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Funding Acknowledgements Type of funding sources: None. Introduction/Purpose: Patent foramen ovale (PFO) is common in asymptomatic adults and is associated with cryptogenic stroke (CS). We sought to evaluate the impact of PFO closure in health-related quality of life (HRQoL) in PFO patients with CS. Method In this pilot study, 19 patients (mean age 47 ± 7.7; 13 male) who underwent PFO closure at our center were invited to a short-term clinical follow up (mean follow-up period 6-10 months). All patients had suffered an ischaemic stroke and their disability level was assessed using the Modified Rankin Scale (MRS, no significant disability 63%). HRQoL was assessed using the 36-Item Short Form Survey (SF-36) and the European Quality of Life-5 Dimensions Questionnaire (EQ-5D) preoperatively and at follow-up. Results Both SF36 and EQ-5D scores improved after the operation as shown by the self-rating scores (20,67% and 40,52% higher scores, respectively). Patients with major mobility problems were more likely to be current smokers (r = 0.481) and those who had lower scores on the MRS scale (r=-0.571) rated higher their scale diagram. The categories of energy/fatigue (r = 0.459; p = 0.048), social functioning (r = 0.547; p = 0.015) and pain (r = 0.550; p = 0.015) were positively correlated with physical function. Finally, there was a positive correlation between role limitations due to emotional problems and energy/fatigue (r = 0,519; p = 0.023), and between energy/fatigue and emotional well-being (r = 0.519; p = 0,023). Conclusions The results of our study indicate that shortly after PFO, subjects perceive improvements in their QoL. However, it seems that poorly rated physical function was more common in active smokers, and affects patients" social life and their emotional state. Health care professionals should encourage these patients to participate in rehabilitation and psychological support programs postoperatively.

Objective:Smokers often hesitate quitting in fear of gaining weight. Smoking is a strong risk factor for coronary artery disease (CAD), while the respective risk of body weight is less clear. We studied the prognostic ability for CAD of different combinations of smoking habits and obesity status.Des

Left ventricular hypertrophy (LVH) conveys an increased risk of cardiovascular morbidity and mortality. We aimed to compare the prognostic value of daytime and nighttime blood pressure (BP) on the changes in LVH status in newly diagnosed hypertensive subjects. Three hundred and five hypertensive, nondiabetic subjects (mean age 51.1 ± 10.2 years, 190 men) were prospectively studied for a mean period of 42 ± 17 months. At baseline and last follow-up visit, all patients underwent office and ambulatory BP monitoring, as well as echocardiographic assessment. We defined the following: LVH development/LVH persistence as the new-onset LVH at the end of follow-up or the presence of LVH at both baseline and the end of follow-up; left ventricular mass index (LVMI) reduction as a decline in LVMI at the end of follow-up of ≥ 15% compared with the baseline value. Multivariate Cox regression analyses revealed that baseline nighttime systolic BP was a significant predictor of LVH development/LVH persistence during follow-up (hazard ratio=1.066, P=0.02), whereas baseline daytime systolic BP was not. Moreover, the reduction of nighttime systolic BP is related to an almost threefold increase in the probability of LVMI reduction, independently of daytime BP reduction. In conclusion, nighttime BP constitutes a better prognosticator of left ventricular mass alterations over time in treated essential hypertensive patients than does daytime BP.

Objective:Several studies have reported a small yet significant decrease in blood pressure (BP) with continuous positive airway pressure (CPAP) application in patients with obstructive sleep apnea (OSA). We investigated the long-term efficiency of CPAP in the management of hypertensive patients with

Data regarding the prognosis of resistant hypertension (RHT) with respect to its severity is limited. We investigated the cardiovascular risk of severe RHT among patients with treated uncontrolled hypertension. In a prospective observational study, 1700 hypertensive patients (aged 57±12 years, 50

BACKGROUND Blood pressure (BP) nondipping has been associated with target-organ damage (TOD) and adverse outcomes in hypertension. Diverse definitions of nondipping status appear in the literature, regarding the BP components taken into account. Aim of this study was to compare the effects of isolated nondipping of systolic, diastolic and combined systolic and diastolic BP on various indices of TOD. METHODS From 630 consecutive subjects with never-treated essential hypertension stage I-II, we selected 279 subjects who were consistently isolated systolic nondippers (SND, n=76) isolated diastolic nondippers (DND, n=64) and combined systolic and diastolic nondippers (SDND, n=139) in two ambulatory BP monitoring sessions. All three subgroups were subjected to echocardiographic examination, carotid-femoral pulse wave velocity (PWV(c-f)) and albumin-to-creatinine ratio (ACR) determination. Metabolic profile was determined in a morning blood sample. RESULTS SND compared to DND and SDND exhibited higher left ventricular mass/height(2.7) (42.4 ± 9.9 vs. 38.0 ± 9.1 vs. 40.9 ± 11.0 g/m(2.7), P < 0.05), higher log(10)(PWV(c-f)) (0.94 ± 0.07 vs. 0.86 ± 0.05 vs. 0.91 ± 0.07 m/s, P < 0.005), and higher log(10)(ACR) (1.2 ± 0.5 vs. 0.9 ± 0.3 vs. 1.1 ± 0.4 mg/g, P < 0.05). Isolated systolic BP nondipping was an independent determinant of all the studied indices of TOD whereas isolated diastolic BP nondipping was not. CONCLUSIONS Isolated systolic as compared to diastolic and to combined systolic/diastolic BP nondipping is associated with higher left ventricular mass, stiffer arteries, and pronounced urinary albumin excretion.

Purpose: Patients with Obstructive Sleep Apnea (OSA) are often hypertensive, and Continuous Positive Airway Pressure (CPAP) may improve at least the circadian profile of blood pressure (BP). As asymptomatic patients with OSA often refuse to follow CPAP treatment, we investigated the efficacy of antihypertensive drug chronotherapy on BP management in this setting. Methods: In a cross-over trial, we studied 40 patients (aged 52±9 years, 77% males) with newly diagnosed hypertension and never treated, at least moderate OSA (apnea-hypopnea index-AHI: 37±20/hour), without daytime sleepiness (Epworth Score ≤10 points). Patients were first applied treatment with valsartan (± amlodipine) in a single morning dose for 8-weeks. In a second period of 8-weeks, patients were assigned to receive the same regimen in a single evening dose before bedtime. Office and ambulatory BP were measured at baseline and after each treatment phase. Based on concurrent start of CPAP application, patients were divided into two groups: on-CPAP (n=19) and off-CPAP (n=21). Results: Office BP was significantly reduced at the end of both the morning and evening dose phases compared to baseline (by 19.5±11.0/15.0±8.6 mmHg and 23.1±11/16.5±8.4 mmHg, repeated measures ANOVA p

Purpose: Even though resistant hypertension (RHT) is a frequent clinical condition, little is known regarding its clinical course and prognosis. We investigated the associated cardiovascular risk of diverse patterns of RHT evolution. Methods: In a prospective observational study, 1911 treated hypertensive patients (aged 59±11 years, 49% males) were followed for a mean period of 3.9±1.7 years. At baseline, clinical data were collected and patients underwent echocardiographic measurements, routine blood testing and additional workup for exclusion of secondary causes of RHT. Four groups were identified depending on presence or absence of RHT (office-based uncontrolled hypertension under at least 3 drugs including a diuretic or controlled hypertension under 4 or more drugs) at baseline and follow-up: 1,153 patients (60%) never having RHT, 189 (10%) with resolved RHT, 204 (11%) with incident RHT and 365 (19%) with persistent RHT. Endpoint of interest was cardiovascular morbidity set as the composite of coronary heart disease and stroke. Results: During follow-up, 65 events occurred (9.7 cases per 1,000 person-years). Incidence rates of cardiovascular events were 6.4 cases per 1,000 person-years in the never having RHT group, 9.1 cases per 1,000 person-years in the resolved RHT group, 13.2 cases per 1,000 person-years in the incident RHT group and 18.1 cases per 1,000 person-years in the persistent RHT group. Unadjusted analysis showed that patients with persistent RHT exhibited a significantly higher risk by 2.5 times (CI:1.42-4.36, p=0.002) for the composite cardiovascular outcome compared with the never having RHT group, while there was a gradually higher risk in patients with resolved and incident RHT that did not reach statistical significance. After adjusting for a series of established risk factors, persistent RHT remained as an independent predictor of the cardiovascular outcome, associated with a more than twofold risk (OR:2.2, CI:1.21-4.05, p=0.01) Conclusions: In treated hypertensive patients, persistence of RHT is frequent and independently associated with adverse cardiovascular prognosis.

The long-term efficiency of CPAP on BP management of hypertensive patients with OSA on top of optimal antihypertensive medication has not been investigated. We prospectively studied 91 non-sleepy patients (aged 54±9 years, 69 males) with essential hypertension and newly diagnosed moderate-to

Objective: Beneficial effects of continuous positive airwaypressure (CPAP) on both blood pressure (BP) levels andvariability have been documented in patients withobstructive sleep apnoea (OSA). We investigated therelevant impact of different dosing times ofantihypertensive drugs beyond CPAP application.Methods: In this prospective, cross-over trial, we included41 patients with newly diagnosed hypertension and nevertreated OSA (apnoea-hypopnea index 15/h), withoutincreased daytime somnolence (Epworth Score designate the importance of improving circadian BP vari-10points). Patients first received treatment with valsartan orwith a fixed combination of amlodipine and valsartan in asingle morning dose for 8 weeks. In the following 8-weekperiod, patients received the same therapeutic regimen ina single evening dose. Office and ambulatory BP weremeasured at baseline and after each treatment period.Results: Compared with morning administration, eveningdosing induced a greater decrease in office SBP (by3.7 6.5mmHg, P¼0.001). The decrease in 24-h SBP/DBPwas significant and similar after morning and eveningdosing (-16.4 11/11.0 7.5 and -18.4 11/12.1 7.5mmHg, respectively, P