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Abstract: PO2096

A Novel Marker of Resistant Hypertension in CKD

Session Information

Category: Hypertension and CVD

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

Authors

  • Gembillo, Guido, Policlinic G. Martino, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
  • Siligato, Rossella, Policlinic G. Martino, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
  • Cernaro, Valeria, Policlinic G. Martino, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
  • Santoro, Domenico, Policlinic G. Martino, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
Background

Inflammation, oxidative stress (OS), atherosclerosis and resistant hypertension (RH) are common features of chronic kidney disease (CKD) leading to higher risk of death from cardiovascular disease. These effects seem to be modulated by impaired anti-oxidant, anti-inflammatory and reverse cholesterol transport actions of high-density lipoprotein cholesterol (HDL). Recently, monocyte count to HDL-cholesterol ratio (MHR) has emerged as a potential marker of inflammation and OS, demonstrating to be relevant in CKD. Our research was aimed to assess, for the first time, its reliability in RH.

Methods

We performed a retrospective study on 214 patients with CKD and arterial hypertension admitted between January and June 2019 to the Unit of Nephrology and Dialysis of Policlinic G. Martino in Messina, Italy. 72 patients were diagnosed with RH, defined as blood pressure >140/90 mmHg despite use of three different classes of antihypertensive medications (one of which must be a diuretic) at the maximum tolerated doses.

Results

MHR appeared inversely related to eGFR (ρ = -0.163; P = 0.0172). MHR was significantly higher among RH patients compared to non-RH ones (12.39 [IQR 10.67 - 16.05] versus 7.30 [5.49 - 9.06] (Figure 1); P < 0.0001). Moreover, MHR was significantly different according to the number of anti-hypertensive drugs per patient in the whole study cohort (F = 46.723; P < 0.001) as well as in the non-RH group (F = 14.191; P < 0.001). Lastly, MHR values differed according to gender, being higher among males (9.41 [6.75 - 12.07] versus 8.02 [5.94 - 10.57]; P = 0.0463).

Conclusion

MHR may be a reliable biomarker due to the connection between HDL and monocytes. HDL prevents and reverses monocyte recruitment and activation into the arterial wall and impairs endothelial adhesion molecule expression. Our study suggests that MHR can reflect inflammatory status and OS in CKD patients with RH, in order to implement appropriate treatment strategies.