Background/Objectives: Mediterranean diet has favorable effects on the cardiovascular system, whereas albuminuria is associated with atherosclerosis progression. The aim of the study was to assess the relationships of adherence rates to the Mediterranean diet with albumin to creatinine ratio (ACR), in a cohort of Greek adolescents who participated in the Leontio Lyceum ALbuminuria (3L) study. Subjects/Methods: In a total of 365 adolescents 12-17 years of age included in 3L study, ACR values were determined in a morning-spot urine. Results: The Mediterranean diet Quality Index for children and adolescents (KIDMED) was estimated and accordingly subjects were divided into those with high (X8), average (4-7) and low (p3) score. Adolescents with low (n ¼ 153, 42%) compared with those with average (n ¼ 187, 51.2%) and high (n ¼ 25, 6.8%) KIDMED score were characterized by greater ACR values (22.4 vs 13.4 vs 12.1 mg/g, Po0.05) even after adjustment for confounders. In the total population, KIDMED score was related to body mass index (r ¼ 0.122, P ¼ 0.02), waist circumference (r ¼ 0.118, P ¼ 0.02), systolic blood pressure (BP) (r ¼ 0.119, P ¼ 0.023), whereas it was negatively associated with ACR (r ¼ À0.111, P ¼ 0.041). Regarding ACR, it was associated with age (r ¼ À0.11, P ¼ 0.044), male sex (r ¼ 0.16, P ¼ 0.003), body mass index (r ¼ À0.131, P ¼ 0.016) and systolic BP (r ¼ À0.144, P ¼ 0.008). Conclusions: Adolescents who adhere to the Mediterranean diet exhibit lower levels of albuminuria, independently of demographic and hemodynamic confounders. The inverse relation of KIDMED index with ACR suggests a close link of accelerated vascular damage reflected by albuminuria with low adherence to this favorable diet of the Mediterranean basin.

Although the significance of MA in paediatric essential hypertension has yet to be determined, its role in diabetic children and adolescents is established and albuminuria assessment has been utilized as a screening test for the presence of diabetes-related kidney disease.

This study aimed to assess the predictive role of body mass index (BMI), waist circumference (WC) and the waist-to-hip ratio (WHR) for the incidence of coronary artery disease (CAD) in a cohort of essential hypertensive patients. We followed up 2266 essential hypertensive individuals (mean age, 57.8 years; males, 1083; office blood pressure (BP), 143/89 mm Hg) who were free of cardiovascular disease for a mean period of 6 years. All subjects had at least one annual visit and, at baseline, underwent blood sampling and a complete echocardiographic study to determine the left ventricular (LV) mass index. CAD was defined as a history of myocardial infarction or significant coronary artery stenosis that was revealed by angiography or a coronary revascularization procedure. The incidence of CAD throughout the follow-up period was 2.33%. Hypertensive individuals who developed CAD (n=53) had a greater baseline WC (101.1±11.7 vs. 96.4±12 cm, P=0.005), WHR (0.94±0.07 vs. 0.89±0.08 cm, P<0.0001) and LV mass index (117±26.8 vs. 103.3±27 g m(-)(2), P<0.0001) compared with those without CAD at follow-up (n=2213), whereas no difference was observed compared with the baseline office BP and BMI values (P=NS for all). Using a multivariate Cox regression model, WC (hazard ratio (HR) 1.037, P=0.002) and LV mass index (HR 1.010, P=0.044) were found to be independent predictors of CAD. In essential hypertensive patients, WC could predict the future development of CAD, whereas BMI and WHR showed no independent prognostic value. These findings suggest that WC constitutes an easy clinical tool to assess risk in hypertension among individuals with obesity.

Both blood pressure (BP) non-dipping and nighttime hypertension have been associated with accelerated target-organ damage (TOD). However, increased nighttime BP in subjects with a dipping circadian BP profile has never been reported or associated with TOD. Here, we investigated the relationships of nighttime BP with indices of vascular and kidney damage in dipper hypertensive subjects. We studied 402 subjects with untreated stage I-II essential hypertension. According to ambulatory BP recordings, 127 dipper subjects were selected and subdivided into nighttime hypertensives (NH, n¼69) (nighttime BP X120/70) and nighttime normotensives (NN, n¼50) (nighttime BP o120/70 mm Hg). All participants underwent echocardiographic examination and assessments of carotid-to-femoral pulse wave velocity (c-f PWV), albumin-to-creatinine ratio (ACR), metabolic profile and high sensitivity C-reactive protein (hs-CRP) level. Compared with NN dippers, NH dippers had higher c-f PWV (Po0.001), ACR values (P¼0.01) and hs-CRP levels (Po0.001). Multiple regression analysis showed that nighttime BP was more correlated with c-f PWV and ACR than was daytime BP. Among dippers, nighttime BP is associated more closely with c-f PWV and ACR than is daytime BP. These findings imply that even in dippers, absolute nighttime BP values should be taken into account when predicting surrogate end points such as arterial stiffness and urinary albumin excretion.

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Introduction: The relationship of renal haemodynamics with cardiac and aortic hameodynamics is still unclear. Hypothesis: We evaluated the relationship of increased renal resistive index (RRI) with Augmentation index (AIx) and cardiac haemodynamics by means of mitral annular early diastolic velocity (E/Ea) in untreated patients with essential hypertension. Methods: 76 newly diagnosed untreated non diabetic patients with stage I-II essential hypertension [35 males, aged 50 years, office blood pressure (BP) = 143/ 91 mm Hg], underwent ABPM, complete echocardiographic study for determination of E/Ea and blood sampling for assessment of metabolic profile. Moreover, data on renal resistive index (RRI), obtained by Doppler ultrasound sampling of the intrarenal arteries, as well as augmentation index (AIx), were retrospectively analyzed. Results: Based on the mean value of RRI (0.60), hypertensives were classified into those with high and low RRI. Hypertensives with high RRI values compared to those with low values were older (55.6±9.8 vs 44.4±11.6 years, p < 0.001), had lower 24-hour diastolic BP (77.5±7.7 vs 84.3±6.7 mmHg, p < 0.001), lower 24-hour HR (71.2±10.3 vs 76.2±9.2 bpm, p < 0.05), higher levels of AIx (27.2±8.2 vs 17.8±14.8 %, p < 0.01), and higher values of E/Ea (lateral) (7.7±1.8 vs 6.2±2.3, p < 0.05). In the total population, RRI was negatively related to 24-hour diastolic BP (r = -0.523, p < 0.001) and 24-hour HR (r = -0.281, p < 0.05), while it was positively associated with CRP (r = 0.335, p < 0.05), TChol (r = 0.296, p < 0.01), age (r = 0.443, r < 0.001), AIx (r = 0.413, p = 0.001) and E/Ea(lateral) (r = 0.465, p < 0.05). Multiple regression analysis revealed that 24-hour diastolic BP and E/Ea (lateral) were independent associated with RRI (R2 = 0.434, p < 0.05). Conclusions: Increased vascular resistance of intrarenal arteries is associated with impaired aortic and cardiac haemodynamics, as reflected by increased AIx and E/Ea (lateral) values. RRI may be considered a useful surrogate of haemodynamics in essential hypertension.

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