Events In Hypertensive Patients Research Articles

What is the Real Efficacy of Beta-Blockers for the Treatment of Essential Hypertension?

This review covers the pharmacokinetics and pharmacodynamic of β-blockers, the rationale for their use, some recent controversies in its use for managing hypertension, as well as, the beneficial properties of the third-generation β-blockers beyond hypertension. The efficacy and safety of β-blockers in the treatment of hypertension and other cardiovascular diseases have been established during more than 50 years of clinical experience. Recent updates of clinical guidelines have downgraded the use of β-blockers for the treatment of uncomplicated hypertension to second and third line therapy. It is a well-known fact that β-blockers exhibit heterogeneous pharmacokinetic and pharmacodynamic properties that clearly influence their clinical efficacy and tolerability in the management of essential hypertension. Conventional nonvasodilating β-blockers (atenolol and metoprolol) are inferior to first-line antihypertensive agents in terms of cardioprotection due to lower ability to reduce central blood pressure and its variability and the adverse effects on glycemic and lipid metabolism. New vasodilating β-blockers, mainly carvedilol and nebivolol, show enhanced hemodynamic and metabolic properties, which probably result in a higher prevention of major cardiovascular events in hypertensive patients. Despite head-to-head clinical trials comparing the effects of vasodilating vs nonvasodilating β-blockers on hard clinical endpoints are lacking, the current evidence suggests that third-generation β-blockers are superior to conventional β-blockers for the prevention of cardiovascular events in patients with essential hypertension. Moreover, beyond their antihypertensive properties, third-generation β-blockers also have pleiotropic, antioxidant and antiinflammatory effects that warrant a "promissory new era" of this newly group.

Aortic atherosclerosis is a key modulator of the prognostic value of postural blood pressure changes

Background and aimsOrthostatic blood pressure decrease or increase has been related to cardiovascular events in hypertensive patients. Large blood pressure changes after orthostatic stress are associated with autonomic and neurohormonal abnormalities; aortic atherosclerosis (ATS) may also play a role. MethodsWe investigated the interaction of ATS on the prognostic value of postural blood pressure changes. In a cohort of 958 hypertensive patients with an aortography (mean ± standard deviation age 44 ± 11 years, 61% men, mean blood pressure 182/110 mmHg), blood pressure was measured after 10 min of rest in the supine position. Systolic blood pressure (SBP) was also measured in standing position, 1 min after the supine position. Blood pressure changes were calculated as supine SBP minus standing SBP and analyzed as absolute or arithmetic means. ATS was assessed using an aortography score. ResultsAfter 15 years of follow-up, 280 all-cause and 167 cardiovascular deaths occurred. In a multivariable Cox regression analysis adjusted for major cardiovascular risk factors and stratified according to ATS status, SBP changes were statistically associated with all-cause and cardiovascular mortality only in the presence of ATS: tertile 3 versus 1, 2.99 (1.37–6.49) and 4.08 (1.55–10.72) respectively, tertile 3 versus 2, 2.89 (1.29–6.46) and 4.82 (1.79–12.98), respectively (p for interaction: 0.003 for all-cause and 0.003 for cardiovascular mortality) for absolute changes. The hazard associated with the magnitude of SBP changes was more important than that associated with its direction. ConclusionsThe prognostic significance of postural SBP changes is markedly influenced by ATS in hypertensive patients.

Relationships Between Components of Blood Pressure and Cardiovascular Events in Patients with Stable Coronary Artery Disease and Hypertension.

URL: http://www.clarify-registry.com. Unique identifier: ISRCTN43070564.

Morpho-functional cardiovascular adaptation in hypertensive patients: two-dimensional speckle tracking echocardiographic study.

Twenty-four-hour blood pressure (BP) variability is an important predictor of organ damage and cardiovascular events. Although epidemiological data are widely based on evaluation of office (clinic) BP, 24-hour ambulatory BP monitoring (ABPM) accurately assess the severity of hypertension to predict cardiovascular events in hypertensive patients, because it more accurately reflects BP load on heart and blood vessels. Conventional transthoracic echocardiography (TTE), such as M-mode and two-dimensional (2D), and more advanced techniques, such as tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE), are used to identify pathological changes of the hypertensive heart disease. In addition, the study of systemic arterial compliance (SAC) predicts the impact of the arterial stiffness on the LV remodeling. Fifty-eight patients (34 males and 24 females, aged 53±12 years) with hypertension for at least one year were studied using Ambulatory Blood Pressure Monitoring (ABPM), with evaluation of 24-hour, day time, night time and sleep and awake average systolic and diastolic BP, and subsequently with TTE, to evaluate the influence of the 24-hour average BP, integrated with echocardiographic parameters, on cardiovascular adaptations in hypertensive patients. ECHO parameters examined were: left ventricle (LV) mass indexed to body surface area (LVMi), LV ejection fraction (EF), left atrial volume indexed to body surface area (LAVi), mitral inflow velocities (E, A and E/A), mitral annulus velocities (S' and E') and E/E' ratio by TDI, LV global longitudinal strain (GLS) using 2D STE. SAC was derived by the ratio SVi/PP, using echocardiographic stroke volume index to body surface area (SVi) and pulse pressure (PP). LVMi showed a correlation with the 24-hour average BP (SBP r=0.32; DBP r=0.26), SBPd (r=0.32), DBPd (r=0.28) and SBPn (r=0.29). GLS was correlated with the 24-hour average BP (SBP r=0.30; DBP r=0.32), SBPd (r=0.32), DBPd (r=0.32) and with LVMi (r=0.42), LAVi with 24 hour SBP (r=0.28), while SAC with LVMi (r=0.29) and LAVi (r=0.33). ABPM and TTE evaluation can be particularly useful in hypertensive patients, even with normal office BP, to highlight the influence of 24-hour blood pressure profile on LVM, and to a lesser extent, on LAV. SAC, instead, seems to be correlated both to LVM and LAV, independently of BP levels.

Left Ventricular Hypertrophy Predicts Cardiovascular Events in Hypertensive Patients With Coronary Artery Calcifications.

Coronary artery calcification (CAC) is associated with increased cardiovascular (CV) risk. Left ventricular hypertrophy (LVH) is an independent risk factor for CV events. Our aim was to estimate the relative CV risk of LVH in the presence of CAC. We included asymptomatic hypertensive patients who were enrolled in the calcification arm of the INSIGHT (International Nifedipine Study Intervention as Goal for Hypertension Therapy). Patients had baseline echocardiography and computed tomography to assess CAC. The primary end-point was the first CV event. Two hundred and fifty-two subjects (mean age 64.7 ± 5.5 years, 54% men) were followed for a mean of 13.3 ± 2.6 years. 72 patients (28.5%) had LVH and 159 patients (63%) had CAC. During follow up, 89 patients had a first CV event. The rate of CV events was higher in those with than in those without CAC (43.4% vs. 21.5%, P < 0.01) and in those with than in those without LVH (44% vs. 31.6%, P < 0.01). However, LVH had no effect on CV events in the absence of CAC, whereas LVH almost doubled the rate of CV events (61.4% vs. 36.5%, P < 0.01) in the presence of CAC. In comparison to patients without CAC and without LVH the hazard ratio for CV event in those with LVH was 1.46 (95% confidence interval [CI], 0.50-4.21) in those without CAC and 4.4 (95% CI, 2.02-9.56) in those with CAC. LVH and CAC independently predict CV events in asymptomatic hypertensive patients. However, the risk of LVH is mainly observed in those with CAC.

Combination of Irbesartan with Amlodipine Enhances Nitrate/Nitrite Generation by Angiotensin II-exposed Endothelial Cells

Background: Endothelial dysfunction is an initial step for atherosclerotic cardiovascular disease and highly prevalent in high-risk patients, such as those with hypertension or chronic kidney disease. Decreased nitric oxide production and/or impaired bioavailability are involved in endothelial dysfunction. Since blood pressure lowering significantly reduces the risk for future cardiovascular events in hypertensive patients, several guidelines recommended combination of anti-hypertensive drugs that had complimentary mode of actions for the treatment of patients with moderate or severe hypertension. However, effects of combination therapy on nitric oxide generation by endothelial cells are not fully understood. Keywords: Endothelial dysfunction, combination therapy, irbesartan, hypertension, amlodipine, cardiovascular disease.

Relationship between blood pressure variability and combined cardiovascular events in 5-10 years in hypertensive patients

To explore the relationship between blood pressure variability (BPV) and combined cardiovascular events in 5-10 years in patients with hypertension. A total of 367 hypertensive patients treated in our hospital from January, 2000 to January, 2005 were analyzed, and their BPV was assessed in comparison with 145 normotensive individuals. The hypertensive patients were classified into high BPV group and low BPV group, and the general clinical data and biochemical profiles were compared. The relationship between BPV and combined cardiovascular events of the patients within 5-10 years were explored. Compared with the normotensive individuals, the hypertensive patients showed significantly increased standard deviation and coefficient of variation of 24-h systolic blood pressure (SBP), 24-h diastolic blood pressrue (DBP), daytime SBP, daytime DBP, night-time SBP and night-time DBP (P<0.01). The percentages of drinking, smoking, diabetes and coronary heart disease were significantly higher in patients with high BPV than those with lower BPV (P<0.01 or 0.05); uric acid, homocysteine, urinary protein/creatinine ratio and urinary microalbumin increased more significantly in patients with high BPV (P<0.01 or 0.05). In addition, the combined cardiovascular events in 5-10 years were significantly higher in the patients with higher BPV than those with lower BPV (P<0.01 or 0.05). Logistic multivariate logistic regression analysis showed that alcohol, diabetes, coronary heart disease, uric acid and homocysteine were independent risk factors for cardiovascular events in hypertensive patients (P<0.01 or 0.05). In hypertensive patients, BPV is closely correlated with the long-term combined cardiovascular events, and a high BPV is associated with a greater likeliness of combined cardiovascular events.

Effects of Blood Pressure Control in Cardiovascular Prevention.

High blood pressure is the main risk factor worldwide for mortality and morbidity. Subjects with uncontrolled hypertension increased in the last decades. This review is based on the material searched for and obtained via MEDLINE and PubMed up to June 2016. The search terms used were "hypertension, blood pressure control" in combination with "pathophysiology, lifestyle, antihypertensive drugs, target organ damage, target values and comorbidity". This narrative review focused its attention on the diagnosis, the pathophysiology, the clinical consequences of arterial hypertension, and on the factors that must be considered for a better blood pressure control. In fact, the attainment of an adequate blood pressure control is a challenge at both a population and an individual level. The review will discuss the best strategy to reduce uncontrolled hypertension and cardiovascular events in hypertensive patients identifying the main conditions which determine and maintain uncontrolled hypertension also highlighting the new possible strategies for a better blood pressure control and including the results of very recent multicenter randomized controlled trials.

PS 05-77 SEXAGENARIAN AS A TURNING POINT OF ARTERIAL STIFFNESS IN HYPERTENSIVE PATIENTS WITHOUT ANGINA PECTORIS

Objective: Large artery damage is an important contributory factor to cardiovascular morbidity and mortality of patients with hypertension. Arterial stiffness increases with age and hypertension. Pulse wave velocity (PWV) can be used as a measure of arterial stiffness. The purpose of this study was to investigate the turning point of arterial stiffness change in hypertensive patients without angina pectoris. Design and Method: One thousand three hundred eighteen patients with hypertension without cardiovascular complication or cerebral infarction were included. We analyzed echocardiographic data, PWV data, demographic information, and risk factors for cardiovascular disease, medical history, medication, and biochemical data. Patients with history of arrhythmia or significant valvular heart disease were excluded. Results: Among 1,318 hypertensive patients, 500 women (mean age; 55 ± 11 years old) and 818 men (mean age; 50 ± 12 years old) were included. PWV showed positive correlation with age (r = 0.324, p < 0.001), systolic blood pressure (r = 0.177, p < 0.001) and pulse pressure (r = 0.196, p < 0.001) in hypertensive men. PWV showed positive correlation with age (r = 0.453, p < 0.001), systolic blood pressure (r = 0.176, p = 0.003) and pulse pressure (r = 0.253, p < 0.001) in hypertensive women. PWV demonstrated positive correlation with systolic and diastolic blood pressure and pulse pressure after adjustment for age in both men and women. Sexagenarian showed significantly higher PWV compared with hypertensive persons in their fifties (1686.1 ± 316.0 cm/sec vs. 1546.3 ± 262.1 cm/sec, p = 0.015). Conclusions: Sexagenarian is a turning point of arterial stiffness in hypertensive patients without angina pectoris. We should pay attention to sexagenarian to prevent cardiovascular events in hypertensive patients.

MPS 13-04 EFFECTS OF VASODILATORS ON THE CARDIO-ANKLE VASCULAR INDEX (CAVI) IN ANESTHETIZED RABBITS

Objective: The arterial stiffness is known to be a good predictor of cardiovascular events in hypertensive patients. Cardio-ankle vascular index (CAVI) has been developed for measurement of vascular stiffness from the aorta to tibial artery, which is clinically utilized for assessing the progress of arteriosclerosis. Our recent study has demonstrated that the CAVI is decreased by a vasodilator affecting conduit and muscular arteries. In this study, we compared acute effects of various types of vasodilators on the CAVI in anesthetized rabbits. Design and Method: New Zealand White rabbits were anesthetized with halothane. For measurements of the heart-ankle pulse wave velocity (haPWV) and CAVI, the signals of electrocardiogram, phonocardiogram and blood pressure were fed to the VaSera system to be automatically calculated from the following well-established basic equation: CAVI = (2ρ/ΔP) × ln(Ps/Pd) × haPWV2, where Ps is systolic blood pressure, Pd is diastolic blood pressure, haPWV is heart-ankle pulse wave velocity, ΔP is Ps–Pd, ρ is blood density. Results: Intravenous administration of nitroglycerin or acetylcholine decreased the CAVI accompanied with hypotensive action and reduction of the haPWV. Intravenous administration of nifedipine, nicardipine or cilnidipine unaffected the CAVI, whereas each drug decreased the blood pressure and haPWV. On the other hand, intravenous administration of nicorandil increased the CAVI but decreased the blood pressure and haPWV. Conclusions: Acute effects on the CAVI were different among the vasodilators examined. Pharmacological properties like nitroglycerin and acetylcholine will be beneficial for the prevention of arteriosclerotic diseases of the large artery.

Prognostic significance of on-treatment home and clinic blood pressure for predicting cardiovascular events in hypertensive patients in the HONEST study.

We investigated the prognostic significance of morning home SBP (MHSBP) and clinic SBP (CSBP) at baseline and during follow-up in on-treatment hypertensive patients. In the Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure study, more than 20 000 Japanese hypertensive patients who started treatment with olmesartan were followed for cardiovascular events for 2 years. MHSBP and CSBP measured at baseline and during follow-up were compared in terms of the prognostic significance in predicting cardiovascular events. The analysis included 21 591 patients (50.6% female; average age 64.9 years; mean follow-up 2.02 years; and 280 cardiovascular events). The mean MHSBP and CSBP were 151.2 and 153.6 mmHg at baseline and 135.2 and 135.2 mmHg during follow-up. Hazard ratios per 1 mmHg increase were 1.011 (95% confidence interval 1.004-1.019) and 1.006 (1.000-1.012) at baseline, and 1.039 (1.029-1.049) and 1.026 (1.016-1.036) during follow-up. When MHSBP and CSBP at baseline and during follow-up were included in the same model, only MHSBP during follow-up was identified as a significant predictive factor. The concordance index of all blood pressure variables showed reasonable discrimination abilities, and that of mean during follow-up were higher than that of SBP at baseline. The results of net reclassification improvement analyses showed that follow-up MHSBP had better reclassification ability than follow-up CSBP. SBP during follow-up (as compared with SBP at baseline), particularly MHSBP (as compared with CSBP), had better prognostic significance in predicting cardiovascular events in Japanese hypertensive patients during a 2-year clinical study.

0146 : Cardiovascular risk stratification and target organ damage in arterial hypertension

Arterial hypertension (AH) is one of the main risk factors of negative cardiovascular (CVR) events and the complex evaluation of CVR is necessary for the successful treatment of patients with AH. To improve the prevention of cardiovascular complications and events in hypertensive patients, it is of major importance to estimate the patient's individual risk for cardiovascular events. Evaluate cardiovascular (CV) risk stratification in hypertensive patients according to the European Society of Hypertension (ESH) guidelines and the level of target organ damage (TOD) using routine examinations in clinical practice. This study was done for a period of 1 year in the University hospital IBN ROCHD of Casablanca and was conducted in a group of 132 patients with AH, cardiovascular risk stratification and TOD was defined following the ESH guidelines.The clinical assessment included urinary albumin excretion rate (UAER), electrocardiogram, self-monitored blood pressure (BP) and ambulatory BP. The mean age of the patients was 56,4 +/– 11,7 years with female predominance. Grade 1 hypertension was found in 31,8%, grade 2 in 42,4% and grade 3 in 25,8%. The prevalence of TOD was: high UAER (8,6%), left ventricular hypertrophy (22,1%), supraventricular arrhythmias (42,3%), ventricular arrhythmias (2,9%), coronary arter disease (19,3%), kidney disease (11,2%), transient ischaemic attack (2,3%), cerebrovascular stroke (8,1%), Peripheral artery disease (18,7%). For the Stratification of total CV risk: (16%) of our patients had a very high risk, (36,5%) high risk, (39,2%) moderate risk and (8,3%) low risk. On the treatment side: (43,6%) were under monotherapy, (37,7%) bitherapy and (18,7%) triple therapy. Modern strategies of cardiovascular prevention in hypertensive patients should move from a single risk factor based approach toward a more comprehensive risk evaluation in the individual patient. The author hereby declares no conflict of interest

Left atrial dimension is related to blood pressure variability in newly diagnosed untreated hypertensive patients.

Variability in daily blood pressure (BPV) recorded 24-h ambulatory blood pressure monitoring (ABPM) is known to be related to left ventricular hypertrophy and an increased incidence of cardiovascular events in hypertensive patients. The aim of this study was to evaluate whether left atrium dimension, which increases early in hypertensive subjects, was related to BPV in a group of 167 drug-naive patients (100M/67F, age: 46±11yr). The patients were chosen among those consecutively sent by their general practitioners to confirm the existence of arterial hypertension and afterwards diagnosed as hypertensive (mean 24-h ABPM ⩾130/80 mm Hg). In each patient, the left atrial posteroanterior diameter index for height (LADi) and the left ventricular mass standardized for body surface area (LVMi) were measured using standardized echocardiographic methods. BPV was calculated as the weighted mean of daytime and nighttime systolic and diastolic blood pressure s.d.'s (ws.d.), according to the formula ws.d.=[(daytime s.d. × 10)+nighttime s.d. × 6)]/16. An increase in left atrial dimension (LADi>24 mm m(-1)) was present in 36 patients (21.6% of the total population). In a univariate regression, LVMi was significantly related to systolic BPV (r=0.24; P=0.02) only in men, whereas LADi was significantly related to both systolic and diastolic BPV in both genders. After adjusting for sex, age, BMI, heart rate, diastolic function and estimated glomerular filtration rate, both systolic and diastolic BPV remained significantly related to LADi (P=0.02 for both) but not to LVMi. In conclusion, this study suggests that BVP, as measured as BPws.d., is significantly and independently associated with increased LADi in newly diagnosed, treatment-naive hypertensive patients.

Coffee consumption and risk of cardiovascular events in hypertensive patients. Results from the HARVEST

BackgroundControversy still exists about the long-term cardiovascular effects of coffee consumption in hypertension. MethodsThe predictive capacity of coffee use for cardiovascular events (CVEs) was investigated in 1204 participants from the HARVEST, a prospective cohort study of non-diabetic subjects aged 18–45years, screened for stage 1 hypertension. Subjects were grouped into three categories of coffee drinking, non-drinkers (none), moderate drinkers (1 to 3cups/day) and heavy drinkers (4or more cups/day). Multivariate Cox proportional hazards models were developed adjusting for possible confounding variables and risk factors. ResultsDuring a median follow-up of 12.6years, CVEs were developed by 60 participants. CVEs were more common among coffee drinkers than abstainers (abstainers, 2.2%; moderate drinkers, 7.0%; heavy drinkers, 14.0%; p for trend=0.0003). In a multivariable Cox regression model, coffee use was a significant predictor of CVE in both coffee categories, with a hazard ratio of 2.8 (95% CI, 1.0–7.9) in moderate coffee drinkers and of 4.5 (1.4–14.2) in heavy drinkers compared to abstainers. After inclusion of change in body weight (p=ns), incident hypertension (p=0.027) and presence of diabetes/prediabetes (p=ns) at follow-up end, the association with CVE was attenuated but remained significant in heavy coffee drinkers (HR, 95% CI, 3.4, 1.04–11.3). ConclusionsThese data show that coffee consumption increases the risk of CVE in a linear fashion in hypertension. This association may be explained in part by the association between coffee and development of hypertension. Hypertensive patients should be discouraged from drinking coffee.

Potential Risk Factors Associated With Vascular Diseases in Patients Receiving Treatment for Hypertension.

BackgroundCurrently, the hypertension (HTN) patients undergo appropriate medical treatment, and traditional risk factors are highly controlled. Therefore, potential risk factors of atherosclerotic vascular diseases (AVD) and venous thromboembolisms (VTE) in HTN should be reconsidered. We investigated thrombophilic genetic mutations and existing biomarkers for AVD or VTE in HTN patients receiving treatment.MethodsA total of 183 patients were enrolled: AVD with HTN (group A, n=45), VTE with HTN (group B, n=62), and HTN patients without any vascular diseases (group C, n=76). The lipid profile, homocysteine (Hcy) levels, D-dimers, fibrinogen, antithrombin, lupus anticoagulant, and anti-cardiolipin antibody (aCL) were evaluated. Prothrombin G20210A, Factor V G1691A, and methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C were analyzed.ResultsAll patients revealed wild type prothrombin G20210A and Factor V G1691A polymorphisms. The frequency of MTHFR polymorphisms was 677CT (n=84, 45.9%); 677TT (n=46, 25.1%); 1298AC (n=46, 25.1%); and 1298CC (n=2, 1.1%). The MTHFR 677TT genotype tended to increase the odds ratio (OR) to AVD events in HTN patients (OR 2.648, confidence interval 0.982-7.143, P=0.05). The group A demonstrated significantly higher Hcy levels (P=0.009), fibrinogen (P=0.004), and platelet counts (P=0.04) than group C. Group B had significantly higher levels of D-dimers (P=0.0001), platelet count (P=0.0002), and aCL (P=0.02) frequency than group C.ConclusionsThe MTHFR 677TT genotype and Hcy level could be potential risk factors associated with development of AVD in HTN patients receiving treatment. D-dimer and aCL might be useful to estimate the occurrence of VTE in them.

Comparison of Multidrug Formulations for Anti-Hypertensive Treatment

The multidrug therapy in the form of Orally Disintegrating Tablets (ODTs) is superior to control and treat high blood pressure and to decrease cardiovascular events in hypertensive patients than individual drug telmisartan, hydrochlorothiazide and amlodipine besylate to provide quick onset of action and improve drug adherence. ODT formulations of telmisartan and amlodipine besylate (F1), telmisartan and hydrochlorothiazide (F2), amlodipine besylate and hydrochlorothiazide (F3) were prepared by direct compression method and evaluated for precompression parameters and post-compression parameters. Formulation F1 showed the highest release of the drug, i.e., 80.7 ± 0.5%, whereas F2 and F3 showed 66.285 ± 0.3% and 65.182 ± 0.7% respectively for 15 min. All three formulations (F1, F2 and F3) passed the tests with disintegrating time within the limit of 20 s. The hardness of formulations was in the range of 4.33 to 5.33 kg/cm2 and the friability of all the formulations were found to be within limit of 1%. The thickness and diameter of all the formulations were found to be 0.2-0.3 cm and 0.8 cm respectively. The % dissolution efficiencies were found in the order of F1>F3>F2. All formulations were found to be stable when were maintained at 40 ± 2°C/75 ± 5% RH and 50 ± 2°C/75 ± 5% RH for 6 months. This multidrug combination therapy may serve as an alternative for conventional single pill dosage form to treat hypertension.

Carotid flow velocity/diameter ratio is a predictor of cardiovascular events in hypertensive patients.

The aim of this study was to evaluate the performance of common carotid artery diameter, flow velocity and flow velocity/artery diameter ratio as predictors of major adverse cardiovascular events (MACEs) in a sample of hypertensive patients. A cohort of 403 hypertensive patients was followed up for a median of 1260 (714) days, and 27 suffered MACEs. At baseline, participants were evaluated by clinical, laboratory, echocardiographic and carotid ultrasound analysis. Patients with peak-systolic flow velocity (sFV) less than the median value and systolic artery diameter (sAD) greater than the median value presented the worst clinical outcome compared to those with isolated sFV less than the median value or sAD greater than the median value, suggesting an additive effect of these two variables. Further, Kaplan-Meier analysis demonstrated worse outcome for individuals with sFV/sAD ratio less than 85.7/s (optimal cut-off point obtained by receiver-operating characteristic analysis) compared to those with higher sFV/sAD values (log-rank test: P < 0.0001). In stepwise multivariable Cox-regression analyses, sFV/sAD was significantly associated with MACEs (P < 0.001), whereas carotid intima-media thickness and clinically defined high cardiovascular risk did not. Furthermore, area under the receiver-operating characteristic curve for sFV/sAD was higher than that for Framingham risk score (0.77 versus 0.64; P = 0.045), whereas adding sFV/sAD to the Framingham risk factors resulted in increased net reclassification improvement (P = 0.041) and integrated discrimination improvement (P < 0.001). Lower carotid sFV/sAD was associated with MACEs in hypertensive patients independent of cardiovascular prediction models and carotid intima-media thickness. These findings suggest that this index may be a promising approach to identify hypertensive subjects at increased risk for future cardiovascular events.

Association of ambulatory arterial stiffness index with sEPCR in newly diagnosed hypertensive patients

Aim: Increased arterial stiffness is strongly associated with cardiovascular diseases, while thrombotic events are more common than hemorrhagic events in hypertensive patients. Markers of a hypercoagulable state may also predict future cardiovascular events in hypertensive patients. Here, we speculated that increased arterial stiffness might lead to the development of a hypercoagulable state that can play a role in the thrombotic complications of hypertension. Soluble endothelial protein C receptor (sEPCR) is one such marker of hypercoagulation. The ambulatory arterial stiffness index (AASI) could be accepted as a non-invasive measure of arterial stiffness. The aim of this study was to investigate association of AASI with levels of sEPCR in newly diagnosed hypertensive patients. Materials and methods: The study included 263 newly diagnosed essential hypertensive patients and 55 healthy normotensive controls. All subjects underwent 24 h ambulatory blood pressure monitoring (ABPM); the AASI was derived from ABPM tracings. Plasma sEPCR was measured by ELISA. Results: Hypertensive patients (n = 263) had higher AASI, C-reactive protein (CRP) and sEPCR versus the normotensive healthy group (n = 55). Univariate analysis showed that AASI was positively associated with age (r = 0.212, p < 0.001) body mass index (r = 0.412, p < 0.001), pulse pressure (r = 0.350, p < 0.001), plasma sEPCR (r = 0.894, p < 0.001), 24-h heart rate (r = 0.176, p = 0.001) and inversely related to high-density lipoprotein (HDL) (r = −0.293, p < 0.001). Multivariate analyses revealed that sEPCR and HDL are independently correlated to AASI. Conclusion: We suggest that increased AASI is associated with elevated sEPCR. It might be responsible for subsequent thrombotic events in newly diagnosed hypertensive patients.

A trial of telmisartan prevention of cardiovascular diseases (ATTEMPT-CVD): Biomarker study.

A trial of telmisartan prevention of cardiovascular disease (ATTEMPT-CVD) was performed to compare the effects of angiotensin II receptor blocker (ARB) therapy and those of non-ARB standard therapy on biomarker level changes and the incidence of cardiovascular events in hypertensive patients. In this multicenter, open-label, randomized, parallel-group, comparative study, the effects of ARB therapy and those of non-ARB standard therapy on urinary albumin creatinine ratio (UACR) and plasma brain natriuretic peptide (BNP) level changes were investigated for three years from the start of antihypertensive treatment as the primary endpoints. The incidences of cardiovascular composite events were compared between the two groups, and the relationship between the incidence of the events and biomarker changes were investigated as secondary endpoints. The study started with 615 patients in the ARB group and 613 patients in the non-ARB group. The ARB group had a significant effect on UACR and plasma BNP level changes compared with the non-ARB group. Fewer cardiovascular events occurred in the ARB group, but the difference was not statistically significant. UACR and plasma BNP levels at baseline were associated with cardiovascular events. This study provided the first evidence that ARB treatment caused a smaller increase in plasma BNP and a greater decrease in UACR than non-ARB treatment, independently of blood pressure control, and gives a novel insight into the significance of BNP and UACR as predictors of cardiovascular and renal risk on antihypertensive treatment.

Left ventricular hypertrophy on long-term cardiovascular outcomes in patients with ST-elevation myocardial infarction

Background: Left ventricular hypertrophy (LVH) had been associated with increased adverse cardiovascular events in hypertensive patients. Prognostic significance of LVH in patients with ST-elevation myocardial infarction (STEMI) is not established. This study aimed to investigate prognostic impact of LVH on the patients with STEMI. Methods: We analyzed the data and clinical outcomes of 30-day survivors with STEMI who underwent successful coronary intervention from 2003 to 2009. Definition of LVH was LV mass index (LVMI) >115 g/m2 in male and >95 g/m2 in female. Patients were classified into a LVH group and a non-LVH group. Occurrence of major adverse cardiovascular events (MACE; death, recurrent MI, target vessel revascularization (TVR)) within 5 years was evaluated. Results: We enrolled 418 patients and mean follow-up duration was 43 ± 17 months. Two hundred and fourteen patients (51%) had LVH. The survival of the patients with LVH was significantly worse than the patients without LVH (log-rank p = 0.024). In a multivariate regression model, the presence of LVH was independently associated with increased risk for all-cause mortality (OR, 2.37; 95% CI, 1.096–5.123, p = 0.028). When the end points were analyzed based on LVH severity, all-cause mortality was significantly correlated with LVH severity (p = 0.011). The severe LVH was independently associated with increased risk for all-cause mortality (OR, 5.110; 95% CI, 1.454–17.9, p = 0.001). Conclusion: LVH was associated with increased rate of adverse clinical outcomes in 30-day survivors after STEMI, who underwent successful coronary intervention.