Effect of Continuous Positive Airway Pressure Therapy on Aortic Stiffness in Patients with Obstructive Sleep Apnea Syndrome

Objective: The most significant complications seen in patients with obstructive sleep apnea syndrome (OSAS) are associated with the cardiovascular system. The present study assessed aortic stiffness in patients with OSAS and evaluated the effect of continuous positive airway pressure (CPAP) therapy on aortic stiffness. Method: Twenty‐four patients with newly diagnosed, previously untreated, moderate or severe OSAS (apnea‐hypopnea index > 15) and a control group of 17 healthy patients were included in the study. M‐mode recordings of the ascending aorta were taken from the parasternal long axis by echocardiograhy, and systolic and diastolic diameters of the aorta were measured. Aortic elastic parameters, aortic strain, and distensibility were calculated. Measurements were repeated after 6 months of CPAP therapy in patients with OSAS and were compared with baseline values. Results: In patients with OSAS, compared with the control group, aortic strain (6.7%± 2.1% vs. 12.4%± 3.1%; P < 0.001) and aortic distensibility (2.8 ± 0.9 × 10^?6 cm² dyn^?1 vs. 5.5 ± 1.7 × 10^?6 cm² dyn^?1; P < 0.001) were evidently lower, and there was a significant correlation between aortic elastic parameters and AHI. After a 6‐month course of CPAP therapy, significant increases were observed in aortic strain (6.1%± 1.5% vs. 7.3%± 1.7%; P < 0.001) and aortic distensibility (2.5 ± 0.7 × 10^?6 cm² dyn^?1 vs. 3.1 ± 0.9 × 10^?6 cm² dyn^?1; P < 0.001) in patients with OSAS. Conclusion: Aortic strain and distensibility were lower in patients with OSAS than in control patients, and CPAP treatment provided improvement in aortic elastic parameters. (ECHOCARDIOGRAPHY, Volume 26, November 2009)     

The velocity of home blood pressure reduction in response to low-dose eplerenone combined with other antihypertensive drugs determined by exponential decay function analysis

Background/objective: Eplerenone is a highly selective aldosterone blocker, which has the potential to lower blood pressure (BP) in patients with hypertension. The objective of this study was to assess the hypotensive effects of low-dose eplerenone (25?mg) using home BP measurements. We also assessed the time required to reach 95% of the maximum antihypertensive effect (stabilization time) by analyzing exponential decay functions using home BP measurements.

Methods: We reviewed the medical records of 83 hypertensive patients who were taking eplerenone 25?mg (age, 68.6?±?11.8?years; men, 36.1%) in addition to other antihypertensive agents. Home BPs were averaged in each patient for the last 5?days of each observation period. The morning versus evening effect (M/E ratio) and the evening versus morning effect (E/M ratio) were calculated to assess the duration of action of eplerenone.

Results: The mean home systolic/diastolic BPs at baseline were 136.8?±?8.8/77.2?±?9.3?mmHg, respectively. After 8?weeks of treatment with eplerenone, home systolic/diastolic BP significantly decreased by ?7.1?±?10.1/?2.6?±?5.0?mmHg (p?p?=?0.006) and 16.5 days (p?=?0.001), respectively. When eplerenone was administered in the morning, the M/E ratio was 1.1?±?0.3. The corresponding E/M ratio for evening administration was 0.9?±?0.6. Although no nocturia was observed, there was a slight but significant increase in serum potassium levels (p?=?0.03).

Conclusions: Our data suggest that the combination of eplerenone with other antihypertensive drugs may be a promising therapeutic strategy for the treatment of essential hypertension.     

Effectiveness of using long-acting angiotensin II type 1 receptor blocker in Japanese obese patients with metabolic syndrome on morning hypertension monitoring by using telemedicine system (FUJIYAMA Study)

Aim: Recently, obesity patients have been diagnosed as metabolic syndrome. The aim of this study was to evaluate which angiotensin type 1 receptor blockers (ARBs), telmisartan or candesartan, is superior for the control of home blood pressure (BP) in the morning when the outpatient clinic BP was well controlled in the patients with metabolic syndrome.

Methods: The patients with metabolic syndrome were enrolled. Home BP was monitored by using a telemedicine system. After a 2- to 4-week control period to establish baseline home BP values, these patients were randomly divided into telmisartan (20–80?mg) and candesartan (4–12?mg) groups. These end points were evaluated by using the telemedicine system during steady-state active therapy. A total of 356 patients attending 60 outpatient Japanese centers were recruited.

Results: On a day of active therapy, telmisartan significantly lowered both systolic and diastolic home BP in the morning to a greater extent compared to candesartan. At the end of the study, reductions in systolic and diastolic home BP in the morning, in telmisartan group were significantly larger compared to the changes in the candesartan group (systolic; Tel: 12.0?±?8.9 versus Can: 8.1?±?17.1?mmHg, p?=?0.0292, diastolic; Tel: 7.4?±?6.1 versus Can: 3.7?±?6.8?mmHg, p?=?0.0053). Additionally in the telmisartan treated group, LDL-cholesterol showed significant reduction (p?=?0.037), but candesartan did not.

Conclusion: The present study by using the telemedicine system clearly demonstrated that telmisartan has a strong effect on reducing morning home BP, and a good effect on lipid metabolism in patients with metabolic syndrome.     

The relationship between fragmented QRS and non-dipper status in hypertensive patients without left ventricular hypertrophy

Background: Fragmented QRS (fQRS) has been shown to be associated with poor outcome in various cardiovascular diseases. Non-dipper hypertension is also associated with increased cardiovascular mortality. The aim of our study is to investigate the relationship between fQRS and non-dipper status in hypertensive patients without left ventricular hypertrophy (LVH). Methods: This study included 106 hypertensive patients without LVH. Patients were divided into two groups: dipper hypertension and non-dipper hypertension. The presence of fQRS was analyzed from surface electrocardiography. Results: Frequency of fQRS (56% vs. 19.6%, p < 0.001) and mean number of leads with fQRS (1.9 ± 1.7 vs. 0.6 ± 1.0, p < 0.001) were significantly higher in patients with non-dipper hypertension compared to dipper hypertension. In addition, the number of leads with fQRS was positively correlated with systolic (r = 0.334, p < 0.001) and diastolic (r = 0.280, p = 0.004) blood pressures (BP). By a multivariate regression analysis, fQRS (OR: 5.207, 95% CI: 2.195–12.353, p < 0.001) was found to be independent predictor of non-dipper status. Conclusion: fQRS is independent predictor of non-dipper status in hypertensive patients without LVH. Also, the higher number of leads with fQRS is associated with higher sleep systolic and diastolic BPs.     

Detection of atrial electrical and mechanical dysfunction in non-dipper pre-hypertensive subjects

Introduction: A relationship between atrial conduction time and hypertension was shown in previous studies. Increased atrial electromechanical intervals used to predict atrial fibrillation by measured tissue Doppler imaging (TDI). So we aimed to search if there was any association between the non-dipping status and atrial electromechanical intervals in pre-hypertensive patients.

Methods: Forty-one non-dipper and 33 dipper pre-hypertensive subjects enrolled in the study. Systolic and diastolic blood pressures were measured with a mercury sphygmomanometer. Twenty-four hours blood pressure was measured with cuff-oscillometric method. All patients were evaluated by transthoracic echocardiography. Using tissue Doppler imaging (TDI), atrial electromechanical coupling (PA) was measured from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum) and right ventricular tricuspid annulus (PA tricuspid).

Results: Systolic and diastolic blood pressures were significantly higher in subjects with non-dipper phenomenon than dipper ones at night. Twenty-four hours average systolic and diastolic blood pressures were higher in non-dipper pre-hypertensive subjects, but this elevation was not significant. Left and right intraatrial (PA lateral-PA septum and PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) electromechanical coupling intervals were measured significantly higher in non-dipper pre-hypertensive patients (31.3?±?3.9 versus 24.1?±?2.3, p?=?0.001; 19.5?±?4.3 versus 13.8?±?2.1, p?=?0.001; and 11.4?±?2.8 versus 8.8?±?1.5, p?=?0.001). Also, interatrial electromechanical delay was negatively correlated with dipping levels.

Conclusion: This study showed that prolonged atrial electromechanical intervals were related non-dipper pattern in pre-hypertensive patients. Prolonged electromechanical intervals may be an early sign of subclinical atrial dysfunction and arrhythmias’ in non-dipper pre-hypertensive patients.     

Impaired aortic elastic properties in patients with chronic graft-versus-host disease

Objectives: Graft‐versus‐host disease (GVHD), which develops as a result of the immunologic response that donor T‐lymphocytes generate against host tissue following hematopoietic stem cell transplantation (HSCT), is the leading cause of morbidity and mortality in these patients. The aim of this study is the investigate relation between aortic wall stiffness and duration of the disease in patients with chronic GVHD. Methods: The study population included 32 patients (18 men; mean age, 36.9 ± 12.5 years, and mean disease duration = 14.7 ± 2.9 months) who received HSCT and was diagnosed with GVHD and 44 patients (23 men; mean age, 35.2 ± 9.6 years, and mean disease duration = 13.5 ± 2.4 months) who did not develop GVHD following HSCT. All patients underwent baseline echocardiography before HSCT and were followed. After approximately 10–14 months following HSCT, these patients were divided into two groups based on whether they had developed chronic GVHD, and were compared to aortic stiffness parameters and cardiac functions. Results: There was no change in basal characteristics, laboratory and echocardiographic findings, and aortic stiffness parameters in both groups before HSCT (P > 0.05). After HSCT, the mean aortic strain and distensibility values of the chronic GVHD patients were significantly lower, compared with the non‐GVHD patients (9.8 ± 3.2% vs. 12.9 ± 5.0%, P = 0.002 and 4.1 ± 1.5 × 10^?6 cm²/dyn vs. 5.3 ± 2.1 × 10^?6 cm²/dyn; P = 0.005, respectively). In addition, aortic stiffness index was increased in the chronic GVHD group compared with non‐GVHD group (2.7 ± 1.7 vs. 2.0 ± 0.8, P = 0.03). Conclusion: Aortic stiffness measurements were significantly different in chronic GVHD group compared to non‐GVHD group and these findings suggested useful explanation for the potential mechanism about the development of disease. (Echocardiography 2011;28:1011‐1018)     

组织多普勒成像评价血压昼夜节律变异对左心室舒张功能的影响

目的探讨血压昼夜节律变异对左心室舒张功能的影响。方法31例非杓型高血压患者(非杓型组)和31例年龄、性别相匹配的杓型高血压患者(杓型组)入选。两组患者均行24 h动态血压监测和组织多普勒成像(DTI)检查。结果两组日间平均收缩压和平均舒张压无显著性差异,非杓型组的夜间平均收缩压和平均舒张压均显著高于杓型组[(145.1±34.5)mm Hg(1 mm Hg=0.133 kPa)vs(127.9±18.1)mm Hg,(94.2±38.1)mm Hgvs(78.5±18.2)mm Hg,P<0.05]。心脏超声检查显示两组在心腔内径、室壁厚度和左心室射血分数等参数无显著性差异,DTI结果显示非杓型组的平均组织舒张早期速度(MEa)、MEa/平均组织舒张晚期速度(MAa)显著低于杓型组[(5.9±2.1)cm/svs(7.8±3.1)cm/s,(0.68±0.56)cm/svs(0.95±0.39)cm/s,P<0.05和P<0.01)];非杓型组的MAa较杓型组明显升高[(9.5±2.8)cm/svs(8.6±1.7)cm/s,P<0.01]。结论血压昼夜节律变异可加重左心室舒张功能受损。对于存在血压昼夜节律变异的高血压患者应尽早诊断,积极治疗和加强随访。     

Hypertrophic cardiomyopathy is associated with abnormal echocardiographic aortic elastic properties and arteriograph-derived pulse-wave velocity

Objective: Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disease and defined by the presence of unexplained left ventricular hypertrophy (LVH). Vascular alterations are frequently associated with HCM including microvascular and/or peripherial endothelial dysfunction. This study was designed to evaluate echocardiographic ascending aortic elastic properties and arteriograph‐derived pulse‐wave velocity (PWV) and augmentation index (Aix) in HCM. Methods: This study comprised 38 patients with typical features of HCM. Their results were compared to 20 hypertensive patients with LVH and 23 controls. Systolic and diastolic ascending aortic diameters were recorded in M‐mode at a level of 3 cm above the aortic valve from a parasternal long‐axis view. The following echocardiographic aortic elastic properties were measured from aortic data and forearm blood pressure values: aortic strain, distensibility, and stiffness index. Arteriograph‐derived PWV and AIx were also measured. Results: Aortic stiffness index (18.4 ± 17.6 vs. 6.88 ± 3.63, P < 0.05), PWV (9.44 ± 4.08 vs. 7.97 ± 1.20 m/sec, P < 0.05) and Aix (‐24.9 ± 32.6 vs. –41.4 ± 24.3, P < 0.05) were increased, while aortic strain (0.061 ± 0.053 vs. 0.100 ± 0.059, P < 0.05) and aortic distensibility (1.94 ± 1.68 cm²/dynes 10^?6 vs. 3.08 ± 1.77 cm²/dynes 10^?6, P < 0.05) were decreased in HCM patients compared to controls. Aortic elastic properties of hypertensive patients with LVH showed similar alterations to HCM patients. Conclusions: Abnormal echocardiographic aortic elastic properties and arteriograph‐derived PWV and Aix could be demonstrated in HCM patients compared to matched controls. (Echocardiography 2011;28:848‐852)     

Arterial Mechanics in Ischemic versus Nonischemic Cardiomyopathy: Clinical and Diagnostic Impact

Background: Differential diagnosis between ischemic (IDCM) and the nonischemic type (NIDCM) of cardiomyopathy constitutes a challenge in the daily medical practice. Carotid and aortic elastic properties deteriorate in patients with coronary artery disease. However, their predictive role in differentiating IDCM from NIDCM has not been addressed so far. Aim of the work: To examine carotid and aortic mechanical functions using conventional and Doppler tissue echocardiography in the distinction between IDCM and NIDCM in patients with clinically undetermined etiology. Methods: 70 patients with dilatation and diffuse impairment of the left ventricular (LV) contraction were studied. All patients underwent carotid duplex for measuring intima‐media (IMT) thickness, peak systolic velocity (PSV), and luminal diameters (LD). Aortic distensibility, strain, and aortic wall velocities (systolic (Sa), early diastolic (Ea), late diastolic (Aa) velocities, Sa_t, and Ea_t) were measured. According to coronary angiographic results, patients were categorized into IDCM (n = 36) (age 57.9 ± 9.2 years) and NIDCM groups (n = 34) (age 56.0 ± 8.3 years); they were compared to 30 age‐ and sex‐matched healthy individuals as a control group. Results: The aortic pulsatile change, aortic strain, and distensibility were significantly reduced in both patient groups in comparison to control (P < 0.001). These parameters were much impaired in patients with IDCM compared with NIDCM (P < 0.001). IDCM have more deterioration of Sa, Ea, and Aa compared with NIDCM group (7.6 ± 2.4 vs. 8.9 ± 1.58, 7.5 ± 2.8 vs. 10.6 ± 1.5, 9.0 ± 1.4 vs. 6.9 ± 2.4 cm/sec; P < 0.001), respectively. In IDCM, the variables of aortic elastic properties were correlated only to age, while in NIDCM they were correlated to hemodynamics, LV volumes, wall thickness, and mass. Both carotid diameter and IMT were significantly increased in IDCM in comparison to NIDCM and control (P < 0.001). Carotid distensibility was significantly reduced in IDCM compared with NIDCM and control (P < 0.001). However, the carotid properties strongly correlated to risk factors in IDCM and to hemodynamics and LV function in NIDCM. Using ROC curve, a cutoff value ≤4.7 (cm²/dyne/10³) for aortic distensibility, value <8 cm/sec for Sa and IMT >0.8 mm predicted IDCM with 94.4%, 72.7%, and 97.2% sensitivity and 88.2%, 85.3%, and 97.1% specificity, respectively. Conclusion: Both carotid and aortic mechanical functions are more deteriorated in ischemic compared with nonischemic dilated cardiomyopathy. Different functional and structural mechanisms might be responsible for the deterioration of arterial elastic properties in each category.     

Aortic elastic properties and left ventricular diastolic dysfunction in patients with obstructive sleep apnea

Although the responsible mechanisms are not yet fully known, obstructive sleep apnea is associated with an increased risk for cardiovascular disease and events. The aorta is not only a conduit delivering blood to the tissues but is also an important modulator of the entire cardiovascular system, its elastic properties also affecting left ventricular function and coronary blood flow. The aim of this study was to determine left ventricular diastolic function and aortic elastic properties in patients with obstructive sleep apnea syndrome. Fourteen male patients with obstructive sleep apnea and 14 age- and body mass index-matched healthy male controls took part in the study as a control group. All subjects underwent echocardiographic examination; left ventricular cavity dimension, standard and tissue Doppler parameters, and aortic diameter (3 cm above aortic valve) at systole and diastole were measured. While the aortic stiffness index in patients with obstructive sleep apnea was significantly higher than that of the control group (4.5 ± 0.3 vs 2.1 ± 0.1, P = 0.001), the aortic distensibility index was found to be lower in this group compared with controls (2.4 ± 1.2 vs 3.9 ± 1.5 cm² dynes⁻¹ 10⁻⁶, P = 0.009). Furthermore, peak velocity of myocardial systolic wave and peak velocities of myocardial diastolic waves in sleep apnea patients were lower than in controls. There was an association between aortic stiffness and the apnea hypopnea index (coefficient = 0.49, P = 0.002). We also found an inverse correlation between peak velocity of myocardial diastolic wave and aortic stiffness (coefficient = −0.43, P = 0.003), using multiple linear regression. Increased aortic stiffness that is associated with the severity of disease in patients with obstructive sleep apnea may lead to diastolic dysfunction of the left ventricle.     

Effect of Masked Hypertension on Aortic Elastic Properties

Aortic stiffness is increased in patients with sustained hypertension (SH). The aim of this study was to investigate the relationship between aortic elastic properties and masked hypertension (MH). We evaluated aortic elastic properties in 35 individuals with MH, 35 patients with SH, and 35 normotensive healthy volunteers using transthoracic Doppler echocardiography. All aortic distensibility values were carried out at the same time or immediately after the blood pressure (BP) measurement. Baseline clinical and demographic characteristics of the patients were similar in all three groups. Aortic stiffness index and elastic modulus values were higher in MH group compared to SH group and control group (8.9 ± 6.3 vs. 5.4 ± 2.2 vs. 4.2 ± 2.5, P < .001 and 9.0 ± 6.3 vs. 6.4 ± 2.5 vs. 4.1 ± 2.4, P < .001, respectively). Aortic strain values were lower in MH group compared to SH group and control group (7.4 ± 5.3 vs. 9.5 ± 4.1 vs. 14.6 ± 7.1, P < .001, respectively). Aortic distensibility values were lower in MH and SH groups compared to controls (3.1 ± 1.9 vs. 3.7 ± 1.6 vs. 6.4 ± 3.4, P < .001, respectively). Furthermore, diastolic aortic diameter, left ventricular mass index, interventricular septum, and posterior wall thickness were higher in MH and SH groups when compared to controls. This study shows that masked hypertensive patients are at higher risk of “aortic” stiffness, a risk factor for cardiovascular morbidity and mortality, than normotensive and sustained hypertensive patients.     

Hypertensive response to exercise in dipper and non-dipper normotensive diabetics

Non-dipper blood pressure (NDP) as an indicator of autonomic dysfunction could be associated with hypertensive response to exercise (HRE) in diabetic patients. HRE was determined as a predictor of development of unborn hypertension. We aimed to investigate if any correlation among NDP and HRE in normotensive type 2 diabetic patients. A total of 59 consecutive type 2 diabetic patients without history of hypertension and with normal blood pressure (BP) on ambulatory blood pressure monitoring (ABPM) were enrolled to the study. We divided the study population in to two groups depending on their BP on ABPM as dipper (group 1) or non-dipper (group 2). There were 22 patients (mean age 49.5?±?7 and 10 male) in group 1 and 37 patients (mean age 53.1?±?10 and 14 male) in group 2. Daytime diastolic and mean BP of dippers and night time systolic and mean BP of non-dippers were significantly higher. HRE was not significantly different between groups (59% vs. 62%, p?=?0.820). Hemodynamic parameters during the exercise test were similar. At multivariate linear regression analysis, resting office systolic blood pressure (SBP) (r?=?0.611, p?r?=?0.266, p?=?0.002) and age (r?=?0.321, p?=?0.010) were independently correlated with peak exercises SBP. Logistic regression analyses identified the resting office SBP (OR 1.191, 95% CI 1.080–1.313; p?p?=?0.012) were independent predictors of HRE. This study revealed that HRE is not related with non-dipper BP in diabetic patients. This study could inspire to further studies to explore the main reasons of HRE in diabetes mellitus.     

Similar Blood Pressure Values Across Racial and Economic Groups: Baseline Data from a Group Randomized Clinical Trial

This paper examines baseline characteristics from a prospective, cluster‐randomized trial in 32 primary care offices. Offices were first stratified by percentage of minorities and level of clinical pharmacy services and then randomized into 1 of 3 study groups. The only differences between randomized arms were for marital status (P=.03) and type of insurance coverage (P<.001). Blood pressures (BPs) were similar in Caucasians and minority patients, primarily blacks, who were hypertensive at baseline. On multivariate analyses, patients who were 65 years and older had higher systolic BP (152.4±14.3 mm Hg), but lower diastolic BP (77.3±11.8 mm Hg) compared with those younger than 65 years (147.4±15.0/88.6±10.6 mm Hg, P<.001 for both systolic and diastolic BP). Other factors significantly associated with higher systolic BP were a longer duration of hypertension (P=.04) and lower basal metabolic index (P=.011). Patients with diabetes or chronic kidney disease had a lower systolic BP than those without these conditions (P<.0001). BP was similar across racial and socioeconomic groups for patients with uncontrolled hypertension in primary care, suggesting that patients with uncontrolled hypertension and an established primary care relationship likely have different reasons for poor BP control than other patient populations.     

Evaluation of Tp-e interval and Tp-e/QT ratio in patients with non-dipper hypertension

Aims: Non-dipper hypertension is associated with increased cardiovascular morbidity and mortality. Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and that increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. The aim of this study was to evaluate ventricular repolarization by using Tp-e interval and Tp-e/QT ratio in patients with non-dipper hypertension.

Materials and method: This study included 80 hypertensive patients. Hypertensive patients were divided into two groups: 50 dipper patients (29 male, mean age 51.5?±?8 years) and 30 non-dipper patients (17 male, mean age 50.6?±?5.4 years). Tp-e interval and Tp-e/QT ratio were measured from the 12-lead electrocardiogram. These parameters were compared between groups.

Results: No statistically significant difference was found between two groups in terms of basic characteristics. In electrocardiographic parameters analysis, QT dispersion (QTd) and corrected QTd were significantly increased in non-dipper patients compared to the dippers (39.4?±?11.5 versus 27.3?±?7.5?ms and 37.5?±?9.5 versus 29.2?±?6.5?ms, p?=?0.001 and p?=?0.01, respectively). Tp-e interval and Tp-e/QT ratio were also significantly higher in non-dipper patients (97.5?±?11.2 versus 84.2?±?8.3?ms and 0.23?±?0.02 versus 0.17?±?0.02, all p value <0.001).

Conclusion: Our study revealed that QTd, Tp-e interval and Tp-e/QT ratio are prolonged in patients with non-dipper hypertension.     

Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension

Background: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are associated with worse outcome in various diseases. Non-dipping blood pressure pattern is associated with higher cardiovascular mortality. The aim of this study was to explore the association between NLR and PLR in patients with dipper versus non-dipper hypertension.

Methods: The study included 166 patients with hypertension. Eighty-three patients (40 male, mean age: 49.1?±?10.5 years) had dipper hypertension, while 83 patients (41 male, mean age: 52.3?±?12.7 years) had non-dipper hypertension.

Results: Baseline demographic characteristics were similar in both groups. Patients with non-dipper hypertension had significantly higher NLR compared to dipper hypertension (2.3?±?0.9 versus 1.8?±?0.5, p?p?=?0.001). In univariate analysis, hyperlipidemia, smoking, presence of diabetes, PLR more than 107 and NLR more than 1.89 were among predictors of dipper and non-dipper status. In logistic regression analyses, only hyperlipidemia (odds ratio: 2.96, CI: 1.22–7.13) and PLR more than 107 (odds ratio: 2.62, CI: 1.13–6.06) were independent predictors of dipper and non-dipper status. A PLR of 107 or higher predicted non-dipper status with a sensitivity of 66.3% and specificity of 68.7%.

Conclusion: We demonstrated that patients with non-dipper hypertension had significantly higher NLR and PLR compared to dipper hypertension, which has not been reported previously. Moreover PLR more than 107 but not NLR was independent predictor of non-dipper status.     

Higher visit-to-visit intra-dialytic blood pressure is associated with the progression of aortic valve stenosis in chronic hemodialysis patients

Aortic valve stenosis (AS) is a frequent complication contributing to poor prognosis in chronic hemodialysis (CHD) patients. High blood pressure (BP) is known to be associated with AS progression in the general population. In CHD patients, however, BP varies during and between hemodialysis sessions with ultrafiltration volume or inter-dialytic weight gain; therefore it is difficult to characterize the BP status with a conventional single measurement. Our purpose was to clarify the BP variables affecting AS progression in CHD patients. We retrospectively enrolled 32 consecutive CHD patients with AS [aortic valve area (AVA), 1.3 ± 0.3 cm²; mean age 69 ± 8 years] who had serial transthoracic echocardiographic studies at least 6 months apart (mean 23 ± 9 months). AS progression was evaluated using absolute reduction in AVA per year. Pre-dialytic and intra-dialytic (every hour during sessions) BPs throughout the 3 consecutive visits were used to determine each patient’s BP status. We calculated the mean values of pre-dialytic and intra-dialytic BPs and their variability. In univariate analysis, mean visit-to-visit pre-dialytic and intra-dialytic BP were associated with AS progression, whereas all variables of BP variability were not. Multiple regression analysis indicated that only mean visit-to-visit intra-dialytic systolic and diastolic BP remained independently associated with AS progression after adjustment for age, sex, hypertension, hypercholesterolemia, diabetes mellitus, and serum parathyroid hormone (p < 0.05). Although BP regulation in CHD patients is complex and multifactorial, mean visit-to-visit intra-dialytic BP was independently associated with AS progression. Prospective studies are necessary before considering intra-dialytic BP as a potential target for therapy.     

Comparison of subclinical left and right ventricular systolic dysfunction in non-dipper and dipper hypertensives: impact of isovolumic acceleration

Objectives: To evaluate subclinical left ventricular and right ventricular systolic impairment in dipper and non-dipper hypertensives by using isovolumic acceleration.

Methods: About 45 normotensive healthy volunteers (20 men, mean age 43?±?9 years), 45 dipper (27 men, mean age 45?±?9 years) and 45 non-dipper (25 men, 47?±?7 years) hypertensives were enrolled. Isovolumic acceleration was measured by dividing the peak myocardial isovolumic contraction velocity by isovolumic acceleration time.

Results: Non-dippers indicated lower left ventricular (2.2?±?0.4?m/s² versus 2.8?±?1.0?m/s², p?2 versus 3.5?±?1.0?m/s², p?=?0.012) compared with dippers. Left ventricular mass index (p?=?0.001), interventricular septal thickness (p?=?0.002) and myocardial performance index (p?p?=?0.002), mass index (p?=?0.001) and right ventricular myocardial performance index (p?Conclusion: The present study demonstrates that non-dipper hypertensives have increased left and right ventricular subclinical systolic dysfunction compared with dippers. Isovolumic acceleration is the only echocardiographic parameter in predicting this subtle impairment.     

Aortic pressure-diameter relation in patients with non-insulin dependent diabetes mellitus: new insights

Aims/hypothesis. Type II (non-insulin-dependent) diabetes mellitus is associated with macrovascular disease. Therefore, we investigated the aortic elastic properties by a new method in patients with diabetes and control patients matched with them. Methods. Patients with Type II diabetes (n = 20) and control patients without diabetes (n = 21) were enrolled in the study. All patients had coronary artery disease. Instantaneous aortic diameter was measured by an intravascular catheter developed in our institution. Instantaneous aortic pressure was measured simultaneously at the same aortic level with a catheter-tip micromanometer. Thus, aortic pressure-diameter loops were obtained and slope and intercept were calculated. Aortic distensibility, stiffness constant and energy loss were also calculated. Results. The mean age and the heart rate were similar in the two groups. The pulsatile changes in aortic diameter were greater in the control group (0.94 ± 0.4 vs 1.28 ± 0.4 mm, p < 0.01). The stiffness of the aortic wall was greater in diabetic patients as indicated from the following variables: the distensibility was less in patients with diabetes (1.16 ± 0.6 vs 1.95 ± 0.9 cm²· dyne^–1· 10^–6, p < 0.01); the slope was greater (113.4 ± 120.1 vs 51.61 ± 3.3 mmHg/mm, p < 0.01) and the intercept was less in diabetic patients (–2301.9 ± 2692.9 vs –1114.45 ± 295.6 mmHg, p < 0.01); the stiffness constant was greater in patients with diabetes (1.66 ± 1.8 vs 0.77 ± 0.8 mm^–1, p < 0.03). Aortic energy loss was, however, similar between the groups. Conclusion/interpretation. In patients with non-insulin dependent diabetes aortic elastic properties, evaluated by pressure-diameter relation, are impaired. This could play an important part in the development of vascular complications related to diabetes. [Diabetologia (2000) 43: 1070–1075] Received: 17 April 2000     

高血压病患者冠状动脉粥样硬化与主动脉脉压的相关性

目的研究冠状动脉粥样硬化与高血压病患者主动脉脉压的关系。方法入选300例初发未经治疗的高血压病患者,根据冠状动脉造影结果将患者分为冠心病组和非冠心病组。在冠状动脉造影前测量主动脉根部的收缩压和舒张压并计算主动脉脉压,收集患者的临床指标和实验室检查资料。结果冠心病组的主动脉收缩压(150.3±26.5 mmHg)和脉压(77.1±22.7 mmHg)明显高于非冠心病组(145.6±23.3 mmHg和70.4±19.3 mmHg,P<0.05),冠心病组每搏输出量与主动脉脉压的比值(1.15±0.44 mL/mmHg)明显低于非冠心病组(1.31±0.50 mL/mmHg,P<0.05)。另外,冠心病组患者的空腹血糖(122.3±24.0 mg/dL比95.6±24.4 mg/dL,P<0.01)和血清肌酐(1.06±0.19 mg/dL比0.99±0.14 mg/dL,P<0.01)比非冠心病组高,而高密度脂蛋白胆固醇(47.7±11.7 mg/dL比54.9±15.6 mg/dL,P<0.01)比非冠心病组低。结论动脉粥样硬化可进一步加重高血压病患者大动脉僵硬度,使主动脉脉压增宽。此外,动脉粥样硬化还导致高血压病患者的肾功能受损,并影响脂质代谢。     

Association of blood pressure and aortic distensibility with P wave indices and PR interval: The Multi-Ethnic Study of Atherosclerosis (MESA)

Introduction

Hypertension is an established risk factor for atrial fibrillation. Understanding the association of blood pressure (BP) levels and aortic distensibility with P wave indices (PWIs) and PR interval, intermediate phenotypes of atrial fibrillation, could provide insights into underlying mechanisms.

Methods

This analysis included 3180 men and women aged 45–84 years participating in the Multi-Ethnic Study of Atherosclerosis, a community-based cohort in the United States. Aortic distensibility was evaluated in 2243 of these individuals using cardiac magnetic resonance imaging. PWIs and PR interval were automatically measured in standard 12-lead ECGs. Sitting BP and other cardiovascular risk factors were assessed using standardized protocols. Left ventricular mass was measured by magnetic resonance imaging.

Results

Higher systolic BP, and diastolic BPs and greater pulse pressure were associated with a significantly greater P wave terminal force. These associations, however, were markedly attenuated or disappeared after adjustment for left ventricular mass. Systolic BP, diastolic BP, and pulse pressure were not strongly associated with PR interval or maximum P wave duration. Reduced aortic distensibility was associated with a longer PR interval but not with PWIs: compared with individuals in the top quartile of aortic distensibility, participants in the lowest quartile had on average a 3.7-ms longer PR interval (95% CI: 0.7, 6.7, p = 0.02), after multivariable adjustment.

Conclusion

In this large community-based sample, associations of BP and aortic distensibility with PWIs and PR interval differed. These results suggest that processes linking hypertension with the electrical substrate of atrial fibrillation, as characterized by these intermediate phenotypes, are diverse.