, Georgios Koutroumpas, Pantelis Sarafidis, Panagiotis Georgianos, Antonis Karpetas, Athanase Protogerou, Christos Syrganis, Pavlos Malindretos, Katherine Raptopoulou, Stylianos Panagoutsos, Ploumis Pasadakis, Philip Zager, Dana Miskulin, Jennifer Gassman, Cynthia Kendrick, Manisha Jhamb, David Ploth, Eva E Vink, A De Boer, Willemien L Verloop, Wilko Spiering, Michiel Voskuil, Evert-Jan Vonken, J M Hoogduin, Tim Leiner, Michiel L Bots, Peter J Blankestijn, Pantelis A. Sarafidis, Antonios V. Karpetas, Panagiotis I. Georgianos, Athanasios Bikos, Romanos Sklavenitis-Pistofidis, Rieni Tzimou, Vassilios Raptis, Pantelis Vakianis, Maria Tersi, Vassilios Liakopoulos, Anastasios N. Lasaridis, Athanase Protogerou, Sandra Ribeiro, João Fernandes, Patrícia Garrido, José Sereno, Helena Vala, Elsa Bronze Da Rocha, Luís Belo, Elísio Costa, Flávio Reis, Alice Santos-Silva, Rigas Kalaitzidis, Petros Skapinakis, Vasilis Karathanos, Despina Karasavvidou, Giorgos Katatsis, Kosmas Pappas, Stelios Hatzidakis, Kostas Siamopoulos, Fernando Margulis, Roberto Sabbatiello, Claudia Castro, Silvia Ramallo, Miriam Martinez, Ruben Schiavelli, Diab Ganem, Farid Nakhoul, Ana Roth, Evgeny Farber, Chang Seong Kim, Ha Yeon Kim, Yong Un Kang, Joon Seok Choi, Eun Hui Bae, Seong Kwon Ma, Soo Wan Kim, Georgios Koutroumpas, Pantelis Sarafidis, Panagiotis Georgianos, Antonis Karpetas, Arhanase Protogerou, Pavlos Malindretos, Christos Syrganis, George Tzanis, Stylianos Panagoutsos, Ploumis Pasadakis, Maciej Jankowski, MałGorzata Kasztan, Robert Kowalski, Agnieszka Piwkowska, Dorota Rogacka, MirosłAwa SzczepańSka-Konkel, Stefan Angielski, Dimitris Evangelou, Katerina Naka, Rigas Kalaitzidis, Lampros Lakkas, Aris Bechlioulis, Ioannis Gkirdis, Giorgos Nakas, Fotios Zarzoulas, Anna Kotsia, Olga Balafa, Giorgos Tzeltzes, Kostas Pappas, Christos Katsouras, Evangelia Dounousi, Lampros Michalis, Kostas Siamopoulos, Dominika Maciorkowska, Edyta Zbroch, Ewa Koc-Zorawska, Jolanta Malyszko, Aysun Karabay Bayazit, Ihsan Yuksekkaya, Sercan Aynaci, Ali Anarat, Kentaro Nakai, Hideki Fujii, Risa Ishida, Chie Utaka, Rie Awata, Shunsuke Goto, Jun Ito, Shinichi Nishi, Rengin Elsurer, Baris Afsar, Zoe Lepar, Daniela Radulescu, Cristiana David, Ileana Peride, Andrei Niculae, Ionel Alexandru Checherita, Alexandru Ciocalteu, Cem I Sungur, Mehmet Kanbay, Dimitrie Siriopol, Ionut Nistor, Omer C Elcioglu, Ozge Telci, Richard Johnson, Adrian Covic, Simone Vettoretti, Enrico Gallazzi, Roberto Meazza, Valentina Gagliardi, Anna Villarini, Carlo Maria Alfieri, Riccardo Floreani, Piergiorgio Messa, Simone Vettoretti, Carlo Maria Alfieri, Enrico Gallazzi, Valentina Gagliardi, Anna Villarini, Roberto Meazza, Riccardo Floreani, Piergiorgio Messa, Yulia Kotovskaya, Svetlana Villevalde, Zhanna Kobalava, Alexandra Circiumaru, Elena Rusu, Diana Zilisteanu, Teodora Atasie, Flavia Cirstea, Monica Ecobici, Mihai Voiculescu, Monica Rosca, Cristiana Tanase, Ines Baotić, Vinko Vidjak, Ingrid Prkačin, Tomislav Bulum, Erol Arslan, Hakan Sarlak, Mustafa Cakar, Seref Demirbas, Muharrem Akhan, Omer Kurt, Sevket Balta, Sirzat Yesilkaya, Fatih Bulucu, Chieh Kai Chan, Yen Hung Lin, Vin Cent Wu, Kwan Dun Wu, E De Beus, M L Bots, A D Van Zuilen, J F Wetzels, P J Blankestijn, Markus Mohaupt, Kim Straessle, Marc Baumann, Luigi Raio, Daniel Sirbek, Marcos A. Nascimento, Margaret G. Mouro, Giovana R. Punaro, Marco T. Mello, Sérgio Tufik, Elisa M.S. Higa. HYPERTENSION, Nephrology Dialysis Transplantation, 2014, iii79-iii89, DOI: 10.1093/ndt/gfu142