Long-term effects of angiotensin II receptor blockade with valsartan on carotid arterial stiffness and hemodynamic alterations in patients with essential hypertension

Increased arterial stiffness and intima media thickness (IMT) in the common carotid artery (CCA) are related to cardiovascular risk in essential hypertension. Angiotensin II plays an important role in structural and functional changes in the vasculature. In this study, we evaluated the long-term effect of the angiotensin II receptor blocker, valsartan, on IMT, arterial stiffness, and hemodynamics in the CCA in patients with essential hypertension. A prospective 24 month study of treatment with valsartan (80-160 mg/day) was performed in 24 hypertensive patients. An ultrasound of the CCA was carried out to determine IMT, the cross-sectional distensibility coefficient (CSDC), the carotid arterial stiffness index beta, and diastolic flow velocity to systolic flow velocity ratio (Vd/Vs). Treatment with valsartan for 24 months reduced systolic and diastolic blood pressure significantly. Compared to baseline, the decrease in pulse pressure was greater after 24 months treatment than after 12 months treatment. Valsartan did not influence IMT; however, after 24 months, it caused a significant increase in CSDC and a decrease in stiffness index beta compared to baseline. These changes were not observed after 12 months of treatment. In addition, Vd/Vs, a sensitive marker of relative diastolic blood flow, increased after 24 months' treatment with valsartan. These results suggest that long-term treatment with valsartan improves vascular wall function and hemodynamics in patients with essential hypertension.     

Intrarenal and carotid hemodynamics in patients with essential hypertension

BACKGROUND: The pulsatility index (PI) and resistive index (RI) are used as markers of peripheral vascular resistance. Recently intrarenal PI and RI were introduced for the evaluation of the severity of acute and chronic renal failure, as well as for the diagnosis of renal artery stenosis and kidney graft rejection. In the present study, we evaluated intrarenal PI and RI in patients with essential hypertension. METHODS: Fifty-one patients with essential hypertension participated. The intima-media thickness (IMT) and mean diastolic (Vd) and systolic velocity (Vs) in the common carotid artery (CCA) were measured using ultrasound and Doppler flow methods. Relative diastolic flow velocity (Vd/Vs) was calculated as an assessment of CCA hemodynamics. Renal Doppler flow was obtained from the interlobar arteries in each of two kidneys. The mean PI ([peak systolic velocity--end-diastolic velocity]/mean velocity) and mean RI ([peak systolic velocity--end-diastolic velocity]/peak systolic velocity) were calculated. RESULTS: Intrarenal PI and RI were positively correlated with IMT and negatively correlated with Vd/Vs in CCA, indicating that renal vascular resistance is related to carotid stiffness. A stepwise regression analysis revealed that age and pulse pressure were independently associated with intrarenal PI and RI. CONCLUSIONS: These results suggest that the measurement of PI and RI is useful for the evaluation of arterial stiffness in patients with essential hypertension.     

Relationship between cardio-ankle vascular index (CAVI) and carotid atherosclerosis in patients with essential hypertension.

Aortic stiffness measured by aorta-iliac or carotid-femoral pulse wave velocity (PWV) predicts all-cause and cardiovascular mortality. Brachial-ankle PWV (baPWV) has been developed as a more convenient assessment of arterial stiffness. However, the problem with clinical use of baPWV is that the index itself is closely dependent on blood pressure. Recently, a new method, termed the cardio-ankle vascular index (CAVI), has been proposed in Japan to overcome the disadvantages associated with measuring PWV. However, its clinical usefulness has not yet been fully clarified. In the present study, we compared the usefulness of CAVI with that of ultrasound for evaluating atherosclerosis in patients with essential hypertension. CAVI was measured in 70 hypertensive patients. The intima-media thickness (IMT), cross-sectional distensibility coefficient (CSDC), stiffness parameter beta, and mean diastolic (V(d)) and systolic (V(s)) flow velocities were evaluated by carotid ultrasound. The V(d)/V(s) ratio, an index of peripheral arterial resistance, was also calculated. CAVI was positively correlated with IMT (r=0.360, p=0.0022) and stiffness beta (r=0.270, p=0.0239) and negatively correlated with V(d)/V(s) (r=-0.471, p<0.0001) and CSDC (r=-0.315, p=0.0079). Stepwise regression analysis revealed that age (r=0.475, p<0.0001) and pulse pressure (r=0.492, r<0.0001) were independent determinants of CAVI. These results suggest that CAVI is a useful clinical marker for evaluating atherosclerosis and arteriolosclerosis in patients with essential hypertension.     

White‐Coat Isolated Systolic Hypertension Is a Risk Factor for Carotid Atherosclerosis

The clinical importance of white‐coat hypertension (WCH) remains a controversial issue. The aim of this study was to evaluate the association of isolated systolic, isolated diastolic, and systolic/diastolic WCH with common carotid artery intima‐media thickness (CCA‐IMT) and to compare each subgroup of WCH against other blood pressure (BP) phenotypes in terms of CCA‐IMT values. A total of 1382 consecutive patients underwent 24‐hour ambulatory BP monitoring and carotid artery ultrasonographic measurements. According to the type of elevated office BP, WCH was divided into three groups: isolated systolic, isolated diastolic, and systolic/diastolic WCH. Patients with isolated systolic WCH (n=112) had significantly higher CCA‐IMT values (0.737 mm) than those with isolated diastolic WCH (n=66) (0.685 mm) and nonsignificantly greater compared with those with systolic/diastolic WCH (n=228) (0.708 mm). Patients with isolated systolic WCH had CCA‐IMT values similar to those with hypertension, patients with isolated diastolic WCH had similar values to those with normotension, and patients with systolic/diastolic WCH had an intermediate risk between normotension and hypertension.     

Association between carotid hemodynamics and asymptomatic white and gray matter lesions in patients with essential hypertension.

The aim of this study was to clarify the magnitude of common carotid artery (CCA) structural and hemodynamic parameters on brain white and gray matter lesions in patients with essential hypertension (EHT). The study subjects were 49 EHT patients without a history of previous myocardial infarction, atrial fibrillation, diabetes mellitus, impaired glucose tolerance, chronic renal failure, symptomatic cerebrovascular events, or asymptomatic carotid artery stenosis. All patients underwent brain MRI and ultrasound imaging of the CCA. MRI findings were evaluated by periventricular hyperintensity (PVH), deep and subcortical white matter hyperintensity (DSWMH), and état criblé according to the Japanese Brain dock Guidelines of 2003. Intima media thickness (IMT), and mean diastolic (Vd) and systolic (Vs) velocities were evaluated by carotid ultrasound. The Vd/Vs ratio was further calculated as a relative diastolic flow velocity. The mean IMT and max IMT were positively associated with PVH, DSWMH, and état criblé (mean IMT: rho=0.473, 0.465, 0.494, p=0.0007, 0.0014, 0.0008, respectively; max IMT: rho=0.558, 0.443, 0.514, p=0.0001, 0.0024, 0.0004, respectively). Vd/Vs was negatively associated with état criblé (rho=-0.418, p=0.0038). Carotid structure and hemodynamics are potentially related to asymptomatic lesions in the cerebrum, and might be predictors of future cerebral vascular events in patients with EHT.     

Effects of amlodipine and valsartan on vascular damage and ambulatory blood pressure in untreated hypertensive patients

The present study was performed to compare the long-term effects of 24-h ambulatory blood pressure (BP) control with amlodipine versus valsartan on vascular damage in untreated hypertensive patients. Amlodipine and valsartan have benefits on cardiovascular mortality and morbidity in hypertensive patients. Although ambulatory BP is associated with severity of target-organ damage in hypertensive patients, beneficial effects of ambulatory BP control with amlodipine versus valsartan on vascular damage have not been compared. Pulse wave velocity (PWV), intima-media thickness (IMT) of the carotid arteries, urinary albumin excretion (UAE) and 24-h ambulatory BP were determined in 100 untreated hypertensive patients before and 12 months after the start of antihypertensive therapy with amlodipine or valsartan. Amlodipine and valsartan decreased ambulatory BP similarly, but the variability of 24-h and daytime ambulatory systolic BP was significantly reduced by amlodipine but not by valsartan. The reduced variability of ambulatory systolic BP caused by amlodipine significantly contributed to the improvement of PWV, although both drugs decreased PWV similarly. Carotid IMT was unaffected by treatment with either drug. Valsartan significantly decreased UAE independently of its depressor effect, but amlodipine had no effect on UAE. These results suggest that the 24-h control of ambulatory BP with amlodipine had functionally improved the stiffened arteries of hypertensive patients by the end of 12 months of treatment, in part through reducing BP variability, whereas ambulatory BP control with valsartan decreased the arterial stiffness to the same degree as amlodipine without affecting BP variability maybe through some pleiotropic effects.     

Telmisartan Improves Morphologic and Functional Changes in Both Left Ventricular Myocardium and Carotid Arterial Wall in Patients with Hypertension: Assessment by Tissue Doppler Imaging and Carotid Ultrasonography

Objective: The aim of the present study was to clarify the beneficial effects of telmisartan on the morphologic and functional changes in left ventricular (LV) myocardium and carotid arterial wall in patients with hypertension (HT) using tissue Doppler imaging and carotid ultrasonography. Methods: Telmisartan (20–40 mg daily) was administered to 35 previously untreated patients with HT. Conventional and pulsed tissue Doppler echocardiography were performed after medication had been continued for 1–2 months with normal values for blood pressure (BP) (phase I) and for 12 months (phase II). Subclinical atherosclerosis also was determined by measuring the intima‐media thickness (IMT) and stiffness β of the left and right common carotid arteries using B‐ and M‐mode ultrasonography. Results: In the phase II, the LV mass index and isovolumic relaxation time were lower, the peak systolic and early diastolic mitral annular motion velocities were greater compared to the phase I. The stiffness β and mean IMT were lower in the phase II than in the phase I. On multivariate regression analyses, age, BP, and LV diastolic variables emerged as stronger predictors of carotid arterial IMT and stiffness β. Conclusions: The 1‐year use of telmisartan improved LV hypertrophy, regional LV myocardial contraction and relaxation, and carotid atherosclerosis in patients with HT. Our results support cardio‐ and arterioprotective benefits from continuous long‐term telmisartan monotherapy, and combined analysis of tissue Doppler imaging and carotid ultrasonography may be a useful tool for understanding ventriculoarterial coupling in patients with HT. (Echocardiography 2010;27:864‐872)     

Increased carotid intima-media thickness in patients with pheochromocytoma in comparison to essential hypertension

Catecholamines due to various mechanisms may contribute to the accumulation of collagen fibers and extracellular matrix in the arterial wall. The aim of this study was to compare intima-media thickness (IMT) of the common carotid artery (CCA) and carotid bifurcation (CB) in patients with pheochromocytoma, essential hypertension and healthy controls. Carotid ultrasound studies were carried out in 30 patients with pheochromocytoma matched for age and gender with 80 patients with essential hypertension and 40 normotensive controls. Significantly higher IMT was found in patients with pheochromocytoma and essential hypertension compared to controls when measured in the CCA (0.931+/-0.223, 0.825+/-0.146 and 0.738+/-0.113 mm; P<0.001; P<0.05), and only in patients with pheochromocytoma compared to controls in the region of CB (1.359+/-0.593, 1.095+/-0.311 and 0.968+/-0.247 mm; P<0.001; P=0.13). Higher IMT in patients with pheochromocytoma compared to patients with essential hypertension was also statistically significant in both carotid regions (both P<0.01). This difference remained significant after adjustment for all relevant clinical and biochemical covariates in the CCA (P=0.014) but disappeared in the region of CB (P=0.079). In summary, patients with pheochromocytoma have increased common carotid IMT when compared to patients with essential hypertension. This finding could be caused by the deleterious effects of the excess of catecholamines on the vascular wall growth and thickening.     

Dissociation between microalbuminuria and common carotid thickness in essential hypertensive men

BACKGROUND: The reasons why microalbuminuria (albuminuria > or = 15 microg/min), an expression of a renal microcirculatory abnormality, predicts cardiovascular disease in essential hypertension are unsettled. To test the hypothesis that microalbuminuria represents a marker of subclinical atherosclerosis, we evaluated its association with common carotid artery (CCA) intima media thickness (IMT), a measure of preclinical atherosclerosis and an independent predictor of cardiac and cerebrovascular events, in uncomplicated essential hypertensive individuals. MATERIALS AND METHODS: Albuminuria, ultrasonographic CCA IMT (the mean of six bilateral far wall measurements within 1.5 cm proximally to the flow divider), brachial blood pressure (BP), smoking habits and lipids were evaluated in 136 stage 1-3 untreated essential hypertensive men free of cardiovascular disease. RESULTS: CCA IMT did not differ between normo- (n = 99) and microalbuminuric (n = 37) patients. The correlation between CCA IMT and albuminuria was not significant, and the prevalence of microalbuminuria across IMT quartiles was not different. Microalbuminuric patients showed higher systolic BP and that parameter was the only independent correlate in a multivariate logistic regression model including also age, CCA IMT, diastolic BP, lipids and smoking habits as independent variables and microalbuminuria as the dependent one. CONCLUSION: This cross-sectional study in hypertensive subjects free of cardiovascular disease has shown a dissociation between microalbuminuria and CCA IMT, a surrogate measure of subclinical atherosclerosis, and a parameter linearly related to cardiovascular events. The data do not support the theory of microalbuminuria as a surrogate measure of subclinical atherosclerosis, while confirming the importance of systolic BP levels as an independent correlate of increased albuminuria in essential hypertension. Journal of Human Hypertension (2000) 14, 831-835     

微粒化非诺贝特对原发性高血压颈动脉内膜中层厚度与脑血流动力学的影响

目的　探讨微粒化非诺贝特对原发性高血压患者颈动脉内膜中层厚度 (IMT)与脑循环动力学 (CVA)的影响。方法　分别对 2 0 7例原发性高血压患者应用微粒化非诺贝特进行为期 2 4个月的治疗和对照 ,观察治疗前后患者颈动脉超声、脑循环动力学及血脂等指标的变化。结果　治疗组 2 4个月后颈动脉IMT基本保持稳定 ,IMT/内径 (D)比率及颈动脉粥样硬化斑块发生率均比治疗前有明显降低 (P <0 0 5 ) ;脑循环动力学指标较治疗前明显改善。结论　在有效降压治疗的同时加用微粒化非诺贝特治疗 ,对原发性高血压患者延缓颈动脉粥样硬化的进展和改善脑循环动力学有良好效果。     

缬沙坦治疗老年人单纯收缩期高血压的临床研究

目的研究缬沙坦对老年单纯收缩期高血压患者的降压作用及其对心血管系统的影响。方法49例老年单纯收缩期高血压患者,平均年龄（76.2±6.0）岁。受试对象均给予缬沙坦80～160mg或加用利尿剂氢氯噻嗪12.5mg治疗,疗程为12个月。治疗前后分别作诊室随测血压、24h动态血压监测、心脏超声检查、颈动脉、椎动脉、肾动脉超声和眼动脉超声检查。结果（1）缬沙坦治疗12个月以后,患者诊室随测收缩压显著下降（P〈0.05）;但24h总体血压、白天及夜间血压均无明显变化;（2）左室短轴缩短率显著升高（P〈0.001）;（3）颈动脉、椎动脉和肾动脉搏动指数（PI）、阻力指数（RI）显著下降（P〈0.05）,肾段间动脉及眼动脉PI及RI无明显变化。结论缬沙坦可有效控制老年单纯收缩期高血压患者诊室血压,并改善其左室收缩功能和动脉顺应性。     

Increased intima-media thickness of the common carotid artery in primary aldosteronism in comparison with essential hypertension

BACKGROUND: Aldosterone contributes to the accumulation of collagen fibers and extracellular matrix in arterial wall. The aim of this study was to compare intima-media thickness (IMT) of the common carotid artery and carotid bifurcation in patients with primary aldosteronism, essential hypertension and healthy controls. METHODS: Carotid ultrasound studies were carried out in 33 patients aged 42-72 years with primary aldosteronism, 52 patients with essential hypertension and in 33 normotensive controls. RESULTS: The patients with primary aldosteronism had significantly higher IMT of the common carotid artery than patients with essential hypertension and controls (0.987 +/- 0.152 mm; 0.892 +/- 0.154 mm versus 0.812 +/- 0.124 mm; P < 0.001; P < 0.05). There was also significantly higher IMT of the common carotid in patients with essential hypertension compared to control group (0.892 +/- 0.154 mm versus 0.812 +/- 0.124 mm; P < 0.01). The differences between both hypertensive groups remained statistically significant after adjustment for age and 24-h systolic blood pressure (P = 0.001). The differences of the IMT in the carotid bifurcation were statistically significant only between patients with primary aldosteronism and controls (1.157 +/- 0.243 mm versus 0.994 +/- 0.199 mm; P <0.05). CONCLUSION: Patients with primary aldosteronism have increased common carotid IMT compared to the patients with essential hypertension. This finding could be caused by the deleterious effects of aldosterone excess on the fibrosis and thickening of the arterial wall, mainly in the straight segments of vessels.     

Pulse pressure in normotensives: a marker of cardiovascular disease

The purpose of the present study was to evaluate the relation of the systemic arterial pulse pressure and other parameters derived from the 24-h arterial blood pressure (BP) monitoring to the severity of coronary artery disease, carotid lesions, and left ventricular (LV) mass index in patients without arterial hypertension. One hundred ten patients with known coronary artery disease underwent coronary arteriography, 24-h arterial BP monitoring, and ultrasound imaging of the carotid arteries and the myocardium. Measurements of 24-h arterial BP monitoring (systolic, diastolic, and average BP, pulse pressure, abnormal values of systolic and diastolic BP, and heart rate), the severity of coronary heart disease (Gensini score), intima-media thickness (IMT) of the common carotid artery and LV mass index were determined in all patients. By univariate analysis, only 24-h pulse pressure was significantly related to the severity of coronary artery disease (P < .01), carotid IMT(P < .01), and LV mass index (P < .01). In a multivariate analysis, 24-h pulse pressure was also the best predictor of the severity of coronary lesions (P = .009), carotid IMT (P = .003), and LV mass index (P = .009). Gensini score was related (P < .01) to LV mass index and not to carotid IMT. In conclusion, systemic arterial pulse pressure derived from 24-h arterial BP monitoring is related to coronary artery disease, carotid IMT, and LV mass index independently of age or any other derivative of 24-h arterial BP monitoring, indicating that this parameter could be a marker of global cardiovascular risk.     

比较不同时间服用缬沙坦对高血压患者血压变异性的影响

目的比较不同时间服用缬沙坦及苯磺酸氨氯地平片对原发性高血压（高血压）患者血压变异性（bloodpressurevariability,BPV）的影响。方法采用随机数字法将120例轻一中度高血压患者分成3组,分别为日间口服缬沙坦组、夜间口服缬沙坦组、日间口服苯磺酸氨氯地平组,治疗前、后进行24h动态血压监测。以动态血压变异标准差作为血压变异性指标,比较3个月后3种治疗方案对血压及血压变异性的影响。结果3种治疗方案均能有效降低血压,与治疗前比较差异有统计学意义（P〈0．05）。在控制BPV方面,日间口服缬沙坦组的BPV改善不明显,与治疗前比较差异无统计学意义（P〉0．05）;与治疗前比较,夜间口服缬沙坦组[收缩压变异性：（11±3）mmHg眠（15±4）nlmHg（1mmHg=0．133kPa）,P〈0．05;舒张压变异性：（7±2）mmHgVS．（10±4）mmHg,P〈0．05]和苯磺酸氨氯地平组[收缩压变异性：（10±3）mmHgIJS．（16±3）mmHg,P〈0．05;舒张压变异性：（6±2）mmHgVS．（11±2）mmHg,P〈0．05]的24h动态血压变异性降低,差异有统计学意义;苯磺酸氨氯地平组在改善BPV方面仍优于夜间口服缬沙坦组,差异有统计学意义（P〈0．01）。结论与日间服药相比,夜间服用缬沙坦能更有效改善血压变异性。     

Carotid intimal-medial thickness and stiffness are not affected by hypercholesterolemia in uncomplicated essential hypertension

The combined effects of hypertension and hypercholesterolemia on carotid anatomy and stiffness were studied in 62 normotensives, 141 uncomplicated essential hypertensives with a total cholesterol level <240 mg/dL, and 60 essential hypertensives with a total cholesterol level >/=240 mg/dL. Carotid ultrasonography was performed to evaluate intimal-medial thickness (IMT), relative wall thickness, and the presence of plaque. Carotid pressure waveforms were recorded by applanation tonometry to measure carotid stiffness (beta) and pressure wave reflection (ie, augmentation index). After adjusting for age, body mass index, and smoking habit by analysis of covariance, no significant differences were found between normocholesterolemic hypertensives and hypercholesterolemic hypertensives in terms of IMT (0.79+/-0.19 versus 0.81+/-0.19 mm), relative wall thickness (0.27+/-0.07 versus 0.28+/-0.07), carotid stiffness (6.1+/-3.2 versus 5.6+/-2.7), augmentation index (18. 7+/-12.9% versus 17.3+/-12.8%), and prevalence of plaque (30.8% versus 30.7%). In the whole population, carotid IMT was significantly related to age (r=0.43), systolic (r=0.35) and diastolic (r=0.35) blood pressures, body surface area (r=0.22), and cholesterol levels (r=0.22) (all P<0.05). Carotid stiffness was significantly related to age, blood pressure, body mass index, and body surface area but not to cholesterol levels. In multivariate analyses, age, body surface area, and systolic blood pressure, but not cholesterol, smoking habit, or sex, were independent correlates of IMT (multiple R=0.54, P<0.0001), whereas carotid stiffness was independently associated with age, body surface area, and sex (R=0. 38, P<0.0001). In conclusion, hypertension is a potent stimulus of vascular hypertrophy. The superimposition of hypercholesterolemia does not substantially augment these changes or further increase arterial stiffness in uncomplicated hypertensive subjects.     

高血压合并糖尿病患者脉压与颈动脉重构的相关性研究

目的探讨高血压合并糖尿病患者24h动态脉压与颈动脉结构和功能间的关系。方法对高血压合并糖尿病患者120例、高血压2—3级患者100例、糖尿病患者100例以及健康对照者50例进行动态血压监测,作颈动脉血管超声测量颈总动脉内膜-中层厚度（IMT）、斑块积分、颈总动脉收缩期和舒张期内径;计算颈动脉扩张性和僵硬度。结果高血压合并糖尿病患者组的24h脉压均值、白天脉压均值、夜间脉压均值及颈动脉粥样硬化（IMT及斑块积分）、僵硬度均较高血压组、糖尿病组明显升高（P〈0．05或P〈0．01）;多因素相关分析发现：脉压尤其是夜间脉压增高与颈动脉粥样硬化（IMT及斑块积分）、僵硬度密切相关。结论高血压、糖尿病患者均存在脉压增大和颈动脉重构,当高血压病合并糖尿病时,颈动脉重构更明显;脉压与颈动脉重构呈正相关,对高血压合并糖尿病患者应重视脉压的监测及治疗。     

长期运动训练对轻中度高血压患者颈动脉内膜中层厚度的影响

目的：观察长期运动训练对轻中度高血压患者颈动脉内膜中层厚度（IMT）的影响.方法：92例原发性轻中度高血压患者按数字表法被随机分为常规治疗组（46例）和运动组（46例,在常规治疗基础上进行运动训练）,随访1年,测量两组患者治疗前后两组血压、颈总动脉内径、颈动脉IMT,并进行比较分析.结果：与基线值比较,运动组训练1年后收缩压[（176.66±11.78） mmHg比（130.89±13.01） mmHg]与舒张压[（101.43±6.41） mmHg比（81.71±8.45）mmHg]均明显降低（P均＜0.05）,颈动脉内径[（6.62±0.97）mm比（6.22±1.01）mm]、颈动脉IMT[（0.98±0.12）mm比（0.84±0.11）mm]显著减小（P均＜0.05）,且较治常规治疗组治疗后显著减小（P均＜0.05）.结论：长期运动训练能有效控制血压,减少颈动脉内径和颈动脉内膜中层厚度.     

Increased ambulatory arterial stiffness index is associated with target organ damage in primary hypertension

Increased arterial stiffness has been shown to predict cardiovascular mortality in patients with primary hypertension. Asymptomatic organ damage is known to precede cardiovascular events. We investigated the relationship between a recently proposed index of stiffness derived from ambulatory blood pressure (BP) and target organ damage in 188 untreated patients with primary hypertension. Ambulatory arterial stiffness index was defined as 1 minus the regression slope of diastolic over systolic BP readings obtained from 24-hour recordings. Albuminuria was measured as the albumin:creatinine ratio, left ventricular mass index was assessed by echocardiography, and carotid abnormalities were evaluated by ultrasonography. The prevalence of microalbuminuria, left ventricular hypertrophy (LVH), and carotid abnormalities was 12%, 38%, and 19%, respectively. Ambulatory arterial stiffness index was positively related to age, triglycerides, office and 24-hour systolic BP, 24-hour pulse pressure, urinary albumin excretion, and carotid intima-media thickness. Patients with microalbuminuria, carotid abnormalities, or LVH showed higher ambulatory arterial stiffness index as compared with those without it. After adjusting for confounding factors, each SD increase in ambulatory arterial stiffness index entails an &2 times higher risk of microalbuminuria, carotid abnormalities, and LVH and doubles the risk of the occurrence of >or=1 sign of organ damage. Ambulatory arterial stiffness index is associated with organ damage in patients with primary hypertension. These data strengthen the role of this index as a marker of risk and help to explain the high cardiovascular mortality reported in patients with high ambulatory arterial stiffness index.     

Impact of statin therapy on left ventricular function and carotid arterial stiffness in patients with hypercholesterolemia.

BACKGROUND: Hypercholesterolemia is a well-established risk factor for the development of vascular events. Statins have pleiotropic effects beyond reducing the low-density lipoprotein-cholesterol (LDL-C) concentration. This study sought to determine whether treatment with pitavastatin affects latent regional left ventricular (LV) systolic and diastolic dysfunction and carotid arterial stiffness in patients with hypercholesterolemia and preserved LV ejection fraction (LVEF), using newly developed ultrasonic strain imaging and carotid ultrasonography. METHODS AND RESULTS: A total of 30 patients with hypercholesterolemia (>or=220 mg/dl for serum total cholesterol, and/or >or=140 mg/dl for LDL-C) were randomized to either administration of pitavastatin (1 or 2 mg/day; n=15) or no statin therapy (n=15) for 12 months. LV systolic and diastolic functions were evaluated by measuring transmitral flow velocity, mitral annular motion velocity, and the myocardial strain and strain rate profiles using pulsed Doppler, tissue velocity, and ultrasonic strain imaging. Subclinical atherosclerosis also was determined by measuring the intima - media thickness (IMT) and stiffness beta of the left and right common carotid arteries using B- and M-mode ultrasonography. During the follow-up period, the mean peak systolic strains of the LV posterior and inferior walls increased from 39.2+/-15.9% to 51.5+/-17.7% (p<0.01) and 46.0+/-12.2% to 57.5+/-10.3% (p<0.01), respectively, in the pitavastatin group compared with the no statin group. The mean peak early diastolic strain rates of the LV posterior and inferior walls also increased from -6.5+/-2.9 s(-1) to -9.5+/-2.8 s(-1) (p<0.01) and -6.5+/-2.5 s(-1) to -9.1+/-2.7 s(-1) (p<0.01), respectively, in the pitavastatin group. The stiffness beta decreased from 5.6+/-2.5 to 4.1+/-0.8 (p<0.05) in the pitavastatin group, whereas there was no significant change in IMT. CONCLUSIONS: One year of pitavastatin treatment improved not only carotid arterial stiffness but also regional LV systolic and diastolic function in patients with hypercholesterolemia and preserved LVEF. Ultrasonic strain imaging has the potential to become a sensitive tool for detecting the effects of early medical intervention on latent regional LV myocardial dysfunction in this patient population.     

代谢综合征患者颈总动脉扩张性、紧张度和僵硬度的检测

目的探讨代谢综合征患者颈总动脉扩张性、紧张度和僵硬度的变化。方法采用彩色多功能超声诊断仪对33例正常人、76例非代谢综合征患者和83例代谢综合征患者颈总动脉的收缩和舒张内径进行检测,并计算动脉的扩张性、紧张度和僵硬度。结果与对照组和非代谢综合征组比较,代谢综合征组患者颈总动脉扩张性、紧张度明显下降(P<0.01),僵硬度明显升高(P<0.01);平均内膜中层厚度增厚(P<0.01);等级相关分析发现,左、右颈总动脉的扩张性和紧张度与代谢综合征成分数目呈负相关(P<0.01),左、右颈总动脉的僵硬度与代谢综合征成分数目呈正相关(P<0.01)。结论代谢综合征患者颈动脉的弹性降低,动脉硬化加剧;颈动脉超声可以作为评价代谢综合征患者心血管病危险性的无创性方法。