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USEFULNESS OF A SERIES OF REPEATED IN-OFFICE BLOOD PRESSURE (ROBP) MEASUREMENTS FOR THE DIAGNOSIS OF WHITE-COAT HYPERTENSION
Oral Communications / European Journal of Internal Medicine 19S (2008) (2008), S1–S59 study, we examined the effect on endothelial dysfunction of adding a mineral corticoid receptor antagonist to the angiotensin-converting enzyme inhibitor in the treatment of essential hypertension. Twenty patients with new diagnosis of moderate to severe essential hypertension based on the WHO/ISH guidelines were treated with either ramipril (10 mg/d) alone (group I: 10 patients, 6 men and 4 women, mean age 51.3±3.2 yrs) or ramipril (10 mg/d) plus potassium canrenoate (50 mg/d) (group II: 10 patients, 5 men and 5 women, mean age 50.0±3.5 yrs). Flow-mediated vasodilatation (FMD) of the brachial artery was measured in the two treatment groups and in 14 normotensive control subjects (8 men and 6 women, mean age 49.5±3.2 yrs) before and after al least 14.2±2.7 weeks. Basal FMD was significantly lower in hypertensive patients with respect to control subjects (4.9±2.4 vs 7.8±3.0%; p<0.01). Antihypertensive therapy restored blood pressure to normal (group I: 128±11/80±8 vs 155±12/98±9 mmHg; group II: 125±7/78±10 vs 158±13/103±7 mmHg) and significantly improved the FMD (group I: 8.2±5.1 vs 4.9±2.4%, p <0.05; group II: 8.0±2.8 vs 4.6±2.1%, p <0.05) without significant differences between the two groups for either the parameters. Results suggest that adding potassium canrenoate has no advantage on endothelial dysfunction in patients with essential hypertension who are receiving an angiotensin-converting enzyme inhibitor
FR-24 USEFULNESS OF A SERIES OF REPEATED IN-OFFICE BLOOD PRESSURE (ROBP) MEASUREMENTS FOR THE DIAGNOSIS OF WHITE-COAT HYPERTENSION Giuseppe Crippa, Antonino Cassi, Claudio Venturi, Elena Bravi, Pietro Cavallotti. Hypertension Unit, Department of Internal Medicine, Guglielmo da Saliceto Hospital, Piacenza, Italy White-coat hypertension is usually defined as an elevated office blood pressure (OBP) level associated with normal home blood pressure (HBP) or ambulatory blood pressure (ABP). However, from the one hand, not all subjects are candidate for HBP measurements since this procedure needs a certain ability and should be avoided in anxious, incompliant and unreliable individuals. From the other hand, the routine use of ABP monitoring is limited by its still insufficient availability, its cost, and the discomfort that it can generate in some patient. Aim of this study was to assess whether a series of repeated office blood pressure (ROBP) measurements was able to discriminate white-coat from sustained hypertensive subjects. We considered one hundred and twenty-two pharmacologically untreated subjects (mean age 58±19, 67 females) referred to our Hypertension Unit by their general practitioner with the main indication of confirming the clinical diagnosis of hypertension through an ABP monitoring. After a 20 minute resting in a comfortable armchair, all subjects underwent ROBP measurement performed by using an automated oscillometric device set to obtain 10 readings at 2.5 minute intervals. After the first reading the examined subject remained alone in the doctor’s office. Few minutes after the end of the series of 10 measurements (ROBP), an ABP monitoring was mounted. The average of the last six measurements obtained with ROBP was compared with mean daytime (from 8 a.m. to 10 p.m.) ABP values. Eighty-one, out of the 122 individuals considered for the analysis, showed daytime ABP patterns compatible with the diagnosis of sustained hypertension (systolic BP > 130 and/or diastolic BP > 80 mmHg) while 41 subjects presented with normal ABP values, suggesting white-coat hypertension. ROBP measurement predicted the white-coat phenomenon in all but one subjects. The average of the sixth-to-tenth values (122/76±7/8 mmHg) obtained with ROBP practically overlapped daytime ABP values (121/75±7/8 mmHg) in those subjects and the correlation was tight and significant (systolic r: 0.84, p<0.001, diastolic r: 0.96, p<0.001, Pearson’s correlation test). In the group of 81 subjects, identified by ABP monitoring as sustained hypertensive patients, ROBP measurement disclosed systolic and/or diastolic values higher than normal (mean ROBP 147/85±12/7, mean daytime ABP 146/85±11/8 mmHg) as well, and a good correlation with daytime mean ABP values was found (systolic r: 0.81, p<0.001, diastolic r: 0.91, p<0.001). In conclusion, our data indicate that ROBP measurements, performed under standardised condition, may be helpful for the diagnosis of white-coat hypertension. Also in patients with sustained hypertension a very good correlation between morning ROBP measurement and mean daytime ABP values was found indicating that, in dipper patients at least, ROBP represents a reliable tool for taking treatment decision.
S35
FR-25 ASSOCIATION OF ENDOTHELIAL DYSFUNCTION, LOW-GRADE INFLAMMATION AND PLATELET ACTIVATION IN HYPERTENSIVE PATIENTS WITH MICROALBUMINURIA Francesca Santilli 1 , Patrizia Ferroni 2 , Maria Teresa Guagnano 2 , Angela Falco 3 , Vincenzo Paoletti 1 , Maria Rosaria Manigrasso 2 , Noemi Michetti 2 , Fiorella Guadagni 3 , Stefania Basili 1 , Giovanni Davì. 1 University of Chieti; 2 IRCCS San Raffaele Pisana, Rome, 3 University of Rome “La Sapienza”, Italy Objectives: To analyze the relationship among platelet activation, endothelial dysfunction low-grade inflammation and sCD40L in hypertensive patients with or without microalbuminuria (MA). Patients and Methods: A cross-sectional comparison of sCD40L levels was performed in 25 patients with essential hypertension and MA (MH) pairmatched for gender and age with 25 patients with essential hypertension (EH) and 25 healthy normotensive subjects. Circulating C-reactive protein (CRP, marker of inflammation), sP-selectin (marker of in vivo platelet activation), asymmetric dimetylarginine (ADMA) and von Willebrand Factor (vWF)(markers of endothelial dysfunction) levels were analyzed in each subject. Results: sCD40L levels were increased in MH patients compared to either EH (p<0.001) or HS (p<0.0001). A highly significant correlation between plasma sCD40L and sP-selectin (p<0.0001), vWF (p<0.001) or CRP levels (p<0.05) was observed in MH patients. Multivariate regression analysis showed that sP-selectin was the strongest independent predictor of sCD40L levels (p<0.0001) in MH patients. Hypertensive patients with both vWF and CRP levels above the median had the highest sCD40L levels (p< 0.0001). Factorial ANOVA analysis of all hypertensive subjects confirmed that only MH patients with low-grade inflammation had elevated levels of sCD40L. Conclusions: sCD40L levels appear to discriminate a subset of patients characterized by microalbuminuria and low-grade inflammation, suggesting that inhibition of the CD40/CD40L system may represent a potential therapeutic target in hypertensive subjects at high risk for cardiovascular events.
FR-26 INFLAMMATION AFFECTS TUBULOINTERSTITIAL DAMAGE IN ESSENTIAL HYPERTENSION A. Savino, A. Berni, M. Torri, L. Poggesi, I. Cecioni, S. Berardino, M Boddi. Dipartimento di Area Critica Medico-Chirurgica, Università degli Studi di Firenze Background: The role played by vascular inflammation in development of hypertensive-target organ damage is still under debate. Recently, hypertensioninduced inflammation was reported not to be related with glomerular damage investigated by microalbuminuria. However, relationship between inflammation and the involvement of the tubulointerstitial compartment was never investigated. Renal resistive index (RRI) was shown to early detect tubulointerstitial damage when renal function is still preserved. This study was aimed to investigate if in essential hypertension, tubulointerstitial damage was affected by the level of inflammatory markers. Methods: We investigated 24 hypertensive patients (HP) (aged 62±14 years, 14M/10F) and 35 age-matched healthy subjects (21M/14F). All subjects had a fasting glucose <110 mg/dL, ejection fraction >50%, creatinine <1.2 mg/dL or creatinine clearance >60 mL/min, and uricemia <6 mg/dL. Patients with cardiovascular events in the previous 6 months, secondary hypertension, or major inflammatory disease were excluded. No subject was on anti-inflammatory drugs. Levels of fibrinogen, alpha-2-globulin, erythrocytes sedimentation rate (ESR), total white blood cell and neutrophil counts were assayed as inflammatory markers. RRI ([peak systolic velocity—end-diastolic velocity]/peak systolic velocity) was calculated by the analysis of the Doppler flow wave obtained from the interlobar arteries at superior, medium, inferior poles in each kidney as the mean of six measurements, and was considered normal when <0.70. Results: In HP, mean levels of inflammatory markers were significantly higher than in controls (fibrinogen 433±132 mg/dL, alpha-2-globulin 13±2.4%, ESR 37±23 mm/h, p<0.05 vs control for all). Total white blood cell and neutrophil counts did not differ between HP and controls. RRI values resulted ≥0.70 in 11/24 HP, with a mean value of 0.68±0.07 (p<0.02 vs control). In HP, RRI was significantly correlated with levels of ESR (r=0.42, p=0.04), fibrinogen (r=0.43, p=0.03) and alpha-2-globulin (r=0.44, p=0.04). Conclusions: Inflammation is associated with and seems to facilitate the renal damage of the tubulointerstitial compartment in essential hypertension
FR-24 USEFULNESS OF A SERIES OF REPEATED IN-OFFICE BLOOD PRESSURE (ROBP) MEASUREMENTS FOR THE DIAGNOSIS OF WHITE-COAT HYPERTENSION Giuseppe Crippa, Antonino Cassi, Claudio Venturi, Elena Bravi, Pietro Cavallotti. Hypertension Unit, Department of Internal Medicine, Guglielmo da Saliceto Hospital, Piacenza, Italy White-coat hypertension is usually defined as an elevated office blood pressure (OBP) level associated with normal home blood pressure (HBP) or ambulatory blood pressure (ABP). However, from the one hand, not all subjects are candidate for HBP measurements since this procedure needs a certain ability and should be avoided in anxious, incompliant and unreliable individuals. From the other hand, the routine use of ABP monitoring is limited by its still insufficient availability, its cost, and the discomfort that it can generate in some patient. Aim of this study was to assess whether a series of repeated office blood pressure (ROBP) measurements was able to discriminate white-coat from sustained hypertensive subjects. We considered one hundred and twenty-two pharmacologically untreated subjects (mean age 58±19, 67 females) referred to our Hypertension Unit by their general practitioner with the main indication of confirming the clinical diagnosis of hypertension through an ABP monitoring. After a 20 minute resting in a comfortable armchair, all subjects underwent ROBP measurement performed by using an automated oscillometric device set to obtain 10 readings at 2.5 minute intervals. After the first reading the examined subject remained alone in the doctor’s office. Few minutes after the end of the series of 10 measurements (ROBP), an ABP monitoring was mounted. The average of the last six measurements obtained with ROBP was compared with mean daytime (from 8 a.m. to 10 p.m.) ABP values. Eighty-one, out of the 122 individuals considered for the analysis, showed daytime ABP patterns compatible with the diagnosis of sustained hypertension (systolic BP > 130 and/or diastolic BP > 80 mmHg) while 41 subjects presented with normal ABP values, suggesting white-coat hypertension. ROBP measurement predicted the white-coat phenomenon in all but one subjects. The average of the sixth-to-tenth values (122/76±7/8 mmHg) obtained with ROBP practically overlapped daytime ABP values (121/75±7/8 mmHg) in those subjects and the correlation was tight and significant (systolic r: 0.84, p<0.001, diastolic r: 0.96, p<0.001, Pearson’s correlation test). In the group of 81 subjects, identified by ABP monitoring as sustained hypertensive patients, ROBP measurement disclosed systolic and/or diastolic values higher than normal (mean ROBP 147/85±12/7, mean daytime ABP 146/85±11/8 mmHg) as well, and a good correlation with daytime mean ABP values was found (systolic r: 0.81, p<0.001, diastolic r: 0.91, p<0.001). In conclusion, our data indicate that ROBP measurements, performed under standardised condition, may be helpful for the diagnosis of white-coat hypertension. Also in patients with sustained hypertension a very good correlation between morning ROBP measurement and mean daytime ABP values was found indicating that, in dipper patients at least, ROBP represents a reliable tool for taking treatment decision.
S35
FR-25 ASSOCIATION OF ENDOTHELIAL DYSFUNCTION, LOW-GRADE INFLAMMATION AND PLATELET ACTIVATION IN HYPERTENSIVE PATIENTS WITH MICROALBUMINURIA Francesca Santilli 1 , Patrizia Ferroni 2 , Maria Teresa Guagnano 2 , Angela Falco 3 , Vincenzo Paoletti 1 , Maria Rosaria Manigrasso 2 , Noemi Michetti 2 , Fiorella Guadagni 3 , Stefania Basili 1 , Giovanni Davì. 1 University of Chieti; 2 IRCCS San Raffaele Pisana, Rome, 3 University of Rome “La Sapienza”, Italy Objectives: To analyze the relationship among platelet activation, endothelial dysfunction low-grade inflammation and sCD40L in hypertensive patients with or without microalbuminuria (MA). Patients and Methods: A cross-sectional comparison of sCD40L levels was performed in 25 patients with essential hypertension and MA (MH) pairmatched for gender and age with 25 patients with essential hypertension (EH) and 25 healthy normotensive subjects. Circulating C-reactive protein (CRP, marker of inflammation), sP-selectin (marker of in vivo platelet activation), asymmetric dimetylarginine (ADMA) and von Willebrand Factor (vWF)(markers of endothelial dysfunction) levels were analyzed in each subject. Results: sCD40L levels were increased in MH patients compared to either EH (p<0.001) or HS (p<0.0001). A highly significant correlation between plasma sCD40L and sP-selectin (p<0.0001), vWF (p<0.001) or CRP levels (p<0.05) was observed in MH patients. Multivariate regression analysis showed that sP-selectin was the strongest independent predictor of sCD40L levels (p<0.0001) in MH patients. Hypertensive patients with both vWF and CRP levels above the median had the highest sCD40L levels (p< 0.0001). Factorial ANOVA analysis of all hypertensive subjects confirmed that only MH patients with low-grade inflammation had elevated levels of sCD40L. Conclusions: sCD40L levels appear to discriminate a subset of patients characterized by microalbuminuria and low-grade inflammation, suggesting that inhibition of the CD40/CD40L system may represent a potential therapeutic target in hypertensive subjects at high risk for cardiovascular events.
FR-26 INFLAMMATION AFFECTS TUBULOINTERSTITIAL DAMAGE IN ESSENTIAL HYPERTENSION A. Savino, A. Berni, M. Torri, L. Poggesi, I. Cecioni, S. Berardino, M Boddi. Dipartimento di Area Critica Medico-Chirurgica, Università degli Studi di Firenze Background: The role played by vascular inflammation in development of hypertensive-target organ damage is still under debate. Recently, hypertensioninduced inflammation was reported not to be related with glomerular damage investigated by microalbuminuria. However, relationship between inflammation and the involvement of the tubulointerstitial compartment was never investigated. Renal resistive index (RRI) was shown to early detect tubulointerstitial damage when renal function is still preserved. This study was aimed to investigate if in essential hypertension, tubulointerstitial damage was affected by the level of inflammatory markers. Methods: We investigated 24 hypertensive patients (HP) (aged 62±14 years, 14M/10F) and 35 age-matched healthy subjects (21M/14F). All subjects had a fasting glucose <110 mg/dL, ejection fraction >50%, creatinine <1.2 mg/dL or creatinine clearance >60 mL/min, and uricemia <6 mg/dL. Patients with cardiovascular events in the previous 6 months, secondary hypertension, or major inflammatory disease were excluded. No subject was on anti-inflammatory drugs. Levels of fibrinogen, alpha-2-globulin, erythrocytes sedimentation rate (ESR), total white blood cell and neutrophil counts were assayed as inflammatory markers. RRI ([peak systolic velocity—end-diastolic velocity]/peak systolic velocity) was calculated by the analysis of the Doppler flow wave obtained from the interlobar arteries at superior, medium, inferior poles in each kidney as the mean of six measurements, and was considered normal when <0.70. Results: In HP, mean levels of inflammatory markers were significantly higher than in controls (fibrinogen 433±132 mg/dL, alpha-2-globulin 13±2.4%, ESR 37±23 mm/h, p<0.05 vs control for all). Total white blood cell and neutrophil counts did not differ between HP and controls. RRI values resulted ≥0.70 in 11/24 HP, with a mean value of 0.68±0.07 (p<0.02 vs control). In HP, RRI was significantly correlated with levels of ESR (r=0.42, p=0.04), fibrinogen (r=0.43, p=0.03) and alpha-2-globulin (r=0.44, p=0.04). Conclusions: Inflammation is associated with and seems to facilitate the renal damage of the tubulointerstitial compartment in essential hypertension