Hypertensive mediated organ damage evolution in resistant hypertension patients after adding spironolactone

INTRODUCTION

Resistant hypertension (RH) represents an important multi-organic impact and increases the morbi-mortality. We aimed to evaluate the evolution of hypertensive mediated organ damage in patients with RH after adding spironolactone.

MATERIAL AND METHODS

Retrospective study of 58 patients with RH who started spironolactone (12.5-25mg daily). Office blood pressure, 24-h ambulatory blood pressure monitoring (24h-ABPM), urine albumin-to-creatinine ratio and echocardiographic parameters were analyzed prior to initiation of spironolactone and after 12 months of treatment.

RESULTS

Thirty-six percent of patients were women and mean age was 67.3±10.1 years. We observed a decrease in urine albumin-to-creatinine ratio (median [RIQ25-75]) of 27.0 (7.5-255.4) to 11.3 (3.1-37.8)mg/g, p=0.009. This was more relevant in patients with albuminuria grade A2 and A3: 371.2 (139.5-797.4) to 68.4 (26.5-186.5)mg/g, p=0.02. The echocardiographic changes were: posterior wall thickness: -1.0±0.4mm (p<0.001), interventricular septal thickness: -0.6±0.5mm (p=0.01), left ventricular (LV) mass index: -14.7±10.2g/m2 (p=0.006), LV remodeling index: -0.04±0.036 (p=0.03), without statistically significant changes in LV ejection fraction, LV end-diastolic diameter, LV end-systolic diameter, left atrial diameter, relationship between early ventricular filling wave and atrial contraction and LV filling pressure index. Systolic/diastolic office blood pressure decreased -12.5±4.9/-4.9±3.0mmHg, p<0.001. In 24h-ABPM, systolic and diastolic BP had a significant decrease in diurnal and nocturnal periods and 38.1% of patients presented a favorable change in the circadian pattern, p<0.001.

CONCLUSIONS

Adding spironolactone to patients with RH contributes to improve hypertensive mediated organ damage by reducing albuminuria levels and echocardiographic parameters of hypertensive heart disease.

Abstract P166: Kidney Changes In Patients With Morbid Obesity After Bariatric Surgery: Looking For The Mechanisms

Morbid obesity (MO) carries an increased risk of kidney damage. Albuminuria and hyperfiltration decrease after bariatric surgery (BS). The relationships between kidney changes obesity-associated are not fully understood.

Aim: to analyze renal changes (Δ) and their determinants at 3-mths after BS (3m-postBS) in patients with MO.

Methods: In a cohort of patients with MO, we analyzed changes in renal function at 3m-postBS and possible associations with anthropometric parameters, ambulatory blood pressure, glucose metabolism, adipocytokine profile, and components of both renin-angiotensin-aldosterone and endocannabinoid systems.

Results: 59 patients were included, 76% women; age (mean ± SD): 42.3 ± 9.5 years; body weight (mean ± SD): 117.8 ± 19.2 Kg. At 3m-postCxB, significant reductions in body weight and waist circumference were observed (p <0.001), but not in blood pressure. Biochemical changes (mean, 95% CI); eGFR-CKDEPI: -4.6 mL/min/1.73m 2 (-8.6; -0.6), p = 0.024; Na + : 2.5 mmol/L (1.9; 3.0), p <0.001; K + : -0.2 mmol/L (-0.3; -0.1), p = 0.006; HbA1c: -0.47% (-0.63; -0.31), p <0.001 and HOMA-IR-Index: -3.13 (-4.19; -2.06), p <0.001. Δ of Albuminuria: Z-1.8 (p = 0.069). The Δ of eGFR-CKDEPI indirectly correlated only with the Δ of plasma renin activity (PRA), p = 0.026. The Δ of albuminuria indirectly correlated with the Δ of leptin (p = 0.039) and directly with the Δ of HbA1c (0.019), HOMA-index (p = 0.013), ACE2 (p = 0.032) and resistin (p = 0.005), as well as with the Δ of the endocannabinoids N-palmitoyl ethanolamine (p = 0.028) and N-stearoyl ethanolamine (p = 0.022). None of the factors analyzed was associated with changes in sNa + . The reduction in sK + was significantly correlated with the Δ of leptin (p = 0.028) and with the Δ of aldosterone (p = 0.025). In multivariate analyzes, no factor was independently associated with the different markers of renal function.

Conclusions: patients with MO experience a decrease in eGFR-CKDEPI associated with an increase in PRA 3m-postBS, indicating that the hyperfiltration present in MO has a hemodynamic origin. On the other hand, the variation in albuminuria is related to the improvement of the carbohydrate metabolism and probably certain cytokines and endocannabinoids have a role, although the latter needs to be confirmed.

MO925VALVULAR HEART DISEASE EVOLUTION IN KIDNEY TRANSPLANT RECIPIENTS AND RELATED RISK FACTORS

Background and Aims

Cardiovascular diseases remains the leading cause of death in recipients of kidney transplantation (KT). Valvular heart disease (VHD) is not an exclusion criteria for KT, however it’s repercussion on KT follow-up has been less studied. Our objective was to analyse the impact of VHD in KT recipients and related risk factors of VHD progression (VHDp).

Method

Observational retrospective cohort study of all patients who underwent KT at Hospital del Mar (Barcelona, Spain) between January 1980 and December 2018. VHD was defined as presence of aortic stenosis (AS), aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid stenosis, tricuspid regurgitation or double valve injury of any degree diagnosed by echocardiography. We analysed the VHDp, defined as worsening of the initial valvular degree on heart ultrasound after KT, risk factors related with VHDp, recipients and graft survival.

Results

During the study period, 1422 patient underwent KT and 48 of them (3.4%) had VHD diagnosed prior to KT. In the median time of follow-up of 56.3 months (IQR25-75 17.7-119 month), 17 patients (35.4%) presented VHDp and 31 patients did not (64.6%). Figure 1 shows the primary outcome in the different types of VHD, AS was the valve with more VHDp after KT.

Statistical evaluation revealed that recipients with VHDp had a higher body mass index (BMI) (27.4 ± 6.3 vs 24.3 ± 3.8 kg/m2, p=0.04) and worse PTH control (427.0 ± 309.3 vs 186.2 ± 140.6 pg/ml, p=0.02) at the moment of the KT. Also, patients with VHDp reached a worse nadir glomerular filtration rate (GFR) (44.1 ± 17.5 vs 56.0 ± 13.9 ml/min/1.73m2, p=0.01) during the follow-up, needed more time to reach their nadir GFR (4 [2-13] vs 1.2 [1.0-4.7] months, p&lt;0.001) and required more furosemide dose at that time (72.7 ± 21.7 vs 15.8 ± 5.6 mg/day, p=0.02).

At the end of follow-up, 213 KT recipients had died, 16 with preKT-VHD (33.3% of all patients with VHD) and 197 without preKT-VHD (14.3% of all cases without VHD). There was a statistical significant association between preKT-VHD status and all-cause mortality after KT (log rank &lt; 0.001). However, there wasn’t statistical association between preKT-VHD status and death-censored graft survival (log rank = 0.2).

Conclusion

VHD has a significant impact on increased pos-KT mortality but it is not associated with graft survival. More than one third of recipients with preKT-VHD presented deterioration after KT. We found that increased preKT BMI and PTH, nadir GFR after KT, time to reach this nadir GFR and diuretic dose at that time are related with VHD progression.

Abstract P073: Arterial Stiffness In Severely Obese Patients: Early Changes After Bariatric Surgery And Pathophysiological Mechanisms

Objective: to analyze AS before and 1 month (m) after bariatric surgery (BS), and search for pathophysiological mechanisms of changes (Δ).

Methods: Forty-seven MO (72% women, 43% hypertensives, age 42.7±9.4 yr, BMI 42.2±5.4 Kg/m 2 , waist circumference 132.4±11.7 cm) were evaluated before and 1m after BS, with AS assessed by pulse-wave velocity (PWV), augmentation index at 75 beats/minute (AIx@75) and pulse pressure (PP) using a Mobile-O-Graph® device. 24h-ambulatory blood pressure (BP), RAAS components and several adipokines and inflammatory markers were also analyzed.

Results: at 1m body weight (-13.6±4.32 Kg) and waist circumference (-9.2±5.3 cm) decreased (p<0.001). There were also significant Δ in BP, RAAS components and adipokines and inflammatory biomarkers (Table). Correlations were also explored. There was no correlation between Δ of any marker of AS and anthropometric changes nor with Δ of adipokines or inflammatory markers. Δ 24h-PP correlated with Δ 24h-systolic BP (coef. P. = 0.749; p <0.001) and with Δ of plasma renin activity (rho = -0.299; p = 0.049). Δ 24h-PWV correlated with Δ 24h-SBP (coef. P. = 0.587; p <0.001), with Δ 24h-DBP (coef. P. = 0.503; p <0.001) and with Δ ACE/ACE2 (coef. P. = -0.474; p =0.002). Δ AIx@75 correlated with Δ ACE (coef. P. = 0.316; p = 0.041).

Conclusions: there is a decrease in AS one month after BS in obese patients. These changes correlated with Δ in both BP and the renin-angiotensin aldosterone system.

( * ) Data shown as median [interquartile range]

Renal safety outcomes of spironolactone in patients with resistant hypertension

INTRODUCTION

Resistant hypertension (RH) is a significant health problem with complex management. The aim of this study was to evaluate the risks and benefits of adding spironolactone to treat RH.

MATERIAL AND METHODS

In total, 216 patients with RH in whom spironolactone (12.5-25mg daily) was added as an antihypertensive were evaluated. One-hundred and twenty-five (125) were analysed retrospectively and 91 prospectively. Blood pressure (BP) and laboratory parameters (serum creatinine [sCrea], estimated glomerular filtration rate [eGFR] and serum potassium [sK]) were analysed at baseline and at 3-6-12 months after introducing spironolactone.

RESULTS

A change of systolic/diastolic BP (mean±standard deviation) of -10.9±2.7/-4.3±1.6mmHg at 3 months and -13.6±2.8/-6.0±1.6mmHg at 12 months; p<0.001 was observed. These values were confirmed with ambulatory-BP monitoring at 12 months. At 3 months, an increase in sCrea of 0.10±0.04mg/dl, a decrease in eGFR of -5.4±1.9ml/min/1.73m² and an increase in sK of 0.3±0.1mmol/l; p<0.001 was observed for all cases. These changes were maintained after 12 months. There were no significant differences in changes of BP, sCrea, eGFR and sK between 3 and 12 months. Results of the retrospective and prospective cohorts separately were superimposable. In the prospective cohort, spironolactone was withdrawn in 9 patients (9.9%) because of adverse effects.

CONCLUSIONS

After 3 months with spironolactone, a decrease in BP associated with a decrease in the eGFR and an increase in sCrea and sK was observed. These changes were maintained at 12 months. Spironolactone is an effective and safe treatment for RH in patients with baseline eGFR ≥30ml/min/1.73m².

Central blood pressure in morbid obesity and after bariatric surgery

Various mechanisms are related to arterial hypertension in obesity. Central blood pressure (BP) seems to correlate more than peripheral BP with future cardiovascular risk. Bariatric surgery is an effective method to reduce BP along with weight loss in patients with morbid obesity. The study of the relationship between weight modification after bariatric surgery and ambulatory BP measurement, not only peripheral BP, but also central BP, could provide information regarding the mechanisms of organic damage associated with elevated BP in obesity. In this review we analyze the available evidence regarding the association between central BP with obesity and its modifications after bariatric surgery.