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Abstract: FR-PO1054

Role of Endothelial Function Determined by Asymmetric Dimethylarginine in the Prediction of Resistant Hypertension: A Subanalysis of the ReHot Trial

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Beraldo, Daniel, Universidade Federal de São Paulo, São Paulo, Brazil
  • Rodrigues, Cassio José de oliveira, Universidade Federal de São Paulo, São Paulo, Brazil
  • Quinto, Beata M r, Universidade Federal de São Paulo, São Paulo, Brazil
  • Batista, Marcelo Costa, Universidade Federal de São Paulo, São Paulo, Brazil
Background

Endothelial dysfunction has been conceived as the basis of cardiovascular disease. Brought in core of global epidemic of obesity and the increased life expectancy, resistant hypertension (ReHy) represents a growing public health issue. We conducted a subanalysis of the Resistant Hypertension Optimal Treatment (ReHOT) study to evaluate the association between endothelial dysfunction and resistant hypertension in a population of patients treated in a staged fashion for hypertension.

Methods

ReHOT was a prospective, multicenter, randomized trial comprising 26 sites in Brazil. One hundred and three hypertensive patients of one site were included for this 6 months study in 7 visits (V0-V6), 28 days apart. There was a first phase (V0-V3) of antihypertensive adjustment with 3 drugs to detect ReHy. A second randomized phase (V3-V6) of treatment with a fourth drug (clonidine or spironolactone) in the hypertensive patients characterized as resistant. Serum asymmetric dimethylarginine (ADMA) was determined by high performance liquid chromatography (HPLC) on Visits 1 and 7.

Results

Of the 103 patients included, 86 (83.5%) underwent the randomization visit (V3), 71 were characterized as non-resistant hypertensives (82.5%) and 15 as resistant hypertensives (17.5%). Patients from the upper tercile of serum ADMA had a higher V1 blood pressure, higher total cholesterol values as well as higher prevalence of cardiovascular disease. There was a parallel reduction in blood pressure levels and ADMA values during follow-up with a positive correlation in both groups and a greater reduction among those with ReHy. Serum ADMA was shown to be an independent predictor of resistant hypertension after adjustment for multiple variables (OR: 11.42, 95% CI: 1.02 - 127.71, p = 0.048) .

Conclusion

We demonstrated that ADMA was an independent predictor of resistant hypertension, and we observed that the improvement in blood pressure levels obtained with the treatment was proportional to the reduction in ADMA values, suggesting a complementary role of ADMA not only as a stratification tool for the occurrence of resistant hypertension, but also as a potential therapeutic target in this population.

Funding

  • Government Support - Non-U.S.