Therapeutic drug monitoring (TDM) of immunosuppressants (IMS) is crucial to prevent rejection or toxicity after solid organ transplantation. Microsampling techniques (sampling <50 μL of blood) can be a good alternative to conventional venous sampling for TDM, due to their numerous advantages, including its easy and low-invasive sampling, enabling self-collection, and cost-saving shipment and storage. Furthermore, volumetric absorptive microsampling (VAMS) enables the collection of precise and accurate blood volumes, overcoming the hematocrit (Hct) effect related to dried blood spots, while offering the same benefits. In this work, an LC–MS/MS method for the determination of the 5 most common IMS (mycophenolic acid -MPA-, tacrolimus -TAC-, sirolimus -SIR-, everolimus -EVE- and cyclosporin A -CsA-) in venous blood collected with Mitra™ VAMS devices was developed and validated, employing a novel LC–MS/MS interface, Unispray™. The method was fully validated including linearity, limits of detection (LOD) and quantification (LLOQ), accuracy, precision, selectivity, carry-over, matrix effect, recovery, impact of Hct on recovery and autosampler and short-/long-term stability, satisfying acceptance criteria in all cases. LLOQs were 0.5 ng/mL for TAC, SIR and EVE, 20 ng/mL for CsA and 75 ng/mL for MPA. No impact of the Hct (range: 0.2 to 0.62 L/L) on recovery was found for any analyte. All compounds were stable in VAMS for at least 8 months at −20 °C. In addition, as part of the VAMS analytical method validation, we performed for the first time a broad statistical study to compare liquid venous blood concentrations from patients under TAC (n = 53) and MPA (n = 20) treatment to those observed when the same specimens were absorbed into VAMS. Our results showed that venous blood VAMS concentrations were correlated to those found in the original liquid venous blood, proving that the VAMS material itself will not bias blood drug concentrations. Therefore, the present method could be applied to evaluate possible correlations between venous blood and capillary blood collected with VAMS.

BACKGROUND AND OBJECTIVE:Cardiovascular (CV) risk stratification is a highly complex process involving an extensive set of clinical trials to support the clinical decision-making process. There are many clinical conditions (e.g. diabetes, obesity, stress, etc.) that can lead to the early diagnosis or establishment of cardiovascular disease. In order to determine all these clinical conditions, a complete set of clinical patient analyses is typically performed, including a physical examination, blood analysis, electrocardiogram, blood pressure (BP) analysis, etc. This article presents a web-based system, called Hydra, which integrates a full and detailed set of services and functionalities for clinical decision support in order to help and improve the work of clinicians in cardiovascular patient diagnosis, risk assessment, treatment and monitoring over time.METHODS:Hydra integrates a number of different services: a service for inputting all the information gathered by specialists (physical examination, habits, BP, blood analysis, electrocardiogram, etc.); a tool to automatically determine the CV risk stratification, including well-known standard risk stratification tables; and, finally, various tools to incorporate, analyze and graphically present the records of the ambulatory BP monitoring that provides BP analysis over a given period of time (24 or 48 hours). In addition, the platform presents a set of reports derived from all the information gathered from the patient in order to support physicians in their clinical decisions.RESULTS:Hydra was tested and validated in a real domain. In particular, internal medicine specialists at the Hypertension Unit of the Santiago de Compostela University Hospital (CHUS) validated the platform and used it in different clinical studies to demonstrate its utility. It was observed that the platform increased productivity and accuracy in the assessment of patient data yielding a cost reduction in clinical practice.CONCLUSIONS:This paper proposes a complete platform that includes different services for cardiovascular clinical decision support. It was also run as a web-based application to facilitate its use by clinicians, who can access the platform from any remote computer with Internet access. Hydra also includes different automated methods to facilitate the physicians' work and avoid potential errors in the analysis of patient data.

“White-coat” effect designs those hypertensive subjects with “uncontrolled” office Blood Pressure (BP) but normal BP values when assessed by Ambulatory BP Monitoring (ABPM) or home BP monitoring (HBPM). Cardiovascular Risk (CV) risk is lower than those with real uncontrolled BP but it still remains unclear if it is comparable to those well controlled hypertensive subjects. This paper presents the study, the results and the web platform that was designed and implemented which make possible the study of the “White-coat” effect as a subclinical target organ damage. The large amount of information that needs to be gathered, calculated and analyzed makes specially complicated, even almost inviable, the development of the study by traditional manual routine. This motivated the implementation of a platform that permitted the doctors make the study with guarantees. The implemented web platform organizes the information of the patients, presenting all the necessary information for the study, including physical and clinical parameters or 48-h ABPM processing. It also automatically estimates glomerular filtration rate by MDRD equation (GFR) and Sokolow-Lyon criteria for left ventricular hypertrophy (LVH) as well as different statistics from the 48-h ABPM. The platform facilitates the doctor’s work avoiding large and tedious manual processes, minimizing the risk of possible miscalculations and analyzing all the information in a easier way. This framework helped the doctors to recognize the so called “ABPM effect”, and what is more important in the management of hypertensive subjects, it helps to better identify hypertensive subjects at poor cardiovascular prognosis.

Objective: The aim of this study was to identify cardiovascular risk factors in a cohort of hypertensive subjects over 70 years. Design and method: We designed a retrospective cohort study. The study population included 72 hypertensive patients over 70 years and they all underwent a complete annual medical examination from January 2011 to December 2014, including 48-hours blood pressure monitoring (ABPM) in order to exclude those with “white-coat” hypertension. They also underwent applanation tonometry to estímate central aortic blood pressure and carotid-femoral pulse wave velocity (PWV). Primary endpoint was the combination of fatal/non-fatal coronary heart disease or fatal/non-fatal stroke, or peripheral revascularization. All events were confirmed on the basis of medical records. Results: A total of 14 cardiovascular events were identified (6 fatal CV events, 3 acute coronary events, 3 acute congestive heart failure episodes and 2 ischemic strokes). There were not any differences between those subjects with or without any CV event regarding age, gender, body mass index, waist perimeter, office systolic/pulse pressure, central systolic BP or PWV. Both office and central diastolic BP were lower in those elderly hypertensive subjects with CV events (71.5 Vs 79.7 mmHg; p = 0.02 and 72.2 Vs 81.8 mmHg; p = 0.01, respectively). When taking into account 48-hour ABPM, we only found significant differences on pulse pressure, higher on those with CV events (67.4 Vs 59.6 mmHg). A multivariate analysis demonstrated that office dyastolic BP under 70 mmHg or central DBP under 75 mmHg were risk factor for the occurrence of fatal/non fatal CV events (RR: 1.78; 95%CI: 1.08–2.93 and RR: 1.57; 95%CI: 1.061–2.53, respectively). Conclusions: We conclude that those hypertensive subjects over 70 years with low office or central diastolic BP had worse cardiovascular prognosis. We suggest 70 mmHg as a valid diastolic BP treshold that below which survival is impaired.

Objective: It has been recently reported that overweight (BMI: 25–30 kg/m2) associates to lower any cause-mortality whereas mild obesity (BMI: 30–35 kg/m2) does not associate to higher mortality when compared to normal-weight. The aim of this study was to assess subclinical target organ damage prevalence and cardiovascular prognostic value of mild-obesity in a cohort of hypertensive subjects. Design and method: We designed a retrospective cohort study. The study population included 381 hypertensive patients with BMI < 35, they all underwent a complete annual medical examination from January 2011 to December 2014, including 48-hours blood pressure monitoring (ABPM) in order to diagnose those with WC effect. Following examinations were held: carotid artery ultrasound with intima/media thickness (IMT), carotid femoral PWV by Sphygmocor At Cor® and oscillometric measurement of ABI. Blood and urine samples were used for the determination of glomerular filtration rate by MDRD equation (GFR) and Sokolow-Lyon criteria for left ventricular hypertrophy (LVH). Primary endpoint was the combination of fatal/non-fatal coronary heart disease or fatal/non-fatal stroke, or peripheral revascularization. All events were confirmed on the basis of medical records. Results: The overall prevalence rates of normal-weight (mean age: 48.8 years) and mild-obesity (mean age: 58.4 years) were 56.7 and 43.3%, respectively. We didn[Combining Acute Accent]t find difference on gender but on waist perimeter, office pulse pressure, 48hour-dyastolic BP and nocturnal blood pressure falling. Regarding TOD prevalence, GFR was higher on normal-weight subjects (84.3 Vs 78.9 ml/min/1.72 m2), PWV lower (8.7 Vs 10.4 m/sec) and also lower IMT (0.76 Vs 0.85 mms). So TOD prevalence among normal weight hypertensive subjects was 27.3% (Vs 51.5%). A total of 13 cardiovascular events were identified: six on normal weight hypertensive subjects (5.2%) and seven on mild-obesity subjects (4.5%). Multivariate analysis didn’t demonstrate higher CV risk on mild-obesity hypertensive patients. Conclusions: Comparing both hypertensive groups, even taking into account higher mean age on mild-obesity group, we did not find differences on CV events incidence rate. Nevertheless, we found higher prevalence of impaired nocturnal BP falling and also subclinical TOD prevalence when mild-obesity.

Objective: The aim of this study was to assess circadian blood pressure pattern and nocturnal hypertension prevalence in those hypertensive subjects with mild-moderate chronic kidney disease. Design and method: A cross-sectional study was conducted among a cohort hypertensive subjects over 18 years old. BP was measured by ambulatory monitoring (ABPM) every 20 min between 07:00 am and 23:00 pm and every 30 min at night, along 48 hours with a Spacelabs 90207 device. The following variables were analysed: age, sex, body mass index (Quetelet), office systolic blood pressure (SBP), office diastolic blood pressure (DBP), 48h-systolic and 48h-dyastolic mean ambulatory blood pressure (48h-SBP and 48h-DBP), 48 h nocturnal systolic and diastolic blood pressure falling. Patients underwent glomerular filtration rate (GFR) as calculated by Modification of Diet in Renal Disease (MDRD), urinary albumin excretion rate (UAER) and microalbuminuria -MAL-. Subjects with advanced renal impairment (CKD stage 5) were excluded. Results: 222 subjects with essential hypertension were included, 160 with preserved renal function and 62 with renal function impairment (CKD-2: 17; CKD-3a: 37; CKD-3b: 6; CKD-4: 2). We didn[Combining Acute Accent]t find any differences on gender, age, weight, body mass index, heart rate or office diastolic BP. Office systolic BP, office pulse pressure and 48h-SBP were higher on those with any stage of CKD. And also regarding nocturnal SBP and nocturnal BP falling, so 74.2% of subjects with CKD had nocturnal hypertension (Vs 57.5%) and 58.1% were “no dipper” (Vs 43.7%). Any subclinical TOD prevalence was higher on those with CKD (85.5% Vs 55.6%), and this difference kept on significant if we only took into account those with mild CKD (stage 2). Conclusions: Even when mild to moderate CKD, office and ambulatory systolic BP is higher if compared to hypertensive subjects with preserved renal function. Moreover, CKD associates to higher nocturnal hypertension prevalence and lower nocturnal systolic BP falling, so a non-dipper circadian BP pattern is more frequent. We suggest both represent potential underlying process of increased cardiovascular risk in that population (even those with mild renal dysfunction).

Objective: “White-coat” (WC) effect designs those hypertensive subjects with “uncontrolled” office blood pressure (BP) but normal BP values when assessed by ambulatory BP monitoring (ABPM) or home BP monitoring (HBPM). Cardiovascular risk (CVR) is lower than those with real uncontrolled BP but it still remains unclear if it is equiparable to those well controlled hypertensive subjects. The aim of this study was to assess the prognostic CVR value of WC effect regarding subclinical target organ damage (TOD) in a cohort of hypertensive subjects. Design and method: We designed a retrospective cohort study. The study population included 344 hypertensive patients and they all underwent a complete annual medical examination from January 2011 to December 2014, including 48-hours blood pressure monitoring (ABPM) in order to diagnose those with WC effect. Following examinations were held: carotid artery ultrasound with intima/media thickness (IMT), carotid femoral PWV by Sphygmocor At Cor® and oscillometric measurement of ABI. Blood and urine samples were used for the determination of glomerular filtration rate by MDRD equation (GFR) and Sokolow-Lyon criteria for left ventricular hypertrophy (LVH). Results: WC effect was present on one fifth of subjects (n: 69; 20.1%). When compared with “well controlled” hypertensive subjects (n: 75; 21.8%), we didn[Combining Acute Accent]t find any differences on gender, age, body mass index or nocturnal blood pressure falling. There were greater incidence on LVH incidence rate (21.7 Vs 7.7%) and PWV (11.3 m/sec Vs 9.5 m/sec). We didn[Combining Acute Accent]t find significant differences regarding ABI, IMT or GFR. Finally, estimated risk of any TOD was over 60% (RR: 2.23; 95%CI: 1.3–3–8) when WC effect was present (Vs 41.1% on well controlled hypertensive subjects). Conclusions: Those hypertensive subjects with WC effect had higher incidence rate of subclinical TOD tan those with well controlled blood pressure. We suggest that both ABPM and HBPM help us to better identify hypertensive subjects at poor CV prognosis.

Objective: It has been recently reported that overweight (BMI: 25–30 kg/m2) associates to lower any cause-mortality whereas mild obesity (BMI: 30–35 kg/m2) does not associate to higher mortality when compared to normal-weight. The aim of this study was to assess subclinical target organ damage prevalence and cardiovascular prognostic value of mild-obesity in a cohort of hypertensive subjects. Design and method: We designed a retrospective cohort study. The study population included 381 hypertensive patients with BMI < 35, they all underwent a complete annual medical examination from January 2011 to December 2014, including 48-hours blood pressure monitoring (ABPM) in order to diagnose those with WC effect. Following examinations were held: carotid artery ultrasound with intima/media thickness (IMT), carotid femoral PWV by Sphygmocor At Cor® and oscillometric measurement of ABI. Blood and urine samples were used for the determination of glomerular filtration rate by MDRD equation (GFR) and Sokolow-Lyon criteria for left ventricular hypertrophy (LVH). Primary endpoint was the combination of fatal/non-fatal coronary heart disease or fatal/non-fatal stroke, or peripheral revascularization. All events were confirmed on the basis of medical records. Results: The overall prevalence rates of normal-weight (mean age: 48.8 years) and mild-obesity (mean age: 58.4 years) were 56.7 and 43.3%, respectively. We didn[Combining Acute Accent]t find difference on gender but on waist perimeter, office pulse pressure, 48hour-dyastolic BP and nocturnal blood pressure falling. Regarding TOD prevalence, GFR was higher on normal-weight subjects (84.3 Vs 78.9 ml/min/1.72 m2), PWV lower (8.7 Vs 10.4 m/sec) and also lower IMT (0.76 Vs 0.85 mms). So TOD prevalence among normal weight hypertensive subjects was 27.3% (Vs 51.5%). A total of 13 cardiovascular events were identified: six on normal weight hypertensive subjects (5.2%) and seven on mild-obesity subjects (4.5%). Multivariate analysis didn’t demonstrate higher CV risk on mild-obesity hypertensive patients. Conclusions: Comparing both hypertensive groups, even taking into account higher mean age on mild-obesity group, we did not find differences on CV events incidence rate. Nevertheless, we found higher prevalence of impaired nocturnal BP falling and also subclinical TOD prevalence when mild-obesity.

In the UK, low-intensity cognitive-behavioural therapy (LICBT) is offered as cost-effective intervention for anxiety and depression in primary care. Whilst research with Latino migrants in the USA highlights the suitability of CBT interventions with this group, these findings may not be generalisable to the UK, due to different sociopolitical circumstances. This mixed-method study explores the effectiveness and meaning of an LICBT group-intervention for Latino migrants in London. Eight participants attended a four-week workshop on anxiety management in Spanish, and pre- and post-intervention scores in CORE-OM, PHQ-9 and GAD-7 were compared. Additionally, focus groups about the intervention were thematically analysed. Although not statistically significant, a trend towards decreasing anxiety levels was identified (p = 0.06). Three of the four themes generated from participants' analysis of their experience are summarised and discussed. These include positive aspects of the intervention and its limitations. Whilst valuing LICBT interventions, participants considered further input necessary. Potential clinical implications as well as recommendations for further research are discussed.

Objective: Tonometric pulse wave velocity (PWV) has been validated as a non-invasive method for arterial stiffness evaluation. On the other hand, it has been reported the relationship between increased target organ damage and non dipping nocturnal blood pressure. The objective was to assess the relationship between nocturnal blood pressure decline and PWV in those elderly hypertensive subjects. Design and methods: 75 subjects with essential hypertension were included, 72.81 ± 4.38 years old (49.3% female). BP was measured by ambulatory monitoring every 20 min between 07:00 am and 23:00 pm and every 30 min at night, throughout 48 hours with a Spacelabs 90207 device. Carotid-femoral pulse wave velocity (PWV) was also measured as an index of aortic stiffness, by using the At Cor Medical device (Sphygmo Cor Px®, Vx®, Sydney, Australia) which uses a validated transfer function. Results: 48-hour systolic/diastolic blood pressure were 130/80 mmHg, Mean nocturnal blood pressure were 124.2/63.36 mmHg and nocturnal blood pressure falling of 7.55/12.45 mmHg. 29.5% of subjects were dipper; 6.4% very dipper and 47.4% non dipper (16.7% riser). PWV was 12.6 m/sec ± 3.1 m/sec. Nocturnal blood pressure directly correlates with PWV (r: 0.619; p < 0.001) and no correlation was observed between PWV and diurnal BP. Conclusions: Nocturnal blood pressure may help us to identify those hypertensive subjects with higher arterial stiffness, that is, higher cardiovascular risk. Further studies are neccessary in order to assess beneficial on lowering nocturnal blood pressure. Ambulatory blood pressure monitoring properly evaluates cardiovascular risk 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.

Objective: Several non-invasive markers of vascular lesions are available to detect cardiovascular disease in the preclinical stage, which is good for cardiovascular disease prevention. The objective was to investigate the usefulness of a range of indices of arterial wall stiffness as intima-media thickness (IMT), pulse wave velocity (PWV) and ankle-arm index (AAI), for identifying vascular damage in naive hypertensive subjects. Design and method: 54 subjects (48 ± 12.5 years old) with untreated essential hypertension were included. At Cor Medical device (Sphygmo Cor Px®, Vx®, Sidney, Australia) was used to derive carotid-femoral PWV. IMT and AAI were also assessed by ultrasound. Clinical, biological and electrocardiographic assessments were also performed to detect target organ damage. Results: Left ventricular hypertrophy, microalbuminuria or low glomerular filtration rate were found by primary care physicians in 22.22% of subjects. When submitted to the Cardiovascular Risk Unit, a more detailed functional vascular assessment was performed, including PWV, IMT or AAI measurements. PWV higher than 12 m/sec was found in 7.4%, IMT > 0.9 mms in 12.9% and AAI < 0.9 in 3.7 %. Thus, detection of target organ damage increased 14.81% of subjects after this functional vascular assessment. Conclusions: Functional vascular assessment may help us to identify hypertensive subjects with higher vascular stiffness, which may be related to increased cardiovascular morbidity and mortality. Some functional vascular parameters are currently not sufficiently widespread, but the information it provides remains desirable as the crucial role of subclinical organ damage in determining the cardiovascular risk of hypertensive subjects.

Background: Body weight (BW) reduction in obese patients favors blood pressure (BP) controls. Evidences have been accumulated mostly in western countries. In Japan, it is far less to see patients as obese as ones studied in those evidences. Distribution of BMI of Japanese is different from those in other countries. Relationship between BP & BW in Japan is to be elucidated. Study aim: This study aimed to clarify the relationship between BW and BP changes in normotensive Japanese women in 5 years. Methods: We retrospectively examined the data obtained in the annual health checks by Fukuoka Foundation of Sound Health, Fukuoka, Japan. A total of 10184 women (mean age: 45.0+-12.2) without anti-hypertensive medications and took health checks both in 2006 and 2011 were studied. We divided the subjects according to the changes of Body Mass Index (BMI) into 3 subgroups: Reduced (&Dgr;BMI=<-1.1), Stayed (-1.1<&Dgr;BMI<1.1) and Gained (1.1=<&Dgr;BMI). We examined the changes of BPs between 2006 and 2011. Results: The average of overall BMI was 21.1+-3.1. Subgroups contained subjects as follows: Reduced-BMI(n:1483), Stayed-BMI(n:6604), Gained-BMI(n:2097). Changes of BPs are: Reduced-BMI(119.1/72.1+-16.3/10.5 to 113.8/68.6+-16.6/10.9), Stayed-BMI(114.9/70.1+-11.3/9.5 to 112.7/68.1+-15.4/10.9), Gained-BMI(113.6/69.6+-14.4/9.6 to 114.3/69.6+-14.8/11.2) mmHg. All changes except for diastolic BP of Gained-BMI were significant at p=<0.005. Only the average systolic BP of Gained-BMI group rose significantly in 5 years. Conclusions: Gain of BMI significantly raised systolic BP in normotensive Japanese women in long term. A BW gain, even tough it stays within the normal range, should be dealt with caution.

s e245

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.

Objective: Increased arterial stiffness associates with cardiovascular mortality, and it is considered a further measurement of cardiovascular risk. Serum fibrinogen (SF) and erythrocyte sedimentation rate (ESR) may predict higher cardiovascular risk. The objective was to assess the relationship between SF levels, ESR and several arterial stiffness markers in untreated hypertensive subjects. Methods: 95 subjects with untreated essential hypertension were included, 47.73 ± 13.10 years old. At Cor Medical device (Sphygmo Cor Px®, Vx®, Sidney, Australia) was used to derive central systolic (cSBP), diastolic BP (cDBP), central pulse pressure (cPP), augmentation pressure (AP) and augmentation index (AIx75). Carotid-femoral pulse wave velocity (PWV) was also measured as an index of aortic stiffness. Results: Mean office BP was 150/94 mmHg and brachial PP was 58,91 ± 13.17 mmHg. Mean cSBP/c DBP were 140.63/92.58 mmHg, and cPP 48.05 mmHg. Mean AP was 14.96 mmHg and AIx75 was 27.46%. Mean PWV was 9.10 m/sec ± 1.98 m/sec. Mean SF levels were 390.32 ± 70.49, whereas ESR was 10.36 ± 9.27. Carotid-femoral PWV correlates with SF levels (R: 0.449; p = 0.07) and ESR (R: 0.271; p = 0.046). It also correlates with cPP (R: 0,315; p = 0.021) and AP (R: 0.316; p = 0.022). There was no correlation between ESR and several arterial stiffness markers as cSBP or cPP. Conclusions: Despite low specificity, fibrinogen correlates with several arterial stiffness markers as PWV, cPP or AP in subjects with untreated hypertension. Determination of ESR and SF levels would be a suitable and recommended assessment of cardiovascular risk in hypertensive subjects.

Objectives: Ambulatory monitoring of blood pressure (ABPM) is the best method to define the cardiovascular risk in hypertensive subjects. The objective is to analyse its prognostic value in a cohort of hypertensive subjects after a 12-year follow-up period. Methods: Cohort study in a non-selected sample of 432 hypertensive subjects without previous cardiovascular disease. Clinical-biological assessment and 24h-ABPM were 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. During the 12.5-year follow-up period, 174 events were reported, with an incidence rate (IR) of 4.68 events/100 subjects-year. 21 cases of PAD (IR: 0.56/100 subjects-year), 59 of CC (IR: 1.59/100 subjects-year), 56 of HF (IR: 1.50/100 subjects-year) and 38 of CVA (IR: 1.02/100 subjects-year) were observed. Diabetes (incidence rate ratio (IRR): 2.35 [1.74-3.18]), worsening renal function (IRR: 2.49 [1.85-3.37]) and microalbuminuria (IRR: 2.66 [1.96-30.37]) have influence on CV prognosis and increase the incidence of events. From ABPM data, both nocturnal BP (IRR: 2.32 [1.53-3.52]) and non-dipper (IRR: 3.56 [2.39-5.27]) and riser (IRR: 7.09 [4.64-10.86]) patterns had higher prognostic correlation. Conclusions: Nocturnal BP and decrease or loss of diurnal/nocturnal ratio of BP are related with a worse CV prognosis in hypertensive subjects, regardless of target organ subclinical damages, which confirms the importance of prognostic value of ABPM in diagnosis and treatment of hypertension.

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.