Function In Hypertensive Patients Research Articles

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.

OP.7B.12] ASSOCIATION BETWEEN HEART DYSFUNCTION AND NOCTURNAL BLOOD PRESSURE PROFILE IN A COHORT OF PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: As previously reported, the circadian rhythm of blood pressure (BP) in hypertensives is associated with the severity of organ damage, this being the maximum for the reverse dipper profile (accompanied by paradoxical nocturnal increase of BP levels), and gradually decreasing towards the categories characterized by a normal circadian rhythm. In light of the paucity of data concerning the assessment of the indices of heart function in hypertensive patients in relation to the different nocturnal BP profile, we designed a retrospective study ad hoc. Design and method: We enrolled 389 patients with essential hypertension. Main exclusion criteria were the evidence of secondary hypertension or any concurrent condition able to influence heart structure and/or function. All patients were evaluated through laboratory tests, clinical data and medical history, echocardiographic recordings, ambulatory blood pressure monitoring (ABPM). The analysis of data was performed comparing the top quintile (38 patients with the greatest fall in blood pressure at night), the bottom quintile(comprising 38 patients with minor or no pressure drop at night) and the middle quintile, as a reference. Men and women were analyzed separately due to the different normal ranges of the echocardigrafic parameters considered. Results: We observed a less impaired cardiac function for the top quintile, also after correction for duration of hypertension, mean age, main comorbities: MEN: Left Ventricular Mass (g/m2.7): 41.51 ± 7.94 (top); 44.48 ± 10.69 (ref); 51.24 ± 14.90 (bottom) (p: 0.001) Left ventricular Relative Wall Thickness (RWT): 0.39 ± 0.07 (top); 0.41 ± 0.05 (ref); 0.48 ± 0.11 (bottom); (p. 0.05) Left Atrium Volume (LA Vol) (ml): 56.32 ± 12.62 (top); 58.05 ± 18.22 (ref); 73.16 ± 24.97 (bottom) (p: 0.01) Left ventricular Ejection Fraction (EF) (%): 61.8 ± 7.23 (top); 61.97 ± 6.78 (ref); 57.16 ± 9.65 (bottom) (p: 0.05) Right Atrium Area (cm2): 14.87 ± 1.61 (top), 15.49 ± 1.66 (ref); 16.36 ± 2.74 (bottom) (p: 0.01) Similar results for women (not enough space to display) Conclusions: Extreme dipper hypertensives seem to have lower level of cardiac damage when compared to the other categories of dipping

The effect of vasodilator β-blockers on renal function in hypertensive patients.

Not only is there a limited number of studies on the effects of vasodilator β-blocker (VBB) therapy on kidney function - specifically, glomerular filtration rate (GFR), serum creatinine (sCr) and proteinuria - but of those that have been reported, the results are mixed. This meta-analysis seeks to assess the efficacy of VBBs on selected renal parameters in hypertensive patients. We conducted a meta-analysis of any prospective trial that provided both baseline and follow-up of at least 4 weeks of VBB therapy - carvedilol, labetalol, dilevalol, nebivolol and celiprolol in patients with hypertension. We used Ovid MEDLINE, EMBASE and PubMed, all without date restrictions. We included 39 studies totaling 3987 patients. Although VBBs did not significantly change GFR or sCr levels after at least 4 weeks of therapy, they did significantly decrease protein excretion by -0.12 SD units [95% confidence interval (CI) -0.19 to -0.04; P < 0.01]. VBBs did not alter renal blood or plasma flow, but renal vascular resistance (RVR) decreased by -20.03 mmHg min/l (95% CI -28.92 to -11.15; P < 0.01). In the analysis which compared VBBs with non-VBBs, the only significant difference was the greater decrease in RVR in the VBB group by -38.44 mmHg min/l (95% CI -60.57 to -16.31; P < 0.01). VBBs do not affect GFR or sCr levels, but decrease protein excretion. This class of β-blockers, however, is not superior to non-VBBs in reducing proteinuria. VBBs decrease RVR significantly more than non-VBBs.

P1347Long-term effect of statin therapy on annual change in renal function in hypertensive patients

P1347Long-term effect of statin therapy on annual change in renal function in hypertensive patients

P1569Osteopontin and interleukin-15 serum levels relation to myocardial function in hypertensive patients with chronic heart failure

P1569Osteopontin and interleukin-15 serum levels relation to myocardial function in hypertensive patients with chronic heart failure

Prevalence and Predictors of Renal Dysfunction among Adult Hypertensive Patients Attending Medical Clinic in North-western Tanzania: A Cross Sectional Study

BackgroundHypertension is a known risk factor for the development of renal dysfunction. With the increasing burden of hypertension in developing countries, especially due to lifestyle modifications, we expect a rise in the development of renal dysfunction. The prevalence, pattern and predictors of renal dysfunction among hypertensive patients in sub-Saharan Africa have not been well described.MethodsAn analytical cross-sectional study was conducted at Bugando Medical Centre (BMC) outpatient clinic from February 2013 to April 2013. The primary end point was renal dysfunction defined as an estimated glomerular filtration rate (eGFR) < 90ml/min/1.73m2 (calculated using the Cockroft-Gault equation) and/or the presence of albuminuria.ResultsThe population consisted of more females than males (54.7% vs. 45.3%). The majority of the population came from urban areas. The prevalence of renal dysfunction was found to be 53.9%. Older age, female gender, obesity, high systolic blood pressure and type of antihypertensive medications were found to be strong predictors of renal dysfunction.ConclusionRenal dysfunction was highly prevalent in this population of non-diabetic hypertensive outpatients in North-western Tanzania. This highlights the critical and underappreciated need to monitor renal function in hypertensive patients in sub-Saharan Africa given the increasing high burden of hypertension in the region.

Annual deterioration of renal function in hypertensive patients with and without diabetes.

BackgroundChronic kidney disease (CKD) complicates hypertension and diabetes. Knowledge of the deterioration rate of CKD may anticipate adjustment of therapies with renal elimination. This study evaluates the rate of annual deterioration of renal function in hypertensive patients either with type 2 diabetes (DM2) or without it (non-DM) followed for 5 years and relates it with blood pressure (BP) and glycemic control.Materials and methodsOut of a total of 1924 patients, 1023 patients (594 non-DM and 429 DM2, 53% female, aged 62.1±10.2 years) were evaluated over 5 years for the annual evolution of renal function (estimated glomerular filtration rate [eGFR], Modification of Diet in Renal Disease) ambulatory 24-hour blood pressure and metabolic parameters, corresponding to the analysis of 2378 patient-years.ResultsDM2 and non-DM did not differ for age, mean 24-hour BP levels, nighttime BP, albuminuria, and body mass index. DM2 versus non-DM showed a higher (p<0.02) prevalence of stage 3 CKD (24.0% vs 18.0%, eGFR 30–59), stage 4 (5.4% vs 2.7%, eGFR 15–29), and stage 5 (0.8% vs 0.5%, eGFR <15). Average annual decline of eGFR was 3.3±8.2 in DM2 versus 2.4±7.7 in non-DM (p=0.12, nonsignificant). Annual changes of eGFR and of albuminuria correlated (r=0.578, p<0.001). In multivariate analysis, age, nighttime BP, double inhibition of renin angiotensin system, albuminuria, and HbA1c >8.0% in DM2 predicted the decline in eGFR. On average, 16.2% of DM2 and 13.1% of non-DM moved each year toward a more severe stage of CKD. For initial eGFR <90 mL/min/1.73 m2, 26.4% of DM2 and 18.1% of non-DM patients showed a reduction per year >10% from the previous eGFR value (p=0.042).ConclusionProgressive deterioration of renal function each year is frequent in hypertensive diabetic and non-diabetic patients. Beyond aging, this is particularly dependent on BP control particularly at nighttime, on drug therapy, and on highly abnormal glucose control.

Clinical value of echocardiography in evaluation of cardiac function in hypertension patients complicated with atrial fibrillation

Objective To discuss the clinical value of using echocardiography to evaluate cardiac function in hypertension patients complicated with atrial fibrillation. Methods 60 hypertension patients complicated with atrial fibrillation were chosen as the observation group, and meanwhile 30 healthy subjects were chosen as the control group. Conventional two dimensional ultrasound was used to observe left front diameter (LAD), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD) and left ventricular ejection fraction (LVEF). And mitral valve flow spectrum was also used to detect A peak and integral E-VTI E peak, A-VTI, and E/A, including the E peak deceleration time (DT). Pulmonary vein blood flow spectrum was used to detect systolic velocity (S), integral S-D-VTI, VTI, D peak, integral record systolic flow velocity (peak) Ar, and calculate the S/D value. Results In the observation group, LAD, LVEDD, LVESD, LAVmax and LAVmin were (43.01±2.34)mm, (48.87±4.35)mm, (30.29±4.34)mm, (42.38±3.55)mL and (20.22±2.35)mL, which were significantly higher than those in the control group [(34.23±2.10)mm, (43.23±4.30)mm, (24.34±4.12)mm, (31.04±3.10)mL and (14.57±2.19)mL], the differences were statistically significant (t=17.34, 5.82, 6.34, 14.88 , 10.99, all P<0.05). In the observation group, the LVEF and TA-EF were (62.03±5.56)% and (58.66±5.45)%, which were significantly lower than those in the control group [(59.35±4.45)% and (52.34±4.68)%], the differences were statistically significant (t=2.30, 10.99, all P<0.05). In the observation group, the E peak, E-VTI and E/A were (91.22±12.10)cm/s, (15.17±3.31) and (2.38±0.55) respectively, which were significantly higher than those in the control group [(71.28±12.11)cm/s, (12.21±3.30) and (0.92±0.30), t=7.37, 4.04, 13.54, all P<0.05]. In the observation group, A peak, A-VTI and DT were (46.89±5.36)cm/s, (4.23±1.06) and (120.32±12.45), respectively, which were significantly lower than those in the control group [(79.44±6.12)cm/s, (7.85±1.15) and (234.37±13.49), t=25.89, 14.84 , 39.84, all P<0.05]. In the observation group, D peak and D-VTI were (53.80±5.76)cm/s and (14.20±1.56) respectively, which were significantly higher than those in the control group [(44.54±3.58)cm/s and (11.15±1.55), t=8.64, 6.34, all P<0.05]. In the observation group, Speak, S-VTI, S/D and Ar were (41.21±4.04)cm/s, (11.87±5.37), (0.78±0.09) and (21.34±3.05) respectively, which were significantly lower than those in the control group [(53.26±4.15)cm/s, (16.28±5.33), (1.29±0.13) and (38.57±3.89), t=12.12, 3.94, 21.75, 23.00, all P<0.05]. Conclusion Echocardiography can reflect the cardiac function in hypertension patients with atrial fibrillation. And assessing myocardial remodeling and atrial room to store the damage situation, pipeline and booster pump function all has important clinical significance for clinical treatment and prognosis assessment. Key words: Echocardiography; Atrial fibrillation; Heart function

Early Impairment of Left Ventricular Function in Hypertensive Patients with Preserved Ejection Fraction using Tissue Doppler Echocardiography

Background: Hypertension is an emerging risk factor for developing heart failure with preserved ejection fraction (HFpEF). Diastolic dysfunction most frequently associated with a subclinical impairment of systolic function in patients with HFpEF. The aim of this study was to detect early impairment of left ventricular function in hypertensive patients with preserved ejection fraction using Tissue Doppler Imaging (TDI).Methods: This cross-sectional study included a total 105 subjects who were divided into three groups (group-1: 35 healthy control; group-2: 35 hypertensive patients without concentric left ventricular hypertrophy, and group-3: 35 hypertensive patients with concentric left ventricular hypertrophy having left ventricular ejection fraction (LVEF)&gt;50% on 2D echocardiography). They underwent TDI to measure systolic dysfunction by systolic annular velocity during systole (S´) and diastolic dysfunction by diastolic filling pressure (E/E´).Results: The results were obtained in 105 subjects: group-1 (40.63±5.0years; 34.4% male); group-2 (49.57±9.7years; 34.4% male) and group-3 (55.17±8.5years; 31.2% male). LVMI and RWT were significantly higher (p&lt;0.001) in both hypertensive groups. The presence of systolic dysfunction by TDI as evidence by systolic annular velocity (S´) was significantly reduced (p&lt;0.001) in both hypertensive groups compared to controls (0.08±0.11 vs.06±0.01 vs. 0.05±0.01).The presence of diastolic dysfunction by TDI as evidence by diastolic filling pressure (E/E´) were significantly higher (p&lt;0.001) in both groups of hypertensive patients. There was significant correlation between E/E´ and S´(r = -593; p= &lt;0.001).Conclusion: TDI provided a new insight into impaired systolic function by detecting lower values of S´ and impaired diastolic function by detecting higher values of E/E´ in hypertensive patients. This study was a clear reflection of early impairment of LV function in hypertensive patients (with or without C-LVH) and it might be helpful for identifying hypertensive patients who are at high risk for heart failure.Cardiovasc. j. 2017; 9(2): 147-154

Diastolic Function Changes during Stress Echocardiography in Hypertensive Patients

Abstract Background: Some hypertensive patients experience dyspnea with exercise due to rise in filling pressures. So, exercise is helpful to determine left ventricular filling tension. Objectives: This study aims to evaluate the effect of dobutamine stress echocardiography on diastolic function in hypertensive patients with normal ejection fraction. Methods: In this study, 30 hypertensive patients (52.7  3.6 years) and 30 sex and age matched healthy controls (50.8  7.6 years) were examined. Exclusion criteria were patients with coronary artery disease, significant valvular heart disease, hypertrophic cardiomyopathy, left ventricular systolic dysfunction (EF (ejection fraction) < 50%), atrial fibrillation and bad echogenic view. We performed complete echocardiography and dobutamine stress echocardiography with pulsed wave Doppler tissue imaging at rest and during peak stress to measure primary mitral inflow diastolic wave rate (E), late mitral inflow diastolic wave rate (A), E/A ratio, primary diastolic myocardial wave rate (E0) and late diastolic myocardial wave velocity (A’). Results: At rest, E’ was significantly lower in patients than controls (8.21.6 vs 14.72.6 P value< 0.001) and E/E (early mitral inflow diastolic wave rate/early myocardial diastolic wave rate) was significantly higher in patients (7.61.2 vs 4.81.0 P value

Relationship Between Hemorheology Assessed Using Microchannel Array Flow Analyzer and Kidney Function in Hypertensive Patients.

BackgroundKidney function is known to be closely associated with the pathogenesis of hypertension. In contrast, hemorheology assessed using microchannel array flow analyzer (MC-FAN) has demonstrated the significance of cardiovascular risk factors in recent clinical studies. The present cross-sectional study aimed to clarify the relationship between hemorheology assessed by MC-FAN and kidney function in hypertensive patients from the perspective of primary prevention of cardiovascular events.MethodsIn total, 453 outpatients undergoing treatment for hypertension (176 men and 277 women; mean age ± standard deviation: 65 ± 13 years) with no history of cardiovascular disease were enrolled. Whole blood passage time (WBPT) was measured using MC-FAN as a marker of hemorheology, and the relationships with various clinical parameters including kidney function were examined.ResultsA significant correlation was observed between WBPT and the parameters of kidney function such as estimated glomerular filtration rate (r = -0.14, P < 0.01), urinary albumin excretion (r = 0.40, P < 0.001), and renal resistive index (r = 0.44, P < 0.001). Furthermore, multivariate analysis demonstrated urinary albumin excretion, renal resistive index, skin autofluorescence, derivatives of reactive oxygen metabolites, and hematocrit as independent variables for WBPT as a subordinate factor.ConclusionsThe results of the present study indicate that hemorheology assessed by the MC-FAN is significantly associated with markers of kidney function, such as albuminuria and increased renovascular resistance, in hypertensive patients.

P235Relation between myocardial deformation by three-dimensional speckle tracking analysis , control of the hypertension and functional capacity in patients with systemic hypertension.

The purpose of this study was to investigate left ventricular (LV) function in hypertensive patients by 3-dimensional (3D) speckle tracking imaging, and determine the relation between the LV mechanics and functional capacity in this population. This cross-sectional study included 20 treated subjects with well-controlled arterial hypertension (group B) and 20 treated participants with uncontrolled hypertension (group A), adjusted by gender and age. All the subjects underwent 24-hour blood pressure monitoring, complete 2-dimensional and 3D examination, and exercise testing. Patients had similar 3D LV ejection fraction. LV mass was higher in group of uncontrolled hypertension (154.71 ± 49.7 g/m2 versus 147.12±44.8 g/m2 p < 0.01), as well as E/E'ratio (11.4 versus 8.9, p =0.02). 3D global longitudinal and circumferential strain and strain rate were significantly decreased in patients with inadequately controlled hypertension (LS 16.25% versus -19.24%, p=0.007, L-SR -0.97/sec versus -1.48/sec, p=0.04, CS -17.89%versus -21.76%, p=0.04, respectively), while the difference of radial strain and strain rate did not reach statistical significance. Group A of patients had also a significantly lower functional capacity (mean duration of test 13,3 min. versus 17,4 min, nr. of METS 9.4 versus 13.7). Duration of exercise was independently associated with LV mass , mean BP at daytime , E/E' ratio and 3D global longitudinal strain (β = 0.34, p = 0.02) in the whole hypertensive population in our study. In conclusion, LV longitudinal strain and functional capacity are significantly impaired in the patients with uncontrolled hypertension in comparison with the well-controlled hypertensive patients and are independently associated.

Total antihypertensive therapeutic intensity score and its relationship to blood pressure reduction

Predicting blood pressure (BP) response to antihypertensive therapy is challenging. The therapeutic intensity score (TIS) is a summary measure that accounts for the number of medications and the relative doses a patient received, but its relationship to BP change and its utility as a method to project dosing equivalence has not been reported. We conducted a prospective, single center, randomized controlled trial to compare the effects of Joint National Committee (JNC) 7 compliant treatment with more intensive (<120/80 mm Hg) BP goals on left ventricular structure and function in hypertensive patients with echocardiographically determined subclinical heart disease who were treated over a 12-month period. For this preplanned subanalysis, we sought to compare changes in BP over time with changes in TIS. Antihypertensive therapy was open label. TIS and BP were determined at 3-month intervals with titration of medication doses as needed to achieve targeted BP. Mixed linear models defined antihypertensive medication TIS as an independent variable and change in systolic BP as an outcome measure, while controlling for gender, age, baseline BP, and treatment group. A total of 123 patients (mean age 49.4 ± 8.2 years; 66% female; 95.1% African-American) were enrolled and 88 completed the protocol. For each single point increase in total antihypertensive TIS, a 14.5 (95% confidence interval: 11.5, 17.4) mm Hg decrease in systolic BP was noted (15.5 [95% confidence interval: 13.0, 18.0] mm Hg for those who completed the trial). Total TIS is a viable indicator of the anticipated BP-lowering effect associated with antihypertensive therapy.

OP.4B.06] THE IMPACT OF UPDATED LEFT VENTRICULAR GEOMETRY CLASSIFICATION ON RIGHT VENTRICULAR REMODELLING IN A HYPERTENSIVE POPULATION

Objective: We aimed to investigate right ventricular (RV) mechanics and function in hypertensive patients with different left ventricular (LV) geometric patterns by using a two-dimensional (2D) strain analysis and three-dimensional echocardiography (3D). Design and method: This cross-sectional study included 232 hypertensive subjects who underwent complete 2D and 3D examination. We applied the updated classification of LV geometry that considers LV mass index (LVMI), LV end-diastolic volume (LVEDV) index and relative wall thickness (RWT). All the subjects were divided into 6 groups: normal LV geometry, concentric remodelling, eccentric LVH, concentric LVH, dilated LVH and concentric-dilated LVH. Results: According to the updated classification, the study sample included 98 subjects with normal LV geometry (42%), 32 patients with LV concentric remodeling (14%), 49 with eccentric LVH (21%), 36 concentric LVH (15%), 11 dilated LVH (5%) and 6 concentric-dilated LVH (3%). 3D RV end-diastolic and end-systolic volume indexes gradually and significantly increased from the subjects with normal LV geometry and LV concentric remodelling, across patients with eccentric and concentric LVH, to participants with dilated and concentric-dilated LVH (61 ± 6 vs. 63 ± 6 vs. 68 ± 8 vs. 67 ± 7 vs. 77 ± 8 vs. 74 ± 8 ml/m2 for RV end-diastolic volume index, p < 0.001), whereas 3D RV ejection fraction gradually decreased in the same direction (59 ± 4 vs. 59 ± 3 vs. 58 ± 3 vs. 57 ± 3 vs. 55 ± 3 vs. 54 ± 3 %, p < 0.001). Global RV longitudinal strain was significantly decreased in patients with concentric and concentric-dilated LVH comparing to subjects with normal LV geometry and concentric LV remodelling (−24.0 ± 3.5 vs. −23.7 ± 3.3 vs. −22.5 ± 3.1 vs. −20.7 ± 2.6 vs. −21.4 ± 2.9 vs. −20.5 ± 2.5 %, p < 0.001). Conclusions: 2D RV myocardial deformation and 3D RV function are significantly impacted by LV geometry in hypertensive patients. Concentric and concentric-dilated LVH patterns have the greatest unfavourable effect on RV mechanics.

OS 20-06 DAILY ALCOHOL CONSUMPTION AFFECTS LEFT VENTRICULAR DIASTOLIC FUNCTION IN HYPERTENSION

Objective: Studies on heavy alcoholic drinkers have reported an association between alcohol intake and left ventricular (LV) function. The effect of moderate alcohol intake on LV function in hypertensive patients, however, is unknown. The aim of the study was to investigate the relationship between alcohol consumption and LV function in hypertension. Design and Method: In 335 non-alcoholic hypertensive patients (age 52 ± 14) we measured plasma glucose, lipids, and liver tests, and 24-h creatinine clearance (CrCl). Patients with an history of alcohol addiction (DSM IV), previous cardiovascular events, LV ejection fraction < 50%, and CrCl < 30 ml/min1.72m2 were excluded. Average daily alcohol consumption was estimated by a questionnaire (AUDIT) and patients were classified in 4 different levels (level 1 = 0 g/day, n = 172; level 2: 1–19 g/day, n = 85; level 3: 20–39 g/day, n = 55; level 4: ≥ 40 g/day, n = 23). LV function was assessed by both conventional echocardiography and tissue-Doppler imaging (TDI). Results: LV inner dimensions, interventricular septum, and LV mass index were progressively greater with increasing levels of alcohol consumption. LV ejection fraction, early/late transmitral flowrate, and isovolumic relaxation time did not differ across patients with different levels of alcohol intake, whereas left atrial diameter increased progressively with increasing alcohol intake. TDI detected LV diastolic dysfunction in 167 (49.8%) of patients and e’ wave velocity was inversely related with alcohol consumption showing progressively impaired LV diastolic function. Patients with LV diastolic dysfunction were older, more frequently diabetics, and had higher BMI, systolic and diastolic BP, plasma glucose, cholesterol, triglycerides, γ-GT, and AST, and LV mass index. Multivariate logistic regression analysis of factors associated with LV diastolic dysfunction indicated that alcohol intake was a significant predictor independent of age, BMI, BP, diabetes, and LV mass. Conclusions: In hypertensive patients without a history of alcohol addiction and normal LV systolic function, daily alcohol consumption is independently associated with LV diastolic dysfunction.

Beneficial effect of azilsartan and amlodipine on endothelial function in hypertensive patients

Beneficial effect of azilsartan and amlodipine on endothelial function in hypertensive patients

PS 14-45 URIC ACID METABOLISM AND RENAL FUNCTION IN PATIENTS TREATED WITH A FIXED DOSE COMBINATION OF ANTIHYPERTENSIVE MEDICATIONS

Objective: Improvement of serum uric acid (SUA) is thought to have a favorable influence on blood pressure (BP) and renal function in hypertensive patients irrespective of diuretic therapy. The effects of switching therapy to a fixed dose combination (FDC) of losartan (LOS) 50 mg with hydrochlorothiazide (HCTZ) 15 mg (LOS/HCTZ) on BP, UA metabolism, and renal function were assessed in hypertensive patients treated with a FDC of telmisartan (TEL) 40 mg with HCTZ 15 mg (TEL/HCTZ) and compared those of a FDC of TEL with amlodipine (AM) 5 mg (TEL/AM). Design and Method: Sixty-seven hypertensive patients were allocated either LOS/HCTZ (n = 36) or TEL/AM group (n = 31), respectively. Results: Both LOS/HCTZ and TEL/AM were effective in reducing SUA but caused no change in BP after 12 months. LOS/HCTZ increased percent fractional excretion of UA (FEUA) but caused no change in estimated glomerular filtration rate (eGFR). TEL/AM increased eGFR, but trend for increase in FEUA was not significant. Although UA metabolism improved, urinary albumin/creatinine excretion ratio (UACR) increased in two groups. The increase in UACR of TEL/AM was greater than that of LOS/HCTZ. The change in UACR was positively correlated with the changes in eGFR but not with SUA or FEUA. Conclusions: The switching therapy equally controlled BP and improved UA metabolism. Although both LOS-induced inhibitory action of urate transporter 1 and deletion of HCTZ-induced plasma volume reduction were associated with improvement of UA metabolism in the patients, it did not support the beneficial effect of SUA lowering therapy on renal protection.

LBPS 02–27 WHAT IS THE ASSOCIATION BETWEEN LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND SIX-MINUTE WALK TEST IN HYPERTENSIVE PATIENTS?

Objective: We aimed to find the association between the degree of LV diastolic dysfunction and the functional capacity assessed by 6-minute walk test (6MWT) in asymptomatic hypertensive patients. Design and Method: The study included 200 asymptomatic hypertensive patients. All patients had undergone full history taking, complete clinical examination, electrocardiography, echocardiography for assessment of left ventricle (LV) dimensions, systolic, and diastolic dysfunction, and 6MWT. Patients were classified into two groups according to the presence or absence of LV diastolic dysfunction. Results: The clinical and echocardiographic data were comparable between the two groups. Regarding 6MWT, at the end of the test patients with diastolic dysfunction had significantly higher systolic (p = 0.0088) and diastolic (p = 0.019) blood pressure and higher Borg score for dyspnea (p < 0.00001). Conclusions: The presence of LV diastolic dysfunction has a bad effect on 6MWT. The degree of LV diastolic dysfunction is correlated with the results of 6MWT. It may be important to investigate LV diastolic function in hypertensive patients.

Cystatin C Based Evaluation of Renal Function in Hypertensive Patients in Ubth, Benin City

Background: Hypertension is a recognized cause of chronic kidney disease. Hypertension in blacks is most important because it is volume dependent and its ensuing renal complication. The widely accepted marker to assess renal function is creatinine and its estimated glomerular filtration rate. However, this is limited in assessing early renal impairment. This necessitate a need to evaluate other renal markers such as cystatin C. Objective: To measure and compare serum cystatin C and creatinine for early renal impairment among hypertensive patients on treatment. Methodology: A total of 48 hypertensive patients attending cardiology clinic for follow up were recruited in this study. Serum specimen were collected and assayed for creatinine and cystatin C. estimated glomerular filtration (eGFR) rate was calculated for the analytes. The two eGFR were compared in assessing renal function. Results: The BMI, Blood pressure and Abdominal circumference of the subjects were significantly higher than the controls (31.5±7.5kg/m 2 , 144/82mmHg and 102.3cm vs 26.1±4.3kg/m 2 , 116/80mmHg and 93cm) respectively Table 1. The hypertensives had a significantly higher serum levels of creatinine and cystatin C when compared with the controls (105µmol/L vs 88µmol/L and 2.9mg/L vs 1.1mg/L) respectively Table 2. Calculated estimated GFR for both serum creatinine and cystatin C were significantly lower among the subjects (89.1ml/min/1.73m 2 vs 110ml/min/1.73m 2 and 67.7ml/min/1.73m 2 vs 118ml/min/1.73m 2 ). Estimated GFR based on cystatin C was significantly lower than eGFR-Cr among the subjects (67.7ml/min/1.73m 2 vs 89.1ml/min/1.73m 2 ). There was a significant correlation between BMI and eGFR-Cr, abdominal circumference also had a significant correlation with fasting plasma glucose among the subjects and controls. Conclusion: serum levels of cystatin C appears to be a better predictor of GFR among hypertensive patients.

Effects of azelnidipine and amlodipine on exercise-induced sympathoexcitation assessed by pupillometry in hypertensive patients.

The pupil is a suitable end organ for studying autonomic function because both sympathetic and parasympathetic nerve activity can be evaluated independently using a light stimulus. Sympathetic response elicited by physical stress is augmented in hypertensive patients compared with normotensive subjects, which increases the risk of cardiovascular events. We used pupillometry to evaluate the effects of the calcium channel blockers azelnidipine (AZ) and amlodipine (AM) on changes in autonomic nervous activity induced by isometric exercise in patients with hypertension. Twenty patients with essential hypertension who were administered AM and 21 who were administered AZ underwent a pupillary function test and blood pressure (BP) and pulse rate (PR) measurements before and after isometric handgrip exercise (IHG). Maximal velocities of pupil constriction (VC) and re-dilation (VD) obtained with light stimulation for 1 s were used as indices of parasympathetic and sympathetic nerve activity, respectively. Increases in systolic BP and PR elicited by IHG were significantly smaller in the AZ group than in the AM group. After IHG, both VC and VD significantly increased in the AM group but not in the AZ group. The low-to-high frequency ratio obtained from analysis of PR variability, another measure of sympathetic activity, also increased in only the AM group. Thus AZ inhibited autonomic activation and suppressed cardiovascular responses to IHG more effectively than AM. The sympathoinhibitory effect of AZ may therefore be beneficial for patients with essential hypertension. In addition, pupillometry was shown to be a useful tool for assessing autonomic function in hypertensive patients.