compliance with antihypertensive therapy: needing a knot in a handkerchief

2
of hypertension, cardiovascular diseases and syndrome metabolic this pop- ulation (Perls T, et al. 2003). A new ongoing research project that aimed to identify important predictors and mechanisms of exceptional human longevity is being conducted in Brazil. Methods: For this purpose, we are collecting clinical and laboratory data of centenarians living in Ribeir~ ao Preto city, Brasil. We have assessed 25% of the estimated centenaries for an average city of 600,000 inhabitants. The study was approved by the Ethic Committee of the Clinical Hospital of School of Medicine of Ribeirao Preto-University of S~ ao Paulo - Brazil. Blood was collected at elderly homes, after fasting for 12 hours, to es- timate glucose, lipids, and homocysteine. Blood pressure (BP) was measured twice at home, by oscillometric method (Omron HEM-431C) in both arms. Results are showed as meanstandard-deviation. Preliminar data were analyzed by Pearson and Spearman correlation coefficients. Results: The age of centenarians (n¼16) was 101.3 1.8 years, with 15 of female gender. The number of comorbidities was 4.2 1.8 and the number of medications in use was 4.4 3.5. Glucose level was 80.115.4 mg/dL, total cholesterol was 161.733.0 mg/dL, HDL cholesterol was 44.36.5 mg/dL and triglycerides, 106.139.8 mg/dL. The homocysteine had values of 24.37.6 Mmol/L (normal values: 5-12 Mmol/L). The sitting systolic BP was 13620 mmHg (minimum value of 110 mmHg and maximum of 180 mmHg) and diastolic BP of 6810 mmHg. The BMI was 20.13.0 Kg/m2 (minimum: 16.2 Kg/m2 and maximum: 27.1 Kg/ m2), and waist circumference was 81.89.7 cm. We found a positive correlation between the sitting SBP and BMI (r¼0.74, p¼0.006), as well as between better cognition and higher BMI (r¼0.60, p¼0.02). Conclusions: Centenarians evaluated had low HDL, elevated homocyste- ine levels, and higher BP when there was higher BMI, which was associ- ated with better cognition. Higher BP and overweight at this age seem to have protective effects. Supported by University of S~ ao Paulo - NAPENV Keywords: Hypertension; Elderly; Centenarians; Cardiovascular risk factors P-137 Central versus peripheral blood pressure components as determinants of retinal microvessel diameters Yu-Mei Gu , 2 Yan-Ping Liu, 2 Lutgarde Thijs, 2 Tatiana Kuznetsova, 2 Fang-Fei Wei, 2 Harry A. .J. Struijker-Boudier, 1 Peter Verhamme, 2 Jan A. Staessen. 2, . 1 1 Maastricht University, Netherlands; 2 University of Leuven, Leuven, Belgium We assessed association of retinal arteriolar and venular diameters with central and periph-eral blood pressure (BP). We post-processed retinal photographs from 514 participants ran-domly recruited from a Flemish population (mean age, 50.6 years; 50.8% women), using IVAN software to generate retinal arteriolar (CRAE) and venular (CRVE) equivalents. We measured peripheral BP by mercury sphygmomanometry and central BP by tonometry at the carotid artery. We applied multivariable-adjusted regression analysis. For peripheral vs. central BP (mm Hg) average levels were 126.6 vs. 122.1 systolic and 79.4 vs. 79.6 diastolic, and 95.1 vs. 97.9 and 47.2 vs. 42.5 for mean and pulse pressure, respectively. CRAE and CRVE averaged 153 mm and 219 mm. Effect sizes (mm) for CRAE for 1-SD increase in pe-ripheral vs. central BP were -3.77 vs. -3.52 systolic, -3.16 vs. -3.13 diastolic, -3.84 vs. -3.64 for mean BP, and -2.07 vs. -1.83 for pulse pressure (P0.006). Models that included two BP components demonstrated that CRAE decreased (P0.035) with systolic (peripheral vs. central, -2.87 vs. -2.40) and diastolic (-1.58 vs. -1.80) BP. CRAE decreased with mean BP (-3.53 vs. -3.53; P<0.0001), but not with pulse pressure (P0.19). CRVE was not related to any peripheral or central BP component (P0.062). All CRAE regression slopes on corresponding peripheral and central BP components were similar (P0.28). In conclu- sion, higher systolic, diastolic and mean BPs were associated with smaller CRAE, regardless of whether BP was measured centrally or peripherally. Central BP does not refine the inverse association of CRAE and CRVE with peripheral BP. Keywords: central blood pressure; microcirculation; retina; peripheral blood pressure P-138 Comparison of cardiovascular, renal, and mortality outcomes in refractory, resistant, and general hypertension (HTN) populations Simran K. Bhandari , 1 Jiaxiao Shi, 1 David Calhoun, 2 John J. Sim. 1 1 Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, United States; 2 University of Alabama at Birmingham, Birmingham, AL, United States The resistant hypertension (RH) population is presumed to have higher risk for target organ damage compared to the general hypertensive population. The prognosis in those with RH as well as those with refractory HTN compared to general HTN is not well described. We sought to compare the risk of cardiovascular events, end stage renal disease (ESRD), stroke, and mortality in individuals with RH, refractory HTN, and general HTN within a large ethnically diverse HTN population. A retrospective cohort study within the Kaiser Permanente Southern Cal- ifornia health system in the period between 1/1/06 - 12/31/10 was per- formed among individuals age 18yrs with HTN and documented blood pressures. Medication usage was determined by internal pharmacy dispensation records. Resistant HTN was defined as a failure to achieve blood pressure control (SBP 140) while on 3 antihypertensive medica- tions or requiring 4 medications. Refractory HTN was defined as having uncontrolled BP (SBP >/¼ 140) despite being on 3 medications. The risk for congestive heart failure (CHF) event, myocardial infarction (MI) event, stroke event, ESRD (defined as need for dialysis or transplant), and death were evaluated using cox proportional hazard modeling to calcu- late hazard ratios (HR) adjusting for age, gender, race, BMI, eGFR, Charl- son comorbidity index, and co morbidities. Among 470,386 HTN individuals, 12.8% (N¼60,327) had RH. Within the RH population, 37,223 (7.9% of all hypertensives) were refractory HTN and 23,104 were non refractory RH. Average blood pressure of the entire HTN population was 133/75 and 154/79 among the refractory HTN pop- ulation. RH and refractory HTN were noted to have greater prevalence of pre-existing CHF, stroke, ischemic heart disease, chronic kidney dis- ease, and DM. Compared to general HTN, RH had multivariate adjusted HR (95% CI) of 1.16 (1.10,1.22) for ESRD, 1.01 (0.95,1.07) for stroke, 1.51 (1.43,1.59) for CHF, 1.21 (1.16,1.26) for MI, and 1.05 (1.02,1.09) for death. Refractory HTN compared to general HTN had HR (95% CI) of 1.45 (1.39,1.52), 1.24 (1.18,1.30), 1.42 (1.35,1.5), 1.26 (1.21,1.31), and 1.06 (1.03,1.09) for ESRD, stroke, CHF, MI, and death respectively. In comparing refractory HTN to non-refractory RH, multivariate adjusted HR (95% CI) were 1.25 (1.18,1.33), 1.23 (1.14,1.31), 0.95 (0.89,1.01), 1.04 (0.99,1.10), and 1.01 (0.97,1.05) for ESRD, stroke, CHF, MI, and death respectively. Among our large ethnically diverse hypertension population, we observed that refractory HTN and RH had greater risk for cardiovascular, renal, and mortality outcomes compared to general HTN. Stroke risk was only increased in those with refractory HTN supporting the strong association with blood pressure and stroke. Keywords: Resistant Hypertension; Refractory Hypertension; Cardiovas- cular Outcomes; End Stage Renal Disease P-139 Compliance with antihypertensive therapy: needing a knot in a handkerchief Aurelio Leone , 1 Linda Landini. 2 1 Medical Research, Castelnuovo Magra, Italy; 2 University of Pisa, Pisa, Italy Background: The control of blood pressure (BP) in hypertensive subjects requires compliance as high as possible to therapy by patients (pts) to e82 Abstracts / Journal of the American Society of Hypertension 8(4S) (2014) e81–e91

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e82 Abstracts / Journal of the American Society of Hypertension 8(4S) (2014) e81–e91

of hypertension, cardiovascular diseases and syndrome metabolic this pop-

ulation (Perls T, et al. 2003). A new ongoing research project that aimed to

identify important predictors and mechanisms of exceptional human

longevity is being conducted in Brazil.

Methods: For this purpose, we are collecting clinical and laboratory data

of centenarians living in Ribeir~ao Preto city, Brasil. We have assessed 25%

of the estimated centenaries for an average city of 600,000 inhabitants.

The study was approved by the Ethic Committee of the Clinical Hospital

of School of Medicine of Ribeirao Preto-University of S~ao Paulo - Brazil.

Blood was collected at elderly homes, after fasting for 12 hours, to es-

timate glucose, lipids, and homocysteine. Blood pressure (BP) was

measured twice at home, by oscillometric method (Omron HEM-431C)

in both arms. Results are showed as mean�standard-deviation. Preliminar

data were analyzed by Pearson and Spearman correlation coefficients.

Results: The age of centenarians (n¼16) was 101.3 � 1.8 years, with 15 of

female gender. The number of comorbidities was 4.2 � 1.8 and the number

of medications in use was 4.4 � 3.5. Glucose level was 80.1�15.4 mg/dL,

total cholesterol was 161.7�33.0 mg/dL, HDL cholesterol was 44.3�6.5

mg/dL and triglycerides, 106.1�39.8 mg/dL. The homocysteine had values

of 24.3�7.6 Mmol/L (normal values: 5-12 Mmol/L).

The sitting systolic BP was 136�20 mmHg (minimum value of 110

mmHg and maximum of 180 mmHg) and diastolic BP of 68�10

mmHg. The BMI was 20.1�3.0 Kg/m2 (minimum: 16.2 Kg/m2 and

maximum: 27.1 Kg/ m2), and waist circumference was 81.8�9.7 cm.

We found a positive correlation between the sitting SBP and BMI

(r¼0.74, p¼0.006), as well as between better cognition and higher BMI

(r¼0.60, p¼0.02).

Conclusions: Centenarians evaluated had low HDL, elevated homocyste-

ine levels, and higher BP when there was higher BMI, which was associ-

ated with better cognition. Higher BP and overweight at this age seem to

have protective effects.

Supported by University of S~ao Paulo - NAPENV

Keywords: Hypertension; Elderly; Centenarians; Cardiovascular risk

factors

P-137

Central versus peripheral blood pressure components as

determinants of retinal microvessel diameters

Yu-Mei Gu,2 Yan-Ping Liu,2 Lutgarde Thijs,2 Tatiana Kuznetsova,2

Fang-Fei Wei,2 Harry A. .J. Struijker-Boudier,1 Peter Verhamme,2

Jan A. Staessen.2,.1 1Maastricht University, Netherlands; 2University ofLeuven, Leuven, Belgium

We assessed association of retinal arteriolar and venular diameters with

central and periph-eral blood pressure (BP). We post-processed retinal

photographs from 514 participants ran-domly recruited from a Flemish

population (mean age, 50.6 years; 50.8% women), using IVAN software

to generate retinal arteriolar (CRAE) and venular (CRVE) equivalents.

We measured peripheral BP by mercury sphygmomanometry and central

BP by tonometry at the carotid artery. We applied multivariable-adjusted

regression analysis. For peripheral vs. central BP (mm Hg) average levels

were 126.6 vs. 122.1 systolic and 79.4 vs. 79.6 diastolic, and 95.1 vs. 97.9

and 47.2 vs. 42.5 for mean and pulse pressure, respectively. CRAE and

CRVE averaged 153 mm and 219 mm. Effect sizes (mm) for CRAE for

1-SD increase in pe-ripheral vs. central BP were -3.77 vs. -3.52 systolic,

-3.16 vs. -3.13 diastolic, -3.84 vs. -3.64 for mean BP, and -2.07 vs. -1.83

for pulse pressure (P�0.006). Models that included two BP components

demonstrated that CRAE decreased (P�0.035) with systolic (peripheral

vs. central, -2.87 vs. -2.40) and diastolic (-1.58 vs. -1.80) BP. CRAE

decreased with mean BP (-3.53 vs. -3.53; P<0.0001), but not with pulse

pressure (P�0.19). CRVE was not related to any peripheral or central

BP component (P�0.062). All CRAE regression slopes on corresponding

peripheral and central BP components were similar (P�0.28). In conclu-

sion, higher systolic, diastolic and mean BPs were associated with smaller

CRAE, regardless of whether BP was measured centrally or peripherally.

Central BP does not refine the inverse association of CRAE and CRVE

with peripheral BP.

Keywords: central blood pressure; microcirculation; retina; peripheral

blood pressure

P-138

Comparison of cardiovascular, renal, and mortality outcomes in

refractory, resistant, and general hypertension (HTN) populations

Simran K. Bhandari,1 Jiaxiao Shi,1 David Calhoun,2 John J. Sim.1 1KaiserPermanente Los Angeles Medical Center, Los Angeles, CA, United States;2University of Alabama at Birmingham, Birmingham, AL, United States

The resistant hypertension (RH) population is presumed to have higher risk

for target organ damage compared to the general hypertensive population.

The prognosis in those with RH as well as those with refractory HTN

compared to general HTN is not well described. We sought to compare

the risk of cardiovascular events, end stage renal disease (ESRD), stroke,

and mortality in individuals with RH, refractory HTN, and general HTN

within a large ethnically diverse HTN population.

A retrospective cohort study within the Kaiser Permanente Southern Cal-

ifornia health system in the period between 1/1/06 - 12/31/10 was per-

formed among individuals age � 18yrs with HTN and documented

blood pressures. Medication usage was determined by internal pharmacy

dispensation records. Resistant HTN was defined as a failure to achieve

blood pressure control (SBP � 140) while on 3 antihypertensive medica-

tions or requiring � 4 medications. Refractory HTN was defined as having

uncontrolled BP (SBP >/¼ 140) despite being on � 3 medications. The

risk for congestive heart failure (CHF) event, myocardial infarction (MI)

event, stroke event, ESRD (defined as need for dialysis or transplant),

and death were evaluated using cox proportional hazard modeling to calcu-

late hazard ratios (HR) adjusting for age, gender, race, BMI, eGFR, Charl-

son comorbidity index, and co morbidities.

Among 470,386 HTN individuals, 12.8% (N¼60,327) had RH. Within the

RH population, 37,223 (7.9% of all hypertensives) were refractory HTN

and 23,104 were non refractory RH. Average blood pressure of the entire

HTN population was 133/75 and 154/79 among the refractory HTN pop-

ulation. RH and refractory HTN were noted to have greater prevalence

of pre-existing CHF, stroke, ischemic heart disease, chronic kidney dis-

ease, and DM. Compared to general HTN, RH had multivariate adjusted

HR (95% CI) of 1.16 (1.10,1.22) for ESRD, 1.01 (0.95,1.07) for stroke,

1.51 (1.43,1.59) for CHF, 1.21 (1.16,1.26) for MI, and 1.05 (1.02,1.09)

for death. Refractory HTN compared to general HTN had HR (95% CI)

of 1.45 (1.39,1.52), 1.24 (1.18,1.30), 1.42 (1.35,1.5), 1.26 (1.21,1.31),

and 1.06 (1.03,1.09) for ESRD, stroke, CHF, MI, and death respectively.

In comparing refractory HTN to non-refractory RH, multivariate adjusted

HR (95% CI) were 1.25 (1.18,1.33), 1.23 (1.14,1.31), 0.95 (0.89,1.01),

1.04 (0.99,1.10), and 1.01 (0.97,1.05) for ESRD, stroke, CHF, MI, and

death respectively.

Among our large ethnically diverse hypertension population, we observed

that refractory HTN and RH had greater risk for cardiovascular, renal, and

mortality outcomes compared to general HTN. Stroke risk was only

increased in those with refractory HTN supporting the strong association

with blood pressure and stroke.

Keywords: Resistant Hypertension; Refractory Hypertension; Cardiovas-

cular Outcomes; End Stage Renal Disease

P-139

Compliance with antihypertensive therapy: needing a knot in a

handkerchief

Aurelio Leone,1 Linda Landini.2 1Medical Research, Castelnuovo Magra,

Italy; 2University of Pisa, Pisa, Italy

Background: The control of blood pressure (BP) in hypertensive subjects

requires compliance as high as possible to therapy by patients (pts) to

e83Abstracts / Journal of the American Society of Hypertension 8(4S) (2014) e81–e91

reach an optimal BP control and reduce cardiovascular complications.

However, to date, it would seem that the results are unsatisfactory in

this regard.

Purpose of the study: The purpose of this paper is to conduct a meta-anal-

ysis of different reports to clarify the compliance of hypertensive pts to

therapy.

Material and methods: This meta-analysis study was conducted by

random sampling of different studies by using Medline, PubMed and EM-

BASE to determine the compliance of hypertensive pts to antihypertensive

therapy. 10 cohort and case-control studies, part of them conducted retro-

spectively, included a total of 13,653 pts from year 1996 to the year 2010.

The degree of compliance of different therapies was recorded and classi-

fied as unsatisfactory when it was less than 80% and good or optimal

when values ¼> 80% were observed.

Results: Compliance to therapy varied from 25% to 85% with a mean of

53% and median value of 50. Higher compliance was seen only in 2

studies, respectively 80% and 85%, concerning, paradoxically, elderly

pts who were more compliant than the younger. Mean systolic and dia-

stolic BP were significantly lower in the compliant pts than in the non-

compliant group with a mean reduction respectively of 18 mmHg vs 9

mmHg for systolic BP (P<0.01) and of 8.3 mmHg vs 4.1 mmHg for dia-

stolic BP (P<0.01). Both estimates were statistically significant.

Conclusions: An unsatisfactory compliance with antihypertensive therapy

characterizes a large majority of hypertensive pts. Metaphorically

speaking, hypertensive pts should make a tie a knot to keep in mind the

proper intake of antihypertensive drugs and, therefore, improve the control

of their BP.

Keywords: Antihypertensive therapy; Compliance

P-141

Estimation of 24-hour sodium, potassium and albumin excretion

from spot urine samples in a national representative survey of

hypertension (PHYSA)

Jorge Polonia,2 Luis Martins,1 Fernando Pinto,1 Jose Nazare.3

1CHEDV, Epe, Santa Maria Feira, Portugal; 2Faculdade Medicina

Porto, Matosinhos, Portugal; 3Hospital Egas Moniz, Lisboa,

Portugal

The 24-hour urine collection is the standard method for sodium (UNa24h)

and albumin (UAE24h) excretion but is difficult to be performed in prac-

tice. Within a large national representative hypertension survey (n¼3720)

we evaluate the accuracy of predicting UNa24h, UK+24h and UAE24h

from a spot urine sample in which we calculate the urine Na/creatinine,

K/ creatinine and albumine/creatinine ratios and then corrected for 24-

hour creatinine excretion. Comparisons were made with real 24-h urinary

samples validated by urinary creatinine (n¼2538). Predicted UNa24h from

spot (average 268�65 mEq/24h) correlated (r¼0.232, p<0.01) with real

UNa24h (average 182�64 mEq/24h) but overestimated it by 47.3%. (by

151.1%, 77.5% 12.1% for UNa24h 200 mEq/24h, respectively). The

spot sample identified persons with UNa excretion <100 mEq/d or

<150 mEq/d with sensitivities of 5 and 2 % and specificity of 78 and

97% respectively. Predicted UK+24h (average 98�34 mEq/24h) correlated

(r¼0.121, p<0.01) with real UK+24h (average 75�26 mEq/24h) and over-

estimated it by 32.9%. UAE24h predicted from spot (23.8�146.3 mg/24h).

correlated (r¼0.890, p<0.001) with real UAE24h (16.1�50.7 mg/24h).

This spot sample identified persons with microalbuminuria (UAE24h

>¼30 mg/24h) with a sensitivity of 44.4 % and specificity of 96.4%. Ac-

curacy of spot urine samples is acceptable to assess 24-h microalbuminuria

but not reliable to predict 24-h sodium and potassium excretion and for as-

sessing sodium and potassium intake.

Keywords: Urinary sodium excretion; 24-h urinary samples; spot urinary

samples; Hypertension national survey

P-142

Estimation of the predictive value for hypertension of different

indices of obesity in the scope of a national representative survey of

hypertension (PHYSA)

Jorge J. Polonia,2 Luis Martins,1 Fernando Pinto,1 Jose Nazare.31CHEDV, Epe, Santa Maria Feira, Portugal; 2Faculdade Medicina Porto,

Matosinhos, Portugal; 3Hospital Egas Moniz, Lisboa, Portugal

Different indices have been used to define obesity. We assessed the rela-

tionship between body mass index (BMI), waist circumference (WC), in-

dex of body adiposity (IBA), waist/height index (W/H), body shape index

(BSI) with both hypertension (HT) and cardiovascular co-morbidities

within a national survey of prevalence of hypertension. Subjects, were

3720 (18-90 years old, 52.6% women) representatives of the national adult

population. Prevalence of HT was 42.2%, of diabetes was 10,2% and of

dyslipidemia 33,2%. Obesity prevalence was 22.4% (BMI �30 Kg/m2)

or 32,2% (waist � 88cm fem � 104 cm male). Mean values (�SD)

were BMI (27.3�4.9 Kg/m2), WC (92.3�13.8 cm), IBA (31.6�6.5), W/

H (0.57�0.09). Systolic blood pressure (BP) correlated more strongly

with BMI (r¼0.364), with WC (r¼0.365) and with W/H (r¼ 0.368) all

p< 0.0001 than with IBA (r¼0.174) or BSI (r¼0.188). Obesity on BMI

and on WC vs non-obesity was associated with 3.7 times more diabetes,

with 1.7 and 2.1 times more coronary disease, with 2.1 times more cardiac

failure, with 1.9 and 2.7 times more stroke, with 1.8 and 2.3 times more

dyslipidemia and with 2.6 and 2.5 times more hypertension. Logistic

regression analysis was conducted using odds ratios (OR) with 95% CI.

BMI and WC were significant predictors of hypertension and dyslipidemia.

Obesity on BMI was a better slight predictor (OR ¼ 4.43) for HT than WC

(OR ¼ 3.85) while obesity on WC (OR ¼ 2.58) was slightly superior to

BMI (OR ¼ 1.58) in predicting adverse lipid profiles. Obesity on BMI

is more closely associated with hypertension, while obesity on WC is

more closely associated with dyslipidemia. Additional indices of obesity

beyond BMI or WC have no advantage for predicting HT or dyslipidemia

Keywords: Hypertension PHYSA; Obesity indices; National Survey

P-143

Health inequalities in a canadian population with hypertension in

primary prevention

Alain Vanasse,1 Lyne Cloutier,2 Josiane Courteau,1 Shabnam Asghri,1

Denis Leroux.2 1Universit�e de Sherbrooke, Sherbrooke, QC, Canada;2Universit�e du Qu�ebec �a Trois-Rivi�eres, Trois-Rivi�eres, QC, Canada

Prevalence, incidence, treatment, mortality and morbidity for primary pre-

vention of cardiovascular disease (CVD) in the hypertensive (HTN) popu-

lation have been largely studied in the past but few have examined the

influence of neighbourhoods on health indicators. The objectives of the

study were to measure and compare, for that specific population, the prev-

alence, mortality and morbidity, the use of medical resources and HTN

drug treatments, according to the level of material and social deprivation

in regard to the place of residence. This is a secondary analysis of a med-

ico-administrative database from the R�egie de l’assurance maladie du

Qu�ebec. The cohort consists of 276,793 people 30 and older, diagnosed

with HTN between 2006 and 2007 with no history of CVD. Health indica-

tors were: prevalence, death, CVD events, medical consultations (family

physicians and specialists), emergency visits, and the use of antihyperten-

sive drugs (overall and by drug class). Twenty five types of residential

neighbourhoods were obtained by combining material and social depriva-

tion quintiles. This study demonstrates significant changes in some health

indicators according to material and social deprivation of the