PW181 Structural Parameters Of Arterial Wall And Inflammatory Biochemical Parameters In Hypertensive Patients With Abdominal Obesity

POSTER ABSTRACTS

BP-lowering and equal or superior to other agents in reducing stroke and myocardial infarction (MI). Objectives: To review the cost and cost effectiveness of amlodipine for the treatment of hypertension. Methods: A literature review of English language articles published between 1996 and 2011 that reported economic data. The literature included health economic assessments as well as prospective and retrospective observational studies. Overall, 39 articles were reviewed and included in this study. Results: In Europe and the US, amlodipine use resulted in improved clinical outcomes (stroke and MI) at a slightly lower cost versus usual care (ARBs, angiotensin-converting enzyme inhibitors, diuretics or beta-blockers), and patients on amlodipine needed fewer hospitalizations and revascularizations at a small incremental cost. According to a 3-year Markov model of the Swiss healthcare system, an amlodipine regimen was costsaving versus an atenolol regimen. US patients switched from nifedipine GITS to amlodipine (5 or 10 mg daily) achieved significantly better BP control at an annual cost saving in favor of amlodipine of US $47,844. Total medication costs to achieve BP goal were $0.87/day on amlodipine versus $1.79/day on felodipine (with 87 and 33% achieving BP goal, respectively). Studies from other regions showed less need for hospitalizations and coronary procedures with amlodipine versus placebo and confirmed the cost-benefit of amlodipine, with the estimated costs of not using amlodipine being $6,519 in Canada (US $4,405) and 64,292 kroner in Norway (US $7,337) over a 4-month period. Conclusion: Data from the literature suggest that amlodipine is cost-effective according to the WHO-recommended threshold, and potentially cost-saving in certain settings in various countries. Disclosure of Interest: D. Liew Grant/research support from: Pfizer Inc., Consultancy for: Pfizer Inc., Honorarium from: Pfizer Inc., L. Liu Employee from: Pfizer Inc., B. Jeffers Employee from: Pfizer Inc., J. Foody Grant/research support from: Pfizer Inc., Consultancy for: Pfizer Inc. PW178

PW180

Hypertensive Women Over 50 Years Of Age: The Value Of Preoperative Electrocardiogram 1

2

2

2

1

Lafayete Ramos* , Flávia Carneiro , Maria Guiotti , Maria Silva , Eliane Elly , Edilberto Castilho1, Bárbara Cristina1, Mônica Wolf1, Isabelle Caroline3, Marcelo Calil1, João Goes1 1 Brazilian Institute for Cancer Control, 2São Camilo Medical School, São Paulo, 3Campos dos Goytacazes Medical School, Campos, Brazil Introduction: Cardiac complications are the major cause of postoperative morbidity and mortality in non-cardiac surgery. Many guidelines recommend a preoperative Electrocardiogram (ECG) for hypertensive patients who are over 50 years old. It is ordered routinely, often before the medical history is obtained and the physical examination is performed. The increased expense is particularly burdensome for lowincome coutries. Objectives: The aim of this study was to determine the importance of abnormalities on the preoperative ECG and its impact on the in-hospital outcome in this subset of patients. Methods: We evaluated a historical cohort of 527 female cancer patients (63.95
8.59 years) scheduled for elective surgical procedures under general anesthesia that were considered to be low-risk. All patients had arterial hypertension as an isolated comorbidity and underwent preoperative ECG. The patients were divided into two groups: without (group A) and with (group B) abnormalities on the preoperative ECG. Each group was subdivided into two other groups according to postoperative outcome. Variables such as age, duration of anesthesia, prior chemotherapy, prior radiotherapy, and surgical risk (ASA) were analyzed. Multivariate logistic regression was used to determine the adjusted influence of the variables on the in-hospital outcome. An adverse outcome was considered to be any complication that increased the in-hospital length of stay or death. Results: Among 527 patients, 381 (72.3%) were found to have normal (group A), and 146 (27.7%) had any type of abnormality on ECG (group B). Of these, 32 (21.9%) were submitted to others cardiac tests, which did not result in any changes in the surgical management. Among the patients from group A, 14 (3,7%) had adverse outcomes, compared to 5 (3.4%) from group B (OR¼0.93 CI 0.33-2.63, p¼0.890). According to multivariate logistic regression, the duration of anesthesia (p¼0.035) and surgical risk (p¼0.015) were associated with postoperative morbi-mortality independently of abnormalities on preoperative ECG (p¼0.511). Conclusion: These results suggest that hypertensive women over 50 years of age who are scheduled for low risk surgery do not derive any significant benefit from preoperative electrocardiogram results. Disclosure of Interest: None Declared PW179 Electrocardiographic abnormalities in a large sample of primary care patients with hypertension Milena Marcolino*1,2, Barbara C. A. Marino2, Maria Beatriz M. Alkmim2, Antonio L. Ribeiro1,2 1 Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, 2 Telehealth Network of Minas Gerais, Belo Horizonte, Brazil Introduction: The 12-lead electrocardiogram (ECG) is the most readily available noninvasive test for the detection of cardiac disease in primary care. The detection of preclinical cardiac abnormalities is a key clinical step in hypertension management, and several

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guidelines for hypertension recommend an ECG in hypertensive patients to improve risk prediction. Objectives: To assess the prevalence of ECG abnormalities in patients with hypertension who were attended at primary care centers in Brazil. Methods: In this observational and retrospective study, all 12-lead standard digital ECGs analyzed by cardiologists of the Telehealth Network of Minas Gerais, a public telemedicine service in Brazil, from January to December 2011, were assessed. This service attends primary care of 660 cities in the state of Minas Gerais. ECGs were sent by remote healthcare professionals through internet to be analyzed by cardiologists who are trained and experienced in the analysis and interpretation of ECG. The prevalence of ECG abnormalities in patients with hypertension was assessed. Results: During the study period, 82,125 primary care patients with hypertension underwent ECG (mean age 60.8
13.5 years, 63.7% females). The most common comorbidities besides hypertension were diabetes (14.2%), smoking (11.4%), hyperlipidemia (7.0%) and Chagas disease (5.6%). Regarding the ECG analysis, 48.3% of them had no abnormalities, and the mean number of abnormalities per patient was 0.9
1.1 (range 0-9). Regarding the rhythm, 2.9% had atrial fibrillation or flutter, 3.2% ventricular premature beats, 2.4% supraventricular premature beats and 0.6% were pacemaker users. Left bundle branch block (LBBB) was observed in 2.4% of the ECGs, incomplete LBBB in 1.8%, right bundle branch block (RBBB) in 4.6% and left anterior hemiblock in 8.7%. First degree atrioventricular block was found in 2.5%, second and third degree in less than 0.1% each. There was electrocardiographic evidence of left ventricular and atrial hypertrophy in 5.2% and 3.2% of patients, respectively, and pathological Q waves in 1.5%. Non-specific repolarization abnormalities were observed in 29.4% of the patients. Conclusion: In this large sample of primary care patients with hypertension, ECG abnormalities were observed in more than 50% of patients. The most common abnormalities were non-specific repolarization abnormalities, RBBB, LBBB, left ventricular hypertrophy, premature beats and atrial fibrillation. Disclosure of Interest: None Declared

Expression and Function of Ryanodine Receptors in Mesenteric Artery Smooth Muscle Cells from patients with hypertension Pengyun Li1, liang mao1, jun cheng1, jing wen1, yan yang1, xiaorong zeng1, Ou Xianhong*1 1 Institute of Cardiovasology, Luzhou Medical College, luzhou, China Introduction: Hypertension is a clinical syndrome characterized by increased peripheral resistance, which is mainly attributable to structural and functional alterations of small arteries and arterioles. However, the molecular mechanism underlying vascular dysfunction during acquired hypertension remains unresolved. Objectives: In this study, we aimed to investigate whether the expression and functional activity of RyRs would be different in mesenteric artery from patients with hypertension. Methods: RyR expression, [Ca2+]i was measured by real-time quantitative RT-PCR, immunofluorescence staining and wide-field fluorescence microscopy, respectively. Results: All three isoforms of RyRs (RyR1, RyR2 and RyR3) mRNA were detected in human mesenteric artery smooth muscle cells (HMASMCs), but their distributions and expression levels were different. Immunofluorescense showed that each RyR isoform distributed differentially among subcellular compartment. RyR1 and RyR3 localize mostly to the central sarcoplasmic reticulum (SR), while RyR2 distribute around the plasma membrane, colocalizing with BKCa channels. Real-time PCR indicated that RyR2 was especially the predominant isoform, and all of the three isoforms expression level significantly increased in patients with hypertension. It was found interesting that more copies of RyR3 mRNA expressed in HMASMCs from the patients with hypertension. Application of caffeine (10 mM) to activate RyRs or high K+ (60 mM) induced different kinetics of intracellular Ca2+ release. Moreover, the increases and decreases in [Ca2+]i induced by caffeine is faster in HMASMCs from patients without hypertension compared to those with hypertension. Conclusion: This study provides comprehensive evidence that RyRs are heterogeneous in expression and functional activity in HMASMCs from patients with hypertension, which may contribute to the diversity of excitation-contraction coupling and intimate communication between sarcoplasmic reticulum and sarcolemmal ion channel in different vascular smooth muscle cells. Disclosure of Interest: None Declared PW181 Structural Parameters Of Arterial Wall And Inflammatory Biochemical Parameters In Hypertensive Patients With Abdominal Obesity Tatiana Petelina1, Ludmila Gapon1, Natalia Musikhina1, Ksenia Avdeeva1, Vadim Kuznetsov*1, Natalia Tretyakova1 1 Tyumen Cardiology Center, Tyumen, Russian Federation Introduction: A number of major studies has shown that increasing stiffness of the arteries is an independent predictor of cardiovascular disease and mortality. The condition of vascular inflammatory reaction is of great importance in the process of endothelial dysfunction and vascular remodeling. Objectives: To study structural parameters of vessel wall, lipid and inflammatory biochemical parameters in patients with arterial hypertension (AH) and abdominal obesity (AO). Methods: 115 patients were included in the study and randomized into 2 groups: I - 72 subjects (mean age 47.39
1.60 years) with AH degree I-III and AO, II - 43 subjects (mean age 47.29
0.95 years) without metabolic disorders. The parameters of sphygmography

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PW182 Factors influencing on endothelial dysfunction in patients with arterial hypertension combined with coronary artery disease Natalia Musikhina1, Tatiana Petelina1, Ludmila Gapon1, Elena Mahneva1, Vadim Kuznetsov*1 Tyumen Cardiology Center, Tyumen, Russian Federation

General practitioners (%)

Clinicians (%)

Cardiologists (%)

Others physicians and non- physicians (%)

Diagnosis

50

20

22

8

Follow-up

38

22

29

11

Treatment

39

25

30

2

2) Use of guidelines Most used guidelines were JNC 7 (15), ESC guidelines (13), national guidelines (10) and/or Nice guidelines (3). 3) Medications Specific medications for treatment were endorsed by the government in 13 countries and 9 countries had specific medications recommended. In 9 countries there were programs/ agreements among pharmaceutical companies/drug manufacturers/government to decrease cost and/or increase availability of medications. 4) Barriers for prescription/compliance Lack of patient understanding for long-term need for medication (100%), lack of effective tools for follow-up (89%), cost of medications (84%), lack of skill among providers to motivate/support patient adherence (63%), lack of consistent availability of prescribed medications (53%), and varying opinions about the recommended medication (21%). Conclusion: Diagnosis/follow-up/treatment of HT are performed in most cases by physicians. There is widespread use of different guidelines. Despite specific medications for treatment of HT being endorsed by the government in most countries, and several of them having programs and/or agreements to decrease cost and/or increase availability of medications, there are still powerful barriers for prescription and compliance. Disclosure of Interest: None Declared

1

Introduction: Arterial hypertension (AH) is one of the major risk factors for atherosclerosis, especially for coronary artery disease (CAD), therefore, these diseases are frequently accompanied by each other. Endothelium becomes a target organ for these diseases. Objectives: To define factors influencing on endothelial dysfunction in patients with AH combined with CAD. Methods: 121 patients (mean age 54.49
0.78 years) were examined. I group included 18 patients without AH and CAD, II group – 57 patients with AH, III group – 46 patients with AH combined with CAD. Patients in all groups were matched for gender, body mass index (BMI), circadian index (CI) of BP (dippers with CI 10-20% and nondippers with CI <10%), level of endothelium-dependent vasodilation (EDV) >10% and <10%. All patients underwent 24-hour blood pressure monitoring and ECG with heart rate variability (HRV) assessment. Pulse wave velocity was measured in elastic arteries (R\L-PWV). Results: The comparison of three groups revealed no significant difference in EDV level. Male patients showed a decrease in EDV in response to AH and CAD (males: I group – 9.59
1.23%, II – 6.42
0.91%, III – 8.21
1.23%; females: I – 10.51
1.40%, II – 9.83
0.78%, III – 8.34
1.09%). In group with AH significant differences in EDV between male and female patients were detected (6.42
0.91% vs 9.83
0.73%, p<0.05). Patients with AH and CAD with BMI >30 demonstrated lower EDV vs patients without obesity (10.1
0.98% vs 7.57
0.80%, p<0.05). The lowest EDV was observed in patients of III group – nondippers (II group, dippers – 12.73
2.30%, nondippers – 7.36
0.72%, p<0.05; III, dippers – 11.41
1.59%, nondippers – 6.32
1.40%, p<0.05). Subjects with impaired EDV in group with AH and CAD showed increase in PWV compared with healthy subjects (I group, R-PWV – 11.23
0.22 m/s vs L-PWV – 11.38
0.10 m/s; III – 14.20
0.62 m/s vs 11.23
0.22 m/s, p<0.05), and decrease in HRV – LF and VLF that indicates the tone of the sympathetic division of the sympathetic nervous system: LF (I group – 1447.80
647.39 m/s2, III – 404.25
60.61 m/s2, p<0.05) and VLF (1867.44
234.31 m/s2 vs 1210.75
117.09 m/s2, p<0.05). Conclusion: Male sex, obesity, abnormal circadian index of BP influence on endothelial dysfunction in patients with AH combined with CAD during reduction in the sympathetic nervous system tone that may cause impaired vessel wall elasticity. Disclosure of Interest: None Declared

PW185 Efficacy of LCZ696, an angiotensin receptor neprilysin inhibitor (ARNI), in patients with systolic hypertension Joseph L. Izzo*1, Dion H. Zappe2, Yan Jia2, Kudsia Hafeez2, Jack Zhang2 1 Clinical Pharmacology, State University of New York, Buffalo, NY, 2Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States Introduction: The progressive increase in arterial stiffness that occurs with aging makes systolic hypertension (SH) difficult to treat. The anti-hypertensive drug LCZ696 (Japanese Adopted Name [JAN]: Sucabitril Valsartan Sodium Hydrate), a first-in-class ARNI, may have unique effects on arterial stiffness and SH. Objectives: To compare the efficacy of LCZ696 against valsartan (V) in patients with SH (mean sitting [ms] systolic blood pressure [SBP]150 mmHg) and isolated SH (ISH, msSBP150 mmHg and ms diastolic BP [DBP]<90 mmHg). Methods: Subjects included in this analysis participated in an 8-week, multicenter, randomized, double-blind, placebo- and active-controlled, parallel-arm study. Primary dependent variable was the change in SBP at 8 weeks; pulse pressure (PP) and mean ambulatory (ma) BP were also evaluated. Results: Overall, 343 patients with SH (age 61 years, 48% 65 years, 68% Caucasian, body weight 82.4 kg, body mass index 29.9 kg/m2, duration of hypertension 8.7 years) were randomized to placebo (n¼58), V 320 mg (n¼143) or LCZ696 400 mg (n¼142). Baseline msSBP, msDBP, and msPP were 159.8, 90.2, and 69.6 mmHg, respectively. ISH was present in 159 patients (46.4%); baseline msSBP, msDBP, and msPP were 159.2, 82.4, and 76.7 mmHg, respectively. After 8 weeks of treatment for SH, LCZ696 400 mg lowered msSBP more than V (5.7 mmHg, p<0.001), along with msPP (3.4 mmHg, p<0.05) and 24-hour maSBP (-3.4 mmHg, p<0.001). Similar results were obtained for ISH (Table).

SH

PW183

Mean (SD)

Latin American Survey 2013 on Hypertension Daniel J. Piñeiro*1, Marcia M. Barbosa2, Wistremundo Dones3, Araceli Delgado4, On behalf the Interamerican Society of Cardiology 1 Hospital de Clínicas "José de San Martin", Universidad de Buenos Aires, Buenos Aires, Argentina, 2Hospital Socor, Belo Horizonte, Brazil, 3Ryder Memorial Hospital, Humacao, Puerto Rico, 4Interamerican Society of Cardiology, Mexico City, Mexico Introduction: High blood pressure is the leading risk factor for heart attack and stroke, and is responsible for over 7 million, largely preventable, deaths each year worldwide. Similar to the global situation, in Latin America (LA), hypertension (HT) is common and poorly controlled. Objectives: This survey aimed to collect data on the clinical practices in the management of adult patients with HT in LA. Methods: A survey was sent to the 20 Presidents of the LA national societies/associations of Cardiology, contacted between October 2011 and February 2012. Results: Responses were received from 19 societies (95%). 1) Diagnoses, follow-up, and treatment

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Placebo

LCZ696 400 mg

ISH Valsartan 320 mg

Placebo

LCZ696 400 mg

Valsartan 320 mg

N

58

142

143

25

64

70

msSBP

-6.5
15.4

-21.5
13.7

-15.7
14.8

-8.2
10.6

-21.7
12.9

-15.8
14.9

msDBP

-3.5
10.5

-9.6
9.6

-6.9
8.7

-1.0
8.9

-5.7
8.5

-5.3
8.5

msPP

-3.0
11.6

-11.9
10.9

-8.8
12.4

-7.2
10.3

-16.0
10.2

-10.5
13.6

maSBP

-0.8
9.1

-13.6
9.3

-9.9
11.9

-0.9
9.3

-11.9
10.1

-9.8
12.4

maDBP

0.1
5.2

-6.6
6.4

-5.1
8.1

+0.5
3.9

-4.4
6.4

-5.1
9.0

All treatments were safe and well tolerated: adverse events with LCZ696 (29.6%) and V (26.6%) were similar to placebo (34.5%). Conclusion: LCZ696 is superior to valsartan in reducing clinic and 24-hour ambulatory SBP in SH and ISH and is thus an attractive treatment strategy for SH. Proof of a direct effect of ARNI on arterial stiffness requires additional study.

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POSTER ABSTRACTS

and 24-hour blood pressure monitoring; biochemical parameters (total cholesterol, lowdensity lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, malonic dialdehyde (MD) and inflammatory markers -homocysteine and hs-CRP) were estimated. Results: In group I there was registered significant increase in sphygmography indices (pulse wave velocity (PWV) – normal importance <12 m/s, cardio-ankle vascular index), in mean 24-hour and mean daytime systolic blood pressure (SBP), in time and square indices and in day time SBP variability (p<0.001) and decrease in ancle-brachial index. In biochemical parameters significant increase in total cholesterol (p¼0.000), low-density lipoprotein cholesterol (p¼0.034), triglyceride level (p¼0.002), MD level (p<0.05) and in inflammatory markers - homocysteine (p¼0.000) and hs-CRP level (p¼0.001); decrease in high-density lipoprotein cholesterol (p¼0.001) was found compared to group II patients. Besides in group I there was detected positive correlation between inflammatory and lipid markers with parameters of sphygmography and 24-hour blood pressure monitoring. It was shown that with an increase in total cholesterol level m>5.0 mmol/l, the risk of high rate PWV>12 m/s in patients with AH and AO increased by 15 times. Besides we revealed that high levels of endothelin-1 and homocysteine were observed more frequently in women than in men, with an increase at 1 fmol/l the risk of high rate PWV>12 m/s increased by 2.6 times and 35%, respectively. Conclusion: The relationship between the markers of inflammation, endothelial dysfunction, parameters of atherogenic lipids and vascular remodeling process factors indicates a high risk of progression of hypertension and cardiovascular complications in patients with AH and AO. Disclosure of Interest: None Declared