e 496 Journal of Hypertension Volume 33, e-Supplement 1, 2015
were performed at baseline and 6 months after TRD. On average, patients were
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Results: The secondary HTN was diagnosed in 29 patients (8,6%). In 45 (13,4%)
taking 4 (3–5) antihypertensive drugs. None of the patients changed the antihy-
pertensive and antidiabetic treatments during follow-up. A 6 months follow up
was completed by 27 patients (43–75 years old, mean aged 59.3 ± 7.9 years,
14 male).
Results: Renal denervation significantly reduced the systolic office BP (SBP)
(from 173.7 ± 20.8 to 149.9 ± 19.4mmHg, p < 0.001), as well as 24-h SBP (from
160.8 ± 18.4 to 147.9 ± 16.9mmHg, p < 0.01) after 6-month follow-up without any
negative effect on renal function. The number of responders with reduction of
SBP > 10mmHg according to office BP and ABPM were similar (18(67%)pts. vs.
15(56%)pts., p > 0.05). TRD significantly reduced the average HbA1c levels (from
6.9 ± 1.8% to 5.8 ± 1.5%, p = 0.04) and non-significantly reduced fasting glucose
levels (from 8.7 ± 2.8 to 7.7 ± 2.1, p = 0.07) after the 6-month procedure. Eleven
patients (41%) had improvement of glycemic control, 9 (23%) remained unchanged,
and 7 (26%) had deterioration. Conspicuously, the responders according to ABPM
had significantly higher mean dynamics of HbA1c than the non-responders (-
2.4 ± 1.9 and -0.1 ± 0.8%, p = 0.02, respectively).
Conclusions: Renal denervation of patients with true resistant hypertension and
diabetes mellitus type 2 after 6 months was followed by HbA1c reduction of the
responders and had no significant effect on glycemic control of non-responders.
FACTORS ASSOCIATED WITH RESISTANT
PP.40.12 HYPERTENSION
A. Faceira, J. Urbano, S. Pereira. Centro Hospitalar de São João, Porto,
PORTUGAL
Objective: To evaluate factors associated with resistant hypertension (rHTN) in
patients followed in a hypertensionś consultation.
Design and method: We selected a sample of all patients followed in a hyper-
tensionś consultation until December 2014, constituted by 102 patients. Data were
obtained on demographic variables, cardio and metabolic diseases, drugs, target
organ damage and blood pressure control. rHTN was defined as uncontrolled hyper-
tension this meaning systolic blood pressure equal to or greater than 140 mmHg
and/or diastolic blood pressure equal to or greater than 90 mmHg and the use of
three or more drugs, one being a diuretic. Statistical analysis was performed using
SPSS; we used the student t test for continuous variables and the chi-square test for
categorical variables. P < .05 was considered significant.
Results: In this sample, 53 (52.0%) were women and 55 (53.9%) were under 65
years. The hypertension was resistant in 54%, with similar prevalence in both gen-
ders and a higher prevalence in the elderly (68.1% vs 40.0%, p = .006). The rHTN
was more frequent in patients with type 2 diabetes (68.6% vs 44.8%, p = .036),
dyslipidemia (62.0% vs 32.3%, p = .009) and in those with statin use (62.2%
vs 22.6%, p < .001). Furthermore, rHTN is also more prevalent with the use of
NSAIDs (100% vs. 48.4%, p = .003), in patients with left ventricular hypertro-
phy, coronary heart disease, in those treated with acid acetylsalicylic and obese,
although in these last variables the results were not statistically significant. The
prevalence was similar in smokers and non-smokers, cerebrovascular, coronary
and kidney diseases, albuminuria and obstructive sleep apnea syndrome. The use
of spironolactone was more frequent in patients with rHTN (88.9% vs. 45.2%,
p = .001).
Conclusions: The prevalence of rHTN was of 54%, which in a way reflects the fact
that it is a hypertensionś consultation. In our population, the rHTN is associated
with advanced age, type 2 diabetes and dyslipidemia. Though such an association
would increase global cardiovascular risk, we didn’t find an increase prevalence of
target organ disease in those with rHTN, probably because of a more strict approach
with pharmacological and non-pharmacological measures.
LONG-TERM EFFECTIVENESS OF COMBINED
PP.40.13 ANTIHYPERTENSIVE TREATMENT OF RESISTANT
HYPERTENSION
I. Emelyanov, N. Avdonina, L. Korostovtseva, Y. Svityaev, N. Zvartau,
A.O. Konradi. Federal North-West Medical Research Centre, Saint
Petersburg, RUSSIA
Objective: To assess the long-term effectiveness of combined multiple antihyper-
tensive medications in ambulant patients with resistant hypertension (RHTN) during
5-years follow-up.
Design and method: We enrolled 336 uncontrolled hypertensive patients (98 males
and 238 females) 39 – 69 (the mean age 54 ± 3) years old, who followed up in
ambulatory HTN specialized center. The repeat “office” blood pressure (BP) mea-
surements, ambulatory BP monitoring (ABPM) were performed in all patients.
Obstructive sleep apnea (OSA) was suspected according to Berlin questionnaire and
subsequently confirmed by polysomnography. During further 3 - 6 month follow-
up correction of treatment regimen was performed. Repeat exams were conducted
every 6 - 12 months during 5-years follow- up.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
patients OSA was revealed, 34 (10,1%) patients had “white-coat” HTN. In 182
cases (55,3%) the main reasons of resistance of HTN were drug-related causes. 61
(33%) patients required the increase of the medication dosage. 73 (39,9%) patients
had poor compliance. Therapeutic inertia can be regarded as the leading cause
of inadequate control of BP in 48 patients. During 3-monts of follow-up “office”
BP decreased significantly from 162 ± 8 /98 ± 5 mm Hg to134 ± 4/86 ± 2 mm Hg
(P < 0.001).
Thus, true RHTN was found in 46 patients (12,6%). Modifications of treatment reg-
imen included addition of spironolactone in 25–50 mg/d and/or increases calcium
blockers and renin-angiotensin system blockers dosages. Only 8 (17,4%) patients
with true RHTN did not achieve goal BP in 12 months follow up. Among them 1
patient with RHTN died due to intracerebral hemorrhage, 1 patient had a stroke,
2 – transient ischemic attack, 2 – permanent atrial fibrillation. We also registered
1 case of successful coronary revascularization,1 transcutaneous coronary stenting
due to acute coronary syndrome and 2 cases of newly diagnosed diabetes mellitus
during the study.
Conclusions: The most frequent reason of RHTN appears to be drug-related fac-
tors in ambulatory hypertensive patients. “True” resistance to treatment is rather
infrequent cause of insufficient BP control.
In the most cases resistance to treatment can be overcome by treatment inten-
sification. Insufficient control of BP in RHTN associates with cardiovascular
complications.
LEPTIN AND LEPTIN RECEPTOR GENE
PP.40.14 POLYMORPHISMS ARE ASSOCIATED WITH CLINICAL
AND METABOLIC PARAMETERS IN RESISTANT
HYPERTENSION
A. De Faria, R. Modolo, A. Ritter, A. Sabbatini, N. Barbaro, N. Corrêa,
V. Brunelli, H. Moreno. University of Campinas, Department of
Pharmacology, Campinas, BRAZIL
Objective: Resistant hypertension (RH) is a multifactorial and polygenic condition
frequently associated with metabolic disorders such as obesity and diabetes. Leptin
– a hormone produced by adipose tissue – has been related to the lack of blood
pressure control as well as target organ damage in RH subjects. Moreover, single-
nucleotide polymorphisms (SNPs) rs7799039 and rs1137101 in leptin (LEP) and
leptin receptor (LEPR) coding genes, respectively, were associated with cardiovas-
cular disease and metabolic syndrome. This study evaluated the association of these
two SNPs -2548G/A and + 668A/G with clinical and biochemical features in RH
subjects.
Design and method: This cross-sectional study comprised 60 RH patients geno-
typed for both polymorphisms by Real-time Polymerase Chain Reaction method
using fluorescent TaqMan probes. We compared GG (n = 46) vs. AA (n = 14) for
rs7799039 and AA (n = 34) vs. GG (n = 26) genotypes for rs1137101. Leptin lev-
els were measured by ELISA and bioimpedance estimated the body composition.
Target organ damages were determined by echocardiography, pulse wave velocity
(PWV) and microalbuminuria.
Results: The both SNPs did not change leptin levels. On the other hand, LEP SNP
modulated the levels of glycated hemoglobin (6.4 ± 1.4 vs.7.8 ± 2.3 %, p = 0.03),
insulin (8.6 ± 4.6 vs. 30.6 ± 27.7 uUI/mL, p = 0.01), HDL-cholesterol (51 ± 16 vs.
39 ± 11 mg/dL, p = 0.001) and PWV (9.5 ± 2.1 vs. 11.2 ± 2.8 m/s, p = 0.03). As the
same way, LEPR SNP modulated heart rate (69 ± 12 vs. 67 ± 12 bpm, p = 0.03),
fat mass (31 ± 11 vs. 24 ± 8 Kg, p = 0.03) and triglycerides levels (175 ± 69 vs.
135 ± 75 mg/dL, p = 0.03).
Conclusions: The -2548G/A and +668A/G modulated some clinical and biochem-
ical traits in RH subjects, although were not associated with leptin levels.
ONE KIDNEY, TWO ARTERIES... A COMPLICATED
PP.40.15 HYPERTENSION STORY
A. Daraban 1,2 , D. Deleanu 3 , I. Arsenescu 3 , C. Scheau 2,4 , C. Ginghina 2,3 ,
R. Jurcut 2,3 . 1 Clinical Emergency Hospital, Internal Medicine Department,
Bucharest, ROMANIA, 2 Carol Davila University of Medicine and
Pharmacy, Bucharest, ROMANIA, 3 C.C. Iliescu Emergency Institute for
Cardiovascular Diseases, Bucharest, ROMANIA, 4 Fundeni Clinical
Institute, Radiology Department, Bucharest, ROMANIA
Objective: To present a case of renovascular hypertension (HTN) emphasising the
long road to reaching blood pressure (BP) targets in resistant HTN.
Design and method: We report a case from a Tertiary University Hospital with a
complicated refractory HTN.
Results: A 61 years-old patient is admitted for severe HTN. He has a 30 years
history of HTN and is dyslipidemic. Two years ago he underwent thorough eval-
uation for a secondary cause of HTN and a right renal artery (RA) occlusion with
a small non-functional kidney were found on ultrasound. Right nephrectomy was