Middle-aged Essential Hypertensive Patients Research Articles

GW26-e4713 Factors associated with morning blood pressure surge in young and middle-aged essential hypertensive patients

GW26-e4713 Factors associated with morning blood pressure surge in young and middle-aged essential hypertensive patients

Left ventricular diastolic dysfunction in newly diagnosed untreated hypertensive patients

Essential hypertension is characterized by a left ventricular dysfunction. However, the majority of the studies performed so far investigated patients under drug treatment and/or with concomitant diseases, such as obesity, diabetes, metabolic syndrome or coronary heart disease, which per se may affect diastolic function independently on the blood pressure elevation. The present study aimed at investigating left ventricular diastolic function in untreated, uncomplicated and newly diagnosed hypertensive patients by employing both routine echo-Doppler and pulse tissue-Doppler technique. Data were collected in 86 middle-aged essential hypertensive patients and in 18 sex-matched normotensive controls. At the echo-Doppler approach, about half of the hypertensive patients displayed a diastolic dysfunction (n = 44, E/A: 0.79 ± 0.02). They showed body mass index values slightly greater than hypertensive patients without diastolic dysfunction but superimposable blood pressure values and metabolic variables. When assessed via the pulse tissue-Doppler approach, patients with a reduced E/A displayed an Em/Am ratio significantly lower than patients without diastolic dysfunction and control subjects. This was the case when the data were related to the lateral and septal mitral annulus or averaged together. Furthermore, whereas myocardial systolic peak velocity (Sm) was lower in hypertensive patients than in control subjects, no significant between-groups difference in E/Em ratio was observed. Differently from the data obtained via the echo-Doppler approach, the tissue-Doppler method in patients without diastolic dysfunction showed a significant higher deceleration and isovolumetric relaxation times, with a lower Em velocity compared with the normotensive subjects. At the stepwise multiple regression analysis E/A ratio and E’/A’ values were related with left ventricular mass index and body mass index after correction for age. These data provide evidence that diastolic dysfunction is of frequent detection in the earlier uncomplicated phases of the disease and that tissue Doppler detects an initial impairment of left ventricular relaxation in the patients in which at echo Doppler is still normal.

Trandolapril, but not Verapamil nor their association, restores the physiological renal hemodynamic response to adrenergic activation in essential hypertension

The purpose of this study was to evaluate the effects of antihypertensive drugs on renal hemodynamics in hypertensive patients during an adrenergic activation by mental stress (MS), which induces renal vasoconstriction in healthy subjects. Renal hemodynamics was assessed twice in 30 middle-aged essential hypertensive patients (57±6 years)-after 15 days of pharmacological wash-out and after 15 days of treatment with Trandolapril (T, 4 mg, n=10), Verapamil (V, 240 mg, n=10), or both (T 2 mg+V 180 mg, n=10). Each experiment consisted of 4 30-min periods (baseline, MS, recovery I and II). Renal hemodynamics was evaluated with effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) from plasminogen activator inhibitor and inulin clearance, respectively. MS increased blood pressure (BP) to a similar extent before and after each treatment. Before treatment, the increasing BP was not associated with any modification of ERPF in the 3 groups. Renal vascular resistances (RVR) markedly increased during MS (+23% in the T group, +21.6% in the V group, and +32.9% in the T+V group); GFR remained constant during the whole experiment. After treatment, ERPF decreased significantly during MS in the T group (-15%, P<0.05) and in the V group (-11.7%, p<0.01); in the T+V group, ERPF modifications were not statistically significant (P=0.07). In the T group, ERPF reverted to baseline values at the end of the stimulus, whereas in the V group, renal vasoconstriction was more prolonged. Only in hypertensive patients treated with 4 mg of T, RVR reverted to baseline during the recovery I, whereas in the V group, RVR remained elevated for the whole experiment. No modifications of GFR were observed in all groups. The kidney of hypertensive patients cannot react to a sympathetic stimulus with the physiological vasoconstriction. A short-term antihypertensive treatment with 4 mg of T restores the physiological renal response to adrenergic activation.

Silent cerebral white matter lesions and cognitive function in middle-aged essential hypertensive patients

Background An association between midlife blood pressure levels and late-life cognitive impairment has been reported. Hypertension is one of the most important factors related to the presence of cerebral white matter lesions, which is a prognostic factor for the development of cognitive impairment. Studies have shown a relationship between white matter lesions and cognitive decline in elderly hypertensive patients. The aim of the present study was to evaluate cognitive function in asymptomatic middle-aged hypertensive patients according to the presence or absence of white matter lesions. Methods Sixty never-treated essential hypertensive patients (38 men, 22 women), aged 50 to 60 years (mean age, 54.4 ± 3.8 years), without clinical evidence of target organ damage, were studied. All patients underwent brain magnetic resonance imaging to establish the presence or absence of white matter lesions, using the Rotterdam criteria. Cognitive function was evaluated by a neuropsychologic test battery measuring attention, memory, intelligence, anxiety, and depression. Results Twenty-three hypertensive patients (38%) were found to have white matter lesions on brain resonance. These patients exhibited a significantly worse performance on digit span forward, a standardized measure of attention than hypertensives without white matter lesions (4.86 ± 1.14 v 5.51 ± 0.97; P = .027). Hypertensive patients with white matter lesions showed no differences on both visual and logical memory tests when compared with patients without lesions. Conclusions We conclude that the presence of silent cerebral white matter lesions in middle-aged hypertensive patients is associated with a mild decline in basic attention.

Cerebral hemodynamics and silent cerebral white matter lesions in middle-aged essential hypertensive patients

Cerebral white matter lesions (WML) represent a subclinical form of ischemic brain damage that have been associated with risk of future stroke. Studies have shown an association between WML and impaired cerebral autoregulation in hypertensives who had previously suffered a stroke. The aim of the study was to evaluate cerebral hemodynamics in asymptomatic hypertensives according to the presence or absence of WML. Fifty never-treated essential hypertensives (32 men, 18 women), aged 50-60 years, without clinical evidence of target organ damage were studied. All patients underwent 24-h ambulatory blood pressure monitoring, and brain-magnetic resonance imaging to establish the presence or absence of WML. Baseline cerebral blood flow velocity (CBF), pulsatility index (PI; differences between systolic and diastolic velocities), and CBF after acetazolamide infusion (vasomotor reactivity of cerebral vessels), were measured by transcranial Doppler ultrasonography in both left and right middle cerebral arteries, and averaged. Twenty hypertensive patients (40%) were found to have WML on brain resonance. No differences were observed on resting and stimulating CBF between hypertensives with and without WML. In contrast, patients with WML exhibited significantly higher PI compared with hypertensives without WML (0.79 ± 0.13 vs 0.66 ± 0.12; p = 0.003). Moreover, PI correlated with 24-h pulse pressure (r = 0.361; p = 0.015). We conclude that the presence of silent WML in middle-aged hypertensives is associated with increased cerebrovascular pulsatility. This increased pulsatility is also associated with higher pulse pressure values, suggesting a pathogenetic link between pulse pressure, pulsatility and the development of WML.

Pulsatile and steady 24-h blood pressure components as determinants of left ventricular mass in young and middle-aged essential hypertensives

In order to explore the relations between left ventricularmass (LVM) and the pulsatile (pulse pressure) andsteady (mean pressure) components of the bloodpressure (BP) curve, 304 young and middle-agedessential hypertensive patients were studied by meansof 24-h ambulatory BP monitoring and echocardio-graphy. In the overall study population, both the BPcomponents showed significant correlations with LVM.These correlations were unevenly distributed in thesubgroups of subjects younger and in those older than50 years. While in this latter subgroup, in multivariateanalysis, both 24-h mean BP (24-MBP) (b¼0.27;P¼0.008) and 24-h pulse pressure (24-h PP) (b¼0.23;P¼0.02) were associated with LVM, in the subset ofyounger hypertensives only 24-h MBP (b¼0.21;P¼0.009) was related to LVM, independent of othercovariates. The relations observed between 24-h PP andLVM in the entire study population and in the patientsolder than 50 years lost statistical significance when theeffect of 24-h systolic blood pressure (24-h SBP) wastaken into account, in a multiple regression model inwhich 24-h MBP was replaced by 24-h SBP. Our findingsseem to suggest that the association of PP with LVM inmiddle-aged hypertensives may partially explain theincreased cardiovascular risk, documented in subjectswith high PP. However, this relation is not independent,but is mediated by SBP.Journal of Human Hypertension (2003) 17, 231–238.doi:10.1038/sj.jhh.1001542Keywords: pulse pressure; mean blood pressure; ambulatory blood pressure; left ventricular mass

Angiotensin converting enzyme (ACE) gene polymorphism and silent cerebral white matter lesions in middle-aged essential hypertensive patients

Angiotensin converting enzyme (ACE) gene polymorphism and silent cerebral white matter lesions in middle-aged essential hypertensive patients

Ambulatory blood pressure and microalbuminuria in essential hypertension

To assess the relationship of subclinical urinary albumin excretion with ambulatory and circadian variability of blood pressure. Patients with essential hypertension (82 males and 59 females, mean +/- SD age 38.9 +/- 7.3 years) who had never been previously treated for hypertension were included in the study. Patients with nephropathy or diabetes mellitus, hyperglycemia > 120 mg/dl, glomerular filtration rate < 80 ml/min per 1.73 m2, urinary tract infection and positive dipstick for albumin or glucose were excluded. Twenty-four-hour ambulatory blood pressure monitoring on a regular working day using an oscillometric device was performed. Twenty-four-hour urinary albumin excretion was measured on two separate days using an immunonephelometric assay. Microalbuminuric patients (urinary albumin excretion 30-300 mg/24 h, n = 31) had significantly higher mean ambulatory systolic blood pressure (SBP) and diastolic blood pressure (DBP) than those with normoalbuminuria (urinary albumin excretion < 30 mg/24 h, n = 96) during the 24-h, daytime (0800-2200 h) and night (2400-0600 h) periods, whereas for office blood pressure only DBP was significantly higher. Urinary albumin excretion was positively correlated with the means of SBP and DBP. Multiple regression analysis similarly confirmed that DBP during daytime was positively and day:night ratio of DBP inversely associated with urinary albumin excretion independent of age, sex and other parameters of ambulatory blood pressure. In conclusion, the present study indicates that, in middle-aged essential hypertensive patients, the presence of microalbuminuria is a marker for the presence of higher values of blood pressure throughout a 24-h period.

Baroreceptor Reflex in Elderly Essential Hypertensives: Effect of Chronic Inhibition of Angiotensin Converting Enzyme

Baroreflex function and plasma angiotensin II (Ang II) were examined in five elderly and five young or middle-aged essential hypertensive patients before and after enalapril treatment. Baroreflex sensitivity (BS) during blood pressure (BP) elevation by phenylephrine (PE) but not during BP reduction by sodium nitroprusside (SNP) was significantly attenuated in the elderly compared with the younger group, while plasma Ang II concentration was not different between the two groups. Enalapril treatment reduced BP without significant changes in heart rate and plasma norepinephrine in both groups, suggesting a leftward shift of barofunction curve. It also increased the BS in some cases in each group. However, plasma Ang II was not significantly reduced during enalapril treatment. The changes in BS did not correlate with changes in plasma Ang II. These results suggest that BS may be attenuated with increasing age independent of plasma Ang II and that ACE inhibitor influences the set point of the barofunction curve and BS by different mechanisms.