The relationship of smoking, sodium intake and physical activity regarding variability parameters of the awake time systolic blood pressure in a general population in Korea

Abstracts / Journal of the American Society of Hypertension 9(4S) (2015) e97–e102 Results: After three weeks hemodialysis treatments (3/week), the therapy could be discontinued. After two years blood tests still provide stable laboratory values in the asymptomatic patient. (Tab. 1 Lab values). Required antihypertensives intake was significantly reduced (4-fold, mid-dose after one year and 3-fold mid-dose after two years) while maintaining optimal BP (ABPM). Duplex-sonography confirmed excellent perfusion of the right kidney consistently over the course of two years after dilatation (Tab. 2 Duplex parameters). Conclusion: Our case confirms the importance of a patient-centered, individual decision for or against interventional treatment of atherosclerotic renal artery stenosis. Here, both reduction of blood pressure and preservation of renal function have to be considered. On the left handside cirrhosis of kidney was diagnosed ( 9 cm, Parenchyma-RI < 0.8) allowed hemodynamic as well as functional success of an intervention to be expected. After two years blood pressure is well controlled under reduced medication and dialysis is still not become necessary. Keywords: Blood pressure; renal artery stenosis; hemodialysis

P-182 Incidence of renal artery stenosis after renal denervation in patients with resistant arterial hypertension Christian Reiter, Thomas Lambert, Alexander Nahler, Stefan Schwarz, Verena Gammer, Michael Grund, Clemens Steinwender. Linz General Hospital, Linz, Austria Background: Catheter based ablation of nerves in the adventitia of renal arteries (renal denervation, RDN) by the use of radiofrequency energy can reduce blood pressure (BP) in patients with resistant arterial hypertension (RAH). Occurrence of renal artery stenosis after RDN is still an important concern. We systematically investigated the renal artery anatomy by the use of MRI- or CT-angiography in a consecutive series of patients 6 months after RDN. Methods: Patients suffering from RAH were treated by RDN after exclusion of secondary causes of hypertension. Renal artery imaging was performed 6 months after RDN by MRI-angiography. In case of any contraindication for MRI, a CT-angiography was performed. The primary endpoint was the incidence of significant renal artery stenosis (>70% lumen diameter reduction). Lumen diameter reductions between 50 and 70% were defined as non-significant stenosis. Results: RDN was performed in 76 patients and evaluation of renal artery anatomy by MRI- (n¼66;86.8%) or CT-angiography (n¼10;13.2%) was performed in all patients 6 months after RDN. Mean office BP was 165.119.8 / 88.313.5 mmHg at baseline and decreased to 149.518.4 / 82.813.9 mmHg after 6 months (p<0.001/p¼0.01). In 49 patients (65%), we found a BP reduction of more than 10mmHg. In these responders, BP reduction was -30.2/-13.7 mmHg. By renal artery imaging, we found no renal artery stenosis (>70%), but two cases with new non-significant stenosis (50-70%). Conclusions: The incidence of significant renal artery stenosis 6 months after RDN seems to be low. Keywords: Renal denervation; renal artery stenosis; resistant arterial hypertension

P-183 The relationship of smoking, sodium intake and physical activity regarding variability parameters of the awake time systolic blood pressure in a general population in Korea Jinho Shin,2 Hyung Tak Lee,2 Sang Hyum Ihm,1 Soon Kil Kim,2 Sung Yong Choi,2 Yeon Soo Kim,3 On Lee.3 1Catholic University College of Medicine, Seoul, Republic of Korea; 2Hanyang University College of Medicine, Seoul, Republic of Korea; 3Seoul National University, Seoul, Republic of Korea

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Objectives: The variability of blood pressure (BP) was considered as a prognostic marker in epidemiologic study and clinical trial. Among them, BP variability (BPV) measured by using ambulatory BP monitoring (ABPM) has long been studied. But the impact of the factors other than demographic factors such as salt intake or physical activity is not fully understood. Method: In the general population study for the middle aged subjects (30w59 years) in the rural area in South Korea, 137 subjects undergone both ambulatory BP monitoring, 3D accelerometer (ActicalÒ), and complete 24 urine study to measure sodium intake in the same day were included for the analysis. Parameters for BPV were standard deviation (SD), weighted average real variability, and approximated entropy (APEN) of awake time systolic BP. Physical activity was expressed as total energy expenditure (TEE) during awake time in KCal per day. Results: Age was 47.9  8.4(female 58%) and awake time systolic BP (SBP) were 128.7  13.8 mmHg. Awake time energy expenditure was 427  236.3 Kcal. SD of awake time SBP was 20.7  7.3 mmHg and ARV of awake time SBP was 20.8  10.3 mmHg. APEN of awake time SBP was 0.23  0.36. In a general linear model including age, sex, awake time SBP, metabolic syndrome (MetS) score, sodium intake and TEE, SD was associated with female gender (beta¼5.1, p¼0.003), awake time SBP (beta¼0.15, p¼0.0006), and sodium intake (beta¼0.53, p¼0.027). ARV showed similar but stronger association with sodium intake (beta¼1.35, p < 0.0001). But for APEN, TEE was the only associated factor (beta¼0.029 per 100 Kcal, p¼ 0.031). In the multiple logistic regression analyses, current smoking was the strong factor for higher SD (OR¼3.34, p¼0.038) or ARV (OR¼4.14, p¼0.017). Conclusion: In addition to high mean BP and female gender, smoking and sodium intake could increase SD and ARV of awake time BPV. But APEN was affected only by physical activity. Keywords: Physical activity; salt intake; blood pressure variability

P-184 Assessment of hypertension control and clinical course of patients who failed screening during the SYMPLICITY-HTN 3 trial Charan Yerasi, Anil K. Jonnalagadda, Nevin Baker, Rebecca Torguson, Suman Singh, Judith Vies, Ron Waksman. Medstar Washington Hospital Center, Washington, DC, United States Background: The screening of patients referred for the SYMPLICITY HTN-3 trial was rigorous, with many found not eligible to participate. We investigate patients who were excluded from the trial, and evaluate their current hypertensive (HTN) therapy, control, and clinical status. Methods: A retrospective review and telephone interview was performed 8-10 months post screening on 45 patients and their referring providers who were ultimately not included. Patients were grouped into 4 categories: 1) Non-interest, 2) Not meeting inclusion criteria 3) Screen failure (excluded during screening visits due to adequate blood pressure (BP) control guided by HTN specialist), or 4) referred after enrollment closure. Primary outcome evaluated was prevalence of resistant, uncontrolled, or controlled HTN. Results: This population consisted of 42% males, mean age of 655 years, 78% African American. Primary referral basis included cardiology (44%), nephrology (30%), and primary care (26%). The majority of patients found with controlled HTN at follow-up (60%), with highest success rates amongst the screen failure group (88%). Resistant and/or uncontrolled HTN was most prevalent in the non-interest or excluded groups, as were hospitalization for cardiovascular and HTN urgency/emergency (table). Conclusion: This study highlights the disparity of HTN control and treatment in daily practice compared with clinical trials, and confirms a need for vigilant screening of those considered candidates for RDN. Keywords: Renal denervation follow up; symplicity HTN 3 trial