Relationship Between Short-Term Blood Pressure Variability and Subclinical Renal Damage in Essential Hypertensive Patients

The authors aimed to analyze the relationship between subclinical renal damage, defined as the presence of microalbuminuria or an estimated glomerular filtration rate (eGFR) between 30 mL/min/1.73 m(2) and 60 mL/min/1.73 m(2) and short-term blood pressure (BP) variability, assessed as average real variability (ARV), weighted standard deviation (SD) of 24-hour BP, and SD of daytime and nighttime BP. A total of 328 hypertensive patients underwent 24-hour ambulatory BP monitoring, 24-hour albumin excretion rate determination, and eGFR calculation using the Chronic Kidney Disease Epidemiology Collaboration equation. ARV of 24-hour systolic BP (SBP) was significantly higher in patients with subclinical renal damage (P=.001). This association held (P=.04) after adjustment for potential confounders. In patients with microalbuminuria, ARV of 24-hour SBP, weighted SD of 24-hour SBP, and SD of daytime SBP were also independently and inversely related to eGFR. These results seem to suggest that in essential hypertension, short-term BP variability is independently associated with early renal abnormalities

Association of renal resistive index with aortic pulse wave velocity in hypertensive patients

Background: Recent data suggest that renal haemodynamic parameters obtained by duplex Doppler sonography, especially the intrarenal resistive index (RI), may be associated with systemic vascular changes. However, conflicting data exist about the independent relationship between aortic stiffness and RI. The aim of this study was to evaluate the relationship between RI and arterial stiffness, assessed by aortic pulse wave velocity (aPWV), in hypertensive patients. Design: Cross-sectional study. Methods: We enrolled 264 hypertensive subjects aged between 30 and 70 years. They were divided into two groups, either with normal renal function (n=140) or with chronic kidney disease (CKD) (n=124). Each patient underwent assessment of ultrasonographic renal RI and measurement of aPWV through oscillometric device. Results: Patients with renal RI>0.7 showed higher values of aPWV, both in the overall population (p<0.001) and in the subgroups with (p<0.01) and without CKD (p<0.01). Moreover, statistically significant correlations were observed between aPWV and RI in the whole population (r=0.38, p<0.001) and in the subgroups with (r=0.35, p<0.001) and without CKD (r=0.31, p<0.001). These correlations held even after adjustment for several confounding factors in multivariate analyses. Conclusions: Our results seem to corroborate the concept that the RI may be considered as a marker of systemic vascular changes and therefore a predictor of cardiovascular risk

SHORT-TERM VARIABILITY OF 24-H SYSTOLIC BLOOD PRESSURE IS ASSOCIATED WITH MICROALBUMINURIA IN PATIENTS WITH PRIMARY HYPERTENSION

Introduction: Limited and conflicting data are available about the association between short-term blood pressure (BP) variability and urinary albumin excretion rate (uAER). Aim: To analyse the relationships between microalbuminuria, defined as an uAER between 20 and 200 lg/min, and short-term BP variability, assessed as average real variability (ARV), weighted standard deviation (SD) of 24-h BP, and as SD of daytime and nighttime BP. Methods: The study population consisted of 316 untreated essential hypertensive patients with normal estimated glomerular filtration rate ([60 ml/min/1.73m2), which underwent 24-h ambulatory BP monitoring and 24-h uAER determination. Results: Microalbuminuria was detected in 83 (26 %) patients. ARV of 24-h systolic BP (SBP) was significantly higher in patients with microalbuminuria [9.9 (8.6–11.1) mmHg] when compared to those without it [9.1 (8–10.2) mmHg; p = 0.007]. This difference held (p = 0.026) after adjustment for age, mean levels of BP and other potential confounders by ANCOVA. The correlation analysis disclosed that, among the indices of short-term BPV, only ARV of 24-h SBP (r = 0.17; p = 0.003) and ARV of 24-h DBP (r = 0.13; p = 0.03) were significantly related to (Log) uAER, whereas the relationships of uAER with SD of daytime SBP and with weighted SD of 24-h SBP did not reach the statistical significance (respectively, r = 0.095 and r = 0.085).The correlation of uAER with ARV of 24-h SBP, but not that with ARV of 24-h DBP, remained significant even after adjustment for average 24-h SBP. This association remained significant (b = 0.14; p = 0.01), also taking into account the effect of age, gender, diabetes, serum uric acid, triglycerides, eGFR in multiple regression analyses. All the other indices of shortterm BP variability tested were not independently associated with microalbuminuria. Conclusions: Our results seem to suggest that in essential hypertension, short-term BP variability, only when estimated by ARV of 24-h SBP, is independently associated with microalbuminuria

INVERSE RELATIONSHIP BETWEEN AORTIC ROOT DIAMETER AND RENAL FUNCTION IN HYPERTENSIVE SUBJECTS

Introduction: Dilatation of aortic root is associated with presence and severity of aortic regurgitation and risk for aortic dissection. Recent studies performed in general population suggest that enlarged aortic root diameter (ARD) may predict cardiovascular events in absence of aneurysmatic alterations. Little is known about the influence of renal function on ARD. Aim: To assess the relationships between glomerular filtration rate (GFR) and ARD in hypertensive subjects. Methods: We enrolled 611 hypertensive individuals (mean age: 52 ± 15 years; men 63 %) consecutively attending our outpatient nephrology and hypertension unit. Patients on dialysis treatment, with valvulopathy more than mild, bicuspid aortic valve, previous cardiovascular events and genetic aortic diseases were excluded. All the subjects underwent echocardiography. ARD was measured at the level of Valsalva’s sinuses by M-mode tracings, under twodimensional control. In line with the PAMELA study, ARD, ARD indexed to body surface area (ARD/BSA) and to height (ARD/H) were considered increased when they exceeded 3.8 cm, 2.1 cm/m2, 2.3 cm/m in men and 3.4 cm, 2.2 cm/m2, 2.2 cm/m in women, respectively. GFR was estimated by the CKD-EPI equation. Results: Estimated GFR (eGFR) was lower in subjects with values of ARD, ARD/BSA and ARD/H above the sexspecific cut-offs when compared to those with normal aortic root size (all p\0.0001). eGFR correlated significantly with ARD (r = -0.17), ARD/BSA (r = -0.43) and ARD/H (r = -0.40; all p\0.001). The associations of eGFR with ARD/BSA (b = -0.23) and ARD/H (b = - 0.17; all p\0.001) held in linear multiple regression analyses, after adjustment for various confounding factors. Conclusions: Our study seems to suggest that a reduced renal function may adversely influence ARD. This may contribute to explain the enhanced cardiovascular risk associated with renal insufficiency

RELATIONSHIP BETWEEN SERUM URIC ACID AND AORTIC STIFFNESS IN UNTREATED HYPERTENSIVE SUBJECTS

Recent studies have reported an association between serum uric acid (SUA) and reduced arterial elasticity. However, in these studies arterial elastic properties have been assessed chiefly by measuring brachial-ankle pulse wave velocity (PWV) or peripheral PWV and only sometimes by using aortic PWV. Moreover, the relationships between SUA and arterial stiffness have never been statistically adjusted for albuminuria. Furthermore, the studies exploring the influence of uric acid on aortic distensibility in subjects with arterial hypertension yielded conflicting results. The aim of our study was to evaluate the relationships between SUA and aortic stiffness in a group of essential hypertensive patients, attending our Hypertension Centre. We enrolled 222 untreated hypertensive patients (mean age: 44 ± 10 years; 60 % males), without cardiovascular complications and without severe renal insufficiency. In all subjects routine blood chemistry, including SUA determination (by uricase/peroxidase method) and albumin excretion rate (AER) assay were obtained. Moreover, measurement of carotid-femoral pulse wave velocity (c-f PWV), by an automatic computerised method (Complior) and 24-h ambulatory blood pressure (BP) monitoring were performed. Patients with c-f PWV > 12 m/sec (n = 44) showed SUA levels significantly higher than those with lower values of PWV (5.9 ± 1.2 vs 5.3 ± 1.1 m/sec; p = 0.002). This difference held after correction by ANCOVA for age, gender, mean arterial pressure (MAP), body mass index, and serum creatinine (p = 0.02), but not after further adjustment for AER. Univariate analysis of correlation disclosed a significant association of SUA with c-f PWV (r = 0.23; p = 0.001). This correlation lost statistical significance when AER was added in a multiple regression model including, as covariates, age, gender, MAP, serum creatinine, metabolic syndrome and SUA. The results of our study show that, in essential hypertensive subjects, a positive relationship between SUA and aortic stiffness exists This association may be mediated by endothelial dysfunction, as suggested by the loss of its statistical significance, after adjustment for albumin excretion rate

ASSOCIATION OF SERUM URIC ACID WITH AORTIC STIFFNESS IN UNTREATED HYPERTENSIVE SUBJECTS.

INTRODUCTION: Recent studies have reported an association between serum uric acid (SUA) and reduced arterial elasticity. However, in these studies arterial elastic properties have been assessed chiefly by measuring brachial-ankle pulse wave velocity (PWV) or peripheral PWV and only sometimes by using aortic PWV, that is considered the gold standard for measuring arterial stiffness. Moreover, the studies exploring the influence of SUA on aortic distensibility in subjects with arterial hypertension yielded conflicting results. AIM: The purpose of our study was to evaluate the relationships between SUA and aortic stiffness in a group of essential hypertensive patients. METHODS: We enrolled 222 untreated hypertensive subjects (mean age: 44 ± 10 years; 60 % males), free from cardiovascular complications and without severe renal insufficiency. In all subjects SUA determination and albumin excretion rate (AER) assay were obtained. Moreover, measurement of carotid-femoral pulse wave velocity (c-f PWV), by an automatic computerised method (Complior) was performed. RESULTS: Patients with c-f PWV [12 m/s (n = 44) showed SUA levels significantly higher than those with lower values of PWV (5.9 ± 1.2 vs 5.3 ± 1.1 m/s; p = 0.002). This difference held after correction by ANCOVA for various confounding factors (p = 0.02), but not after further adjustment for AER. Univariate analysis of correlation disclosed a significant association of SUA with c-f PWV (r = 0.23; p = 0.001). This correlation lost statistical significance when AER was added in a multiple regression model including, as covariates, age, gender, mean arterial pressure, serum creatinine, metabolic syndrome and SUA. CONCLUSIONS: The results of our study showed that, in hypertensive subjects, a positive relationship between SUA and aortic stiffness exists This association may be mediated by endothelial dysfunction, as suggested by the loss of its statistical significance, after adjustment for AER

RELATIONSHIP BETWEEN OBESITY AND LEFT VENTRICULAR MASS IN CAUCASIAN HYPERTENSIVE SUBJECTS. DOES SEX MATTER?

Objective The excess of adiposity affects the heart through haemodynamic and non haemodynamic mechanisms leading to left ventricular hypertrophy (LVH) and ultimately to heart failure. It has been been previously observed, in a large study performed in American Indians, that the impact of obesity on left ventricular mass (LVM) is greater in women than men, while the results of other investigations carried out in other ethnic groups have yielded conflicting results .The aim of our study was to evaluate the potential influence of gender on the relationships between obesity and LVM in Caucasian patients with essential hypertension (EHs) . Design and method We enrolled 724 subjects with EH (mean age 45 ± 12 years, 63 % men ) without cardiovascular complications. In all subjects the anthropometric indices (weight, height and waist circumference ) and the routine biochemical parameters were determined . Furthermore, all patients underwent a 24-h blood pressure monitoring and an echocardiogram. LVM was indexed for body surface area (LVMI ) and for height2.7 (LVMH2.7) . Results The univariate correlations of LVM , LVMI , LVMH2.7 with body mass index (BMI) and the comparison of Pearson coefficients between the two sexes, evaluated using the Fisher r-to-z transformation, are shown in the following table. The greatest strength of the association of obesity with LVM , LVMI , LVMH2.7 in women than in men was also confirmed (p always < 0.01) in multivariate models, where the interaction term “sex x obesity' was added along with multiple confounding factors. Similar results were obtained when as an index of adiposity waist circumference was used instead of BMI. Conclusions Our study seems to indicate that in Caucasians hypertensive subjects the impact of obesity and overweight on LVM is greater in women than in men

Relationship between aortic root size and glomerular filtration rate in hypertensive patients

OBJECTIVE: Recent studies suggest that enlarged aortic root diameter (ARD) may predict cardiovascular events in absence of aneurysmatic alterations. Little is known about the influence of renal function on ARD. Our study was aimed to assess the relationships between glomerular filtration rate (GFR) and ARD in hypertensive subjects. METHODS: We enrolled 611 hypertensive individuals (mean age: 52 ± 15 years; men 63%). ARD was measured by echocardiography at the level of Valsalva's sinuses using M-mode tracings. It was considered as absolute measure, normalized to body surface area (ARD/BSA) and indexed to height (ARD/H). GFR was estimated by the Chronic Kidney Disease Epidemiology Collaboration equation. The study population was categorized into seven groups: subjects without chronic kidney disease (no CKD) and subjects with increasing severity of CKD (1, 2, 3a, 3b, 4, 5), as proposed by the 2012 Kidney Disease: Improving Global Outcomes guidelines. RESULTS: ARD/BSA and ARD/H showed a stepwise increase from the group with normal renal function to the groups with increasing severity of CKD. GFR correlated significantly with ARD (r = -0.17), ARD/BSA (r = -0.43) and ARD/H (r = -0.35; all P &lt; 0.001). The associations of GFR with ARD/BSA (β = -0.26; P &lt; 0.001) and ARD/H (β = -0.13; P = 0.01) held in linear multiple regression analyses, after adjustment for various confounding factors. CONCLUSION: Our study seems to suggest that a reduced renal function may adversely influence ARD. This may contribute to explain the enhanced cardiovascular risk associated with renal insufficiency

Body composition of individuals with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is one of the principle forms of hyperandrogenism that affects women of reproductive age. Few studies have evaluated the body composition of patients with PCOS being based mainly on an evaluation of the quantity and distribution of the fat mass. Objectives: to evaluate the body composition of patients affected by PCOS and to establish the hormonal factors that determine possible differences in body composition compared with healthy women. Methods: 110 Caucasian women affected by clinical hyperandrogenism and/or irregular menstrual periods were included in the study; the control group was made up of 90 healthy Caucasian women, of reproductive age, without hyperandrogenism. The control group and the patients were similar in age (23 ± 3 vs. 24.1 ± 6.4 years old) but not in body weight or body mass index (BMI). A hematic sample was taken from both groups, on the fifth day of the menstrual cycle, to measure the quantities of glycaemia, insulin, testosterone (T), SHBG and dehydroepiandrosterone sulphate (DHEAS). In the hyperandrogenic patients the quantities of serum 17-hydroxyprogesterone (on the 5th day of the menstrual cycle) and of progesterone (on the 22nd day of the menstrual cycle) were also measured. Moreover, the hyperandrogenic patients underwent a pelvic or intra-vaginal ultrasound scan to evaluate the ovarian morphology. Results: the patients with classic PCOS showed serum levels higher in testosterone, FAI and insulin than the patients with ovulatory PCOS and idiopathic hyperandrogenism; the patients with ovulatory PCOS had higher levels of testosterone, FAI and insulin (p<0.01) than the control group. The patients with Idiopathic Hyperandro-genism had higher levels of testosterone (p<0.01) and FAI (p<0.01) but similar levels of BMI and insulin, and similar waist circumference and body composition. Conclusions: the hyperandrogenic patients have a different body composition to normal women. The increase in the fat free mass seems to be primarily a consequence of hyperinsulinemia, as the fat free mass correlated significantly with the circulating insulin and the insulin resistance. Consequently, these alterations have an influence on the body composition and therefore both on the quantity and distribution of body fat and on the increase in muscle mass