No abstract

Aims Since December 2015, the European/International Fibromuscular Dysplasia (FMD) Registry enrolled 1022 patients from 22 countries. We present their characteristics according to disease subtype, age and gender, as well as predictors of widespread disease, aneurysms and dissections. Methods and results All patients diagnosed with FMD (string-of-beads or focal stenosis in at least one vascular bed) based on computed tomography angiography, magnetic resonance angiography, and/or catheter-based angiography were eligible. Patients were predominantly women (82%) and Caucasians (88%). Age at diagnosis was 46 ± 16 years (12% ≥65 years old), 86% were hypertensive, 72% had multifocal, and 57% multivessel FMD. Compared to patients with multifocal FMD, patients with focal FMD were younger, more often men, had less often multivessel FMD but more revascularizations. Compared to women with FMD, men were younger, had more often focal FMD and arterial dissections. Compared to younger patients with FMD, patients ≥65 years old had more often multifocal FMD, lower estimated glomerular filtration rate and more atherosclerotic lesions. Independent predictors of multivessel FMD were age at FMD diagnosis, stroke, multifocal subtype, presence of aneurysm or dissection, and family history of FMD. Predictors of aneurysms were multivessel and multifocal FMD. Predictors of dissections were age at FMD diagnosis, male gender, stroke, and multivessel FMD. Conclusions The European/International FMD Registry allowed large-scale characterization of distinct profiles of patients with FMD and, more importantly, identification of a unique set of independent predictors of widespread disease, aneurysms and dissections, paving the way for targeted screening, management, and follow-up of FMD.

No abstract

Recent analyses of the influence of renal function on the cardiovascular outcome in essential hypertensive patients have confirmed the relevance of the kidney in cardiovascular prognosis even in the initial stages of renal failure. The evaluation of renal function in clinical practice is based mainly on the finding of changes in serum creatinine, but the estimation of creatinine clearance or its determination after 24-hour urine collection is not usually performed. The objective of this study was to analyze the prevalence of mild chronic renal insufficiency (MCRI) through the determination of creatinine clearance in patients with essential hypertension to reinforce the need to consider using this parameter in daily clinical practice. We analyzed clinical and biochemical data from 2686 essential hypertension patients referred to our unit from 1979-1999. MCRI was defined as a serum creatinine > or =1.5 mg/dL in men and > or =1.4 mg/dL in women, or a creatinine clearance estimated by the Cockroft-Gault formula or by a 24-hour urine collection of <60 mL/min. A prevalence of MCRI was found in 7.6% according to serum creatinine levels. This prevalence increased to 22.3% and 21.5% respectively when the diagnostic criteria for MCRI was the estimation of 24-hour creatinine clearance in urine, or its estimation using the Cockroft-Gault formula. When classified by creatinine clearance values, patients with MCRI were characterized by older age, elevated systolic blood pressure, higher serum total cholesterol, low-density lipoprotein cholesterol, and triglycerides, lower levels of high-density lipoprotein cholesterol, higher serum uric acid, fasting serum glucose, serum potassium, and higher levels of urinary albumin excretion. In summary, MCRI is more prevalent in essential hypertension than previously thought, particularly if the estimated creatinine clearance is used to define MCRI. The finding of an altered renal function is associated with a significant increase in cardiovascular risk. This fact reinforces the need to pay attention to any of the manifestations of renal damage observed in the usual clinical assessment of any hypertensive patient.

Abstract. Recent evidence highlights the relationship between metabolic syndrome (MS) and increased risk of cardiovascular (CV) diseases. Mild renal function abnormalities are associated with an enhanced CV risk, considered to be due to the presence of associated risk factors. Hence, MS and renal abnormalities could be linked and contribute to augment CV risk. For estimating the prevalence of diminished creatinine clearance (CC; Ͻ60 ml/min per 1.73 m 2 ) in hypertensive patients with or without MS and for investigating the factors accompanying this abnormality, 1625 hypertensive patients, aged 18 yr or older, were included. The presence of MS was defined according to the Adult Treatment Panel III criteria. The overall prevalence of MS was 49.4% (n ϭ 802). No significant difference was found for CC between those with and without MS, albeit the presence of MS was accompanied by greater urinary albumin excretion (P ϭ 0.01). The prevalence of a diminished CC was also similar in the two groups. MS-positive patients presented a progressive decay in CC when classified as normoglycemic (n ϭ 319), impaired fasting glucose (n ϭ 237), and diabetic patients (n ϭ 246; 85.9 Ϯ 30.2, 81.8 Ϯ 26.8, and 75.2 Ϯ 25.7 ml/min per 1.73 m 2 , respectively; P ϭ 0.0007 linearity test) and the opposite for microalbuminuria (29.5 Ϯ 45.5, 45.0 Ϯ 96.6, and 74.1 Ϯ 146.3 mg/24 h, respectively; P ϭ 0.001 linearity test). In multiple regression analysis, factors related to the finding of a diminished CC in MS and non-MS patients were similar. Hypertensive patients at a relatively young age present with an elevated prevalence of minor abnormalities of renal function that is mostly related to the presence of metabolic alteration of glucose together with age and BP.The prevalence of metabolic syndrome (MS) varies according to the population considered, ranging from 8.8 to 14.3% in Europe (1,2) to 22.6 to 23.7% in United States (3,4). In patients with MS, cardiovascular disease (CVD) and all-cause mortality are increased (5), even in the absence of baseline CVD and diabetes (1). After adjustment for conventional cardiovascular risk factors, men with MS are 2.9 times more likely to die of coronary heart disease (1). In addition, minor abnormalities of renal function (MRA; microalbuminuria, increased serum creatinine concentrations, decrease in estimated creatinine clearance (CC), or overt proteinuria) are also common and associated with a high prevalence of CVD (6). The association of MRA with the risk for adverse outcomes is strongly related to coexisting CVD and CVD risk factors (6 -8). Recently, the National Kidney Foundation classified renal failure according to the levels of estimated GFR (9). An estimated GFR Ͻ60 ml/min (chronic kidney disease stage 3) has been identified as a predictor of elevated risk for CVD and death (6,10 -12). There are few data relating the presence of MS to the presence of MRA. Therefore, our aims were (1) to determine the prevalence of MS in a cohort of hypertensive patients, (2) to analyze the prevalence of MRA in pati...