Valsartan and retinal endothelial function in elderly hypertensive patients

BACKGROUND: The aim of this study was to investigate the impact of short-term treatment with the angiotensin II receptor blocker (ARB) valsartan on retinal endothelial function in elderly patients with mild to moderate essential hypertension. METHODS: In an open-labeled study, 20 elderly, male patients with arterial hypertension (WHO I-II) were treated with the ARB valsartan (80-160 mg once daily) over 8 days. Central retinal artery perfusion at rest and during flicker light stimulation was measured before and after treatment using pulsed wave Doppler sonography. Retinal capillary flow was assessed with scanning laser Doppler flowmetry at rest and following systemic infusion of the nitric oxide synthase (NOS) inhibitor NG-monomethyl-L-arginine (L-NMMA). RESULTS: While valsartan significantly lowered blood pressure, central retinal artery perfusion at rest as well as after flicker light stimulation was similar before and after treatment. Similarly, retinal capillary flow at rest and after infusion of L-NMMA did not change with valsartan after 7 days of treatment. Subgroup analysis revealed that changes in retinal capillary flow in response to L-NMMA might be dependent on serum low-density lipoprotein (LDL) cholesterol levels of study participants. After treatment with valsartan, retinal capillary flow in response to L-NMMA decreased more in patients with low (< 3.54 mmol/l) than with high LDL-cholesterol levels (-12.6 +/- 20.2% vs 12.3 +/- 19.5%, p < 0.05). CONCLUSION: Short-term treatment with valsartan did not improve retinal endothelial function in elderly hypertensive patients.     

Non-invasive methods of evaluation in hypertensive patients

Major strides have been made, in the past few years, in the field of arterial hypertension, due to the availability of methods permitting a non-invasive, and precise evaluation, outside of the office, of the blood pressure as well as the cardiac response to chronic pressure surcharge. The devices used to record pressure profiles, in an ambulatory situation, are periodically activated, either automatically or by the patient himself. They are portable blood pressure recorders connected to a conventional inflatable arm cuff. The arterial blood pressure thus measured may be quite different from that measured by a physician. The value of the arterial blood pressure recorded in ambulatory is not predictable on the basis of the values obtained in a medical environment. An important factor is that the risk of cardiovascular complication seems to be better correlated to the blood pressure measurements obtained in the usual patient's environment than to those taken by the physician. Sonocardiography is another non-invasive method allowing a better screening of the patients likely to benefit from an antihypertensive treatment. A left ventricular hypertrophy may be detected quite early in an hypertensive patient. The regression of such anomaly under antihypertensive treatment permits to ascertain the good quality of the blood pressure control obtained with antihypertensive medications.     

苯那普利对老年高血压病患者血管内皮功能的影响

目的　探讨苯那普利对老年高血压血管内皮功能的影响。方法　采用放射免疫法测定 32例老年高血压患者服用苯那普利前后血管内皮功能的影响变化。结果　治疗前 ET水平升高 ,NO水平降低 ,与对照相比有显著性差异 (P<0 .0 1 )。治疗后 ET水平降低 ,NO水平升高 ,治疗前后比较有显著的差异性。结论　苯那普利可降低 ET,升高 NO,从而改善血管内皮功能。     

Evaluation of endothelial function in hypertensive elderly patients by high-resolution ultrasonography.

BACKGROUND: Multiple investigations, both in experimental models and in middle-aged patients with essential hypertension, demonstrate impaired endothelium-dependent vasodilatation. HYPOTHESIS: We attempted to determine whether hypertension still exerts additional negative effect on endothelial function of large arteries in hypertensive elderly patients who may already be affected by endothelial dysfunction due to aging. METHODS: We compared 13 elderly patients with hypertension [69 +/- 9 years, (mean +/- standard deviation)] with 13 matched healthy elderly subjects (72 +/- 6 years) as controls. Using high-resolution vascular ultrasound, we measured brachial artery responses to reactive hyperemia (with increased flow causing endothelium-dependent dilatation) and sublingual nitroglycerin (causing endothelium-independent dilatation). RESULTS: Flow-mediated dilatation correlated inversely with age (r = -0.60, p = 0.03) in the controls. Flow-mediated dilatation was significantly impaired in hypertensive elderly patients (6.7 +/- 3.3 vs. 13.3 +/- 1.8% in controls, p < 0.0001). No significant difference could found in nitroglycerin-induced dilatation between controls (12.1 +/- 4.9%) and hypertensive elderly patients (10.2 +/- 6.8%, p = 0.5). On multivariate analysis, flow-mediated dilatation in hypertensive elderly patients was inversely related to aging (r = -0.37, p = 0.04) and mean blood pressure (r = -0.57, p = 0.03). CONCLUSIONS: Our study showed decreased flow-mediated dilatation with aging even in the healthy controls, and further decline in flow-mediated dilatation in hypertensive elderly patients compared with controls. This impairment of flow-mediated dilatation in hypertensive elderly patients was related to age and mean blood pressure, indicating that aging and hypertension may independently impair endothelial function in the brachial artery of these patients.     

Impaired endothelial function in hypertensive elderly patients evaluated by high resolution ultrasonography.

BACKGROUND: Multiple investigations both in experimental models and in middle-aged patients with essential hypertension have demonstrated impaired endothelium-dependent vasodilation. OBJECTIVE: To determine whether hypertension exerts an additional negative effect on endothelial function of large arteries in hypertensive elderly patients who may already be affected by endothelial dysfunction due to aging. PATIENTS AND METHODS: Thirteen elderly patients with hypertension (69 9 years of age [mean SD]) were compared with 13 matched healthy elderly subjects (72 6 years of age). High resolution vascular ultrasound was used to measure brachial artery responses to reactive hyperemia (with increased flow causing endothelium-dependent dilation) and to sublingual nitroglycerine (causing endothelium-independent dilation). RESULTS: Flow-mediated diameter (FMD) was significantly impaired in the hypertensive elderly group (6.7 3.3% versus 13.3 3.8% in the control group, P<0.05). No significant difference could be found in nitroglycerine-induced dilation between the elderly control group (12.1 4.9%) and the hypertensive elderly (10.2 6.8%). On simple linear analysis, FMD was inversely correlated with age (r=-0.60, P=0. 03) in the healthy elderly group. FMD in the hypertensive elderly was inversely related to age (r=-0.41, P=0.04) and mean blood pressure (r=-0.67, P=0.01). CONCLUSIONS: This study showed decreased FMD with aging even in the healthy elderly, with a further decline in hypertensive elderly compared with healthy elderly subjects. This impairment of FMD in the hypertensive elderly group was related to age and mean blood pressure, indicating that aging and hypertension may impair endothelial function in the brachial artery of elderly patients with hypertension.     

老年高血压合并糖尿病前期患者肱动脉内皮功能及颈动脉内膜中层厚度变化的研究

目的探讨老年糖尿病前期患者肱动脉内皮功能及颈动脉内膜中层厚度(IMT)的变化。方法选择老年高血压合并糖尿病前期患者143例,根据口服葡萄糖耐量试验(OGTT)结果,分为OGTT正常组(NGT组)32例、单纯空腹血糖受损组(IFG组)35例、单纯OGTT受损组(IGT组)40例和IFG合并IGT组(IGR组)36例。检测4组患者的血脂、空腹血糖、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、高敏C反应蛋白(hs-CRP)、胱抑素C、OGTT 2h血糖(2hPG)、2h胰岛素(2hINS)以及肱动脉内皮功能和IMT。应用多元逐步回归分析内皮依赖性舒张功能(EDD)和IMT的影响因素。结果与NGT组比较,IFG组、IGT组及IGR组IMT升高[(0.98±0.15)mm、(0.99±0.14)mm、(0.99±0.16)mmvs(0.83±0.13)mm,P<0.05],EDD减低[(6.45±0.92)%、(5.60±0.95)%、(4.85±0.86)%vs(7.46±0.96)%,P<0.05,P<0.01]。IFG组、IGT组及IGR组EDD比较,差异有统计学意义(P<0.05)。结论老年糖尿病前期患者的肱动脉EDD减低,颈动脉IMT增加。     

无创血管内皮功能评价,从科研到临床

<正>血管内皮细胞是覆盖于血管最内壁的单细胞层,是人体最重要的代谢和内分泌器官之一。成人约有1012个内皮细胞,覆盖在400～500 m2的血管内腔表面。内皮细胞是血管壁和血管腔的机械与生物学屏障,除维持血管壁的完整和内表面的光滑以外,还具有调节血管的通透性和张力、抗炎、抗氧化、抑制增殖、维持凝血、抗凝及纤溶平衡以及促进新生血管形成等,故对维持血管的稳态具有重要作用。尽管血管内皮细胞有较强的修复能力,但在心血管危险因素、药物、微生物、免疫     

老年原发性高血压患者心脏舒张功能的评价

目的观察老年原性发高血压(EH)患者血压水平及昼夜节律,探讨其与左心舒张功能的相关关系。方法选择因冠心病、糖尿病、缺血性脑血管病等在我院老年心血管内科住院的EH患者57例(EH组)。血压正常患者57例(NBP组)。对所有患者行24h动态血压监测、心脏超声及组织多普勒检查,测量二尖瓣舒张早期血流峰速(E)、二尖瓣环舒张早期运动峰值速度(E′),计算E/E′比值。结果 EH组糖尿病、冠心病的发病率明显高于NBP组(P0.05);行多重线性回归分析显示:年龄、24h平均收缩压(24hSBP)、脉压、24h收缩压负荷(24hSBPL)与E/E′比值呈显著正相关(P0.01),为E/E′比值的危险因素;24h平均舒张压(24hDBP),24h舒张压负荷(24h DBPL)为E/E′比值的保护性因素(P0.05,P0.01)。回归方程为E/E′比值=0.062+2.533×年龄+3.765×24hSBP-2.919×24hDBP+3.75×脉压+3.331×24hSBPL-1.933×24hDBPL。结论老年EH患者心脏舒张功能较显著下降,其收缩压升高、舒张压降低、脉压增加、SBPL增加,均是舒张功能降低的危险因素。     

Non-invasive evaluation of left-ventricular function in hypertension

Left-ventricular functions were assessed by means of mechanocardiography in patients with essential hypertension in the absence of signs of heart failure. A significant prolongation of the isovolumic relaxation phase, rapid filling phase, and an increase in the amplitude of apex-cardiographic "a" wave were found in hypertensive patients showing no ventricular hypertrophy. Similar but more pronounced disorders were observed in patients with ventricular hypertrophy where, in addition, the pre-ejection period was prolonged and there were signs of asynergic contraction. The findings testify to diastolic dysfunction of the left ventricle as a result of its impaired compliance, already present in the early phases of essential hypertension. Mechanocardiography is a suitable method for the detection of cardiac dysfunction in essential hypertension.     

缬沙坦对高血压患者血管内皮功能的影响

目的探讨高血压患者血管内皮功能的变化及缬沙坦对其影响。方法52例原发性高血压患者缬沙坦治疗8周与22例正常血压者对照,检测缬沙坦治疗前后血浆内皮素-1(ET-1)浓度,以及肱动脉超声检测血管内皮舒张功能的变化。结果(1)高血压组血浆ET-1明显高于对照组(P<0.01),缬沙坦治疗后明显下降(P<0.01)。(2)高血压组血流介导的肱动脉舒张低于对照组(P<0.01),缬沙坦治疗后明显改善(P<0.01)。结论高血压患者血管内皮功能受损,缬沙坦在降低血压的同时能改善血管内皮功能。     

Effects of nebivolol versus bisoprolol on endothelial function in hypertensive patients

OBJECTIVE:

To determine the effects of two beta-blockers, nebivolol and bisoprolol, on endothelial function in newly diagnosed hypertensive patients.

METHODS:

Twenty-five hypertensive patients with a mean (± SD) age of 45.3±11.5 years were randomly assigned to receive either nebivolol or bisoprolol for eight weeks in an open-label, crossover design. Flow-mediated endothelial-dependent vasodilation (FMD) was measured at baseline and after each eight-week treatment period. At the end of each treatment period, 24 h ambulatory blood pressure (BP) monitoring was performed.

RESULTS:

The effect of the two beta-blockers on BP was similar. The mean FMD before initiation of treatment was 4.14±3.55%. After treatment with nebivolol, FMD increased to 8.99±4.21%, with a statistically significant difference from baseline (P<0.001). The effect of bisoprolol treatment on FMD was not as dramatic (3.72±6.84%), with no statistically significant difference from baseline. Comparing FMD after each therapeutic regimen, nebivolol treatment resulted in a marked increase in the reactivity of the brachial artery (ie, improvement of endothelial function) compared with bisoprolol treatment (P<0.001).

CONCLUSION:

Nebivolol treatment of untreated hypertensive patients led to a significant improvement in endothelial function compared with bisoprolol treatment, despite the similar effect on BP with either therapeutic agent.     

福辛普利对老年高血压患者内皮依赖性血管舒张功能的影响

目的探讨福辛普利对老年高血压患者内皮依赖性血管舒张功能(FMD)的影响及机制。方法应用高频彩色多普勒超声检测仪对68例老年高血压患者进行FMD的无创检查,并观察福辛普利治疗前后患者FMD的变化。结果福辛普利治疗后老年高血压患者血管内径和硝酸甘油诱发的肱动脉内径变化率与治疗前无明显差异(P>0.05),但反应性充血诱发的肱动脉内径变化率较治疗前明显增加(P<0.05)。结论老年高血压患者出现明显FMD障碍,福辛普利治疗可改善老年高血压患者血管内皮功能。     

Non-invasive evaluation of cardiac function in young patients with type 1 diabetes

Cardiac function was evaluated in 40 Type 1 diabetic patients aged less than 30 years and compared with 20 age- and sex-matched control subjects using resting and exercise electrocardiography, and echocardiography. The duration of diabetes was from 0.25 to 25 years (mean 10 years), and few patients had microvascular complications. Left ventricular end-diastolic and end-systolic diameters were similar in both groups, with no significant differences between the groups in mean thickness of the intraventricular septum and the posterior wall of the left ventricle. Fractional shortening and mean velocity of circumferential fibre shortening as indices of ventricular function were similar in both groups. Left ventricular hypertrophy (Minnesota Code 3,1) was observed in the resting electrocardiogram of 22 patients and 12 control subjects (NS), but no other significant abnormalities were observed. One diabetic patient developed asymptomatic ST segment depression during exercise electrocardiography. In conclusion, the chamber size, wall thickness, and systolic function of the left ventricle are normal in most young Type 1 diabetic patients who have few microvascular complications.     

氯沙坦对糖尿病合并原发性高血压患者内皮细胞功能的影响

目的观察血管紧张素Ⅱ受体拮抗剂氯沙坦对糖尿病合并高血压患者内皮细胞功能及其分泌因子的影响。方法入选48例糖尿病合并1～2级高血压患者,给予氯沙坦50mg／d治疗4周,如血压未得到控制[收缩压≥140mmHg和（或）舒张压≥90mmHg],将药物剂量加倍继续治疗4周。采取静脉血测定治疗前、后血浆降钙素基因相关肽（CGRP）、一氧化氮（NO）、前列环素（PGI2）、内皮素（ET）、血管紧张素Ⅱ（AngⅡ）水平及血压的变化。结果31例治疗2周末血压降至正常,收缩压（162．3±23．8）mmHg比（131．5±17．3）mmHg（P〈0．05）,舒张压（106．4±14．9）mmHg比（85．3±13．5）mmHg（P〈0．01）,其后血压稳定。治疗4周后血浆CGRP和PGI2显著升高,分别为（117．3±19．5）ng／L比（164．2±23．1）ng／L（P〈0．01）和（116．6±69．1）pg／ml比（223．5±84．9）pg／ml（P〈0．01）;血浆AngⅡ水平显著降低[（539．8±226．2）pg／ml比（441．3±161．1）pg／ml,P〈0．05]。其余17例治疗4周后,因收缩压或舒张压未降至正常水平,药量加倍再治疗4周,血压显著下降,收缩压（167．2±21．7）mmHg比（144．2±13．5）mmHg,P〈0．05,舒张压（112．7±13．7）mmHg比（96.3±12．1）mmHg,P〈0．01;血浆CGRP水平显著升高[（112．7±13．7）ng／L比（171．6±37．1）ng／L,P〈0．05],和健康人水平[（178．1±34．7）ng／L]差异无统计学意义（P〉0．05）。结论氯沙坦是一种安全有效的降压药物,同时可以改善糖尿病合并高血压患者血管内皮细胞功能。     

北京某社区老年高血压患者认知功能调查

目的了解社区60岁以上老年高血压患者的认知功能情况。方法选择社区60岁以上老年高血压患者为调查对象,同社区未患高血压的老年人为对照,以简易智能状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)来评估两组人群的认知功能状况。结果与对照组比较,老年高血压组的MMSE总分差异无统计学意义(27.98±2.68比28.37±2.81,t=1.634,P=0.103),但在回忆分项得分差异有统计学意义(2.27±0.84比2.46±0.76,t=2.747,P=0.006);而MoCA总得分、视空间与执行功能、语言、延迟回忆得分均明显减低,差异均有统计学意义(24.61±4.55比25.61±4.44,t=2.572,P=0.01;3.78±1.37比4.04±1.22,t=2.355,P=0.019;2.22±0.80比2.39±0.74,t=2.698,P=0.007;2.39±1.60比2.66±1.60,t=1.978,P=0.048)。结论老年高血压患者认知功能受损,MoCA对认知功能减退患者敏感度较高,可作为临床早期筛查认知功能减退的首选量表。     

Non-invasive evaluation of cardiac function in professional cyclists

Cardiac dimensions and left ventricular function were investigated at rest with non-invasive methods in 14 professional road race cyclists and in 11 age-matched sedentary control subjects. The electrocardiographic findings were in agreement with previous studies in endurance athletes and the vectocardiographic data showed anterior displacement of the electrical forces. Echocardiographic dimensions at end-diastole showed higher values in the cyclists for left ventricular internal diameter, left ventricular posterior wall thickness, and interventricular septal thickness. Derived values for left ventricular volume and left ventricular mass were also much larger in the cyclists and there was excellent agreement between total heart volume measured with radiology and total measured by echocardiography. There was a significant correlation between maximal oxygen consumption and end-diastolic left ventricular diameter.