Evaggelia K. Aissopou

Mean arterial pressure values calculated using seven different methods and their associations with target organ deterioration in a single-center study of 1878 individuals.

To assess the differences among seven different methods for the calculation of mean arterial pressure (MAP) and to identify the formula that provides MAP values that are more closely associated with target organ deterioration as expressed by the carotid cross-sectional area (CSA), carotid-to-femoral pulse-wave velocity (cf-PWV) and left ventricular mass (LVM). The study population consisted of 1878 subjects who underwent noninvasive cardiovascular risk assessment. Blood pressure (BP) was assessed in all subjects, and MAP was calculated by direct oscillometry and six different formulas. Carotid artery ultrasound imaging was performed in 1628 subjects. The CSA of the right and left common carotid artery (CCA) were calculated and used as surrogates of arterial wall mass and hypertrophy. Aortic stiffness was evaluated in 1763 subjects by measuring the cf-PWV. Finally, 218 subjects underwent echocardiographic examination for the assessment of LVM. Among the examined methods of MAP calculation, the formula MAP1=[diastolic BP]+0.412 × [pulse pressure] yielded the strongest correlations with the LVM, cf-PWV and CSA of the right and left CCA, even after adjusting for age and gender. The MAP calculation using the 0.412 was superior compared with the traditional formula that uses the 0.33 for the discrimination of subjects with left ventricular and carotid wall hypertrophy, as well as subjects with increased aortic stiffness. MAP estimated with the 0.412 is better correlated with target organ deterioration compared with other formulas. Future studies are needed to explore the accuracy of these formulas for MAP estimation compared with direct intra-arterial BP measurement.

The Keith-Wagener-Barker and Mitchell-Wong grading systems for hypertensive retinopathy: association with target organ damage in individuals below 55 years.

Background: The usefulness of the hypertensive retinopathy classification by Keith–Wagener–Barker (KWB) in clinical practice remains controversial. The simplified Mitchell–Wong grading, combining the two initial KWB’ grades in one stage, is proposed as an alternative method; both systems are poorly validated regarding their association with target organ damage. Objective: In a population free of cardiovascular disease and diabetes, we aimed to investigate the interobserver and intraobserver agreement of both grading systems, their association with aortic stiffness, carotid hypertrophy or plaques and the role of age and sex on this association. Methods: Digital retinal images were obtained and graded – according to both classifications – by two independent and blinded observers; aortic stiffness (carotid-femoral pulse wave velocity, m/s) and common carotid hypertrophy (cross-sectional area, mm2) or plaques were assessed by tonometry and ultrasound, respectively. Results: From the gradable retinal photos obtained by 200 eyes of 107 consecutive patients (age: 54 ± 13 years, 51% men, 79% hypertensive patients) and after adjustments for confounders, the intraobserver and interobserver level of agreement was as following: KWB 88/64% and Mitchell–Wong 91/71%, respectively; exclusively in younger, not older, individuals aortic stiffness, carotid hypertrophy, but not plaques, were significantly associated with both systems, independently from confounders; no differences regarding target organ damage were found between stages 1 and 2 of KWB. Conclusion: Detecting early signs of hypertensive retinopathy may be of value in young individuals; the Mitchell–Wong seems preferable to the KWB classification system only for reasons of simplifying clinical practice.

Phenotypes of office systolic blood pressure according to both brachial and aortic measurements: frequencies and associations with carotid hypertrophy in 1861 adults.

Background/aim: Aortic SBP (aSBP) associates with arterial damage more consistently than brachial SBP (bSBP). However, it is unknown how often aSBP is normal in the presence of elevated bSBP, and vice versa; if SBP phenotyping on the basis of bSBP and aSBP cut-off values improves cardiovascular risk stratification. We tested the frequency of four office SBP phenotypes: type I (both normal bSBP and aSBP); type II (high bSBP but normal aSBP); type III (normal bSBP but high aSBP), and type IV (both high bSBP and aSBP), the probability of each phenotype to be associated with increased arterial damage, using type Ia (i.e. normal bSBP and low-normal aSBP) as reference. Methods: In 1861 participants (age: 54 years, 49.1% men), we measured simultaneously bSBP, aSBP, and carotid cross-sectional wall area with ultrasound. Results: Depending on the applied cut-off values, type II and type III phenotypes represented together 5–11% of the population (0.9–3.4 and 1.8–10.3%, respectively) and type IV around 20%. Subgroups with phenotypes, Ib (i.e. normal bSBP and high-normal aSBP), II, III, and IV had gradually significantly higher probability (by 1.37–1.91, 2.3–3.3, 3.3–8.9 times, and 4.18–6.25, respectively) to present elevated carotid artery cross-sectional wall area compared with the reference group, even after adjustment for DBP and other confounders. Conclusions: Type II (i.e. isolated high bSBP) and type III (i.e. isolated high aSBP) office SBP phenotypes were common and had intermediate level (between types I and IV) of arterial damage.

PULSE PRESSURE AMPLIFICATION DIPPING PATTERN DURING SLEEP TIME: THE SAFAR STUDY

Objective: The difference in pulse pressure (PP) between peripheral arteries and the aorta, called pulse pressure amplification (PPamp), is a well-described physiological phenomenon which is independently associated with cardiovascular events. Recent studies suggest that it exhibits circadian variability. Our aim was to evaluate the 24 hour profile of peripheral and central hemodynamics and detect the factors associated with the circadian variability of PPamp. Design and method: In 497 consecutive subjects (aged 54 years, 56.7% male, 79.7% hypertensives) we assessed the circadian pattern of peripheral and central arterial hemodynamics by 24-hour evaluation of brachial and aortic blood pressure (BP), augmentation index (AI) and pulse wave velocity (PWV) using a validated brachial-cuff based oscillometric device (Mobil-O-Graph). Results: All parameters exhibited a circadian variation. Sleep dipping (decrease) pattern was observed for PPamp (Figure 1), brachial and aortic systolic BP, mean BP (Figure 2) and PWV (Figure 3), whereas a rising pattern (higher sleep than wake values) was observed for brachial PP, aortic PP (Figure 4) and AI (Figure 5). The factors independently associated with the less sleep-dipping in PPamp were: older age, lower height, the use of antihypertensive medication, sleep decrease in arterial stiffness (PWV); whereas female gender, the presence of hypertension, sleep increase of pressure wave reflections (AI), sleep decrease in heart rate and mean BP were associated with a greater sleep-dipping in PPamp (Table 1). Figure. No caption available. Conclusions: These data provide further pathophysiological understanding of the mechanisms leading to PPamp dipping. Several implications regarding the clinical use of the aortic and brachial BP, especially during sleep time, are raised that should be addressed in future research.

Biologic Treatment Options for Retinal Neovascularization in Behçet’s Disease

ABSTRACT Purpose: Relapsing ocular inflammation occurs in about 70% of patients with Behçet’s disease (BD) and can lead to permanent loss of vision. Neovascularization of the optic disc (NVD) or elsewhere in the retina (NVE) is a relatively uncommon but severe complication that lacks standardized treatment. Methods: We report on the therapeutic use of anti-TNF monoclonal antibodies for BD-associated NVD and NVE in one pediatric patient (subcutaneous adalimumab) and one young man (intravenous infliximab). Also, we review the previously published experience on biologic therapeutic options, namely anti-TNF agents and interferon-alpha in a total of three and eight patients, respectively. Results: A fast-onset therapeutic effect was observed in both patients leading to complete regression of neovascularizations. Conclusions: Both options may lead to regression of neovascularization, thus preventing loss of vision, but comparative studies need to determine the optimal treatment for this sight-threatening complication of BD.

[PP.06.15] DETERMINANTS OF WHITE-COAT AND MASKED HYPERTENSION IN THE GENERAL POPULATION: THE DIDIMA STUDY

Objective: White-coat (WCH) and masked hypertension (MH) are common phenotypes between normotension and hypertension. This cross-sectional study investigated the clinical profile associated with increased likelihood for these phenomena. Design and method: Office (1 visit, 3 measurements) and home (3 days, 12 readings) blood pressure (BP) measurements were obtained in a general population study at Didima, Argolida, Greece. Average office and home BP were used to define WCH and MH. Participants’ characteristics (age, gender, BMI, diabetes and cardiovascular disease history, smoking, antihypertensive treatment) were assessed as potential determinants of WCH and MH. Results: 665 adults (age 54.4 ± 17.7 years, 42% men, 14.1% treated, 28.1% with office hypertension) were analyzed. The overall prevalence of WCH and MH was 8.7% and 7.5%, respectively (8.8% and 6.3% in untreated subjects, respectively). In multivariate logistic regression analysis, younger age (p = 0.004), untreated status (p = 0.044) and lower office BP (p = 0.01 for stage I versus stage II hypertension) were independent predictors of WCH among participants with office hypertension. For MH independent predictors were male gender (p = 0.034), ageing (p < 0.001), obesity (p < 0.001), antihypertension treatment (p = 0.03) and high-normal office BP (p = 0.01) among participants with office normotension. In sensitivity analysis performed in untreated subjects with office hypertension, only female gender (p = 0.048) and younger age (p = 0.001) increased the odds for WCH. In untreated subjects with low office BP older age (p < 0.001), higher BMI (p = 0.001), diabetes (p = 0.04) and high-normal office BP (p = 0.005) independently predicted MH. Figure. No caption available. Conclusions: In this general population study, age, gender, antihypertensive treatment and office BP level consistently predicted WCH and MH.

[OP.1C.07] PROGNOSTIC VALUE OF HOME VERSUS OFFICE BLOOD PRESSURE VARIABILITY: DIDIMA STUDY 19-YEAR FOLLOW-UP

Objective: Accumulating evidence suggests that blood pressure variability (BPV) predicts cardiovascular risk independently of the average blood pressure (BP). This study explored the prognostic ability of home versus office BPV. Design and method: In 1997 all adult population of Didima, Argolida, Greece was invited to participate in a study involving office (2 visits, 6 readings) and home (3 days, 12 readings) BP measurements. Cardiovascular morbidity and mortality were assessed after 19.0 ± 1.4 years (2016). Standard deviation (SD) and coefficient of variation (CV) of home and office BP were used to quantify BPV. Results: 665 participants (age 54.4 ± 17.7 years, 42% men) were analyzed. During follow-up 216 deaths (124 cardiovascular) and 146 cardiovascular events (fatal and non-fatal) were documented. In Cox regression models, all indices of systolic home BPV were predictive of cardiovascular risk, even after adjustment for all available cardiovascular risk factors (adjusted HR 1.05 for a 1-SD increase in systolic home BPV and 1.06 for 1% increment in percentage CV; all p < 0.05). The HR for SD (but not CV) of diastolic home BP significantly predicted cardiovascular outcome, yet it lost statistical significance after adjustment for several cardiovascular risk factors (adjusted HR 1.03 for a 1-SD increase in BPV, p = NS). For office BP, only unadjusted indices of BPV were predictive of cardiovascular risk (adjusted HR 1.01/1.03 for a 1-SD increase in systolic/diastolic BPV and 1.02/1.02 for 1% increment in percentage CV; all p = NS). In Cox model including CVs of both home and office systolic BP as independent variables, CV of home BP remained a significant predictor of cardiovascular outcome independent of office BPV. Figure. No caption available. Conclusions: In this long-term general population outcome study, both home and office BPV independently predicted cardiovascular events, with indices of home systolic BPV exhibiting superior prognostic ability.

Retinal microcirculation in association with caffeinated and alcoholic drinks in subjects at increased cardiovascular risk

The association of caffeinated and alcoholic drinks with microcirculation is poorly investigated. The aim of the study was to investigate the associations of daily consumption of caffeinated and alcoholic drinks with retinal vessel calibers.