Blood pressure measurement
Results: SRI inversely correlated to SSI (Kendall’s tau=-0.22,p<0.03), and it was
larger in SR than in SS (0.35+0.03 vs. 0.22+0.03 mmHg/bpm, M+SEM, p<0.01).
ROC analysis showed that 89% of hypertensives with SRI<0.31 were SS, and
did not demonstrate gender differences (figure).
1051
tensive and lipid-lowering drugs. After adjustment for sex, age, diabetes mellitus,
history of myocardial infarction and antihypertensive and lipid-lowering treatment
24-hour AASI was the independent predictor for ACS (OR 4.0; 95% CI 1.3-12.0).
Conclusions: AASI has an important role as a risk factor of ACS in patients with
coronary atherosclerosis.
P5658 | BEDSIDE
Aldosterone to renin ratio is associated with 24 hour ambulatory
blood pressure in essential hypertensives: the Styrian
Hypertension study
ROC analysis by gender
Conclusion: In uncomplicated essential hypertensives, a condition of saltsensitivity risk under habitual diet seems identifiable in both M and F simply by
evaluating whether SRI is lower than a given threshold.
References: [1] Hypertension, 2011;57:180-5; [2] J Hypertens, 2011;29A:1A.08.
P5656 | BEDSIDE
Mir-143/mir-145 levels in peripheral blood mononuclear cells
associate with ambulatory blood pressure monitoring parameters
in patients with essential hypertension
J.E. Kontaraki 1 , M.E. Marketou 2 , E.A. Zacharis 2 , F.I. Parthenakis 2 , P.E. Vardas 2 .
1
University of Crete, Faculty of Medicine, Molecular Cardiology Laboratory,
Heraklion, Greece; 2 University Hospital of Heraklion, Department of Cardiology,
Heraklion, Greece
Purpose: MicroRNAs (miRs) are essential gene expression regulators and are
implicated in cardiovascular function both in health and disease. MiR-143/miR145 have been shown to affect blood pressure in mice, they are highly expressed
in Vascular Smooth Muscle Cells (VSMCs) and are known to be critical regulators
of VSMCs differentiation and phenotypic switch which have a fundamental role in
the development of hypertension. Ambulatory blood pressure monitoring (ABPM)
is a useful tool for evaluating 24-hour blood pressure profile and a good predictor
of target organ damage in hypertensive patients. We evaluated miR-143/miR-145
levels in peripheral blood mononuclear cells of patients with essential hypertension in relation to ABPM parameters.
Methods: 24-hour ABPM and blood sampling were obtained in 60 untreated
hypertensive patients (29 males, aged 60.42±9.6 years). Blood samples were
also obtained from 29 healthy volunteers (13 males, aged 56.69±8.59 years)
for comparison. Peripheral blood mononuclear cells (PBMCs) were isolated and
microRNA levels were determined by quantitative real time reverse transcription
PCR.
Results: MiR-143 (2.20±0.25 versus 4.19±0.57, p<0.001) and miR-145
(13.51±1.73 versus 22.37±3.31, p=0.010) levels were found to be lower in hypertensive patients compared to healthy controls. In hypertensive patients, miR143 (r=-0.380, p=0.003) and miR-145 (r=-0.405, p=0.001) levels showed strong
negative correlations with 24-hour diastolic blood pressure (DBP) as well with 24hour mean blood pressure (MBP) (r=-0.371, p=0.004) and (r=-0.385, p=0.002)
respectively. We also observed significant negative correlations of miR-143 (r=0.292, p0.025) and miR-145 (r=-0.399, p=0.002) levels with 24-hour mean pulse
pressure.
Conclusions: MiR-143/miR-145 levels are lower in PBMCs of hypertensive patients compared to healthy controls and show strong negative correlations with
DBP and MBP derived from 24-hour ABPM. Correlations with 24h pulse pressure
might indicate a possible implication of these microRNAs in target organ damage.
Our data define miR-143/miR-145 as possible candidate biomarkers as well as
possible therapeutic targets in hypertension.
P5657 | BEDSIDE
Arterial ambulatory stiffness index predicts acute coronary
syndromes
W. Sobiczewski, M. Wirtwein, M. Gruchala, I. Kocic, A. Rynkiewicz. Medical
University of Gdansk, Gdansk, Poland
Purpose: Ambulatory Arterial Stiffness Index (AASI) is a composite marker of
cardiovascular properties. The study was conducted to investigate the relationship between AASI and cardiovascular events in patients with significant coronary
atherosclerosis confirmed in angiography.
Methods: Associations between AASI and cardiovascular events were examined
in 891 subjects referred for diagnostic coronary angiography. In a period of two
to four weeks after coronary angiography, 24-hour ambulatory BP monitoring was
obtained with BP readings set at 20-minute intervals (06:00 AM – 06:00 PM) and
at 30-minute intervals (06:00 PM – 06:00 AM). AASI was calculated as 1 minus
the slope of the linear relation between 24-hour DBP and 24-hour SBP.
Results: During follow-up (median 6.7 years), 135 acute coronary syndromes
(ACS), including 5 deaths and 55 strokes occurred in the studied group. There
was a higher 24-hour AASI in patients with ACS than in patients with no ACS
(0.35±01 vs. 0.30±0.1, p<0.01). The stuied groups did not differ in antihyper-
M. Grubler 1 , K. Kienreich 1 , A. Tomaschitz 2 , N. Verheyen 2 , M. Gaksch 1 ,
A. Fahrleitner-Pammer 1 , J. Schmid 2 , B. Pieske 2 , T.R. Pieber 1 , S. Pilz 1 . 1 Medical
University of Graz, Department of Medicine, Division of Endocrinology, Graz,
Austria; 2 Medical University of Graz, Department of Cardiology, Graz, Austria
Purpose: The aldosterone to renin ratio (ARR) is a screening tool for primary aldosteronism (PA). Accumulating evidence suggests that ARR may be significantly
associated with blood pressure (BP) even below the threshold for PA. We therefore aimed to evaluate the relationship between the ARR and 24 hour ambulatory
BP monitoring measurements (ABPM).
Methods: We recruited essential hypertensive patients derived from the outpatient clinic at the department of internal medicine of the local medical university hospital. ABPM measurements were obtained every 15min during the day
(06:00-24:00 o’clock) and every 30 min during the night (00:00–06:00). Plasma
aldosterone and plasma renin concentrations were measured by means of a RadioImmunoAssay (RIA).
Results: We examined 172 hypertensive patients (age: 59.6±11.3years; 51.2%
females) with a mean systolic/diastolic 24-hour ABPM value of 129/77mmHg. In
linear regression analyses adjusted for age, sex, 24-hour urinary sodium and
body mass index, ARR was significantly associated with night-time systolic (beta
coefficient:0.19; p=0.017) and diastolic ABPM (beta coefficient:0.28; p<0.001). In
subgroup analyses of patients with ARR below the cut-off for positive PA screening (ARR<3.7 - ng/dl divided by μU/mL) ARR remained significantly associated
with diastolic ABPM (beta coefficient:0.26; p=0.001) and by trend with systolic
ABPM (beta coefficient:0.15; p=0.056). These associations remained materially
unchanged when additionally adjusted for other possible confounders, e.g. antihypertensive medications, HbA1c or NT-proBNP.
Conclusions: In patients with essential hypertension and even in those patients
not suggestive for PA, we found a strong relationship between ARR and diastolic
night-time BP. In view of the strong relationship between diastolic night-time BP
and risk of cardiovascular events further studies are needed to evaluate cardioprotective effects of mineralocorticoid blockade in hypertensive patients without
PA.
P5659 | BEDSIDE
The effect of different circadian blood pressure rhythms on left
ventricular systolic dyssynchrony in patients with newly
diagnosed essential hypertension
O. Turak, F. Ozcan, I. Kadife, A. Isleyen, M. Cebeci, F.N. Basar, M.T. Selcuk,
Z. Golbasi, D. Aras, S. Aydogdu. Turkiye Yuksek Ihtisas Hospital, Cardiology
Clinic, Ankara, Turkey
Objectives: Left Ventricular (LV) synchronous contraction is impaired in patients
with.Hhypertension (HT). The deleterious effects of HT on cardiovascular system
are more evident in patients with non-dipper HT than dippers. In this study, we
aimed to investigate the effect of non-dipping HT on LV systolic synchronicity
compared with dippers and controls.
Methods: One hundred patients with newly diagnosed essential HT and 50 normotensive subjects were enrolled the study. The hypertensive patients were assigned two groups comprising 55 dippers and 45 non-dippers. Each subject
underwent a comprehensive transthoracic echocardiographic examination. The
evaluation of systolic dyssynchrony was performed by tissue synchronization
imaging, and the time to regional peak systolic tissue velocity (Ts) in LV was
measured on the basis of 12 segmental models. The Standard Deviation (SD) of
the 12 LV segments (Ts-SD-12) and maximal difference in Ts between any two of
the 12 LV segments (Ts-12) were calculated.
Results: Compared with the control group, the synchronicity indexes were significantly prolonged in the hypertensive patients. Furthermore, Ts-SD-12 and Ts-12
values were found to be significantly impaired in patients with non-dipper HT,
compared with dippers: Ts-SD-12 (38.1±18.7 vs. 31.8±15.4, P<0.001); Ts-12
(123.0±50.6 vs. 98.4±42.3, P<0.001). Stepwise multivariate logistic regression
analysis revealed a significant negative association between LV dyssynchrony
indices and percentage decline in BP level from day to night.
Table 1. Tissue synchronization imaging analysis of three groups
Ts-12
Ts-SD-12
Control (n=50)
Dippers (n=55)
Non-dippers (n=45)
p ANOVA
70.0±31.5
22.6±13.4
98.4±42.3
31.8±15.4
123.0±50.6
38.1±18.7
<0.001
<0.001
Ts, time to peak tissue velocity; Ts-12, maximal difference in Ts between any 2 of the 12 LV
segments; Ts-SD-12, standard deviation of Ts of the 12 LV segments.
Conclusion: Synchronous systolic contraction of LV is found to be significantly