Abstract
Objective: The functional and structural properties of large arteries in patients with severe hypertension, more suitable for cardiovascular complications, have not been studied. The aim of our study was to evaluate modifications of large arteries obtained by noninvasive methods (pulse wave velocity-PWV and carotid ultrasound), its major determinants and the correlations with inflammatory markers in patients with severe hypertension. Design and method: We evaluated 48 patients (age 53,6 ± 8 years; 75% white; 71% women), with stage 3 arterial hypertension, under the same antihypertensive treatment for one month. Carotid parameters (diameter, wall thickness, distension) were evaluated by radiofrequency ultrasound and arterial stiffness by PWV measurements. All patients were submitted to 24-hs ambulatory blood pressure monitoring and blood samples were collected to analyze inflammatory markers and biochemical profile. Results: The office mean arterial pressure (MAP) was 117,1 ± 17 mmHg, mean PWV 12,21 ± 2,7 m/s, intima media thickness(IMT) 0,76 ± 0,12 mm, carotid diameter 7,38 ± 1,1 mm and carotid distension 5,27 ± 2 %. We observed a significative correlation between PWV and MAP (r = 0.38, p < 0.05) while carotid distension did not correlate to MAP. PWV measurements significantly correlated to SBP during sleep period (r = 0.356, p = 0.01), the lowest SBP during sleep (0.402, p < 0.01), and morning surge (r = 0.309, p < 0.05). Carotid distension was negatively correlated to glycemia (r = -0.32, p = 0.026). Concerning inflammatory markers, PWV was inversely correlated to adiponectin levels (r = -0.306, p = 0.03). Also PWV and IMT values were significantly correlated (r = 0,32, p < 0.05). Conclusions: In patients with stage 3 hypertension arterial stiffness is correlated to nocturnal blood pressure and morning surge, and is associated to elevated glycemia and a decreased adiponectin production. The data suggests an integrative role of metabolic, inflammatory and hemodynamic changes in large arteries impairment linked to hypertension.
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