C. Gadaleta

[PP.37.23] CARDIOVASCULAR REMODELLING IN HYPERTENSIVE PATIENTS: DOES GENDER MATTER?

Objective: To investigate whether common cardiovascular risk factors act differently between genders in the development of organ damage in untreated mild hypertensive patients. To correlate also any differences in subclinical organ damage to office, 24 h and central blood pressure (BP). Design and method: We enrolled 60 women and 50 men (without cardiovascular disease or diabetes, non smokers) aged between 35 and 55 years old with mild hypertension. For the control group were enrolled 60 normotensive women and 50 normotensive men matched for age and BMI. For each subject, we evaluated office and 24 h BP. Each patient underwent arterial tonometry (central blood pressure), echocardiography (left ventricular mass, thoracic aortic diameters), carotid (intima media thickness, IMT) and abdominal aortic ultrasonography and blood tests. Results: Using a regression analysis we found an outstanding role of BMI (beta = 0.47, p = 0.0001) and central BP (beta = 0.26, p = 0.002) to predict left ventricular mass in women. In men, BMI (beta = 0.40, p = 0.001) age (beta = 0.21, p = 0.003) and 24 h SBP (beta = 0.34, p = 0.0001) seem to play a major role. Regarding thoracic aorta we found a significant correlation to central BP in both men and women (beta = 0.23, p = 0.01 and beta = 0.19, p = 0.03), whereas this association is detectable for abdominal aorta only in women (beta = 0.37, p = 0.01). Finally, in the prediction model of IMT, age and BMI were significant in both genders. In women we found a significant correlation with 24 h BP (beta = 0.20, p = 0.007), while in men with central BP (beta = 0.23, p = 0.007). Conclusions: In men target organ damage appears mainly related to age, BMI and 24 h BP. In women the role of age seems lower and CV remodelling appears also related to central BP.

GESTATIONAL DIABETES AND DEVELOPMENT OF HYPERTENSION: A STUDY USING AMBULATORY BLOOD PRESSURE MONITORING

Objective: To evaluate the incidence of arterial hypertension (AH) using ambulatory blood pressure monitoring (ABPM) after a long-term follow-up (average: 9 years) in women with pregnancy complicated by (gestational hypertension, GH) or (preclampsia, PE) or (gestational diabetes, GDM) versus women with uncomplicated pregnancies (UP). Design and method: We retrospectively selected, in the database of our city hospital, 200 women who delivered between 2002 and 2007: 50 with GH, 50 with PE, 50 with GDM, 50 with UP. Exclusion criteria were pre-existing AH and diabetes and previous cardiovascular events. For all women, we obtained family and personal medical history, obstetric and laboratory data both at baseline and at follow-up; ABPM was performed at follow-up in order to establish a possible diagnosis of AH. Results: At baseline and follow-up, groups were not different in age, family history of AH, smoking prevalence, BMI, renal function. GH, GDM and PE groups had higher values of mean 24 h SBP and 24 h DBP than UP group. The diagnosis of hypertension was made in 40% of women in GH group and in 32% of women in GDM group vs 14% in UP group (p = 0.005). Incidence of AH in PE group was higher than in UP group, but the difference did not reach statistical significance. Using a Kaplan-Meier analysis, no difference was found in the incidence of AH between GH, PE and GDM groups. No difference was found in the prevalence of masked hypertension and white coat hypertension in all groups. Conclusions: A pregnancy complicated by GDM gives a significantly higher risk of developing AH later in life, and this risk is not significantly different than that given by PE or GH.

[PP.23.02] RESISTANT HYPERTENSION AND RENAL RESISTIVE INDEX

Objective: Renal resistive index (RRI), assessed by Doppler sonography, has been classically considered as an expression of intrarenal vascular resistance. Recent studies, however, have showed that RRI is also influenced by arterial compliance, confirming its possible role as a marker of systemic vascular alterations. Our purpose was the evaluation of the renal resistive index in patients with uncontrolled hypertension with 3 or more antihypertensive drugs, including a diuretic (RH), in comparison with a group of patients with resistant drug hypertension controlled with 4 or more antihypertensive drugs (RH4) and patients with hypertension controlled with 3 antihypertensive agents (CH3). We also considered the correlation between renal resistive index and subclinical organ damage. Design and method: We enrolled 120 patients (40 RH, 40 RH4, 40 CH3) without renal arterial stenosis and known nephropathy from our outpatient clinic for hypertension. We matched patients for age, sex and BMI. Each patients performed a 24-hour blood pressure monitoring (ABPM), office blood pressure (OBP) measurement, Glomerular Filtration Rate (according to MDRD) assessment, echocardiography and carotid echo-color-Doppler ultrasonography. We also estimated renal resistive index by Doppler sonography. Results: OBP and ABP were higher in RH group in comparison with the RH4 and CH3 groups (OBP: 155 ± 7/88 ± 5 vs 130 ± 7/79 ± 9 vs 127 ± 7/76 ± 5 mmHg, p = 0.001; ABP: 141 ± 10/85 ± 6 vs 122 ± 8/73 ± 6 vs 121 ± 8/72 ± 6 mmHg, p = 0.001). Office pulse pressure was higher in RH than RH4 and CH3 groups (66 ± 12 vs 53 ± 10 vs 51 ± 6 mmHg, p = 0.001). Renal resistive index was similar in RH and RH4 (0.72 ± 0.08 vs 0.70 ± 0.07, p = n.s.) and higher than CH3 group (0.72 ± 0.08 vs 0.65 ± 0.06, p = 0.004; 0.70 ± 0.07 vs 0.65 ± 0.06, p = 0.019). We also found a significant correlation between renal resistive index and age (r = 0.421, p = 0.0001), GFR (r = −0.197, p = 0.036), office pulse pressure (r = 0.4 p = 0.0001). We did not observe significant correlation between renal resistive index and left ventricular mass index and carotid intima-media thickness. Conclusions: Renal resistive index is higher in patients with drug-resistant hypertension. The correlation between office pulse pressure and the renal resistive index confirms that the latter depends much more on systemic haemodynamics than on renal ones. These data need to be confirmed by larger and prospective studies.