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THE RELATIONSHIP BETWEEN CENTRAL AORTIC PRESSURE, BRACHIAL BLOOD PRESSURE AND LEFT VENTRICULAR MASS INDEX: IN FIRST DIAGNOSED HYPERTENSIVE PATIENTS: PP.29.164

Background: Central (aortic) blood pressure (BP) has been reported as a more powerful indicator to predict cardiovascular risk than peripheral (brarchial) BP. Also, increased left ventricular mass index (LVMI) and its change during treatment can predict cardiovascular complications in hypertensive subjects. However, the relationship between aortic or peripheral BP and LVMI is not clear especially in first diagnosed hypertensive subjects. We purposed to compare the relationship of LVMI with central and peripheral BP parameters. Methods: We studied 111 patients who diagnosed hypertension for the first time without any medical history including diabetes (mean age: 47 ± 10 years, 72 males). Subjects with heart failure, any significant valvular disease or cardiomyopathy on echocardiogram were excluded. Peripheral BP was measured by automatic sphygmomanometer at brachial artery and central BP was measured by analysis of non-invasive radial artery pulse wave using automated applanation tonometry. The LVMI was calculated from M-mode echocardiographic data and body surface area. To avoid multiple co-linearity among BP parameters, multiple regressions predicting LVMI were done four times. Results: Baseline central and peripheral systolic BP (SBP) were 136 ± 17 and 150 ± 18mmHg (p < 0.001) and each mean pulse pressure (PP) was 41 ± 11 and 53 ± 13 mmHg respectively (p < 0.001). Mean PP difference was 11.7 ± 12.0 mmHg and mean LVMI was 109 ± 22 g. The LVMI was positively correlated with age, peripheral SBP & PP, central SBP & PP, and carotid intima-media thickeness (r = 0.231, 0.276, 0.283, 0.248, 0.343, 0.259 respectively, each p < 0.05). But, PP difference was not significantly correlated (p = 0.915). Although central and peripheral systolic and pulse pressures were still significantly related to LVMI after adjustment for age in the four different analyses, central PP was stronger predictor than peripheral PP (β coefficient = 0.311, p = 0.001 vs. 0.281, p = 003). Conclusion: Left ventricular mass index, which is one of useful indicators for predict cardiovascular risk and outcome of hypertension, is independently and positively associated with blood pressure parameters. Central pulse pressure is particularly more strongly related with LVMI than peripheral BP parameters.

IMPACT OF OBSTRUCTIVE SLEEP APNOEA AND TREATMENT RESPONSE ON IMMUNOSENESCENCE PARAMETERS IN HYPERTENSION

Objective: Inflammation and immunosenescence (IS) have been considered to be associated with hypertension. (HTN) Obstructive sleep apnea (OSA) was also associated with chronic inflammation by repetitive oxidative stress. However, the relationship between immunosenecenece parameters and treatment of HTN with or without OSA is unclear. We evaluate to demonstrate the association of chronic inflammation and IS parameters with OSA in hypertensive patients and the changes according to BP treatment. Design and method: Multicenter longitudinal observational study from April 2013 to October 2015. A total of 131 Hypertensive patients (SBP>140 mm Hg or DBP>90 mm Hg) were devided into OSA low risk and OSA high risk according to Berlin sleep apnea questionnaire. CD28 null and CD58 (+) fraction of CD8 T-cells were sampled at baseline in both groups. 87 patients among them were analyzed for baseline and 6 months follow-up immunosenescence parameters with treatment of HTN. Results: Among 131 subjects, 88 patients (67.2%) were OSA high risk, and 43 patients (32.8%) were OSA low risk. CD28 null fraction of CD8 T cells in OSA high risk group was 35.1 ± 18.3% vs 43.9 ± 19.9% in low risk group with a p-value 0.014. CD58+ fraction of CD8 T-cells in OSA high risk group was 37.0 ± 16.9% vs 44.7 ± 20.0% in OSA low risk group with a p-value 0.023. HTN was controlled in 56 patients (64.4%). CD28nullCD8+ T cell was significantly decreased from 41.1 ± 17.9% to 37.5 ± 18.8% (p-value=0.01) but CD57+CD8+ T cell was not correlated with HTN treatment. (42.2 ± 17.5% vs 42.7 ± 18.4%, p-value = 0.596). In multivariate analysis, only age was associated with change in CD28nullCD8+ T cell with greater reduction in CD28nullCD8+ T cell. (beta: 0.373, t = 2.412, p-value = 0.019). Conclusions: CD28 null and CD58 (+) fraction of CD8 T-cell in hypertensive patients with OSA were paradoxically higher in patients without OSA. IS parameter, CD28nullCD8+ T cell was significantly decreased with HTN treatment, especially in younger patients.

OS 01-08 IMPACT OF HYPERTENSION TREATMENT ON IMMUNOSENESCENCE PARAMETERS.

Objective: Inflammation by adaptive immune response of T cells was associated with hypertension (HTN) in previous animal study. And recent human research demonstrated that patients with HTN had a higher level of serum immunosenescence (IS) parameters, which were CD28null fraction of CD8 + (CD28nullCD8) and CD57 + fraction of CD8 + (CD57 + CD8) T cell. However there were limited data regarding impact of HTN treatment on these IS parameters. Design and Method: Multicenter longitudinal observational study from April 2013 to August 2015. A total of 87 consecutive hypertensive patients (SBP > 140 mmHg or DBP > 90 mmHg) were enrolled and followed up for 6 months. The clinical characteristics and routine laboratory values were examined at baseline visit. Blood pressure (BP), heart rate (HR), fraction of CD28nullCD8 + and CD57 + CD8 + T cell were measured at baseline and 6 months follow-up visits. Multivariable regression analysis was performed to assess the factors influencing the change of these IS parameters. Results: HTN was controlled in 56 patients (64.4%). After HTN treatment, systolic BP and diastolic BP were decreased from 147.7 ± 11.1mmHg to 135.9 ± 12.6mmHg (p-value = 0.001) and from 87.2 ± 10.2mmHg to 81.6 ± 9.6mmHg (p-value = 0.001). CD28nullCD8 T cell was significantly decreased from 41.1 ± 17.9% to 37.5 ± 18.8% (p-value = 0.01) but CD57 + CD8 T cell was not correlated with HTN treatment. (42.2 ± 17.5% vs 42.7 ± 18.4%, p-value = 0.596). In multivariate analysis, only age was associated with change in CD28nullCD8 + T cell. Younger patients demonstrated greater reduction in CD28nullCD8 T cell. (p-value = 0.019) Conclusions: IS parameter, CD28nullCD8 T cell was significantly decreased with HTN treatment, especially in younger patients.

EFFECT OF ANGIOTENSIN II RECEPTOR BLOCKER ON HEART, VESSEL AND METABOLIC PARAMETERS IN HYPERTENSIVE PATIENTS: COMPARATIVE STUDY WITH TELMISARTAN AND VALSARTAN: PP.33.322

Background: Angiotensin II receptor blockers (ARBs) are known to be effective in improving heart structure, vascular functions and metabolic indices, but few clinical comparative studies with different ARBs have been performed. The aim of this study is to compare those effects between hypertensives who were treated with telmisartan and valsartan. Methods: The subjects with essential hypertension (48.4¡ 3/4 9.6 years) were randomly assigned to take either telmisartan (80 mg/day, n = 30) or valsartan (160 mg/day, n = 30) for 12 weeks. Their anthropometric data, laboratory measurements, vascular indices and echocardiographic data were measured at the baseline and the study end. Results: Baseline characteristics were not significantly different between the two groups except carotid-femoral pulse wave velocity (cfPWV, telmisartan group vs. valsartan group; 841.2¡ 3/4 131.0 vs. 761.1¡ 3/4 104.4 cm/s, respectively, p = 0.041). Systolic and diastolic blood pressures (BP) were significantly decreased in both groups at the study end and the changes were not significantly different between the two. Compared with the baseline, telmisartan group achieved significant reductions in cfPWV (−7.6%, p = 0.023) and left ventricular mass index (LVMI, −9.6%, p = 0.018) and showed trends for reduction in total cholesterol (−5.7%, p = 0.075) and triglyceride (−13.7%, p = 0.058) at the study end, while valsartan group did not. There were no significant changes in other vascular and metabolic parameters in both groups. When we compared, however, the changes during the study between the two groups, there was the only significant difference in LVMI (p = 0.036). Conclusions: Although the level of BP reduction was similar in both groups, telmisartan significantly improved LVMI compared with valsartan and the result may be based on the significant effect of telmisartan on cfPWV. There were no significant changes in both groups regarding metabolic parameters.