Artery Disease In Hypertensive Patients Research Articles

An elevated level of soluble suppression of tumorigenicity 2, but not galectin-3, is associated with the presence of coronary artery disease in hypertensive patients.

We investigated whether there were associations between coronary artery disease (CAD) and soluble suppression of tumorigenicity (sST2) and galectin-3 levels at the time of coronary artery computed tomography angiography (CCTA) for CAD screening. The subjects consisted of 429 patients who underwent CCTA examination. CAD was diagnosed when there was 50% or more stenosis in the coronary artery. Patient backgrounds were collected and plasma levels of sST2 and galectin-3 were measured. The presence or absence of CAD and factors that contributed to CAD were analyzed for all patients and for those with or without hypertension (HTN). The CAD group had significantly higher sST2 levels than the non-CAD group, whereas there was no significant difference in galectin-3 levels. The number of patients in the non-HTN and HTN groups was 174 and 255, respectively. In the HTN group, the CAD group was significantly older than the non-CAD group and had higher sST2 levels. Multivariate analysis showed that the factors that contributed to CAD in the HTN group were age and sST2 levels. On the other hand, in the non-HTN group, the CAD group was significantly older than the non-CAD group, and had a higher proportion of males and higher sST2 levels, while the contributing factors for the CAD group were age and male gender, but not sST2. In conclusion, a higher level of sST2, but not galectin-3, was a contributing factor for CAD in HTN patients. However, in non-HTN patients, a high level of sST2 was not a contributing factor for CAD.

Association between dietary fiber intake and peripheral artery disease in hypertensive patients

BackgroundAt present, no studies explored whether dietary fiber intake was associated with the risk of peripheral artery disease (PAD) in hypertensive patients. This study assessed the association between dietary fiber intake and PAD in hypertensive patients.MethodsThis cross-sectional study collected the data of 4628 participants with the measurement of ankle-brachial pressure index in the National Health and Nutrition Examination Surveys database. Univariate logistic regression analysis was applied to identify variables associated with PAD as confounding factors. Univariate and multivariable logistic regression analyses were used to explore the association between dietary fiber intake and PAD in hypertensive patients. Subgroup analysis was stratified by age, cardiovascular disease, dyslipidemia, diabetes, smoking, and physical activity.ResultsAfter adjusting for confounding factors, decreased risk of PAD was observed in hypertensive patients with dietary fiber intake > 21 g [odds ratio (OR) = 0.67, 95% confidence interval (CI) 0.46–0.99]. Compared with people with dietary fiber intake ≤ 21 g, those with dietary fiber intake > 21 g were associated with decreased risk of PAD in hypertensive patients < 60 years (OR = 0.23, 95%CI 0.08–0.66). In hypertensive patients without dyslipidemia, dietary fiber intake > 21 g were associated with reduced risk of PAD (OR = 0.33, 95%CI 0.12–0.95). Decreased risk of PAD was also found in hypertensive patients without diabetes in dietary fiber intake > 21 g group (OR = 0.50, 95%CI 0.31–0.78). Dietary fiber intake > 21 g was linked with reduced risk of PAD in hypertensive patients in never smoke group (OR = 0.46, 95%CI 0.24–0.86).ConclusionHigher dietary fiber intake was associated with reduced risk of PAD in hypertensive patients, suggesting the importance of increase the daily dietary quality especially fiber intake in hypertensive people.

Diagnostic accuracy of non-invasive investigations for coronary artery disease in hypertensive patients: A meta-analysis

Diagnostic accuracy of non-invasive investigations for coronary artery disease in hypertensive patients: A meta-analysis

Correlation Between Left Ventricular Structural and Functional Changes and Coronary Artery Disease in Hypertensive Patients (Speckle Tracking Echocardiographic Study)

Correlation Between Left Ventricular Structural and Functional Changes and Coronary Artery Disease in Hypertensive Patients (Speckle Tracking Echocardiographic Study)

Predictive value of machine learning algorithm of coronary artery calcium score and clinical factors for obstructive coronary artery disease in hypertensive patients

BackgroundThe addition of coronary artery calcium score (CACS) to prediction models has been verified to improve performance. Machine learning (ML) algorithms become important medical tools in an era of precision medicine, However, combined utility by CACS and ML algorithms in hypertensive patients to forecast obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CCTA) is rare.MethodsThis retrospective study was composed of 1,273 individuals with hypertension and without a history of CAD, who underwent dual-source computed tomography evaluation. We applied five ML algorithms, coupled with clinical factors, imaging parameters, and CACS to construct predictive models. Moreover, 80% individuals were randomly taken as a training set on which 5-fold cross-validation was done and the remaining 20% were regarded as a validation set.Results16.7% (212 out of 1,273) of hypertensive patients had obstructive CAD. Extreme Gradient Boosting (XGBoost) posted the biggest area under the receiver operator characteristic curve (AUC) of 0.83 in five ML algorithms. Continuous net reclassification improvement (NRI) was 0.55 (95% CI (0.39–0.71), p < 0.001), and integrated discrimination improvement (IDI) was 0.04 (95% CI (0.01–0. 07), p = 0.0048) when the XGBoost model was compared with traditional Models. In the subgroup analysis stratified by hypertension levels, XGBoost still had excellent performance.ConclusionThe ML model incorporating clinical features and CACS may accurately forecast the presence of obstructive CAD on CCTA among hypertensive patients. XGBoost is superior to other ML algorithms.

Relation of the left ventricular geometric patten to coronary artery disease in hypertensive patients using a 320-detector-row CT scanner

BackgroundIt was estimated that about 1.3 billion people were diagnosed to be hypertensive in 2015. All countries consistently show this high prevalence. Ischemic heart disease stands as the most common cause of systolic blood pressure-related deaths per year. Left ventricular hypertrophy determined by echocardiography can predict cardiovascular morbidity and mortality. The question of whether the LV geometric pattern has an additional prognostic value is still not clearly answered. Currently, coronary computed tomography is widely used in clinical practice with a great capability of simultaneous evaluation of the LV mass and the coronary arterial tree. Our study aims to examine the relationship between LV mass and geometry and coronary artery disease using an ECG-gated 320-detector- row CT scanner.ResultsTwo hundred ninety-eight hypertensive Egyptian individuals were enrolled in our study, the mean age was 57.5 ± 10.5, and males comprised 76.5% of the study population. The mean LV mass and LV mass index were 193 ± 60 gm and 95.2 ± 27.5 g/m2 respectively. One-fifth of the patient had CAD luminal stenosis ≥ 50%. Normal LV geometric pattern was observed in about 37% of the study population. About one-third of the patients showed concentric remodeling. Patients with increased LV mass index represented one-third of the study population with a greater percentage of the concentric hypertrophy pattern than the eccentric hypertrophy pattern. Patients with high CAD-RADS showed statistically significant higher LV mass, LV mass index, and septal wall thickness. Patients with high CAD-RADS showed a greater percentage of concentric and eccentric hypertrophy. The LV geometric pattern was the only independent predictor of the high CAD-RADS. The LV geometric patterns associated with high RADS ordered from the highest to the lowest, were concentric LVH, Eccentric LV, and concentric remodeling.ConclusionsLV geometric pattern is the only independent predictor of high CAD-RADS after adjustment for LV mass index and septal wall thickness. Among abnormal LV geometric patterns, concentric hypertrophy stands as the most important predictor of high CAD-RADS.

Triglyceride glucose index is associated with obstructive coronary artery disease in hypertensive patients

BackgroundHypertension is a leading risk of coronary artery disease (CAD). Triglyceride glucose index (TyG) is a surrogate of insulin resistance (IR). Few studies explore the association between TyG and the incidence of obstructive CAD (OCAD) in hypertensive patients.MethodsWe retrospectively screened 1841 hypertensive subjects who were free of a history of CAD and underwent coronary computed tomography angiography (CCTA) because of chest pain. TyG index was calculated as ln (fasting TG [mg/dL] * fasting glucose [mg/dL]/2). The outcome of this research was OCAD, which was defined as the presence of diameter stenosis ≥ 50% in any of the four major epicardial coronary arteries detected on CCTA.ResultsA total of 310 (16.8%) patients developed obstructive CAD. The restricted cubic spline (RCS) analysis showed a J-shaped relationship between TyG and OCAD and the OR for OCAD increased as the TyG rose over 8.61 (OR perSD) 1.64, 95% CI 1.13–2.54, p = 0.008). After full adjustments for confounding covariates, patients with TyG index in tertile 3 (T3) had 2.12 times (95% CI 1.80 to 3.81) and in T2 had 2.01 times (95% CI 1.40 to 2.88) as high as the risk of OCAD compared with patients in T1 (p for trend = 0.001). When regarding TyG as a continuous variable, 1-SD increase elevated 49% (OR (95%CI), 1.49 (1.30–1.74)) risk of obstructive CAD (p = 0.007). This positive effect was still consistent across the subgroups (p for interaction > 0.05).ConclusionTyG index was associated with the incidence of obstructive CAD in hypertensive patients.

Left ventricular mass versus pulse wave velocity as predictors of coronary artery disease in hypertensive patients: data from a 6-year-follow-up study.

In treated hypertensive patients, there is a substantial residual cardiovascular (CV) risk that cannot be assessed by the available prediction models. This risk can be associated with subclinical organ damage, such as increased left ventricular mass (LVM) and arterial stiffness. However, it remains unknown which of these two CV markers better predicts coronary artery disease (CAD). A prospective cohort study was used to answer the above question. The study sample consisted of 1033 patients with hypertension (mean age 55.6 years, 538 males) free of CAD at baseline, who were followed for a mean period of 6 years. At baseline, all subjects underwent a complete echocardiographic study and pulse wave velocity (PWV) measurement. Hypertensive individuals who developed CAD (2.8%) compared to those without CAD at follow-up, had a higher baseline LVM index (by 16.7 g/m2, p < 0.001), higher prevalence of left ventricular hypertrophy (LVH) (21% greater, p = 0.027) and greater prevalence of high PWV levels at baseline (21% greater, p = 0.019). Multivariate Cox regression analysis revealed that baseline age >65 years (HR = 2.067, p = 0.001), male gender (HR = 3.664, p = 0.001), baseline chronic kidney disease (HR = 2.020, p = 0.026), baseline diabetes mellitus (HR = 1.952, p = 0.015) and baseline LVH (HR = 2.124 p = 0.001) turned out to be independent predictors of CAD, whereas high PWV levels were not. LVH proved to be an independent prognosticator of CAD in contrast to arterial stiffness that was not related to CAD after accounting for established confounders. Therefore, LVM can reliably help physicians to identify high-risk hypertensives in whom an intensified therapeutic management is warranted.

Morning blood pressure surge is associated with the severity of stable coronary artery disease in hypertensive patients

ABSTRACT Background: We aimed to investigate the association between morning surge (MS) of blood pressure (BP) and SYNTAX score (SS) which gives information regarding the complexity and extent of coronary artery disease (CAD) in hypertensive patients. Methods: We included 187 hypertensive patients (134 males, 53 females; mean age: 62.5 ± 10.9 years) who underwent elective coronary angiography. Patients with the acute coronary syndrome and a history of coronary intervention were excluded from the study. The MBPS was calculated as the difference between the average BP during the 2 hours after awakening (four BP readings) and the lowest nighttime BP. The severity of coronary lesions was evaluated based on the SS assessed by coronary angiography. Patients were classified into two groups according to SS: low SS (SS ≤ 22) and intermediate-to-high SS (>22). Results: Patients in the intermediate-to-high SS group were found to be older, have higher uric acid levels, average daytime systolic BP (SBP), nighttime SBP, morning SBP, MS of BP and have higher rates of diabetes (DM) and female gender. There was no significant difference in terms of hypertensive treatment. In multivariate analysis, MS of BP (OR: 2.151, p: 0.005) and DM (OR: 0.014, p: 0.015) were independent parameters for predicting intermediate-to-high SS. The cutoff value of MS of BP obtained by ROC curve analysis was 18,5 mmHg for prediction of intermediate–high SS (sensitivity: 76.5%, specificity: 71.2%). The area under the curve was 0.762 (p < .001). Conclusion: MS of BP significantly correlates with the severity of coronary stenosis in hypertensive patients, suggesting that it could be a potential predictive marker of CAD.

Beta blocker rebound phenomenon is important, but we do not know its definition, incidence or optimal prevention strategies

The aim of this review is to analyze whether there is a need for scientific information about the beta blocker (BB) rebound phenomenon; whether such information is available; and, if it is, how detailed is the BB rebound phenomenon explained in the guidelines and papers? A narrative review is used due to the lack of valid randomized clinical trials (RCTs) on the topic, which are needed for a meta-analysis. The BB rebound phenomenon can have dangerous consequences. The discontinuation of a BB leads to a fourfold increased risk of events related to coronary artery disease in hypertensive patients; it increases in-hospital mortality in heart failure patients; it can precipitate angina pectoris attack; and it increases the risk for death and rehospitalization in patients who survive acute myocardial infarction. Consequently, being considered in the guidelines, the BB rebound phenomenon is believed to be clinically relevant (by experts in the field). This is in sharp contrast with the lack of any additional relevant information about the BB rebound phenomenon in the various important guidelines. For example, we lack a consensus about the precise definition. Moreover, data about the incidence and optimal prevention strategies are lacking for the phenomenon (which is sometimes life-threatening). The BB rebound phenomenon is an additional reason why it is very important to test the prognosis of patients following the cessation of long-term medicaments in RCTs, particularly for BBs.

Invasive Assessment of Central Aortic Blood Pressure, Differential Impact of Beta Blocker vs. Non-Beta Blockers and their Correlation with Severity of Coronary Artery Disease in Hypertensive Patients Undergoing Coronary Angiography

Invasive Assessment of Central Aortic Blood Pressure, Differential Impact of Beta Blocker vs. Non-Beta Blockers and their Correlation with Severity of Coronary Artery Disease in Hypertensive Patients Undergoing Coronary Angiography

Arterial stiffness, carotid remodeling and other risk factors determining coronary artery disease in hypertensive patients

Increased arterial stiffness and carotid artery Intima-Media Thickness (IMT) are associated with atherosclerosis and Coronary Artery Disease (CAD), but their correlation with the anatomic extent of atherosclerosis in hypertensive patients is not completely known. We aim to evaluate whether Pulse Wave Velocity (PWV), carotid IMT and Vascular Aging Index (VAI) predict CAD in hypertensives. We enrolled 76 consecutive patients (36 males; mean age 58.2 years) with arterial hypertension who were undergoing elective coronary angiography for the diagnosis or exclusion of CAD. Carotid-femoral pulse wave velocity (PWV), vascular aging index (VAI) calculated from the second derivative of photopletismography, and carotid IMT and diameter (CD) measured by high definition echotracking device were done in all subjects. Correlations between hemodynamic data, traditional cardiovascular risk factors and the presence or absence of CAD were analyzed. CAD (stenosis S 50% in at least one coronary) was observed in 52 patients.ResultsConcerning clinical, demographic and laboratory parameters there were no significant differences between patients with and without CAD. PWV in patients with CAD were significantly higher (10.7 vs. 11.87 m/ s)(p = 0,01), but the correlation disappeared after adjustment for age. Carotid IMT and CD were similar in patients with and without CAD. Logistic regression analysis showed that patients older than 60 years, with PWV > 12 m/s, CD > 7.67 mm, VAI > −0.05, and cholesterol levels > 200 mg/dl had a significantly higher percentage of CAD than its counterparts. In conclusion, the presence of CAD enhances age-induced changes of arterial stiffness in hypertensive patients. Besides classical cardiovascular risk factors, significant changes in PWV and CD could identify CAD in high risk hypertensive patients.

GW27-e0863 A predictive model for the pre-test probability of coronary artery disease in hypertensive patients

GW27-e0863 A predictive model for the pre-test probability of coronary artery disease in hypertensive patients

PS 15-02 Usefulness of the lipid ratios predicting peripheral artery disease in hypertensive patients

PS 15-02 Usefulness of the lipid ratios predicting peripheral artery disease in hypertensive patients

Coronary Artery Atherosclerosis in Hypertensive Patients: The Role of Fibrinogen Genetic Variability

Introduction and objectivesWe examined whether the rs180070 and rs2070011 polymorphisms of the fibrinogen gene could affect the risk of coronary artery disease in hypertensive patients by modifying the inflammatory process and coagulation. MethodsA total of 744 participants underwent coronary angiography due to symptoms of stable angina, while hypertension was present in 332 patients. ResultsThe presence of the A allele (rs180070) was associated with significantly high levels of fibrinogen in hypertensive patients (P=.05). On multivariate analysis, A homozygosity (rs180070) (β = 0.257 ± 18.6; P<.001), but not hypertension status (β = 0.05 ± 11.9; P=.29) was an independent predictor of fibrinogen levels. In hypertensive patients, higher fibrinogen levels>443mg/dL (odds ratio = 3.50; 95% confidence interval, 1.14-10.90; P=.029), but not A homozygosity (odds ratio = 3.00; 95% confidence interval, 0.78-11.90; P = .110) were independent predictors of the presence of coronary artery disease. Moreover, interleukin-6 levels were higher in A homozygotes for the rs180070 polymorphism compared with all other genotypes (P=.046). Indeed, this genotype was the only adjusted independent predictor of interleukin-6 levels (β = 0.151 ± 0.642; P=.032). It was also associated with higher D-dimer levels in hypertension compared with G allele carriers (P=.048). ConclusionsThe presence of A homozygosity (rs180070) is associated with increased levels of inflammatory mediators and a higher incidence of angiographic coronary artery disease. Importantly, fibrinogen is an independent predictor of the angiographic presence of coronary artery disease in hypertensive patients.

Ateroesclerosis coronaria en pacientes hipertensos: el papel de la variabilidad genética del fibrinógeno

Introduction and objectivesWe examined whether the rs180070 and rs2070011 polymorphisms of the fibrinogen gene could affect the risk of coronary artery disease in hypertensive patients by modifying the inflammatory process and coagulation. MethodsA total of 744 participants underwent coronary angiography due to symptoms of stable angina, while hypertension was present in 332 patients. ResultsThe presence of the A allele (rs180070) was associated with significantly high levels of fibrinogen in hypertensive patients (P = .05). On multivariate analysis, A homozygosity (rs180070) (β = 0.257 ± 18.6; P < .001), but not hypertension status (β = 0.05 ± 11.9; P = .29) was an independent predictor of fibrinogen levels. In hypertensive patients, higher fibrinogen levels > 443mg/dL (odds ratio = 3.50; 95% confidence interval, 1.14-10.90; P = .029), but not A homozygosity (odds ratio = 3.00; 95% confidence interval, 0.78-11.90; P = .110) were independent predictors of the presence of coronary artery disease. Moreover, interleukin-6 levels were higher in A homozygotes for the rs180070 polymorphism compared with all other genotypes (P = .046). Indeed, this genotype was the only adjusted independent predictor of interleukin-6 levels (β = 0.151 ± 0.642; P = .032). It was also associated with higher D-dimer levels in hypertension compared with G allele carriers (P = .048). ConclusionsThe presence of A homozygosity (rs180070) is associated with increased levels of inflammatory mediators and a higher incidence of angiographic coronary artery disease. Importantly, fibrinogen is an independent predictor of the angiographic presence of coronary artery disease in hypertensive patients.Full English text available from:www.revespcardiol.org/en

Prognostic value of cytokines for ischemic heart disease in patients with hypertension stage II

Aim of the study is to determine the predictive value with respect to the development of coronary heart disease (CHD) of inflammatory activity, in patients with hypertension (HT) stage II. Methods: We examined 180 patients (men and women) with documented HT stage II. All surveyed people were divided into two groups: the first group consisted of 130 primary HT patients stage II without CHD, the average age of 56.5±0.5 years; a second comparison group – 50 patients with CHD combined with HT II stage, average age of 58.1±0.8 years. Results: The results of the ROC-analysis showed significantly higher (AUC = 0.87) (95% CI AUC 0,812-0,915) predictive value ratio of IL-1β / IL-10 in the development of coronary artery disease in hypertensive patients, with an optimal distribution of the threshold of > 1.7 sensitivity was 64.0 % and specificity - 94.6 %. The high sensitivity (90.0%), to the development of coronary artery disease in hypertensive patients was significantly (AUC = 0,87) hs-CRP found at the point of separation of> 4.7 mg / L specificity was 72.3%.

0074: The stress test as a diagnostic toolfor coronary artery disease in hypertensive patients

In hypertensive patients, there are multiplecauses of error in the diagnosis of coronary artery disease: The objective of this study was to evaluate the sensitivity of the positive electrical criteria in the stress test in diagnosing coronary artery disease within the hypertensive patients. 120 hypertensive patients with positive stress test underwent coronary angiography. 33 % of patients had significant coronary lesions and 67% had normal coronary angiography. Two groups of patients were identified: group A (77 patients) withST segment depression in DII, DIII, aVF and V6 with maximal effort and group B (43 patients) with a ST segment depression in DII, DIII, aVF and/or V4, V5, V6 with maximal effort. In group A, 65 patients (84.4%) had normal coronary angiography. In group B, 31 patients (72%) had significant coronary lesions. In a subgroup of 46 patients in group A with persistent ST segment depression in V4 to V6 and recovering for 4 to 6 minutes, 93% of coronary angiograms were normal. In another subgroup of 19 patients in group B with persistent ST segment depressionin V4 to V6 and recovering for 4 to 8 minutes, 16 patients (86%) had significant lesions on coronary angiograms. hypertensive patients with stress test showing ST segment depression in DII, DIII, aVF and/or V4, V5, V6 on maximum effort and persisting for 4-8 minutes recovering have a high probability of significant coronary artery disease.

Non-Invasive Diagnostic Testing for Coronary Artery Disease in the Hypertensive Patient: Potential Advantages of a Risk Estimation-Based Algorithm

Hypertension is a major risk factor for cardiovascular disease, including coronary atherosclerosis and its clinical manifestations. Non-invasive diagnosis of coronary artery disease in hypertension, however, remains a major clinical challenge. Chest pain frequently occurs in hypertensive patients with and without impairment of coronary blood flow supply. Electrocardiographic abnormalities are also common in these patients, thereby leading to further diagnostic difficulty. On the other hand, international guidelines are rather elusive on the recommended diagnostic pathway for coronary artery disease detection in hypertensive patients.In this article, we review the strengths and limitations of current diagnostic methods used to properly identifying coronary artery disease in hypertensive patients. Furthermore, we analyze the usefulness of adopting preliminary and comprehensive cardiovascular risk stratification, together with the evaluation of markers of organ damage, in order to improve the diagnostic efficacy.Despite the high prevalence of arterial hypertension, we still lack a strategy which would lead to validated and cost-effective clinical decision-making processes in hypertensive patients, which help clinicians to minimize useless, ineffective and expensive diagnostic steps. For this purpose, future guidelines should address the issue of diagnostic strategies for an early identification of hypertensive patients at risk of coronary artery disease. This may facilitate appropriate therapeutic choices to optimize the clinical management of coronary disease in hypertension.

Myocardial perfusion scintigraphy and echocardiography for detecting coronary artery disease in hypertensive patients: a meta-analysis

This meta-analysis summarized the accuracy of stress myocardial perfusion scintigraphy (MPS) and stress echocardiography for the diagnosis of coronary artery disease (CAD) in patients with arterial hypertension. We searched for studies in which stress MPS or stress echocardiography were performed to detect CAD in hypertensive patients, with coronary angiography used as the reference test, published from January 1980 to December 2010. Studies performed in patients with known CAD, acute coronary syndrome and previous revascularization procedures were excluded. Of 1,263 studies, 13 met the inclusion criteria. Pooled summary estimates showed that stress MPS had a sensitivity of 0.90 [95% confidence interval (CI) 0.82-0.95] and a specificity of 0.63 (95% CI 0.53-0.72). For stress MPS, the area under the curve (AUC) at the summary receiver-operating characteristic (SROC) graph was 0.83 (95% CI 0.80-0.86). At meta-regression analysis, the presence of positive stress electrocardiography as inclusion criterion was the only significant effect modifier (p < 0.01). Pooled summary estimates showed that stress echocardiography had a sensitivity of 0.77 (95% CI 0.69-0.83) and a specificity of 0.89 (95% CI 0.83-0.93). For stress echocardiography, the AUC at SROC was 0.91 (95% CI 0.88-0.93). At the meta-regression analysis no significant effect modifier was detected. MPS has high sensitivity for detecting CAD in hypertensive patients, with specificity comparable to that reported in the general population, whereas stress echocardiography shows higher specificity but substantially reduced sensitivity compared to MPS.