Decrease In Pulse Wave Velocity Research Articles

Does Obstructive Sleep Apnea Influence Blood Pressure and Arterial Stiffness in Response to Antihypertensive Treatment?

Untreated obstructive sleep apnea (OSA) is common in patients with hypertension and may impair blood pressure (BP) and target-organ damage responses to antihypertensive therapy. In this study, we recruited hypertensive patients who underwent treatment with a 30-day regimen of hydrochlorothiazide 25 mg plus enalapril (20 mg BID) or losartan (50 mg BID) and were assessed with a baseline clinical evaluation, polysomnography, 24-hour ambulatory BP monitoring, and carotid-femoral pulse wave velocity. All the examinations except for polysomnography were repeated at 6 and 18 months of follow-up. We studied 94 hypertensive patients (mean age, 55±9 years). The frequency of OSA was 55%. Compared with baseline, we did not observe significant differences between groups in 24-hour BP, daytime systolic and diastolic BPs, or night-time systolic BP at 6 and 18 months. The BP control rate at 24 hours (<130/80 mm Hg) was similar between the groups (baseline, 42.3% versus 45.2%; 6 months, 46.9% versus 57.5%; 18 months, 66.7% versus 61.5%). However, patients with OSA had higher night-time diastolic BP decrease than did the non-OSA group (6 months, -4.9±11.8 versus -0.3±10.3 mm Hg; 18 months, -6.7±11.1 versus -1.2±10.6 mm Hg; P=0.027). There were no differences in the number and class of antihypertensive medications prescribed during follow-up. In terms of arterial stiffness, patients with OSA had higher pulse wave velocity than did patients without OSA at baseline (10.3±1.9 versus 9.2±1.7 m/s; P=0.024), but both groups had similar decreases in pulse wave velocity during follow-up. In conclusion, with combined antihypertensive treatment aimed at controlling BP, hypertensive patients with OSA had similar 24-hour BP and arterial stiffness to those without OSA.

The Effects of Below-Knee Medical Compression Stockings on Pulse Wave Velocity of Young Healthy Volunteers.

Szolnoky, G, Gavallér, H, Gönczy, A, Bihari, I, Kemény, L, Forster, T, and Nemes, A. The effects of below-knee medical compression stockings on pulse wave velocity of young healthy volunteers. J Strength Cond Res 35(1): 275-279, 2021-The effects of graduated medical compression stockings (MCS) on cardiovascular responses are poorly investigated. A simple study was undertaken to investigate whether the application of below-knee leg MCSs with different pressures could influence aortic pulse wave velocity (PWV) as the gold standard for aortic stiffness measurement evaluated by arteriography. Ten volunteers underwent PWV measurement at baseline, then in below-knee compression class (ccl) 1 (18-21 mm Hg), 2 (23-32 mm Hg) and 3 (34-46 mm Hg) MCSs in a consecutive manner. Baseline PWV (mean value: 7.86 ± 1.70 m·s-1) was significantly reduced by ccl 1 MCSs (mean value: 6.55 ± 0.88 m·s-1, p = 0.04). ccl 2 and ccl 3 stockings also notably decreased baseline PWV (mean values: 6.63 ± 0.65 m·s-1, p = 0.058 and 6.62 ± 1.00 m·s-1, p = 0.067; respectively). The application of low compression MCSs (ccl 1) leads to a significant decrease in PWV indicating a beneficial cardiovascular influence.

Effects of Different Exercise Modes on Arterial Stiffness and Nitric Oxide Synthesis.

Aerobic training (AT) and high-intensity intermittent training (HIIT) reduce arterial stiffness, whereas resistance training (RT) induces deterioration of or no change in arterial stiffness. However, the molecular mechanism of these effects of different exercise modes remains unclear. This study aimed to clarify the difference of different exercise effects on endothelial nitric oxide synthase (eNOS) signaling pathway and arterial stiffness in rats and humans. In the animal study, forty 10-wk-old male Sprague-Dawley rats were randomly divided into four groups: sedentary control (CON), AT (treadmill running, 60 min at 30 m·min, 5 d·wk for 8 wk), RT (ladder climbing, 8-10 sets per day, 3 d·wk for 8 wk), and HIIT (14 repeats of 20-s swimming session with 10-s pause between sessions, 4 d·wk for 6 wk from 12-wk-old) groups (n = 10 in each group). In the human study, we confirmed the effects of 6-wk HIIT and 8-wk AT interventions on central arterial stiffness and plasma nitrite/nitrate level in untrained healthy young men in randomized controlled trial (HIIT, AT, and CON; n = 7 in each group). In the animal study, the effect on aortic pulse wave velocity (PWV), as an index of central arterial stiffness, after HIIT was the same as the decrease in aortic PWV and increase in arterial eNOS/Akt phosphorylation after AT, which was not changed by RT. A negative correlation between aortic PWV and eNOS phosphorylation was observed (r = -0.38, P < 0.05). In the human study, HIIT- and AT-induced changes in carotid-femoral PWV (HIIT -115.3 ± 63.4 and AT -157.7 ± 45.7 vs CON 71.3 ± 61.1 m·s, each P < 0.05) decreased, and plasma nitrite/nitrate level increased compared with those in CON. HIIT may reduce central arterial stiffness via the increase in aortic nitric oxide bioavailability despite it being done in a short time and short term and has the same effects as AT.

Organoprotective properties of therapy by fixed combination of perindoprile and amlodipine in patients with arterial hypertension and diabetes mellitus type 2

Actuality: the contribution of changes in central aortic pressure (CAP) to target organ damage and the effect of a fixed combination of perindopril with arnolate with amlodipine besylate on these parameters in patients with arterial hypertension (AH) and type 2 diabetes (DM) has not been studied. Objective: to reveal the relationship between the main indicators of CAP and the damage of target organs (vessels, kidneys and heart) in patients with AH and type 2 diabetes; assess the organoprotective properties of a 12-week therapy with a fixed combination of perindopril arginate with amlodipine besylate in this category of patients. Materials and methods: 30 patients with AH stage III and DM at the age of 45 to 65 years were examined. The indicators of CAP were determined by Vasotens 24 software (“Petr Telegin” LLC, Russia). The structural and functional state of the myocardium was assessed echocardiographically with a Doppler sensor. The pulse wave velocity (PWV) was measured with Polyspectr 8/E apparatus (Neurosoft, Russia). To evaluate the kidney function, the glomerular filtration rate (GFR) was calculated, and albumin excretion in the urine was determined. A fixed combination of perindopril arginine / amlodipine besylate was administered for 12 weeks. Results: 12-week therapy was accompanied by the achievement of target values of blood pressure in 100% of patients, a decrease in office systolic and diastolic blood pressure. There was a significant improvement in indicators of CAP, which was accompanied by a statistically significant decrease in PWV in vessels of the elastic and muscular type, an improvement in the functional state of the kidneys: a decrease in the level of the albumin/creatinine ratio of urine, an increase in rGFR, by a significant decrease in the left ventricular myocardium index. Conclusion: admission of a fixed combination of perindopril and amlodipine in patients with AH in combination with type 2 diabetes for 12 weeks is accompanied by reliable cardio, nephroprotective and endotheliotropic effects, statistically significantly reduces systolic and diastolic CAP, augmentation index in daytime and night hours, leads to a significant reduction of rigidity of the main arteries.

Early Effects of Renal Replacement Therapy on Cardiovascular Comorbidity in Children With End-Stage Kidney Disease: Findings From the 4C-T Study.

The early impact of renal transplantation on subclinical cardiovascular measures in pediatric patients has not been widely investigated. This analysis is performed for pediatric patients participating in the prospective cardiovascular comorbidity in children with chronic kidney disease study and focuses on the early effects of renal replacement therapy (RRT) modality on cardiovascular comorbidity in patients receiving a preemptive transplant or started on dialysis. We compared measures indicating subclinical cardiovascular organ damage (aortal pulse wave velocity, carotid intima media thickness, left ventricular mass index) and evaluated cardiovascular risk factors in 166 pediatric patients before and 6 to 18 months after start of RRT (n = 76 transplantation, n = 90 dialysis). RRT modality had a significant impact on the change in arterial structure and function: compared to dialysis treatment, transplantation was independently associated with decreases in pulse wave velocity (ß = -0.67; P < 0.001) and intima media thickness (ß = -0.40; P = 0.008). Independent of RRT modality, an increase in pulse wave velocity was associated with an increase in diastolic blood pressure (ß = 0.31; P < 0.001). Increasing intima media thickness was associated with a larger increase in body mass index (ß = 0.26; P = 0.003) and the use of antihypertensive agents after RRT (ß = 0.41; P = 0.007). Changes in left ventricular mass index were associated with changes in systolic blood pressure (ß = 1.47; P = 0.01). In comparison with initiating dialysis, preemptive transplantation prevented further deterioration of the subclinical vascular organ damage early after transplantation. Classic cardiovascular risk factors, such as hypertension and obesity are of major importance for the development of cardiovascular organ damage after renal transplantation.

The influence of Losartanum and Amlodipinum fixed combination use on cardiovascular complications risk factors seasonal variability in patients with arterial hypertension

Rationale: The influence of drugs on adaptation to high temperatures and seasonal variability of cardiovascular disease factors is one of the most important issues of treatment raised during re-cent heat waves. The safety of calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs) use during heat waves is quite controversial. Aim: To assess the seasonal variability of hemodynamic parameters, vessel wall stiffness, lipid, carbohydrate and electrolyte metabolism in patients with arterial hypertension (AH) and to as-sess safety and effectiveness of fixed combination of Losartanum and Amlodipinum (Lortenza® KRKA) use according to one-year follow-up results. Materials and methods. The study included 26 patients with stage 1 and 2 AH aged from 42 to 81 years. Office blood pressure measurement, electrocardiography, volumetric sphygmography (pulse-wave velocity, cardio-ankle vascular index), serum chemistry, blood osmolarity tests were performed. Visual Analog Scale (VAS), Heat Questionnaries and self-control diaries were also assessed. The baseline visit took place in spring of 2016, the first visit - in May-June 2016, the second - during the heat wave, the third - in September-October 2016, the fourth - in January-February 2017, and the fifth - in April-May 2017. Results. The treatment resulted in systolic and diastolic blood pressure decrease (р=0.000) to target value which persisted during the follow-up period. According to the self-control diaries 81% of patients did really control BP. During the heat wave only 58% of patients succeeded in BP control, in autumn - 63%, in winter and spring - 81% and 86%, respectively. By the third visit the heart rate decreased on -6.0 (-11.1; -2.8) beats per minute, p=0.007. The decrease in pulse-wave velocity from 15.2±3.4 m/s to 13.6±2.7 m/s, p=0.01 and CAVI on -2.1 (-2.9; -0.65), p=0.01 was observed on the third visit. Decrease in uric acid level (р

Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study

SummaryBackgroundLong-term exposure to pollution can lead to an increase in the rate of decline of lung function, especially in older individuals and in those with chronic obstructive pulmonary disease (COPD), whereas shorter-term exposure at higher pollution levels has been implicated in causing excess deaths from ischaemic heart disease and exacerbations of COPD. We aimed to assess the effects on respiratory and cardiovascular responses of walking down a busy street with high levels of pollution compared with walking in a traffic-free area with lower pollution levels in older adults.MethodsIn this randomised, crossover study, we recruited men and women aged 60 years and older with angiographically proven stable ischaemic heart disease or stage 2 Global initiative for Obstructive Lung Disease (GOLD) COPD who had been clinically stable for 6 months, and age-matched healthy volunteers. Individuals with ischaemic heart disease or COPD were recruited from existing databases or outpatient respiratory and cardiology clinics at the Royal Brompton & Harefield NHS Foundation Trust and age-matched healthy volunteers using advertising and existing databases. All participants had abstained from smoking for at least 12 months and medications were taken as recommended by participants' doctors during the study. Participants were randomly assigned by drawing numbered disks at random from a bag to do a 2 h walk either along a commercial street in London (Oxford Street) or in an urban park (Hyde Park). Baseline measurements of participants were taken before the walk in the hospital laboratory. During each walk session, black carbon, particulate matter (PM) concentrations, ultrafine particles, and nitrogen dioxide (NO2) concentrations were measured.FindingsBetween October, 2012, and June, 2014, we screened 135 participants, of whom 40 healthy volunteers, 40 individuals with COPD, and 39 with ischaemic heart disease were recruited. Concentrations of black carbon, NO2, PM10, PM2.5, and ultrafine particles were higher on Oxford Street than in Hyde Park. Participants with COPD reported more cough (odds ratio [OR] 1·95, 95% CI 0·96–3·95; p<0·1), sputum (3·15, 1·39–7·13; p<0·05), shortness of breath (1·86, 0·97–3·57; p<0·1), and wheeze (4·00, 1·52–10·50; p<0·05) after walking down Oxford Street compared with Hyde Park. In all participants, irrespective of their disease status, walking in Hyde Park led to an increase in lung function (forced expiratory volume in the first second [FEV1] and forced vital capacity [FVC]) and a decrease in pulse wave velocity (PWV) and augmentation index up to 26 h after the walk. By contrast, these beneficial responses were attenuated after walking on Oxford Street. In participants with COPD, a reduction in FEV1 and FVC, and an increase in R5–20 were associated with an increase in during-walk exposure to NO2, ultrafine particles and PM2.5, and an increase in PWV and augmentation index with NO2 and ultrafine particles. In healthy volunteers, PWV and augmentation index were associated both with black carbon and ultrafine particles.InterpretationShort-term exposure to traffic pollution prevents the beneficial cardiopulmonary effects of walking in people with COPD, ischaemic heart disease, and those free from chronic cardiopulmonary diseases. Medication use might reduce the adverse effects of air pollution in individuals with ischaemic heart disease. Policies should aim to control ambient levels of air pollution along busy streets in view of these negative health effects.FundingBritish Heart Foundation.

Difference between ejection times measured at two different peripheral locations as a novel marker of vascular stiffness.

Pulse wave velocity (PWV) has been recommended as an arterial damage assessment tool and a surrogate of arterial stiffness. However, the current technology does not allow to measure PWV both continuously and in real-time. We reported previously that peripherally measured ejection time (ET) overestimates ET measured centrally. This difference in ET is associated with the inherent vascular properties of the vessel. In the current study we examined ETs derived from plethysmography simultaneously at different peripheral locations and examined the influence of the underlying arterial properties on ET prolongation by changing the subject’s position. We calculated the ET difference between two peripheral locations (ΔET) and its corresponding PWV for the same heartbeat. The ΔET increased with a corresponding decrease in PWV. The difference between ΔET in the supine and standing (which we call ET index) was higher in young subjects with low mean arterial pressure and low PWV. These results suggest that the difference in ET between two peripheral locations in the supine vs standing positions represents the underlying vascular properties. We propose ΔET in the supine position as a potential novel real-time continuous and non-invasive parameter of vascular properties, and the ET index as a potential non-invasive parameter of vascular reactivity.

Efficiency of triple antihypertensive therapy in patients with uncontrolled hypertension and depressive disorders

To evaluate the efficiency of triple antihypertensive therapy in patients with uncontrolled hypertension and depressive disorders (DD). 153 patients with uncontrolled hypertension were examined, of whom 82 patients were diagnosed with mild and moderate DD. A combination of perindopril 10 mg/day, indapamide SR 1.5 mg/day, and amlodipine at an initial dose of 5 mg/day was given to patients with hypertension and DD. After 4 weeks of treatment, if target blood pressure (BP) levels could not be achieved, the dose of amlodipine was increased up to 10 mg/day. General clinical examination and 24-hour BP monitoring (BPM) were performed in all the patients at baseline and in the patients with DD also after 24 weeks of therapy. The traditional measures of the diurnal BP profile, as well as the parameters characterizing arterial stiffness and central aortic pressure (CAP) were estimated. After 8 weeks of therapy, target BP levels were recorded in 63 (76.8%) patients. After 24 weeks of treatment, the hypertensive patients with DD showed significant positive changes in all the investigated 24-hour BPM parameters and normalization of the diurnal BP profile in 65.1% of cases. During the treatment, there were significant decreases in pulse wave velocity, brachial arterial and aortic augmentation indices, aortic systolic and diastolic pressures, and mean aortic BP and an increase in the velocity of the reflected wave. Triple therapy, including perindopril, indapamide SR, and amlodipine, contributed to the achievement of target BP levels in the majority of hypertensive patients with DD, with significant positive changes in all 24-hour BPM parameters, optimization of the diurnal BP profile in most patients, clinically significant improvement of the parameters that characterize arterial stiffness and CAP.

Randomized Controlled Trial for the Effect of Vitamin D Supplementation on Vascular Stiffness in CKD.

Vitamin D is implicated in vascular health in CKD. This study compared placebo, calcifediol, and calcitriol treatment with changes in vascular stiffness, BP, proteinuria, mineral metabolism parameters, C-reactive protein, and fibroblast growth factor 23 in patients with stable CKD. We conducted a double-blind, randomized controlled trial in out-patient CKD clinics in Vancouver, Canada, from February of 2011 to August of 2014, enrolling 119 patients with an eGFR of 15-45 ml/min per 1.73 m2. Change in pulse wave velocity (PWV) was measured after 6 months of treatment with a fixed dose of oral calcifediol (5000 IU 25-hydroxyvitamin D3), calcitriol (0.5 µg 1,25-dihydroxyvitamin D3), or placebo, thrice weekly. Eighty-seven participants were evaluated. Mean age was 66 years, 71% were men, 40% were diabetic, and mean baseline PWV was 11.5 m/s (SD=3.9 m/s). After 6 months, the PWV decreased in the calcifediol group (mean change, -1.1; 95% confidence interval [95% CI], -2.2 to 0.1 m/s), remained unchanged in the calcitriol group (mean change, 0.2; 95% CI, -0.9 to 1.4 m/s), and increased in the placebo group (mean change, 1.1; 95% CI, -0.1 to 2.2 m/s). The overall P value for between-arm changes was 0.03. Absolute PWV change was significantly different between groups (P=0.04): the combined vitamin D treatment group saw decreased PWV (mean change, -0.4; 95% CI, -1.2 to 0.4 m/s) whereas the placebo group saw increased PWV (mean change, +1.1; 95% CI, -0.1 to 2.2 m/s). The treatment group demonstrated significantly decreased serum parathyroid hormone (mean difference, -0.5; 95% CI, -0.7 to -0.3 ln[pg/ml]; P<0.001) and increased calcium (mean difference, 0.4; 95% CI, -0.1 to 0.7 mg/dl; P=0.02). In observational analysis, participants in the highest 25-hydroxyvitamin D tertile at trial end had significant decreases in PWV (mean change, -1.0; 95% CI, -2.0 to 0.0 m/s) compared with the middle and lowest tertiles (P<0.01). Side effects were minor and rare. Six months of supplemental vitamin D analogs at fixed doses may achieve a reduction of PWV in patients with advanced CKD. Because the treatment effect was attenuated when baseline PWV was included as a covariate, these findings should be replicated in larger populations and further studied.

Efecto del ejercicio aeróbico en la rigidez vascular en una población sana

IntroductionA healthy lifestyle is key for cardiovascular health. There is controversy about beneficial vascular effects of physical exercise. MotivationTo assess the behaviour of vascular stiffness parametres in a healthy population group that practices routine aerobic exercise in comparison with another group of healthy population with a sedentary lifestyle. MethodsStudy of 32 healthy individuals, paired according to age and gender: 12 men and 20 women (46.3±9.7 years old); the study assessed and compared arterial stiffness parametres (brachial systolic and diastolic blood pressure, brachial and central augmentation index, pulse wave velocity, central systolic and diastolic blood pressure and brachial and central pulse pressure). Measurements were conducted using the noninvasive oscillometric method Arteriograph® (TensioMed Budapest Hungary, Ltd.). ResultsArterial stiffness parametres were compared between both groups (16 active individuals vs. 16 sedentary ones), and the following significant differences were found: heart rate 53.25±8.0 bpm vs. 59.75±8.6 bpm (p=0.034), brachial diastolic blood pressure of 70.0 (4.5) mmHg vs. 77.5 (8.3) mmHg (p=0.043), central diastolic blood pressure of 70.0 (4.5) mmHg vs. 77.5 (8.1) mmHg (p=0.043) and pulse wave velocity of 6.70 (1.1) m/s vs. 7.75 (1.1) m/s (p=0.001). ConclusionsRoutine aerobic exercise has a beneficial effect on vascular stiffness in a healthy population group, at the expense of a significant decrease in pulse wave velocity, heart rate and diastolic blood pressure (both brachial and central). These findings help explain the benefits of aerobic exercise on the cardiovascular system.

Changes in Aortic Pulse Wave Velocity and the Predictors of Improvement in Arterial Stiffness Following Aortic Valve Replacement.

The interaction between valvular aortic stenosis (AS) and arterial stiffness, as well as the impact of aortic valve replacement (AVR) on arterial stiffness, remains unclear. In this study, we aimed to evaluate the degree of AS severity on non-invasive pulse wave velocity (PWV) measurements. We also searched whether the AVR procedure favorably affects PWV. In all, 38 patients undergoing AVR for chronic AS were included. The degree of aortic stiffness was measured with PWV at both baseline and 6 months after AVR. Improvement in aortic stiffness was defined as the absolute decrease in PWV at 6 months compared to the baseline value. The study population had a mean age of 59 ± 16 years, mean aortic gradient of 47.1 ± 6.4 mmHg, and mean aortic valve area (AVA) index of 0.45 ± 0.11 cm² /m² . Baseline PWV values correlated positively with the mean aortic gradient (r = 0.350, p = 0.031) and negatively with the AVA index (r = -0.512, p = 0.001). The mean PWV improved in 20 patients (53%) and worsened in 18 patients (47%). The baseline New York Heart Association (NYHA) class (odds ratio [OR] = 1.023, 95% confidence interval [CI] = 1.005-1.041, p = 0.041) and AVA index (OR = 1.040, 96% CI = 1.023-1.057, p = 0.028) emerged as the independent predictors of improvement in PWV following AVR. The severity of AS was significantly associated with baseline PWV. In general, the mean PWV did not change with AVR. Baseline NYHA class and the AVA index independently predicted PWV improvement following AVR. Since the change in PWV after AVR was polarized based on the patients' characteristics, such as preoperative NYHA functional class or AVA index, further studies are needed to confirm clinical significance of PWV change following AVR in severe AS patients.

CLINICAL VALUE OF THE PARAMETERS OF LOCAL AND REGIONAL VASCULAR RIGIDITY, WAYS FOR PHARMACOLOGICAL CORRECTION

Aim. To study the influence of age on the parameters of local vascular rigidity in healthy persons, and to assess correlations of carotid arteries rigidity in coronary heart disease (CHD) patients with arterial hypertension (AH) of 1-2 grades with assessment of vasoprotective effect of a sartan — antagonist of angiotensin II receptors (AAR). Material and methods. With an aim to study age and cardiovascular pathology influence on the parameters of local rigidity, 44 healthy persons included and 20 patients with AH of 1-2 grades comorbid with proven CHD. Local carotid stiffness was assessed by ultrasound examination of carotid arteries, My Lab 90 device with the technology of radiofrequency analysis of vessel wall condition — echo tracking. Also, the influence was analyzed, of 24-week therapy by one of sartans on structural and functional characteristics of carotid arteries. Results. Comparison of the results of local stiffness in healthy group showed the local pulse wave velocity (PWV) in the range from 5,9±0,7 m/s in those 30-39 year old to 6,6±1,1 m/s in normotonics >50 y.o., there were significant differences in those >50 y.o. comparing with participants <40 y.o. Analogical changes were shown for the stiffness index β. Together with normalized office blood pressure (BP), AAR treatment was followed by a decrease of local pressure in carotid arteries, and decrease of carotid PWV from 9,9 (9,1; 11,5) m/s to 8,3 (6,6; 8,6) m/s with regression by 17% (p<0,05). Positive influence of AAR on structural and functional properties of carotid arteries confirms the significant growth of the coefficient by 3,3% (p<0,05), and decrease of stiffness indexes α & β by 19,4% (р<0,05) and 19,9% (p<0,01), respectively. Conclusion. Parameters of local stiffness significantly correlated with anthropometric parameters, duration of AH, systolic and diastolic BP in patients with cardiovascular comorbidity. Therapy with sartan followed by not only normalization of BP, but improved the parameters of local arterial rigidity.

Sacubitril/valsartan therapy is associated with decrease of pulse wave velocity in stable patients with heart failure with reduced ejection fraction

Sacubitril/valsartan therapy is associated with decrease of pulse wave velocity in stable patients with heart failure with reduced ejection fraction

Effect of hormone replacement therapy with the anti-mineralocorticoid progestin Drospirenone compared to tibolone on endothelial function and central haemodynamics in post-menopausal women

Drospirenone (DRSP) is an antialdosterone agent with progestogenic and antiandrogenic effects. This compound, has been recently used in combination with 17β-estradiol (E2) as hormonal therapy in postmenopausal women and has been shown to exert a significant antihypertensive effect in hypertensive post-menopausal women. Aim of the present study was to compare the effect of DRSP/E2 with those of Tibolone (T) on endothelial function, arterial stiffness, and lipid profile of early postmenopausal women naïve on post-menopausal hormonal therapy. Twenty-four women met the inclusion criteria and entered the study. Women were randomized to receive either DRSP/E2 or T for 6months. Blood pressure and heart rate were similar in both groups at baseline and at the end of the study. Compared to baseline, endothelial function assessed by Reactive Hyperemia (RH) significantly improved in women receiving E2/DRSP, whereas no significant differences between baseline and follow up were detected in women receiving Tibolone. Women receiving E2/DRSP showed a significant decrease in pulse wave velocity and Augmentation Index compared to baseline while no changes were observed in women receiving Tibolone. The capacity of sera to trigger endothelial cells apoptosis in vitro measured by cell death assay was significantly reduced by E/DRSP but not by T (HFA-E 70±5,6% vs HFD-E 41±4,5%, p<0,001). In conclusion, the present study shows that the association of Estradiol and Drospirenone as hormonal replacement therapy significantly improves vascular parameters and the composition of sera relevant for vascular protection in early post-menopausal normotensive women. These effects are not shared by Tibolone.

PP.23.04] ADIPOKINES LEVELS AND SYMPATHETIC ACTIVITY AFTER RENAL DENERVATION

Objective: Renal denervation results in reduction of local and overall noradrenaline spillover, which may lead to alteration of different parameters associated with excess sympathetic activity. Obesity is closely linked to increased sympathetic tone and we assessed the change of circulating adipokines levels and their relation to vascular reactivity and stiffness after renal denervation in patients with true resistant hypertension (RHTN) during one year follow-up. Design and method: Renal denervation (Ardian, Medtronic) was performed according to standard protocol in 20 patients (8 men and 12 women, mean age 56,6 ± 10,0 years) with confirmed true resistant hypertension. All patients were examined before and 12 months after the procedure, including: anthropometric parameters, office blood pressure (BP), 24-hours urine excretion of metanephrines, applanation tonometry (SphygmoCor, Artcor Medical) with calculation of central systolic and diastolic pressure, augmentation index *75HR (AI), pulse wave velocity (PWV), reactive hyperemia index (RHI) by EndoPat (Itamar Medicals). Serum adipokine levels (adiponectin, leptin, resistin, visfatin, adipsin) were determined by Bio Plex Pro Human assays. During 1-year follow-up the patients were on conventional, but stable diet, physical activity and antihypertensive treatment. Results: There were no significant changes in anthropometric parameters one year after procedure: BMI 30.65 ± 4.99 vs 30.20 ± 5.11, weight 86.36 ± 20.33 vs 85.95 ± 19.56 and waist 98.41 ± 9.18 vs 99.54 ± 10.20, p = 0.34–0.63. Adipokines levels were also stable, with the only exception being adiponectin, which decreased significantly one year after procedure: 36.06 ± 21.20/15.55 ± 9.07 μg/ml (p = 0.010). Metanephrine secretion decreased significantly 12-months after renal denervation: 0.803 ± 0.100/0.379 ± 0.074 (p = 0.000). Vascular stiffness improved at the end of follow-up with decrease of PWV from 10.09 ± 1.88 to 9.25 ± 2.04 (p = 0.034). While there was a negative trend in endothelial function with decrease of RHI from 2.14 ± 0.63 to 1.7 ± 0.38 (p = 0.011), but still within normal values. We calculated differences between final and baseline parameters and revealed that the change of PWV was associated with decrease of adipsin level (r = 0.949, p = 0.05) and central systolic blood pressure (r = 0.397, p = 0.028). Conclusions: Renal denervation have a limited impact on obesity parameters. Decrease of arterial stiffness after procedure appears to be associated with change in adipsin and blood pressure levels.

PP.33.12] THE INFLUENCE OF ANTIHYPERTENSIVE TREATMENT ON THE FUNCTION OF LEFT VENTRICLE IN PATIENTS WITH PRIMARY, UNCOMPLICATED HYPERTENSION

Objective: The aim of the study was to check if chosen antihypertensive drugs can influence the ejection fraction of left ventricle (EF) and to assess possible factors for this change. Design and method: 95 never treated patients with HT stage 1 or 2 were randomized to 6 months monotherapy with: quinapril, amlodipine, hydrochlorothiazide, losartan or bisoprolol. Each therapeuthic group consisted of 19 patients (N=19). Before and then after 1, 3 and 6 months of treatment EF in echocardiography, arterial stiffness indexes: carotid-femoral pulse wave velocity (PWV) by using COMPLIOR device and aortic pulse pressure (AoPP) from pulse wave in applanation tonometry by using SPHYGMOCOR device were measured. Results: At baseline no differences between groups were observed in EF. ANOVA for repeated measurements revealed for all groups significant increase in EF (p = 0.01). No differences appeared between therapeutic groups in mentioned above effect. PWV and AoPP decreased significantly during observation period in all examined groups (p value: 0.0007 and 0.0003 respectively), with no between-groups difference. Conclusions: Irrespectively of chosen drug we observed similar effect for EF increase; PWV and AoPP decrease drop. Improvement of left ventricle function as a result of antihypertensive therapy is strongly connected with arterial stiffness decrease.

PP.26.08] THE ENDOTHELIAL FUNCTION AND ARTERIAL STIFFNESS DYNAMICS UNDER THE EFFECT OF ROSUVASTATIN ADDED TO A STANDARD ANTIHYPERTENSIVE THERAPY

Objective: We studied the influence of rosuvastatin added to a standard therapy on endothelial dependent vasodilatation (EDVD) and arterial stiffness markers in patients with uncontrolled hypertension. Design and method: 56 patients (40 men and 16 women aged 51.19.1) with uncontrolled hypertension were randomized into two groups. Group 1 included 30 patients who received a fixed combination of 10 mg/day lisinopril and 5 mg/day amlodipine. Group 2 consisted of 26 patients who followed the same regimen of therapy with addition of 20 mg/day of rosuvastatin. The office and central (aortic) BP, augmentation index (AIx), carotid-femoral and carotid-radial pulse wave velocity (PWV) as well as EDVD by cuff occlusion test were evaluated before and after a 24-week follow-up period. Results: The office systolic/diastolic BP decreased in both groups from 172.424.3/105.413.5 to 136.712,8/88.19.4 mmHg (p < 0.001) in the 1st group and from 170.820.0/104.014.3 to 131.09.1/83.37.7 mmHg (p < 0.001) in the 2nd one. Central BP also decreased in both groups from 153.622.1/100.513.2 to 118.610.5/82.48.5 mmHg (p < 0.001) in the 1st group and from 154.220.3/98.810.0 to 118.311.9/81.26.8 mmHg (p < 0.001) in the other. The extent of office and central BP decline did not differ. AIx decreased from 30.614.0 to 25.814.6% (p = 0.05) in the 1st group and from 34.38.3% to 24.712.6% in the 2nd group (p < 0.001) with more prominent AIx decrease in the latter (-4.8% and -9.6% respectively, p = 0.035). Mean carotid-femoral PWV decreased statistically only in the 1st group from 9.22.0 to 8.11.3 m/s (p < 0.005). The carotid-radial PWV did not change in both groups. The level of EDVD was equally more pronounced in the 1st group from −1.35.2% to 4.24.9% (p < 0.001) vs -0.56.4% to 3.95.9% (p = 0.01) in the 2nd group. Conclusions: Addition of rosuvastatin to a fixed lisinopril/amlodipine combination in treatment of patients with uncontrolled hypertension resulted in a more pronounced decline of augmentation index, but was beneficial neither for decrease of carotid-femoral pulse wave velocity nor endothelial dependent vasodilatation increase.

Short-term atorvastatin therapy improves arterial stiffness of middle-aged systemic lupus erythematosus patients with pathological pulse wave velocity.

Objectives Statins have been proposed as a potential treatment for systemic lupus erythematosus (SLE) due to their immunomodulatory properties, their role restoring endothelial function and preventing atherosclerosis. We evaluate the effect of a short period treatment with a low dose of atorvastatin and its withdrawal on early stage subclinical atherosclerosis. Methods Thirty-seven SLE females received 20 mg/day atorvastatin during eight weeks. At baseline, at the end of treatment and six months after atorvastatin withdrawal, disease activity, subclinical atherosclerosis -assessed by measuring carotid-femoral pulse wave velocity (PWV) - and quantification of circulating endothelial progenitor cells (EPC) - as a surrogate biological marker of subclinical atherosclerosis - were carried out. Results The group of SLE patients with baseline pathological arterial stiffness showed a significant decrease of PWV after atorvastatin therapy (8.43 ± 1.45 m/s vs 7.42 ± 1.06 m/s; p = 0.002) that is maintained six months after treatment finished. Only patients of the middle-aged group showed a nearly significant decrease in the PWV measured along the study (7.16 ± 1.23 m/s vs 6.76 ± 0.82 m/s; p = 0.05). Atorvastatin induced a significant decrease in the circulating EPC percentage (0.65 ± 0.67 vs 0.40 ± 0.31; p = 0.023) as well as a downward trend of disease activity that it is observed by a decrease in SLE disease activity index simultaneously with an increase in C3 complement and significant decrease in serum concentration of vascular endothelial grow factor (VEGF) and sVCAM-1. Conclusions Short-term atorvastatin therapy reduces arterial stiffness of SLE patients with baseline pathological PWV, who are mainly in the group of middle-aged patients. Further studies are needed to determine whether these patients would benefit from statin therapy in preventing cardiovascular events.

Central arterial stiffness is associated with systemic inflammation among Asians with type 2 diabetes.

To examine the relationship between inflammation and central arterial stiffness in a type 2 diabetes Asian cohort. Central arterial stiffness was estimated by carotid-femoral pulse wave velocity and augmentation index. Linear regression model was used to evaluate the association of high-sensitivity C-reactive protein and soluble receptor for advanced glycation end products with pulse wave velocity and augmentation index. High-sensitivity C-reactive protein was analysed as a continuous variable and categories (<1, 1-3, and >3 mg/L). There is no association between high-sensitivity C-reactive protein and pulse wave velocity. Augmentation index increased with high-sensitivity C-reactive protein as a continuous variable (β = 0.328, p = 0.049) and categories (β = 1.474, p = 0.008 for high-sensitivity C-reactive protein: 1-3 mg/L and β = 1.323, p = 0.019 for high-sensitivity C-reactive protein: >3 mg/L) after multivariable adjustment. No association was observed between augmentation index and soluble receptor for advanced glycation end products. Each unit increase in natural log-transformed soluble receptor for advanced glycation end products was associated with 0.328 m/s decrease in pulse wave velocity after multivariable adjustment (p = 0.007). Elevated high-sensitivity C-reactive protein and decreased soluble receptor for advanced glycation end products are associated with augmentation index and pulse wave velocity, respectively, suggesting the potential role of systemic inflammation in the pathogenesis of central arterial stiffness in type 2 diabetes.