Background The role of resting Heart Rate on the progression of arterial stiffness has not yet been extensively evaluated. The aim of this study is to investigate the relationship between resting HR and baseline arterial stiffness (evaluated by cfPWV) as well as its progression in a population of hypertensive patients over a 3.7 years follow-up period. Methods We enrolled 572 hypertensive outpatients 18–80 aged, followed by one hospital in Northern Italy. Anamnestic, clinical and laboratory data, BP and cfPWV were assessed at baseline and after a median follow-up time of 3.7±0.5 years Results At baseline the mean age was 53.9±12.7 years, SBP and DBP were 141.2±17.8 and 86.5±10.5 mmHg, HR was 65.6±10.9 bpm and PWV was 8.6±2.0 m/s. Despite an improvement in BP values (from 141.2/86.5 to 132.6/79.2 mmHg, p<0.001), during follow-up, PWV increased (ΔPWV 0.5±2.2 m/s). In patients with a ΔHR above as compared to those under the median value (9 bpm), ΔPWV was significantly higher (0.82±2.22 vs. 0.27±2.25 m/s, p=0.003). At multivariate analysis, HR was among the significant determinants of both baseline PWV and its progression (β = 0.031, p<0.001). Furthermore, ΔHR was a significant determinant of ΔPWV (β = 0.019; p=0.017). Conclusions in hypertensive patients there is a significant relationship between basal resting HR and basal PWV as well as between the increase of HR and the increase of PWV during the follow-up period. Beyond age and BP, resting HR must be considered as an independent determinant of arterial stiffness. This represents a possible mechanism through which HR contributes to the increase in CV risk. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Niguarda Hospital, Milan, Italy

Introduction polyvascular atherosclerotic involvement is one of the definitions of extreme CV risk. For this reason, the search for carotid or lower limb asyntomatic atherosclerotic pathology can be useful to guarantee more intensive treatments for these individuals, who have already had a heart attack. Purpose: the aim was to understand how much the polyvascular patients can improve in functional terms after Cardiological Rehabilitation, comparing them with monovasculars. Besides, the study purpose was to evaluate how many patients are reclassified with an active research of asyntomatic atherosclerotic pathology with carotid ultrasound and Ankle Brachial Index (ABI). Methods The study sample was composed by 87 patients who underwent a cardiological rehabilitation cycle at the Niguarda hospital in Milan from March 2021 to April 2022. Of these, personal, medical, clinical, laboratory and instrumental data were collected. Functional improvement was assested as the difference in meters walked on the 6–minutes walking test (6MWT) on the start day (6MWT–1) and on the end day of rehabilitation (6MWT–2). All patients performed an ABI (to evaluate asyntomatic PAD) and a carotid ultrasound (to evaluate asyntomatic cerebrovascular disease). Results pre–riclassification, polyvascolar patients (13) compared to monovascular (74), in addition to being on average older (70 years vs 59 years, p=0.01), males (100% vs 73%, p<0.001) and having had more previous recurrent myocardial infarctions (46% vs 8%, p=0.002), are less performing in terms of 6MWT–1 (428m vs 514m, p=0.002) and 6MWT–2 (517m vs 597m, p=0.008). About absolute functional improvement from the beginning to the end of rehabilitation, there are no statistically significant differences (81m vs 82m, p=0.919). Following reclassification, 7 patients switched from monovascular (67) to polyvascular (20). Conclusions our data showed that polyvascular patients can improve as much as monovasculars after Cardiological Rehabilitation. Furthermore, following ABI and carotid ultrasound, 8% of patients were reclassified. Polyvascular patients may receive more targeted and intensive therapies if properly diagnosed.

Although uncommon in the general population, hyperkalemia can affect up to 50% of patients with heart failure who are receiving MRA and/or are affected by CKD . Since potassium is the most abundant intracellular cation, hyperkaliemia causes a profound change in action potential, which manifests as expected electrocardiographic changes (lower voltage P wave, AV block, wide QRS, high voltage T wave) and arrhythmias. Clinic case. A 77–year–old woman was admitted to ED for dyspnea. She had a medical history of stage 3 CKD and a HFrEF with a recent admission in medical department for worsening congestion, from which was dimitted with a supratherapeutic dose of MRA (canrenone 300 mg/die). Physical examination at the admission excluded signs of central or peripheral congestion . An EKG was performed and revealed an heart rate of 95 beats per minute and extremely wide QRS (280 ms). Contextually, a blood gas analysis showed high potassium level (K 9 mmol/l) and metabolic acidosis. Due to the inability to demonstrate the presence of P wave and a regular A–V conduction, a differential diagnosis between a VT and a SVT with a wide QRS was required. The presence of a fusion beat, a negative concordance of QRS in the precordials derivation, and an extreme right axis deviation led to a diagnosis of slow VT. Cuncurrently with the onset of hyperkalemia therapy, an ECV with sinus rhythm restoration was done. The following EKGs showed expected electrical changes based on the measured potassium level. After ECV with K 8 mmol/l: QRS remained wide (180ms) with an heart rate of 65 beats per minute in the presence of possible junctional rhythm or sino–ventricular rhythm, which is sometimes described in hyperkalemia as an expression of atrial inectability with the exception of the conduction fibers. After 1 hour with K 6.3 mmol/l: QRS of normal duration with an HR of 60 bpm and a sinus rhythm but with low voltage P wave and concomitant AV block of I grade that was gradually restored with the normalization of potassium levels after canrenone suspension. Because the numerous side effects of hyperkaliemia careful monitoring of MRA therapy and potassium level plays a critical role in the prevention and diagnosis of arrhythmias and EKG changes in patients with HFrEF.

Objective The role of resting Heart Rate on the progression of arterial stiffness has not yet been extensively evaluated. The aim of this study is to investigate the relationship between resting HR and baseline arterial stiffness (evaluated by cfPWV) as well as its progression in a population of hypertensive patients over a 3.7 years follow–up period. Methods We enrolled 572 hypertensive outpatients 18–80 aged, followed by the Hypertension Unit of St. Gerardo Hospital (Monza, Italy). Anamnestic, clinical and laboratory data, BP and cfPWV (complior) were assessed at baseline and after a median follow–up time of 3.7 ± 0.5 years. Results At baseline the mean age was 53.9 ± 12.7 years, SBP and DBP were 141.2 ± 17.8 and 86.5 ± 10.5 mmHg, HR was 65.6 ± 10.9 bpm and PWV was 8.6 ± 2.0 m/s. Despite an improvement in BP values (from 141.2/86.5 to 132.6/79.2 mmHg, p < 0.001), during follow–up, PWV increased (ΔPWV 0.5 ± 2.2 m/s). In patients with a ΔHR above as compared to those under the median value (9 bpm), ΔPWV was significantly higher (0.82 ± 2.22 vs. 0.27 ± 2.25 m/s, p = 0.003). At multivariate analysis, HR was among the significant determinants of both baseline PWV and its progression (β = 0.031, p < 0.001). Furthermore, ΔHR was a significant determinant of ΔPWV (β = 0.019; p = 0.017). Conclusions In hypertensive patients there is a significant relationship between basal resting HR and basal PWV as well as between the increase of HR and the increase of PWV during the follow–up period. Beyond age and BP, resting HR must be considered as an independent determinant of arterial stiffness. This represents a possible mechanism through which HR contributes to the increase in CV risk.