Baroreceptor reflex sensitivity (BRS) is an important factor in the homeostatic regulation of the cardiovascular system. Arterial stiffening also provides direct evidence of target organ damage in ...hypertensive patients. The aim of the present study was to evaluate a possible association between BRS and pulse wave velocity (PWV) in a population of normotensive and hypertensive patients.
A consecutive series of 160 patients underwent office blood pressure (BP) measurements, 24-h ambulatory BP monitoring, a 15-min electrocardiographic and noninvasive BP monitoring, and carotid-femoral PWV measurements. Power spectral analysis was carried out to calculate cardiac BRS, expressed as the alpha-index. The study population was divided into two groups according to the office BP values: patients with systolic and diastolic BP<140/90 mmHg were defined as normotensives, whereas patients with systolic BP≥140 mmHg and/or diastolic BP≥90 mmHg were defined as hypertensives.
Hypertensive patients (79%) had significantly higher PWV values (P=0.004) and a lower alpha-index (P<0.001) than the normotensive patients (21%). Multivariate linear regression analyses showed significant and independent associations of PWV with the following factors: age 0.510, 95% confidence interval (CI): 0.260-0.760; P<0.001, 24-h systolic BP (0.320, 95% CI: 0.120-0.520; P=0.002), and log(alpha-index) (-1.465, 95% CI: -2.686 to -0.244; P=0.019). A 1 ms/mmHg decrease in the log(alpha-index) correlated to an increment of 1.465 m/s (95% CI: 0.244-2.686) in the PWV of the study population.
Increased arterial stiffness is significantly and independently associated with impaired BRS in normotensive and hypertensive patients.
The masking effect (ME) is present in masked hypertensive patients; however, both normotensive and hypertensive individuals may show a similar phenomenon. Previous studies have shown that ME has been ...associated with left ventricular hypertrophy and microalbuminuria in treated hypertensive patients. The aim of our study was to evaluate the association between the magnitude of systolic ME and the extent of common carotid artery intima-media thickness (CCA-IMT) development in normotensive individuals and untreated masked hypertensive and hypertensive patients.
A total of 1154 individuals underwent 24 h ambulatory blood pressure (BP) monitoring and carotid artery ultrasonographic measurements. The final study population included 360 patients with systolic ME (daytime systolic BP higher than office systolic BP). The participants were divided into three groups according to office and daytime BP values: normotensives, masked hypertensives, and hypertensives.
Masked hypertensives presented significantly higher systolic ME (-14.6 mmHg) than their normotensive (-8.2 mmHg) and hypertensive (-9.5 mmHg) counterparts. However, systolic ME was associated significantly with CCA-IMT only in the group of masked hypertensives (r=-0.399, P<0.001). The multivariate linear regression analyses showed significant and independent associations of CCA-IMT with the following factors: age (B=0.028, 95% confidence interval: 0.001-0.055; P=0.044) and systolic ME (B=-0.034, 95% confidence interval: -0.066 to -0.003; P=0.034). A 10 mmHg decrease in systolic ME correlated to an increase of 0.034 mm in the CCA-IMT.
Systolic ME was associated significantly with CCA-IMT values in masked hypertensives. Both normotensive and hypertensive participants have failed to show similar associations.
Ambulatory blood pressure monitoring (ABPM) forms the basis for the diagnosis of masked hypertension, a condition associated with increased target organ damage, and of white-coat hypertension, a ...common condition among subjects referred to hypertensive centers. The aim of this study was to compare the circadian blood pressure (BP) and heart rate (HR) profiles in 1676 Greek subjects in order to identify the circadian patterns in these two categories of patient.
A total of 1676 subjects underwent 24-hour ABPM. The study population was divided into 5 subgroups in terms of the clinic and ambulatory BP levels: normotensives (224 subjects), white-coat hypertensives (353 subjects), masked hypertensives (42 subjects), treated (653 subjects) and untreated (404 subjects) hypertensives.
The patterns of circadian BP and HR profiles were identical in the 5 groups. A clear nocturnal fall (23:00-04:00), an afternoon nadir (16:00), two daytime peaks (one between 09:00 and 14:00 and the other in the evening at 20:00), and a morning surge in systolic BP, diastolic BP, and HR were observed.
The circadian profiles of BP and HR in white-coat and masked hypertension show the same pattern as in normotensive and hypertensive patients (treated and untreated). These findings indicate that factors other than disturbances in BP and HR circadian pattern are likely to be responsible for the pathogenesis of white-coat and masked hypertension. A direct influence of autonomic nervous system activity on the circadian pattern of BP and HR could explain the persistence of a basic circadian profile in normotension, white-coat, masked, and sustained hypertension, independently of 24-hour BP and HR levels.
CHADS sub(2) and CHA sub(2)DS sub(2)-VASc scores are used to assess stroke risk in patients with atrial fibrillation (AF). We investigated whether these scores are associated with stroke outcome in ...non-AF stroke patients. Consecutive patients with acute first-ever ischemic stroke but without AF were classified into subgroups according to prestroke CHADS sub(2) and CHA sub(2)DS sub(2)-VASc scores and followed up for 5 years. Among 1,756 patients (aged 67.2 + or - 12.3 years, 68.2% males), there were 258 (14.7%), 617 (35.3%), and 878 (50.0%) patients with low, intermediate, and high CHADS sub(2) score, respectively. Prestroke CHADS sub(2) and CHA sub(2)DS sub(2)-VASc scores predict long-term stroke outcomes in non-AF patients with acute ischemic stroke. These scores may provide a simple way of stroke prognostic risk stratification among non-AF stroke patients.
Aim:
Personality traits, including hostility, play an important role in the development of cardiovascular disease. Moreover, abnormalities in blood pressure circadian pattern, such as a lack of ...nocturnal BP fall, are related with target organ damage and increased cardiovascular risk. The aim of this study was to investigate the impact of hostility and its dimensions on dipping status, in newly diagnosed hypertensive patients.
Methods:
The study population consisted of 114 newly diagnosed untreated essential hypertensives. All participants underwent 24-hour ambulatory blood pressure monitoring (ABPM) in order to assess dipping status. Hostility was assessed by Hostility and Direction of Hostility Questionnaire (HDHQ). The study population was divided in terms of dipping status in two groups, “dippers” and “non-dippers.”
Results:
The statistical analysis revealed that dippers presented significantly higher score of extrapunitiveness (13.2 + 4.9 vs 11.4 + 3.9, p = 0.032), as well as significantly higher score of the dimension “urge to act out hostility (AH)” (4 + 3 vs 3 + 2, p = 0.025) compared to non-dippers. Multivariate regression analysis revealed extrapunitiveness as the only independent predictor of dipping status. The odds ratio (OR) for dipping status associated with each point increase in extrapunitiveness was 0.912 (95% CI: 0.832–0.992; p = 0.048).
Conclusion:
The present findings may suggest that hostility and its features affect the circadian variation of blood pressure in hypertensive patients, providing a promising objective for future investigations linking psychological factors and dipping status in essential hypertension.
PREDICTORS OF EARLY MORTALITY IN STROKE PATIENTS Panoutsopoulos, Athanasios; Pappas, Apostolos; Dimitriadis, Ioannis ...
European journal of internal medicine,
2011, Letnik:
22
Journal Article
Hyperhomocysteinemia has been recognised as an independent cardiovascular risk factor, while statins have been reported to have pleiotropic effects other than lipid lowering. In our study we sought ...to evaluate the possible effect of short-term administration of simvastatin on homocysteine (Hcy) and other established serum proatherogenic and inflammatory markers in essential hypertensive patients. Our study population consisted of 18 untreated mild essential hypertensive patients (9 men, mean age: 51.2±10.9 years, office blood pressure = 149/96 mmHg). All subjects received simvastatin (40mg/day) for a period of 1 month. Venous blood samples were drawn before and after the period of treatment with simvastatin in order to evaluate lipid, lipoprotein-a (Lp-a), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), fibrinogen, uric acid, homocysteine, folic acid, vitamin B12, high sensitivity-CRP (hsCRP) levels, by standard methodology. For the pooled population BMI was 27.2±3.6 kg/m2, left ventricular mass index was 106±35.1 g/m2, relative wall thickness was 0.45±0.07 and hsCRP levels were 1.5±0.3 mg/l. After 1 month on simvastatin, there was a significant reduction in total cholesterol (215.1±40.7 vs 156.0±29.2 mg/dl, p<0.001), triglycerides (114.1±30.9 vs 89.6±27.8 mg/dl, p<0.05), LDL (141.4±29 vs 89.6±21.6 mg/dl, p<0.001), ApoB (101.6±19.2 vs 71.8±15 mg/dl, p<0.001), uric acid (5.8±1.2 vs 5.4±1.1 mg/dl, p<0.05), homocysteine (13.6±7.3 vs 12.7±7.4 μmol/l, p<0.05). In all subjects, apoA1 and hs-CRP did not exhibit any statistically significant attenuation (p=NS, for all cases). Moreover, the reduction of Hcy serum levels was not correlated with the observed reductions in total cholesterol, triglycerides, LDL, ApoB and uric acid values (p=NS, for all cases). Even in newly diagnosed essential hypertensive subjects, short-term administration of simvastatin resulted in a significant and independent attenuation of Hcy serum levels. These findings may elucidate the diverse pathophysiological mechanisms by which statins reduce cardiovascular risk, in this setting.
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