Objective: Atrial fibrillation (AF) is common arrhythmia in hypertensive patients. Besides hypertension, several other conditions are deemed to be associated with AF. High blood homocysteine levels (hyperhomocysteinemia) is a known risk factor for cardiovascular disease and are associated with vitamin B12 deficiency that possibly increase cardiovascular risk, as well. The present study assessed the possible effect of high homocysteine and low B12 levels on AF prevalence in hypertensive patients. Design and method: This retrospective study comprised all hypertensives referred to our institutions and had a blood sample measurement of homocysteine and B12 (n = 32800). The presence of sustained AF (SAF; Long-standing/Persistent or Permanent AF) was recorded with a resting electrocardiogram (ECG). Paroxysms of AF (PAF) were confirmed with previous relevant ECGs provided by the patient. The population was divided in quartiles according to homocysteine levels (groups 1, 2, 3 and 4 for increasing levels) and B12 levels (groups 1, 2, 3 and 4 for decreasing levels). The prevalence of AF (SAF and PAF) was calculated for each homocysteine and B12 quartile group as well as for each of the 16 homocysteine/B12 combination quartile subgroups. Results: The mean values for homocysteine were 13.3 ± 7.2 ?mol/l and for B12 525 ± 196 pg/ml. The prevalence of SAF, PAF and all-type AF (SAF and PAF) was 5.0%, 6.1% and 11.1%, respectively. For homocysteine quartiles 1, 2, 3, 4, SAF prevalence was 2.9%, 5.3%, 11.7%, 24.3% (pfor trend 0.049), PAF prevalence was 0.6%, 0.9%, 4.6%, 14.0% (pfor trend 0.090) and all-type AF prevalence was 3.2%, 5.4%, 11.5%, 22.2% (pfor trend 0.051), respectively. For B12 quartiles 1, 2, 3, 4, SAF prevalence was 2.9%, 6.4%, 11.0%, 20.2% (pfor trend 0.030), PAF prevalence was 2.5%, 5.1%, 7.7%, 9.0% (pfor trend 0.009) and all type-AF prevalence was 2.4%, 7.1%, 16.8% 21.0% (pfor trend 0.019), respectively. The synergistic effect of increasing homocysteine and decreasing B12 values on SAF, PAF and all-type AF prevalence is presented in Figure. Conclusions: High homocysteine levels and low vitamin B12 levels are individually and synergistically associated with the prevalence of AF in hypertensive individuals. Underlying mechanisms merit further examination.

High homocysteine levels and low vitamin B12 levels are individually and synergistically associated with the underlying CV and stroke risk of hypertensive individuals. Possible mechanisms merit further examination.

Abstract Background/Introduction Nocturnal blood pressure (BP) dipping status, defined by the night-to-day BP ratio, has been correlated with the cardiovascular (CV) risk in patients with arterial hypertension. The risk is higher in those with less than normal or no drop in nocturnal BP while data in extreme dippers are inconsistent. On the other hand, white-coat hypertension (WCHT), defined as an elevated office BP despite a normal out-of-office BP, is characterized by a lower CV risk than that of sustained hypertension and rather comparable with that of true normotension. Purpose The present study assessed the possible relation between the nocturnal BP dipping status and the underlying CV risk in WCHT individuals. Methods Among all individuals examined in our outpatient anti-hypertensive units over the past 15 years, 2310 (42% men, 52.2±13.1 years of age) were diagnosed with WCHT (increased office BP: 156.4±10.0/99.6±6.2 mmHg and normal 24-hour ambulatory BP: 122.4±6.3/75.3±5.4 mmHg) and were enrolled in the study. A night-to-day BP ratio (from the 24-hour ambulatory BP monitoring) 0.8–0.9 defined Normal nocturnal BP Dipping, <0.8 Extreme Dipping, 0.9–1 Mild Dipping and >1 Absence of Dipping. The underlying 10-year CV risk of death in the studied population was calculated with the Hellenic version of the HeartScore (Hellenic Score), as proposed by the current 2018 European Society of Hypertension guidelines, based on age, gender, smoking status, systolic BP and total cholesterol levels. Results From 2310 individuals studied, 1208 (52.3%) were found with Normal Dipping, 386 (16.7%) with Extreme Dipping, 622 (26.9%) with Mild Dipping and 94 (4.1%) with Absence of Dipping. Hellenic Score was 3.21±4.67% in subjects with Normal Dipping, 3.49±4.97% in those with Extreme Dipping, 3.66±5.04% in those with Mild Dipping, 6.21±7.29%, in those with Absence of Dipping (p for trend<0.05) and 3.50±4.99% in the whole cohort of the studied population. Conclusions Nocturnal BP dipping status is closely associated with the underlying CV risk of WCHT individuals. Extreme Dipping, Mild Dipping and especially Absence of Dipping increase CV risk thus necessitating closer follow-up of these individuals and possibly faster initiation of BP-lowering drug treatment.

Objective:Nocturnal blood pressure (BP) dipping status, defined by the night-to-day BP ratio, has been correlated with the cardiovascular (CV) risk in patients with arterial hypertension. The risk is higher in those with less than normal or no drop in nocturnal BP while data in extreme dippers are i

Objective: Target organ damages (TODs) are common in hypertensive patients especially when an impaired glycaemic profile co-exists. Both hypertension and impaired glycaemic profile cause kidney damage that brings on anaemia. This study examined the prevalence of TODs (left ventricular hypertrophy, LVH and microalbunimuria) in hypertensives according to their glycaemic profile and the presence/absence of anaemia. Design and method: The study comprised 20236 hypertensives (57.4 ± 13.9 years, 165.2 ± 10.9/99.7 ± 9.0 mmHg). A 2-hour post-load plasma glucose (mg/dl) < 140 defined normal glycaemic profile (NGP), 140–199 impaired glucose tolerance (IGT) and > 199 diabetes. Haemoglobin (g/dl) < 13 in men; < 12 in women defined anaemia. Left ventricular mass index (LVMI, g/m2) > 115 in men; > 95 in women defined LVH. Albumin-to-creatinine ratio (ACR, mg/g) 30–300 defined microalbuminuria. The glomerular filtration rate (eGFR, ml/min/1.73 m2) was also estimated. Results: All TODs markers (LVMI, ACR, eGFR) were worse in the presence of anaemia or/and worse glycaemic profile (p < 0.01 for all comparisons). In NGP patients LVMI was 119.0 ± 15.0 in anaemics vs 118.7 ± 15.3 in non-anaemics, in IGT 131.4 ± 14.4 vs 127.3 ± 16.9, in diabetics 144.2 ± 17.3 vs 131.9 ± 14.9 and in total 126.7 ± 18.7 vs 121.9 ± 16.3. In NGP patients LVH prevalence was 47.0% in anaemics vs 41.0% in non-anaemics, in IGT 82.6% vs 68.5%, in diabetics 95.1% vs 83.1% and in total 63.7% vs 51.2%. In NGP patients ACR was 35.0 ± 24.0 in anaemics vs 32.5 ± 28.7 in non-anaemics, in IGT 62.5 ± 37.7 vs 52.6 ± 36.1, in diabetics 126.0 ± 136.9 vs 85.9 ± 47.9 and in total 60.1 ± 78.7 vs 43.1 ± 38.2. In NGP patients micoalbuminuria prevalence was 43.7% in anaemics vs 35.4% in non-anaemics, in IGT 77.9% vs 67.3%, in diabetics 95.4% vs 89.5% and in total 61.1% vs 48.0%. In NGP patients eGFR was 74.2 ± 17.3 in anaemics vs 74.7 ± 17.6 in non-anaemics, in IGT 61.2 ± 15.6 vs 66.4 ± 15.4, in diabetics 50.5 ± 9.5 vs 60.6 ± 13.4 and in total 66.7 ± 18.5 vs 71.4 ± 17.6. Percentage differences between anaemics/non-anaemics were 0.3, 3.2, 9.3% for LVMI, 7.7, 18.8, 46.7% for ACR and −0.7, −7.7, −16.5% for eGFR in NGP, IGT, diabetic hypertensives, respectively. Conclusions: The prevalence of TODs in hypertensives is higher in the presence of anaemia especially in those with impaired glycaemic profile. Underlying mechanisms need to be explored.

Objective: Atrial fibrillation (AF) is a common arrhythmia in hypertensive patients. Several conditions are deemed to be associated with AF. This study examined the effect of social factors (sex, age, obesity, smoking, alcohol consumption and marital status) on AF prevalence in a large cohort of hypertensive patients. Design and method: The study comprised 30785 hypertensives (52.4% men, 58.8 ± 12.9 years, 165.2 ± 10.6/99.1 ± 9.8 mmHg). Sex, age (years), smoking status (current, former, never), alcohol consumption (rare, light, moderate, heavy), and marital status (married, single, divorced) were recorded. Body mass index (BMI, kg/m2), body surface area (BSA, m2), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR) and sphericity index (SI = BMI/BSA, kg/m4) were calculated. Results: Sinus rhythm (SR) was prevalent in 90.1%, paroxysmal AF (PAF) in 5.5% and sustained AF (SAF) in 4.4% of patients. In SR, PAF, SAF groups, men were 52.1%, 52.7%, 57.3% and women were 47.9%, 47.3%, 42.7%, respectively (p for trend < 0.01). In SR, PAF, SAF male and female subgroups, mean age was 56.1, 65.9, 73.2 and 59.1, 68.5, 75.1, mean BMI 28.04, 28.71, 30.07 and 29.19, 31.32, 30.67, mean WHR 0.919, 0.942, 0.968 and 0.845, 0.889, 0.896, mean WSR 0.574, 0.600, 0.635 and 0.562, 0.603, 0.614, mean SI 13.99, 14.34 14.96 and 16.39, 17.33, 17.58, current smokers were 38.3%, 26.5% 26.3% and 29.7%, 20.0%, 25.0% of patients, former smokers 14.4%, 29.4% 35.1% and 7.8%, 12.9%, 20.8% of patients, light alcohol consumption was present in 56.7%, 46.6% 23.8% and 38.0%, 65.1%, 53.5% of patients, moderate alcohol consumption in 14.9%, 42.2%, 56.4% and 3.1%, 25.3%, 21.4% of patients, heavy alcohol consumption in 3.0%, 9.9%, 18.3% and 0.4%, 1.4%, 4.6% of patients, married were 82.1%, 87.4% 90.4% and 86.6%, 81.4%, 90.9% of patients, single 13.7%, 8.2%, 4.0% and 9.4%, 14.0%, 4.5% of patients and divorced 4.2%, 4.4%, 5.6% and 4.0%, 4.6%, 4.6% of patients, respectively (in men all p for trend < 0.01, in women p for trend < 0.01 only for age, WHR, WSR, SI, former smoking, heavy alcohol consumption). Conclusions: All the examined social factors (sex, age, obesity, smoking, alcohol consumption and marital status) are associated with AF prevalence in hypertensive patients, especially in men.

Objective: Arterial hypertension is a component of metabolic syndrome (MS) while both are related to increased cardiovascular risk. High serum uric acid (UA) has been reported as additional cardiovascular risk factor. The aim of this study was to assess the relation of UA levels to MS and its components in hypertensive patients. Possible differences between men and women, as well as within women's group according to their menopausal status were also examined. Design and method: The study comprised all hypertensives referred to our institutions from 1985 to 2016 (n = 20450, 57.9 ± 13.9 years). Women's menopausal status (pre-menopause, post-menopause, hysterectomy) was recorded. The presence of MS and the number of MS components were defined according to the National Cholesterol Education Program - Adult Treatment Panel III criteria. Serum UA was measured. Results: Metabolic syndrome was present in 8898 of the 20450 patients examined (43.5%), in 4999 of the 10949 men (45.7%), in 3899 of the 9501 women (41.0%), in 648 of the 2428 pre-menopause individuals (26.7%), in 2758 of the 5923 post-menopause individuals (46.6%) and in 493 of the 1150 individuals with hysterectomy (42.9%). Patients with MS had increased UA levels compared to non-MS subjects in all subgroups: 5.94 versus 4.94 mg/dl in the whole cohort, 6.32 versus 5.58 mg/dl in men, 5.45 versus 4.25 mg/dl in women, 5.02 versus 3.98 mg/dl in pre-menopause individuals, 5.54 versus 4.37 mg/dl in post-menopause individuals, 5.50 versus 4.41 mg/dl in individuals with hysterectomy (all p < 0.001). Increasing number of MS components (1, 2, 3, 4 and 5) was related to increasing UA levels in all subgroups: 4.72, 5.16, 5.60, 5.98 and 6.78 mg/dl in the whole cohort; 5.37, 5.79, 6.04, 6.34 and 7.09 mg/dl in men; 4.06, 4.47, 5.02, 5.55 and 6.41 mg/dl in women; 3.89, 4.11, 4.65, 5.23 and 6.09 mg/dl in pre-menopause individuals; 4.14, 4.59, 5.11, 5.61 and 6.47 mg/dl in post-menopause individuals; 4.18, 4.66, 5.07, 5.63 and 6.34 mg/dl in individuals with hysterectomy (all p for trend < 0.01). Conclusions: Metabolic syndrome and its severity are related to UA levels in hypertensive patients, both men and women regardless of their menopausal status.

Objective: Uric acid (UA) levels in serum have been previously correlated with serum biomarkers of pro-inflammatory and pro-thrombotic state in patients with arterial hypertension. The aim of the present study was to examine whether these correlations differ between men and women. Possible differences were also examined within women's group according to their menopausal status. Design and method: The study comprised all hypertensives referred to our hypertensive units from 1985 to 2016 (n = 20450, 57.9 ± 13.9 years, 53.5% men). Menopausal status of female patients (pre-menopause, post-menopause, hysterectomy) was recorded. Levels of UA, pro-inflammatory (c-reactive protein, CRP; serum amyloid A, SAA; homocysteine) and pro-thrombotic (fibrinogen; plasminogen activator inhibitor-1, PAI-1; D-Dimer) biomarkers were measured in serum. Correlations adjusted for age were performed with the use of Pearson coefficient r. Results: Statistically significant positive correlations (adjusted for age) were found between UA and pro-inflammatory/pro-thrombotic biomarkers in all groups (p < 0.001). In the whole cohort, r values for the correlations of UA with CRP, SAA, homocysteine, fibrinogen, PAI-1 and D-Dimer were 0.159, 0.244, 0.319, 0.256, 0.249 and 0.159, respectively. In women (n = 9501, 59.0 ± 13.3 years) correlations were stronger than in men (n = 10949, 56.9 ± 14.4 years): r values 0.300, 0.268, 0.302, 0.251, 0.257 and 0.194 versus 0.102, 0.209, 0.232, 0.218, 0.183 and 0.117, respectively. Within women's group, correlations were by far stronger in those with hysterectomy (n = 1150; 61.1 ± 9.8 years; r values 0.380, 0.373, 0.367, 0.359, 0.325 and 0.316) compared to post-menopause (n = 5923; 65.3 ± 9.8 years; r values 0.291, 0.248, 0.291, 0.237, 0.254 and 0.185) and pre-menopause individuals (n = 2428; 42.8 ± 7.6 years; r values 0.273, 0.269, 0.296, 0.234, 0.231 and 0.142). Correlations were also clearly stronger in post-menopause compared to pre-menopause women when adjustment for age was not performed: r values 0.319, 0.280, 0.329, 0.274, 0.288 and 0.186 versus 0.282, 0.279, 0.306, 0.247, 0.246 and 0.143, respectively. Conclusions: Possible pro-inflammatory and pro-thrombotic effect of UA in hypertensive patients is affected by gender, menopausal status and age.

Objective: The purpose of this study was to assess the role of urine α1-microglobulin as a marker of hypertension-induced renal damage compared to the gold-standard markers (estimated glomerular filtration rate, eGFR; urine albumin and urine albumin-to-creatinine ratio, ACR). Its response on different BP-lowering drugs was also studied. Design and method: Sixty never-treated hypertensives (65.0% males, 46.9 years, 141.4/94.0 mmHg) were randomized to an angiotensin receptor blocker (ARB)- or non-dihydropyridine calcium channel blocker (CCB)-based regimen. Patients with diabetes, established cardiovascular or renal disease were excluded. Blood samples and 24-hour urine were analyzed at baseline and 6 months after pharmaceutical blood pressure (BP) normalization. Serum creatinine was measured and eGFR was calculated. Urine albumin, creatinine, and α1-microglobulin were measured and ACR was calculated. Results: Minor changes (p = NS) in eGFR were noted during follow-up in both groups (from 111.0 to 108.4 and from 111.3 to 114.0 ml/min/1.73 m2 in the ARB and CCB group, respectively). 24-hour urine indices were all significantly improved (P < 0.01) with ARB (albumin from 19.4 to 8.2 mg/l, ACR from 21.5 to 10.0 mg/g, α1-microglobulin from 5.06 to 3.64 mg/l) but not (P = NS) with CCB treatment (albumin from 15.6 to 13.9 mg/l, ACR from 17.6 to 17.1 mg/g, α1-microglobulin from 4.94 to 4.79 mg/l). These differences between groups remained significant (P < 0.05) after adjusting for office heart rate (HR) and BP. Alpha-1-microglobulin was significantly correlated (P < 0.05) to albumin and ACR both at baseline (r = 0.283 and 0.299, respectively) and at the end of follow-up (r = 0.432 and 0.465, respectively) but not (P = NS) to eGFR. It was also significantly related (P < 0.05) to cardiovascular risk scores (Framingham and HeartScore) both at baseline (r = 0.264 and 0.436, respectively) and at the end of follow-up (r = 0.308 and 0.472, respectively). Conclusions: Urine α1-microglobulin emerges as a potentially valuable marker of hypertension-induced renal impairment. Its kinetics and its response to treatment appears similar to that of albumin. ARBs emerge as superior to non-dihydropyridine CCBs at improving its excretion in urine, independently of HR/BP control.

Objective: Evidence suggests that serum uric acid (UA) is a relevant and independent risk factor for cardiovascular disease. A better understanding of its relationship with cardiometabolic and subclinical hypertensive target organ damage (TOD) profile may help clarify this association. Design and method: We studied 660 consecutive never treated newly diagnosed essential HTN patients (51 ± 13 years, 46.8% female), free of diabetes and overt cardiovascular or other systemic disease, who visited our antihypertensive outpatient clinic. All patients underwent office, home and 24-hour ABPM measurements. The evaluation of target organ damages (TODs) was performed according to ESH Guidelines. Subjects with isolated office hypertension were excluded from the study. Based on gender-specific upper limit of normal for uricemia (6.1 for females and 7.2 mg/dl for males), study population was categorized in normouricemic (NU, n = 583) and hyperuricemic (HU, n = 77). Results: Prevalence of hyperuricemia was 11.7%, significantly higher in males (16.2% vs. 6.5%, p < 0.001). While there was no difference regarding age, all indices of general and abdominal obesity, including metabolic syndrome, all classical cardiovascular risk factors, including office and 24hr blood pressure and target organ damage severity were more prevalent in HU group (table). Figure. No caption available. Conclusions: Essential hypertensive hyperuricemic patients presents an adverse cardiometabolic profile which is reflected in the target organ damage prevalence and severity. Large scale lifestyle and/or medical intervention studies to assess the impact of lowering hyperuricemia in hypertensive patients are warranted.

Objective: Evidence suggests that serum uric acid (UA) is a relevant and independent risk factor for cardiovascular disease. A better understanding of its relationship with cardiometabolic and subclinical hypertensive target organ damage (TOD) profile may help clarify this association. Design and method: We studied 660 consecutive never treated newly diagnosed essential HTN patients (51 ± 13 years, 46.8% female), free of diabetes and overt cardiovascular or other systemic disease, who visited our antihypertensive outpatient clinic. All patients underwent office, home and 24-hour ABPM measurements. The evaluation of target organ damages (TODs) was performed according to ESH Guidelines. Subjects with isolated office hypertension were excluded from the study. Based on gender-specific upper limit of normal for uricemia (6.1 for females and 7.2 mg/dl for males), study population was categorized in normouricemic (NU, n = 583) and hyperuricemic (HU, n = 77). Results: Prevalence of hyperuricemia was 11.7%, significantly higher in males (16.2% vs. 6.5%, p < 0.001). While there was no difference regarding age, all indices of general and abdominal obesity, including metabolic syndrome, all classical cardiovascular risk factors, including office and 24hr blood pressure and target organ damage severity were more prevalent in HU group (table).Conclusions: Essential hypertensive hyperuricemic patients presents an adverse cardiometabolic profile which is reflected in the target organ damage prevalence and severity. Large scale lifestyle and/or medical intervention studies to assess the impact of lowering hyperuricemia in hypertensive patients are warranted.

Objective: Evidence suggests that uric acid is a possibly causal factor for human primary hypertension. Early life-style modifications for the prevention of hyperuricemia might delay the development of essential hypertension. We sought to identify possible modifiable lifestyle factors that are associated with hyperuricemia in newly diagnosed essential hypertensive patients. Design and method: Our cross-sectional study consisted of 660 consecutive newly diagnosed, never treated, non diabetic essential hypertensive patients (mean age 51 ± 13, 47% female), without known cardiovascular or other systemic disease. In all participants anthropometric data were recorded and venous blood sampling was performed to determine their metabolic profile. All patients completed a validated food-habits questionnaire. Based on gender-specific upper limit of normal for uricemia (6.1 for females and 7.2 mg/dl for males), study population was categorized in normouricemic (NU, n = 583) and hyperuricemic (HU, n = 77). Results: Prevalence of hyperuricemia was 11.7%, significantly higher in males (16.2% vs. 6.5%, p < 0.001). In overall population, uric acid was significant positive correlated with food quantity, frequency of fast food and refreshments, consumption of white bread, cold meat, poultry, red meat, coffee, full fat milk products and dinner consumption, and negative correlated with fruits, juices, tea and dinner consumption (Table). HU compared to NU reported higher frequency of alcohol intake (moderate consumption: 18.7% vs. 12.7, heavy consumption: 13.3% vs. 5.5%, p = 0.017) and more than 2/3 of HU reported absence of daily exercise (60.5% vs. 41%, p = 0.023). Consequently, HU compared to NU, had higher BMI (28 ± 5 vs. 31 ± 5, p < 0.001), waist and hip circumference (94.5 ± 13 vs. 102 ± 13, p < 0.001 and 105 ± 10.8 vs. 108 ± 10.1, p = 0.014, respectively) and higher prevalence of metabolic syndrome (41.2% vs. 64.5%, p = 0.001).Conclusions: The dietary and lifestyle patterns that are associated with increased cardiometabolic risk increases also plasma uric acid levels.

Objective: Development of left ventricular hypertrophy (LVH) is a multifactorial and incompletely understood process. Aim of our study was to determine the contributory factors for this maladaptive phenomenon, at the very beginning of essential hypertension. Design and method: We studied 780 consecutive newly diagnosed, never treated, non-diabetic, hypertensive patients stage I-III (51 ± 13 years old, 45.3% females). Echocardiographic left ventricular mass calculation was performed from parasternal long axis and normalized for height in meters to the power of 2.7 (LVMi). Using established cutoffs (>49 for males and >45 g/m2.7 for females), the study population was split in group with normal (n = 649) and increased LVMi (n = 131). Results: Prevalence of normal geometry and concentric remodeling in patients with normal LVMi was 53% and 47%, while prevalence of concentric and eccentric hypertrophy in patients with LVH was 71.4% and 28.6%, respectively. LVMi was significantly correlated with age, BMI, waist and hip circumference, metabolic syndrome, snoring, hs-CRP, HbA1c, GFRCKD-EPI, uric acid, triglycerides and HDL-cholesterol, aortic pulse wave velocity, microalbuminuria, left atrial volume index, diastolic dysfunction grade, carotid IMT and plaques, severity of hypertension, number of CV risk factors and TODs. Patients with LVH were older, with higher general and abdominal obesity, impaired metabolic, hemodynamic and TODs profile (Table).Conclusions: In newly diagnosed hypertensive patients left ventricular hypertrophy is already present in a sizable proportion being the result not only of BP levels but also of numerous metabolic and CVD risk factors.

Objective: Aim of our study was to evaluate the prevalence of erectile dysfunction (ED) and its associations with target organ damages (TODs) in newly diagnosed never treated essential hypertensive males. Design and method: We studied 293 consecutive EH non-diabetic patients (mean age 48 ± 13 years), without overt cardiovascular or other systemic disease, referred to our antihypertensive unit. Evaluation of patients was performed according to ESH guidelines and ED was assessed by SHIM-5 questionnaire. The study population was split based on the absence (N, n = 246) and presence of ED (ED, n = 47). Results: In our population, prevalence of ED was 16%. Compared to N, ED patients were older, less physically active, with higher aortic stiffness and sleeping disturbances, impaired lipidemic profile and systolic and diastolic left ventricular function, and advanced retinal damage. ED presented significant associations with age (r = 0.167, p = 0.004), height (r = -0.149, p = 0.010), waist to hip ratio (r = 0.122, p = 0.038), snoring (r = 0.168, p = 0.004), GFR CKD-EPI (r = -0.134, p = 0.033), triglycerides (r = 0.171, p = 0.007), LDL-Cholesterol (r = 0.140, p = 0.029), fundoscopic Sheie grade (r = 0.310, p < 0.001), aortic PWV (r = 0.142, p = 0.019), Aix@75 (r = 0.164, p = 0.049), LV ejection fraction (r = -0.135, p = 0.022), LV concentric and eccentric geometry (r = 0.131, p = 0.026), TDI Em/Am (r = -0.148, p = 0.012), E/Em (r = 0.117, p = 0.049), carotid plaques (r = 0.118, p = 0.046), and treadmill stress test METs (r = -0.257, p = 0.001). Figure. No caption available. Conclusions: In newly diagnosed essential hypertensives, ED is highly prevalent and is associated with micro and macrovascular alterations that affect the heart and vasculature. ED assessment in the early course of hypertension appears a reasonable strategy for the better assessment of total cardiovascular risk.

Objective: Development of left ventricular hypertrophy (LVH) is a multifactorial and incompletely understood process. Aim of our study was to determine the effect of blood pressure's (BP) circadian abnormalities on LVH. Design and method: We studied 780 consecutive newly diagnosed, never treated, non-diabetic, hypertensive patients stage I-III (51 ± 13 years old, 45.3% females). Echocardiographic left ventricular mass calculation was performed from parasternal long axis and normalized for height in meters to the power of 2.7 (LVMi). Using established cutoffs (>49 for males and >45 g/m2.7 for females), the study population was split in group with normal (n = 649) and increased LVMi (n = 131). Dipping status was defined according to day-night SAP circadian variation from 24 hour ambulatory blood pressure monitoring. Results: Patients with LVH were older (54 ± 13 vs 51 ± 13, p = 0.018), while there was no difference regarding gender (females 43.7 vs 45.6, p = 0.693). Prevalence of dippers was higher in patients with no LVH (50% vs. 35.6%), while there was no difference in the prevalence of non-dippers between the two groups (34.2 vs. 35.6). Moreover, prevalence of extreme dippers and reverse dippers was higher in patients with LVH (18.6% vs. 9.3% and 10.2% vs. 6.5%). Logistic regression analysis revealed that, compared to dippers, extreme dippers had 2.9 higher odds (95% CI: 1.5–5.5, p = 0.001) of LVH, independent of age, gender and body mass index, while reverse and non-dippers had no significant difference (OR: 1.8, 95% CI: 0.8–4, p = 0.132 and OR: 1.3, 95% CI: 0.8–2.3, p = 0.315, respectively). Conclusions: Extreme dipping status is an independent predictor of left ventricular hypertrophy.

Objective: Despite that recently normative and reference values have been published for Carotid-femoral Pulse Wave Velocity (cf-PWV), they did not take into account all phenotypic expressions of hypertension (HTN), such as isolated office (white coat) and masked HTN. Design and method: We studied 1163 consecutive subjects (383 normotensive, 780 newly HTN), free of diabetes and overt cardiovascular disease. Cf-PWV was evaluated by Sphygmocor device using intersecting tangent algorithm and substructed path length method. According to age and office, home and ambulatory blood pressure monitoring participants were categorized in 8 blood pressure (BP) categories and 6 age groups. Results: The prevalence of optimal, normal, high normal, white coat, masked, HTN stage I, stage II and stage III was 3.1%, 6.5%, 12.3%, 11.2%, 3.9%, 36.9%, 18.7% and 7.4%, respectively. Cf-PWV increased with age and BP category, it was significantly higher in HTN compared to normotensive subjects (8.3 vs. 7.5, p < 0.001) and there was not any gender differences (8.09 in males vs. 8.06 in females, p = 0.771). Importantly, normal BP category exhibited significantly higher values of PWV compared to optimal BP group (7.4 vs. 6.3, p = 0.001). Moreover, white coat category had significantly higher cf-PWV compared to masked and high normal groups (8.1 vs. 7.2 vs. 7.5, p = 0.004 and p = 0.001, respectively) and significantly lower compared to HTN stage II and stage III (8.1 vs. 8.6 vs. 9.2, p = 0.035 and p < 0.001, respectively), while they did not differ regarding HTN stage I (8.11 vs. 8.15, p = 0.833). In contrary, masked category had significantly higher cf-PWV compared to optimal group (7.23 vs. 6.32, p = 0.008), and significantly lower compared to HTN I, II and III (7.23 vs. 8.15 vs. 8.55 vs. 9.24, p < 0.001 for all, respectively), while they did not differ regarding normal and high normal groups (7.23 vs. 7.35 vs. 7.47, p > 0.3 for all, respectively). Conclusions: In a large population of normotensive and essential hypertensive newly diagnosed never treated patients, even normal levels of BP are characterized by increased cf-PWV compared to optimal levels. Contrary to widely held beliefs, white coat phenotype presents a worse aortic stiffness profile compared to masked HTN.

Objective: Aim of our study was to determine the relationship between Scheie fundoscopic classification and left ventricular hypertrophy in essential hypertension. Design and method: We studied 780 consecutive newly diagnosed, never-treated, non-diabetic, hypertensive patients stage I-III (51 ± 13 years, 45.3% females). Echocardiographic left ventricular mass calculation was performed from parasternal long axis and normalized for height in meters to the power of 2.7 (LVMi). Using established cutoffs (>49 for males and > 45 g/m2.7 for females), the study population was split in group with normal (n = 649) and increased LVMi (n = 131). All patients underwent fundoscopic examination and alterations were classified according to Scheie grading system, as 0, 1, 2 and 3. Results: Compared to hypertensives without LVH, patients with LVH were older (54 ± 13 vs. 51 ± 13, p = 0.018), with higher general and abdominal obesity, metabolic profile and target organ damage frequency and severity, while there was no difference regarding gender (females 43.7 vs. 45.6, p = 0.693). Fundoscopic grade severity was significantly correlated with age (r = 0.189, p < 0.001), flow-mediated dilation of brachial artery (r = -0.166, p = 0.001), LVMi (r = 0.097, p = 0.039), carotid IMT (0.212, p < 0.001), TDI Em/Am ratio (r = -0.108, p = 0.022), pulse pressure amplification ratio radial to central (r = -0.140, p = 0.042), 24 hour SAP (r = 0.119, p = 0.011), 24 hour pulse pressure (r = 0.128, p = 0.006) and BP severity (r = 0.170, p < 0.001). Prevalence of grades 0 and 1 was higher in patients with no LVH (45.3% vs. 36.1% and 31.8% vs. 23.6%, respectively), while grades 2 and 3 were more prevalent in patients with LVH (20.1% vs. 33.3% and 2.9% vs. 5.6%, respectively), p = 0.007 for all. Conclusions: In the early course of essential hypertension, advanced arteriolar retinal damage is associated with left ventricular hypertrophy.