Function In Essential Hypertension Research Articles

Effects of two-month treatment with a mixture of natural activators of autophagy on oxidative stress and arterial stiffness in patients with essential hypertension: A pilot study

Background and aimsTrehalose, spermidine, nicotinamide, and polyphenols are natural substances that exert pro-autophagic and antioxidant properties. Their role in blood pressure (BP) regulation and preservation of vascular function in essential hypertension is unknown. The aim of this study was to evaluate the effect of a mixture of these agents on BP level, markers of oxidative stress, autophagy, endothelial function, and vascular stiffness in outpatients with grade 1 uncomplicated essential hypertension. Methods and resultsA single-centre, open-label, case–control, pilot study was conducted in adult outpatients (aged ≥18 years) receiving or not the mixture for two months along with the standard therapies. Both at baseline and at the end of the treatment the following clinical parameters were evaluated: brachial seated office BP level, central aortic pressure, pulse wave velocity, augmentation index (AI@75). Both at baseline and at the end of the treatment, a blood sample was drawn for the measurement of: H2O2, HBA%, levels of sNOX2-dp, Atg 5, P62, endothelin 1, and NO bioavailability. The mixture of nutraceuticals did not influence BP levels. Patients receiving the mixture showed a significant decrease of oxidative stress, stimulation of autophagy, increased NO bioavailability and no increase of the AI@75, in contrast to what observed in hypertensive patients not receiving the mixture. ConclusionsThe supplementation of the trehalose, spermidine, nicotinamide, and polyphenols mixture counteracted hypertension-related arterial stiffness through mechanisms likely dependent on oxidative stress downregulation and autophagy stimulation. These natural activators of autophagy may represent favourable adjuvants for prevention of the hypertensive cardiovascular damage.

Serum aldosterone effect on left ventricular structure and diastolic function in essential hypertension

Aldosterone has hypertrophic and profibrotic effects on the heart. This study aims to determine the relationship between serum aldosterone concentration (SAC) and aldosterone-to-renin ratio (ARR) with left ventricular (LV) geometry and diastolic function in essential hypertension (EH). We investigated 213 EH patients (50.3±12.6 years; 57.7% male). SAC, ARR measurements, and echocardiographic analysis were performed for participants. Overall, stepwise multiple regression analysis showed significant associations between SAC and interventricular septum, LV posterior wall thickness, LV amass, LV mass index, e' velocity, a' velocity, and E/e' ratio after adjustment of potentially confounding covariates. When patients were divided into three SAC tertiles, multivariate-adjusted analysis of covariance (ANCOVA) demonstrated a significant increase in LV mass (P ˂ 0.001), LV mass index (P ˂ 0.001), relative wall thickness (P=0.003), interventricular septum (P=0.001), LV posterior wall thickness (P=0.001) and E/e' ratio (P ˂ 0.001), but a decrease in e' velocity (P=0.002) from the first to third tertile of SAC. In logistic regression analysis, increased SAC was independently associated with concentric LV hypertrophy [OR: 1.21, 95% CI: 1.11-1.33, P ˂ 0.001]. No significant associations were found between ARR and echocardiographic parameters of LV structure or diastolic function. In conclusion, SAC, but not ARR, is independently associated with echocardiographic indices of LV structure and diastolic function and is also related to concentric LV hypertrophy. Our findings suggest that aldosterone's pro-hypertrophic and myocardial fibrosis effects contribute to alterations in LV structure and diastolic function in EH beyond blood pressure.

345 Blood pressure and autonomic function in essential hypertension: comparative evaluation of 24-hour heart rate variability and blood pressure

Abstract Aims Arterial hypertension (AHT) represents the leading cause of cardiovascular disease (CVD) and premature death worldwide. Essential AHT accounts for 95% of all cases of hypertension; although the aetiology of essential AHT is still largely unknown, a pivotal role of autonomic nervous system has been proposed and demonstrated. Both excessive sympathetic tone and vagal withdrawal, that define autonomic dysfunction, has been associated with essential AHT. The aim of our study was to investigate the relationship between blood pressure and autonomic function in essential hypertension; this was done comparing 24 h heart rate variability and 24 h blood pressure data, simultaneously collected, in a population of essential AHT subjects. Methods A prospective registry of 179 consecutive not selected essential AHT patients were considered in the present study. All patients underwent cardiac evaluation at the Primary and Secondary Cardiovascular Prevention Unit of the Don Gnocchi Foundation of Parma. All subjects underwent 24 h ECG monitoring, and 24 h Ambulatory Blood Pressure Monitoring, during the same day. Twenty-four hours Heart Rate variability analysis included: Time-domain, frequency-domain and non-linear domain. Results Mean age was 60 0a11.7 years, male gender was prevalent (68.4%). Among the population 26 (14.7%) subjects had diabetes; the prevalence of family history of CVD was 61.7% and 66.5% had dyslipidaemia; body mass index mean values were 27.6 7.4.3. In the whole population, the prevalence of uncontrolled AHT was 80.5%, divided into: 53.1% systo-diastolic, 17.9% isolated systolic, and 9.5% isolated diastolic. The prevalence of untreated AHT (recent diagnosis) was 40.2%, while treated AHT was 59.8% and only 19.6% had controlled blood pressure values (AHT at target). 12.3% of patients were treated with Beta Blockers. A significant correlations between diastolic blood pressure (DBP) values (24 h and day-time), LF/HF ratio (24 h) (r = 0.200; P = 007) and DFA alfa1 (24 h) (r = 0.325; P = 0.000), two know markers of sympathetic tone, were found. A higher sympathetic tone, expressed as high LF/HF, was found in isolated diastolic AHT compared to other types of AHT and the lowest sympathetic tone was found in isolated systolic AHT. Considering non-linear (complexity) analysis, DFA alfa1 (24 h) showed a significant correlation with DBP values that remained independent even after multiple adjustment for BMI, age, gender and Beta Blockers (β = 0.218; P = 0.011). Moreover, the lack of DBP control was associated with high sympathetic tone (LF/HF 3.8 112.3 vs 5.5 .33.3; P < 0.0001). On the other hand, no significant correlations between all DBP data and vagal markers, such as SDNN index, RMSSD and HF, were found. Again, no significant correlations between 24 h, daytime, night-time SBP and time or frequency HRV data as well as with non-linear (complexity) analysis were found. Finally, considering ‘autonomic dipping’, expressed as changes in HRV data between day and night, a strong inverse correlation between vagal markers and Heart Rate Dipping (r = −0.297; P < 0.0001) was found; correlation that remain independent even adjusted for age, gender, BMI, and BB. On the other hand, no association between blood pressure dipping and autonomic dipping was found. Conclusion Diastolic blood pressure and uncontrolled diastolic AHT, rather than systolic AHT, are associated with a hyper-sympathetic tone rather than with blunted vagal tone. The lack of heart rate dipping during night-time in AHT is associated with blunted vagal activation rather than a persistent night-time hyper-adrenergic tone.

The Sympathetic Nervous System in Hypertension: Roadmap Update of a Long Journey.

The present paper will provide an update on the role of sympathetic neural factors in the development and progression of essential hypertension by reviewing data collected in the past 10 years. This will be done by discussing the results of the published studies in which sympathetic neural function in essential hypertension and related disease has been investigated via sophisticated and highly sensitive techniques, such as microneurographic recording of sympathetic nerve traffic and regional norepinephrine spillover. First, the relevance of the pathophysiological background of the neurogenic alterations will be discussed. It will be then examined the behavior of the sympathetic neural function in specific clinical phenotypes, such as resistant hypertension, pseudoresistant hypertension, and hypertensive states displaying elevated resting heart values. This will be followed by a discussion of the main results of the meta-analytic studies examining the behavior of sympathetic nerve traffic in essential hypertension, obesity, metabolic syndrome, and chronic renal failure. The sympathetic effects of renal denervation and carotid baroreceptor stimulation as well as the possible involvement of sympathetic neural factors in the determination of the so-called “residual risk” of the treated hypertensive patients will be finally discussed.

BNP LEVELS AND LEFT VENTRICULAR MORPHOLOGY AND FUNCTION IN HYPERTENSIVE PATIENTS BEFORE AND AFTER AN INTRAVENOUS SALINE LOAD

Objective: Previous studies have reported a relationship between BNP levels and left ventricular (LV) morphology and function in essential hypertension (EH), but results are conflicting. The aim of the study was to investigate the relationships between BNP levels measured before and after a standard saline load (SLT), plasma aldosterone (PA), active renin (AR), and LV variables in EH patients without heart failure or valvular disease. Design and method: In 155 EH patients (age 48 ± 12 years, 92 males, 64 treatment-naïve, the remaining 91 after drug wash-out), a SLT (0.9% saline, 2 L in 4 hours) was performed with baseline and post-SLT measurement of PA, AR, BNP pre- and post-test (pre-BNP, post-BNP). Echocardiography with Tissue Doppler Imaging (TDI) was performed, with measurement of indexed LV mass (LVMI), ejection fraction (EF), TDI-S velocity, E/A and E/e’ ratios, and TDI-e’ velocity. Results: Pre-BNP level was higher in females than males, and in patients with previous antihypertensive treatment than in naive patients. Pre-BNP level was significantly and directly related to age, LVMI, E/e’, and inversely related to glomerular filtration (GFR), AR, TDI-S, E/A, and TDI-e’. Post-BNP levels was higher in females and in previously treated patients, and it was positively related to age, E/e’ ratio, and inversely related to GFR, AR, TDI-S, E/A, and TDI-e’. At multivariate analysis pre-BNP level was independently associated with age, female gender, GFR, and AR, while post-BNP level was independently associated with age, AR, and previous antihypertensive treatment. Conclusions: In EH patients, plasma BNP is related with LVMI and LV systolic and diastolic function before and after a SLT, but this relationship seems to be limited to female sex and older subjects. Measurement of BNP might be useful for identification and follow-up of subclinical LV abnormalities in these patients.

Mechanisms Of Akap150 In Aerobic Exercise-induced Improvement Of Cerebral Arterial Function In Essential Hypertension

A-kinase anchoring protein AKAP150, facilitating transduction events by binding protein kinase Cα (PKCα) to specific cellular microdomains, plays a central role in voltage-gated L-type Ca2+ channel (LTCC) remodeling in vascular smooth muscle during hypertension. Emerging evidence have demonstrated the beneficial effects of regular exercise on reducing blood pressure and improving arterial function in hypertension, however, less is known regarding the cellular mechanisms underlying the vascular changes with exercise. PURPOSE: To investigate the mechanism of AKAP150/PKCα signaling pathway in exercise-mediated LTCC function of cerebral arteries during hypertension. METHODS: 12-week-old male spontaneously hypertensive rats (SHR) and Wistar-Kyoto (WKY) rats were randomly assigned to sedentary (WKY-SED, SHR-SED) and exercise training (WKY-EX, SHR-EX) groups. Exercise groups were performed a moderate-intensity treadmill running (about 55-65% VO2max, 20 m/min, 0 grade, 60 min, 5 days/week). After 12 weeks, artery contraction myography, patch-clamp electrophysiology, Ca2+ image, Western blot and immunofluorescence were used to detect cerebral vascular tone, LTCC whole-cell and single channel currents, Ca2+ sparklets, and AKAP150/PKCα signaling pathway. RESULTS: Exercise attenuated LTCC contribution to cerebral vascular tone regulation (39.0±1.3 vs. 27.5±2.0 %Kmax) and LTCC currents in cerebral arterial myocytes of SHR (−13.2±1.7 vs. −9.6±1.5 pA/pF, both P<0.05). The LTCC channel open probability (nPo) and persistent Ca2+ sparklet activity (nPs) of cerebral arterial myocytes were significantly reduced in SHR-EX as compared with SHR-SED (nPo: 0.08±0.01 vs. 0.12±0.01; nPs: 0.65±0.15 vs. 0.82±0.10; both P<0.05). The protein expression of AKAP150 in cerebral artery was significantly up-regulated in SHR-SED (4.9±0.6), while down-regulated in SHR-EX (1.4±0.2, P<0.05). The colocalization rate of AKAP150 and PKCα at the sarcolemma were lower in cerebral arterial myocytes from SHR-EX than those from SHR-SED (20.1±1.1 vs. 30.0±1.6%, P<0.05). CONCLUSIONS: Chronic exercise inhibits LTCC channel activity and persistent Ca2+ sparklets in vascular smooth muscle via suppression of AKAP150/PKCα signaling pathway, and ameliorates the dysfunction of cerebral arteries during hypertension.

Effect of Tianteng Jiangya decoction on blood pressure and vascular endothelial function in essential hypertension

Objective To observe the effect of Tianteng Jiangya decoction on vascular endothelial function in essential hypertension. Methods 70 patients with essential hypertension were enrolled in this study, they were divided into study group(35 cases) and control group(35 cases) according to the random number table.The control group was treated with levamlodipine for 8 weeks, the study group was treated with Tianteng Jiangya decoction on the basis of the control group for 8 weeks.Then, the DBP and SBP were observed before and after treatment.The ET-1 and nitric oxide(NO) were measured by radioimmunoassay and spectrophotometry.The curative effect and symptom of both two groups were evaluated. Results The levels of DBP and SBP in the study group and the control group were (80±4)mmHg and (88±5)mmHg, (118±13)mmHg and (131±15)mmHg, respectively, which were significantly lower than those before treatment(t=7.263, 4.488, 9.227, 4.422, all P 0.05). The total effective rates of dizziness, headache, five upset hot, forgetfulness in the study group and the control group were 89.47% and 64.71%, 90.00% and 63.16%, 88.89% and 50.00%, 82.35% and 47.37%, respectively, the differences were statistically significant (χ2=6.422, 6.585, 6.247, 6.456, all P<0.05). The total effective rate of the study group was 94.29%, which was significantly higher than 71.43% of the control group, the difference was statistically significant(χ2=9.622, P<0.01). Conclusion Tianteng Jiangya decoction can effectively control the blood pressure of patients with essential hypertension, improve the efficacy of traditional Chinese medicine and vascular endothelial function, has obvious advantages, it is worthy of clinical use. Key words: Hypertension; Tianteng jiangya decoction; Vascular endothelial growth factors

Cilostazol suppresses angiotensin II-induced apoptosis in endothelial cells.

Patients with essential hypertension undergo endothelial dysfunction, particularly in the conduit arteries. Cilostazol, a type III phosphodiesterase inhibitor, serves a role in the inhibition of platelet aggregation and it is widely used in the treatment of peripheral vascular diseases. Previous studies have suggested that cilostazol suppresses endothelial dysfunction; however, it remains unknown whether cilostazol protects the endothelial function in essential hypertension. The aim of the present study was to investigate whether, and how, cilostazol suppresses angiotensin II (angII)-induced endothelial dysfunction. Human umbilical vein endothelial cells (HUVECs) and Sprague Dawley rats were exposed to angII and treated with cilostazol. Endothelial cell apoptosis and function, nitric oxide and superoxide production, phosphorylation (p) of Akt, and caspase-3 protein expression levels were investigated. AngII exposure resulted in the apoptosis of endothelial cells in vitro and in vivo. In vitro, cilostazol significantly suppressed the angII-induced apoptosis of HUVECs; however, this effect was reduced in the presence of LY294002, a phosphoinositide 3 kinase (PI3K) inhibitor. Furthermore, cilostazol suppressed the angII-induced p-Akt downregulation and cleaved caspase-3 upregulation. These effects were also alleviated by LY294002. In vivo, cilostazol suppressed the angII-induced endothelial cell apoptosis and dysfunction. Cilostazol was also demonstrated to partially reduced the angII-induced increase in superoxide production. The results of the present study suggested that cilostazol suppresses endothelial apoptosis and dysfunction by modulating the PI3K/Akt pathway.

Association Between Serum Cortisol and Chronic Kidney Disease in Patients with Essential Hypertension

Background/Aims: Serum cortisol level is elevated in patients with essential hypertension. We aimed at investigating the association of serum cortisol levels with parameters of renal function in essential hypertension. Methods: One hundred and seventy-eight patients with essential hypertension participated in the study. Fasting serum samples were collected at 8:00 am. Renal function was measured as estimated glomerular filtration rate (eGFR) calculated by the Chronic Kidney Disease Epidemiology Collaboration creatinine- cystatin C equation (eGFRcr-cys). Correlation analysis and stepwise regression analysis were used to detect the relationship between cortisol and eGFRcr-cys. The distributions of serum cortisol were split by the tertiles and subjects were stratified into those with low, median and high levels accordingly. Results: Serum cortisol levels were significantly higher in subjects whose eGFRcr-cys<90 ml/min/1.73 m² than subjects whose eGFRcr-cys>90 ml/min/1.73 m² (394.0±93.4 vs. 343.2±98.4 nmol/L, P=0.001). Age, systolic blood pressure, and serum total cholesterol, uric acid, cortisol levels were significantly associated with eGFRcr-cys, serum levels of creatinine and cystatin C. After adjusting for clinical factors, serum cortisol level had a statistically significant negative association with the eGFRcr-cys (β=-0.19, P=0.027), and positive associations with cystatin C (β=0.31, P=0.001) and creatinine (β=0.14, P=0.044). With the increment of cortisol tertile, the eGFRcr-cys significantly decreased (93.18±14.36 vs. 84.61±14.67 vs. 81.29±12.36 ml/min/1.73 m² for low, median and high tertile, respecively, P=0.001). Conclusion: Serum cortisol level was negatively correlated with eGFRcr-cys in subjects with essential hypertension. Further studies are needed to investigate whether cortisol plays a role in hypertensive nephropathy development.

Central arterial stiffness and systemic vascular resistance influence on left ventricular geometry and diastolic function in essential hypertension

Central arterial stiffness and systemic vascular resistance influence on left ventricular geometry and diastolic function in essential hypertension

Renal and Heart Function in Essential Hypertension

Background: The relationship between heart and renal function is a precarious matter that has been investigated through the years. Lately many studies suggest that renal injury is associated with early stage heart dysfunction. The aim of the present study is to investigate the grade of renal deterioration according to heart function in non diabetic essential, never treated, hypertensive patients. Methods: We studied 7970 consecutive patients (4419 males, mean age 53 years) with uncomplicated essential hypertension and the correlation between cardiac function using the Tei index (defined as the sum of the isovolumetric relaxation and contraction time divided by the ejection time), transmitral blood flow velocities ratio (E/A), ejection fraction (EF) and kidney injury [eGFR( ml/min), ACR (urine albumin-creatinine ratio)]. Patients were grouped by ACR (ACR>30 and ACR90, eGFR 90-60, eGFR 60-40). Results: The model was adjusted for age, gender, blood pressure, lipid profile and smoking habit. EF was decreased with renal function deterioration as did the E/A ratio, while the Tei index increased (Table). Furthermore EF has higher normal levels in patients with ACR <30 as did the E/A ratio while Tei index present lower levels. Conclusions: We found that the Tei index and E/A was correlated with eGFR, and ACR. It seems that systolic and diastolic heart function indices can be used not only for the evaluation of the global myocardial performance of hypertensive patients but also for the assessment of the risk of kidney damage.

3-dimensional speckle tracking echocardiography for left ventricular rotation and twist in patients with hypertension

To analyze the characteristics of left ventricular rotation and twist in patients with essential hypertension (EH) of different left ventricular configurations by 3-dimensional speckle tracking echocardiography (3D-STE). A total of 106 EH patients were divided into 4 groups: a left ventricular normal configuration (LVN) group (n=30), a concentric remodeling (CCR) group (n=31), a concentric hypertrophy (CCH) group (n=29), an eccentric hypertrophy (ECH) group (n=16), and a control group of 30 healthy subjects. The parameters of LVEF, peak basal rotation (Prot-B), peak apical rotation (Prot-A), left ventricular peak apical rotation (LV-rot), and left ventricular peak apical twist (LV-tw) were compared. The left ventricular mass index in the EH groups, which kept increasing, was higher than that in the normal control group (P<0.05). Compared with the normal control group, LVN and ECH group, the left ventricular posterior wall thickness, interventricular septum at end-diastole, and relative wall thickness significantly increased in the CCH and CCR group (P<0.05). LVEF showed no significant difference among the normal control, LVN, CCR and CCH group (P>0.05), but LVEF was lower in the ECH group than in other groups (P<0.05). Compared with the normal control group, Prot-B, Prot-A, LVrot and LVtw were significantly higher in the LVN, CCR and CCH group (P<0.05), but decreased in the ECH group (P<0.05). 3D-STE can evaluate the left ventricular rotation and twist in EH patients with different configurations, and reflect changes in the left ventricular systolic function in EH of different configurations.

Association of E/E′ and NT-proBNP with Renal Function in Patients with Essential Hypertension

ObjectivesTo evaluate the association of left ventricular (LV) diastolic function and N-terminal pro-brain natriuretic peptide (NT-proBNP) with renal function in essential hypertension.MethodsLV diastolic function was estimated by the ratio of early diastolic velocities (E) from transmitral inflow to early diastolic velocities (E′) of tissue Doppler at mitral annulus (septal corner); NT-proBNP was measured in 207 hypertensive patients (mean age 56±14 years). The subjects were classified into 3 groups: E/E′≤10 group (n = 48), 10<E/E′≤15 group (n = 109) and E/E′>15 group (n = 50). The renal function was estimated by glomerular filtration rate (GFR) with 99mTc-DTPA. GFR from 30 to 59 ml/min/1.73 m2 was defined as Stage 3 chronic kidney disease (CKD). GFR was also estimated using the modified MDRD equation. Albuminuria was defined by urinary albumin/creatinine ratio (UACR).ResultsGFR was lower and UACR was higher in E/E′ >15 group than in 10< E/E′ ≤15 group or E/E′ ≤10 group (p<0.0001), GFR was significantly negative and UACR was positive correlated with E/E′ and NT-proBNP (p<0.0001). In multivariate stepwise linear analysis, GFR had significant correlation with age (p = 0.001), gender (p = 0.003), E/E′ (p = 0.03), lgNT-proBNP (p = 0.001) and lgUACR (p = 0.01), while eGFR had no significant correlation with E/E′ or lgNT-proBNP. Multivariate logistic regression analysis, adjusted for potential confounding factors, showed that participants in E/E′>15 group were more likely to have Stage 3 CKD compared with those in E/E′≤10 group with an adjusted odds ratio of 8.31 (p = 0.0036).ConclusionsLV diastolic function, assessed with E/E′ and NT-proBNP is associated with renal function in essential hypertension.

761 ASSOCIATION OF E/Ea AND NT-proBNP WITH RENAL FUNCTION IN PATIENTS WITH ESSENTIAL HYPERTENSION

Background: To evaluate the association of left ventricular (LV) diastolic function and N-terminal pro-brain natriuretic peptide (NT-proBNP) with renal function in essential hypertension. Methods: In 406 hypertensive patients(mean age, 59±13 years), LV diastolic function was measured by the ratio of early diastolic transmitral E wave velocities to tissue Doppler mitral annulus early diastolic Ea wave velocities (E/Ea) and NT-proBNP was determined. The subjects were classified into three groups: E/Ea≤10 group(n = 85), 10 < E/Ea≤15 group(n = 230) and E/Ea>15 group(n = 91). The renal function was estimated by glomerular filtration rate (GFR) with 99mTc-DTPA. GFR from 30 to 59 ml/min/1.73m2 was defined as Stage 3 CKD. Urinary albumin/creatinine ratio (UACR) served to determine albuminuria. Results: GFR and UACR was significantly correlated with E/Ea and NT-proBNP (P < 0.0001). GFR was lower and UACR was higher in E/Ea≤15 group than in 10 < E/Ea≤15 group or E/Ea≤10 group(P < 0.0001). GFR had significant correlation with age, gender, E/Ea, lgNT-proBNP and lgUACR in multivariate analysis. Patients with higher NT-proBNP were characterized by poorer renal function, while GFR was even lower in patients of LV diastolic dysfunction with higher NT-proBNP. Patients with Stage 3 CKD could be detected by an elevation of NT-proBNP at a cut-off point of 103pg/ml or by increased E/Ea at a cut-off point of 12.4. Conclusions: LV diastolic function, assessed with E/Ea and NT-proBNP is associated with renal function in essential hypertension.

Evaluation of left ventricular diastolic function by tissue Doppler echocardiography in essential hypertension

ObjectiveLeft ventricular (LV) diastolic dysfunction is common in essential hypertension. The aims of this study were to evaluate LV diastolic function in essential hypertension using conventional pulse-wave Doppler echocardiography (cPWD)...

The evaluation of left ventricular diastolic function by tissue Doppler echocardiography in essential hypertension

To evaluate Left ventricular(LV) diastolic function in essential hypertension by conventional pulse-wave Doppler echocardiography (cPWD) and Doppler tissue imaging (DTI) and compare the two modalities. Two hundred patients with essential hypertension were classified as NLVH subgroup (n = 160) and LVH subgroup (n = 40) based on left ventricular mass index (LVMI) with one hundred and sixty health subjects as control group. The mitral valve flow pattern (MVFP) was obtained.Early diastolic (E) and late velocities (A) were measured and E/A was calculated. DTI was used to obtain the left ventricular lateral wall early diastolic mitral annulus velocity (Em) and E/Em was calculated. Essential hypertension patients had LV diastolic dysfunction both by cPWD (higher E and lower E/A ratio) and DTI (lower Em and higher E/Em ratio) compared with healthy subjects [E: (0.88 ± 0.18) cm/s vs (0.76 ± 0.19) cm/s; E/A ratio: 0.86 ± 0.28 vs 1.02 ± 0.38; Em: (9.4 ± 2.8) cm/s vs (11.9 ± 3.8) cm/s; E/Em ratio: 7.9 ± 2.7 vs 6.0 ± 1.8: with all P value < 0.01]. Em was significantly reduced and E/Em was significantly elevated in LVH subgroup than NLVH subgroup [Em: (7.7 ± 2.6) cm/s vs (9.9 ± 2.8) cm/s, E/Em:9.6 ± 3.6 vs 7.4 ± 2.4, P < 0.05]. No significant difference was found in A and E/A between these two subgroups [(0.90 ± 0.22) cm/s vs (0.87 ± 0.17) cm/s; 0.80 ± 0.34 vs 0.88 ± 0.28, P > 0.05]. cPWD and DTI both had implications to detect diastolic dysfunction in non-hypertrophic stage hypertension. Em, E/Em could be more sensitive and precise to reflect the impairment of diastolic function in the progress of hypertension.

IMPROVEMENT ON INSULIN SENSITIVITY AND MUSCLE BLOOD FLOW IN AEROBIC TRAINED OVERWEIGHT-OBESE HYPERTENSIVES IS NOT ASSOCIATED WITH AMBULATORY BLOOD PRESSURE: PP.37.504

Background: The effects aerobic training on ambulatory blood pressure (ABP) and vascular function in essential hypertension was not fully investigated and is still poorly understood. Objective: The aim of this randomized controlled trial was to investigate effects of a supervised aerobic training program on ABP, vascular function, and hormonal profile in essential hypertension. Methods: Sedentary non-medicated hypertensive subjects were randomized to an aerobic training (n = 55, electronic treadmill, intensity 50–75% VO2max, 3–5 45-min sessions per week) program or a postural protocol (n = 24, control group), on a 2/1 proportion. Prescribed exercise intensity was controlled in every aerobic session through Polar A3 monitor. At the beginning and after 3 months of intervention, subjects were evaluated for 24-hr ABP (SpaceLabs 90207 monitor, USA), arterial compliance (radial tonometry, CR 2000, HDI, USA), forearm blood flow and flow-mediated vasodilation (EC6 venous occlusion pletysmograph, Hokanson, USA), and hormonal profile including HOMA-RI calculation. Results: The aerobic training was effective to promote a 12% increase in VO2max (p = 0.0001), while no significant variation was observed in the control group. In both groups, ambulatory blood pressure did not significantly modify, as well as arterial compliance, plasma renin, aldosterone, C-peptide, and urine metanephrines. In the aerobic, but not in the control group, was observed a decrease in insulin resistance (HOMA-RI, p = 0.039), a decrease in plasma cortisol (p = 0.006), an increase in flow-mediated vasodilation (p = 0.002), and an increase in forearm blood flow (p = 0.001). Conclusion: The 3-month supervised aerobic training did not significantly modify the blood pressure profile of hypertensive subjects when compared to a postural control protocol. Nevertheless, the results suggest that fitness gain can promote a decrease in cardiovascular risk of hypertensive subjects, improving endothelial function and insulin resistance.

Abstract 5532: Apoptosis, Interstitial Collagen and Diastolic Function in Essential Hypertension

Introduction: Sustained hypertension (HT) leads to left ventricular hypertrophy (LVH) and left ventricular dilatation, processes associated with loss of cardiac myocytes through apoptosis. Nevertheless, the relationship of apoptosis, myocardial fibrosis and diastolic function remains unknown. Therefore, the aims of the present study were to analyze the relationship between aminoterminal propeptide levels of type III procollagen (PIIINP), sFas, soluble TNF receptor 1 (sTNF-R1) and diastolic function in essential HT. Hypothesis: We assessed the hypothesis that increased cardiac collagen turnover would be associated with LVH, diastolic dysfunction and apoptosis even in asymptomatic HT. Methods: The asymptomatic hypertensive group consisted of 253 Caucasian patients (mean age 60±13 years, 139 males) from 11 hospitals. A routine physical examination, laboratory analyses, and echo-Doppler study were performed. Results: Serum concentrations of PIIINP were higher in hypertensive patients compared to control group [4.18 (3.55 – 5.04 μ g/L) vs. 3.54 (2.98 – 4.54 μ g/L), p=0.006] and also plasma levels of sFas and sTNF-R1 [1.40 (1.13 – 1.69 ng/mL) vs. 1.00 (0.84 – 1.27 ng/mL), p&lt;0.0001; 385 (291 – 545 pg/mL) vs. 236 (194 – 302 pg/mL), p&lt;0.0001]. Log-transformed concentrations of anti-apoptotic cytokines were correlated between them (r=0.404, p&lt;0.0001). Moreover, serum PIIINP concentrations were associated with log-transformed sFas (r=0.386, p&lt;0.0001) and sTNF-R1 (r=0.298, p&lt;0.001). Then, multivariate analyses included sFas (p&lt;0.0001) and sTNF-R1 (p&lt;0.0001) as independent factors of serum procollagen levels. Finally, marker concentrations were significantly correlated with diastolic parameters. Conclusions: This study showed increased circulating levels of PIIINP, sFas and sTNF-R1 in our group of asymptomatic hypertensive patients. Furthermore, sFas and sTNF-R1 are independent factors of serum type III procollagen, and diastolic parameters showed a highly significant relationship with myocardial fibrosis and anti-apoptotic cytokines.

P-367 Protective Role of Vascular Endothelial Growth Factor on Renal Function in Essential Hypertension

P-367 Protective Role of Vascular Endothelial Growth Factor on Renal Function in Essential Hypertension

A randomized, double-blind study of valsartan versus metoprolol on arterial distensibility and endothelial function in essential hypertension

Antihypertensive drugs may have differential, pressure-independent effects on hypertension-associated alterations of arterial function. We compared the effects of a 12-week therapy with the AT(1)-receptor antagonist valsartan (Val) versus the beta-blocker metoprolol (Met) on arterial stiffness and endothelial function in mildly hypertensive patients at rest and during generalized sympathetic stimulation. Sixty-eight patients (37 male, 31 female, 46 +/- 6 years) were randomized to Val (80-160 mg/d) or Met (50-100 mg/d). Effects of therapy on endothelial function, brachial and carotid artery distensibility coefficients, pulse wave velocity, carotid intima-media thickness and elastic modulus were assessed at rest and during the cold pressor test. Fifty-two patients were available for per protocol analysis. Blood pressure was comparably reduced in both treatment groups. Effects on endothelial function and large artery elastic wall properties did not differ significantly between the two antihypertensive treatment regimens. Trends did not differ significantly between groups for any parameter including carotid intima-media thickness and elastic modulus. Short-term treatment with Val and Met had similar effects on large artery functional vessel wall properties in a population of mildly hypertensive patients.