Maria Luisa Romero

843 VARIABILITY OF BLOOD PRESSURE AND PROGNOSTIC VALUE OF LEFT VENTRICULAR HYPERTROPHY

Objectives: Left ventricular hypertrophy (LVH) is the earliest sign of cardiac impact in the hypertensive subject and a risk factor for cardiovascular complications. The objective is to know the cardiovascular prognosis of hypertensive subjects with LVH, regarding the variability of blood pressure. Methods: Cohort study in a non-selected sample of 432 hypertensive subjects (218 women, aged 55.5 years) without previous cardiovascular disease. Clinical-biological assessment, 24h-ABPM and echocardiography study (calculating left ventricular mass index -LVMI-) performed. Follow-up implied going through the clinical charts, registering date and kind of event (peripheral artery disease –PAD-, coronary cardiopathy –CC-, heart failure –HF- or cerebrovascular accident –CVA-). Results: Follow-up of 405 subjects (218 women, average age 55.5 years) provided an information of 3721.7 patients/year. Subjects with LVH had more events, IR of 5.99 vs 3.06 without LVH (incidence rate ratio (IRR): 1.96 [1.42–2.72]). Concentric LVH has a worse prognosis: IRR: 3.99: 2.69-5.91. LVH with dipper pattern increases the occurrence of events (IRR: 7.19 [3.29-15.74]) and non dipper and riser patterns, with LVH (12.18 [5.77-25.72]) and 20.98 [9.81-44.91]) and without LVH (9.16 [4.15-20.24]) and 25.41 [9.31-72.75]) increase the risk. Only nocturnal decrease of BP (odds ratio (OD): 0.97 [0.95-0.98], p = 0.0007) along with LVMI (OD: 1.02 [1.01-1.03]), p < 0.0001) had influence on prognosis. Conclusions: Loss in diurnal/nocturnal ratio of BP is related with a worse CV prognosis in hypertensive subjects. Presence of LVH determines higher incidence of CV events. Although eccentric LVH is more frequent, concentric LVH is associated with higher CV risk.

545 ADMINISTRATION OF ALISKIREN AND VALSARTAN AND ITS CHRONOTHERAPEUTIC EFFECTS ON DIABETIC NEPHROPATHY

Objectives: AVOID study showed that addition of aliskiren to ARB in diabetic subjects with nephropathy decreases the development of renal damage but has no influence on blood pressure. However, cronotherapeutic effects of the combination were not assessed. The objective is to study the evolution of diabetic nephropathy if aliskiren is added to valsartan at different times. Methods: 71 hypertensive diabetic subjects with proteinuria (albumin/creatinine ratio > 250 mg/g in men and >350 mg/g in women), preserved renal function (eGFR>60 ml/min), previously treated with valsartan 320 mg/day for 12 weeks and with controlled BP were randomised. Aliskiren 300 mg/day was added in three combinations for 24 weeks: valsartan + aliskiren in the morning; valsartan morning + aliskiren at night; valsartan + aliskiren at night. Results: Valsartan + aliskiren in the morning do not increase the antihypertensive efficacy of valsartan alone but have and additional effect of 21% (p < 0.0001) in proteinuria reduction. Valsartan in the morning + aliskiren at night offer more protection against proteinuria (29.5%) than valsartan alone, without significant changes in ambulatory BP. Valsartan + aliskiren at night decreases nocturnal ambulatory BP (p < 0.001), increases diurnal/nocturnal ratio of BP (p < 0.001) and have the highest additional effect (35.1%) in proteinuria reduction. Conclusions: Aliskiren added to valsartan means an additional and significant decrease in protein urinary excretion, higher when the combination is administered at night. This decrease seems independent from control of BP in morning administration and may have to be with an increase in diurnal/nocturnal ratio of BP and with a higher reduction of BP at rest, when the combination is administered at night.

194 CIRCADIAN PATTERN OF BLOOD PRESSURE, DIABETES MELLITUS AND TARGET ORGAN DAMAGE

Objective: Nephropathy and cardiopathy are the most frequent complications in diabetic hypertensive subjects. The objective is to analyse the features in a cohort of hypertensive subjects in relation with the presence of diabetes and/or target organ damage (TOD) in order to stratify accurately their cardiovascular risk. Methods: 405 hypertensive subjects assessed and stratified basing on their cardiovascular risk were studied. Ambulatory blood pressure monitoring (ABPM), echocardiographic study and lab tests to determine the presence of nephropathy (microalbuminuria –MAL, hidden kidney disease –HKD- or both) were performed. Results: No differences in age, gender, body mass index and previous treatment were seen between both groups, with a longer presence of hypertension in diabetic patients, p<0.0001. When ABPM is analysed, diabetic subjects have higher nocturnal SBP and DBP (p=0.02 and 0.03, respectively) with a significant decrease in the diurnal/nocturnal ratio of SBP (6.2% in diabetics vs 12.1% in non-diabetics,p<0.0001). The most prevalent circadian pattern in diabetics is non-dipper (37.3% vs 27.6%,p<0.0001) and riser (26.2% vs 7.7%,p<0.0001). When TOD is assessed, diabetic subjects have high prevalence of left ventricular hypertrophy (85% vs 34.9%, p<0.0001) and nephropathy, including MAL (25.3% vs 17.1%, p<0.0001) and HKD (36.4% vs 10.4%, p<0.0001). Conclusions: Diabetes and hypertension associated determine a significant alteration in the circadian pattern of BP and higher presence of TOD, especially heart and kidney. The presence of cardiopathy and nephropathy in hypertensives increases the development of cardiovascular complications and the cardiovascular risk in these patients.

546 CHRONOTHERAPY WITH TELMISARTAN/AMLODIPINE AND AMBULATORY BLOOD PRESSURE IN ELDERLY HYPERTENSIVE SUBJECTS

Objective: Elderly hypertensive subjects require combined treatment for an adequate control of hypertension. Nocturnal drug administration produces a significant increase in the diurnal/nocturnal ratio of systolic blood pressure (SBP). The objective was to assess the effects of the combination telmisartan (TEL) and amlodipine (AML) administered at different times of the day on ambulatory BP in elderly hypertensive subjects. Methods: We studied 51 untreated elderly hypertensive patients, 76.1 ± 7.3 years-old, assigned to two groups of treatment according time of administration of a combination of TEL 160 mg/AML 5 mg a day, on awakening or at bedtime, for three months. Clinical and biological assessment and ABPM were performed before and after therapeutic intervention, to assess changes at both moments. Results: Significant decrease of 24h-BP and diurnal BP regarding baseline values (p > 0.001) was observed, similar in both groups, (24 h-SBP/DBP/PP: -19.2/6.1/13.6 mmHg on awakening, -19.3/5.3/14.0 mmHg at bedtime; diurnal SBP/DBP/PP: -19.4/5.6/13.8 mmHg on awakening, -18.5/5,0/13,5 mmHg at bedtime). Subjects receiving TEL/AML at bedtime had a higher reduction of nocturnal BP (nocturnal SBP/DBP/PP: -18,7 /5,8/12,9 mmHg on awakening, -22,4/6,1/16,4 at bedtime, p < 0.001 for SBP and PP). Diurnal/nocturnal ratio of BP was only modified with bedtime administration (Ratio SBP/DBP: +3,82, p < 0,001). Conclusions: Combination of TEL/AML is efficient and reduces BP throughout 24 hours in elderly hypertensive subjects, regardless of administration time. In these subjects, who have a loss in diurnal/nocturnal ratio of BP with the subsequent alteration of the circadian pattern, bedtime TEL/AML administration may improve the antihypertensive efficacy.