Healthy Normotensive Subjects Research Articles

Longitudinal trajectories of Alzheimer's disease CSF biomarkers and blood pressure in cognitively healthy subjects.

We examined whether hypertension (HTN) was associated with Alzheimer's disease-related biomarkers in cerebrospinal fluid (CSF) and how changes in blood pressure (BP) related to changes in CSF biomarkers over time. A longitudinal observation of cognitively healthy normotensive subjects (n=134, BP<140/90, withno antihypertensive medication), controlled HTN(n=36, BP<140/90, taking antihypertensive medication), and 35 subjects with uncontrolled HTN (BP ≥ 140/90). The follow-up range was 0.5to15.6 years. Total tau (T-tau) and phospho-tau181 (P-tau 181) increased in allbut controlled HTN subjects (group×timeinteraction: p<0.05 for both), but no significant Aβ42 changes were seen. SignificantBP reduction wasobserved in uncontrolled HTN, andit was related to increase in T-tau (p=0.001) and P-tau 181 (p<0.001). Longitudinal increases in T-tau and P-tau 181 were observed in most subjects; however, onlyuncontrolled HTN had both markers increase alongside BPreductions. We speculatecumulative vascular injury renders thebrain susceptible to relative hypoperfusion with BP reduction. Over the course of the study, participants with uncontrolled HTN at baseline showed greater accumulation of CSF total tau and phospho-tau181 (P-tau 181) than subjects with normal BP or with controlled HTN. In the group with uncontrolled HTN, increases in total tau and P-tau 181 coincided with reduction in BP. We believe this highlights the role of HTN in vascular injury and suggests decline in cerebral perfusion resulting in increased biomarker concentrations in CSF. Medication use was the main factor differentiating controlled from uncontrolled HTN, indicating that earlier treatment was beneficial for preventing accumulations of pathology.

Association Between Highly-Sensitive C- Reactive Protein and Neutrophil to Lymphocyte Ratio as Markers of Inflammation Among Adult Nigerians with Essential Hypertension

Background: Hypertension is a medical condition with global public health importance that is associated with significant morbidity and mortality in both developed and developing countries. It is important to identify readily available parameters that may indicate the level of inflammation that is associated with hypertension. Objective: To assess the relationship between highly-sensitive C-Reactive Protein (hs-CRP) and neutrophil-to-lymphocyte ratio (NLR) in hypertensive adults. Methods: Three hundred and sixty adults comprising 240 hypertensive and 120 healthy normotensive subjects (control) were studied. The full blood count (FBC) and highly-sensitive C-Reactive Protein (hs-CRP) levels were determined using standard methods. Results: The mean values of Total White Blood Cells count (WBC) (p = 0.03), absolute neutrophil count (p = 0.03), absolute lymphocyte count (p = 0.01), NLR (p = 0.001) and hs-CRP (p &lt;0.001) in the hypertensive subjects were significantly higher than in the normotensive subjects. The mean values also differed significantly with increasing severity of hypertension. There was a significant but weak positive correlation between NLR and hs-CRP (r = 0.248, p &lt;0.001). The Areas Under the Curve (AUC) of the Receiver Operating Characteristic (ROC) of NLR and hs-CRP (p = 0.01) were 0.68 and 0.639 respectively. Conclusion: NLR is closely associated with hs- CRP among hypertensive subjects. Therefore, NLR may be utilised routinely instead of hs-CRP as a screening test for inflammation in essential hypertension.

Simultaneous quantitation of urine aldosterone and tetrahydroaldosterone in healthy Chinese subjects using a validated LC-MS/MS method.

Aldosterone (ALD) is excreted in urine mainly as glucuronide conjugates of ALD and tetrahydroaldosterone. Measuring these urinary metabolites might be an alternative screening test to plasma ALD for primary aldosteronism. We report a validated LC-MS/MS method to measure both analytes simultaneously. Urine samples underwent enzymatic hydrolysis to release the analytes from their glucuronide conjugates followed by organic solvent extraction and LC-MS/MS. The analytical performance of this method was evaluated. The within-batch and between-batch coefficients of variation for urine ALD and urine THA were all ≤5.2 and ≤3.7%. The lower limit of quantification was 0.5nmol/L, and the linearity was up to at least 2770 nmol/L for both analytes. No significant matrix interference and carryover were observed. Both analytes in urine were stable for at least 48 h at 10°C and at least 18 months at -80°C. Local reference intervals were established from 126 healthy normotensive Chinese subjects (53% women, age: 20-65 years). Reference intervals for urine ALD and tetrahydroaldosterone were 2-38 and 9-139 nmol/day, respectively. This validated method can be applied to screening and diagnosing primary aldosteronism.

#4777 BLOOD PRESSURE RESPONSE TO A LOW SODIUM DIET IN NORMOTENSIVE SUBJECTS

Abstract Background and Aims The term salt sensitivity (SS) has been used to show an increase in BP in response to saline overload in both normotensive and hypertensive patients. Age, sex, and obesity have been proposed as predisposing factors. The objective of our work was to evaluate the response of office BP (OBP) and ambulatory BP (ABP) to changes in salt intake in healthy normotensive subjects. Method We analyzed 193 subjects who participated in the evaluation as potential kidney donors; none had a history of hypertension, diabetes, renal or cardiovascular disease. They received two consecutive standardized diets, one with 300 mEq and the other with 30 mEq of Na+/day. On the last day of each diet, a 24-h urine collection was obtained and an ambulatory BP monitor was placed for 24 h in the non-dominant arm, following recording of OBP. Data were expressed as mean and standard deviation (SD). Student's test and one-way ANOVA were used to compare means, values of p&amp;lt;0.05 were considered statistically significant differences. Results In the study group there were 120 females (62%) and 71 were salt sensitive (SS) (37%). The mean age was 46.9 ± 10 years (20 – 72) without significant gender differences (F = 46.7 ± 10 vs M = 47.3 ± 9 p = 0.704). The age of the salt sensitive (Ss) group was significantly higher than the salt resistant (Sr) (49.8 ± 9 vs 45.3 ± 10 p = 0.002). BMI was found to be increased (27.7 ± 4) without significant gender or incidence of SS differences. We found no association between gender and SS (p = 0.509). After the high sodium and before low sodium diets, the mean difference in urinary Na+ excretion was 165.2 ± 83 mEq/24h, significantly higher among men than women (201.6 ± 84 vs 142.3 ± 75 p = 0.0001). There were no differences based on SS. We did not find significant gender differences in the variation of OBP or ABP, with the changes in the diet. The mean reduction of systolic pressure OBP for the group was 6.13 ± 10 and of diastolic pressure OBP 0.35 ± 5 mmHg. In separate analysis, systolic and diastolic OBP drops were significantly higher in the Ss than in the Sr (9.69 ± 12 vs 2.57 ± 8 and 2.24 ± 7 vs – 0.95 ± 5 mmHg respectively, p = 0.001). The average reduction in systolic ABP was 7.13 ± 8 and in diastolic ABP 3.33 ± 5 mmHg. In separate group analysis we also observed a significantly greater reduction in Ss than in Sr (12.83 ± 7 vs 1.8 ± 5 and 6.56 ± 5 vs. 0.12 ± 3 mmHg respectively, p = 0.001). Conclusion In our study group, the reduction of both OBP and ABP following a low sodium diet in normotensive subjects depends on salt sensitivity and is independent of gender and body weight.

The association of plasma sortilin with essential hypertension and subclinical carotid atherosclerosis: A cross-sectional study.

BackgroundSortilin, a protein that regulates glucose and lipid metabolism, has recently been linked to cardiovascular diseases (CVDs) such as coronary heart disease and carotid artery stenosis. In this study, we measured circulating sortilin concentrations in essential hypertensive (EH) patients, and evaluated the association between sortilin, hypertension, and subclinical carotid atherosclerosis in hypertensive individuals.MethodsThis cross-sectional study included 336 individuals, including 186 newly diagnosed EH patients and 150 age-and-sex-matched normotensive healthy subjects (NT). Plasma sortilin and adiponectin (ADI) levels were measured using ELISA kits. In the EH group, high-resolution B-mode ultrasound was used to detect the existence of subclinical carotid atherosclerosis (subAS), which was defined as having a carotid intima–media thickness (cIMT) ≥ 1.0 mm and/or plaque on the carotid artery without any clinical manifestations.ResultsOur findings showed that plasma sortilin concentrations ranged from 3.34–11.34 ng/ml for all subjects. Sortilin levels were significantly higher in the EH group than in the NT group (8.10 ± 1.82 ng/ml vs. 6.37 ± 1.52 ng/ml, P < 0.001) and were further upregulated in the EH with subclinical carotid atherosclerosis (EH + subAS) group compared to the EH without subclinical carotid atherosclerosis (EH-subAS) group (8.42 ± 1.75 ng/ml vs. 7.79 ± 1.84 ng/ml, P < 0.05). In correlation analysis, sortilin was positively correlated with systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), white blood cell (WBC), endothelin-1 (ET-1), high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and cIMT (all P < 0.05) and negatively associated with NO and ADI (P < 0.001). Multiple linear regression analysis revealed that SBP, LDL-C, and ET-1 were independently associated with plasma sortilin levels. Increased sortilin levels were independently associated with the risk of EH (OR: 1.86, 95%CI: 1.56–2.20, P < 0.001) and EH + subAS (OR: 1.33, 95%CI: 1.07–1.66, P = 0.011), after adjustment for multiple risk factors. Restricted spline curve showed that elevated sortilin levels increase the odds of having EH.ConclusionElevated sortilin levels are associated with an increased risk of essential hypertension and subclinical carotid atherosclerosis in hypertensive patients.

RIGHT HEART PULMONARY CIRCULATION UNIT RESPONSE TO EXERCISE IN PATIENTS WITH SYSTEMIC ARTERIAL HYPERTENSION. INSIGHTS FROM THE RIGHT-NET STUDY

Objective: Systemic arterial hypertension is the main risk factor for the development of heart failure with preserved ejection fraction (HFpEF). The aim of this study was to assess the right heart-pulmonary circulation unit response to exercise doppler echocardiography (EDE) in patients with hypertension in order to evaluate the capacity of EDE to unmask a pre-HFpEF state. Design and method: EDE was performed in 155 hypertensive patients and in 145 healthy normotensive subjects on a semi-recumbent cycle ergometer with load increments of 25 watts every 2 minutes. Left ventricular (LV) and right ventricular (RV) dimensions, function and hemodynamics were evaluated. Linear mixed models were used to test the interaction between hypertension and age group on the echocardiographic parameters at peak exercise, adjusting for baseline values. Results: Impaired echo-Doppler LV and RV function was observed both at rest and peak exercise in hypertensives compared to healthy subjects. Pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance were higher in the former. The entire population was then divided into tertiles of age: at rest no significant differences were recorded for each age group between hypertensives and normotensives except for E/E’ that was higher in the hypertensives of the middle age tertile. At peak exercise, hypertensives had higher pulmonary artery systolic pressure (PASP) and E/E’ but lower tricuspid annular plane systolic excursion (TAPSE) as age increased, compared to normotensives. Differences in E/E’ and TAPSE between the 2 groups at peak exercise were explained by the interaction between hypertension and age even after adjustment for baseline values (p &lt; 0.001 for E/E’, p = 0.011 for TAPSE). At peak exercise, the oldest group of hypertensive patients had a mean E/E’ of 13.0, suggesting a significant increase in LV diastolic pressure combined with increased PASP. Conclusions: Age and hypertension have a synergistic effect on E/E’ and TAPSE at peak exercise indicating that the detrimental effect of aging on cardiac function is amplified in hypertension. EDE appears a useful tool for unmasking a pre-HFpEF state in hypertension even in patients with controlled resting blood pressure.

Twenty-four-hour and nocturnal ambulatory blood pressure variability patterns in diabetics and hypothyroid patients: Looking through different temporal windows

ABSTRACT This cross-sectional study attempted to determine the 24-h blood pressure variability (BPV) and nocturnal dipping, through designated temporal windows in diabetic and hypothyroid patients. BPV profiles were examined in the cohorts of 26 diabetics and 27 hypothyroid patients on their prescribed medications. Fifty-seven (57) healthy normotensive subjects were treated as controls. We recorded blood pressure (BP)parameters in each subject over at least two to three consecutive days, using an ambulatory blood pressure monitor (ABPM). We analyzed the data employing A&D software, Cosinor rhythmometry, and SPSS software. Most of the patients displayed a statistically significant circadian rhythm with prominent periodsat 24 h and/or 12 h. The hourly-averaged data in patients exceeded the normal range of BP during the early morning and late afternoon. BP parameters in studied patients were significantly higher than in the controls. The results depicted significant and independent effects of “temporal window” and “disease” on the nocturnal BP profile. Higher BPV and bouts of nocturnal hypotension in diabetic and hypothyroid patients indicate poor BP management. The diagnosis of BP and efficacy of treatment in diabetic and hypothyroid patients could be detected proficiently by ambulatory BP monitoring. Temporal window analysis could be beneficial for tracing nocturnal dipping precisely.

Plasma and Urinary Levels of Nerve Growth Factor Are Elevated in Primary Hypertension.

Nerve growth factor (NGF) is the main neurotrophic factor that can control sympathetic nerve innervation and sympathetic neural activity in cardiovascular organs. Although NGF overproduction and its influences on the sympathetic nervous system have been shown in hypertensive animals, NGF status and its association with sympathetic nerve activity have not yet been explored in human hypertension. In the present study, therefore, plasma and urinary levels of NGF and those of catecholamines (i.e., indices for NGF status and sympathoadrenal activity, respectively) were compared between 83 untreated primary hypertensives without apparent cardiovascular damages and 81 healthy normotensive subjects. Plasma and urinary levels of NGF were significantly greater in the hypertensive group (311 ± 158 pg/mL and 72.7 ± 54.0 ng/g of Cr) than in the normotensive group (168 ± 188 pg/mL and 54.5 ± 38.8 ng/g of Cr) (p < 0.05 for each measurement), even if the baseline differences of age and gender between the groups were adjusted. Similarly, plasma and urinary levels of catecholamines were significantly higher in the hypertensive group than in the normotensive group except for plasma noradrenaline. In addition, despite no significant correlations between plasma levels of NGF and catecholamines in both groups, urinary NGF significantly correlated positively with both urinary noradrenaline and urinary adrenaline in the hypertensive group (r = 0.259, p=0.018 and r = 0.232, p=0.035), but not in the normotensive group (r = 0.115, p=0.307 and r = −0.018, p=0.871). On the contrary, plasma and urinary levels of NGF as well as those of catecholamines did not associate with any systemic hemodynamic indices such as blood pressure and pulse rate in either group. Thus, primary hypertension was characterized by the enhancements of both NGF status and sympathoadrenal activity and the positive relationship between them. Our data indicate that enhanced NGF status and subsequent NGF-induced sympathoadrenal overactivity could occur in primary hypertension.

Quantitation of plasma angiotensin II in healthy Chinese subjects by a validated liquid chromatography tandem mass spectrometry method.

Quantitation of plasma angiotensin (Ang) II, the active mediator of the renin-angiotensin system, is challenging owing to its low physiological concentration. We report a validated liquid chromatography-mass spectrometry (LCMS) method to overcome this challenge. Ang II was extracted from EDTA plasma by an offline solid-phase extraction procedure with a Waters MAX μElution plate. LCMS quantitation was performed on the Waters TQS system, monitoring the 3+ ions of the peptide. The analytical performance of the LCMS method was validated. The stability of Ang II was studied with or without the presence of a protease inhibitor. Local reference intervals were established from 143 healthy normotensive subjects (57% female, 21-60 years old). The Ang II LCMS method had a measurable range of 3.3-700 pmol/L. The between-batch precision coefficient of variation was <7% over Ang II concentrations of 8.6-110 pmol/L. No significant matrix interference and carryover were observed. There was no significant difference in Ang II concentration in EDTA blood and plasma for at least 2h and 1h at room temperature, respectively. Ang II was stable for at least 1 year when stored at -80°C, with or without the protease inhibitor. Age-dependent Ang II reference intervals were established: 4.4-17.7pmol/L (21-30 years) and 3.9-12.8pmol/L (31-60 years). The present LCMS method is suitable for quantitation of plasma Ang II to study the renin-angiotensin system.

Heart Failure and Aortic Stiffening in Patients with Preserved Ejection Fraction

Objective: This study aimed to explore a possible relationship between aortic stiffness parameters and diastolic function in patients with asymptomatic or symptomatic diastolic dysfunction, and subsequently, the effect of aortic stiffness parameters on the progression from asymptomatic diastolic dysfunction to clinical diastolic heart failure.&#x0D; Methods: Seventy-five subjects were enrolled in the study of whom 20 had diastolic heart failure with the left ventricle ejection fraction (LVEF) &gt;50%, 20 had asymptomatic diastolic dysfunction with LVEF&gt;50%, 16 had hypertension with normal diastolic function, and 19 were normotensive healthy subjects. Ascending aorta recordings for measuring aortic strain and distensibility as markers of aortic stiffness were obtained from a spot nearly 3 cm above the aortic valve using 2-D echocardiography under M-mode. Doppler echocardiography and 2-D echocardiographic measurements were used to determine diastolic function. &#x0D; Results: While no statistically significant difference in aortic strain or distensibility values was observed between the asymptomatic group and the diastolic heart failure group; however, E/E’ values were higher in the heart failure group [12.1 (10.0-17.1) vs. 10.0 (6.2-22.5)] (p=0.014). Aortic strain and distensibility values significantly decreased as E/E’ values increased (r = −0.416; p &lt; 0.001 and r = −0.576; p &lt; 0.001, respectively) for pooled data from all groups.&#x0D; Conclusion: Although aortic stiffness parameters did not have a direct effect on the progression from asymptomatic diastolic dysfunction to diastolic heart failure, echocardiographic monitoring of these parameters may be beneficial in identifying patients who would progress to clinical heart failure from diastolic dysfunction.

Effect of dietary calcium and vitamin D supplementation on blood pressure control following salt loading

Epidemiological and animal studies assert an inverse relationship between calcium intake and risk of clinical hypertension. Nonetheless, there is a paucity of information on the effect of calcium and vitamin D co-administration on sodium chloride (NaCl)-induced blood pressure (BP) elevation in apparently healthy normotensive subjects. Hence, this study evaluated this relationship. For a 5-day study period, a group of 10 subjects (Group A) was placed on placebo while another group of 5 subjects (Group B) had dietary NaCl (200 mmol/day) and a third group of 5 subjects (Group C) had dietary NaCl (200 mmol/day) with calcium/vitamin D supplement (625 mg/200 IU). Before and after the 5-day regimen, blood pressure (BP) was measured, and blood, as well as urine samples, were collected from the subjects for evaluation of electrolyte status. Mean arterial BP (MABP) increased (p<0.01) in group B, but decreased in group C (p<0.01). Plasma potassium level increased in both groups B and C (p<0.01). However, while plasma calcium decreased in the two groups (p<0.01), plasma sodium decreased (p>0.01) only in group C, after the 5-day regimen. Urinary excretion of calcium increased and decreased (p<0.01) in groups B and C, respectively, a converse of the trend in urinary potassium. Whereas that of sodium increased in both groups B and C (p<0.01). These results suggest that oral Ca and Vitamin D supplementation may prevent a rise in BP in subjects on a high NaCl diet by attenuating plasma Na retention, with an augmented urinary excretion.

Role of Divalent Cations in Pathophysiology of Essential Hypertension

Introduction: Essential hypertension (EHTN) accounts for 95% of all cases of hypertension affecting approximately one billion individuals worldwide. Alteration in trace elements like calcium and magnesium can be helpful in knowing the elemental involvement in the pathophysiology of EHTN and its associated complications. Aims and Objectives: To estimate serum levels of calcium and magnesium in patients of EHTN and compare it with normotensive healthy subjects. To find the correlation of serum levels of calcium and magnesium with systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients of EHTN. Materials and Methods: The study was conducted in 100 subjects, out of which 50 were essential hypertensive patients (cases) and 50 were normotensive healthy subjects (controls), within the age group of 25-65 years. Serum calcium and magnesium were measured by using the auto analyzer Beckman Coulter DXC 600. The results were analysed by using students ‘t’ test and pearson’s correlation. Results: Our study found a significantly (p&lt;0.001**) increased levels of serum calcium and significantly (p&lt;0.001**) decreased levels of serum magnesium in cases as compared to controls. Our study also revealed a significant positive correlation between serum calcium with SBP (r= 0.842, p&lt;0.001**) and DBP (r= 0.403, p= 0.004**); and a significant negative correlation between serum magnesium with SBP (r= -0.805, p&lt;0.001**) and DBP (r=-0.395, p=0.005**) among essential hypertensives. Keywords: EHTN-Essential hypertension, HTN-Hypertension, SBP-Systolic blood pressure, DBP-Diastolic blood pressure, BP-Blood pressure.

ALTERATION IN SERUM MAGNESIUM LEVELS IN PATIENTS WITH ESSENTIAL HYPERTENSION

Introduction: Essential hypertension (EHTN) accounts for 95% of all cases of hypertension affecting approximately one billion individuals worldwide. Alteration in trace elements like magnesium can be helpful in knowing the elemental involvement in the pathophysiology of EHTN and its associated complications.&#x0D; Aims and Objectives: 1. To estimate serum levels of magnesium in patients of EHTN and compare it with normotensive healthy subjects. 2. To find the correlation of serum levels of magnesium with systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients of EHTN.&#x0D; Materials and Methods: The study was conducted in 100 subjects, out of which 50 were essential hypertensive patients (cases) and 50 were normotensive healthy subjects (controls), within the age group of 25-65 years. Serum magnesium were measured by using the auto analyzer Beckman Coulter DXC 600. The results were analysed by using students ‘t’ test and pearson’s correlation.&#x0D; Results: Our study found a significantly (p&lt;0.001**) decreased levels of serum magnesium in cases as compared to controls. Our study also revealed a significant negative correlation between serum magnesium with SBP (r= -0.805, p&lt;0.001**) and DBP (r= -0.395, p=0.005**) among essential hypertensives.&#x0D; Keywords: EHTN- Essential hypertension, HTN – Hypertension, SBP – Systolic blood pressure, DBP – Diastolic blood pressure

Serum Uric Acid, Lipid Profile and Atherogenic Index of Plasma in Dipper and Non-dipper Normotensive Subjects

The cardiovascular risk evidentially found to have an association with disparities of the dipper and non-dipper hypertension. There is less celerity with regard to mechanism of diurnal blood pressure variations and related disorders. The serum uric acid and AIP are considered as cardiovascular risk factors. The current study aims to determine and compare serum uric acid level and atherogenic index of plasma (AIP) in dipper and non-dipper normotensive subjects. The study population is 64 healthy normotensive subjects (32 dippers and 32 non-dippers), age between 30-55 years. The subjects were identified into dippers and non-dippers by using ambulatory blood pressure monitoring device (Spacelabs 90207, USA). After identifying dipping status of the subjects, uric acid, triglycerides and HDL cholesterol were measured. AIP was calculated by using formula (log [TG/HDL]). Median (interquartile range) of serum uric acid in the dipper group was 5.08mg/dl (4.12-5.66) and the non-dipper group was 5.27mg/dl (4.63-6.33). The median (interquartile range) for AIP was 0.24 (0.05-0.38) in the dipper group and 0.48 (0.32-0.67) in the non-dipper group. The median (interquartile range) of uric acid and AIP in the non-dipper group was significantly higher than that of dipper group (p&lt;0.05). This study observed in even normotensive subjects, the non-dipper group has significantly higher serum uric acid and AIP than that of dipper group. These cardiovascular risk factors increased in non-dipper group compared to dipper group. The study come out with concluded that non-dipper group had higher cardiovascular risk than dipper group even in normotensive healthy subjects.

Tp-Te interval prolongs in hypertension independent of the left ventricular geometry

Background/Aim: Hypertension (HT) may modulate left ventricular (LV) geometry. Electrocardiographic Tp-Te, QT and QTc interval, and Tp-Te/QTc ratio are among the parameters of ventricular repolarization (VR) that may predict ventricular arrhytmogenic potential and possess prognostic significance. It is well known that left ventricular hypertrophy is associated with increase in the parameters of VR; however, little is known about the association of these parameters with other forms of LV geometry in HT. Our aim was to assess this association. Methods: A total of 162 newly diagnosed essential HT patients were enrolled and divided into those with concentric LV remodeling (n=79) and those with normal LV geometry (n=83). Healthy normotensive subjects (n=76) comprised the control group. Data were gathered retrospectively from electrocardiographic, echocardiographic, and demographic records. Results: QT interval, P-wave duration, and QRS duration were similar among the 3 groups (P>0.05). Tp-Te, QTc and Tp-Te/QTc were greater in the HT group compared with the controls (P 0.05). There was no correlation between Tp-Te interval, LV mass and LV mass index among the study population. Conclusion: Tp-Te may be useful in prognostic stratification of HT. Regardless of the LV geometry, HT patients have prolonged Tp-Te and QTc intervals, and increased Tp-Te/QTc ratio compared to the healthy subjects. Our findings may suggest possible utilization of Tp-Te as HT-related end-organ damage in the future.

Assessment of Inflammatory Markers IL- 6 and TNF- Alpha in Newly Diagnosed Type II Diabetics without Hypertension in Comparison with Non-Diabetic Normotensive Subjects

Background: The present study was conducted to assess inflammatory markers IL- 6 and TNF- alpha in newly diagnosed type II diabetics without hypertension. Subjects and Methods: 68 types of II diabetes mellitus patients and equal numbers of normotensive non-diabetic subjects were also recruited. Glycated hemoglobin (HbA1c) levels, TNF- alpha and IL- 6 were determined. Results: The mean IL- 6 level in group I was 17.4 pg/ml and in group II was 4.2 pg/ml. TNF- alpha level in group I was 35.8 pg/ml and in group II was 12.5 pg/ml. The difference was significant (P&lt; 0.05). Conclusion: TNF- alpha and IL- 6 level was higher among diabetic patients as compared to healthy normotensive non-diabetic subjects.

Clinical Evaluation of Assays for Plasma Renin Activity and Aldosterone Measurement by Liquid Chromatography-Tandem Mass Spectrometry.

Aldosterone and renin are pivotal hormones in the regulation of salt and water homeostasis and blood pressure. Measurement of renin and aldosterone in serum/plasma is essential for the investigation of primary hyperaldosteronism (PA) and monitoring of glucocorticoid replacement therapy. We report 2 LC-MS/MS methods developed to measure aldosterone and plasma renin activity (PRA). PRA was determined by endogenous enzymatic generation of angiotensin I using 150 µL of sample. Generated angiotensin I was purified by solid phase extraction prior to chromatographic separation and mass spectrometry. Aldosterone measurement required 300 μL of sample extracted with MTBE prior to LC-MS/MS analysis. The PRA method was linear (1.2-193 nmol/L), sensitive (LLOQ = 1.2 nmol/L), precise (CV = 4.1%), and specific (no cross reactivity for a number of structurally similar steroids). Dilutional linearity and recovery (84%) were acceptable. Accuracy was confirmed by comparison against our current RIA method. The aldosterone method had equally acceptable performance characteristics. Reference ranges in 110 healthy normotensive subjects were: PRA 0.2-3.7 nmol/L/h and aldosterone 50-950 pmol/L. Consecutive patients (n = 62) with adrenal incidentalomas shown to have no functional adrenal disease; their post overnight 1 mg dexamethasone test values were: PRA 0.2-2.6 nmol/L/h and aldosterone 55-480 pmol/L. Serum aldosterone values after 2 liter saline suppression were-normal subjects (n = 17): 78-238 pmol/L and confirmed primary hyperaldosteronism (n = 25): 131-1080 pmol/L. We have developed robust assays for PRA and aldosterone with appropriate clinical evaluation. These assays are now in routine practice in the UK.

Impact of diastolic blood pressure on speckle tracking derived myocardial work components in a population of normotensive and untreated hypertensive patients

Abstract Background Arterial hypertension deeply influences left ventricular (LV) mechanics and global longitudinal strain (GLS). The effect of blood pressure (BP), in particular systolic BP burden, on speckle tracking derived myocardial work (MW) was demonstrated in both hypertensive and healthy subjects. Purpose Aim of our study was to evaluate the impact of diastolic BP (DBP) on MW components in a population of newly-diagnosed, never treated hypertensive patients and healthy subjects. Methods The study population included 105 newly-diagnosed, never treated hypertensive patients (M/F= 62/43; age=46.1±13.0 years, BP=145.1±10/89.8±7.4 mmHg), and 105 healthy normotensive subjects (BP=121.6±9.8/73.7±7.4mmHg), matched for age and sex. All participants underwent standard echo exam, including GLS evaluation (in absolute value). Cuff BP was employed as a surrogate of LV peak pressure for the assessment of global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). Exclusion criteria were diabetes mellitus, coronary artery disease, overt heart failure, valve heart disease, primary cardiomyopathies, atrial fibrillation and inadequate echo imaging. The study population was divided into two groups according to DBP threshold of normalcy defined by 2018 ESH/ESC guidelines: the first group including individuals with normal DBP (n=135, DBP&amp;lt;90mmHg) and the second group including patients with abnormal DBP (n=75, DBP ≥90 mmHg). Results The two groups were comparable for sex prevalence, age and heart rate. Body mass index (BMI), systolic and mean BP were higher in the group with abnormal DBP (all p&amp;lt;0.0001). Among echo data, no significant intergroup difference was found in LV mass index, relative wall thickness, ejection fraction and diastolic parameters. GLS was lower in patients with abnormal DBP (20.4±1.9 vs. 22.1±2.1%, p&amp;lt;0.0001). GWI (2443.0±403.1 vs. 2277.3±359.6 mmHg%, p&amp;lt;0.002), GCW (2733.5±406.0 vs. 2556.9±405.6 mmHg%, p=0.003) and GWW (112.8±84.4 vs. 76.8±45.1 mmHg%, p&amp;lt;0.0001) were significantly higher in patients with abnormal DBP, whereas GWE (95.3±2.8 vs. 96.2±1.7%, p&amp;lt;0.002) was lower in this group. In the pooled population, DBP was positively related to GWI, GCW (both r=0.30, p&amp;lt;0.0001) and GWW (r=0.26, p&amp;lt;0.0001), while negatively correlated with GLS (r=−0.37, p&amp;lt;0.0001) and GWE (r=−0.21, p&amp;lt;0.002). By separate multiple linear regression analyses, GWI (β=0.45, p&amp;lt;0.0001), GCW (β=0.47, p&amp;lt;0.0001), GWW (β=0.20, p=0.007) and GWE (β=−0.15, p&amp;lt;0.05) were all independently associated with DBP, after adjusting for male sex, age, BMI, heart rate, GLS and E/e' ratio. Conclusions In a population of untreated hypertensive patients and healthy subjects, increased DBP affects longitudinal function and MW. In particular, elevated diastolic BP induces an increase of wasted work which is only partially balanced by the increased constructive work, thus provoking a clear reduced efficiency of myocardial mechanics. Figure 1 Funding Acknowledgement Type of funding source: None

Effect of Short-Term Cold Exposure on Central Aortic Blood Pressure in Patients with CKD

Objectives: Study determined effects of arterial hypertension and impaired kidney function on acute cold exposure induced changes in peripheral and central aortic blood pressure (BP). Methods: Five-six subjects were divided into 3 groups including 20 hypertensive patients with normal kidney function (AH-non-CKD), 20 patients with hypertension and CKD (AH-CKD) stage 3b–4 and 16 healthy normotensive subjects (C). Baseline BP, central BP, and central pulse pressure, unadjusted augmentation index (AI) and central augmented pressure were assessed by applanation tonometry (SphygmoCor) before entering the room with constant temperature −10°C (°C), after 10 min in the cold room and in same conditions in room temperature. Results: Cold exposure led to significant increase of central aortic, systolic, and diastolic BP in both AH-non-CKD (p < 0.01) and AH-CKD (p < 0.001). The central aortic BP did not change in healthy subjects. The increase of central aortic systolic blood pressure was significantly larger in AH-CKD compared to AH-non-CKD group (p = 0.0002). Increase of aortic central and brachial systolic and diastolic BP was significantly larger in AH-CKD and AH-non-CKD patients than in controls. AI increased and subendocardial viability ratio and heart rate decreased after cold exposure in all groups. Central aortic and brachial rate pressure product increased by approximately 2,300 bpm × mm Hg (p < 0.001) and 1,600 bpm × mm Hg (p < 0.001), respectively, in the AH-CKD group and by 1,000 bpm × mm Hg (p = 0.007) and 500 bpm × mm Hg (p = 0.19) in AH-non-CKD group after cold exposure. Conclusion: Short-term cold exposure induces larger increase of brachial and central aortic BP in patients with arterial hypertension than in healthy subjects. The changes in central aortic pressure are augmented in hypertensive patients with impaired kidney function.

Effect of Losartan and Amlodipine on Lung Function Status in Hypertensive Patients: A Randomized Control Trial

Introduction: Essential hypertension is associated with altered pulmonary function. Antihypertensive medication and lung function are also associated. Losartan (angiotensin II receptor blocker) and amlodipine (calcium channel blocker) are commonly used antihypertensive drugs.&#x0D; Objectives: To evaluate the effects of antihypertensive drugs on lung function status in patients with essential hypertension.&#x0D; Materials and Methods: This prospective observational study was carried out in the Department of Physiology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, from July 2012 to June 2013 on 100 newly diagnosed hypertensive patients without any antihypertensive medication (group B, age 30-55 years). They were selected from the Out Patient Department (OPD) of Cardiology, BSMMU, Dhaka. Age, sex and BMI matched 50 apparently healthy normotensive subjects were also studied as control (group A). Based on treatment, these study subjects were divided into two groups (B1 and B2). Group B1 included 50 patients received losartan 50 mg daily and B2 included 50 patients received amlodipine 5 mg daily. They were observed once before the treatment (B1a and B2a), after 3 months of medication (B1b and B2b) and after 6 months of medication (B1c and B2c). For assessing lung function status, Forced Vital Capacity (FVC), Forced Expiratory Volume in 1st second (FEV1) and Peak Expiratory Flow Rate (PEFR) were measured with a RMS computer based Spirometer.&#x0D; Results: Mean FVC, FEV1 and PEFR were significantly lower in newly diagnosed hypertensive patients in comparison with that of healthy normotensive. Mean FVC, FEV1 and PEFR were found significantly higher in the group taking losartan and amlodipine for 6 months when compared to newly diagnosed but lower than those of controls.&#x0D; Conclusion: Reduced lung function occurs in newly diagnosed hypertensive patients which was improved by treatment with losartan and amlodipine.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 42-44