M. Torralba González de Suso

PARATHYROID HORMONE, BUT NOT 25-HYDROXI VITAMIN D, SERUM LEVELS ASSOCIATE WITH ALDOSTERONE-TO-RENIN RATIO AND NOCTURNAL MEAN BLOOD PRESSURE VARIABILITY

Objective: To assess the association between serum parathyroid hormone (PTH) or vitamin D serum levels with blood pressure, aldosterone-to-renin ratio, and target organ damage in a series of hypertensive patients. Design and method: Observational cross-sectional study of hypertensive patients who undergone 24-hour ambulatory blood pressure monitoring (24-h ABPM), in whom plasma aldosterone, plasma aldosterone-to-renin ratio, PTH and 25-OH D serum levels were available. Blood pressure (BP) was measured by 24-hour ABPM. BP was assessed as average real variability. Renin-angiotensin-aldosterone axis status was assessed through plasma aldosterone levels and aldosterone-to-renin ratio. Electrocardiography, echocardiography and urine albumin-to-creatinine ratio were used to evaluate left ventricular hypertrophy and renal damage, respectively. Patients with primary hyperparathyroidism were excluded. Results: We enrolled 170 consecutive patients (median age [IQR] -year), 52 [42–64]; 48.2%, female). In comparison with patients with normal PTH serum levels (<88 pg/ml), those with high PTH serum levels (>88 pg/ml) showed a significantly increase in plasma aldosterone-to-renin ratio [mean ± SD] (37.8 ± 46.6 vs. 20.7 ± 27.0; p = 0.032), and nocturnal pulse pressure (56.3 ± 17.9 vs. 50.6 ± 13.1 mm Hg; p = 0.029). Furthermore, when compared with patients in the PTH 1st quartile, those in the 4th PTH quartile showed significantly higher nocturnal systolic BP (129.5 ± 25.6 vs. 119.9 ± 14.4 mm Hg; p = 0.038), plasma aldosterone (204.9 ± 128.4 vs. 153.8 ± 88.7 pg/ml; p = 0.037), plasma aldosterone-to-renin ratio (36.4 ± 45.8 vs. 18.9 ± 24.5; p = 0.033), and nocturnal mean BP variability (8.9 ± 4.4 vs. 7.1 ± 1.7 mm Hg; p = 0.016). Differences in aldosterone-to-renin ratio and nocturnal mean BP variability remained significant after adjusting by age, gender, renal function and ACE/ARB therapy in multivariate analysis. No such differences were observed in patients with vitamin D deficiency (25-OH D < 20 ng/ml), when compared with patients with normal vitamin D serum levels. Conclusions: High PTH, but not low 25-OH D serum levels associate with increased aldosterone-to renin ratio and elevated nocturnal mean blood pressure variability. Our results might explain, in part, the lack of consistent clinical benefit of vitamin D supplementation on high blood pressure and cardiovascular risk. We suggest that serum PTH status should be considered in trials searching for cardiovascular benefits from vitamin D supplementation in patients with hypovitaminosis D.

CP-155 Prevalence and effectiveness of antiretroviral treatment combinations used in hiv patients not included in guidelines

Background Most studies in HIV infected patients focus on the effectiveness of antiretroviral therapy (ART) combinations included in clinical guidelines. However, few studies have analysed combinations not listed in these guidelines. Purpose To analyse the prevalence and effectiveness of ART combinations not included in HIV guidelines. Material and methods A retrospective observational study was carried out between January 2014 and December 2015. All patients with ART followed for at least 1 year by the outpatient pharmacy were included. ART were classified in two groups:(1) all combinations listed in the Spanish National AIDS Plan Recommended Guidelines (GESIDA) for initial antiretroviral therapy 2014–2015; and combinations not listed in GESIDA Guidelines. To determine the effectiveness of the treatment, plasma viral load (VL) and CD4+ lymphocytes were reviewed. Two analyses according to different criteria were conducted:(1) criteria reflected in Spanish GESIDA guidelines: VL <50 copies/mL (undetectable) and CD4 repeatedly >300 cells/μL, on at least two consecutive occasions;(2) criteria reflected in the American DHHS guidelines: VL <200 copies/mL (to prevent errors by blip) and CD4 repeatedly >300 cells/μL, on at least two consecutive occasions. Data were analysed with SPSS 20.0 software. Results 245 patients were analysed. 68.6% (168) were men. The median age was 48.5 years (IIC: 43.5 to 53). Patients ART combinations included in guidelines ART combinationsnot included in guidelines Total (n (%)) 224 (91.4) 21 (8.6) VL <50 copies/mL and CD4 >300 cells/μL (n (%)) 110 (49.1) 9 (42.9) OR=1.287 95% CI OR: 0.521–3.174 p=0.584 VL <200 copies/mL and CD4 >300 cells/μL (n (%)) 174 (77.7) 14 (66.7) OR=1.740 95% CI OR: 0.666–4.545 p=0.253 Conclusion This study shows that few patients receive ART combinations not included in clinical practice guidelines. The high power of current ART could explain the similar effectiveness between the listed and non-listed therapies in the guidelines. No conflict of interest