Primary Arterial Hypertension Research Articles

Стан ендотеліальної функції у підлітків із артеріальною гіпертензією

У підлітків із різними формами артеріальної гіпертензії (первинна артеріальна гіпертензія та артеріальна гіпертензія на тлі надмірної маси тіла) вивчено стан ендотеліальної функції. Виявлено, що у підлітків із артеріальною гіпертензією та надмірною масою тіла відбувається формування ендотеліальної дисфункції.

Emergency management of hypertension in children.

Systemic arterial hypertension in children has traditionally been thought to be secondary in origin. Increased incidence of risk factors like obesity, sedentary life-styles, and faulty dietary habits has led to increased prevalence of the primary arterial hypertension (PAH), particularly in adolescent age children. PAH has become a global epidemic worldwide imposing huge economic constraint on health care. Sudden acute increase in systolic and diastolic blood pressure can lead to hypertensive crisis. While it generally pertains to secondary hypertension, occurrence of hypertensive crisis in PAH is however rare in children. Hypertensive crisis has been further subclassified depending on presence or absence of end-organ damage into hypertensive emergency or urgency. Both hypertensive emergencies and urgencies are known to cause significant morbidity and mortality. Increasing awareness among the physicians, targeted at investigation of the pathophysiology of hypertension and its complications, better screening methods, generation, and implementation of novel treatment modalities will impact overall outcomes. In this paper, we discuss the etiology, pathogenesis, and management of hypertensive crisis in children. An extensive database search using keywords was done to obtain the information.

Skin Microcirculation in Primary Arterial Hypertension

Laser Doppler Fluxometry (LDF) was used to assess basic flow (PP) of microcirculation (mc) of dorsal hand skin in 10 healthy persons of both sex (k) – of age 41,3 ± 7,18 years and 10 persons suffering from primary arterial hypertension (nt) – of age 41,3 ± 10,95 years. In obtained record it has beed evaluated: basic flow (PP – in arbitray units of perfusion – PU) and, by analysing frequency spectrum – heart rhythm (RS) and its variation (ZRS), respiratory rhythm (RO), myogenic rhythm of precapillary sphincters tone (RM) and its amplitude (RMa), neurogenic rhythm of precapillary sphincters tone (RN) and its amplitude (NRa) and endothelium-dependent rhythm of precapillary sphincters tone (RE) and its amplitude (REa). The rhythm was assessed in cycles per minute (Hz) and the amplitude by value of signal power in arbitrary units. Means (x¯ ) and standard deviations (± SD) were defined; differences were assessed using t-Student test. In the group of individuals, suffering from arterial hypertension, the decrease of heart rhythm variability, acceleration of respiratory rhythm and neurogenic rhythm on the microcirculation level was observed, what testifies to higher sympathetic activity. In people with arterial hypertension such regularity was not observed, which can prove the endothelium dysfunction. LDF enables complex, noninvasive assessment of circulatory system functioning that can be widely used in clinical

Pulmonary Hypertension in Elderly Patients with Diastolic Dysfunction and Preserved Ejection Fraction

Purpose:Patients with diastolic dysfunction may have a disproportionate degree of elevation in pulmonary pressure, particularly in the elderly. Higher pulmonary vascular resistance in the elderly patients with heart failure but preserved ejection fraction suggests that beyond the post-capillary contribution of pulmonary venous congestion, a pre-capillary component of pulmonary arterial hypertension occurs. We aim to identify if pulmonary vascular resistance in elderly patients with diastolic dysfunction is disproportionately higher than patients with systolic dysfunction independent of filling pressures.Methods:389 patients identified retrospectively between 2003- 2010; elderly with preserved ejection fraction, elderly with depressed ejection fraction, and primary arterial hypertension who underwent right-heart catheterization at Rush University.Results:No significant difference in pulmonary vascular resistance between systolic and diastolic dysfunction. The mean difference in pulmonary vascular resistance was not statistically significant at 0.40 mmHg·min/l (95% CI -3.03 to 3.83) with similar left ventricular filling pressures with mean difference of 3.38 mmHg (95% CI, -1.27 to 8.02). When adjusted for filling pressures, there remained no difference in pulmonary vascular resistance for systolic and diastolic dysfunction. The mean pulmonary vascular resistance is more elevated in systolic heart failure compared to diastolic heart failure with means 3.13 mmHg·min/l and 3.52 mmHg·min/l, respectively.Conclusion:There was no other association identified for secondary pulmonary hypertension other than diastolic dysfunction and chronic venous pulmonary hypertension. Our results argue against any significant arterial remodeling that would lead to disproportionate pre-capillary hypertension, and implies that treatment should focus on lowering filling pressure rather than treating the pulmonary vascular tree.

The Role of Distress in Uptake and Response to Predisposition Genetic Testing: TheBMPR2Experience

This study examines psychological determinants and effects of participating in genetic testing among persons diagnosed with or at risk for developing primary pulmonary arterial hypertension. Longitudinal data were drawn from orally administered surveys with 70 affected or at-risk individuals concerning their thoughts, feelings, and decision making about testing for mutations in BMPR2. Distress was measured by use of the Impact of Events Scale. Variations in tolerance for ambiguity were also examined. Although uptake of testing was low, as is common for incompletely penetrant mutations that lack clear therapeutic interventions, we found that those who participated in testing evidenced greater reduction in distress compared to those who had not participated in testing, irrespective of test result. No differences in tolerance for ambiguity by testing status were found. Participation in genetic testing, irrespective of test results, may be particularly beneficial to individuals who may have genetic mutations and who are experiencing high levels of distress.

PCV17 Cost-Effectiveness Analysis of Bosentan and Sildenafil Compared with Standard therapy in Treatment of Primary Pulmonary Arterial Hypertension in Russian Federation

To conduct cost-effectiveness analysis of bosentan and sildenafil compared with standard therapy (ST, i.e. calcium channel blockers and warfarin) in treatment of primary pulmonary arterial hypertension (PAH) in Russian Federation. We undertook cost-effectiveness analysis of bosentan (62.5 mg bid during first 4 weeks and 125 mg bid further) and sildenafil (25 mg tid) and estimated incremental cost-effectiveness ratios (ICER) for each drug vs ST. A cohort of 20 patients with PAH, functional class (FC) III was simulated in a model. The patients either received bosentan+ST, or sildenafil+ST, or ST only. The number of patients whose health state improves by one FC was considered a criterion of efficacy. Costs of hospitalization, standard therapy medications, and investigational drugs were calculated in the model. Data on clinical efficacy of bosentan, sildenafil, and ST were extracted from clinical trials. Patient's treatment scheme considered in the model was based on the results of peer interview. In our model treatment with bosentan was the most effective: 9 of 20 patients versus 6 and 2 of 20 patients who had improved by one FC with bosentan, sildenafil and ST, respectively. Also, the highest overall costs were in the bosentan group: 1,163,948 USD per 20 patients per year. Overall costs in case of sildenafil and standard therapy were 724,520 and 57,969 USD per group per year, respectively. However, comparison of bosentan with ST yielded lower ICER than comparison of sildenafil with ST: 157,997 and 166,638 USD per one patient with improvement by one FC, respectively. Trend in the results remained the same with bosentan price up to 4400 USD per pack in one-way sensitivity analysis. The results of this study suggest that treatment of FC III PAH with bosentan is more preferable than treatment with sildenafil.

Mortality in Primary Pulmonary Arterial Hypertension Stratified by Hemoglobin Levels

Anemia has been shown to be an independent predictor of increased morbidity and mortality in multiple chronic conditions including heart failure and coronary artery disease. Primary Pulmonary Arterial Hypertension (PAH) is associated with an increased mortality despite aggressive therapy. We explored if lower hemoglobin (Hb) levels have prognostic significance and are associated with increased mortality and morbidity in patients with PAH.

Hypertension artérielle pulmonaire disproportionnée : caractéristiques et pronostic d’une cohorte de patients niçois référés au laboratoire d’échocardiographie

ObjectivesTo characterize and compare patients with disproportionate PH versus patients with primary pulmonary arterial hypertension (PAH). MethodsAll patients referred to our cardiology unit for echocardiography from November 2006 to May 2008 and who have been followed by our pneumologist were screened for severe PH (i.e mean arterial pulmonary pressure>35–40mmHg at rest). Patients were excluded if a factor that could influence pulmonary hemodynamics was present. We investigated these patients by pulmonary function tests, echocardiography and right heart catheterisation. ResultsWe reported 16 cases of severe PH in stable patients (n=8, chronic obstructive pulmonary disease-emphysema) and 13 patients with PAH. Our findings suggest that the patients with disproportionate PH had right heart dysfunction similar to that observed in PAH. But their outcomes were more severe. It seemed that specific vasodilatator therapy was not efficient.

Surgical palliation of primary pulmonary arterial hypertension by a unidirectional valved Potts anastomosis in an animal model

Patients with idiopathic pulmonary hypertension are at risk for right-sided heart failure and sudden death. Despite improvement in pharmacologic management, some still require lung transplantation. Potts anastomosis has been demonstrated as a good palliation in children to alleviate symptoms and medical therapy despite desaturation in the lower part of the body. Young adult patients with pulmonary hypertension and isosystemic pressure remain at risk, particularly at exercise. The goal of this research was to find a palliation for patients in whom suprasystemic pulmonary hypertension developed at exercise. Creating a Potts anastomosis involved a unidirectional valve between the left pulmonary artery and the descending aorta. Experimental study was performed on 14 pigs. A prosthetic patch of polytetrafluoroethylene (Gore-Tex; WL Gore & Associates Inc, Newark, Del) was used to create the unidirectional valve and implanted in the Potts anastomosis. Via a left thoracotomy, an aorto-aortic shunt between the aortic isthmus and the distal descending thoracic aorta was instituted, allowing a safe surgical procedure. Intrapulmonary injection of Erciplex glue (Peters Surgical, Bobigny, France), diluted in 70% alcohol, was used to create acute pulmonary hypertension. The right to left shunt across the unidirectional valvular patch was evaluated after clamping the aorta in the acute phase of pulmonary hypertension by echo-pulsed Doppler at the level of the descending thoracic aorta by withdrawal of blood gas (arterial carbon dioxide tension, alveolar carbon dioxide tension) and assessment of peripheral oxygen saturation. Similar reevaluation of the shunt was performed at a mean interval of 13 ± 2.5 weeks. In the first series, Erciplex glue increased pulmonary artery pressure from 15.3 ± 3.1 mm Hg to 38.7 ± 6.0 mm Hg. Mean peripheral oxygen saturation decreased from 100% to 85% ± 1.5%. Mean partial pressure of carbon dioxide increased from 31.9 ± 9.1 mm Hg to 46.2 ± 12.5 mm Hg after shunt opening (P < .01), and mean peripheral oxygen decreased from 435.1 ± 109.4 mm Hg to 261.9 ± 77.9 mm Hg (P < 0.05), indicating right to left shunt through the Potts valve (P < .013). Pulsed Doppler showed a mean peak laminar flow of 133.3 ± 35.3 cm/s before aortic clamping, turbulent flow of 234.9 ± 40.1 cm/s after glue injection, and return of laminar flow 128.5 ± 30.1 cm/s after aortic isthmus unclamping. In the second series, the same results were obtained but with a lesser peak flow velocity because of the endothelialization on the valvular patch. Gross analysis of the patch did not show thrombosis, aneurysm, or fissure. Palliation of exercise suprasystemic pulmonary hypertension was demonstrated by a unidirectional valved Potts anastomosis. This technique can be of help in young adult patients with pulmonary hypertension and isosystemic pressure but with exercise intolerance.

Relationships of night/day heart rate ratio with carotid intima media thickness and markers of arterial stiffness

Objectives To analyze the relationship between office and ambulatory heart rate, and its variability, and arterial stiffness in patients with primary arterial hypertension. Methods A cross-sectional study was conducted in a primary care setting, with the inclusion of 356 hypertensive patients aged 30–80 years. Office and ambulatory blood pressure, heart rate, night/day heart rate ratio and the corresponding standard deviations, were determined. Arterial stiffness was assessed according to carotid intima media thickness, pulse wave velocity, the central and peripheral augmentation index, and the ambulatory arterial stiffness index. Results Carotid intima media thickness, central and peripheral augmentation index, and ambulatory arterial stiffness index were negatively correlated to office and ambulatory heart rate and its standard deviation, and positively correlated to the night/day heart rate ratio. Pulse wave velocity showed a negative correlation to 24 h standard deviation heart rate and a positive correlation to nocturnal heart rate and the night/day heart rate ratio. For each 10 bpm increment in 24 h heart rate, the pulse wave velocity increased 0.42 m/s (95%CI: 0.23–0.60) and ambulatory arterial stiffness index decreased 0.01 (95%CI: 0.01–0.02); in the case of office heart rate, the peripheral augmentation index decreased 4.74 (95%CI: 3.15–6.33) and central augmentation index decreased 3.52 (95%CI: 2.43–4.30), while for 24 h standard deviation heart rate, carotid intima media thickness decreased 0.03 mm (95%CI: 0.01–0.06). Conclusions Office and ambulatory heart rate, and the corresponding standard deviations, are inversely associated to the arterial stiffness markers, with the exception of pulse wave velocity, where a direct correlation is observed. A greater increase in night/day ratio, i.e., a lesser decrease in nocturnal heart rate, is associated to increased arterial stiffness.

Elevated Pulmonary Artery Pressure Is a Risk Factor for Primary Graft Dysfunction Following Lung Transplantation for Idiopathic Pulmonary Fibrosis

Idiopathic pulmonary fibrosis (IPF) is often associated with elevations in pulmonary artery pressures. Although primary pulmonary arterial hypertension (PAH) has been associated with primary graft dysfunction (PGD), the role of secondary PAH in mediating PGD risk in patients with IPF is incompletely understood. The purpose of this study was to evaluate the relationship between mean pulmonary artery pressure (mPAP) and PGD among patients with IPF. We performed a multicenter prospective cohort study of 126 lung transplant procedures performed for IPF between March 2002 and August 2007. The primary outcome was grade 3 PGD at 72 h after lung transplant. The mPAP was measured as the initial reading following insertion of the right-sided heart catheter during lung transplant. Multivariable logistic regression was used to adjust for confounding variables. The mPAP for patients with PGD was 38.5 ± 16.3 mm Hg vs 29.6 ± 11.5 mm Hg for patients without PGD (mean difference, 8.9 mm Hg [95% CI, 3.6-14.2]; P = .001). The increase in odds of PGD associated with each 10-mm Hg increase in mPAP was 1.64 (95% CI, 1.18-2.26; P = .003). In multivariable models, this relationship was independent of confounding by other clinical variables, although the use of cardiopulmonary bypass partially attenuated the relationship. Higher mPAP in patients with IPF is associated with the development of PGD.

Exudative retinal detachment and angle closure glaucoma as the presenting signs of primary pulmonary hypertension.

Primary pulmonary arterial hypertension is a rare systemic condition that may present with distinct ocular findings. To report a patient whose ophthalmic manifestations led to a diagnosis of pulmonary arterial hypertension. A 58-year-old woman presented with bilateral serous detachments, angle closure, dilated episcleral blood vessels, subretinal drusenoid-like deposits, and intraretinal hemorrhages. She was diagnosed with pulmonary arterial hypertension. Her ocular findings resolved once her underlying systemic disorder had been treated. To our knowledge, this is the first reported case in which an ophthalmic evaluation led to the diagnosis of pulmonary arterial hypertension.

Unexpected positive effect of fresh frozen plasma on standard anticoagulation in the case of pulmonary embolism accompanied by sepsis – a case report

. In recent years there have been significant advances in the diagnosis and management of venous thromboembolism. This has resulted in the establishment of detailed diagnostic and therapeutic guidelines. Despite the benefits coming from their implementations, a clinical outcome of thromboembolic complications in particular patients poses a number of diagnostic difficulties. Treatment results and prognosis, despite following commonly recognized therapeutic standards, are difficult to predict. . This paper aimed at presenting an atypical course of high-risk pulmonary embolism (PE) and the remote outcome of its treatment in a surgical patient with an initial low risk of thrombotic complications. . The patient was a 58-year old female with a history of primary arterial hypertension who was electively operated on for euthyreotic polynodular goiter. On the 2 nd postoperative day, she had to be resuscitated due to PE accompanied by sepsis with disseminated intravascular coagulation and shock. As shock symptoms did not subside despite the administration of typical treatment (Dextran, intravenous infusion fluids, dopamine, heparin, broad-spectrum antibiotics), and because of gastrointestinal bleeding suspicion, the patient was also administered fresh frozen plasma. Following resuscitation, lasting 2.5 hours, long-term improvement in hemodynamic parameters occurred. After respiratory therapy, lasting several hours, a gradual improvement of the patient's general condition was observed. She regained consciousness, dyspnea subsided, and features of acute right ventricular overload gradually subsided in electrocardiogram. . On the one hand, the effectiveness of a combined treatment employing heparin and fresh frozen plasma could have resulted from its effect on improving tissue hypoperfusion secondary to the shock; and, on the other hand, because of the coexisting intravascular coagulation process. Fresh frozen plasma, apart from its commonly known procoagulative effect, may also enhance fibrinolytic processes. The potential influence of endogenous anticoagulants contained in plasma with respect to the course of PE has been discussed. It may have contributed to the regression of PE symptoms, despite the fact that in the acute phase the patient was on heparin only. . Fresh frozen plasma, due to its endogenous anticoagulation activity, may positively influence the course of high-risk PE.

The Assessment of Artery Stiffness in Young Population with Primary Arterial Hypertension

The Assessment of Artery Stiffness in Young Population with Primary Arterial Hypertension

Evaluation of arterial hypertension control and treatment in daily practice of family physicians

THE OBJECTIVE OF THIS STUDY was to evaluate the percentage of patients with primary arterial hypertension treated with antihypertensive drug(s), who achieved target arterial blood pressure (ABP), and to compare the characteristics of patients with controlled and uncontrolled ABP, their current treatment, and treatment modifications. A total of 429 18-80-year-old patients with primary arterial hypertension treated for ≥ 1 year participated in this study. General practitioners collected data on patients' demographic and clinical characteristics, current treatment for primary arterial hypertension, and treatment modifications. According to physicians, 45.4% of patients achieved target ABP levels. Adequately controlled ABP was documented more often in the group of low and moderate cardiovascular risk than in high- and very high-risk group (n=141, 62.9% versus n=54, 26.3%; P<0.0001). Based on ABP measurements, 160 (37.3%) patients had ABP of <140/90 mm Hg. The majority of patients were treated with a combination of two (n=153, 35.7%) to three (n=144, 33.6%) antihypertensive drugs. Patients with uncontrolled ABP more frequently than patients with controlled ABP were given combination therapy. Treatment was not modified in 37.8% (n=162) of patients, more commonly in those with controlled ABP. The level of hypertension control in study population was far from optimal, especially in the group of patients at high- and very high-risk where target ABP was lower. Almost 12% of patients with uncontrolled ABP were still undergoing monotherapy, whereas 16% of patients were not recommended any modifications of antihypertensive treatment despite their ABP was not controlled.

Assessment of cross-sectional lung ventilation–perfusion imbalance in primary and passive pulmonary hypertension with automated V/Q SPECT

Cross-sectional lung ventilation (V)-perfusion (Q) imbalance in primary pulmonary arterial hypertension (PAH) and passive pulmonary hypertension (PH) was characterized by automated V/Q single-photon emission computed tomography (SPECT). Technegas/macro-aggregated albumin SPECT-derived V/Q SPECT and V/Q profile were automatically built to characterize cross-sectional lung V-Q imbalance in 12 patients with primary (idiopathic or familial) PAH and 15 patients with passive PH associated with left ventricular dysfunction or failure. The abnormality of V/Q distribution in these patients was correlated with PaO2 and pulmonary arterial pressure and with lung morphologic changes on computed tomography (CT). Markedly low V/Q ratios (reverse V-Q mismatch) in the background lungs with heterogeneous V/Q distribution was seen in 12 of the 12 (100%) patients with primary PAH and in 10 of the 15 (66%) patients with passive PH, which were predominantly seen in the upper lung zone. Including these regions with reverse V-Q mismatch, the V/Q profile frequently showed flattened peaks with asymmetric and broadened V/Q distribution in all patients, with significant correlation between the standard deviation of V/Q ratios in the entire lungs and PaO2 and mean pulmonary arterial pressure (both; P<0.01). At the regions of the lungs with reverse V-Q mismatch, bronchial lumens compressed by dilated pulmonary arteries and heterogeneous lung attenuations were frequently seen on CT. Patients with primary PAH and passive PH seem to characteristically have a high prevalence of reverse V-Q mismatch indicative of an inadequate hypoxic vasoconstriction reflex on V/Q SPECT, frequently accompanied with heterogeneous lung attenuations and compressed airways on CT.

THE ESTIMATION OF CONCENTRATION OF APELIN, INSULIN, FASTING GLUCOSE AND ANTHROPOMETRIC FACTORS IN YOUNG HYPERTENSIVE PATIENTS: PP.12.455

Objective: Apelin is a new cytokine with proven functions in the cardiovascular system. The negative correlation between its concentration and the value of systolic blood pressure in patients with essential arterial hypertension gained attention. Due to its participation in modification of insulin action, the role of apelin in pathogenesis of obesity and insulin resistance also has been called on. The aim of this paper was to estimate the concentration of apelin, insulin, fasting glucose and anthropometric factors in young population with primary arterial hypertension. Design and Method: 34 young patients with essential arterial hypertension were qualified to this study. The control group consisted of 10 properly chosen healthy people. The anthropometric and blood pressure measurements were taken. The BMI and WHR were calculated. In blood serum the concentration of apelin, insulin and fasting glucose were assessed. Results: In group of people with arterial hypertension, compared to control group, significantly higher values of systolic (129.8 ± 33.2 mm Hg vs. 117.6 ± 18.4 mm Hg) and diastolic (81.7 ± 21.7 mm Hg vs. 71.2 ± 13.2 mm Hg) blood pressure were observed. Furthermore, higher BMI (22.9 ± 6.4 kg/m2 vs. 21.0 ± 2.9 kg/m2), fasting glucose concentration (5.02 ± 0.95 mmol/l vs. 4.70 ± 0.37 mmol/l) and insulin concentration (15.46 ± 10.67 ìIU/ml vs. 11.52 ± 4.2 ìIU/ml) in group of hypertensive patients were performed. The concentration of apelin in this group were significantly lower (103.11 ± 81.74 pg/ml vs. 61.55 ± 27.87 pg/ml). Conclusions: 1. Low apelin concentration in group of hypertensives, suggests its role in pathogenesis of arterial hypertension. 2. The presence of arterial hypertension in youth is correlated with higher values of fasting glucose and insulin concentration and higher BMI.

Advances in diagnosis and treatment of pulmonary arterial hypertension in neonates and children with congenital heart disease

This article aims to review recent advances in the diagnosis and treatment of pulmonary arterial hypertension in neonates and children with congenital heart disease. Articles on pulmonary arterial hypertension in congenital heart disease were retrieved from PubMed and MEDLINE published after 1958. A diagnosis of primary (or idiopathic) pulmonary arterial hypertension is made when no known risk factor is identified. Pulmonary arterial hypertension associated with congenital heart disease constitutes a heterogenous group of conditions and has been characterized by congenital systemic-to-pulmonary shunts. Despite the similarities in histologic appearance of pulmonary vascular disease, there are differences between pulmonary arterial hypertension secondary to congenital systemic-to-pulmonary shunts and those with other conditions with respect to pathophysiology, therapeutic strategies, and prognosis. Revision and subclassification within the category of secondary pulmonary arterial hypertension based on pathophysiology were conducted to improve specific treatments. The timing of surgical repair is crucial to prevent and minimize risk of postoperative pulmonary arterial hypertension. Drug therapies including prostacyclin, endothelin-receptor antagonist, phosphodiesterase inhibitor, and nitric oxide have been evolved with promising results in neonates and children. Among the different forms of congenital heart diseases, an early correction generally prevents subsequent development of pulmonary arterial hypertension. Emerging therapies for treatment of patients with idiopathic pulmonary arterial hypertension also improve quality of life and survival in neonates and children with congenital heart disease associated with pulmonary arterial hypertension. Heart and lung transplantation or lung transplantation in combination with repair of the underlying cardiac defect is a therapeutic option in a minority of patients. Partial repair options are also beneficial in some selected cases. Randomized controlled trials are needed to evaluate the safety and efficacy of these therapies including survival and long-term outcome.

Influence of atorvastatin on blood pressure control in treated hypertensive, normolipemic patients – An open, pilot study

Aims. The aim of the study was to determine whether a high dose of atorvastatin lowers blood pressure (BP) in normolipemic patients with well controlled primary arterial hypertension and if this effect is associated with alteration of biomarkers of endothelial function and oxidative stress. In this open-label study, normolipemic patients (n=56) were randomized in the proportion of 2:1 to receive atorvastatin 80 mg daily for 3 months (statin-treated, ST n=39), or to previous therapy (statin-free, SF). BP was measured using a 24-h ambulatory BP measurement device. Plasma levels of 6-keto-PGF1α (prostacyclin metabolite), serum nitric oxide (NO) and levels of autoantibodies immunoglobulin G against oxidatively modified low-density lipoprotein (ox-LDL) were measured. Major findings. The mean change in systolic BP and diastolic BP for ST was – 5.7 mmHg (95% CI –4.1 to –7.2 mmHg) and –3.9 mmHg (95% CI –2.7 to –5.0 mmHg), respectively. Hypotensive statin effect was independent of lipid lowering. No change of BP in SF patients was observed. In ST, prostacyclin metabolites and NO concentrations were not significantly increased and autoantibodies against ox-LDL concentrations did not change. In ST, the decrease in BP correlated with increase in NO and decrease in autoantibodies against ox-LDL. Principal conclusion. High-dose atorvastatin resulted in reduction of BP independently of lipid-lowering effect, changes in endothelial function and oxidative stress, but it was related to the increase in NO and decrease in autoantibodies against ox-LDL. However, because of the open design of the study, these results should be carefully debated.

Utility of Echocardiography Versus BNP Level for the Prediction of Pulmonary Arterial Pressure in Patients With Pulmonary Arterial Hypertension

Recent advances in the treatment of pulmonary arterial hypertension provide a rational basis for earlier, noninvasive diagnosis of pulmonary arterial hypertension. However, the reliability of transthoracic echocardiography, plasma BNP levels, and other parameters for the diagnosis of pulmonary arterial hypertension remains unclear. Thus, the purpose of this study was to determine the utility of these modes of investigation for the prediction of pulmonary arterial pressure as compared with the current gold standard, Swan-Ganz catheterization. Among 46 PAH patients, 37 had connective tissue diseases, while the remainder had primary pulmonary arterial hypertension, chronic pulmonary thromboembolism, and interstitial pneumonitis. Systolic pulmonary arterial pressure calculated by transthoracic echocardiography was significantly correlated with systolic pulmonary arterial pressure measured using a Swan-Ganz catheter (r = 0.51, P < 0.01). Plasma BNP concentration did not correlate with systolic pulmonary arterial pressure (r = 0.10, NS) in the overall patient population. However, when we excluded left ventricular heart failure and left ventricular hypertrophy, BNP concentration was correlated with systolic pulmonary arterial pressure (r = 0.508, P < 0.05). Among other variables tested, ECG electrical axis was correlated with pulmonary arterial pressure (r = 0.46, P < 0.05) but uric acid, lactate dehydrogenase, %DLCO, enhanced IIp sound, and pulmonary artery enlargement on chest x-ray did not correlate with pulmonary arterial pressure. These data suggest that echocardiography is the noninvasive modality of choice for the assessment of pulmonary arterial hypertension. Plasma BNP level also predicts pulmonary arterial pressure, when left ventricular heart failure and cardiac hypertrophy are excluded.