Objective: To evaluate blood pressure (BP) profile and subclinical target organ damage in patients with renal fibromuscular dysplasia (FMD) enrolled into the ARCADIA-POL study. Design and method: From 144 patients with FMD in any vascular bed enrolled in the ARCADIA-POL study in 2015, we analyzed 127 patients (104F, 23 M, mean age:44.8 ± 15.9 years, range:18–75) with confirmed renal FMD. All patients underwent detailed clinical evaluation including office blood pressure (BP) levels, ABPM, biochemical evaluation, biobanking, duplex Doppler of cervical and abdominal arteries and whole body angio-CT. In all patients left ventricular hypertrophy (LVH) was evaluated in echocardiography according to the current 2013 ESH/ESC guidelines. In parallel as a reference group we also evaluated 62 patients with essential hypertension (EHT) (43F, 19 M, mean age: 48.3 ± 11.1 years) matched in regards to gender, body mass index, glycemic status, BP levels and number of medication (p > 0.05). Results: When comparing 127 patients with FMD to the matched group of patients with EHT we observed no significant differences in office and ambulatory BP levels. The prevalence of resistant hypertension (RHT) and true RHT did not differ between patients with FMD and EHT (16.5% vs 13.8%, p = 0.65; 12.6% vs. 8.2%, p = 0.37). There was also no difference in regards to the dipping status between both groups. We also evaluated the subclinical target organ damage in both groups. There were no differences in the prevalence of LVH between the groups (38.4% vs. 35.1%, p = 0.72) as well as between the parameters assessing systolic and diastolic LV function. Both groups did not also differ in intima-media thickness, estimated glomerular filtration ratio and albuminuria as well as resistive and pulsatility indexes assessed in duplex Doppler. After excluding patients with the presence of significant renal artery stenosis from the group with renal FMD the results remained still non-significant. Conclusions: Our results indicate that patients with FMD included into ARCADIA-POL study did not differ from patients with essential hypertension in respect to blood pressure profile and intensity of subclinical target organ damage.

Objective: To compare clinical presentation of two angiographic subtypes of renal fibromuscular dysplasia (FMD) in patients with renal FMD enrolled to ARCADIA-POL registry. Design and method: From 84 patients with confirmed FMD in any vascular bed enrolled in the ARCADIA-POL registry in 2015 (instituted on the basis of as Polish-French collaboration), we analyzed 74 patients (54F, 20 M, mean age:41.7 ± 15.2 years, range:18–72) with renal FMD. All patients underwent evaluation including ambulatory blood pressure monitoring, biochemical evaluation, biobanking, duplex Doppler of carotid and abdominal arteries and whole body angio-CT. In this analysis we divided patients into two groups according to angiographic subtypes of renal FMD lesions (Savard et al. Circulation 2012). FMD lesions were classified according to angio-CT as multifocal if there were at least 2 stenoses in the same arterial segment (Group 1); otherwise as unifocal (Group2). Results: Of 74 patients with renal FMD, 48 pts (64.9%) were classified as multifocal (Group 1) and 26 pts (35.1%) as unifocal (Group 2). Patients in Group 1 as compared to Group 2 were characterized by non-significantly higher rate of females (79.2vs.61.5%; p = 0.103). At evaluation there were no differences in age, frequency of smokers, hypertension rate, median number of antihypertensive medications, nor in office and 24-hour blood pressure values. Group 1 differed significantly from Group 2 in mean age at diagnosis of FMD (29.2 ± 14.2vs.41.0 ± 15.5 years, p = 0.003) and hypertension (23.4 ± 12.6vs.34.8 ± 14.0 years, p = 0.002). Among 27 patients in whom FMD was diagnosed at age over 40 years only 4 (14.8%) had unifocal and 20 (85.2%) had multifocal type. Group 1 were characterized by non-significantly higher proportion of patients with more than one vascular bed involved (36% vs. 54.2 %,p = 0.14). Aneurysm of renal artery was found in 10 pts with multifocal and in 3 patients with unifocal lesions (20.8% vs.11.5 %,p = 0.316). In two patients with multifocal and none of patients with unifocal FMD renal artery dissection was observed. Conclusions: A binary angiographic classification in unifocal and multifocal FMD discriminated two groups of patients with different age at diagnosis of FMD and hypertension, as well as tendency towards different proportion of multiple beds involvement and vascular complications.

Objective: To present preliminary evaluation of clinical features, presenting symptoms and cardiovascular complications in patients with fibromuscular dysplasia (FMD) enrolled to ARCADIA-POL registry. Design and method: The first 84 patients with confirmed FMD in any vascular bed were enrolled in ARCADIA-POL registry from 15 Polish sites. Based on Polish-French collaboration ARCADIA-POL registry was instituted in January 2015 to better understand clinical characteristics and management of FMD in Poland, representing region of Central Europe. A standardized FMD data form was used for data collection. All patients underwent detailed clinical evaluation including ambulatory blood pressure monitoring, biochemical evaluation, biobanking, duplex Doppler of carotid and abdominal arteries and whole body angio-CT. Results: We included 84 patients (59F[70.2%], 25M[29.8%], mean age: 42.5 ± 14.8 years, range: 18–72). In the analyzed group FMD was identified most frequently in renal arteries (88.1%). The mean age at the diagnosis of hypertension was 31.7 ± 17.8 years and the FMD was diagnosed on average 5.6 ± 9.5 years later with the mean age at the diagnosis of FMD 38 ± 15.8 years. The most common presenting symptoms of the disease were: hypertension (84.5%), headaches (71.4%), tinnitus (40.5%), dizziness (36.9%) and epigastric (34.5%) or cervical bruits (11.9%). At evaluation 76 patients (90.5%) were found to be hypertensive and were taking a median number of 2 (interquartile range[IR]:1–3) antihypertensive agents. The mean office and 24 h ABPM systolic and diastolic BP values were 131 ± 21/82 ± 13mmHg and 126 ± 16/77 ± 10mmHg, respectively. 41 patients(48.8%) were smokers - 18(21.4%) and 23(27.4%) patients were current and former smokers respectively. Based on questionnaire taken from 84 patients, one patient reported confirmed FMD in her family - 9 members were evaluated and FMD was confirmed in two sisters and father. Among cardiovascular complications reported by patients, cerebrovascular events occurred in 19 patients(22.6%), coronary artery disease in 4 patients(4.8%) and myocardial infarction in 1 patient(1.2%). Conclusions: Preliminary data of ARCADIA-POL registry showed that FMD is occurring primarily in middle-aged women and most frequently in renal arteries. Although a significant proportion of FMD patients may present with a serious cardiovascular complications, many present with nonspecific symptoms and a subsequent delay in the diagnosis.

Objective: The aim of study was to differentiate factors most related to obstructive sleep apnea (OSA) in a large cohort of patients with controlled, difficult to treat and resistant hypertension (HT) undergoing routine polysomnography (PSG) screening. Design and method: We included 309 consecutive HT patients (188 M, 121 F, mean age 51.3 ± 12.7, years) referred for PSG on the basis of one or more of the following clinical features suggestive for OSA: typical symptoms, resistant or difficult-to-treat HT, comorbidities known to be associated with OSA and high cardiovascular risk. Age, gender, neck circumference (increased -was defined as >/=43 cm M and >/=41 cm F), office blood pressure (BP) levels, presence of metabolic syndrome (MS) and its components (abdominal obesity, increased fasting glucose or diabetes, increased triglycerides, decreased HDL cholesterol levels), known cardiovascular disease (CVD) as well as OSA symptoms: presence of snoring, nycturia and daytime somnolence (Epworth Sleepiness Scale – ESS) were evaluated. All patients underwent PSG - the apnea/hypopnea index (AHI) > 15 events/h defined clinically important moderate-to-severe OSA was defined as AHI. Results: Moderate-to-severe OSA was diagnosed in 128 patients (41,4%). Patients with OSA were characterized by higher age (56.0 ± 10.6 vs 48.0 ± 13.0 years; p < 0.001), higher frequency of males, MS and its components and increased neck circumference (50.5 vs. 27.2% p < 0.001). They were also characterized by higher median number of anti-HT medications (4 vs. 2; p < 0.001), higher frequency of resistant HT (51.8 vs 40.4%; p = 0.041), higher frequency of snoring (85.1 vs. 58.1%; p < 0.001) and nycturia (66.7% vs 43.9%; p = 0.001). There were no differences in ESS score and BP levels. In a multivariate model factors independently related with OSA were: older age (odds ratio (OR) 1.45 for 10 years increase; p = 0.033), increased neck circumference (OR 2.50; p = 0.012), treatment with 3 or more antihypertensive medication (OR 3.11; p = 0.004) and snoring (OR 2.78; p = 0.019). Conclusions: Older age, increased neck circumference, snoring and treatment with 3 or more antihypertensive medication were most strongly related with the presence of moderate-to-severe OSA in a large group of consecutive patients with controlled and resistant hypertension undergoing PSG.

Objective: The aim of study was to differentiate factors most related to obstructive sleep apnea (OSA) in a large cohort of patients with controlled, difficult to treat and resistant hypertension (HT) undergoing routine polysomnography (PSG) screening. Design and method: We included 309 consecutive HT patients (188 M, 121 F, mean age 51.3 ± 12.7, years) referred for PSG on the basis of one or more of the following clinical features suggestive for OSA: typical symptoms, resistant or difficult-to-treat HT, comorbidities known to be associated with OSA and high cardiovascular risk. Age, gender, neck circumference (increased -was defined as >/=43 cm M and >/=41 cm F), office blood pressure (BP) levels, presence of metabolic syndrome (MS) and its components (abdominal obesity, increased fasting glucose or diabetes, increased triglycerides, decreased HDL cholesterol levels), known cardiovascular disease (CVD) as well as OSA symptoms: presence of snoring, nycturia and daytime somnolence (Epworth Sleepiness Scale – ESS) were evaluated. All patients underwent PSG - the apnea/hypopnea index (AHI) > 15 events/h defined clinically important moderate-to-severe OSA was defined as AHI. Results: Moderate-to-severe OSA was diagnosed in 128 patients (41,4%). Patients with OSA were characterized by higher age (56.0 ± 10.6 vs 48.0 ± 13.0 years; p < 0.001), higher frequency of males, MS and its components and increased neck circumference (50.5 vs. 27.2% p < 0.001). They were also characterized by higher median number of anti-HT medications (4 vs. 2; p < 0.001), higher frequency of resistant HT (51.8 vs 40.4%; p = 0.041), higher frequency of snoring (85.1 vs. 58.1%; p < 0.001) and nycturia (66.7% vs 43.9%; p = 0.001). There were no differences in ESS score and BP levels. In a multivariate model factors independently related with OSA were: older age (odds ratio (OR) 1.45 for 10 years increase; p = 0.033), increased neck circumference (OR 2.50; p = 0.012), treatment with 3 or more antihypertensive medication (OR 3.11; p = 0.004) and snoring (OR 2.78; p = 0.019). Conclusions: Older age, increased neck circumference, snoring and treatment with 3 or more antihypertensive medication were most strongly related with the presence of moderate-to-severe OSA in a large group of consecutive patients with controlled and resistant hypertension undergoing PSG.