Spurious systolic hypertension of youth: fit young men with elastic arteries

BACKGROUND: We examined the role of high pulse pressure (PP) amplification in spurious systolic hypertension (SSH). METHODS: We recorded demographic characteristics, brachial blood pressure (BP) (Omron Model HEM-705 CP, Vernon Hills, IL), aortic BP, and arterial wave reflection (Sphygmocor, AtCor Medical, version 6.2, NSW, Australia) and PP amplification in 174 healthy medical students (87 male) and 22 young male hypertensive subjects. RESULTS: Eleven subjects had SSH (147 +/-2 v control 114 +/-1 mm Hg, mean +/- SEM,), normal aortic and brachial diastolic BP with an aortic pressure waveform that was normal in contour and amplitude. All were male, tall, nonsmokers, and active in sports, with slower heart rate, reduced arterial wave reflection (-8 +/- 3 v -0.7 +/-1) and enhanced PP amplification (31 +/-1 v 18 +/-1 mm Hg, P <.01. In contrast, male hypertensive subjects had reduced amplification (14 +/-0.9 mm Hg) and enhanced arterial wave reflection (17 +/-1.9). CONCLUSIONS: The SSH of youth, with raised brachial but normal aortic systolic BP, is commonly seen in tall men who are active in sports and are nonsmokers. It may be explained by the exaggerated first systolic peak in the brachial artery pressure waveform, which is due to very high PP amplification and low arterial wave reflection due to elastic arteries.     

Echographic assessment of carotid and femoral arterial structure in men with essential hypertension

Extracoronary in vivo structural arterial changes were studied in asymptomatic essential hypertension. Carotid and femoral arteries were examined with B-mode echography for the presence or absence of plaque (the whole vascular segments of each vessel in the both sides) and for automated measurement of the far wall intima-media thickness (the vascular segment of each vessel proximal to the bifurcation in the right side) in 53 never treated hypertensive men and 133 normotensive men similar with regard to age, serum cholesterol levels, and smoking history. In the hypertensive group carotid plaque was more frequent (P < .05) and carotid and femoral intima-media thicknesses were greater (P < .001) than in the normotensive group. In the overall normotensive and hypertensive population intima-media thickness was independently associated with age and systolic pressure in both arteries (P < .001) and with cholesterol in the femoral artery (P < .05) while plaque was associated with systolic pressure (P < .01), and cholesterol (P < .01) in the carotid arteries and with age (P < .01), cholesterol (P < .05), and smoking (P < .001) in the femoral arteries. No significant difference in intima-media thickness in both arteries existed between hypertensive subjects with plaque and those without.Wall thickening and plaque were more frequent in hypertensive patients. Thickening was distributed homogeneously to both arteries, while plaque affected preferentially the femoral bed. The influence of age and pressure was more marked on intima-media thickness than on plaque. The lack of association between wall thickening and plaque suggested that vascular hypertrophy and early atherosis might be two different structural changes.     

Increased arterial intima-media thickness and in vivo LDL oxidation in young men with borderline hypertension

We used borderline hypertension as a model for prehypertension to examine the early influences of elevated blood pressure on subclinical atherosclerosis, lipoprotein oxidation, and cardiac adaptation. Healthy men (age 37+/-4 years) were classified prospectively into 2 groups on the basis of having either borderline hypertension (systolic 130 to 140 mm Hg or diastolic 85 to 89 mm Hg, n=16) or normal (<130/85 mm Hg, n=22) blood pressure values during the previous 2 years. The groups were matched for age, body size, and serum cholesterol levels. High-resolution ultrasound was used to measure intima-media thickness (IMT) of the carotid and brachial arteries, cardiac dimensions, and brachial artery endothelial function. Baseline low-density lipoprotein (LDL)-diene conjugation was measured as an estimate of in vivo LDL oxidation (ox-LDL). Compared with normotensive controls, men with borderline hypertension had higher IMT of the carotid artery (0.58+/-0.06 versus 0.75+/-0.07 mm, P<0.001) and IMT of the brachial artery (0.45+/-0.05 versus 0.57+/-0.07 mm, P<0.001), and increased levels of ox-LDL (29+/-9 versus 47+/-17 mol/L, P<0.001), but similar endothelial function. Left ventricular mass was similar in both groups, but there were significant differences in left ventricular geometry. In multivariate analyses, the predictors of carotid IMT were 24-hour systolic blood pressure (P<0.001) and ox-LDL (P=0.10). The current study demonstrates evidence of increased subclinical atherosclerosis and ox-LDL in borderline hypertension. These results are consistent with the idea that enhanced ox-LDL may be one of the pathophysiological events related to development of atherosclerosis in men with borderline elevated blood pressure.     

临界性高血压患者冠状动脉血流储备功能的研究

目的 :了解无症状临界性高血压患者是否有冠状动脉功能异常。方法 :经食管超声心动描记术研究 2 0例正常人 (正常对照组 )及 17例无症状临界性高血压患者 (临界性高血压组 )的冠状动脉血流储备 (CFR)。以潘生丁静脉注射后和静息时舒张期的最大血流速度比率 (D/R PDV)和收缩期最大血流速度比率 (D/R PSV )作为CFR指标。结果 :1两组受检者静息时的 PDV无显著性差异〔(43± 10 ) m m/s∶ (46± 8) mm /s,P >0 .0 5〕;2静脉注射潘生丁后临界性高血压组的 D/R PDV、D/R PSV较正常对照组明显减少 ,两组之间有显著性差异 (D/RPDV:2 .2 5± 0 .36∶ 2 .86± 0 .42 ,D/R PSV:2 .0 0± 0 .2 6∶ 2 .5 6± 0 .41,P<0 .0 5 )。结论 :无症状临界性高血压患者 CFR能力降低。     

Echocardiographic assessment of myocardial fibrosis in young men with arterial hypertension and different types of left ventricular remodeling

In order to study structural functional characteristics of myocardium including parameters of myocardial fibrosis according echocardiography data in men with various levels of arterial pressure (AP) we examined 215 men aged 18-25 (mean 21.1+/-0,1) years with history of elevated AP at casual measurement. AP phenotype (normotension, stable arterial hypertension [AH], unstable AH) was determined on the basis of multiple measurements of clinical AP and 24 hour AP monitoring. At echocardiography we assessed presence of left ventricular (LV) hypertrophy (LVH), type of LV geometry, proportionality of LV myocardial mass (LVMM), diastolic function. Myocardial fibrosis was assessed by pixel density distribution range (PDDR) with the use of analysis of reflected signal. There were no manifestations of LV remodeling in subjects with normal AP. Concentric LV remodeling was found in 27.5 and 60.5% of patients with unstable and stable AH, respectively. Concentric LVH was found only in patients with stable AH (4.8%). Disproportionally high LVMM was found in 16.1% of subjects with stable AH. In a combined group with concentric LV remodeling and LVH rate of disproportionally high LVMM was 20.8%. We noted significant (p<0.001) increase of PDDR in stable AH (181.4+/-2.2) compared with PDDR in normal AP (164.6+/-4.6) and unstable AH (160.1+/-2.7). In stable I degree AH PDDR (177.3+/-2.2) was insignificantly lower than in II degree AH (185.7+/-3.9). PDDR in concentric LV remodeling was 180.5+/-2.3, in concentric LVH- 166.8+/-13.2, in normal LV geometry - 168.4+/-2.5. PDDR in disproportionally high LVMM was higher than in proportional LVMM. Independent interrelationship was found between PDDR and body mass index (r=0.17; p=0.03), duration of AH (r=0.17; p=0.03), isovolumic relaxation time (r= 0.15; p=0.04). In young men LV remodeling can be detected at the stage of unstable AH. In stable AH degree of myocardial fibrosis was associated with higher AP level, concentric LV geometry, disproportionally high LVMM, lowering of diastolic function.     

A 2D Echo color-Doppler study of the extracranial carotid arteries in borderline arterial isolated systolic hypertension

BACKGROUND: The aim of this study was to evaluate the prevalence of atherosclerotic carotid lesions in isolated systolic borderline arterial hypertension by 2D echo color-Doppler and effect of night-time pressure fall by ambulatory blood pressure monitoring. METHODS: Outpatients from January 1992 to December 1998 were examined. One hundred and twenty normotensive control subjects and 99 isolated systolic borderline untreated hypertensives were studied, based on blood pressure fall were divided into dippers, with nocturnal systolic and/or diastolic blood pressure fall of >10%, and non dippers. Subjects with ischemic heart disease, valvulopathies, heart failure, renal insufficiency, cerebrovasculopathies, hypercholesterolemia (total cholesterol >200 mg/dl) and diabetes. Normotensives and hypertensives were homogenous for cardiovascular risk factors. A thickness of =/> 0.95 mm, calculated as a mean of 5 measurements of the common carotid artery, 2-3 cm from the carotid bifurcation, was considered a sign of myointimal thickening, and the plaque as a focal thickening of =/> 2 mm, based on echogenic characteristics and site. RESULTS: Compared to normotensives, isolated systolic borderline hypertensives, showed carotid arteries with an intima-media thickening (p=0.002) with one or more plaques (p=0.0001) much more frequently, while normal carotid arteries (p=0.0001) were less frequent. In normotensives, like in hypertensives, the prevalence of vasal lesions was not significantly different in dippers compared with non dippers. Plaques were most often localized at level of the common carotid and lesions were hard. CONCLUSIONS: The conclusions is drawn that isolated systolic hypertension is the sign of major vascular atherosclerotic lesions. The night-time pressure fall does not affect the importance of the lesions.     

Impaired arterial elasticity in young patients with white-coat hypertension

BACKGROUND: Conflict still exists over whether patients with white-coat hypertension are at increased risk of developing target organ damage compared with normotensive individuals. METHODS: We studied vascular distensibility in 117 young-to-middle age patients with white-coat hypertension, 174 patients with sustained hypertension, and 51 normotensive controls. To obtain a measure of compliance, a model was used that divides the total systemic compliance into large artery (C1) and small artery (C2) compliance. With this aim, radial arterial pulse waves were recorded with a tonometer sensor array by means of an HDI CR2000 device (Eagan, Minnesota, USA). Moreover, pulse wave velocity and the augmentation index were measured using the Specaway DAT system (St Pauls, Sydney, Australia). RESULTS: Patients with sustained hypertension had a greater body mass index than patients with white-coat hypertension (P=0.04) or the normotensive individuals (P=0.01). C1 and C2 were decreased in the two hypertensive groups as compared with those in the normotensive group (P=0.0002 and 0.03, respectively, versus sustained hypertension; P=0.00007 and 0.0004, respectively, versus white-coat hypertension). Pulse wave velocity and aortic augmentation index were increased in the white-coat hypertension patients compared with the normotensive individuals (P=0.02 and 0.004, respectively). Aortic augmentation index (P=0.008) but not pulse wave velocity was increased in the sustained hypertensive patients compared with that in the normotensive individuals. All indexes of arterial distensibility were similar in the two hypertensive groups. CONCLUSIONS: Indexes of arterial distensibility are impaired in the white-coat hypertensive group and similar to those in the sustained hypertensive group, indicating that early changes in the arterial wall can occur in white-coat hypertension. This may account for the higher risk of stroke that has been described in this condition.     

Cardiac functional state in arterial hypertension

The results of studies of the function of the heart in 592 patients with hypertensive disease are reported. In 120 cases it was established that a dependence exists between the cardiac pains and the level of the diastolic arterial pressure, minute volume and the mass of the left ventricle (r = +0.822; p less than 0.01). The study of the magnitude of intramyocardial "stress" in 127 patients enabled the authors to distinguish those with "adequate" and "inadequate" hypertrophy. With submaximum exercise an inverse correlation (r = -0.78, p less than 0.01) was found to exist between the changes in the output fractions and the mass of the myocardium of the left ventricle, pointing to the latent cardiac insufficiency in patients with marked myocardial hypertrophy. Observation of 106 patients for 3-5 years has revealed hypertrophy involution in 20 out of 79 patients with the labile and in 2 out of 27 cases with a stable form of hypertension. A relationship was found to exist between the increase of the hypertrophy and the increase of the systolic arterial pressure, and between its decrease and the drop in the general peripheral resistance.     

The vessel-mechanics of the common carotid artery in arterial hypertension]

The pressure-diameter relationship of the intact common carotid artery was studied in each of 36 normotensive and hypertensive patients of the same age. The diameter and its changes by pulse pressure were measured using an ultrasound echo-ranging device. The arterial blood pressure simultaneously was determined by the auscultatory method...     

Accelerated arterial hypertension in a young male

Hypertensive crises are situations when arterial hypertension shows its immediate damaging potential, and in such circumstance, antihypertensive therapy provides its life-saving effectiveness. Among these situations are hypertensive emergencies, hypertensive urgencies, hypertensive encephalopathy, and also accelerated-malignant hypertension characterised by the presence of grade 3 or grade 4 Keith-Wagener retinopathy and numerous complications (acute renal failure, heart failure, haemorrhagic brain stroke or acute coronary events). Despite of antihypertensive therapy, the mortality rate of accelerated-malignant hypertension is about 25% after the 5th year. We present the case of a thirty-three years old male, with a five-year history of non-treated hypertension, who develops accelerated- hypertension with heart failure, microangiopathic haemolytic anaemia and renal failure that requires renal replacement therapy. After a strict control of blood pressure; initially using parenteral agents such as Solinitrin and Urapidil, followed by angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-adrenergic receptor blockers, calcium channel blockers and Hydralazine, the patient partially recovers his renal function, resulting in the withdrawal of haemodialysis.     

Pathogenesis of borderline arterial hypertension in young persons

A total of 1000 students were screened, and borderline arterial, hypertension (BAH) was found in 152 of those. The investigation of microcirculation (by conjunctive biomicroscopy), central hemodynamics and physical stress tolerance showed increased minute blood volume in the absence of adequate arteriole dilatation to be the primary factor in BAH pathogenesis. Physical stress tolerance was similar in BAH and normotensive subjects. BAH subjects showed a specific pattern of cardiovascular response to muscular work.     

Polymorphisms of angiotensin converting enzyme and angiotensin II type 1 receptors genes and the state of regional hemodynamics in borderline arterial hypertension in young men

Relationship between polymorphisms of ACE and ATR1 genes to morphological and functional states of cardiovascular system was studied in young men with borderline hypertension living in north-west region of Russia. Prevalences of ACE DD and ATR1 AC genotypes were 46 and 54%, respectively. There were no significant correlations between genotypes studied and parameters of central, intracardiac, ophthalmic hemodynamics, as well as presence and severity of albuminuria. Compared with other gene combinations simultaneous carriers of DD and CC genotypes had significantly more pronounced changes of target organs.     

Early impairment of coronary flow reserve in young men with borderline hypertension

Objectives. The purpose of this study was to investigate whether functional abnormalities in coronary vasomotion are present in young healthy asymptomatic men fulfilling the World Health Organization (WHO) criteria for borderline hypertension.Background. Previous studies have reported reduced coronary flow reserve in middle-aged subjects with sustained hypertension and hypertension-induced microvascular heart disease or left ventricular hypertrophy.Methods. Myocardial blood flow was measured at baseline and during dipyridamole-induced hyperemia by means of positron emission tomography and oxygen-15–labeled water in asymptomatic young men with borderline hypertension (group 1: n = 16, mean ± SD age 37 ± 4 years, 24-h ambulatory blood pressure 135 ± 10/81 ± 9 mm Hg) and matched healthy control subjects (group 2: n = 19, age 35 ± 3 years, 24-h ambulatory blood pressure 119 ± 8/69 ± 8 mm Hg, p < 0.001). Left ventricular (LV) mass, dimensions and function were measured by echocardiography.Results. LV mass, dimensions and diastolic function were similar in the study groups. Baseline myocardial blood flow was similar (0.83 ± 0.21 vs. 0.80 ± 0.22 ml/g per min, group 1 vs. group 2, respectively, p = NS), and a significant increase in flow was detected after dipyridamole infusion (0.56 mg/kg body weight in 4 min intravenously) in both groups. However, the flow response to dipyridamole was significantly lower in group 1, leading to lower hyperemic flow in group 1 than in group 2 (2.85 ± 1.20 vs. 3.80 ± 1.44 ml/g per min, respectively). Consequently, the coronary flow response was lower in hypertensive than in normotensive men (3.46 ± 1.23 vs. 4.99 ± 2.5 ml/g per min, group 1 vs. group 2, respectively, p < 0.05).Conclusions. These results demonstrate reduced coronary reactivity present in young asymptomatic men with borderline hypertension and no signs of hypertension-induced angina or left ventricular hypertrophy. Because baseline basal myocardial blood flow was unchanged, the reduction in coronary flow reserve depends on an impaired maximal vasodilator capacity.     

Effect of nebivolol on the state of pituitary-gonadal system and lipid peroxidation in young and middle aged men with hypertension

Nebivolol (5-10 mg/day) was given for 12 weeks to 32 patients aged 30-65 years with mild and moderate hypertension. Parameters of pituitary-gonadal system, lipid peroxidation and antioxidant system were determined before nebivolol, and after 1 and 3 months. Normalization of diastolic blood pressure effect was achieved in 87.5% of patients with maximal blood pressure lowering (by 18-20%) after 3 months. Administration of nebivolol was associated with decreases of follicle-stimulating and luteinizing hormones, significant elevation of testosterone concentration (p<0.001), suppression of processes of lipid peroxidation and improvement of activity of antioxidant system. The drug was well tolerated.     

Left ventricular hypertrophy and thickening of common carotid artery wall in men aged 40 - 54 years with I degree arterial hypertension

We carried out clinical-instrumental examination of 456 men aged 40-54 years. First degree arterial hypertension was revealed in 165 men. Left ventricular hypertrophy was found in 48 (30%), increased intima-media thickness (IMT) - in 67 (41%) patients. There was significant medium power relationship between IMT and left ventricular myocardial mass (correlation coefficient 0.41). Formation of left ventricular hypertrophy was related to parameters of 24 hour blood pressure monitoring, arterial hypertension in brothers and sisters, body weight, and duration of obesity. Significant medium power relation was obtained between tension of endothelial system of hemostasis (protein C) and severity of left ventricular hypertrophy (correlation coefficient - 0,3). Age, heredity, low density lipoprotein, cholesterol, uric acid level mattered for IMT increase.     

Interrelation of cardiac and vascular structure in young men with borderline hypertension

It is not established whether left ventricular hypertrophy andstructural vascular changes are primary phenomena or secondaryconsequences of raised blood pressure. In this study we investigated54 borderline hypertensive men (BH) (SBP 140–160 mmHgand/or DBP 84–95 mmHg) and 20 normotensive men (NC) (SBP110–130 mmHg and DBP 60–80 mmHg), recruited froman unbiased population sample (age 20 ± 2 years). Bloodpressure (BP) levels were confirmed by i.a. BP recordings. Leftventricular mass (LVM) was determined with M-mode echocardiographyand minimal vascular resistance (R_min) was calculated from theblood flow in the calf and forearm after maximal ischaemic work.Central haemodynamics were assessed by intra-arterial bloodpressure recordings and cardiac output determinations by thedye dilution technique. In the BH group, LVM and R_min were stronglycorrelated to body size, especially weight and body surfacearea. However, LVM and R_min were only weakly correlated to bloodpressure. In the normokinetic BH subgroup (NBH) (n = 38) minimalforearm vascular resistance was significantly higher than inthe hyperkinetic BH individuals (HBH) (n = 16), indicating thepresence of structural vascular changes in the former. Furthermore,in the NBH group there was a significant correlation betweenLVM and R_min both in the calf (r = 0.490 P = 0002) and in theforearm (r = 0.520 P = 0.001). This association remained aftercorrection for body size. No such correlation was seen in theHBH subgroup or in the NC group. The present study does givelong-reaching conclusions as regards the aetiological factorsunderlying the cardiovascular remodelling. However, our datashow that (1) cardiovascular changes appear early in the courseof blood pressure elevation, (2) the cardiac and vascular changesdevelop in parallel, and (3) structural remodelling is not solelyexplained by the degree of blood pressure elevation since bloodpressure was similar in the two BH subgroups. Thus, other factorsthan blood pressure appear to be important determinants of structuraladaptation in mildly hypertensive states.