Structural alterations of small arteries in patients with essential hypertension are characterized by inward eutrophic remodeling. However, small arteries in patients with secondary hypertension, as ...well as in experimental models of hypertension with high circulating renin, are characterized by inward hypertrophic remodeling, which is characterized by smooth muscle cell hypertrophy in animal models. The aim of our study was to determine whether remodeling of subcutaneous small arteries in patients with secondary forms of hypertension is associated with smooth muscle cell hypertrophy and/or alterations in the elastic modulus of the vessel wall. Fifteen patients with renovascular hypertension, 9 with primary aldosteronism, and 13 with essential hypertension and 9 normotensive subjects were included in the study. A biopsy of subcutaneous fat was taken from all subjects. Small arteries were dissected, and morphology was determined on a micromyograph. Unbiased estimates of cell volume and number were made in fixed material. From the resting tension-internal circumference relation of the small arteries, the incremental elastic modulus was calculated and plotted as a function of wall stress. Blood pressure was greater in patients with essential hypertension, renovascular hypertension, or primary aldosteronism than in normotensive subjects, but no significant difference was observed among the 3 groups of hypertensive patients. The media/lumen ratio, the medial cross-sectional area, and the smooth muscle cell volume were significantly greater in patients with renovascular hypertension than in normotensive subjects and patients with essential hypertension. No difference in cell number or in the elastic properties was observed among the 4 groups of subjects. In conclusion, our data demonstrate for the first time that a pronounced activation of the renin-angiotensin-aldosterone system is associated with vascular smooth muscle cell hypertrophy in human hypertension in a manner similar to that found in animal models.
Objective: Background: at present, few data are available on the prognosis of hypertensive emergencies and urgencies admitted to Emergency Departments (ED). The aim of our study was to evaluate the ...incidence of total and cardiovascular events during follow-up in hypertensive patients admitted in 2 ED in Italy and Greece with hypertensive emergencies or urgencies. Design and method: Methods: medical records of patients aged > 18 yrs, admitted to the ED with blood pressure values > = 180 mmHg (SBP) and/or > = 120 mmHg (DBP) were collected and analysed (24% of patients were classified as “hypertensive emergency” and 76 % as “hypertensive urgency”). Data in 1218 patients (556 men and 662 women, mean age 70 + 13 years) were analysed; the mean duration of follow-up after admission to the ED was 19.5 + 7 months years. Results: Results: During the follow-up cardiovascular events occurred in 148 patients (69 cardiac events, 43 cerebrovascular events). In 272 pts (22 %) a new episode of acute BP rise was recorded. A total of 87 deaths was recorded during follow-up (in 28 patients for cardiovascular causes). All cause and CV mortality were greater in patients with a previous hypertensive emergency (14.7 vs 4.7 %, chisquare p = 0.0001 and 5.8 vs 1.2% chisquare p < 0.0001 for all-cause and for CV mortality, respectively). The incidence of non fatal cardiovascular events was 10,11 and 2,11 per 100 patient-years in patients with hypertensive emergency and urgency, respectively and similar results were obtained when we considered separately the occurrence of cerebrovascular events. Conclusions: Conclusions: admission to the ED for hypertensive emergencies identifies hypertensive patients at increased risk for fatal and non fatal cardiovascular events. Our results underline the need for an accurate follow-up in patients with hypertensive emergencies and urgencies.
Abstract
Background
Left atrial (LA) enlargement (LAE) is associated to an increased risk of cardiovascular complications, and in particular of atrial fibrillation. The 2018 ESH/ESC Hypertension ...guidelines suggested the use of LA volume instead of linear dimensions, and for the first time proposed the indexation to height2 (h2)
The aim of our study was to assess the prevalence of left atrial dilatation in a large sample of patients undergoing an echocardiogram for cardiovascular risk stratification at an ESH excellence centre in Italy.
Design and methods 3872 subjects undergoing a diagnostic work-up for arterial hypertension (known or suspect) were analysed. The mean age was 56±15 years, BMI 26±5 kg/m, 44% normal weight, 39% overweight, 17% obese, 53% males. Left atrial volume was measured by the area-length method using the apical 4-chamber and 2-chamber views.
Results
The prevalence of left ventricular hypertrophy (LVH) was 11% when indexing for BSA and 12% when indexing for height2.7. LAE was observed in 30% of subjects when indexing for h2 and in 9% when indexing for BSA. In obese or overweight subjects the prevalence of LAE was 38% of subjects when indexing for h2 and in 11% when indexing for BSA. The different prevalence of LAE was particularly evident in extremely obese patients.
LAE was very common in patients with LVH: 62% and 26% when indexing for h2 and for BSA, respectively. Interestingly, it was frequent also in patients without LVH, in particular when the indexation for h2 was used (25% as compared to 7% when indexing for BSA).
Conclusions
In a large sample of subjects undergoing a diagnostic work-up for arterial hypertension LAE was frequently observed, particularly when the new indexation proposed by the 2018 ESH/ESC hypertension guidelines was used. Even in the absence of clear-cut LVH, LAE was observed in one quarter of subjects. The indexation to BSA leads to an under-recognition of LAE, in particular in patients with overweight and/or obesity
Background
In patients with Systemic lupus erythematosus (SLE) a greater prevalence of structural and functional cardiovascular (CV) alterations has been described, possibly explaining the higher ...incidence of CV events, as compared to subjects matched for age and sex.
Aim of this study was to analyze the presence of target organ damage in premenopausal women with SLE and in controls matched not only for demographic characteristics but also for other cardiovascular risk factors.
Subjects and methods
4 patients with SLE clinically stable(SLEDAI Score 2.5±1.5)(age 32±7years, range 19–44) and 34 controls matched for sex, age, BMI, clinic blood pressure(BP) and antihypertensive treatment(if present), underwent:24 hours BP monitoring, echocardiography with tissue Doppler analysis(TDI) for the evaluation of left ventricular(LV)structure and of systolic and diastolic function, carotid ultrasound for intima-media thickness(IMT), carotid distensibility measurement, and pulse wave velocity measurement(PWV).
Results
By definition no difference was observed for age, sex, BMI and clinic BP values and a similar Framingham risk score was observed between SLE and controls(1.3±2.7 vs 1.5±2.3%, p = ns). No significant differences were observed for all echocardiographic parameters except LV longitudinal systolic function(Sm), an early index of LV systolic dysfunction(see Table). Carotid IMT and distensibility, as well as PWV and the prevalence of an abnormal aortic stiffness were both similar in the two groups. At the logistic analysis, PWV was independently associated with LV mass in controls and with the steroid weekly dose in SLE patients.
Conclusions
In patients with SLE and low activity index of the disease we did not observe significant vascular alterations as compare to controls with similar cardiovascular risk. The early LV systolic impairment observed in this group of patients needs confirmation in larger cohorts.
This study was designed to evaluate left ventricular (LV) anatomy and function in patients with Cushing’s syndrome.
A high prevalence of LV hypertrophy and concentric remodeling has been reported in ...Cushing’s syndrome, although no data have been reported on LV systolic and diastolic function.
Forty-two consecutive patients with Cushing’s syndrome and 42 control subjects, matched for age, gender, and blood pressure, were studied. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were measured by echocardiography, endocardial and midwall fractional shortening (FS) were assessed, and diastolic filling was measured by Doppler transmitral flow.
The RWT was significantly greater in Cushing patients than in controls. Left ventricular hypertrophy and concentric remodeling were observed in 10 and 26 patients with Cushing’s syndrome, respectively. In Cushing patients, midwall FS was significantly reduced compared with controls (16.2 ± 3% vs. 21 ± 4.5%, p = 0.01). The ratio of transmitral E and A flow velocities was reduced and E deceleration time was prolonged in Cushing patients compared with controls (p = 0.03 and p < 0.001, respectively).
In patients with Cushing’s syndrome, cardiac structural changes are associated with reduced midwall systolic performance and with diastolic dysfunction that may contribute to the high risk of cardiovascular events observed in these patients.
OBJECTIVE:Primary aldosteronism is a relatively common condition in hypertensive patients. Only few studies, in small groups of patients, have evaluated large arteries alterations. In some, but not ...in all studies, positive relationship with vascular damage was observed.Aim of the studyTo compare the prevalence of cardiac and large arteries vascular organ damage in patients with essential hypertension (EH) or primary aldosteronism (PA).
DESIGN AND METHOD:In 243 consecutive patients with no interfering therapy (147 M, mean age 48 ± 11 years) a routine blood sample, including measurement of aldosterone/renin ratio (ARR) and saline load if ARR>30, was obtained. Echocardiography, carotid ultrasound and measurement of pulse wave velocity (PWV) were performed. We considered 3 groups48 patients with EH (ARR < 30); 122 patients with positive ARR screening but negative saline load (indeterminate aldosteronism, IA); 73 patients with PA (positive ARR and post saline aldosterone >100ng/ml)(51 % with adrenal adenoma).
RESULTS:No differences between groups were observed in age, gender, BMI, BP values (clinic and 24 hours), glucose, lipids and renal function. LVMI was greater in PA vs both IA and EH (PA 45 ± 18, IA 39 ± 12, EH 39 ± 10 gr/m2.7, p < 0,05). Left atrial volume/BSA was significantly greater in PA vs EH (PA 27 ± 10, IA 24 ± 8, EH 23 ± 6 ml/m2, p < 0,05 for PA vs EH). A positive correlation was observed between ARR and LVMI (r = 0,20 p = 0,002), left atrium volume (r = 0,201,p < 0,001) and relative wall thickness (r = 0,394, p < 0,005). Indices of vascular damage did not differ between groups (see table). Aldosterone levels and ARR were not significantly correlated with indices of vascular damage.(Figure is included in full-text article.)
CONCLUSIONS:A greater prevalence of cardiac, but not of large arteries damage is observed in PA as compared to EH when a simultaneous assessment of cardiac and vascular OD is performed.
Background. Data on cardiac and vascular structure in secondary hypertension are generally scarce, and no data on the interrelations between cardiac mass and structural characteristics of the vessel ...wall, both in large and in small resistance arteries, are presently available.
Objectives. The aim of this study was to investigate the relation between structural changes in subcutaneous small arteries, left ventricular mass and wall thickness of the common carotid artery in patients with primary and secondary hypertension.
Methods. Seventy-four subjects were included in the study: 11 patients with pheochromocytoma, 14 with primary aldosteronism (PA), 19 with renovascular hypertension (RVH), 18 with essential hypertension (EH) and 12 normotensive (NT) control subjects. All subjects were submitted to a biopsy of subcutaneous fat. Morphologic characteristics of subcutaneous small resistance arteries (relaxed diameter <300 μm) were directly evaluated using a micromyographic technique. All subjects were submitted to calculation of left ventricular mass index (LVMI) and common carotid artery intima-media thickness (CCIMT), using ultrasound technique.
Results. The correlation coefficients between the media to lumen ratio in subcutaneous small arteries (M/L) and LVMI or between M/L and CCIMT were closer in RVH than in pheochromocytoma, EH or NT; in PA the correlation coefficients were slightly less close than those in RVH. An excess prevalence of carotid plaques in RVH was observed.
Conclusions. A close relation between small resistance artery morphology and cardiac or carotid artery structure may be observed in those hypertensive patients in whom the renin-angiotensin-aldosterone system is activated. In constrast, in NT, EH and pheochromocytoma no significant correlation between M/L and LVMI or CCIMT was observed.
The aim of our study was to evaluate the relationships between endothelial function, small resistance artery structure, and blood pressure in patients with primary or secondary hypertension. Sixty ...subjects were included in the study: 9 patients with pheochromocytoma, 10 with primary aldosteronism, 17 with renovascular hypertension, and 13 with essential hypertension with 11 normotensive subjects who served as controls. Clinic and 24-hour ambulatory blood pressure (ABPM) were evaluated. All subjects were submitted to a biopsy of subcutaneous fat. Small resistance arteries were dissected and mounted on a micromyograph and the media/lumen ratio was calculated. A dose-response curve to acetylcholine was performed at cumulative concentrations from 10(-9) to 10(-5) mol/L. The vasodilator response to acetylcholine was similarly impaired in the four groups of hypertensive patients (ANOVA P<.05 versus normotensive controls), without any significant difference among them. In subcutaneous small arteries of patients with either primary aldosteronism or renovascular hypertension, a marked increase in media:lumen ratio was observed, while in patients with pheochromocytoma, the extent of vascular structural alterations was similar to that observed in essential hypertension. No significant correlation between media-lumen ratio or clinic blood pressure and maximum acetylcholine-induced vasodilatation was observed. On the contrary, a significant, albeit not very close, correlation between ABPM values and maximum acetylcholine-induced vasodilatation was observed (r=34, P<.05 with 24-hour systolic blood pressure, r=0.36, P<.05 with 24-hour diastolic blood pressure). In conclusion, endothelial dysfunction seems to be independent from the degree of vascular structural alterations and from the etiology of hypertension, and it is probably more linked to the hemodynamic load.
Background
Vascular structural(intima-media thickness, IMT) and functional(carotid stiffness, cPWV)alterations are related to different pattern of left ventricular (LV) geometry in general ...populations and in hypertensives. The relationship between vascular damage and LV geometry has not been analyzed prospectively in patients undergoing coronary angiography.
Methods
399 consecutive patients with clinical indication to coronary angiography, prospectively underwent standard ultrasound examination for the evaluation of LV mass index(LVMi g/m2.7), relative wall thickness(RWT), distal anterior descending coronary artery flow velocity(LADd_vel), carotid ultrasound with real time echotracking system for measurement of central blood pressure(cSBP, cDBP), common carotid intima media thickness(cIMT) and carotid pulse wave velocity(cPWV) (Esaote MyLab 70). The noninvasive evaluations were performed blindly to clinical information, before coronary angiography.
Results
cIMTand cPWVwere higher in patients with concentric LVH(LVMI>49 g/h2.7 in men and ≥47 g/h2.7 in women and RWT≥ 0.42) as compared to N (normal LV mass and geometry) and CR (concentric remodeling, normal LVMi and RWT>0.42). LADd_vel was greater in patients with concentric LVH than in others groups. The prevalence of coronary stenosis(>50%) was greater in patients with concentric LVH and CR as compared to N. Patients with concentric geometry (RWT≥0.42) showed higher values of cIMT(773±169 vs 729±162, p<0.005), cPWV(8.9±2.7 vs 9.6±2.6, p<0.05) and LADd_vel(40±22 vs 48±31, p<0.05) and a greater prevalence of coronary stenosis(>50%)than patients with RWT<0.42(53 vs 69%, p<0.005).
Conclusions
Our results confirm that in patients undergoing coronary angiography concentric geometry in associated with structural and functional carotid alterations, with increased central blood pressure and anterior descending coronary artery flow velocity. In this large group of patients, concentric geometry is associated with a greater prevalence of coronary stenosis, as assessed by coronary angiography.
PDF
