Left ventricular structural characteristics in unilateral renovascular hypertension and primary aldosteronism

To assess the importance of the renin-angiotensin system and plasma volume as determinants of hypertensive left ventricular hypertrophy and its anatomy, patients with unilateral renovascular hypertension and primary aldosteronism were studied by echocardiography. Blood pressure, age and sex were matched as closely as possible. The 19 patients with unilateral renovascular hypertension and the 19 patients with primary aldosteronism were similar in age, sex and blood pressure (168 +/- 19/97 +/- 11 and 163 +/- 17/99 +/- 10 mm Hg, respectively), but plasma volume was increased in the patients with primary aldosteronism. Interventricular septal thickness, left ventricular posterior wall thickness, left ventricular mass index and relative wall thickness did not differ between the 2 groups of patients. There was a significant correlation between the level of systolic blood pressure and either left ventricular mass index (r = 0.34, p less than 0.05) or relative wall thickness (r = 0.58, p less than 0.001) in both groups of patients. Left ventricular end-diastolic dimension index was increased in the patients with primary aldosteronism compared with those with unilateral renovascular hypertension (3.2 +/- 0.4 vs 2.9 +/- 0.3 cm/m2, p less than 0.02). When confined to the patients with systolic pressure greater than or equal to 150 mm Hg, relative wall thickness was significantly increased in the patients with unilateral renovascular hypertension. Patients with primary aldosteronism and unilateral renovascular hypertension of similar blood pressure levels, age and sex have almost identical degrees of left ventricular hypertrophy and anatomy. In contrast, the patients with primary oldosteronism had increased left ventricular dimension index.(ABSTRACT TRUNCATED AT 250 WORDS)     

QT interval in patients with primary aldosteronism and low-renin essential hypertension

INTRODUCTION: QT interval prolongation increases the risk of sudden death in several medical conditions. Patients with primary aldosteronism and salt-sensitive hypertension experience more cardiovascular events than those with normal-renin essential hypertension. QT interval prolongation might represent one of the risk factors for cardiovascular events in these patients. The aim of the present study was to evaluate the QT interval in patients with primary aldosteronism and low-renin essential hypertension (LREH). METHODS: Twenty-seven patients with primary aldosteronism, 17 patients with LREH, 117 patients with essential hypertension and 25 healthy individuals were studied. Plasma aldosterone, plasma renin activity, and aldosterone to plasma renin activity ratio (ARR) were determined. Corrected QT intervals (QTcs) were measured from a 12-lead electrocardiogram. RESULTS: The QTc was longer in primary aldosteronism (434 +/- 23 ms) and LREH (430 +/- 18 ms) compared with essential hypertension (419 +/- 22 ms) and healthy controls (412 +/- 19 ms) (P = 0.0004). The prevalence of QTc longer than 440 ms was higher in primary aldosteronism (48%) and LREH (23%) compared with essential hypertension (11%) and healthy controls (4%) (P < 0.0001). QTc correlated with plasma aldosterone (P = 0.01), ARR (P = 0.02), and diastolic blood pressure (P = 0.01). ARR (P = 0.01) and systolic blood pressure (P = 0.01) were identified as independent predictors of QTc. CONCLUSIONS: We postulate that the elevated aldosterone secretion contributes to the prolongation of the QT interval in patients with primary aldosteronism and LREH through both a depletion of intracellular potassium concentration and higher blood pressure values. QTc measurement might represent one simple, non-invasive and reproducible index to characterize the cardiovascular risk in patients with primary aldosteronism and LREH.     

Left ventricular circumferential function in patients with essential hypertension

The aim of the study was to investigate left ventricular (LV) systolic and diastolic circumferential myocardial function using tissue Doppler imaging in patients with essential hypertension. One hundred and two patients and 33 healthy age-matched controls were studied. Each patient underwent echocardiographic study with analysis of tissue velocity curves, which included mean peak systolic (Sm), early (Em) and late diastolic velocity (Am) and isovolumic relaxation time (IRTm). These parameters were expressed as means from the six basal segments of left ventricle reflecting its longitudinal function (L). The same indices estimated in mid-anteroseptal (C-AS) and mid-posterior (C-P) segments in parasternal short-axis view served as a measure of LV circumferential function. Higher value of C-AS-Sm and a similar trend in C-P-Sm suggest increased LV circumferential systolic function in hypertensive patients, whereas lower values of C-AS-Em, C-P-Em, C-AS-Em/Am and C-P-Em/Am indicate impaired LV circumferential diastolic function. Decreased L-Sm as well as decreased L-Em and L-Em/Am reflects LV longitudinal systolic and diastolic dysfunction, respectively. By univariate analysis, positive correlations were demonstrated between C-AS-Sm and LV mass index (LVMI) (r=0.61, P<0.001), interventricular septum thickness (IVS) (r=0.55, P<0.001) and LV posterior wall thickness (PW) (r=0.43, P<0.01) and negative ones between L-Sm and LVMI (r=-0.51, P<0.001) and PW (r=-0.36, P<0.04). By stepwise multivariate regression analysis, LVMI, IVS and age independently predicted C-AS-Sm and LVMI predicted L-Sm. Our study demonstrated in hypertensive patients increased LV circumferential systolic and decreased diastolic function. The former may be a compensatory response to the impairment in LV longitudinal systolic performance.     

Cytosolic free calcium concentration in platelets in patients with renovascular hypertension and primary aldosteronism.

To investigate the role of cytosolic free calcium, [Ca2+]i, in secondary hypertension, the levels in platelets from 14 secondary hypertensives (7 renovascular hypertension, 7 primary aldosteronism) were compared with those from 21 essential hypertensives and 15 normotensives by means of the fluorescent indicator, quin-2. The mean BP was significantly higher in both the secondary hypertensives and essential hypertensives (122 +/- 8 and 124 +/- 12 mmHg) than in the normotensives (89 +/- 10 mmHg). Cytosolic free calcium in platelets was significantly higher in the essential hypertensives, but not in the secondary hypertensives, compared with the normotensives (182 +/- 34, 141 +/- 17, 138 +/- 15 nM respectively). There was no significant difference in platelet [Ca2+]i between renovascular hypertension and aldosteronism (142 +/- 19 versus 139 +/- 16 nM). There was no correlation between platelet [Ca2+]i and plasma renin activity, plasma aldosterone concentration or plasma noradrenaline concentration in the three groups. Thus, the increase in platelet [Ca2+]i seen in essential hypertension was not found in patients with secondary hypertension. Our results suggest that the cytosolic calcium handling of secondary hypertensive patients with renal artery stenosis or primary aldosteronism differs from that of essential hypertensives.     

原发性醛固酮增多症患者左室结构损害的研究

目的 探讨原发性醛固酮增多症(PA)患者左室结构损害的特点.方法 将2007年1月至2010年6月住院行PA筛查最终确诊为PA(213例)及原发性高血压(EH)的患者(225例)纳入研究,依据超声心动图结果评价两组患者的左室结构.结果 PA组的病程、醛固酮水平明显高于EH组(P＜0.01),而血钾、肾素活性明显低于EH组(P＜0.01).协方差分析校正病程后,PA组患者的室间隔厚度、左室舒张末期内径、左室重量指数、左室舒张末期容积和每搏输出量均高于EH组(P＜0.01).PA组患者左室肥厚的发生率明显高于EH组(53.1％对33.8％,x2=16.57,P＜0.01);PA组患者正常构型、向心性重构、向心性肥厚及离心性肥厚的构成比分别是:24.9％、22.1％、22.1％和30.9％.多元逐步回归分析显示收缩压、坐位醛固酮水平是影响PA患者左室重量指数的主要因素,回归系数分别为0.45 (P＜0.01)、0.43 (P＜0.01);病程是影响相对室壁厚度的主要因素,回归系数是0.011 (P＜0.05).结论 PA患者左室肥厚的发生率高于EH患者,其左室构型以离心性肥厚最多见.     

原发性醛固酮增多症与原发性高血压代谢异常的比较

目的 探讨原发性醛固酮增多症的代谢异常.方法 入选已确诊的原发性醛固酮增多症(原醛)患者220例(男117例,女103例)与性别、年龄及高血压病程相匹配的同期住院原发性高血压(EH)患者200例(男104例,女96例).记录入选者一般临床资料和生化指标,在两组间行代谢综合征患病率及两组代谢异常特点比较.结果 (1)原醛组代谢综合征患病率显著高于同期住院EH组(47.3％对31.5％,P=0.009).(2)原醛患者整体血压水平显著高于EH患者[24 h平均收缩压(150.67±15.45)mm Hg对(145.69±17.13)mm Hg,P=0.042;24 h平均舒张压(93.03±10.51)mm Hg对(85.83±14.44)mm Hg,P=0.037],且原醛组以2、3级高血压为主.(3)原醛患者腹型肥胖和胰岛素抵抗发生率显著高于EH患者[86.8％(191/220)对78.5％(157/200),P=0.024;胰岛素抵抗指数42.42±16.11对49.58±22.43,P=0.008].结论 原醛以腹型肥胖、中重度高血压及严重的胰岛素抵抗为主要特征,直接导致其代谢综合征患病率显著高于EH患者.     

Left ventricular structural and functional characteristics in Cushing's syndrome

OBJECTIVES: This study was designed to evaluate left ventricular (LV) anatomy and function in patients with Cushing's syndrome. BACKGROUND: A high prevalence of LV hypertrophy and concentric remodeling has been reported in Cushing's syndrome, although no data have been reported on LV systolic and diastolic function. METHODS: Forty-two consecutive patients with Cushing's syndrome and 42 control subjects, matched for age, gender, and blood pressure, were studied. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were measured by echocardiography, endocardial and midwall fractional shortening (FS) were assessed, and diastolic filling was measured by Doppler transmitral flow. RESULTS: The RWT was significantly greater in Cushing patients than in controls. Left ventricular hypertrophy and concentric remodeling were observed in 10 and 26 patients with Cushing's syndrome, respectively. In Cushing patients, midwall FS was significantly reduced compared with controls (16.2 +/- 3% vs. 21 +/- 4.5%, p = 0.01). The ratio of transmitral E and A flow velocities was reduced and E deceleration time was prolonged in Cushing patients compared with controls (p = 0.03 and p < 0.001, respectively). CONCLUSIONS: In patients with Cushing's syndrome, cardiac structural changes are associated with reduced midwall systolic performance and with diastolic dysfunction that may contribute to the high risk of cardiovascular events observed in these patients.     

Left ventricular hypertrophy and endothelial functions in patients with essential hypertension

OBJECTIVE: In this study, we used a non-invasive method in patients with essential hypertension and without any overt clinical evidence of atherosclerosis to investigate the role of left ventricular hypertrophy (LVH) in endothelial functions. METHODS: We assessed endothelial function in 32 hypertensive patients with LVH (group 1), 28 hypertensive patients without LVH (group 2) and 29 normotensive subjects (control group). Flow-mediated (endothelium-dependent) and nitrate induced (endothelium-independent) dilatation of the brachial artery was evaluated in all groups. RESULTS: Flow-mediated dilatation was considerably higher in the control group than in group 1 and 2 (13.98 +/- 2.92%, 4.67 +/- 1.09% and 7.02 +/- 1.79% respectively, p < 0.001). In addition, endothelium-dependent dilatation was significantly lower in group 1 than in group 2 (p < 0.001), whereas nitrate induced changes were similar in all groups. CONCLUSION: Vascular endothelial functions are impaired in hypertensive patients. There may be heterogeneity of endothelial dysfunction among patients with hypertension. Presence of LVH has an additional negative effect on endothelial function in hypertensive patients.     

Plasma osteopontin levels are higher in patients with primary aldosteronism than in patients with essential hypertension

BACKGROUND: The incidence of cardiovascular events is higher in patients with primary aldosteronism (PA) than in patients with essential hypertension (EHT). Aldosterone has been shown to play an important role in the development of vascular inflammation and myocardial fibrosis in animal models. Elevated serum inflammatory cytokine is an independent cardiovascular risk factor in patients with EHT. In the present study, we compared levels of inflammatory cytokines between patients with PA and EHT. METHODS: The study subjects were 15 patients with PA and 15 age-matched patients with EHT. Serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), high sensitive C-reactive protein (hsCRP), and plasma osteopontin (OPN) levels were measured by enzyme-linked immunosorbent assays. RESULTS: Systolic and diastolic blood pressure (BP) did not differ between the PA and EHT patient groups. Levels of serum IL-6 (P = .563), TNF-alpha (P = .480), and hsCRP (P = .870) did not differ between the two groups. In contrast, plasma OPN levels in patients with PA were significantly higher than those in patients with EHT (P < .0001). There was no relationship between BP and plasma OPN levels in patients with PA. CONCLUSIONS: The present study showed that plasma OPN levels were higher in patients with PA than in patients with EHT.     

Studies on abnormalities of adrenal steroidogenesis in essential hypertension, primary aldosteronism and renovascular hypertension: responses of plasma steroids to angiotensin III

In the present study, effects of angiotensin on the adrenal steroidogenesis were studied in essential hypertension, primary aldosteronism and renovascular hypertension (RVH). Angiotensin III(A III), an analogue of angiotensin II, was administered to 17 normal volunteers (9 male and 8 female), 44 patients with essential hypertension (EH) (15 with high renin; HREH, 15 with normal renin; NREH and 14 with low renin; LREH), 8 patients with primary aldosteronism (5 with adrenal adenoma; APA and 3 with bilateral adrenocortical hyperplasia; IHA) and 5 patients with renovascular hypertension. In all the patients with hypertension and normal subjects, blood pressure (BP) and plasma concentrations of progesterone (P), corticosterone (B), aldosterone (Aldo), 17 alpha-hydroxyprogesterone(17-OHP) and cortisol(F) were measured before and after intravenous administration of A III (0.1, 0.5, 1.0, 10, 20 and 40 ng/kg/min, for 15 min, respectively). 1) BP rose from 164 +/- 19/88 +/- 8 to 180 +/- 19/112 +/- 10 mmHg [systolic BP(SBP); P less than 0.01, diastolic BP(DBP); P less than 0.01] in HREH, from 162 +/- 12/96 +/- 7 to 186 +/- 11/118 +/- 8 mmHg in NREH(SBP; P less than 0.01, DBP; P less than 0.01), 165 +/- 12/94 +/- 8 to 202 +/- 12/126 +/- 9 mmHg in LREH(SBP; P less than 0.001, P less than 0.001) and 118 +/- 8/72 +/- 7 mmHg to 136 +/- 11/88 +/- 8 mmHg in controls (SBP; P less than 0.01, DBP; P less than 0.01). The elevation in NREH and LREH was greater than that in HREH and controls. The elevations of BP both in APA and IHA were remarkably greater than that in controls and as similar as LREH(APA; 174 +/- 21/103 +/- 12 to 204 +/- 18/136 +/- 8 mmHg, IHA; 176 +/- 10/104 +/- 4 to 206 +/- 17/138 +/- 10 mmHg). The elevation in RVH was similar to that in NREH(173 +/- 9/108 +/- 8 to 194 +/- 13/132 +/- 10 mmHg). 2) Plasma P increased from 25.5 +/- 7.5 to 39.5 +/- 13.8 ng/100 ml(P less than 0.001) in HREH, from 28.0 +/- 7.7 to 45.3 +/- 12.7 ng/100 ml(P less than 0.001) in NREH, from 23.8 +/- 8.2 to 47.2 +/- 19.4 ng/100 ml(P less than 0.001) in LREH and 26.6 +/- 11.0 to 43.4 +/- 14.6 ng/100 ml in controls. The increment in HREH or NREH was similar to that in controls(P less than 0.1, respectively), whereas greater than controls in LREH(P less than 0.05).(ABSTRACT TRUNCATED AT 400 WORDS)     

老年原发性醛固酮增多症和高血压患者N末端B型钠尿肽前体及心脏早期损害的研究

目的分析老年原发性醛固酮增多症(PA)和原发性高血压(EH)患者N末端B型钠尿肽前体(NT-proBNP)水平对老年患者早期心脏损害的评价价值。方法连续选择2009年12月~2014年6月在我院接受治疗的149例高血压患者,其中确诊为PA的70例患者为病例组,排除PA并确诊为EH的79例患者为对照组。观察并比较2组患者早期心脏损害指标NT-proBNP和左心室质量指数(LVMI)。结果病例组log NT-proBNP(1.9±0.4 vs1.7±0.5,P=0.001)、LVMI[(116.5±20.8)g/m2 vs(106.3±21.7)g/m2,P=0.004]和左心室肥厚(67.1%vs50.6%,P=0.041)比例明显高于对照组。多元线性逐步回归分析显示,病例组LVMI及激活醛固酮水平与NT-proBNP独立相关,对照组诊室收缩压水平与NT-proBNP独立相关。结论老年PA患者较EH患者有独立于血压水平的更高的log NT-proBNP水平及更早的心脏损害。     

Left ventricular mass change during treatment and outcome in patients with essential hypertension

BACKGROUND: It is uncertain whether reduction of left ventricular (LV) mass during antihypertensive treatment predicts reduces cardiovascular complications of hypertension. METHODS: A total of 172 prospectively identified patients with essential hypertension without complications of hypertension at baseline and follow-up echocardiograms 5.5 +/- 3.0 years apart, were followed an additional 4.8 +/- 2.9 years. Antihypertensive treatment was determined by primary physicians. RESULTS: After the second echocardiograms, cardiovascular events occurred in 24 patients (14%). Fewer of the 91 patients with unchanged or decreased LV mass experienced cardiovascular events than of the 81 patients whose LV mass increased during follow-up (8.8% [95% confidence interval (CI): 3.9%-13.7%] v 19.8% [95% CI 12.6%-27.0%]; P =.04) despite greater baseline LV mass in the former group (118 g/m(2) [95% CI 111-125] v 95 g/m(2) [95% CI 88-102]; P <.0001). Absence or presence of LV hypertrophy on the follow-up echocardiogram was the strongest predictor of relatively low (9.2% [95% CI 5%-13.4%]) v high (28.6% [95% CI 17.1%-40.1%]; P =.004) rates of subsequent morbid events. In multivariate analyses, only LV mass index at follow-up consistently predicted adverse outcomes. CONCLUSIONS: The LV mass reduction during antihypertensive treatment is associated with reduced rate of complications of essential hypertension. Our data further suggest that development or regression of LV hypertrophy during antihypertensive treatment may be more closely linked to prognosis than are changes in clinic blood pressure.     

原发性醛固酮增多症与原发性高血压的糖脂代谢比较

目的:比较原发性醛固酮增多症与原发性高血压的糖脂代谢特征。方法:431例已确诊的原发性醛固酮增多症(PA)患者,其中256例行肾上腺静脉取血,分为原醛单侧组(LPA,n=147)、原醛双侧组(NLPA,n=109)。同时入选与性别、年龄、及高血压病程相匹配的同期住院原发性高血压(EH)患者200例为对照组。收集各组的临床资料和生化指标,计算PA检出率并分析糖脂代谢特点。结果:(1)PA检出率为10.54%(431/4100);(2)体重指数、腰围PA组较EH组高;(3)血三酰甘油LPA组高于NLPA组和EH组,高密度脂蛋白NLPA较EH组低;(4)血糖水平、血胰岛素各点及胰岛素抵抗指数均PA组高于EH组,且NLPA组高于LPA组;(5)体重指数可增加LPA组危险性(OR值=2.24,P=0.024);(6)三酰甘油与尿醛固酮呈显著正相关,体重指数与卧位醛固酮水平呈正相关,各点胰岛素水平和胰岛素抵抗指数均与醛固酮水平和尿醛固酮呈显著正相关。结论:与EH患者相比,PA糖脂代谢异常程度重,其中LPA脂代谢以及NLPA组糖代谢异常更为严重。     

原发性高血压合并室性早搏患者的临床特征

目的 观察原发性高血压患者室性早搏(简称室早)的发生特点,为临床治疗提供依据.方法 选取住院时同步接受动态心电图和动态血压监测的200例原发性高血压患者,观察室早与24 h血压、血压昼夜节律变化、左心室肥厚、心肌缺血以及心功能间的关系.结果 ① 伴和不伴室早的原发性高血压患者,其24 h血压差异无统计学意义;室早Low...     

Increased arterial wall stiffness in primary aldosteronism in comparison with essential hypertension

BACKGROUND: Aldosterone has been shown to substantially contribute to the accumulation of collagen fibers and growth factors in the arterial wall, which can increase wall stiffness. This study aimed at comparing arterial stiffness between patients with primary aldosteronism (PA), essential hypertension (EH), and normotensive controls using carotid-femoral pulse wave velocity (PWV) and central augmentation index (AI). METHODS: Thirty-six patients with confirmed PA, 28 patients with EH, and 20 normotensive subjects were investigated by Sphygmocor applanation tonometer. RESULTS: The office blood pressure (BP) at the time of the measurement (PA 167+/-34/92+/-12 mm Hg; EH 166+/-19/91+/-10 mm Hg), age, body mass index (BMI), cholesterol, triglyceride, blood glucose levels were comparable between PA and EH groups. The patients with PA had significantly higher PWV than the EH patients and control subjects (9.8+/-2.6 m/sec v 7.5+/-1.0 m/sec v 5.9+/-0.7 m/sec, respectively; all mutual differences P<.001). The difference in PWV between PA and EH remained statistically significant also after the adjustment for all clinical variables including 24-h BP using multivariate analysis (P=.001). CONCLUSIONS: Arterial wall stiffness is independently increased in PA compared to EH. This could be caused by the deleterious effects of aldosterone excess (potentially modulated by hypernatremia) on the fibrosis and remodeling of the arterial wall.     

The characteristics of right ventricular function in patients with essential hypertension

Two-dimensional and pulsed Doppler echocardiography were used to evaluate the function of right ventricule in 166 patients with essential hypertension and the results were compared with those of 79 normal subjects. The pulmonary artery peak flow velocity in 100 patients without left ventricular hypertrophy (LVH) had no significant difference with that of normal controls (0.65 +/- 0.17 vs 0.63 +/- 0.18, P greater than 0.05). The tricuspid early peak flow velocity (E) decreased (0.43 +/- 0.08 vs 0.46 +/- 0.12, P less than 0.01) but the late peak flow velocity (A) increased (0.30 +/- 0.09 vs 0.24 +/- 0.06, P less than 0.001). E/A reduced also (1.57 +/- 0.53 vs 2.02 +/- 0.78, P less than 0.01). The pulmonary peak flow velocity in 66 patients with LVH elevated markedly as compared with those without LVH (0.71 +/- 0.18 vs 0.65 +/- 0.17, P less than 0.001), A increased (0.34 +/- 00.10 vs 0.30 +/- 0.09, P less than 0.001) and E/A decreased (1.29 +/- 0.37 vs 1.57 +/- 0.53, P less than 0.001). The decrement of E/A correlated with the thickness of interventricular septum and the left ventricular mass (r = -0.68 and -0.60 respectively, P less than 0.01). The results show that the diastolic function of right ventricule was damaged in the early stage of essential hypertension but the systolic function remains unchanged. The diastolic function decreased and the systolic function increased further concomitantly with the development of LVH.