Jiří Špác

A multicentre study on unattended automated office blood pressure measurement in treated hypertensive patients

Abstract Aims: Unattended automated office blood pressure (uAutoOBP) may eliminate white-coat effect. In the present study, we studied its relationships to attended office blood pressure (BP) and ambulatory BP monitoring (ABPM). Material and methods: Stable treated hypertensive subjects were examined in four Czech academic hypertension centres. uAutoOBP was measured with the BP Tru device; attended BP was measured six times: three times with auscultatory method (AuscOBP) by the physician followed optionally by three oscillometric measurements (OscOBP). ABPM was performed within one week from the clinical visit. Results: Data on 172 subjects aged 63.7 ± 12.4 years with AuscOBP 127.6 ± 12.1/77.6 ± 10.0 mm Hg are reported. uAutoOBP was by 8.5 ± 9.0/3.0 ± 6.1 mm Hg lower than AuscOBP. The AuscOBP-uAutoOBP difference increased with the AuscOBP level and it did not depend on any other factor. OscOBP differed by 8.6 ± 8.6/1.9 ± 5.7 mm Hg from uAutoOBP. 24-hour mean BP was by 4.2 ± 12.1/3.5 ± 7.8 mm Hg lower than AuscOBP and by 4.3 ± 11.0/0.5 ± 6.9 mm Hg higher than uAutoOBP; the correlation coefficients of 24-hour mean BP with AuscOBP and with uAutoOBP did not differ (p for difference ≥.13). In the lowest BP group (systolic AuscOBP <120 mm Hg or diastolic AuscOBP <70 mm Hg), both AuscOBP and uAutoOBP were lower than 24-hour mean BP, while in the highest BP group (systolic AuscOBP ≥140 mm Hg or diastolic AuscOBP ≥90 mm Hg), they were higher. Conclusions: Compared to uAutoOBP, attended BP measurement gives higher values, both when measured with auscultatory or oscillometric method. Inter-individual variability of AutoOBP – uAuscOBP difference, as well of uAutoOBP – ABPM difference, is large. We did not prove that uAutoOBP would be associated to 24-hour ambulatory BP more closely than attended BP.

Worse prognosis of real-world patients with acute heart failure from the Czech AHEAD registry in comparison to patients from the RELAX-AHF trial

The randomized clinical trial RELAX‐AHF demonstrated a positive effect of vasodilator therapy with serelaxin in the treatment of AHF patients. The aim of our study was to compare clinical characteristics and outcomes of patients from the AHEAD registry who met criteria of the RELAX‐AHF trial (relax‐comparable group) with the same characteristics and outcomes of patients from the AHEAD registry who did not meet those criteria (relax‐non‐comparable group), and finally with characteristics and outcomes of patients from the RELAX‐AHF trial.

[PP.10.11] ENDOTHELIAL (DYS)FUNCTION IN PATIENTS WITH HYPERTENSION AND RESISTANT HYPERTENSION - PROFOUND VASOCONSTRICTION OR IMPROPER VASODILATION? PILOT RESULTS

Objective: Endothelial dysfunction (ED), one of the first steps in the pathophysiology of hypertension, is highly complex process that is still not fully understood. The aim of the current study was to test various modalities reflecting the endothelial function or damage in newly identified hypertensive patients compared to healthy individuals and compared to patients with resistant hypertension in order to shed more light on the pathophysiology of hypertension. Design and method: Study is conducted as prospective single-center study. 56 patients (44 males) have already been enrolled: 28 newly identified untreated hypertensive patients (group H), 18 healthy individuals (group C) and 10 patients with resistant hypertension (group RH). All the hypertensive patients underwent 24-ABPM and echocardiography followed by examination of pulse wave velocity (PWV), CAVI and augmentation index and carotid intima media thickness. Levels of vasoactive factors were determined by ELISA from the peripheral blood including nitric oxide (NO), endothelin, oxidized LDL and osteopontin. Statistical analysis was performed in the STATISTICA software using appropriate statistical tests. Results: Selected echocardiography parameters describing heart structure differed significantly between H and RH group, reflecting structural remodelling of the heart. Statistically significant differences have been observed among individual groups in the levels of NO (C vs. H vs. RH: 30,93 ± 22,36 vs. 17,76 ± 10,53 vs. 14,36 ± 7,19 [&mgr;M]; p = 0,005), differences of borderline significance have been observed for the levels of oxidized LDL (C vs. H vs. RH: 12,13 ± 3,03 vs. 12,71 ± 2,84 vs. 10,40 ± 1,66 [U/ml]; p = 0,069). No statistically significant differences have been observed for endothelin and osteopontin. Values of pulse ware velocity, augmentation or CAVI index and cIMT did not differ between H and RH groups. Various correlations among the levels of the plasmatic factors with the paraclinical examination methods results have been observed. Conclusions: Production of NO is significantly decreased in newly identified hypertensive individuals and further decreases in patients with RH; the levels of vasoconstrictive endothelin and other factors do not show this trend. It can be suggested that the impossibility of proper vasodilation contributes significantly to the development and progression of hypertension. Supported by MUNI/A/0949/2016 and MUNI/A/1356/2016 grants.

Measurement of arterial pulse wave velocity support the suspicion of asymptomatic left ventricular dysfunction in hypertensive patients with metabolic syndrome or diabetes mellitus

The aim of this study was to evaluate myocardial function and vascular wall elasticity using pulse wave velocity (PWV)between aorta and femoral artery in patients with hypertension and metabolic syndrome (MS) or type 2 diabetes mellitus(HT+DM).Results:Pts in both groups revealed normal systolic function of the LV(EF 65 % versus 61%),pts with HT+DM had higher values of the LV mass than the group with MS (44,9 v.s. 54,0 g/height2,7, p=0.005) Average values of PWV were lower in the group with MS than in HT+DM group(11,38m/s vs 12,79 m/s,p=0.002) as well as BNP(54,7 vs 141,12 pg/l, p=0.005)and NT pro BNP(66,5 vs 279,6 pg/l). In both groups of pts increased PWV was significantly correlated with TDI measurements indicating reduced diastolic function (PWV and E/Evm r = 0,698, p<0,001)and values of natriuretic peptides(PWV versus NT pro BNP r = 0,776, p<0,001).Conclusions:Arterial stiffness in hypertensive pts revealed some relation to the LV dysfunction. The measurment of the PWV may contribute to the prediction of LV diastolic dysfunction in hypertensive pts with metabolic syndrome or diabetes mellitus.