Function In Hypertensive Patients Research Articles

Effects of functional olive oil enriched with its own phenolic compounds on endothelial function in hypertensive patients. A randomised controlled trial

The additional health-promoting properties of functional virgin olive oil (FVOO) enriched with its own phenolic compounds (OOPC) versus the parental virgin olive oil (VOO) must be tested in appropriate human clinical trials. Our aim was to assess the effects of FVOO on endothelial function in hypertensive patients. Thirteen pre- and stage-1 hypertensive patients received a single dose of 30mL of FVOO (OOPC=961mg/kg) or VOO (OOPC=289mg/kg) in a postprandial randomised, double blind, crossover trial. Endothelial function, measured as ischemic reactive hyperemia (IRH) and related biomarkers, were followed for 5h after consumption. Compared with VOO, FVOO increased IRH (P<0.05) and plasma Cmax of hydroxytyrosol sulphate, a metabolite of OOPC 2h postprandial (P=0.05). After FVOO ingestion, oxidised LDL decreased (P=0.010) in an inverse relationship with IRH AUC values (P=0.01). FVOO provided more benefits on endothelial function than a standard natural virgin olive oil in pre- and hypertensive patients. Trial registration: isrctn.org. Identifier ISRCTN03450153.

Carotid intima-media thickness and estimated glomerular filtration rate in hypertensive patients

To determine the association between carotid atherosclerosis and renal function in hypertensive patients. A total of 2 809 hypertensive patients aged (56.59±10.79) years were enrolled. Carotid intima-media thickness (cIMT) was derived via B-mode ultrasonography and chronic kidney disease (CKD) was evaluated by the estimated glomerular filtration rate (eGFR) with Cockcroft- Gault method. The patients were divided into 3 groups: a normal group, a thick group, and a plaque group according to the results of carotid ultrasonography. The eGFR of the normal group was (111.09±25.61) mL/(min.1.73m(2)), that of the thick group and the plaque group was (94.45±27.14) mL/(min.1.73m(2)) and (85.98±26.92) mL/ (min.1.73m(2)). Binary logistic analysis showed that age (OR=3.590), smoking status (OR=1.543), systolic blood pressure (OR=1.018), diastolic blood pressure (OR=0.977), fasting plasma glucose (OR=1.132), triglyceride (OR=0.873) and eGFR (OR=0.986) were significantly correlated with cIMT. Subgroup analyses on different genders showed that eGFR was a significant independent risk factor in men (OR=0.991) but not in women. The thicker the cIMT, the lower the eGFR in hypertensive patients. With the development of cIMT, eGFR gradually decreases and contributes to the occurrence and development of early-stage atherosclerosis in hypertensive patients.

The correlation of carotid artery stiffness with heart function in hypertensive patients

The correlation of carotid artery stiffness with heart function in hypertensive patients

Impact of Azelnidipine and Amlodipine on Left Ventricular Mass and Longitudinal Function in Hypertensive Patients with Left Ventricular Hypertrophy

The impact of long-acting calcium channel blocker (CCB) administration on serial changes in left ventricular (LV) function and morphology in hypertensive patients with LV hypertrophy remains unclear. This study attempted to clarify this impact by comparing the effects of administration of azelnidipine with that of amlodipine using conventional and speckle tracking echocardiography. An equal number (16) of 32 hypertensive patients was prospectively assigned to a group administered 5 mg of amlodipine/day or a group administered 16 mg of azelnidipine/day. LV function and morphology was examined by conventional and speckle tracking echocardiography at baseline and at 1, 3, 6, and 12 months after treatment initiation. Both groups were found to have experienced a significant decrease in systolic blood pressure by 1 month after treatment initiation; a significant reduction in septal thickness and LV mass index at 6 and 12 months. Transmitral flow E/A ratio and early diastolic mitral annular velocity at lateral wall significantly improved at 12 months. On the other hand, a significant improvement of global longitudinal strain was observed earlier than the above indexes at 3, 6, and 12 months. Ar-A duration difference was significantly decreased at 3 months. The global circumferential strain improved significantly at 3 months, but there were no significant changes in mid-/apical circumferential and radial strains throughout the study period. Azelnidipine has beneficial effects on LV mass regression, transmitral flow, tissue Doppler, and LV longitudinal strain that are comparable to those of amlodipine on the same parameters.

Association between erectile dysfunction and echocardiographic variables of ventricular hypertrophy and diastolic function in hypertensive patients with type 2 diabetes mellitus: A cross‐sectional study 在合并2型糖尿病的高血压患者中勃起功能障碍与心室肥厚以及舒张功能超声心动图变量之间的关系：一项横断面研究

AbstractBackgroundThis study was conducted among individuals with diabetes and hypertension in order to assess the prevalence of erectile dysfunction (ED) and the association between ED and cardiovascular risk variables such as echocardiographic changes.MethodsWe evaluated 114 men with type 2 diabetes mellitus and hypertension. ED was assessed by International Index of Erectile Function (IIEF‐5) score. Clinical and laboratory variables were evaluated, including C‐reactive protein (CRP), ambulatory blood pressure monitoring (ABPM), ankle brachial index (ABI) and transthoracic echocardiography. Comparisons between patients with ED (IIEF‐5 &lt; 22) and without ED (IIEF‐5 ≥ 22) were performed.ResultsPatients were 56.8 ± 5.7 years‐old, systolic and diastolic blood pressure were 150.7 ± 19.5 mmHg and 85.4 ± 11.4 mmHg, respectively, and HbA1c was 8.0 ± 1.7%. The majority (74.6%) of patients had ED. Levels of CRP, ABPM values and ABI were similar between men with and without ED. Echocardiography variables related to cardiac chamber diameters, left ventricular hypertrophy and diastolic function were similar between groups, except there was a slight lower left ventricular ejection fraction in men with ED (64.9 ± 7.3 vs 68.1 ± 3.9%, P = 0.004).ConclusionsIn high cardiovascular risk hypertensive individuals with type 2 diabetes, ED is highly prevalent as expected, but its presence is associated with neither echocardiographic variables, nor other cardiovascular risk factors.

Comparison of Left Atrial Function between Hypertensive Patients with Normal Atrial Size and Normotensive Subjects Using Strain Rate Imaging Technique

Background: Patients with hypertension are at risk of structural and functional changes in the left atrium (LA). There are only a few studies on the impact of hypertension on LA function, especially in hypertensive patients with a normal LA size. We, therefore, designed this study to evaluate LA function in patients with a normal LA size via deformation imaging. Objectives: We assessed regional longitudinal strain rate imaging (SRI) profiles along with tissue velocity imaging (TVI) in the LA walls to quantify LA reservoir function and explore changes in LA function in hypertensive patients with a normal value of LA size. Patients and Methods: One hundred twenty-four subjects with normal angiography (mean age = 56.28 ± 8.91 years, 46% male), who were referred to the Echocardiography Laboratory of our institution, were enrolled in this study. These subjects were categorized into two groups: hypertensive (75 cases) and age-matched normotensive (49 cases) groups. All the cases of the patient and control groups had a normal LA size. SRI parameters included strain (ST, %) and strain rate (SR, s -1 ), and tissue imaging parameters such as peak systolic velocity (Sm, m/s) were measured in four septal, lateral, anterior, and inferior LA walls at the mid-level. Results: Compared with the controls, the patients with a history of hypertension showed significantly lower values of Sm, ST, and SR in each segment of the LA. There was no effect of age on these indices. Also, no differences regarding Sm, ST, and SR were found between the septal, lateral, anterior, and inferior LA walls in each group. By multivariate linear regression analysis, a history of hypertension was the only independent determinant of average LA strain rate in the all the individuals (P < 0.001). When this analysis was repeated in the patients with a history of hypertension, the only independent determinant of average LA strain rate was heart rate (P = 0.026). Conclusions: In our subjects, with a normal value of LA size, the effect of hypertension on LA reservoir function was independent of age, sex, heart rate, left ventricular mass index, and left ventricular ejection fraction. Additionally, heart rate independently correlated with reduced TVI and SRI parameters in the patients with hypertension.

The Role of Microalbuminuria in Arterial Endothelial Dysfunction in Hypertensive Patients With Carotid Plaques

The aim of this study was to evaluate the correlations between microalbuminuria (MAU) and endothelial function in hypertensive patients with carotid plaques (CP). A total of 71 hypertensive patients with CP (CP group) and 20 healthy people as normal controls (NC group) were enrolled in this study. The CP group was divided into an MAU group (MAU group, n = 33) and a non-microalbuminuria group (NM group, n = 38) according to their urinary albumin excretion rates (UAER). Endothelial function was assessed by flow-mediated dilation (FMD) in the brachial artery by ultrasonography, and nitroglycerin-mediated dilation (NMD) was used as a control test for FMD. Intima-media thickness (IMT) and biochemical parameters were evaluated. The ΔFMD% was significantly lower in patients with and without MAU in the CP group compared to the NC group. All patients with MAU had significantly lower ΔFMD% and ΔNMD% compared to the patients without MAU. ΔFMD% showed significant negative correlations with IMT, systolic blood pressure, glucose, total cholesterol, low density lipoprotein, high-sensitivity C-reactive protein, and log UAER. ΔNMD% demonstrated significant negative correlations with age, IMT, systolic blood pressure, glucose, and log UAER. Stepwise multiple linear regression analysis revealed that FMD was independently correlated with UAER and total cholesterol, while NMD was independently correlated with UAER and age. These results suggest that MAU might aggravate the arterial dysfunction and play a role in the arterial endothelial function in patients with hypertension and CP. Both endothelium-dependent and endothelium-independent vasodilatations were impaired in hypertensive patients with CP.

Disturbed Left Atrial Function is Associated with Paroxysmal Atrial Fibrillation in Hypertension

BackgroundHypertension is the most prevalent and modifiable risk factor for atrial fibrillation. The pressure overload in the left atrium induces pathophysiological changes leading to alterations in contractile function and electrical properties. ObjectiveIn this study our aim was to assess left atrial function in hypertensive patients to determine the association between left atrial function with paroxysmal atrial fibrillation (PAF). MethodWe studied 57 hypertensive patients (age: 53±4 years; left ventricular ejection fraction: 76±6.7%), including 30 consecutive patients with PAF and 30 age-matched control subjects. Left atrial (LA) volumes were measured using the modified Simpson's biplane method. Three types of LA volume were determined: maximal LA(LAVmax), preatrial contraction LA(LAVpreA) and minimal LA volume(LAVmin). LA emptying functions were calculated. LA total emptying volume = LAVmax−LAVmin and the LA total EF = (LAVmax-LAVmin )/LAVmax, LA passive emptying volume = LAVmax− LAVpreA and the LA passive EF = (LAVmax-LAVpreA)/LAVmax, LA active emptying volume = LAVpreA−LAVmin and LA active EF = (LAVpreA-LAVmin )/LAVpreA. ResultsThe hypertensive period is longer in hypertensive group with PAF. LAVmax significantly increased in hypertensive group with PAF when compared to hypertensive group without PAF (p=0.010). LAAEF was significantly decreased in hypertensive group with PAF as compared to hypertensive group without PAF (p=0.020). A' was decreased in the hypertensive group with PAF when compared to those without PAF (p = 0.044).ConclusionIncreased LA volume and impaired LA active emptying function was associated with PAF in untreated hypertensive patients. Longer hypertensive period is associated with PAF.

Effects of single pill-based combination therapy of amlodipine and atorvastatin on within-visit blood pressure variability and parameters of renal and vascular function in hypertensive patients with chronic kidney disease.

Both strict blood pressure (BP) control and improvements in BP profile such as BP variability are important for suppression of renal deterioration and cardiovascular complication in hypertension and chronic kidney disease (CKD). In the present study, we examined the beneficial effects of the single pill-based combination therapy of amlodipine and atorvastatin on achievement of the target BP and clinic BP profile, as well as markers of vascular and renal damages in twenty hypertensive CKD patients. The combination therapy with amlodipine and atorvastatin for 16 weeks significantly decreased clinic BP, and achievement of target BP control was attained in an average of 45% after the combination therapy in spite of the presence of no achievement at baseline. In addition, the combination therapy significantly decreased the within-visit BP variability. With respect to the effects on renal damage markers, combination therapy with amlodipine and atorvastatin for 16 weeks significantly decreased albuminuria (urine albumin-to-creatinine ratio, 1034 ± 1480 versus 733 ± 1218 mg/g-Cr, P < 0.05) without decline in estimated glomerular filtration rate. Concerning parameters of vascular function, the combination therapy significantly improved both brachial-ankle pulse wave velocity (baPWV) and central systolic BP (cSBP) (baPWV, 1903 ± 353 versus 1786 ± 382 cm/s, P < 0.05; cSBP, 148 ± 19 versus 129 ± 23 mmHg, P < 0.01). Collectively, these results suggest that the combination therapy with amlodipine and atorvastatin may exert additional beneficial effects on renal and vascular damages as well as BP profile in addition to BP lowering in hypertension with CKD.

Abnormal Regulation of Renin Angiotensin Aldosterone System Is Associated With Right Ventricular Dysfunction in Hypertension

BackgroundRight ventricular dysfunction (RVD) is a major predictor of cardiovascular mortality. Inadequate suppression of the renin-angiotensin-aldosterone system (RAAS) after postural manoeuvres favours alterations of left ventricular (LV) function. The effects of RAAS dysregulation on RV performance remain elusive. The present study investigated RV function in hypertensive patients with or without altered RAAS activation. MethodsPlasma renin activity (PRA) and plasma aldosterone concentration (PAC) were measured in 104 newly diagnosed hypertensive patients after both supine and upright positioning to assess dynamic changes of RAAS induced by antigravitational stress. Twenty-four–hour ambulatory blood pressure monitoring and echocardiographic evaluation of the right ventricle including tissue Doppler imaging (TDI) were performed. Patients were divided as follows: (1) normal PRA and PAC (N group [n = 58]), (2) suppressible RAAS after supine positioning (SR group [n = 24]), and (3), nonsuppressible RAAS (NSR group [n = 22]). RVD was identified by the TDI-derived myocardial performance index (MPI) calculated with a multisegmental approach. ResultsPatients in the NSR group had reduced indices of RV function compared with patients in the N and SR groups. MPI of the right ventricle as well as prevalence of RVD were also significantly higher in the NSR group. Regression models showed that inadequate RAAS suppression was independently associated with RVD, regardless of blood pressure values and LV dysfunction (LVD). ConclusionsPatients without supine normalization of RAAS display a significant impairment of RV function. Our findings suggest that a dynamic RAAS evaluation may help to identify hypertensive patients at higher risk of RVD.

Effects of an Angiotensin II Receptor Blocker on the Impaired Function of Endothelial Progenitor Cells in Patients With Essential Hypertension

Endothelial progenitor cells (EPCs) induce neovascularization and repair vascular damage. We have demonstrated that EPC function is impaired in hypertensive rats with increases in oxidative stress and that angiotensin II receptor blockers improved the impaired function of EPCs. In this study, we investigated basal EPC functions in normotensive control subjects and patients with essential hypertension and the effect of losartan on EPC function in hypertensive patients. Eighteen normotensive control subjects and 36 patients with essential hypertension who were undergoing treatment participated in the study. Hypertensive patients were randomly selected to receive 50mg of losartan or 4 mg of trichlormethiazide daily for 4 weeks. Peripheral blood mononuclear cells were isolated and cultured to assay EPC colony formation. Blood pressure, biological examination, and oxidative stress were evaluated in all subjects. The number of EPC colonies was significantly lower in patients with essential hypertension than in normotensive control subjects. EPC colony number was significantly and inversely correlated with systolic and diastolic blood pressure in all subjects. EPC colony number was significantly increased by treatment with losartan in patients with essential hypertension but not affected by treatment with trichlormethiazide. EPC function was inversely correlated with blood pressure and was impaired in essential hypertension. Losartan significantly improved the impaired EPC function in hypertensive patients. Impaired EPC function may determine the cardiovascular complications in essential hypertension. The improvement of EPC function with the administration of angiotensin II receptor blockers is considered to be one of the cardiovascular protective effects.

The Effects of Amlodipine and S(-)-Amlodipine on Vascular Endothelial Function in Patients With Hypertension

Amlodipine has been shown to improve vascular endothelial function in hypertensive patients, but whether S(-)-amlodipine has a similar effect remains controversial. This study compared the effects of amlodipine and S(-)-amlodipine on vascular endothelial function in hypertensive patients and investigated relevant mechanisms of action in cell culture. Twenty-four patients with essential hypertension received amlodipine and S(-)-amlodipine for 6 weeks in a randomized, crossover study. Associated flow-mediated dilation (FMD), nitric oxide (NO), and endothelial nitric oxide synthase (eNOS) levels were determined. NO levels were measured after exposure of human umbilical vein endothelial cells (HUVECs) to amlodipine, S(-)-amlodipine, the eNOS inhibitor N w-nitro-L-arginine (L-NA), and the Protein Kinase C (PKC) inhibitor Ro 31-8220. Phosphorylation levels of Ser(1177) and Thr(495) in eNOS were determined after exposure to amlodipine, S(-)-amlodipine, and Ro 31-8220. FMD, NO, and eNOS levels significantly improved after treatment with amlodipine and S(-)-amlodipine. The levels were all higher with amlodipine, although the between-treatment difference was not statistically significant. Amlodipine and S(-)-amlodipine significantly increased NO levels in cultured HUVECs, but increases in NO levels were more marked with amlodipine. Western blot assay showed that both amlodipine and Ro31-8220 induced Ser(1177) phosphorylation and weakened Thr(495) phosphorylation in eNOS. S(-)-amlodipine had no similar effects. Amlodipine, but not S(-)-amlodipine, decreased the PKC phosphorylation in a time-dependent manner. Amlodipine and S(-)-amlodipine can both improve endothelial function in hypertensive patients. Amlodipine has greater potential for vascular endothelial protection than S(-)-amlodipine. It affects eNOS phosphorylation at Ser(1177) and Thr(495) by the PKC pathway, further enhancing eNOS activation.

Utility of cystatin C as a marker for the severity of aortic regurgitation in hypertensive patients

BackgroundCystatin C, a cathepsin inhibitor, is involved in the remodeling of human aortic valve and left ventricle (LV). ObjectiveCystatin C may be related to the severity of aortic regurgitation (AR). MethodsWe measured cystatin C and CRP in hypertensive patients with mild-to-moderate AR (n=120) and in those without AR (n=128). Echocardiography was performed to assess the vena contracta width (the narrowest region of regurgitant jet, VCW) as a marker of the severity of AR, relative wall thickness as a marker of LV concentric remodeling, and the ratio of early peak mitral flow to early diastolic mitral annular velocity (E/e′) as an index of LV diastolic function. Glomerular filtration rate (GFR) was estimated using the MDRD methods. ResultsCystatin C levels were greater in hypertensive patients with AR than in those without AR. A multiple linear regression analysis indicated cystatin C levels correlated with the VCW independent of GFR, body mass index, CRP, relative wall thickness, and E/e′ in hypertensive patients with AR. ConclusionsCystatin C was associated with the severity of regurgitation independent of renal function body composition chronic inflammation LV remodeling and diastolic function in hypertensive patients with mild-to-moderate AR.

Echocardiographic parameters and renal function in hypertensive patients with chronic kidney disease: the cardio-renal connection

Echocardiographic parameters and renal function in hypertensive patients with chronic kidney disease: the cardio-renal connection

Changes of endothelial function in hypertensive patients with persistent atrial fibrillation

Changes of endothelial function in hypertensive patients with persistent atrial fibrillation

Characterization of left atrial function in hypertensive patients. Cardiovascular magnetic resonance study

Purpose: Left atrial (LA) function includes reservoir, conduit and booster pump functions. In stiff ventricles these change in order to improve the filling. The aim of the study was to assess these changes in hypertensive patients (HT) with cardiovascular magnetic resonance (CMR). Methods: HT subjects referred for a clinical CMR and who did not have signs of myocardial necrosis, no cardiomyopathy except HT, no significant valve disease and no signs of secondary HT were included and compared to matched normotensives (NT). Cine sequences were acquired in a short axis stack of the atria and ventricles. LA volumes (maximum= LAmax, pre-atrial contraction= LAa, minimum= LAmin) were quantified. Several parameters were calculated for reservoir function (expansion index= (LAmax-LAmin)*100/LAmin; total emptying fraction= (LAmax-LAmin)*100/LAmax), conduit function (passive emptying percentage = (LAmax-LAa)*100/(LAmax-LAmin); passive emptying fraction= (LAmax-LAa)*100/LAmax) and pump function (active emptying percentage = (LAa-LAmin)*100/(LAmax-LAmin); active emptying fraction= (LAa-LAmin)*100/LAa). Differences regarding these parameters were tested with ANOVA (factors: group, age, gender, BSA). Correlations with age and LV mass were explored. Results: 35 hypertensives (22 males, 35-80yrs) were included. They showed a significant decrease in parameters of reservoir and conduit functions, while the active emptying percentage was significantly increased. Results are shown on the table. Age correlated with LA volumes (LAmax, r= 0.48; LAa, r= 0.50; LAmin, r= 0.52), but not with LA function. LV mass was inversely correlated with parameters of reservoir function (expansion index, r= -0.597; total emptying fraction, r= -0.532) and relative wall mass was found to be inversely correlated with active emptying fraction (r= -0.464). Conclusions: In HT subjects a decrease in passive atrial function and an increased in pump function occur. These changes do not correlate with age but with LV mass (reservoir function) and relative wall mass (pump function), and might have prognostic implications.

The effect of long-term angiotensin receptor blocker administration on improvement in diastolic function in hypertensive patients with diastolic dysfunction

The effect of long-term angiotensin receptor blocker administration on improvement in diastolic function in hypertensive patients with diastolic dysfunction

GW24-e1361 Relationship between serum uric acid and endothelial function in hypertensive patients with metabolic syndrome

ObjectivesTo investigate the association between Serum Uric Acid (SUA) and endothelial function in Chinese hypertentive patients with or without Metabolic Syndrome (MS).MethodsSUA and endothelial function were evaluated in 615 hypertensive...

GW24-e2126 Study of left atrial function in patients with essential hypertension using velocity vector imaging

ObjectivesVelocity vector imaging (VVI) was used to study the characteristics of strain and strain rate (SR) of the left atrium in hypertensive patients with and without left ventricular hypertrophy, in...

Echocardiographic assessment of hypertensive patients with or without hyperhomocysteinemia

The study was designed to assess left ventricular (LV) systolic and diastolic function in hypertensive patients with or without Hhcy. The study participants consisted of 40 hypertensive patients with Hhcy, 40 hypertensive patients without Hhcy and 40 age-matched healthy control participants. Cardiac functions were determined using echocardiography and the Tei index was calculated for analysis. LAVI (left atrial volume index), IVST (interventricular septum thickness in diastole), PVST (posterior ventricular septum thickness in diastole), LVMI (left ventricular mass index), E/A (peak early and late diastolic transmitral filling flow velocities ratio), DT (deceleration time of the E wave), IRT (isovolumic relaxation time), and the Tei index were different in the hypertensive patient groups (hypertension with Hhcy and hypertension without Hhcy) compared with the controls. The Tei index was significantly higher in the hypertensive groups compared with the controls (0.62 ± 0.05, 0.51 ± 0.04, and 0.40 ± 0.04, respectively, p < 0.01). Significant differences were also observed between the hypertensive patients with Hhcy and the hypertensive patients without Hhcy regarding LAVI (25.6 ± 4.7 versus 22.9 ± 3.5 ml/m2), E/A (0.73 ± 0.22 versus 0.92 ± 0.14), DT (93.1 ± 6.9 versus 84.3 ± 8.1 ms), IRT (93.1 ± 6.9 versus 84.3 ± 8.1 ms) and the Tei index. Significant correlations were observed between serum homocysteine levels and LV diastolic function parameters (LAVI: r = 0.39, E/A: r = −0.32, DT: r = 0.47, IRT: r = 0.51, p < 0.05). We found that Hhcy had contributory effects on myocardial impairment induced by hypertension. Moreover, there were strong relationships between homocysteine level and LV diastolic dysfunction parameters.