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Phlebotomy decreases arterial stiffness and endothelial dysfunction in patients with hereditary hemochromatosis
Journal of the American Society of Hypertension 9(4S) (2015) e5–e8
FEATURED POSTER SESSION I
ARTERIAL STRUCTURE AND COMPLIANCE FP-1 Phlebotomy decreases arterial stiffness and endothelial dysfunction in patients with hereditary hemochromatosis Mariano Duarte,1 Analıa Aquieri,1 Javier Coyle,1 Esteban Gonzalez Ballerga,1 Jorge Daruich,1 Juan A. Sorda,1 Sara Berenstein,1 Eleonora Savio-Galimberti.2 1Hospital de Clinicas UBA, Buenos Aires, Argentina; 2Vanderbilt University, Nashville, TN, United States Hereditary Hemochromatosis (HH) is a genetically determined disease of iron overload with excessive tissue storage, which can lead to tissue injury, fibrosis and organ failure. Recently, an increase of cardiovascular risk (CVR) has been reported in this group. Pulse wave velocity (PWV) is the simplest way to assess arterial stiffness (AS), and has predictive value for CV events. PWV variation pre- and postinduced ischemia of brachial artery has been validated to evaluate endothelial dysfunction (ED). We previously reported a significant enhanced PWV and endothelial dysfunction in 30 HH patients compared with healthy controls. Patients with HH treated with repetitive phlebotomies (standard of care for these patients) show significantly longer survival rate (5-10 years) than untreated patients. We hypothesized that phlebotomy reduces iron overload and decreases the excessive storage of this metal in the arterial wall, reducing the vascular stiffness and therefore decreasing carotid-femoral PWV. To test this hypothesis we measured carotid-femoral PWV before and after phlebotomy in HH patients to assess AS and carotid-braquial PWV variation pre and post induced ischemia to assess ED. We compared these results against matching controls. PWV and PWV variation were assessed using Complior System (Artech-Medical, Francia). Carotid-femoral PWV was significantly increased in HH patients compared to control group (8.51.7 m/s vs 6.40.8 m/s, P<0.001, n¼22/30 patients/ group). Change in braquial PWVafter transient ischemia was reduced in HH patients (0.3%) compared to controls (8.2%) (P<0.001). Phlebotomy significantly reduced carotid-femoral PWV (Post-phlebotomy: 6.50.8 m/s vs pre-plebotomy: 8.51.7 m/s, P<0.00001) back to control values (6.40.8 m/s). Change in braquial PWV was parcially rescued after phlebotomy (0.714% vs 2.48.7%). These results showed a significant reduction in AS and a partial rescue of ED in HH patients post-phlebotomy, suggesting that the arterial wall may represent a novel target in HH treatment endpoint organs. Our findings may support features research including more patients with HH and others iron overload disorders. Keywords: Haemochromatosis; Reversal Arterial Stiffness; Phlebotomy BLOOD PRESSURE MEASUREMENT/MONITORING FP-2 White coat hypertension as predictor of long-lasting blood pressure decline in stage 1 hypertension Lucio Mos,1 Enzo Benetti,2 Adrano Mazzer,3 Susanna Cozzio,4 Alessandra Bortolazzi,5 Claudio Fania,6 Olga Vriz,1 Stefano Martina,1 Edoardo Casiglia,6 Paolo Palatini.7 1Emergency Department, Sant’Antonio Hospital, San Daniele del Friuli, Italy; 2Medicine Department, University of Padova, Padova, Italy; 3Medicine Department,
Town Hospital, Vittorio Veneto, Italy; 4Medicine Department, Town Hospital, Trento, Italy; 5Medicine Department, Town Hospital, Rovigo, Italy; 6Medicine Department, University of Padova, Padova, Italy; 7 Medicine Department, University of Padova, Padova, Italy Objective: A strong reaction to BP measurement can cause a wrong diagnosis of hypertension and lead to unnecessary treatment. In the HARVEST study, about one fifth of the participants showed a progressive office BP decline after baseline assessment which was still present after 11 years (Normotensives). The aim of this study was to test the predictive capacity of baseline ambulatory BP for identifying these subjects. Design and methods: This investigation was conducted in 1104 subjects with initial stage 1 hypertension (mean of 6 readings) who remained untreated for at least 3 months and had complete follow-up data (mean age 339 years, 291 females). Patients were seen periodically and were given non-pharmacological recommendations. Antihypertensive treatment was started if they met the criteria for drug treatment according to current guidelines (Hypertensives, n¼890). Results: In the Normotensives (n¼214), a noticeable BP decline occurred within the first year of follow-up (from 14211/916 to 13510/858 mmHg). However, BP further declined after the first year to reach 1287/835 mmHg after 11 years. A greater follow-up decline in heart rate (5.510 bpm) was found in the Normotensives than the Hypertensives (2.011 bpm, p<0.001). White-coat hypertension (WCH) at the baseline defined on the basis of 24-hour BP was more common among the Normotensives than the Hypertensives (34.6% versus 18.9%, p<0.001). When WCH was defined on the basis of night-time BP the frequencies were 43.5% and 25.0%, respectively (p<0.001). WCH subjects had a lower systolic (p¼0.001) and diastolic (p<0.001) office BP at baseline. No betweengroup differences were found for age, heart rate, and sex distribution. In a sex-and-age-adjusted Cox regression including office BP decline after 6 months (p¼0.008), WCH (<0.001) remained a significant predictor of future normotension (HR, 1.36; 95%CI, 1.13-1.63). A slight improvement of the model was obtained when WCH was calculated from night-time BP (Akaike Information Criterion difference¼2.10). Conclusions: In a substantial portion of young-to-middle-age stage 1 hypertensives antihypertensive treatment can be deferred because of a spontaneous long-lasting BP decline. WCH at baseline is an important predictor of this favourable outcome even when the initial clinic BP drop is taken into account. Keywords: White coat hypertension; Blod pressure Monitoring; HARVEST Study
FP-3 In older people with systolic hypertension, office but not home BP correlates with ambulatory BP and white matter hyperintensity lesions Hazel Mae A. Abraham,3 Leslie Wolfson,3 Nicola Moscufo,1 Charles Guttmann,1 Dorothy Wakefield,3 Vinay Gulati,2 Ravi Marfatia,3 William White.3 1Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States; 2Hartford Hospital, Hartford, CT, United States; 3University of Connecticut Health Center, Farmington, CT, United States White matter (WM) disease burden progression, a form of microvascular disease of the brain, affects cognitive function and mobility in older persons. The relationship among clinic, home (self-measured), and 24 hour
1933-1711/$ - see front matter Ó 2015 American Society of Hypertension. All rights reserved.
FEATURED POSTER SESSION I
ARTERIAL STRUCTURE AND COMPLIANCE FP-1 Phlebotomy decreases arterial stiffness and endothelial dysfunction in patients with hereditary hemochromatosis Mariano Duarte,1 Analıa Aquieri,1 Javier Coyle,1 Esteban Gonzalez Ballerga,1 Jorge Daruich,1 Juan A. Sorda,1 Sara Berenstein,1 Eleonora Savio-Galimberti.2 1Hospital de Clinicas UBA, Buenos Aires, Argentina; 2Vanderbilt University, Nashville, TN, United States Hereditary Hemochromatosis (HH) is a genetically determined disease of iron overload with excessive tissue storage, which can lead to tissue injury, fibrosis and organ failure. Recently, an increase of cardiovascular risk (CVR) has been reported in this group. Pulse wave velocity (PWV) is the simplest way to assess arterial stiffness (AS), and has predictive value for CV events. PWV variation pre- and postinduced ischemia of brachial artery has been validated to evaluate endothelial dysfunction (ED). We previously reported a significant enhanced PWV and endothelial dysfunction in 30 HH patients compared with healthy controls. Patients with HH treated with repetitive phlebotomies (standard of care for these patients) show significantly longer survival rate (5-10 years) than untreated patients. We hypothesized that phlebotomy reduces iron overload and decreases the excessive storage of this metal in the arterial wall, reducing the vascular stiffness and therefore decreasing carotid-femoral PWV. To test this hypothesis we measured carotid-femoral PWV before and after phlebotomy in HH patients to assess AS and carotid-braquial PWV variation pre and post induced ischemia to assess ED. We compared these results against matching controls. PWV and PWV variation were assessed using Complior System (Artech-Medical, Francia). Carotid-femoral PWV was significantly increased in HH patients compared to control group (8.51.7 m/s vs 6.40.8 m/s, P<0.001, n¼22/30 patients/ group). Change in braquial PWVafter transient ischemia was reduced in HH patients (0.3%) compared to controls (8.2%) (P<0.001). Phlebotomy significantly reduced carotid-femoral PWV (Post-phlebotomy: 6.50.8 m/s vs pre-plebotomy: 8.51.7 m/s, P<0.00001) back to control values (6.40.8 m/s). Change in braquial PWV was parcially rescued after phlebotomy (0.714% vs 2.48.7%). These results showed a significant reduction in AS and a partial rescue of ED in HH patients post-phlebotomy, suggesting that the arterial wall may represent a novel target in HH treatment endpoint organs. Our findings may support features research including more patients with HH and others iron overload disorders. Keywords: Haemochromatosis; Reversal Arterial Stiffness; Phlebotomy BLOOD PRESSURE MEASUREMENT/MONITORING FP-2 White coat hypertension as predictor of long-lasting blood pressure decline in stage 1 hypertension Lucio Mos,1 Enzo Benetti,2 Adrano Mazzer,3 Susanna Cozzio,4 Alessandra Bortolazzi,5 Claudio Fania,6 Olga Vriz,1 Stefano Martina,1 Edoardo Casiglia,6 Paolo Palatini.7 1Emergency Department, Sant’Antonio Hospital, San Daniele del Friuli, Italy; 2Medicine Department, University of Padova, Padova, Italy; 3Medicine Department,
Town Hospital, Vittorio Veneto, Italy; 4Medicine Department, Town Hospital, Trento, Italy; 5Medicine Department, Town Hospital, Rovigo, Italy; 6Medicine Department, University of Padova, Padova, Italy; 7 Medicine Department, University of Padova, Padova, Italy Objective: A strong reaction to BP measurement can cause a wrong diagnosis of hypertension and lead to unnecessary treatment. In the HARVEST study, about one fifth of the participants showed a progressive office BP decline after baseline assessment which was still present after 11 years (Normotensives). The aim of this study was to test the predictive capacity of baseline ambulatory BP for identifying these subjects. Design and methods: This investigation was conducted in 1104 subjects with initial stage 1 hypertension (mean of 6 readings) who remained untreated for at least 3 months and had complete follow-up data (mean age 339 years, 291 females). Patients were seen periodically and were given non-pharmacological recommendations. Antihypertensive treatment was started if they met the criteria for drug treatment according to current guidelines (Hypertensives, n¼890). Results: In the Normotensives (n¼214), a noticeable BP decline occurred within the first year of follow-up (from 14211/916 to 13510/858 mmHg). However, BP further declined after the first year to reach 1287/835 mmHg after 11 years. A greater follow-up decline in heart rate (5.510 bpm) was found in the Normotensives than the Hypertensives (2.011 bpm, p<0.001). White-coat hypertension (WCH) at the baseline defined on the basis of 24-hour BP was more common among the Normotensives than the Hypertensives (34.6% versus 18.9%, p<0.001). When WCH was defined on the basis of night-time BP the frequencies were 43.5% and 25.0%, respectively (p<0.001). WCH subjects had a lower systolic (p¼0.001) and diastolic (p<0.001) office BP at baseline. No betweengroup differences were found for age, heart rate, and sex distribution. In a sex-and-age-adjusted Cox regression including office BP decline after 6 months (p¼0.008), WCH (<0.001) remained a significant predictor of future normotension (HR, 1.36; 95%CI, 1.13-1.63). A slight improvement of the model was obtained when WCH was calculated from night-time BP (Akaike Information Criterion difference¼2.10). Conclusions: In a substantial portion of young-to-middle-age stage 1 hypertensives antihypertensive treatment can be deferred because of a spontaneous long-lasting BP decline. WCH at baseline is an important predictor of this favourable outcome even when the initial clinic BP drop is taken into account. Keywords: White coat hypertension; Blod pressure Monitoring; HARVEST Study
FP-3 In older people with systolic hypertension, office but not home BP correlates with ambulatory BP and white matter hyperintensity lesions Hazel Mae A. Abraham,3 Leslie Wolfson,3 Nicola Moscufo,1 Charles Guttmann,1 Dorothy Wakefield,3 Vinay Gulati,2 Ravi Marfatia,3 William White.3 1Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States; 2Hartford Hospital, Hartford, CT, United States; 3University of Connecticut Health Center, Farmington, CT, United States White matter (WM) disease burden progression, a form of microvascular disease of the brain, affects cognitive function and mobility in older persons. The relationship among clinic, home (self-measured), and 24 hour
1933-1711/$ - see front matter Ó 2015 American Society of Hypertension. All rights reserved.