Function In Hypertensive Patients Research Articles

COLOR M-MODE PROPAGATION VELOCITY (VP) TO ASSESS THE LEFT VENTRICULAR DIASTOLIC FUNCTION IN HYPERTENSION PATIENTS

Objective: To evaluate the color M-mode (Vp) propagation velocity parameter and the correlation between Vp and left ventricular diastolic function parameters in hypertension patients. Subjects and Methods: A echocardiography study of 51 hypertensive patients, admitted to the Department of Cardiology of Hue University of Medicine and Pharmacy Hospital. This is a cross-sectional study. Results: The Vp value was 63.34 ± 28.22 cm/s. In the left ventricular hypertrophy group, the Vp was lower (62.68 ± 28.08 cm/s) than Vp of the left ventricular non hypertrophy group but not significative (p > 0.05). We found clearly a diminution of the Vp in the groupe with degree 2 of diastolic dysfunction (Vp = 36.18 ± 4.17 cm/s) in comparison with degree 1 (55.65 ± 21.43 cm/s). Vp was positively correlated with the left ventricular peak E-wave velocity (r = 0.304, p < 0.05) and the E/A wave ratio (r = 0.319, p < 0.05). In addition, Vp was inversely correlated with ventricular septal thickness (r = - 0.372, p < 0.01) and left ventricular post wall (r = -0.347; p < 0.01). Conclusion: The Vp parameter may be used as a complement parameters to assess the left ventricular diastolic function in hypertensive patients. This parameter is valuable in patients with 2 stage or more of diastolic function disorder. Key words: Hypertension, ventricular diastolic function, color M-mode propagation velocity

Relationship between angiopoietin-2 and vascular endothelial factor and vasodilation function in hypertensive patients

Objective: To analyze the relationship between angiopoietin 2 (Ang2) and vascular endothelial factor and vasodilation function in hypertensive patients. Methods: Patients with new onset grade 1~2 hypertension (n=40) and healthy control group (n=25) wereenrolledprospectively. Serum Ang2 and nitric oxide (NO), nitric oxide synthase (eNOS), endothelin-1 (ET-1) were measured in both groups. Flow-mediated vasodilation (FMD) were measured in hypertensive patients. The above indicators were reviewed in hypertensive patients after antihypertensive treatment until blood pressure<140/90 mmHg. Results: Compared with the control group, serum Ang2 (P=0.049) and ET-1 (P<0.001) were significantly higher. Serum NO (P<0.001) and eNOS (P<0.001) was significantly lower in the hypertensive group. Compared with baseline, serum Ang2 (P=0.049) and ET-1 (P<0.001) were decreased significantly, meanwhile serum NO (P<0.001) and eNOS (P<0.001) were significantly increased. Serum Ang2 after antihypertensive treatment was not significantly different from that of the control group, but no statistical difference was observed in FMD after antihypertensive therapy. Correlation analysis found that serum Ang2 was positively correlated with mean arterial pressure (R=0.432, P<0.001), and negative correlated with serum NO(R=-0.374, P=0.001) and FMD (R=-0.368 0, P=0.002). Multiple linear regression found that serum Ang2 was independently associated with body mass index, mean arterial pressure, and serum NO. Conclusion: Serum Ang 2 can reflect the degree of endothelial and vasodilation impairment in hypertensive patients. Antihypertensive therapy can improve endothelial function, but whether it can restore damaged vasodilation function needs further verification.

Vascular effects of isometric handgrip training in hypertensives

ABSTRACTThe isometric handgrip training (IHT) has been emerging as an alternative approach for blood pressure (BP) reduction in hypertensive patients. However, the mechanisms underlying the reductions in BP after IHT are poorly known. Thus, the aim of this study was to analyze the vascular effects of IHT in hypertensive patients. A randomized controlled trial was conducted with 33 hypertensive patients (61 ± 2 y.o.; 67% female) who were randomly assigned to two groups: IHT or control group. The IHT group has completed three weekly sessions of isometric handgrip (4 × 2 min sets, alternating the hands at 30% of maximal voluntary contraction). Before and after a period of 12 weeks BP, arterial stiffness, central and peripheral pulse wave velocity (PWV) and endothelial function were measured. The IHT approach has significantly decreased systolic (∆ = −16 ± 2 vs. ∆ = −3 ± 3 mmHg, p < 0.001) and diastolic (∆ = −8 ± 2 vs. ∆ = 0 ± 2 mmHg, p = 0.014) BP. Reductions in central PWV (IHT: 9.1 ± 0.5 vs. 8.0 ± 0.3 m/s; Control: 8.8 ± 0.5 m/s, p < 0.05) and shear rate area after occlusion have significantly reduced by using the IHT (37822 ± 6931 vs. 24829 ± 5337 s−1, p < 0.05). In conclusion, 12 weeks of IHT have reduced the BP and arterial stiffness and improved markers of endothelial function in hypertensive patients.

Comparative effect of calcium channel blockers on renal function in hypertensive patients with diabetes mellitus

Comparative effect of calcium channel blockers on renal function in hypertensive patients with diabetes mellitus

Value of Assessing Autonomic Nervous Function by Heart Rate Variability and Heart Rate Turbulence in Hypertensive Patients.

Purpose To explore the relationship between blood pressure control and autonomic nervous function assessing by heart rate variability (HRV) and heart rate turbulence (HRT) in hypertensive patients. Methods A total of 120 consecutive hypertensive patients and 80 nonhypertensive patients (N-HP group) were enrolled in this study. The hypertensive patients were divided into controlled blood pressure and uncontrolled blood pressure groups according to their blood pressure on admission. All subjects underwent 24-hour Holter monitoring. This study compared HRV and HRT in nonhypertensive and hypertensive patients and hypertensive patients with controlled and uncontrolled blood pressure. HRV parameters include square root of mean of the sum of squares of successive NN interval differences (rMSSD), number of successive NN intervals differing by > 50ms divided by the total number of successive NN intervals (pNN50), very low frequency (VLF) at frequency between 0.0033 and 0.04 Hz, low frequency (LF) at frequency between 0.04 and 0.15 Hz, and high frequency (HF) at frequency between 0.15 and 0.4 Hz. Turbulence slope (TS) belongs to HRT parameters. Results TS, rMSSD, pNN50, VLF, LF, and HF values were significantly lower in the HP group than in the N-HP group. Multiple logistic regression analysis showed that reduced TS, rMSSD, pNN50, LF, and HF values were risk factors of hypertension. TS, rMSSD, pNN50, VLF, LF, and HF values were significantly lower in hypertensive patients with uncontrolled blood pressure than in hypertensive patients with controlled blood pressure. Multiple logistic regression analysis showed that reduced TS, rMSSD, pNN50, VLF, LF, and HF values were risk factors for uncontrolled blood pressure. Conclusions This study indicates impaired autonomic nervous function in hypertensive patients, especially in hypertensive patients with uncontrolled blood pressure despite guideline recommended antihypertensive medications.

A3705 Relationship between blood pressure variability and vascular elasticity and endothelial function in hypertensive patients

Objectives: To investigate the Relationship between visit-to-visit blood pressure variability and vascular elasticity and endothelial function in hypertensive patients. Methods: Collecting 169 cases of essential hypertensive patients and all participants were followed every three months. VBPV was indicated by a standard deviation of visit-to-visit blood pressure .According to tertile of visit-to-visit systolic blood pressure variability (VSBPV), all participants were divided into low VSBPV group (n = 56), medium VSBPV group (n = 57) and high VSBPV group (n = 56). Results: The changes of FMD and NO in low VSBPV group was significantly higher than that of medium and high VSBPV group, the difference was statistically significant (P < 0.05). The changes of ET-1, cfPWV and AIx in the low VSBPV group, was significantly higher than that of medium and high VSBPV group, the difference was statistically significant (P < 0.05). The difference was statistically significant (P < 0.05). The change of IMT in high VSBPV group was significantly higher than that in medium VSBPV group, the difference was statistically significant (P < 0.05). Changes of FMD and NO were significantly negatively correlated with VSBPV (P < 0.05).Yet,Changes of ET-1, cfPWV, IMT and AIx were significantly positively correlated with VSBPV (P < 0.05).Changes of FMD and NO were negatively correlated with VDBPV (P < 0.05). Changes of ET-1 and cfPWV were positively correlated with VDBPV (P < 0.05). Controlling other variables, VSBPV was independently related to the rate of change of AIx, IMT, cfPWV, NO, ET-1 and FMD. Conclusion: The variability of visit-to-visit blood pressure is closely correlated with vascular elasticity and endothelial function in essential hypertension patients.

Vascular Smooth Muscle Remodeling in Conductive and Resistance Arteries in Hypertension.

Cardiovascular disease is a leading cause of death worldwide and accounts for >17.3 million deaths per year, with an estimated increase in incidence to 23.6 million by 2030. 1 Cardiovascular death represents 31% of all global deaths 2 -with stroke, heart attack, and ruptured aneurysms predominantly contributing to these high mortality rates. A key risk factor for cardiovascular disease is hypertension. Although treatment or reduction in hypertension can prevent the onset of cardiovascular events, existing therapies are only partially effective. A key pathological hallmark of hypertension is increased peripheral vascular resistance because of structural and functional changes in large (conductive) and small (resistance) arteries. In this review, we discuss the clinical implications of vascular remodeling, compare the differences between vascular smooth muscle cell remodeling in conductive and resistance arteries, discuss the genetic factors associated with vascular smooth muscle cell function in hypertensive patients, and provide a prospective assessment of current and future research and pharmacological targets for the treatment of hypertension.

Effect of long-term lifestyle intervention on mild cognitive impairment in hypertensive occupational population in China.

Background:The incidence of hypertension in China is high, which seriously affects people's health, including occupational population in mining areas. Cognitive dysfunction has a serious impact on the work and life of patients. Lifestyle intervention can improve diabetes and cardiovascular diseases. However, there are few studies on the effects of lifestyle interventions on cognitive function in hypertensive patients. So the aim of this study was to analyze the effect of long-term lifestyle intervention on mild cognitive impairment in hypertensive occupational population in China.Methods:In September 2013, a cluster sampling was conducted for the workers in the Shaanxi Jinduicheng (intervention group) and Hancheng (control group) mining areas. In both groups, according to the blood pressure (BP) level, they were divided into hypertension stage 1 to 3 subgroups; according to their age, they were divided into between 45 and 59 and under 45 years subgroups; and according to whether or not taking medicine, they were divided into Lifestyle intervention, Lifestyle intervention plus medication, Medication, and No lifestyle intervention nor medication subgroups. The intervention group received regular lifestyle intervention for 2 years, which included diet, smoke, drink, and exercise intervention. Mild cognitive impairment was measured by the Montreal Cognitive Assessment (MoCA). The arterial stiffness was measured by Omron Automatic Atherosclerosis Tester. We conducted BP measurement and MoCA questionnaire at baseline, 6, 12, and 24 months.Results:We analyzed a total of 510 mine workers, whose average age was 45.6 ± 13.4 years old. With the increase of BP level, the MoCA scores decreased significantly both in control and lifestyle intervention groups (P < .05). There was no obvious difference between the hypertensive patients whose age was between 45 and 59 to those under 45 in MoCA scores (P > .05). After 2 years, the BP, total cholesterol, glucose, and brachial-ankle pulse wave velocity of the Lifestyle intervention subgroup and Lifestyle intervention plus medication subgroup decreased (P < .05), and the MoCA scores and ankle-brachial index increased (P < .05), and the latter improved more significantly. Compared with the No lifestyle intervention nor medication subgroup, the BP and MoCA scores had no obvious changes at 6 months (P > .05), but the BP decreased and the MoCA scores increased significantly in the Lifestyle intervention and Lifestyle intervention plus medication subgroups after 1 and 2 years of lifestyle intervention (P < .05).Conclusion:Long-term lifestyle intervention can be used as adjunctive therapy to improve the BP and cognitive function of hypertensive occupational population in China.

Taurine Ameliorates Thyroid Hypofunction and Renal Injury in L-NAME-Induced Hypertensive Rats.

There is a growing global interest in hypertension due to its associated complications including renal dysfunction in patients. The thyroid system reportedly regulates renal function in both animal and human. The present study investigated the therapeutic efficacy of taurine on renal and thyroid dysfunctions in hypertensive rats. Hypertension was induced by oral administration of nitric oxide synthase inhibitor, N-nitro L-arginine-methyl-ester (L-NAME), at 40 mg/kg body weight to the male Wistar rats for 14 consecutive days. The hypertensive rats were subsequently treated with either taurine (100 and 200 mg/kg) or reference drug atenolol (10 mg/kg) for another 14 consecutive days. Hypertensive rats showed renal damage evidenced by elevated plasma creatinine and urea levels when compared with normotensive control rats. Furthermore, L-NAME-induced hypertensive rats showed decreased circulatory concentrations of thyroid stimulating hormone, thyroxine, triiodothyronine and the ratio of triiodothyronine to thyroxine. The marked decrease in the renal antioxidant enzyme activities and nitric oxide level was accompanied by significant increase in myeloperoxidase activity and biomarkers of oxidative stress in hypertensive rats. Histological examination of kidneys from hypertensive rats revealed congestion of blood vessels, hemorrhagic lesion and disorganized glomerular structure. However, treatment with taurine or atenolol significantly reversed the suppression of thyroid function, ameliorated renal oxidative stress and histopathological lesions in L-NAME-induced hypertensive rats. Taurine may be a useful chemotherapeutic supplement in enhancing renal and thyroid functions in hypertensive patients.

Effects of interval training on blood pressure and endothelial function in hypertensive patients

Background Several studies have recently shown that high-intensity interval training (HIIT) is superior to moderate-intensity continuous exercise (MICE) for improvements on endothelial in patients with cardiovascular disease. However, little is known about its effects on changes in blood pressure, especially in hypertensive patients. Purpose To compare the effects of HIIT and MICE on changes in blood pressure reduction and endothelial function in hypertensive patients. Methods Fourteen hypertensive patients, aged 52.1±7.6, participated in this study. They tapered off their medications, if necessary, and were randomized to either HIIT (n = 7) or CME (n = 7) group. HIIT was composed of 5 sets of 3 min exercise at 80% HRR, and each interval was separated by 3 min recovery at 40% HRR. MICE was composed of 35 min exercise at 60% HRR. Both groups were designed to use same energy expenditure, and performed exercise 5 days/week for 4 weeks. Endothelial function was determined by assessing endothelial progenitor cells (EPCs) using flow cytometry and flow mediated dilation (FMD) using ultrasonography. Blood pressure (BP) and heart rate (HR) were measured at rest by using automatic blood pressure monitor. Repeated ANOVA was performed to analyze if the changes in dependent variables after training are different between HITT and MICE group. Statistical significance was at p&lt; .05. Results There was a significant interaction in resting HR, but not in BP, FMD, and EPCs between groups after training. Systolic BP was significantly decreased in both HITT group (p = .012) and MICE group (p = .048) after training. However, diastolic BP and FMD was significantly decreased (p = .021) and increased (p = .049) in only HIIT group, respectively. EPCs were not significantly changed after training in both HIIT and MICE group. Conclusion The results of this study indicate that there is no big difference in HIIT and MICE for BP reduction, and HIIT and MICE are both effective for BP reduction in hypertensive patients. However, further researches are needed to illuminate differential effects of HIIT and MICE on BP response and endothelial function.

Early detection strain/strain rate and time to strain/strain rate abnormalities for left atrial mechanical function in hypertensive patients

Objective: To evaluate left atrial (LA) deformation parameters strain (S)/strain rate (SR) and time to peak S/SR obtained by two-dimensional speckle tracking echocardiography (2D-STE) in patients with hypertension for three LA mechanical phases and to compare them with the same indices in the control subjects.Methods: Fifty-five patients with hypertension (HT) and 29 healthy controls were included in the study. All patients had normal LA poster-anterior diameter, LA and left ventricular ejection fractions (LVEF >50%) in two-dimensional echocardiography (2-DE). The peak S/SR values (PS/PSR), the time to peak S/SR (TPS/TPSR) were measured using the 12-segment model for the left atrium during contractile (CP) reservoir (RP) and conduit period (COP) of the LA cycle.Results: For two periods (RP and COP), all of the PS and PSR values were significantly lower in hypertensive patients with preserved LAEF and LVEF compared to those in the controls, except for the CP. Similarly, hypertensive patients had significantly higher TPS and TPSR than those in the controls for the RP and COP in the LA wall, except for the CP.Conclusion: LA mechanical function was impaired in hypertensive patients with preserved LA and LV ejection fraction compared to the controls. Although the PS and PSR were decreased for the RP and COP of LA mechanical phases, the TPS/TPSR were prolonged in the HT patients compared to the controls. This might be additional diagnosis criteria to detect the LA myocardial dysfunction and might be a predisposing factor for atrial arrhythmia formation in the hypertensive patients.

THE IMPACT OF DIURETICS ON ERECTILE FUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: Erectile dysfunction is frequently encountered in hypertensive patients. Along with blood pressure elevation, antihypertensive drugs have been implicated in the pathogenesis of erectile dysfunction. Although the effects of diuretics on erectile function seem detrimental, contradictory findings are available in the literature. We therefore aimed to evaluate the impact of diuretic therapy on erectile function in hypertensive patients without erectile dysfunction. Design and method: Consecutive male hypertensive patients between 30 and 70 years of age attending our Hypertension Outpatient Clinic who initiated diuretic therapy participated in the study. Erectile function was evaluated at baseline and three months after diuretic initiation. Erectile function was assessed using the International Index of Erectile Function, a validated 15-item questionnaire. Results: Overall, 247 male hypertensive patients participated in the study. Diuretic monotherapy was initiated in 56 participants, while diuretics were added to prior therapy in the rest 191 participants. From the latter group, 122 were on monotherapy with angiotensin receptor blockers and 69 were on dual therapy with angiotensin receptor blockers plus calcium antagonists. Erectile dysfunction appeared in 8/56 participants (14.2%) on diuretic monotherapy, in 27/122 participants (22.1%) on dual therapy with diuretics added to ARBs, and in 14/69 participants (20.3%) on triple therapy (diuretics on top of prior ARBs plus calcium antagonists administration). Conclusions: Diuretic-induced erectile dysfunction is common among patients with arterial hypertension. Further studies are needed to verify our findings, enlighten the mediating mechanisms, and clarify the management of such patients.

Effects of High Intensity Interval Exercise Training on Blood Pressure in Patients with Hypertension

PURPOSE: To compare the effects of HIIT and CAE on changes in blood pressure reduction and endothelial function in hypertensive patients. METHODS: Seventeen hypertensive patients, aged 52.1±7.6, participated in this study, tapered off their medications, if necessary, and were randomized to either HIIT (n=9) or CAE (n=8) group. HIIT was composed of 5 sets of 3 min exercise at 80% HRR, and each interval was separated by 3 min recovery at 40% HRR. CAE was composed of 35 min exercise at 60% HRR. Both groups were designed to use same energy expenditure, and performed exercise 5 days per week for 4 weeks. Endothelial function was determined by assessing endothelial progenitor cells (EPCs) using flow cytometry and flow mediated dilation (FMD) using ultrasonography. Arterial stiffness was measured by pulse wave velocity (PWV). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at rest and during exercise at 60% HRR by using automatic blood pressure monitor. RESULTS: At rest, SBP was significantly decreased in HIIT (p<0.01) and CAE (p<0.05), and DBP was significantly decreased in HIIT (p<0.001), but not in CAE. During exercise, SBP was significantly decreased in CAE (p<0.05), but not in HIIT, and DBP was significantly decreased in HIIT (p<0.01), but not in CAE. FMD and EPCs were significantly improved in HIIT (p<0.01 and p<0.05, respectively), but not in CAE. There were significantly different changes in DBP during exercise and EPCs between groups (p<0.05). However, PWV was not changed in both groups. CONCLUSIONS: The results of this study suggest that HIIT and CAE equally have beneficial effects on blood pressure reduction at rest and during exercise. However, HIIT may improve endothelial function greater than CAE. Therefore, HIIT could be a better exercise program than CAE for hypertensive patients.

Effects of a new nutraceutical combination on cognitive function in hypertensive patients

BackgroundChronic increased arterial blood pressure has been associated with executive dysfunction, slowing of attention and mental processing speed, and later with memory deficits. Due to the absence of a concrete therapeutic approach to this pathophysiological process, in the last decades there has been an increasing interest in the use of nutraceuticals, especially those with antioxidant properties, which own strong neuroprotective potential, that may help to improve cognitive function and to delay the onset of dementia.ResultsWe evaluated the effects of the treatment with a new nutraceutical preparation containing different molecules with potent antioxidant properties (AkP05, IzzeK®) and placebo on a cohort of thirty-six hypertensive patients. At baseline, neuropsychological evaluation, arterial stiffness and biochemical parameters of the subjects were comparable. After 6 months of treatment, there was a significant reduction of the augmentation index in the AkP05-treated group. Moreover, the measurement of cognitive function, evaluated with MoCA test and Word Match Testing, showed a significant improvement in patients receiving the active treatment. In addition, the group treated with nutraceutical reached a better Stroop test score, while subjects that received placebo did not showed any improvement. Finally, a positive relationship between SBP variation and the psychometric assessment with the EQ-VAS scale was observed only in the active treatment group.ConclusionsIn this study, we demonstrated that the therapy with a new nutraceutical preparation is able to significantly increase the scores of important neuropsychological tests in hypertensive patients already on satisfactory blood pressure control. Although future studies are needed to better characterize the molecular mechanisms involved, these results candidate the new nutraceutical combination as a possible therapeutic strategy to support the cerebrovascular functions and delay the onset of dementia in hypertensive patients.

Association between urinary vanin-1 and decrease in kidney function in hypertensive patients

Symptoms of chronic kidney disease (CKD) are not usually apparent in its early stages. If diagnosed early, the progression of CKD can be altered. Several new biomarkers for damage of renal tubular epithelia such as neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) have been identified. Previously, we found a novel renal biomarker, urinary vanin-1, in several animal models with acute kidney injury as well as CKD. In the present study, we have examined the relationship between these new biomarkers and kidney function assessed using estimated glomerular filtration rate (eGFR) in hypertensive patients. The patients were enrolled in this study with written informed consent. Among 42 cases, urinary vanin-1 was significantly inversely correlated with eGFR (r = -0.52; P<0.001). Among patients classified with CKD G2, those with proteinuria tended to show high urinary vanin-1. Therefore, urinary vanin-1 might be a potential biomarker relating the decrease in kidney function in hypertensives patients.

Impact of abnormal circadian blood pressure profile on left atrial function assessed by 2D speckle tracking echocardiography and its effect on the functional capacity of hypertensive patients

Background The left atrial (LA) function has an important role in hypertension as it is strongly predictive of adverse cardiac events and death, assessment of the circadian blood pressure (BP) profile is more predictive than assessment of the office BP reading in estimating the cardiovascular risk. The 2D speckle tracking echocardiography (2D-STE) provides more insight into early hypertension-induced LA dysfunction. Aim The aim of this work is to assess the impact of abnormal circadian BP profile on LA function using 2D-STE and its effect on functional capacity in hypertensive patient with preserved ejection fraction assessed by conventional echocardiography. Patients and methods This work included 60 consecutive hypertensive patients with preserved ejection fraction by conventional echocardiography [mean age 48±5 years and body surface area (BSA) 1.9±1.1] they were classified into two groups according to the data derived from 24 h ambulatory BP, group 1: dipper group that included 28 patients (mean age 48±8 years and BSA 1.9±0.1) and group 2: nondipper group that included 32 patients (mean age 50±6 years and BSA 1.9±0.09). All patients were evaluated by comprehensive 2D and Doppler echocardiographic techniques, TDI and 2D-STE, ambulatory BP, and stress. Myocardial perfusion imaging using treadmill exercise test was done to exclude coronary artery disease (CAD) and to assess the functional capacity. Results The results showed a statistically high significant decrease in the average peak left atrial global longitudinal strain in group 2 (the nondipper group) (group 1=26±4 vs. 20.4±3.5 in group 2, P&lt;0.00), and a statistically significant decrease in the functional capacity parameter using treadmill metabolic equivalents (METs) in group 2 (group 1=7.3±1.4 vs. 6.2±0.8 in group 2, P&lt;0.01) in comparison with group 1. Also we found a significant positive correlation between the average peak atrial longitudinal strain and the functional capacity assessed by treadmill stress test (r=0.424, P=0.05). There were no other significant differences between the two groups with respect to other LA parameters by conventional echo Doppler, TDI, and 2D-STE. Conclusion Abnormal circadian BP profile add more deleterious effect on LA function in hypertensive patients as detected by 2D-STE that denotes more decrease in functional capacity and worse cardiac events.

Penile microvascular endothelial function in hypertensive patients: effects of acute type 5 phosphodiesterase inhibition

The primary aim of this study was to evaluate penile endothelial microvascular function in patients with primary arterial hypertension and age-matched normotensive subjects using laser speckle contrast imaging (LSCI). Additionally, we analyzed the acute penile microvascular effects induced by oral phosphodiesterase type 5 inhibitor (sildenafil; SIL) administration. Endothelium-dependent microvascular reactivity was evaluated in the penises and forearms of hypertensive patients (aged 58.8±6.6 years, n=34) and age-matched healthy volunteers (n=33) at rest and 60 min following oral SIL (100 mg) administration. LSCI was coupled with cutaneous acetylcholine (ACh) iontophoresis using increasing anodal currents. Basal penile cutaneous vascular conductance (CVC) values were not significantly different between control subjects and hypertensive individuals. Penile CVC values increased significantly after SIL administration in control (P<0.0001) and hypertensive (P<0.0001) subjects. Peak CVC values were not different between the two groups during penile ACh iontophoresis before SIL administration (P=0.2052). Peak CVC values were higher in control subjects than in hypertensive subjects after SIL administration (P=0.0427). Penile endothelium-dependent microvascular function is, to some extent, preserved in patients presenting with primary arterial hypertension under effective anti-hypertensive treatment. LSCI may be a valuable non-invasive tool for the evaluation of penile vascular responses to phosphodiesterase type 5 inhibitor.

Evaluation Cystatin C Levels and Some Factors of Renal Function in Hypertensive Patients

Evaluation Cystatin C Levels and Some Factors of Renal Function in Hypertensive Patients

Effect of Angiotensin-Converting Enzyme Inhibitor/Calcium Antagonist Combination Therapy on Renal Function in Hypertensive Patients With Chronic Kidney Disease: Chikushi Anti-Hypertension Trial - Benidipine and Perindopril.

BackgroundAppropriate blood pressure control suppresses progression of chronic kidney disease (CKD). If an angiotensin-converting enzyme (ACE) inhibitor is ineffective, adding a calcium antagonist is recommended. We compared the long-term effect of two ACE inhibitor/calcium antagonist combinations on renal function in hypertensive patients with CKD.MethodsPatients who failed to achieve the target blood pressure (systolic/diastolic: < 130/80 mm Hg) with perindopril monotherapy were randomized to either combined therapy with perindopril and the L-type calcium antagonist amlodipine (group A) or perindopril and the T/L type calcium antagonist benidipine (group B). The primary endpoint was the change of the estimated glomerular filtration rate (eGFR) after 2 years. Eligible patients had a systolic pressure ≥ 130 mm Hg and/or diastolic pressure ≥ 80 mm Hg and CKD (urine protein (+) or higher, eGFR < 60 min/mL/1.73 m2).ResultsAfter excluding 38 patients achieving the target blood pressure with perindopril monotherapy, 121 patients were analyzed (62 in group A and 59 in group B). Blood pressure decreased significantly in both groups, but there was no significant change of the eGFR. However, among patients with diabetes, eGFR unchanged in group B (n = 37, 59.1 ± 15.1 vs. 61.2 ± 27.9, P = 0.273), whereas decreased significantly in group A (n = 31, 57.3 ± 16.0 vs. 53.7 ± 16.7, P = 0.005).ConclusionsIn hypertensive patients with diabetic nephropathy, combined therapy with an ACE inhibitor and T/L type calcium antagonist may prevent deterioration of renal function more effectively than an ACE inhibitor/L type calcium antagonist combination.

Correlations between anterior wall motion velocity of ascending aorta measured by quantitative tissue velocity image and left ventricular geometry as well as left heart function in hypertension patients.

This study aimed to analyze the correlations between anterior wall motion velocity of ascending aorta measured by quantitative tissue velocity image (QTVI) technique and left ventricular geometry as well as left heart function to evaluate its value of clinical application. One hundred ten hypertension patients and 35 healthy controls were included, divided into left ventricular concentric remodeling group and left ventricular hypertrophy group. The QTVI technique was used to obtain the velocity curve of anterior wall of ascending aorta, the peak systolic velocity (Vs), peak velocity of early diastolic motion (Ve) and peak velocity of late diastolic motion (Va). The single-plane Simpson method was utilized to measure the left ventricular ejection fraction (EF). The QTVI method was used to obtain the index of left ventricular diastolic function (Em/Am). Compared to control group, both Vs and Ve values significantly reduced in hypertension group (P<0.05). Both Vs and Ve values were significantly negatively correlated with LVMI and RWT (P<0.01). The Va value was negatively correlated with LVMI (P<0.05). The Vs value was significantly positively correlated with EF value (P<0.01). The Ve value was significantly positively correlated with both EF and Em/Am (P<0.01). The Va value was positive correlated with Em/Am (P<0.05). The QTVI anterior wall velocity of ascending aorta could be indicator for the geometric patterns and function of left ventricle, which may provide a simple and comprehensive method for clinical assessment of hypertensive heart disease.