Sex‐related relationships between uric acid and target organ damage in hypertension

Heterogeneous results have been obtained in the relationship between serum uric acid (SUA) and target organ damage (TOD) in patients with hypertension. Clinic blood pressure, SUA, and cardiac, arterial (carotid and aortic), and renal TOD were assessed in 762 consecutive patients with hypertension. Hyperuricemia was defined as an SUA >7.0 in men and >6.0 mg/dL in women. Men with hyperuricemia compared with those with normal SUA showed lower estimated glomerular filtration rates and E/A ratios and a higher prevalence of carotid plaques. Women with hyperuricemia showed lower estimated glomerular filtration rates and E/A ratios and a higher intima‐media thickness. Except for pulse wave velocity, all TODs significantly correlated with SUA. However, at multivariate analysis, only estimated glomerular filtration rate was significantly determined by SUA. Our data provide evidence on the role of SUA in the development of TOD only in the case of renal alteration. It is likely that SUA may indirectly act on the other TODs through the increase in blood pressure and the decrease in glomerular filtration rate.     

Glycated hemoglobin correlates with arterial stiffness and endothelial dysfunction in patients with resistant hypertension and uncontrolled diabetes mellitus

This study aimed to evaluate the effects of glycated hemoglobin (HbA_1c) on flow‐mediated dilation, intima‐media thickness, pulse wave velocity, and left ventricular mass index in patients with resistant hypertension (RHTN) comparing RHTN–controlled diabetes mellitus and RHTN–uncontrolled type 2 diabetes mellitus. Two groups were formed: HbA_1c <7.0% (RHTN–controlled diabetes mellitus: n = 98) and HbA_1c ≥7.0% (RHTN–uncontrolled diabetes mellitus: n = 122). Intima‐media thickness and flow‐mediated dilation were measured by high‐resolution ultrasound, left ventricular mass index by echocardiography, and arterial stiffness by carotid‐femoral pulse wave velocity. No differences in blood pressure levels were found between the groups but body mass index was higher in patients with RHTN–uncontrolled diabetes mellitus. Endothelial dysfunction and arterial stiffness were worse in patients with RHTN–uncontrolled diabetes mellitus. Intima‐media thickness and left ventricular mass index measurements were similar between the groups. After adjustments, multiple linear regression analyses showed that HbA_1c was an independent predictor of flow‐mediated dilation and pulse wave velocity in all patients with RHTN. In conclusion, HbA_1c may predict the grade of arterial stiffness and endothelial dysfunction in patients with RHTN, and superimposed uncontrolled diabetes mellitus implicates further impairment of vascular function.     

Arterial stiffness and renal impairment in non‐proteinuric type 2 diabetic patients

Aims/Introduction: Although increases in urinary protein excretion generally precede a decline in the glomerular filtration rate, non‐proteinuric renal impairment is common in patients with diabetes. In the present study, we examined the relationship between indices of arterial stiffness and renal function in type 2 diabetic patients without proteinuria. Methods: Blood sampling, 24‐h urine collection, brachial–ankle pulse wave velocity, and 24‐h ambulatory blood pressure monitoring were performed in type 2 diabetic patients without overt proteinuria. The ambulatory arterial stiffness index was calculated as (1 – the regression slope of diastolic/systolic ambulatory blood pressure). Estimated glomerular filtration rate (eGFR)was calculated using the simplified prediction equation proposed by the Japanese Society of Nephrology. Results: Of 213 non‐proteinuric patients with type 2 diabetes, 60 (28.2%) had a reduced eGFR (<60 mL/min per 1.73 m²). Although the urinary albumin excretion rate was significantly correlated with the eGFR, 34 of 152 patients with normoalbuminuria (22.4%) had a reduced eGFR. The eGFR was significantly and negatively correlated with the ambulatory arterial stiffness index and brachial–ankle pulse wave velocity, but not with 24‐h pulse pressure. Multivariate analysis revealed that increased age and increased urinary albumin excretion were independently associated with decreased eGFR. In addition, the ambulatory arterial stiffness index, but not brachial–ankle pulse wave velocity, were found to be independently and significantly associated with eGFR. Conclusions: Ambulatory arterial stiffness index is a marker for increased risk of renal failure in non‐proteinuric patients with type 2 diabetes. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00146.x, 2012)     

Nocturnal pulse rate correlated with ambulatory blood pressure and target organ damage in patients with chronic kidney disease

The relationship between resting pulse rate (PR) and the occurrence of hypertension and cardiovascular (CV) mortality has been described in the general population. Few studies have examined the relationship between ambulatory PR, ambulatory blood pressure (BP), and target organ damage (TOD) in patients with chronic kidney disease (CKD). A total of 1509 patients with CKD were recruited in our hospital. Ambulatory blood pressure monitoring (ABPM) over a 24‐hours period was performed and referenced with clinical data in this cross‐sectional study. TOD was measured by estimated glomerular filtration rate (eGFR), left ventricular hypertrophy (LVH), and carotid intima‐media thickness (cIMT). Univariate and multivariate analyses were used to evaluate the relationship between PR, BP, and TOD. The percentage of male patients was 58.3% with a mean age of 44.6 ± 16.2 years. Nocturnal PR rather than 24‐hours PR or daytime PR was an independent risk factor for clinical hypertension, 24‐hours hypertension, BP dipper state, poor renal function, and LVH. In addition, the authors found that nighttime PR >74 beats/min (bpm) group was independently associated with clinical hypertension, 24‐hours hypertension, day and night hypertension, nondipping BP, lower eGFR, and LVH when compared with nighttime PR <64 bpm group. Furthermore, 1:1 propensity score matching between PR ≤74 bpm group and PR >74 bpm group was performed. Multivariate analyses indicated nighttime PR >74 bpm remained independently associated with clinical hypertension, daytime and nighttime hypertension, and LVH. An increased nocturnal PR is associated with TOD, higher BP, and nondipping BP in patients with CKD.     

Central pulse pressure and aortic stiffness determine renal hemodynamics: pathophysiological implication for microalbuminuria in hypertension

A significant link has been reported between aortic stiffening and renal microvascular damage, but the underlying mechanism remains poorly understood. We hypothesized that alterations in central and renal hemodynamics are responsible for this link. In 133 patients with hypertension, pressure waveforms were recorded on the radial, carotid, femoral, and dorsalis pedis arteries with applanation tonometry to estimate the aortic pressures and aortic (carotid-femoral) and peripheral (carotid-radial and femoral-dorsalis pedis) pulse wave velocities. Flow-velocity waveforms were recorded on the renal segmental arteries with duplex ultrasound to calculate the resistive index (RI) as [1 - (end-diastolic velocity/peak systolic velocity)] and on the femoral arteries to calculate the reverse/forward flow index and diastolic/systolic forward-flow ratio. Albuminuria was defined as urinary albumin/creatinine ratio ≥30 mg/g of creatinine. The renal RI (mean: 0.65±0.07) was strongly correlated (P<0.001) with the aortic pulse pressure (r=0.62), incident pressure wave (r=0.55), augmented pressure (r=0.49), and aortic pulse wave velocity (r=0.51), although not with the mean arterial pressure or peripheral pulse wave velocities. The correlations remained highly significant after consideration of confounders including age, cholesterol, hemoglobin A(1c), and glomerular filtration rate. The renal RI was inversely correlated with the femoral reverse and diastolic forward flow indices. Both aortic pulse pressure and renal RI correlated with the urinary albumin/creatinine ratio independent of confounders. Each 0.1 increase in renal RI was associated with a 5.4-fold increase in the adjusted relative risk of albuminuria. In conclusion, increased aortic pulse pressure causes renal microvascular damage through altered renal hemodynamics resulting from increased peripheral resistance and/or increased flow pulsation.     

Prevalence of Homocysteine‐Related Hypertension in Patients With Chronic Kidney Disease

Patients with both hypertension and hyperhomocysteinemia, termed H‐type hypertension, have a high risk for cardiocerebrovascular diseases. However, little is known about the prevalence of H‐type hypertension or its role in target organ damage in patients with chronic kidney disease (CKD). The authors recruited 1042 patients with CKD who were admitted to their hospital division. Multiple linear regression analyses were used to evaluate the association between H‐type hypertension and renal/cardiovascular parameters. A total of 460 (44.14%) CKD patients had H‐type hypertension. Multivariate logistic regression analysis showed that H‐type hypertension is associated with serum albumin, uric acid, estimated glomerular filtration rate (eGFR), and 24‐hour systolic blood pressure. Patients with H‐type hypertension had the worst renal function and left ventricular hypertrophy among all patients, while the levels of carotid intima‐media thickness (cIMT) in patients with H‐type hypertension were only slightly higher than in patients with normotension and normohomocysteinemia (P<.05). H‐type hypertension was associated with eGFR, left ventricular mass index, and cIMT according to multiple linear regression analyses. The prevalence of H‐type hypertension was high and H‐type hypertension was associated with target organ damage in patients with CKD.     

Sleep Blood Pressure Self‐Measured at Home as a Novel Determinant of Organ Damage: Japan Morning Surge Home Blood Pressure (J‐HOP) Study

To study whether sleep blood pressure (BP) self‐measured at home is associated with organ damage, the authors analyzed the data of 2562 participants in the J‐HOP study who self‐measured sleep BP using a home BP monitoring (HBPM) device, three times during sleep (2 am , 3 am , 4 am ), as well as the home morning and evening BPs. The mean sleep home systolic BPs (SBPs) were all correlated with urinary albumin/creatinine ratio (UACR), left ventricular mass index (LVMI), brachial‐ankle pulse wave velocity (baPWV), maximum carotid intima‐media thickness, and plasma N‐terminal pro‐hormone pro–brain‐type natriuretic peptide (NTproBNP) (all P<.001). After controlling for clinic SBP and home morning and evening SBPs, associations of home sleep SBP with UACR, LVMI, and baPWV remained significant (all P<.008). Even in patients with home morning BP <135/85 mm Hg, 27% exhibited masked nocturnal hypertension with home sleep SBP ≥120 mm Hg and had higher UACR and NTproBNP. Masked nocturnal hypertension, which is associated with advanced organ damage, remains unrecognized by conventional HBPM.     

Monocyte Chemoattractant Protein‐1 and Large Artery Structure and Function in Young Individuals: The African‐PREDICT Study

To better understand hypertension development, the authors determined whether monocyte chemoattractant protein‐1 (MCP‐1) is associated with arterial stiffness (pulse wave velocity [PWV]) and carotid intima‐media wall thickness (cIMT) in a young apparently healthy black and white population (N=403, aged 20–30 years). Carotid‐femoral PWV, central systolic blood pressure, and cIMT were measured, and MCP‐1, reactive oxygen species, inflammatory markers (interleukin 6, tumor necrosis factor α), and endothelial activation (intercellular adhesion molecule, vascular cell adhesion molecule) were determined from blood samples. Although carotid‐femoral PWV and cIMT were similar between blacks and whites, black men and women showed higher central systolic blood pressure, MCP‐1, and reactive oxygen species than whites (all P<.05). In addition, black women had higher brachial blood pressure and interleukin 6 (all P<.001). A consistent positive association only in black women between cIMT and MCP‐1 in multiple regression analyses was found (R²=0.151, β=0.248; P=.021). In this model, cIMT was also independently associated with vascular cell adhesion molecule (β=0.251; P=.022). The authors found elevated central systolic blood pressure and MCP‐1 in young blacks, where cIMT was independently associated with MCP‐1 in black women.     

Performance of 4 definitions of childhood elevated blood pressure in predicting subclinical cardiovascular outcomes in adulthood

We aimed to compare the ability of the pediatric blood pressure (BP) standards issued by the US Fourth Report, the recently proposed US, Chinese, and international standards to predict adult hypertension and subclinical cardiovascular disease (CVD). 2296 children were randomly selected from Beijing at baseline. The follow‐up survey was conducted among 1177 adults. Subclinical adult CVD was assessed using the carotid‐femoral pulse wave velocity (cfPWV), carotid intima‐media thickness (CIMT), and left ventricular mass index (LVMI). The prevalence of pediatric elevated BP was significantly higher according to the Chinese standards vs the Fourth Report, the updated US standards, and the international standards (18.7% vs 14.2%, 17.5%, and 18.0%, respectively; all Ps < .001). Children identified as elevated BP using any of the 4 standards were more likely to have adult hypertension, high cfPWV, and high LVMI than children without elevated BP. However, only the Chinese and updated US standards can predict the increased risk of adult high CIMT. Our results indicated that the Chinese standards performed equally or better compared with 3 other standards in predicting adult hypertension and subclinical CVD.     

高血压病患者微量白蛋白尿与动脉病变关系的研究

目的:分析高血压病伴及不伴微量白蛋白尿患者的动脉结构及功能的差异。方法:入选高血压病患者307例,对入选患者分别进行晨尿白蛋白/肌酐测定、大动脉弹性指数、小动脉弹性指数、颈—股动脉脉搏波传导速度(cfPWV)和颈动脉超声检查。根据尿白蛋白/肌酐测定结果将入选患者分为正常组(n=232)和异常组(n=75),应用统计学方法进行动脉功能和结构指标的组间差异比较。结果:①大动脉弹性指数和小动脉弹性指数在异常组均低于正常组;②cfPWV在异常组显著高于正常组;③应用Logistic回归进行多元分析,小动脉弹性指数和cfPWV在两组之间的差异仍存在;④颈动脉内膜中层厚度在异常组显著高于正常组,Logistic回归去除年龄、性别、高血压病程和糖尿病等影响因素后组间差异仍存在;⑤异常组颈动脉斑块检出数显著高于正常组。以上P均<0.05～0.01,差异均有统计学意义。结论:微量白蛋白尿和动脉功能、结构异常在高血压病情判断中可能具有一定的应用价值。     

Hypertension with primary aldosteronism is associated with increased carotid intima‐media thickness and endothelial dysfunction

Patients with primary aldosteronism induced hypertension are more likely to experience cardiovascular events compared to patients with essential hypertension. Primary aldosteronism may therefore have distinct adverse effects on cardiovascular structure and function, independent of hypertension. However, current data on such effects of primary aldosteronism are conflicting. The aim of the present study was to investigate the influence of primary aldosteronism on vascular structure and endothelial function, using intima‐media thickness as a vascular remodeling index and flow‐mediated dilation as a functional parameter. In total, 70 participants were recruited from patients with resistant hypertension. Twenty‐nine patients diagnosed with primary aldosteronism and 41 patients with essential hypertension were prospectively enrolled. Primary aldosteronism was due to aldosterone‐producing adenoma in 10 cases and due to idiopathic adrenal hyperplasia in 19 cases. All patients underwent ultrasound of the common carotid intima‐media thickness and flow‐mediated dilation of the brachial artery. Primary aldosteronism patients had significantly lower flow‐mediated dilation (3.3 [2.4‐7.4] % vs 14.7 [10.3‐19.9] %, P < 0.01) and significantly higher carotid intima‐media thickness (0.9 [0.7‐1.0] mm vs 0.8 [0.6‐0.9] mm, P = 0.02) compared to patients with essential hypertension. These differences remained significant after adjusting for age, sex, diabetes mellitus, 24‐hours systolic blood pressure, and smoking (P < 0.01). No differences in either outcome were observed between the adenoma and adrenal hyperplasia groups (both P > 0.05). Hypertensive patients with hyperaldosteronism appear to exhibit deteriorative effects on both vascular structure and function, independent of hypertension.     

Choroidal thickness is associated with renal hemodynamics in essential hypertension

The choroid is the most vascularized structure of the eye and plays a central role in the development of the retinal vascular changes that occur in arterial hypertension. Changes of choroidal thickness (ChT) assessed by optical coherence tomography (OCT) technology could reflect the vascular complications of hypertension. Also, intrarenal hemodynamic damage, associated with endothelial dysfunction, demonstrated to be a good indicator of systemic morphofunctional arterial impairment. The aim of this study is to assess the relationship between ChT and renal hemodynamics in subjects with essential hypertension. Routine laboratory tests, clinical history, and physical examination, including blood pressure assessment, were performed in 90 subjects with essential hypertension. All patients underwent Doppler ultrasonographic evaluation of intra‐renal hemodynamics and OCT imaging to assess ChT. When subjects were divided in two groups based on renal resistive index (RRI), group I (RRI ≥ 75% percentile) showed significantly lower values of ChT than group II (RRI < 75% percentile) (P < .001). When divided in two groups based on the ChT median values, patients with lower ChT had significantly higher RRI values than those with ChT above the median values (P < .05). In multivariate model including age, eGFR, and other variables as confounding factors, RRI ≥ 75% was independently associated with ChT. ChT was significantly correlated with renal resistive index in subjects with essential hypertension, confirmed in multivariate analyses. This result could be referred to changes in vascular elastic properties that occur in retinal and intrarenal vascular system probably due to oxidative stress and endothelial dysfunction commonly found in early complications of hypertension.     

Resistant Hypertension: Risk Factors,Subclinical Atherosclerosis,and Comorbidities Among Adults—The Brazilian Longitudinal Study of Adult Health (ELSA‐Brasil)

The frequency of resistant hypertension—defined as blood pressure (BP) ≥140/90 mm Hg with proven use of three antihypertensive medications, or as the use of four antihypertensive drug classes regardless of BP—is unknown in low‐middle–income countries. Using data from the Brazilian Longitudinal Study of Adult Health, a cohort of 15,105 civil servants aged 35 to 74 years, the authors identified 4116 patients taking treatment for hypertension, 11% of who had resistant hypertension. These participants were more likely to be older, black, less educated, poorer, and obese. The adjusted prevalence ratios (95% confidence intervals) were diabetes, 1.44 (1.20–1.72); glomerular filtration rate (<60 mL/min/1.72 m²), 1.95 (1.60–2.38); albumin‐to‐creatinine ratio (>300 mg/g), 2.43 (1.70–3.50); carotid‐femoral pulse‐wave velocity, 1.07 m/s (1.03–1.11 m/s); common carotid intima‐media thickness, 2.57 mm (1.64–4.00 mm); left ventricular hypertrophy, 2.08 (1.21–3.57); and atrial fibrillation, 3.55 (2.02–6.25). Thus, the prevalence of resistant hypertension in Brazil is high and associated with subclinical markers of end‐organ cardiovascular damage.     

老年高血压患者肱踝脉搏波传导速度与颈动脉粥样硬化相关性的临床研究

目的探讨老年高血压患者肱踝脉搏波传导速度与颈动脉粥样硬化的关系。方法将136例老年观察对象分为老年高血压组（76例）和老年健康对照组（60例）。用欧姆龙动脉硬化检测仪检测肱踝脉搏波传导速度（brachialankle pulse wave velocity,baPWV）,彩色多普勒检测颈动脉内膜-中层厚度（carotid intimamediathickness,clMT）,对肱踝脉搏波传导速度与颈动脉粥样硬化进行相关性分析。结果老年高血压患者肱踝脉搏波传导速度、颈动脉内中膜厚度明显高于对照组,差异有统计学意义（P〈O．05o在控制了年龄、体重指数、高血脂等多种动脉粥样硬化危险因素后,肱踝脉搏波传导速度与颈动脉内中膜厚度仍然存在正相关性（r=0．452,P〈0．01）。结论老年高血压患者肱踝脉搏波传导速度与颈动脉粥样硬化关系密切;控制血压对于延缓老年患者动脉粥样硬化的进展,减少心脑血管事件的发生有着重要意义。     

Higher arterial stiffness is associated with lower cognitive performance in patients with hypertension

Cognitive impairment and elevated arterial stiffness have been described in patients with arterial hypertension, but their association has not been well studied. We evaluated the correlation of arterial stiffness and different cognitive domains in patients with hypertension compared with those with normotension. We evaluated 211 patients (69 with normotension and 142 with hypertension). Patients were age matched and distributed according to their blood pressure: normotension, hypertension stage 1, and hypertension stage 2. Cognitive function was assessed using the Mini‐Mental State Examination, Montreal Cognitive Assessment, and a battery of neuropsychological evaluations that assessed six main cognitive domains. Pulse wave velocity was measured using a Complior device, and carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. The hypertension stage 2 group had higher arterial stiffness and worse performance either by Mini‐Mental State Examination (26.8±2.1 vs 27.3±2.1 vs 28.0±2.0, P=.003) or the Montreal Cognitive Assessment test (23.4±3.5 vs 24.9±2.9 vs 25.6±3.0, P<.001). On multivariable regression analysis, augmentation index, intima‐media thickness, and pulse wave velocity were the variables mainly associated with lower cognitive performance at different cognitive domains. Cognitive impairment in different domains was associated with higher arterial stiffness.     

Is hypertension the fate of aortic coarctation patients treated with Cheatham Platinum (CP) stent?

Aim

The aim of this study is to address the presence of hypertension and risk for cardiovascular diseases in patients with Coarctation of the Aorta (CoA) who were treated with endovascular stent placement.

Methods

Twenty patients (mean age: 14.2 ± 3.9 years) who were treated with stent and 20 age‐ and sex‐matched controls were included to the study. Structure and functions of left ventricle were assessed by echocardiography. Carotid intima media (CIM) thickness was measured by using sonography as a marker for detecting cardiovascular risk. As indirect marker of arterial stiffness, pulse wave velocity, and augmentation index were recorded by ambulatory blood pressure monitorization/arteriography device.

Results

By ambulatory blood pressure monitorization, 24 h and daytime systolic and mean arterial pressure values were found to be significantly higher in patient group. Based on percentile values, 15% and 5% of patients were pre‐hypertensive and hypertensive, respectively. Pulse wave velocity and cardiac output values were found to be significantly higher than control group. CIM thickness was also found to be significantly higher in patient group when compared to controls.

Conclusions

It was shown that hypertension incidence as demonstrated by ambulatory blood pressure monitorization and risk for cardiovascular diseases as indicated by CIM thickness and Pulse wave velocity were higher than those in healthy population even after CoA is corrected.     

Impact of different antihypertensives on carotid arterial wall thickness

Hypertension has been associated with atherosclerosis and cardiovascular disease. Carotid intima media thickness is increased in hypertensive patients. But, the correlation between carotid intima media thickness and antihypertensive agents is still uncertain. Therefore, we investigated carotid intima media thickness based on types of antihypertensive agents. 1809 patients were enrolled in this study and it showed that 1079 hypertensive patients had thicker carotid intima media thickness than non‐hypertensive patients, with carotid intima media thicknesses of (0.72 ± 17 mm vs 0.64 ± 15 mm, P < .001), (0.31 ± 0.07 mm vs 0.30 ± 0.06 mm, P < .001), and (0.41 ± 0.13 mm vs 0.35 ± 0.12 mm, P < .001). Additionally, hypertensive patients on beta‐blockers also had thicker carotid intima media thickness than the non‐beta‐blocker group, with carotid intima media thicknesses of (0.74 ± 0.18 mm vs 0.71 ± 0.16 mm, P = .018), (0.33 ± 0.09 mm vs 0.31 ± 0.07 mm, P = .029), and (0.43 ± 0.13 mm vs 0.40 ± 0.13 mm, P = .035). Multivariate analysis showed that carotid intima thickness was only correlated with beta‐blockers (odds ratio = 2.489, confidence interval = 1.183‐5.239, P = .016); however, this study showed that beta‐blocker could be associated with increased carotid wall thickness as well.     

Noninvasive Assessment of Atherosclerosis in Patients with Isolated Hypertension

Background: Endothelial dysfunction is considered the first stage in the development of atherosclerosis. Brachial artery flow‐mediated dilatation (FMD) has been used to assess endothelial dysfunction. An impaired FMD response may reflect a vascular phenotype prone to atherosclerosis. The thickness of the common carotid intima‐media (CIMT) as measured by ultrasound represents a marker of structural atherosclerosis. Recently, it has been shown that color M‐mode propagation velocity measured along the origin of descending thoracic aorta (AVP) may reflect atherosclerosis. In this study, the effects of isolated hypertension on these atherosclerosis markers are investigated. Methods: Fifty patients with newly diagnosed hypertension and forty healthy people were enrolled. Patients were evaluated with transthoracic echocardiography. Diastolic functions were evaluated by transmitral filling parameters of deceleration time (DT), E/A ratio, and isovolumetric relaxation time (IVRT). Carotid intima‐media thickness, FMD, and AVP were measured. Results: Age, gender, and BMI of both groups were similar. Compared to control group CIMT, DT and IVRT values were significantly higher, and FMD and AVP values were significantly lower in hypertensive patients. There were significant correlations between AVP and CIMT (r =−0.699, P < 0.001), AVP and FMD (r = 0.400, P < 0.001), and FMD and CIMT (r =−0.600, P < 0.001). Carotid intima‐media thickness, AVP, and FMD were significantly correlated with systolic and diastolic blood pressures and DT and IVRT. Conclusions: In patients with isolated hypertension, AVP and FMD decrease and CIMT increases. In addition, CIMT is inversely correlated with AVP and FMD, and AVP is directly correlated with FMD. (ECHOCARDIOGRAPHY 2010;27:155‐160)     

Prognostic significance of the renal resistive index in the primary prevention of type II diabetes

The renal resistive index has been demonstrated to predict the progression of renal disease and recurrence of major cardiac events in high‐risk cardiovascular patients, in addition to other comorbidities. We aimed to assess the prognostic significance of the renal resistive index in type 2 diabetic patients for primary prevention. From 2008 to 2011, patients with type 2 diabetes underwent cardiovascular evaluation, including renal resistive index assessment by renal Doppler ultrasound. The incidence of all‐cause death, cardiovascular events, dialysis requirement or a twofold increase in creatinine was recorded. Survival curves were estimated by the Kaplan‐Meier method. Two hundred sixty‐six patients were included; 50% of the patients were men, an HbA1C level of 8.1 ± 1.7% (65 ± 13.6 mmol/mol) and a serum creatinine level of 8 [7‐9] mg/L. The mean 24‐hour systolic blood pressure, 24‐hour diastolic blood pressure, and 24‐hour pulse pressure were 133.4 ± 16.7, 76.5 ± 9.4, and 56.9 ± 12.4 mm Hg, respectively. The median renal resistive index was 0.7 [0.6‐0.7] with a threshold of 0.7 predictive of monitored events. After adjustment of the 24‐hour pulse pressure, age and 24‐hour heart rate, a renal resistive index ≥0.70 remained associated with all‐cause death (hazard ratio: 3.23 (1.16‐8.98); P = .025) and the composite endpoint of major clinical events (hazard ratio: 2.37 (1.34‐4.18); P = .003). An elevated renal resistive index with a threshold of 0.7 is an independent predictor of a first cardiovascular or renal event in type 2 diabetic patients. This simple index should be implemented in the multiparametric staging of diabetes.     

颈动脉粥样硬化与冠状动脉粥样硬化的关系

目的　探讨颈动脉粥样硬化与冠状动脉粥样硬化的关系。方法　对 94例老年患者进行了冠状动脉造影和颈动脉超声检查。颈动脉粥样硬化斑块积分采用Sutton法。结果　单支组及多支组内膜中膜厚度、斑块积分显著高于正常组 ,多支组显著高于单支组 (P<0 .0 5 )。斑块指数与年龄、吸烟、低密度脂蛋白胆固醇与高密度脂蛋白胆固醇的比值、收缩压以及高血压病程的程度呈正相关。结论　颈动脉粥样硬化与冠状动脉粥样硬化的病变是平行的