Dysfunction In Hypertensive Patients Research Articles

Renal resistive index and aortic knob width relationship as a predictor of renal prognosis in essential hypertension.

The scientific studies that have been conducted so far highlight that renal resistive index (RI) and aortic knob width (AKW) indicate poor prognosis regarding renal and cardiovascular mortality. But the existence of a direct relationship RI and AKW is unclear. This study aims investigating the relationship between RI and the measured AKW in chest radiography of the patients with hypertensive nephropathy who do not require renal replacement therapy.This prospective study included 268 consecutive patients with essential hypertension. Patients were divided into 2 groups as RI ≥0.7 and RI <0.7. The ROC curve, sensitivity, and specificity ratios were evaluated to determine which AKW value is the best predictive one for the RI ≥0.7.The cutoff point of AKW was evaluated as ≥36 for the cases with RI ≥0.7: sensitivity was 71.22%; specificity was 71.32%; the positive predictive value (PPV) was 72.79; the negative predictive value (NPV) was 69.70, and the accuracy was 71.27. Area under the ROC curve ± standard error (AUC ± SE) = 0.729 ± 0.031 (P < .001).AKW can provide important predictive information about the subclinical renal dysfunction in hypertensive patients with RI ≥0.7. Moreover; AKW is a predictive factor for both the diagnostic and prognostic evaluation of renal pathologies.

Left ventricular dysfunction in hypertensive patients: an echocardiographic assessment

Introduction: Echocardiography is noninvasive procedure to assess heart. Ventricular mass increases due to left ventricular hypertrophy and performance of left ventricle decreases with increase in blood pressure. Left ven­tricular diastolic dysfunction (LVDD) is early sign of heart weakness which can be picked up early with Echo. This study was aimed to study cardiac anatomic and functional parametric alteration in echocardiography among hypertensive patients. &#x0D; Methods: This was a non-invasive, cross sectional hospital based retrospective review of the patient record from echo room among the hypertensive patient who undergone echocardiographic as­sessment from September 2017-February 2018 in Shree Birendra Hospital (SBH), Chhauni, Kathmandu. &#x0D; Results: Among 447 hypertensive cases, 232(51.9%) were having normal diastolic function while rest 215(48.1%) were having diastolic dysfunction of the heart. Among total cases evaluated, only 12(2.7%) patients were having ejec­tion fraction lower than 55%, while in rest it was normal. There were 53 (11.9%) cases having some form of as­sociated complication. Gender, Concentric Left Ventricular Hypertrophy and left atrial dilatation has significant difference (p&lt;0.05) with LVDD. Statistically significant differences in age distribution of individuals with different categories of left ventricular systolic dysfunction (LVSD) and LVDD (p˂0.001) was observed. &#x0D; Conclusion: Signifi­cant number of hypertensive individuals were having LVDD though in most of the individual LV ejection fraction was maintained.

Three-dimensional echocardiographic ventricular mass/end-diastolic volume ratio in native hypertensive patients: relation between stroke volume and geometry.

Elevated left ventricular (LV) mass/end-diastolic volume ratio (LVM/EDV) has been associated with higher evidence of myocardial fibrosis and dysfunction in hypertensive patients by cardiac magnetic resonance, a technique with limited availability. We investigated the ability of three-dimensional (3D) echocardiography in identifying a phenotype of LV concentric geometry according to LVM/EDV ratio, possibly detecting early myocardial damage in native-hypertensive patients. One hundred and twenty-eight native-hypertensive patients underwent 2D and 3D-echocardiography. The population was divided into two groups, according to cut-off point values of 3D-LVM/EDV ratio corresponding to its upper 95% confidence interval in a population of 90 healthy normotensive individuals: LVM/EDV ratio cut-off was 1.22 in men and 1.23 in women. An increased 3D-LVM/EDV ratio identified a higher rate of LV concentric geometry in comparison with 2D-derived relative wall thickness (37 versus 24%, P = 0.03). Patients with LVM/EDV ratio of 1.22 or more in men and 1.23 or more in women were significantly older, had smaller 3D-LV end-diastolic and end-systolic volumes and higher LV mass index, without difference in ejection fraction. 3D-stroke volume (P < 0.0001) was lower in patients with elevated LVM/EDV ratio. By a multilinear regression analysis, after adjusting for sex, age, heart rate, mean blood pressure and BMI, stroke volume was independently and negatively associated to LVM/EDV ratio (β = -0.55, P < 0.0001). In native hypertensive patients, 3D-echo-derived LVM/EDV ratio identifies a higher prevalence of LV concentric geometry than 2D-relative wall thickness. Stroke volume is independently and negatively associated with LVM/EDV ratio and its reduction represents an early marker of myocardial dysfunction in hypertensives with LV concentric geometry.

Role of speckle tracking echocardiography in detecting early left atrial dysfunction in hypertensive patients.

BackgroundArterial hypertension adversely affects left atrial (LA) size and function, effect on function may precede effect on size. Many techniques were used to assess LA function but with pitfalls.ObjectivesEarly detection of left atrial dysfunction with speckle tracking echocardiography in hypertensive patients with normal left atrial size.Patients and methodsThe study was conducted on 50 hypertensive patients and 50 age matched normotensive controls, all with normal LA volume index and free from any other cardiovascular disease that may affect the LA size or function. They were all subjected to history taking, clinical examination and echocardiographic study with assessment of LA functions [total LA stroke volume, LA expansion index by conventional 2D echocardiography and Global peak atrial longitudinal strain by speckle tracking (PALS)], left ventricular (LV) systolic and diastolic functions, and LV mass.ResultsDifferent indices of LA dysfunction (Total LA stroke volume, LA expansion index and global PALS) were significantly lower in the hypertensive group despite the normal LA volume index in all the studied subjects. The presence of diabetes mellitus (DM) and higher grade of LV diastolic dysfunction were significantly associated with lower global PALS. The higher age, systolic blood pressure (BP), body mass index (BMI), LA volume index, and LV mass index and the lower LA expansion index were associated with lower global PALS.ConclusionSpeckle tracking echocardiography is a useful novel technique in detecting LA dysfunction in hypertension even before LA enlargement occurs.

LEFT VENTRICULAR DEFORMATION IN PATIENTS WITH SYSTEMIC ARTERIAL HYPERTENSION BY 2D SPACKLE TRACKING ECHOCARDIOGRAPHY

Objective: Systemic arterial hypertension represents an increase in cardiac afterload and the compensatory mechanism is the development of left ventricular concentric hypertrophy with diastolic dysfunction, and secondarily atrial dysfunction. The aim of our study is to evaluate the left ventricular mechanical deformation by 2D spackle tracking echocardiography and estimate left ventricular longitudinal and circumferential strain in the patients with systemic arterial hypertension. Design and method: We investigated 38 patients with systemic hypertension without heart failure, valvular or myocardial lesion and 36 healthy controls. The control group had no clinical symptoms, and the electrocardiogram and echocardiogram were normal. All patients had conventional transthoracic echocardiography following current guidelines and longitudinal and global longitudinal and circumferential strain by 2D speckle tracking. All statistical analyses were performed with SPSS version 17.0 Results: Statistically significant differences were not found between hypertensive and control patients in left atrial volume, inter-ventricular septum, posterior wall thickness, left ventricular diastolic diameter, left ventricular relative wall thickness, left ventricle mass index, E/A ratio, E/e[Combining Acute Accent] ratio, systolic pulmonary artery pressure. The global circumferential strain showed significantly decreased (p < 0.001) in the patients with arterial hypertension compared to the controlled group (−17.8 ± 4 versus - 20.4 ± 6). The longitudinal strain also significant decreases (p < 0.008) in the hypertensive patients (−20.38 ± 2.3 versus −22.30). Conclusions: In hypertensive patients the global longitudinal and global circumferential deformation was significantly decreased. The speckle tracking gives the knowledge of subclinical left ventricular dysfunction in hypertensive patients.

Performing under pressure: hypertension and the regulation of cerebral oxygen delivery.

Reductions in arterial oxygen content () elicit increases in cerebral blood flow (CBF) that are adequate to maintain convective delivery of oxygen to the brain in healthy humans (i.e. cerebral oxygen delivery, ) (Hoiland et al. 2016). Deviations from this prototypical response in clinical populations are, however, less well understood. In this issue of The Journal of Physiology is a well-designed study by Fernandes and colleagues that investigated the impact of untreated stage-1 hypertension on the cerebrovascular, femoral vascular and sympathetic nervous activity (SNA) responses to isocapnic hypoxaemia (Fernandes et al. 2018). Several particularly interesting findings, specific to the cerebral circulation, included the following: (1) hypertensive individuals had a markedly lower posterior cerebrovascular reactivity to isocapnic hypoxaemia than normotensive individuals as determined by duplex ultrasound measurements of vertebral artery (VA) flow; (2) this reduction in posterior cerebrovascular reactivity to hypoxaemia was of a considerable magnitude and precipitated a hypoxaemia-induced reduction (−16%) in posterior ; and (3) the changes in posterior CBF and were unrelated to increases in muscle SNA. Internal carotid artery (ICA) flow reactivity was not statistically impaired in hypertensive patients despite an ostensible 36% difference between hypertensive and normotensive individuals. This, coupled with a statistically ascertained impairment in the cerebrovascular conductance response of the ICA during hypoxaemia in hypertensive individuals signifies that the lower reactivity (or vasodilatory capacity) of the VA in hypertensive patients (−80% compared to normotensive) may not be selective per se. A more judicious interpretation is that there is a diffuse impairment of cerebrovascular reactivity to isocapnic hypoxaemia throughout the brain in hypertension, although impairments are clearly exaggerated in the posterior circulation with consequential implications for . This finding is in itself novel, although confirmation in a larger cohort is required. Compromised posterior during hypoxaemia in hypertensive patients is important given that posterior cerebrovascular reactivity to hypoxaemia (in relative terms, % reactivity) is typically, albeit not always, reported to be greater than that of the anterior circulation in healthy individuals – a response characteristic attributed to a preferential/teleological protection of brainstem regions associated with basal homeostatic functions (reviewed in Hoiland et al. 2016). The authors speculated that the impaired posterior cerebrovascular reactivity was due to endothelial dysfunction. This is an interesting point given peripheral arterial endothelial function, indexed via brachial artery flow-mediated dilatation, is impaired in hypertensive patients and coincides with impaired cerebrovascular reactivity to CO2 (Lavi, 2006), thus providing inferential evidence for cerebral manifestation of endothelial dysfunction in hypertensive patients. This latter point is further strengthened by recent findings that more directly reinforce the notion that cerebrovascular CO2 reactivity is indeed indicative of cerebral conduit artery endothelial function in humans (Hoiland et al. 2017). Notably, although hypoxaemia elicited increases in both blood velocity and arterial diameter of the VA in normotensive individuals, the VA did not dilate during hypoxaemia in the hypertensive patients consistent with the manifestation of cerebral endothelial dysfunction (Table 2 in Fernandes et al. 2018). The increase in blood velocity through the VA was also lower – although not abolished – in the hypertensive patients, which coupled with the minimal increase in VA conductance likewise suggests additional functional impairments distal to large cerebral arteries. Whether ATP-sensitive potassium (KATP) channel dysfunction is also related to this decrement in posterior cerebrovascular reactivity, as speculated by the authors, is less clear. Despite evidence in animals that KATP channels possess an important role in hypoxic vasodilatation, to my knowledge no studies have investigated this in healthy humans (reviewed in Hoiland et al. 2016). The reduction in posterior due to exaggerated impairment of posterior cerebrovascular reactivity (Fernandes et al. 2018) holds great relevance for the re-emergent selfish brain hypothesis. This hypothesis encompasses the theory that elevated cerebrovascular resistance and consequent cerebral tissue hypoxia leads to elevations in SNA output that increases blood pressure in order to restore optimal CBF at the expense of ensuing hypertension. Indeed, a recent landmark study in humans provided evidence for an involvement of elevated cerebrovascular resistance and reduced CBF/ in the pathogenesis of hypertension (Warnert et al. 2016). The reduction in VA reactivity observed in the study by Fernandes and colleagues indicates that functional changes in CBF control, in addition to the previously ascribed anatomical variations (Warnert et al. 2016), may be a contributory factor to the sub-optimal perfusion that is thought to underlie reflex SNA activity in hypertension (Warnert et al. 2016). Although blood would be fully oxygenated as it flows through larger cerebral vessels (i.e. VA) in both normotensive and hypertensive individuals, potential reductions in hypoxic vasodilatory signal transduction at the level of microvessels where oxygen levels are lower (due to extraction) may be reflected in reduced flow measured in larger vessels. Indeed, this latter point is consistent with the above speculation that vasodilatory function was impaired in large and small cerebral arteries of hypertensive individuals (Fernandes et al. 2018). It remains to be determined if the increased SNA attributed to central hypoxia in the selfish brain hypothesis is due to independent or intertwined influences of both anatomical and functional cerebral abnormalities/impairments. With respect to this latter point, there was no relationship between cerebrovascular function (ΔVA flow and ) and the increase in SNA elicited with isocapnic hypoxaemia. However, the relationship between resting SNA and VA reactivity as well as posterior during hypoxia may provide more insight into the potential role of functional impairments in the proposed selfish brain hypothesis. While not presented in this manner by the authors, or reflective of causation, an x–y plot of VA reactivity (x-axis) and resting SNA (y-axis) may provide insight into a potential functional contribution to the selfish brain hypothesis. The author has no conflict of interest, financial or otherwise. The author is supported by a Natural Sciences and Engineering Research Council of Canada Post-Graduate Scholarship.

Correlation between pulmonary hypertension severity and left ventricular diastolic function indices in hypertensive patients

BackgroundAssociation between pulmonary hypertension and left ventricular diastolic dysfunction in hypertensive patients has been observed. However, the relation between the severity of pulmonary hypertension and different indices of diastolic dysfunction is still unclear. ObjectivesTo explore the relationship between pulmonary hypertension severity and different indices of LV diastolic dysfunction in hypertensive patients. Patients and methods112 asymptomatic hypertensive patients were included in our study. History taking, clinical examination, and echocardiography were done to all patients, LV dimensions, systolic and diastolic function, and systolic pulmonary artery pressure (SPAP) were measured. We classified the patients into two groups according to the presence or absence of diastolic dysfunction. ResultsPatients with diastolic dysfunction had significantly higher SPAP (p<0.00001), and significantly higher incidence of severe pulmonary hypertension (p=0.034). There was a significant positive correlation between SPAP and E/E′ ratio (r=0.354, p=0.00013), and between SPAP and systolic blood pressure (r=0.231, p=0.231), and a significant negative correlation between SPAP and E′/A′ ratio (r=−0.289, p=0.0019), and between SPAP and E-wave DT (r=−0.265, p=0.0047). Independent predictors for the presence of severe pulmonary hypertension were E/E′>15, E′/A′<1, and E-wave DT<160. ConclusionHypertensive patients with diastolic dysfunction had a higher systolic pulmonary artery pressure and a higher incidence of severe pulmonary hypertension. Systolic pulmonary artery pressure was significantly correlated with of LV diastolic dysfunction indices.

Relation between aortic knob width and subclinical left ventricular dysfunction in hypertensive patients

ABSTRACTBackground: The assessment of left ventricular (LV) structure and function is important in the evaluation of hypertensive heart disease, as it provides information on the cardiovascular morbidity and mortality. Aortic knob width (AKW) is a measurement of radiographic structure formed by the foreshortened aortic arch and a portion of the descending aorta. The main aim of this study was to investigate the relation between AKW on the routine chest radiography and subclinical LV dysfunction in hypertensive patients.Patients and Methods: A total of 144 patients with hypertension admitted to the cardiology outpatients clinic were enrolled consecutively. The patients were divided into two groups according to tissue Doppler-derived myocardial performance index (MPI): subclinical LV dysfunction group (abnormal MPI ≥ 0.5, n = 85) and absence of subclinical LV dysfunction group (normal MPI< 0.5, n = 59).Results: Patients with subclinical LV dysfunction were older (60 ± 8 vs. 54 ± 8, p = 0.001). Left ventricular mass index (LVMI) (96 ± 27 vs. 74 ± 24, p < 0.001) and prevalence of LV hypertrophy (28 vs. 8%, p = 0.011) were significantly different between two groups. Patients with subclinical LV dysfunction had higher AKW (42 ± 6 vs. 34 ± 5, p < 0.001) compared with patients without subclinical LV dysfunction. There was a significant correlation between MPI and AKW (r = 0.7, p < 0.001). Multiple logistic regression analysis showed that AKW (β = 0.617, p = 0.001) and posterior wall thickness (PWth) (β = 1.189, p = 0.021) were independently associated with subclinical LV dysfunction. Analysis using the Receiver Operating Characteristic (ROC) curve has demonstrated that aortic knob of 37 mm constitutes the cutoff value for the presence of subclinical LV dysfunction with 85.9% sensitivity and 86.4% specificity (The Area under the Curve ± Standard Error (AUC±SE) = 0.916 ± 0.024, p < 0.001).Conclusion: AKW may provide important predictive information on subclinical LV dysfunction in patients with hypertension.

Left ventricular function and contractile reserve in patients with hypertension.

An impaired contractile reserve (CR) may be an early manifestation of left ventricular (LV) systolic dysfunction in hypertensive patients. Using normotensive patients as controls, we examined LV CR and its correlates in hypertensive patients. One hundred and twenty-nine (68 men, aged 58.6 ± 9.5 years, 73 had hypertension) patients underwent dobutamine echocardiography. Patients with significant coronary or valvular disease, previous myocardial infarction or revascularization, and diabetes were excluded. LV ejection fraction (LVEF), global longitudinal strain (GLS), circumferential, and radial strain were measured at rest and at low-dose dobutamine. Absolute CR was calculated as the difference in LVEF and multi-directional strain between low-dose dobutamine and their corresponding resting values. Relative CR is the ratio of absolute CR to their corresponding resting values. Hypertensive patients, compared with controls, have significantly impaired GLS at rest (-16.8 ± 2.2% vs. -19.6 ± 1.5%, P < 0.0001) and at low-dose dobutamine (-17.9 ± 2.7% vs. -22.8 ± 2.6%, P < 0.0001). Absolute and relative GLS CR were significantly lower in hypertensive patients (-1.1 ± 2.1% vs. -3.2 ± 2.2% and 7.4 ± 13.9% vs. 16.4 ± 11.7%, respectively, both P < 0.001). Circumferential strain was preserved at rest but impaired at low-dose dobutamine in hypertensive patients (-23.0 ± 4.1% vs. -25.2 ± 3.4%, P = 0.002). There were no differences in LVEF or radial strain between the groups. LV wall thickness and systolic blood pressure correlated significantly with GLS at rest and at low-dose dobutamine. LV wall thickness is the only independent correlates of absolute CR. Compared with controls, hypertensive patients have impaired LV GLS at rest and impaired CR despite normal LVEF. Impaired CR correlated with LV wall thickness but independent of prevailing blood pressure.

Speckle Tracking Echocardiography in the Diagnosis of Subclinical Left Ventricular Systolic Dysfunction in Hypertensive Patients

Speckle Tracking Echocardiography in the Diagnosis of Subclinical Left Ventricular Systolic Dysfunction in Hypertensive Patients

The function of the left atrium in hypertensive patients

It has been established that the volume of OG is a marker of alteration of the diastolic function of the left ventricle. The aim of this study is to determine the relationship between left atrium remodeling and left ventricle diastolic dysfunction in hypertensive patients with preserved systolic function and the repercussions of high blood pressure (HTA) on size and function OG. A prospective study of 200 hypertensive patients in the cardiology department of the Avicenne military hospital in Marrakech during the period from July 2015 to July 2016. The average age of hypertensuve patients was 52 ± 5 years, 80 men, whose data were all evaluated by echocardiography measuring left atrium volumes during the reservoir, conduit and pump phases. Standard indices reflecting left ventricular filling were also assessed. Medium left atrium volume indexed for body surface was significantly higher in hypertensive patients–32.1 ± 4.6 mL/m 2 vs.21.72 (2.52) mL/m 2 . When compared to normal subjects, patients with mild diastolic dysfunction had lower corrected passive emptying volumes ( P < 0.001) and higher corrected active emptying volumes, thus leading to similar corrected total emptying volumes ( P < 0.001). However, patients with moderate diastolic dysfunction had smaller active emptying volumes, but higher passive and total emptying volumes when compared to normal controls and patients with mild diastolic dysfunction. The HTA induces an increase in the pump function and the reservoir function and an alteration of the function of the OG; these changes appear to be related to left ventricular hypertrophy and the degree of left ventricular diastolic dysfunction.

Link of renal microcirculatory dysfunction to increased coronary microcirculatory resistance in hypertensive patients.

This study investigated the correlation between renal microcirculation and coronary microcirculation in hypertensive patients. Participants consisted of 231 consecutive candidates who were referred to the Second Affiliated Hospital of Wenzhou Medical University from March 2014 to May 2016 for elective coronary angiography due to suspected myocardial ischemia. All participants were evaluated for the index of microvascular resistance (IMR), coronary flow reserve (CFR), and fractional flow reserve (FFR) us¬ing a pressure wire. Blood and urine samples were collected for determination of the levels of urinary microalbuminuria (mALB), b2-microglobulin (b2-MG), serum cystatin C (CysC), and uric acid (UA). All participants were categorized into two groups according to the renal microcirculatory function. Participants in the observation group had a higher IMR (31 ± 5 vs. 22 ± 6; p < 0.01) and a lower FFR (0.84 ± 0.10 vs. 0.87 ± 0.09 U; p < 0.05) during hyperemia than those in the control group. Linear regression tests revealed that mALB, b2-MG, CysC, and UA levels were positively cor¬related with IMR (r = 0.610, 0.553, 0.701, and 0.647, respectively, p < 0.01). The hs-CRP levels were positively correlated with IMR (r = 0.419, p < 0.01). Multiple regression analysis indicated that renal microcirculation was an independent predictor of IMR. Renal microcirculatory dysfunction in hypertensive patients is characterized by higher IMR and lower FFR; in addition, it is closely correlated with an increased coronary microcirculatory resistance.

Association of tricuspid regurgitation within normal range on the development of left ventricular diastolic dysfunction in patients with uncomplicated hypertension

Aim: Tricuspid regurgitation (TR) with the maximum velocity >2.8m/s has been newly integrated into the diagnostic criteria for left ventricular (LV) diastolic dysfunction. Although the maximum velocity of TR within the normal range (TR < 2.8m/s) is frequently detected in hypertensive patients and is associated with enlarged left atrial (LA) volumes, the influence of TR < 2.8m/s on LV diastolic dysfunction remains unknown in uncomplicated hypertension.Methods: Echocardiography was performed to assess the mitral annular velocity (e’), E/e’, LV mass, and LA phasic volumes and emptying fractions (total, passive, and active) in 100 patients with uncomplicated hypertension with TR within the normal range and in 77 of those without measurable TR. Patients were defined as having normal, inclusive, or dysfunction of LV diastolic function, according to how many parameters met the cut-off levels (maximum LA volume index >34ml/mm2, e’<7 cm/s, and E/e’>15). Pulmonary artery systolic pressure (PASP) was estimated by the formula; PASP =4 (maximum velocity of TR)2 + 5 mmHg.Results: The maximum velocity of TR or PASP saw a positive correlation, and LA total or passive emptying fractions saw an inverse correlation with LV diastolic dysfunction in hypertensive patients with TR < 2.8. In contrast, pulse pressure and LV mass saw positive correlation in hypertensive patients without TR. A stepwise ordinal logistic regression analysis indicated that PASP and LA passive emptying fractions were associated with LV diastolic dysfunction in hypertensive patient with TR < 2.8m/s.Conclusion: The presence of TR may be related to the development of LV diastolic dysfunction in hypertensive patients with TR <2.8m/s.

Correlation between Flicker-Induced Retinal Vessel Vasodilatation and Plasma Biomarkers of Endothelial Dysfunction in Hypertensive Patients

ABSTRACTPurpose: Hypertension (HT) strongly affects the vascular endothelium, resulting in chronic inflammatory disease. Dynamic vessel analysis (DVA) is a modern methodological approach to analyze vascular function in the retinal microcirculation. The aim of this study was to examine whether a defective retinal vessels response is associated with HT-induced endothelial dysfunction.Materials and Methods: Retinal vessel reactions to flicker stimulation were examined by DVA in both eyes of 37 hypertensive and 41 healthy control subjects. Plasma concentrations of C-reactive protein (CRP), interleukin-6, and tumor necrosis factor alpha (TNFɑ) were measured using the enzyme-linked immunosorbent assay.Results: Both arterial and vein responses to flicker stimulation were significantly decreased in patients with HT compared with the healthy controls (dilatation of the arteries was lower in the HT group by, on average, 1.31, p = 0.001 and dilatation of the veins was lower in the HT group by, on average, 1.32, p = 0.002) after independent adjustment for age, sex, body mass index, and pressure values. In the hypertensive group, there was a negative correlation between the arterial response to flicker stimulation and the plasma CRP concentration (Spearman’s Rank-order Coefficient (Rs) = −0.29, p = 0.07). Similarly, the plasma TNFα concentrations negatively correlated with the arterial response to flicker stimulation (Rs = −0.39, p = 0.02).Conclusions: Our results indicate that DVA directly reflects the actual metabolic status of the retinal endothelium. DVA might be used as an early noninvasive screening tool to detect vascular dysregulation and pan-endothelial dysfunction in patients with HT.

8 A Scoring System for Detecting Left Ventricular Diastolic Dysfunction in Hypertensive Patients

Introduction: Hypertension is the most common condition seen in primary care and a risk factor for diastolic dysfunction. Diastolic dysfunction occurred before heart failure in hypertensive patients with preserved ejection fraction, therefore early diagnosis of diastolic dysfunction is very important. Several factors have been known to be associated with left ventricular diastolic dysfunction and a new scoring system could be generated from those factors. Methods: A cross sectional study was conducted in Tarakan General District Hospital North Kalimantan with hypertensive subjects on October 2016. Patients characteristics, all factors related to left ventricular diastolic dysfunction, and echocardiographic data were collected and analysed. Results: There were 132 total samples in this study, and left ventricular diastolic dysfunction was found in 40.2% samples. From logistic regression analysis, age ≥55 years old (p = 0.006), poor blood pressure control (p < 0.001), left ventricular hypertrophy (p = 0.003), and abnormal fasting blood glucose (p = 0.001) were found to have a significant relation with left ventricular diastolic dysfunction and became a final model variables of scoring system. Left ventricular diastolic dysfunction scoring system could be generated form those variables final models. Calibration and internal validation tests for this scoring system showed good results. Conclusion: A scoring system can be generated to detect left ventricular diastolic dysfunction in hypertensive patients.

[PP.04.23] A DIASTOLIC DYSFUNCTION SCORING SYSTEM (DSS) FOR DETECTING LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN HYPERTENSIVE PATIENTS

Objective: To identify factors related to left ventricular diastolic dysfunction in hypertensive patients, and to create a scoring system from those related factors. Design and method: A cross sectional study was conducted in Tarakan General District Hospital North Borneo with hypertensive subjects on October 2016. Patients characteristics, all factors related to left ventricular diastolic dysfunction, and echocardiographic data were collected and analysed. Results: There were 132 total samples in this study, and left ventricular diastolic dysfunction was found in 40,2% samples. From logistic regression analysis, age more than 55 years old (OR 4.97, 95% CI 1.60–15.42), poor blood pressure control (OR 22.33, 95% CI 4.11–121.48), left ventricular hypertrophy (OR 4.23, 95% CI 1.14–15.72), and abnormal fasting plasma glucose (OR 13.24, 95% CI 2.89–60.67) were found to have a significant relation with left ventricular diastolic dysfunction and became a final model variables of scoring system. Left ventricular diastolic dysfunction scoring system could be generated from those variables final models. Calibration and internal validation tests for this scoring system showed good results. Conclusions: A scoring system can be generated to detect left ventricular diastolic dysfunction in hypertensive patients.

[PP.24.09] THE ROLE OF STRUCTURAL AND FUNCTIONAL ALTERATIONS OF LARGE ARTERIES IN VENTRICULAR HYPERTROPHY AND DIASTOLIC DYSFUNCTION IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: The aim of the study was to evaluate the influence of structural and functional alterations of large arteries on left ventricular hypertrophy and diastolic dysfunction in hypertensive patients. Design and method: Individuals with essential hypertenstion without any signs and symptoms of diastolic heart failure (n = 98, age 40–70 years, mean age: 55.1 ± 8.8 years, 42% females) were included in the study. Excluding criteria were: any other cardiovascular disease, diabetes and renal impairment with eGFR < 60 ml/min/m2. Applanation tonometry was used to determine central aortic pressures: cSBP, cDBP, Pulse Pressure (PP), Augmentation Index (AIx) and carotid-femoral pulse wave velocity (PWV). Intima media thickness of common carotid artery was measured by multiarray echotracking system. Echocardiography was used to assess left ventricular mass index (LVMI) and diastolic dysfunction: mitral peak E and A wave velocity, E/A ratio, Deceleration Time of peak E wave velocity (DecT), isovolumetric relaxation time (IVRT), pulsed wave TDI mitral e’ and a’ velocity, E/e’ ratio, pulmonary veins systolic (S) and diastolic (D) velocity, S/D ratio, atrial reversal velocity in pulmonary veins (Ar v) and left atrium volume index (LAVI). Results: IMT was negatively correlated with E/A ratio (r = −0.22, p < 0.05), septal e’ (r = −0.3, p < 0.05) and lateral e’ (r = −0.21, p < 0.05), however it was not related to LVMI. PWV was significantly related to LAVI (r = 0.29, p < 0.05), E/A ratio (r = −024, p < 0.05), lateral e’ (r = −0.17, p < 0.05), Ar v (r = 0.31, p < 0.05) and to LVMI (r = 0.30, p < 0.05). There was significant relationship between cSP and septal e’ (r = −0.26, p < 0.05), E/e’ ratio (r = 0.32, p < 0.05) and Ar v (r = 0.32, p < 0.05). Whereas, cDP was only correlated with Ar v (r = 0.28, p < 0.05). Central PP was significantly associated with E/A ratio (r = −0.28, p < 0.05) and septal e’ (r = −0.26, p < 0.05). There was negative correlation of AIx and E/A ratio (r = −0.28, p < 0.05), septal e’ (r = −0.27, p < 0.05, lateral e’ (r = −0.38, p < 0.05) and positive correlation with E/e’ ratio (r = 0.30, p < 0.05) Central aortic pressures were not associated with LVMI. Conclusions: All structural and functional measurements of large arteries relate to diastolic dysfunction and might be usefull to detrmine it at preclinical stage. Only PWV was associated with LVMI.

Abstract P355: Prevalence of Diastolic Dysfunction With Preserved Left Ventricular Systolic Function in Hypertensive and Type II Diabetic Patients in a Large Community Practice in Greenville, South Carolina

Diastolic dysfunction with preserved left ventricle systolic function is a major cause for adverse cardiovascular events in hypertensive and Type II Diabetic patients. Review of medical literature reveals prevalence of diastolic dysfunction in the range of 20 to 60 percent in hypertensive and diabetic patients. The aim of this study is to examine prevalence of diastolic dysfunction with normal systolic function in hypertensive and Type II Diabetic patients in a community practice. This is a retrospective chart review of 3085 hypertensive and 899 type II Diabetic patients. All patients underwent 2D color Doppler studies for the evaluation of diastolic dysfunction using American Society of Echocardiography criteria. E wave velocity, A wave velocity, E to A ratios, and deceleration time were measured. Patients with known systolic heart failure were excluded from the study. The age distribution of the patients in the study ranged from 45 to 85 years with a mean age of 65 years. The sex distribution of the hypertensive patients were 45% male and 55% female. The sex distribution of Type II Diabetic patients were 44% male and 56% female. Given the data, we conclude prevalence of diastolic dysfunction in hypertensive patients is 29% and prevalence of diastolic dysfunction in type II Diabetic patients is 33%. Echocardiography is an excellent tool to risk stratify hypertensive and type II Diabetic patients. Aggressive management of this high-risk group may reduce cardiovascular mortality and morbidity.

Impact of Ambulatory Blood Pressure on Early Cardiac and Renal Dysfunction in Hypertensive Patients without Clinically Apparent Target Organ Damage.

PurposeImpaired left ventricular (LV) global longitudinal strain (GLS) and the presence of microalbuminuria indicate early cardiac and renal dysfunction. We aimed to determine the relationships among 24-h ambulatory blood pressure (BP) variables, LV GLS, and urine albumin creatinine ratio (UACR) in hypertensive patients.Materials and MethodsA total of 130 hypertensive patients (mean age 53 years; 59 men) underwent 24-h ambulatory BP monitoring, measurements of peripheral and central BPs, and transthoracic echocardiography. Patients with apparent LV systolic dysfunction (LV ejection fraction <50%) or chronic kidney disease were not included. LV GLS was calculated using two-dimensional speckle tracking, and UACR was analyzed from spot urine samples.ResultsIn simple correlation analysis, LV GLS showed the most significant correlation with mean daytime diastolic BP (DBP) (r=0.427, p<0.001) among the various BP variables analyzed. UACR revealed a significant correlation only with night-time mean systolic BP (SBP) (r=0.253, p=0.019). In multiple regression analysis, daytime mean DBP and night-time mean SBP were independent determinants for LV GLS (β=0.35, p=0.028) and log UACR (β=0.49, p=0.007), respectively, after controlling for confounding factors. Daytime mean DBP showed better diagnostic performance for impaired LV GLS than did peripheral or central DBPs, which were not diagnostic. Night-time mean SBP showed satisfactory diagnostic performance for microalbuminuria.ConclusionThere are different associations for daytime and night-time BP with early cardiac and renal dysfunction. Ambulatory BP monitoring provides more relevant BP parameters than do peripheral or central BPs regarding early cardiac and renal dysfunction in hypertensive patients.

What is the association between left ventricular diastolic dysfunction and 6-minute walk test in hypertensive patients?

Heart failure (HF) is a major health problem. Hypertension is an important cause of HF. Most hypertensive patients have some degree of left ventricular (LV) diastolic dysfunction. The 6-minute walk test (6MWT) provides objective data about the exercise tolerance. We aimed to find the association between the degree of LV diastolic dysfunction and the functional capacity assessed by 6MWT in hypertensive patients. The study included 200 asymptomatic hypertensive patients. All patients had undergone full history taking, complete clinical examination, electrocardiography, echocardiography for assessment of LV dimensions, systolic and diastolic dysfunction, and 6MWT. Patients were classified into two groups according to the presence or absence of LV diastolic dysfunction. Clinical and echocardiographic data were comparable between the two groups. Regarding 6MWT, at the end of the test, patients with diastolic dysfunction had significantly higher systolic (P = .0088) and diastolic (P = .019) blood pressure and higher Borg score for dyspnea (P < .00001). The distant walked and percentage of the distance to predicted value were significantly lower in patients with diastolic dysfunction (P = .0322 and .0002, respectively). Incidence of abnormal 6MWT was significantly higher in patients with diastolic dysfunction (P = .00041). Compared to patients with grades I and II, patients with grade III diastolic dysfunction had significantly higher Borg score (P = .013), lower distance walked (P = .039), and lower percentage of distance to predicted vale (P = .009). Independent predictors for abnormal 6MWT were as follows: E/E' ≥15 (P = .0022), E'/A' <1 (P = .0081), and deceleration time of E-wave <160 (P = .013). The presence of LV diastolic dysfunction in hypertensive patients has a bad effect on 6MWT. The degree of LV diastolic dysfunction was correlated with 6MWT results. It may be important to investigate LV diastolic function in asymptomatic hypertensive patients.