Early Stages Of Essential Hypertension Research Articles

Changes in the indicators of stiffness and remodeling of magistral arteries in young patients at the early stage of essential hypertension under conditions of syntropy with obesity.

Aim: The study and analysis of indicators of remodeling and rigidity of magistral vessels in young essential hypertension patients with abdominal obesity and determination of the detected changes as a possible criterion for their remodeling.. Materials and Methods: 98 young people with essential hypertension and obesity were included in the study. The structure of the carotid artery and its stiffness were assessed using the ultrasound method, and the level of abdominal fat was determined using dual-energy X-ray absorptiometry. Results: Carotid Intima-Media Thickness in patients with essential hypertension reliably exceeded the corresponding indicator of the control group. We observed a significant increase in arterial stiffness indicators, which is explained by the increased stiffness of blood vessels in patients with obesity. During the correlation analysis, it was established that the relationship between the level of abdominal fat and the elasticity of the vascular wall was positive and strong, which indicated the dominant role of the abdominal type of obesity in the remodeling of the vascular wall in young patients with essential hypertension in combination with obesity. Conclusions: In young patients at the early stage of the formation of essential hypertension, there are signs of a decrease in resilient-elastic properties and remodeling of magistral vessels, whose severity is significantly stronger in combination with abdominal obesity.

Prevention and Risk Factors in Early Stage of Essential Hypertension

Prevention and Risk Factors in Early Stage of Essential Hypertension

The frontal plane QRS-T angle may affect our perspective on prehypertension: A prospective study

ABSTRACT Backround The frontal plane QRS-T [f(QRS-T)] angle is an easy marker of myocardial repolarization and was associated with adverse cardiovascular outcomes like prehypertension (PHT). This study was aimed to investigate to evaluate the f(QRS-T) angle in patients with PHT. Methods We measured f(QRS-T) angle of 70 subjects with PHT, 109 patients with hypertension (HT), and 102 normotensive healthy volunteers. The f(QRS-T) angle was calculated from 12-lead electrocardiography. Results The f(QRS-T) angle was significantly higher in the HT and PHT groups as compared to the control group, but there was no significant difference in the f(QRS-T) angle between the HT and PHT groups. The f(QRS-T) angle was significantly and positively correlated with age, systolic blood pressure (BP) in 24 hours, average BP in 24 hours, pulse pressure in 24 hours, hemoglobin, QT dispersion, TpE distance while was negatively correlated with left ventricular ejection fraction. In multivariable analysis, we showed that systolic BP, average BP in 24 hours, pulse pressure in 24 hours, hemoglobin, QT dispersion, Tpe distance were independent predictors of higher f(QRS-T) angle. Conclusions The f(QRS-T) angle, a noninvasive measurement analyzing the dysfunction in cardiac conduction system, was increased in subjects with PHT as compared to normotensives, and the subjects with PHT had f(QRS-T) angle as higher as patients with HT did. Our findings are supportive for the hypothesis that disturbances in ventricular repolarization is present in an early stage of essential hypertension.

REAL TIME ASSESSMENT OF MICROCIRCULATION IN HYPERTENSION USING LASER SPECKLE CONTRAST ANALYSIS

Objective: Skin microcirculation has been suggested as a model of generalized microvascular function. It has also been used as a window to access endothelial function in the microvasculature. In this study we evaluated endothelial dysfunction of skin microcirculation in hypertensive patients compared to healthy, normotensive individuals using Laser Speckle Contrast Analysis (LASCA), a novel tool to assess microcirculation non-invasively, in real time and with high reproducibility. Design and method: We studied a group of 26 untreated hypertensive patients with new-onset essential hypertension without cardiovascular comorbidities, mean age 50.5 ± 15.7 years and 13 healthy individuals matched for age, sex and body mass index. In all subjects, forearm skin blood flow was recorded under standardized conditions using a laser speckle contrast imager (PeriCam PSI NR System, Perimed, Järfälla, Sweden). Post-occlusive reactive hyperemia (PORH) was assessed following a standardized protocol and data were analyzed with signal processing software (PIMSoft, Perimed). The amplitude of PORH responses was expressed as a percentage increase between peak and baseline perfusion (%), baseline Cutaneous Vascular Conductance (CVC), peak CVC and peak CVC minus baseline CVC. The CVC was calculated as the flux divided by mean arterial pressure and expressed in perfusion units (PU)/mmHg. Results: Baseline perfusion was similar between the two groups. However, during PORH patients with hypertension showed significantly lower percentage increase from baseline to peak perfusion (145.9 ± 9.72 vs 181.68 ± 12.35 %, p = 0.019). In addition, baseline CVC (0.34 ± 0.019 vs 0.43 ± 0.03 PU/mmHg, p = 0.009) and peak CVC (0.82 ± 0.04 vs 1.2 ± 0.06 PU/mmHg, p < 0.001) were significantly lower in hypertensive patients compared to controls. Finally, PORH amplitude as expressed by peak CVC minus baseline CVC (0.48 ± 0.03 vs 0.76 ± 0.04 PU/mmHg, p < 0.001) was significantly lower in hypertensive patients compared to normotensives. Conclusions: Using LASCA, a non-contact, real-time, highly reproducible and sensitive technique for the assessment of skin microcirculation, we showed that hypertensive patients demonstrate impaired microvascular responses to stimulation tests. Endothelial dysfunction is present in the very early stages of essential hypertension, long before the establishment of overt cardiovascular disease, and LASCA may represent a novel, valuable tool for its assessment.

Aldosterone as a mediator of microvascular and macrovascular damage in a population of normotensive to early-stage hypertensive individuals

We investigated whether aldosterone concurrently mediates microvascular and macrovascular impairment, in a population of treatment-naïve young- to middle-aged individuals free from cardiovascular comorbidities. Newly diagnosed, never-treated essential hypertensive patients and normotensive individuals participated in the study. Pulse wave velocity (PWV) and augmentation index were estimated with applanation tonometry. Microalbuminuria was determined from 24-hour urine collections. Laboratory tests included measurement of plasma renin activity, serum aldosterone, and high-sensitivity C-reactive protein. In 221 individuals aged 42.0 ± 12.3 years, classification in the highest aldosterone tertile was associated with the highest levels of blood pressure (BP), PWV, and high-sensitivity C-reactive protein (P < .05 for all). These individuals also exhibited twice the prevalence of microalbuminuria, compared to the first tertile (P = .081). Multivariate analysis showed that the positive association between PWV and increasing aldosterone tertiles remained significant after adjustment for BP and other parameters (P = .035). Likewise, aldosterone independently predicted microalbuminuria (P = .026) in the logistic regression analysis. In treatment-naïve individuals whose BP ranges from normal to early-stage hypertension, significant interactions exist between aldosterone and indices of microvascular and macrovascular damage. These findings suggest that aldosterone concurrently modulates microvascular and macrovascular function from the very early stages of essential hypertension and is dynamically implicated in the pathogenesis of hypertensive vascular disease.

Preliminary Study on the Relationship Between Intracardiac Blood Flow and Diastolic Function of Left Ventricle in Patients with Essential Hypertension

Left ventricular diastolic dysfunction can be detected in the early stage of essential hypertension. Previous studies have used Ganau configuration classification with the European population criterion rather than Chinese population. In this study, we evaluate the energy loss and vortex circulation in diastolic left ventricle in patients with essential hypertension under the criterion of Chinese population and explore the relationship between intracardiac blood flow change and diastolic function. Collect the structural and hemodynamic information in left ventricular diastolic period by echocardiography. Measure the energy loss and vortex circulation in left ventricle at different phases by VFM on the offline station. 63 patients with essential hypertension and 23 volunteers as controls are included. Compared to the controls, the energy loss and vortex circulation is significantly increased in hypertension which has a correlation with the diastolic function. The subgroups under the European criterion which find no significant difference in energy loss, have significant difference in ratio from that of Chinese criterion. The study shows the different results under two criterions and indicates the Chinese criterion can acquire a better reflection of the left ventricular energy loss in hypertension patients. VFM technology can be used to analyze the left ventricular flow in patients with hypertension, providing a new method to evaluate diastolic function.

PP.03.12] PULSE WAVE VELOCITY CHANGES IN PATIENTS WITH ESSENTIAL HYPERTENSION AND DIFFERENT CATEGORY OF CARDIOVACULAR RISK

Objective: Research objective was studying of the PWV features at male patients with essential hypertension (EH) stage I-II and moderate and severe cardiovascular risk. Design and method: It were surveyed 128 male patients with EH of 1–3 degrees. All patients were divided into 3 groups after stratification of risk factors for cardiovascular disease: IA group (n = 22) – patients with EH stage I and moderate CV risk; IB group (n = 22) - patients with EH stage I and high CV risk; II group (n = 84) - patients with EH stage II and high CV risk. It were investigated 2 diagnostic thresholds for detection of arterial stiffness: PWV normal level < 10 m/s and the individual threshold of PWV depending on age and hypertension grade [Arterial Stiffness’ Collaboration, 2010], which was the normal (in the range of 10th percentile - median) and high normal PWV (above median). Clinical characteristics of the observed groups are presented at the table 1.All results per category are represented as mean ± SEM (m) and median (25th to 75th percentile). Measurement of PWV was carried out using the device Arteriograph TensioMed (TensioClinic, Hungary). Results: PWV level in IA group was 7,15 (6,38; 7,70) m/s, PWV high level frequency registered in 11 (50%) patients according to age and blood pressure level. In IB group PWV value was 8,10 (7,23; 8,53) m/s, PWV high level frequency registered in 17 (77.3%) patients according to age and blood pressure level. In II group PWV value was 9,85 (8,5; 10,9) m/s and in 42 patients (50%) PWV level increased more than 10 m/s, that was testified to the target organ damage. In 22 male patients from the II group (26,20%) was individual increasing of PWV according to age and blood pressure level. Conclusions: The detected signs of arterial wall stiffness in patients with early stage of EH indicate increasing of cardiovascular risk severity and necessary for timely evaluation of pulse wave velocity for the early identifying of premature vascular aging.

Reduced parasympathetic tone in newly diagnosed essential hypertension

AimThe aim of the study was to compare heart rate variability (HRV) of newly diagnosed essential hypertensive subjects with controls. MethodsThe study was conducted on 120 hypertensive subjects and 120 controls. ResultsThe time-domain measures, standard deviation of all RR intervals (SDNN), the square root of the mean of the sum of the squares of differences between adjacent RR intervals (RMSSD), and percentage of consecutive RR intervals that differ by more than 50ms (pNN50) which reflect parasympathetic activity were significantly less in hypertensive subjects. In frequency-domain measures, high frequency [HF (ms2)] and [HF (nu)], which reflects parasympathetic activity, was significantly less in hypertensive subjects while LF (nu) and LF/HF (%), which reflect sympathetic activity, were comparable between the groups. ConclusionThese findings suggest that HRV is reduced in subjects with newly diagnosed essential hypertension and the parasympathetic dysregulation is present in the early stage of essential hypertension.

Abstract 15243: Does Renal Haemodynamics Relate With Cardiac and Aortic Haemodynamics in the Early Stages of Essential Hypertension?

Introduction: The relationship of renal haemodynamics with cardiac and aortic hameodynamics is still unclear. Hypothesis: We evaluated the relationship of increased renal resistive index (RRI) with Augmentation index (AIx) and cardiac haemodynamics by means of mitral annular early diastolic velocity (E/Ea) in untreated patients with essential hypertension. Methods: 76 newly diagnosed untreated non diabetic patients with stage I-II essential hypertension [35 males, aged 50 years, office blood pressure (BP) = 143/ 91 mm Hg], underwent ABPM, complete echocardiographic study for determination of E/Ea and blood sampling for assessment of metabolic profile. Moreover, data on renal resistive index (RRI), obtained by Doppler ultrasound sampling of the intrarenal arteries, as well as augmentation index (AIx), were retrospectively analyzed. Results: Based on the mean value of RRI (0.60), hypertensives were classified into those with high and low RRI. Hypertensives with high RRI values compared to those with low values were older (55.6±9.8 vs 44.4±11.6 years, p &lt; 0.001), had lower 24-hour diastolic BP (77.5±7.7 vs 84.3±6.7 mmHg, p &lt; 0.001), lower 24-hour HR (71.2±10.3 vs 76.2±9.2 bpm, p &lt; 0.05), higher levels of AIx (27.2±8.2 vs 17.8±14.8 %, p &lt; 0.01), and higher values of E/Ea (lateral) (7.7±1.8 vs 6.2±2.3, p &lt; 0.05). In the total population, RRI was negatively related to 24-hour diastolic BP (r = -0.523, p &lt; 0.001) and 24-hour HR (r = -0.281, p &lt; 0.05), while it was positively associated with CRP (r = 0.335, p &lt; 0.05), TChol (r = 0.296, p &lt; 0.01), age (r = 0.443, r &lt; 0.001), AIx (r = 0.413, p = 0.001) and E/Ea(lateral) (r = 0.465, p &lt; 0.05). Multiple regression analysis revealed that 24-hour diastolic BP and E/Ea (lateral) were independent associated with RRI (R2 = 0.434, p &lt; 0.05). Conclusions: Increased vascular resistance of intrarenal arteries is associated with impaired aortic and cardiac haemodynamics, as reflected by increased AIx and E/Ea (lateral) values. RRI may be considered a useful surrogate of haemodynamics in essential hypertension.

Abstract 18907: Relationships Between Renal Haemodynamics With Cardiac and Aortic Haemodynamics in the Early Stages of Essential Hypertension

Introduction: The relationship of renal haemodynamics with cardiac and aortic hameodynamics is still unclear. Hypothesis: We evaluated the relationship of increased renal resistive index (RRI) with Augmentation index (AIx) and cardiac haemodynamics by means of mitral annular early diastolic velocity (E/Ea) in untreated patients with essential hypertension. Methods: 76 newly diagnosed untreated non diabetic patients with stage I-II essential hypertension [35 males, aged 50 years, office blood pressure (BP) = 143/ 91 mm Hg], underwent ABPM, complete echocardiographic study for determination of E/Ea and blood sampling for assessment of metabolic profile. Moreover, data on renal resistive index (RRI), obtained by Doppler ultrasound sampling of the intrarenal arteries, as well as augmentation index (AIx), were retrospectively analyzed. Results: Based on the mean value of RRI (0.60), hypertensives were classified into those with high and low RRI. Hypertensives with high RRI values compared to those with low values were older (55.6±9.8 vs 44.4±11.6 years, p &lt; 0.001), had lower 24-hour diastolic BP (77.5±7.7 vs 84.3±6.7 mmHg, p &lt; 0.001), lower 24-hour HR (71.2±10.3 vs 76.2±9.2 bpm, p &lt; 0.05), higher levels of AIx (27.2±8.2 vs 17.8±14.8 %, p &lt; 0.01), and higher values of E/Ea (lateral) (7.7±1.8 vs 6.2±2.3, p &lt; 0.05). In the total population, RRI was negatively related to 24-hour diastolic BP (r = -0.523, p &lt; 0.001) and 24-hour HR (r = -0.281, p &lt; 0.05), while it was positively associated with CRP (r = 0.335, p &lt; 0.05), TChol (r = 0.296, p &lt; 0.01), age (r = 0.443, r &lt; 0.001), AIx (r = 0.413, p = 0.001) and E/Ea(lateral) (r = 0.465, p &lt; 0.05). Multiple regression analysis revealed that 24-hour diastolic BP and E/Ea (lateral) were independent associated with RRI (R2 = 0.434, p &lt; 0.05). Conclusions: Increased vascular resistance of intrarenal arteries is associated with impaired aortic and cardiac haemodynamics, as reflected by increased AIx and E/Ea (lateral) values. RRI may be considered a useful surrogate of haemodynamics in essential hypertension.

Assessment of Retinal Vasculature in Pregnancy: Unveiling the Complex Pathogenesis of Gestational Vascular Complications

Lupton et al1 get our applause for their innovative study on retinal microvascular alterations and subsequent development of preeclampsia. Changes in retinal calibers are not only overt in the early stages of essential hypertension as shown previously by our group2 but are now for the first time implicated in the multifaceted hypertensive disorder of preeclampsia. However, data on blood pressure (BP) levels and unadjusted for BP retinal calibers are not provided by the authors. Although normotensive until 20 weeks of gestation, women who subsequently develop preeclampsia may lack the BP drop normally observed during first weeks of pregnancy and exhibit prehypertensive BP levels. Indeed, normal but higher BP levels …

Autonomic dysfunction in essential hypertension: A systematic review.

IntroductionGreater sympathetic drive has been established in the early stages of essential hypertension, suggesting that neurohormonal dysregulation may be key to its aetiology and progression. The aims of this review are to discuss evidence of the role of autonomic dysfunction in essential hypertension and proposed mechanisms, and also some applications of this knowledge to current management strategies of essential hypertension.MethodsA computer search was performed using the PUBMED database for peer reviewed original articles comparing autonomic function tested via heart rate variability (HRV), muscle sympathetic nerve activity (MSNA) or plasma noradrenaline levels in normotensive (mean blood pressure (BP) of ≤140/90 mmHg or ≤135/85 mmHg if measured via home BP measurements) and hypertensive groups (mean resting BP of ≥140/90 mmHg (or ≥135/85 mmHg if measured via home BP measurements). Subjects were excluded with secondary causes of hypertension or autonomic dysfunction.ResultsA total of 17 studies were included for discussion. The main findings of this study include that of reduced baroreflex sensitivity, believed to be secondary to increased arterial stiffness, is hypothesised to be implicated in the pathogenesis of essential hypertension. Also, angiotensin converting enzyme inhibitors were not as effective on markers of autonomic control of blood pressure when compared with alternative anti-hypertensive drugs.ConclusionsConsistent research is needed to establish the effectiveness of pharmacotherapies at each of stage of hypertension, and on markers of autonomic dysfunction. Consistent study designs will enable more accurate accumulation of data across multiple studies, and appropriate application of such data into clinical practice.

Oxidative stress-related biomarkers in essential hypertension and ischemia-reperfusion myocardial damage.

Cardiovascular diseases are a leading cause of mortality and morbidity worldwide, with hypertension being a major risk factor. Numerous studies support the contribution of reactive oxygen and nitrogen species in the pathogenesis of hypertension, as well as other pathologies associated with ischemia/reperfusion. However, the validation of oxidative stress-related biomarkers in these settings is still lacking and novel association of these biomarkers and other biomarkers such as endothelial progenitor cells, endothelial microparticles, and ischemia modified albumin, is just emerging. Oxidative stress has been suggested as a pathogenic factor and therapeutic target in early stages of essential hypertension. Systolic and diastolic blood pressure correlated positively with plasma F2-isoprostane levels and negatively with total antioxidant capacity of plasma in hypertensive and normotensive patients. Cardiac surgery with extracorporeal circulation causes an ischemia/reperfusion event associated with increased lipid peroxidation and protein carbonylation, two biomarkers associated with oxidative damage of cardiac tissue. An enhancement of the antioxidant defense system should contribute to ameliorating functional and structural abnormalities derived from this metabolic impairment. However, data have to be validated with the analysis of the appropriate oxidative stress and/or nitrosative stress biomarkers.

Elevated Levels of MMP-9 in Untreated Patients with Stage I Essential Hypertension

Increased expression and activity of metalloproteinases have been implicated in the pathophysiology of vascular remodeling and in the growth of atherosclerotic lesions. We aimed at determining the levels of MMP-2, MMP-9, their specific inhibitors TIMP-2 and TIMP-1, and the inflammatory cytokines IL-6 and TNF-α, which are related to the stimulation of MMPs, in patients with untreated mild essential hypertension (UH) and normotensive (NT) volunteers. Serum MMP-9 and TIMP-1 levels were significantly different in UH volunteers when compared to NT volunteers. Thus, MMP-9 is elevated in the early stages of essential hypertension and may be used as a marker of cardiovascular risk and vascular dysfunction.

Impaired exercise tolerance is associated with increased urine albumin excretion in the early stages of essential hypertension

Our aim was to investigate the relationship between impaired exercise capacity and albumin excretion level in the setting of never treated essential hypertension. For this purpose, 338 consecutive essential hypertensives (52 ± 8.5 years, 227 males, office BP = 148.6/96.1 mmHg) performed a negative for myocardial ischemia, maximal treadmill exercise testing and were classified based on the gender specific median value of the amount of metabolic equivalents (METs) achieved (10.1 ml/kg/min for women and 11 ml/kg/min for men) as fit (n = 177) and unfit (n = 161). All the participants underwent 24-h ambulatory BP monitoring, complete echocardiographic study including left ventricular diastolic function evaluation and determination of albumin to creatinine ratio (ACR) on two non-consecutive morning spot urine samples. Unfit hypertensives compared to the fit ones were older by 4.5 years (p < 0.001) and had greater waist circumference by 4.5 cm (p < 0.001), body mass index by 1.3 kg/m(2) (p = 0.001), 24-h pulse pressure by 3.0 mmHg (p = 0.005), ACR levels by 12.6% (p = 0.003) and prevalence of microalbuminuria (19.5% vs 10.3%, p = 0.007) while the differences in diastolic function indices lost significance after adjustment for confounders. By applying stepwise multivariate linear regression analysis in order to identify the predictors of METs, it was revealed that age (β = -0.338, p = 0.045), gender (β = 0.274, p = 0.045), body mass index (β = -0.230, p = 0.045) and logACR (β = -0.151, p = 0.004) were the only independent predictors of exercise capacity. Increased ACR is associated with diminished exercise capacity in the early stages of essential hypertension independently from adverse cardiac adaptations, further elucidating the adverse prognostic role of albuminuria in this setting.

Effects of normal blood pressure, prehypertension, and hypertension on autonomic nervous system function

BackgroundAutonomic nervous system plays an important role in blood pressure (BP) regulation, and large proportion of patients with hypertension have increased sympathetic and decreased parasympathetic activity. Heart rate recovery (HRR) is a simple non-invasive measurement for investigating autonomic nervous system influence on the cardiovascular system; however, this methodology has not been used to evaluate autonomic nervous system in subjects with prehypertension (PHT). Accordingly, the present study was designed to evaluate HRR in subjects with PHT. Methods and resultsWe measured HRR of 91 subjects with PHT, 44 patients with hypertension, and 53 normotensive healthy volunteers. HRR was significantly lower in the HT and PHT groups as compared to the control group (24.4±5.7, 26.0±8.4, 30.0±8.7; hypertension, PHT, and control groups, respectively), but it did not significantly differ between HT and PHT groups. HRR was significantly and inversely correlated with age, systolic and diastolic BP, fasting and postprandial glucose level, waist circumference, total cholesterol, LDL cholesterol and non-HDL cholesterol, whereas exercise duration and METs were positively correlated with HRR. In multivariable analysis, we found that systolic BP, postprandial glucose level and exercise duration were independent predictors of lower HRR. ConclusionsHRR, a non-invasive measurement analyzing the dysfunction in autonomic nervous system, was reduced in subjects with PHT as compared to normotensives, and the subjects with PHT had HRR as lower as patients with HT did. Our findings are supportive for the hypothesis that autonomic dysregulation is present in an early stage of essential hypertension.

Association of Resistin With Urinary Albumin Excretion in Nondiabetic Patients With Essential Hypertension

Evidence suggests that resistin, a recently described protein, is associated with subclinical atherosclerosis in different clinical settings. In this study, we investigated the relationship of increased resistin levels with urinary albumin excretion, expressed as the albumin-to-creatinine ratio (ACR), an established index of diffuse vascular damage, in hypertensives. Our population consisted of 132 untreated nondiabetic subjects with stage I-II essential hypertension (49 males, mean age = 54 years, mean office blood pressure (BP) = 159/100 mm Hg). In all patients, ACR was determined as the average of three nonconsecutive morning spot urine samples, and venous blood sampling was performed for estimation of resistin concentrations. The distribution of resistin was split by the median (4.63 ng/ml), and accordingly, subjects were stratified into those with high and low values. Hypertensive patients with high (n = 66) compared to those with low resistin (n = 66) exhibited higher ACR values (21.8 + or - 15.3 vs. 10.3 + or - 3.8 mg/g, P < 0.01), even after adjustment for confounders. In the total population, resistin was associated with 24-h systolic BP (r = 0.244, P < 0.05), serum creatinine (r = 0.311, P = 0.007), and ACR (r = 0.499, P < 0.01). Multiple regression analysis revealed that age (b = 0.193, P = 0.02), body mass index (b = 0.237, P = 0.02), 24-h systolic BP (b = 0.338, P < 0.0001), 24-h heart rate (b = 0.169, P = 0.04), and resistin (b = 0.77, P < 0.01) were independently associated with ACR (R(2) = 0.471, P < 0.01). Hypertensive subjects with augmented resistin levels exhibit higher albuminuria, independently of established risk factors. Moreover, the association of resistin with ACR suggests a link between resistin and microvascular disease in the early stages of essential hypertension.

The level of uric acid and its role at early stages of essential hypertension

Aim: correlation of uric acid (UA) level on serum blood and urine with indicators of not specific inflammation and clinical characteristic in essential hypertension (EH) patients. Methods: 67 patients with EH (48 men) 30-65 years age (442) with stage 1 EH (n=37) and 2 (n=30) with moderate or high cardiovascular (CV) risk. The control group - 14 healthy peoples: (6 men) 45,52,1 years age with normal blood pressure (BP). The normal level of С-reactive protein (CRP) is less 3 mg/l. The normal level of UA in blood is 202,3-416,5 mkmol/l, and in urine is 1,48-4,43 mmol/24 hour. The estimates of creatinine clearance by the Cockroft-Gault formula. Results: the patients with EH have bigger level CRP, UA in blood and urine than healthy peoples with normal BP. Higher levels UA in blood and urine have patients even with early stages EH and moderate CV risk. The bigger level of UA in blood has EH patients with obesity and dyslipidaemia. The level of UA in blood and urine is higher at EH patients with hyperfiltration vs patients with normal creatinine clearance. Conclusion: the patients with early stage of EH have higher level of UA in blood and urine than healthy peoples with normal BP. The level of UA in blood and urine is correlated with dyslipidaemia. Key words: essential hypertension, uric acid, non specific inflammation

Left ventricular mass but not geometry determines left atrial size in the early stages of hypertension

We investigated whether the type of left ventricular (LV) geometry is associated with left atrial (LA) size as determined either by LA diameter or by volume, indexed for body surface area, in essential hypertensives. A total of 339 consecutive, untreated, hypertensives (aged 51.8 years, 234 males) underwent 24-h ambulatory blood pressure (BP) monitoring and estimation of LA diameter and volume, as well as LV structure and function by echocardiography. LV hypertrophy was present in 130 (38.3%) patients whereas normal geometry (LV-NG), concentric remodeling (LV-CR), concentric hypertrophy (LV-CH) and eccentric hypertrophy (LV-EH) represented 34.5, 27.1, 25.7 and 12.7%, respectively. Patients with either LV-CH or LV-EH had increased LA diameter index compared with those with either LV-NG (by 1.1 mm m(-2), P<0.01 and 1.4 mm m(-2), P=0.003, respectively) or LV-CR (by 1.3 mm m(-2), P=0.003 and 1.6 mm m(-2), P=0.001, respectively). Similarly, patients with either LV-CH or LV-EH had significantly increased LA volume index compared with those with either LV-NG (by 3.2 ml m(-2), P<0.001 and 3.4 ml m(-2), P<0.005, respectively) or LV-CR (by 4.5 and 4.7 ml m(-2), respectively, P<0.001 for both). Multiple linear regression analysis showed that the independent predictors of both LA volume and diameter index were LV mass index, 24-h pulse pressure and E/Em.LA size assessed either by its diameter or by volume is closely related only to LV mass index and not to any specific LV geometric pattern in the early stages of essential hypertension.

Independent association of circulating resistin with glomerular filtration rate in the early stages of essential hypertension

Resistin, a newly discovered protein, promotes endothelial dysfunction and proinflammatory activation, contributing to subclinical atherosclerosis in different clinical settings. In this study we sought to investigate the relationship of increased resistin levels with estimated glomerular filtration rate (eGFR), the most established marker of kidney impairment, in hypertensive subjects. Our population consisted of 132 untreated non-diabetic subjects with stage I-II essential hypertension (49 males, mean age=54 years, office blood pressure (BP)=159/100 mm Hg). In all patients eGFR was assessed by the Modification in Renal Disease equation and venous blood sampling was performed for estimation of resistin concentrations. The distribution of resistin was split by the median (4.63 ng ml(-1)) and accordingly subjects were stratified into those with high and low values. Hypertensive patients with high (n=66) compared to those with low resistin (n=66) exhibited lower eGFR values (77.1+/-9.4 vs 89.1+/-12.2 ml min(-1) per 1.73m(2), P<0.0001), even after adjustment for established confounders. In the total population, resistin was associated with 24-h systolic BP (r=0.244, P<0.05), serum creatinine (r=0.311, P=0.007) and eGFR (r=-0.519, P<0.0001). Multiple regression analysis revealed that age (b=0.379, P=0.01), body mass index (b=0.158, P=0.022), 24-h systolic BP (b=0.284, P=0.006) and resistin (b=0.429, P<0.0001) were independent predictors of eGFR (R(2)=0.436, P<0.0001). In essential hypertensive subjects, higher resistin levels are associated with renal function impairment, as reflected by decreased eGFR. Moreover, the independent association of resistin with eGFR suggests involvement of resistin in the progression of kidney damage in the early stages of hypertension.