Similar Systolic Blood Pressure Research Articles

Blood pressure variability in controlled and uncontrolled blood pressure and its association with left ventricular hypertrophy and diastolic function.

High systolic blood pressure (SBP) variability has been associated with higher risk for target-organ damage. In a cross-sectional study done in a tertiary outpatient hypertension clinic, we compared short-term SBP variability among controlled and uncontrolled hypertensive patients and evaluated the association between higher levels of SBP variability and diastolic function and left ventricular hypertrophy (LVH). Patients were evaluated by 24-h ambulatory blood pressure monitoring and transthoracic Doppler echocardiogram. Blood pressure (BP) variability was evaluated by the time-rate index and high variability corresponded to index values in the top quartile of distribution. Echocardiographic parameters were compared in patients with and without higher BP variability within controlled and uncontrolled office BP (⩽140/90 mm Hg). The analyses included 447 patients with 58±12 years of age, 67% were women, 68% white, 43% current or previous smokers and 32% with diabetes mellitus. Among the whole sample, 137 patients had controlled and 310 uncontrolled BP. The 75th percentile cutoff points for the time-rate index were 0.502 mm Hg min(-1) and 0.576 mm Hg min(-1) for participants with controlled and uncontrolled BP, respectively. After adjustment for confounders, the time-rate index did not differ between controlled and uncontrolled patients. BP variability was not associated with LVH or diastolic function in controlled and uncontrolled BP after adjustment for 24-h SBP and age. Patients with controlled and uncontrolled BP had similar SBP variability assessed by time-rate index, which was not associated with LVH or diastolic function. These findings should be confirmed in studies with larger sample size.

Effects of exercise intensity on postexercise hypotension after resistance training session in overweight hypertensive patients.

Among all nonpharmacological treatments, aerobic or resistance training (RT) has been indicated as a significantly important strategy to control hypertension. However, postexercise hypotension responses after intensity alterations in RT are not yet fully understood. The purpose of this study was to compare the outcomes of differing intensities of RT on hypertensive older women. Twenty hypertensive older women participated voluntarily in this study. After a maximum voluntary contraction test (one repetition maximum) and determination of 40% and 80% experimental loads, the protocol (3 sets/90″ interset rest) was performed in a single session with the following exercises: leg press, leg extension, leg curl, chest press, elbow flexion, elbow extension, upper back row, and abdominal flexion. Systolic and diastolic blood pressures were evaluated at rest, during exercise peak, and after 5, 10, 15, 30, 45, and 60 minutes of exercise and compared to the control. Both experimental loads were effective (P<0.01) in promoting postexercise systolic hypotension (mmHg) compared to controls, after 30, 45, and 60 minutes, respectively, at 40% (113±2, 112±4, and 110±3 mmHg) and 80% (111±3, 111±4, and 110±4 mmHg). Both procedures promoted hypotension with similar systolic blood pressures (40%: −11%±1.0% and 80%: −13%±0.5%), mean arterial blood pressures (40%: −12%±5.5% and 80%: −12%±3.4%), and rate-pressure products (40%: −15%±2.1% and 80%: −17%±2.4%) compared to control measures (systolic blood pressure: 1%±1%, mean arterial blood pressure:\\ 0.6%±1.5%, rate-pressure product: 0.33%±1.1%). No differences were found in diastolic blood pressure and heart rate measures. In conclusion, hypertensive older women exhibit postexercise hypotension independently of exercise intensity without expressed cardiovascular overload during the session.

Abstract 004: Splenectomy Differentially Affects Angiotensin-2 and L-NAME Murine Models of Hypertension

The immune system plays a major role in animal models of hypertension (HTN) and end-organ damage. However, few studies have assessed the role of lymphoid organs in the pathogenesis of HTN. We have shown previously that prior splenectomy (SPLX) significantly alters tissue inflammation; however the effect of SPLX on HTN remains unclear. Therefore, the objective of the current study is to determine whether prior SPLX influences the development of HTN in 2 different mouse models. Mice underwent SPLX or sham surgery 7 days prior to the induction of HTN using angiotensin-II (AngII, 400ng/kg*min s.c.) or nitric oxide synthase inhibition using L-NAME (30mg/kg*d in drinking water). Systolic blood pressure (SBP) was measured by tail-cuff manometer daily and mice were euthanized 14 days after induction of HTN. Heart weight/body weight (H/BW) ratios were calculated and kidney leukocyte infiltration was analyzed by flow cytometry. Mice with prior SPLX+AngII had significantly lower (P=0.03) SBP at both week 1 (148±7) and week 2 (135±7) as compared to Sham+AngII (174 and 173±7mmHg, n=5). Similarly, SPLX+AngII mice had significantly smaller (P=0.007) H/BW (4.3±0.3) as compared to Sham+AngII treated mice (5.2±0.4mg/g BW). Interestingly, no difference was observed in renal CD45+ (9.8±3 vs 10.6±3x105 cells/g, P=0.64) or CD3+ T-cell infiltration (8.8±0.2 vs 9.6±0.1x104 cells/g , P=0.64) between the Sham+AngII and SPLX+AngII treated mice, respectively (n=4/5). Furthermore, SPLX did not appear to influence the development of L-NAME HTN. SPLX+L-NAME mice had similar (P=0.84) SBP (145±4mmHg) as the Sham+L-NAME group (146±4mmHg, n=6) after 2 weeks. Relative heart weights were also similar (P=0.45) between SPLX+L-NAME (4.9±0.2) and Sham+L-NAME treated mice (4.8±0.3mg/g BW). Our data suggests that the full pressor response to AngII is dependent on the spleen. However, the effect of the spleen appears to be independent of renal inflammation. Moreover, the protective effect of the spleen is specific to AngII-dependent HTN and does not appear to be generalizable to all mouse models of hypertension. Further studies are needed to understand the physiological link between lymphoid organs (such as the spleen), renal inflammation, and the development of chronic HTN.

Older age is associated with greater central aortic blood pressure following the exercise stress test in subjects with similar brachial systolic blood pressure.

Brachial systolic pressure (BSP) is often monitored during exercise by the stress test; however, central systolic pressure (CSP) is thought to be a more direct measure of cardiovascular events. Although some studies reported that exercise and aging may play roles in changes of both BSP and CSP, the relationship between BSP and CSP with age following the exercise stress test remains unclear. The aim of this study was to evaluate the effect of age on the relationship between BSP and CSP measured after exercise. Ninety-six subjects underwent the diagnostic treadmill exercise stress test, and we retrospectively divided them into the following 3 groups by age: the younger age group (43±4years), middle age group (58±4years), and older age group (70±4years). Subjects exercised according to the Bruce protocol, to achieve 85% of their age-predicted maximum heart rate or until the appearance of exercise-associated symptoms. BSP, CSP, and pulse rate (PR) were measured using a HEM-9000AI (Omron Healthcare, Japan) at rest and after exercise. BSP, CSP, and PR at rest were not significantly different among the 3 groups (p=0.92, 0.21, and 0.99, respectively). BSP and PR immediately after exercise were not significantly different among the groups (p=0.70 and 0.38, respectively). However, CSP immediately after exercise was 144±18mmHg (younger age), 149±17mmHg (middle age), and 158±19mmHg (older age). CSP in the older age group was significantly higher than that in the younger age group (p<0.01). Despite similar BSPs in all age groups after exercise, CSP was higher in the older age group. Therefore, older subjects have a higher CSP after exercise, which is not readily assessed by conventional measurements of BSP.

Inadequate Blood Pressure Control in Orthotopic Heart Transplant: Is There a Role of Kidney Function and Immunosuppressive Regimen?

IntroductionCardiac transplantation is the definitive therapy for eligible patients with end-stage heart failure. Hypertension is a widely accepted risk factor for its outcome. Patients and MethodsWe analyzed 169 heart transplant recipients. The diagnosis of hypertension was made on the basis of information gathered at 3 consecutive visits. Complete blood count, urea, serum lipids, fasting glucose, creatinine, and N-terminal pro–B-type natriuretic peptide were also studied. ResultsIn the orthotopic heart transplantation (OHT) population, 11% had diabetes and 68% had chronic kidney disease. Hypertension was diagnosed and treated in 68% of the OHT patients. Hypertensive patients were significantly older, with a lower estimated glomerular filtration rate and higher serum creatinine and erythrocyte count. Thirty-three percent of patients did not achieve target blood pressure despite optimal medical treatment. Patients treated with tacrolimus had similar systolic blood pressure compared with those treated with cyclosporine (with a tendency to have lower values). Patients treated with mammalian target of rapamycin inhibitors had similar systolic and diastolic blood pressures compared with those treated without these inhibitors. In the group of patients given steroids, systolic and diastolic blood pressures were significantly lower than in the group not treated with steroids. In addition, steroid-treated patients had a significantly lower estimated glomerular filtration rate, hemoglobin, and erythrocyte count and higher serum creatinine, N-terminal pro–B-type natriuretic peptide, and New York Heart Association class. Chronic kidney disease was also more prevalent in this group. Blood pressure was not related to the kidney function. ConclusionsDespite polytherapy, optimal blood pressure control was not achieved in the majority of patients. OHT patients have a high prevalence of hypertension, which should be treated adequately. More efforts should be made to optimize blood pressure control, particularly when other comorbidities are present. Blood pressure was not related to patient kidney function.

Assessment of Arterial Elastance and Ventricular-Arterial Coupling in Patients with Systemic Lupus Erythematosus

To the Editor:Patients with systemic lupus erythematosus (SLE) are at in-creased risk of premature atherosclerosis, mediated by endothelialdysfunction and increased arterial stiffness[1]. The latter, mostcommonly assessed using carotid-femoralpulse wave velocity, isincreased in patients with SLE and is associated with cardiovascu-lar risk factors[1]. Recently, a more sensitive measure of arterialstiffness (effective arterial elastance; Ea), and ventricular-arterialcoupling (ratio of arterial and end-systolic ventricular elastance;Ea/Ees) demonstrated incremental prognostic value in patientswith chronic heart failure[2]. We aimed to assess the potential ofEa and Ea/Ees as novel biomarkers of cardiovascular risk in SLEwomen without ischemic heart disease.Women whosatisfiedtherevised American College of Rheumatolo-gy classification criteria for SLE were prospectively recruited from therheumatology clinics, as described previously [3]. Patients with recentactive flares, ischemic heart disease (all patients underwent nuclearstress perfusion imaging as part of the study), cardiomyopathies(including myocarditis) and valvular heart disease of≥ moderateseverity were excluded. Cardiovascular risk was defined as historyof hypertension, hyperlipidemia, diabetes mellitus, current tobacco use,cerebrovascularevents,familyhistoryofcoronaryarterydiseaseandsec-ondary anti-phospholipid syndrome. Age-matched control women wererecruited from the community. Left ventricular mass, diastolic functionand systolic ejection fraction were assessed with echocardiography;Ea was estimated as 0.9 x (arm-cuff systolic pressure/Doppler strokevolume) and Ees was calculated by the well-validated approach ofusing arm-cuff pressures, Doppler stroke volumes, ejection fraction,pre-ejection and systolic periods [4,5]. The study was conducted inaccordance with the Declaration of Helsinki and approved by the localresearch ethics committee. Written informed consent was obtainedfrom all participants.Continuousvariableswerepresentedinmean±SDormedian[inter-quartile range] and compared using either the Student t test or Mann-Whitney U test, as appropriate. The mean differences in Ea and Ea/Eeswere adjusted for age,systolic ejection fraction and systolicblood pres-sure. We assessed associations using the Pearson (r) or Spearman (ρ)correlation, as appropriate. All statistical analyses were performedwiththeSPSSversion19(SPSSInc,Chicago,USA).Atwo-sidedP b0.05 was considered statistically significant.Forty-eight patients with SLE (43±9 years old; disease durationof 14±6 years; 1 [0,2] risk factors) and 20 control women (42±9years old) were recruited. There were no differences in left ventricu-lar mass, diastolic function and Ees between SLE and control women(PN0.50 for all;Table 1). Compared to control individuals, patientswithSLEhadlowersystolicejectionfraction,albeitasmalldifference(71±8 versus 75±7%; P=0.04). Despite similar systolic blood pres-sure compared with control women (116±12 versus 119±16mmHg; P=0.52), patients with SLE had increased Ea (1.77±0.56versus 1.37±0.27 mmHg/mL; adjusted mean difference 0.30mmHg/mL, 95% confidence interval [CI] 0.08 to 0.53 mmHg/mL,Pb0.001) and Ea/Ees (0.61±0.18versus 0.50±0.07; adjusted meandifference 0.06, 95% CI 0.01 to 0.12, P=0.04). Furthermore, Ea wasassociated with increasing cardiovascular risk (ρ=0.35; P=0.02),systolic blood pressure (r=0.55, Pb0.001) and duration of predniso-lone use (ρ=0.33, P=0.03).Over 3 years of follow-up (median 31 [17,37] months), 8% ofpatients with SLE developed cardiovascular events (event rate 3.2 per100 person-years; non-fatal myocardial infarction, n=2; stroke, n=1;

Left ventricular geometric remodeling in relation to non-ischemic scar pattern on cardiac magnetic resonance imaging.

Left ventricular (LV) remodeling and myocardial fibrosis have been linked to adverse heart failure outcomes. Mid wall late gadolinium enhancement (MW-LGE) on cardiac magnetic resonance (CMR) imaging is well-associated with non-ischemic cardiomyopathy (NICM), but prevalence in ischemic cardiomyopathy (ICM) and association with remodeling are unknown. The population comprised patients with systolic dysfunction [LV ejection fraction (LVEF ≤ 40 %)]. CMR was used to identify MW-LGE, conventionally defined as fibrosis of the mid-myocardial or epicardial aspect of the LV septum. 285 patients were studied. MW-LGE was present in 12 %, and was tenfold more common with NICM (32 %) versus ICM (3 %, p < 0.001). However, owing to higher prevalence of ICM, 15 % of patients with MW-LGE had ICM. LV wall stress was higher (p = 0.02) among patients with, versus those without, MW-LGE despite similar systolic blood pressure (p = 0.24). In multivariate analysis, MW-LGE was associated with CMR-quantified LV end-diastolic volume (p = 0.03) independent of LVEF and mass. Incorporation of clinical and imaging variables demonstrated MW-LGE to be associated with higher LV end-diastolic volume (OR 1.13, CI 1.004-1.27 per 10 ml/m(2), p = 0.04) after controlling for presence of NICM (OR 16.0, CI 5.8-44.1, p < 0.001). While more common in NICM, MW-LGE can occur in ICM and is a marker of LV chamber dilation irrespective of cardiomyopathic etiology.

YIA2 PMCA1 Deletion Leads to Increased Blood Pressure and Cardiac Hypertrophy

IntroductionHeart failure is the common and final end point of cardiovascular disease. Seventy four percent of congestive heart failure patients also suffer from hypertension. Genome wide association studies (GWAS) have...

Low Tissue Oxygen Saturation Is Associated with Requirements for Transfusion in the Rural Trauma Population

Tissue O2 saturation (StO2) is a measure of tissue perfusion and should decrease during active hemorrhage. An initial StO2 value upon trauma center arrival measured concurrently with or prior to vitals, may predict hemorrhagic shock, requiring early blood product transfusion. Our aim was to identify the early StO2 threshold associated with a greater volume of packed red blood cell (PRBC) transfusion 24 h after injury. All highest tier triage trauma patients from January 2011 to July 2012 were included in this study. The initial StO2 value upon arrival was used for comparison. A total of 632 patients were considered, 74% of them male with a mean age of 46 years. Initial StO2 values were available for 325 patients. An StO2 value of 65% was determined as the cutoff due to the marked increase in PRBC consumption in 24 h. There were 23 patients (7%) with an StO2 reading <65% compared to 302 patients with values ≥65%. Both groups had similar systolic blood pressure (118 vs. 126) and heart rate (99 vs. 95) in the trauma bay. In addition, there was no difference in the initial hemoglobin, pH, or base deficit. An early StO2 value <65% also led to a greater number of PRBC transfused in 24 h (6.4 vs. 1.7). Regression analysis demonstrated that an StO2 <65% was the only variable associated with a higher PRBC transfusion volume in 24 h (p = 0.01). An StO2 value <65% correlates with greater requirement for PRBC transfusion 24 h after injury. This suggests that StO2 can be used as an early marker of hemorrhage which may be superior to traditional vital signs in the trauma population.

Effects of chronotherapy of benazepril on the diurnal profile of RAAS and clock genes in the kidney of 5/6 nephrectomy rats

This study investigated the effects of benazepril administered in the morning or evening on the diurnal variation of renin-angiotensin-aldosterone system (RAAS) and clock genes in the kidney. The male Wistar rat models of 5/6 subtotal nephrectomy (STNx) were established. Animals were randomly divided into 4 groups: sham STNx group (control), STNx group, morning benazepril group (MB) and evening benazepril group (EB). Benazepril was intragastrically administered at a dose of 10 mg/kg/day at 07:00 and 19:00 in the MB group and EB group respectively for 12 weeks. All the animals were synchronized to the light:dark cycle of 12:12 for 12 weeks. Systolic blood pressure (SBP), 24-h urinary protein excretion and renal function were measured at 11 weeks. Blood samples and kidneys were collected every 4 h throughout a day to detect the expression pattern of renin activity (RA), angiotensin II (AngII) and aldosterone (Ald) by radioimmunoassay (RIA) and the mRNA expression profile of clock genes (bmal1, dbp and per2) by real-time PCR at 12 weeks. Our results showed that no significant differences were noted in the SBP, 24-h urine protein excretion and renal function between the MB and EB groups. There were no significant differences in average Ald and RA content of a day between the MB group and EB group. The expression peak of bmal1 mRNA was phase-delayed by 4 to 8 h, and the diurnal variation of per2 and dbp mRNA diminished in the MB and EB groups compared with the control and STNx groups. It was concluded when the similar SBP reduction, RAAS inhibition and clock gene profile were achieved with optimal dose of benazepril, morning versus evening dosing of benazepril has the same renoprotection effects.

Salt‐deficient diet does not attenuate the development of slowly progressive ANG II‐dependent hypertension in Cyp1a1‐Ren2 transgenic rats

The present study was performed to determine the effects of dietary salt restriction on conscious systolic blood pressure (SBP), and 24‐hour urine flow and urinary sodium and protein excretion in Cyp1a1‐Ren2 rats with slowly progressive ANG‐II dependent hypertension. Adult male Cyp1a1‐Ren2 rats (n=5–6/group) were fed either a normal salt (0.6%) or salt‐deficient diet (&lt;0.01%) containing indole‐3‐carbinol (I3C; 0.15%, wt/wt) to induce slowly progressive ANG II‐dependent hypertension. Both normal salt and salt‐deficient groups fed an I3C‐containing diet showed increases in SBP by day 4 of treatment (134±3 to 162±3 and 147±4 to 160±3 mmHg, respectively, P&lt;0.001) and reached similar SBP levels by day 16 (207±8 vs. 194±7 mmHg, NS). Induced rats on salt‐deficient diet exhibited markedly reduced 24‐hour urinary sodium excretion (74.4±15.8 to 0.20±0.07 mEq/day, P&lt;0.001) and urine output (10.2±1.3 vs. 18.8±3.5 mL/day, P&lt;0.05. Urinary protein excretion increased similarly in response to I3C administration regardless of dietary salt intake (7.5±0.8 to 25.2±4.4, and 6.6±0.3 to 35.7±5.7 mg/d, respectively, P&lt;0.05). These findings demonstrate that dietary salt restriction does not attenuate the development of slowly progressive ANG II‐dependent hypertension or the associated proteinuria in Cyp1a1‐Ren2 transgenic rats.Support: NHLBI, Tulane COBRE in Hypertension and Renal Biology.

Differences in cardiovascular risk factors in rural, urban and rural-to-urban migrants in Peru

ObjectivesTo assess differences in cardiovascular risk profiles among rural-to-urban migrants and non-migrant groups.MethodsCross-sectional study in Ayacucho and Lima, Peru. Participants were: rural (n=201); rural-to-urban migrants (n=589); and urban (n=199). Cardiovascular...

Trait self-focused attention, task difficulty, and effort-related cardiovascular reactivity

Using motivational intensity theory as a framework, the present experiment examined how individual differences in self-focused attention interact with task difficulty to predict effort, assessed via cardiovascular reactivity. Participants (n=50) worked on a cognitive task fixed at an easy, medium, or hard level of difficulty, and individual differences in private self-consciousness and self-reflection were measured. Regression models indicated that trait self-focus interacted with task difficulty to predict cardiovascular reactivity, particularly systolic blood pressure (SBP) reactivity. Participants low and high in trait self-focus showed similar SBP reactivity in the easy and medium conditions, but they diverged in the hard condition: High trait focus was associated with higher SBP reactivity, indicating greater effort, whereas low trait self-focus was associated with low SBP reactivity, indicating disengagement. The findings thus support the motivational intensity approach to effort and its interpretation of self-focus's role in effort mobilization.

Combined Effects of Glycated Hemoglobin A1c and Blood Pressure on Carotid Artery Atherosclerosis in Nondiabetic Patients

The relationship between HbA(1c), blood pressure, and carotid atherosclerosis in nondiabetic patients is not clear. HbA(1c) and blood pressure can affect carotid-artery atherosclerosis in nondiabetic patients. This retrospective cross-sectional study included 216 patients without diabetes mellitus. A positive carotid ultrasonographic result was defined as intima-media thickness of the common carotid artery ≥ 0.9 mm, or presence of carotid plaque. Compared with patients without carotid atherosclerosis, patients with carotid atherosclerosis had significantly higher levels of HbA(1c) and systolic blood pressure (SBP). Higher levels of HbA(1c) and SBP were found to be associated with increased carotid atherosclerosis. Given similar SBP levels, higher HbA(1c) (>5.6%) was also related to increased carotid atherosclerosis. In multiple logistic regression analysis, HbA(1c) (odds ratio: 4.1, P = 0.009) emerged as the only statistically significant modifiable factor that was associated with carotid atherosclerosis, independent of smoking, body mass index, fasting plasma glucose, 2-hour plasma glucose, SBP, diastolic blood pressure, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. Our study shows that a slight increase of HbA(1c) may associate with carotid atherosclerosis in nondiabetic patients. Moreover, the coexistence of an elevated SBP level and a slightly increased HbA(1c) level may have a more significant effect on carotid atherosclerosis.

Prevalence of ambulatory hypotension in elderly patients with CKD stages 3 and 4

Recent understanding of the incidence of chronic kidney disease (CKD) has led us to the introduction of national blood pressure (BP) targets aimed at reducing the incidence of end-stage renal failure. The target clinic BP is <140/90 mmHg and <130/80 in patients with significant proteinuria according to UK NICE guidelines. However, the relationship between clinic BP and ambulatory hypotension has not been studied. We prospectively collected data regarding cardiovascular risk factors, clinic and 24-h ambulatory blood pressure monitoring (24-h ABPM) in 98 treated patients with CKD stages 3 and 4. The mean percentage of systolic blood pressure (SBP) recordings <100 mmHg was 21.2 +/- 16.2% and of diastolic blood pressure (DBP) recordings <60 mmHg was 19.8 +/- 16.9%. The patients were divided into two groups above and below the median age. The older group had a higher percentage of cardiovascular disease than younger patients (57.1 versus 34.7, P = 0.03) and a lower percentage of primary renal disease (18.4 versus 55.1, P < 0.01). Clinic SBP was higher in the older group (158.4 +/- 20.1 versus 147.2 +/- 17.8 mmHg, P < 0.01) but 24-h ABPM SBP was not different (117.3 +/- 14.7 versus 121.0 +/- 12.8 mmHg, P = 0.19). DBP was lower in the older group for both clinic BP (80.3 +/- 10.2 versus 85.5 +/- 12.3 mmHg, P = 0.03) and 24-h ABPM (69.1 +/- 8.2 versus 76.7 +/- 8.8 mmHg, P = <0.01). There were a higher percentage of systolic (SBP <100 mmHg) and diastolic (DBP<60 mmHg) hypotensive episodes in the older group (21.3 +/- 18.9 versus 13.2 +/- 13.6% P = 0.02 and 21.6 +/- 17.9 versus 8.1 +/- 13.3%, P < 0.01, respectively). Hypotension was common among treated CKD patients and despite similar clinic SBP, older CKD patients had lower 24-h ABPM DBP and more frequent systolic and diastolic hypotensive episodes. Further research is underway into how this relates to antihypertensive therapy and future outcomes.

Influence of arterial wave reflection on carotid blood pressure and intima‐media thickness in older endurance trained men and women with pre‐hypertension

Increased carotid intima-media thickness (IMT) with aging is a significant predictor of mortality. Older endurance trained (ET) individuals have lower carotid artery stiffness but similar carotid IMT when compared to sedentary (SED) age-matched peers. The purpose of this study was to examine the contribution of arterial wave reflections to carotid hemodynamics and IMT in older ET and SED with pre-hypertension. Subjects consisted of endurance-trained master athletes and age-matched sedentary controls (mean age 67 years). Carotid artery Beta-stiffness index and IMT was assessed with ultrasonography. Carotid pressure and augmented pressure from wave reflections (obtained from pulse contour analysis) was measured with applanation tonometry. Carotid systolic blood pressure (SBP) and IMT were not different between groups (P>0.05). Carotid stiffness was significantly lower in ET versus SED (7.3 +/- 0.8 versus 9.9 +/- 0.6, P<0.05). Augmented pressure was significantly greater in ET versus SED (17.7 +/- 1.6 versus 13.3 +/- 1.5 mmHg, P<0.05). When adjusting for differences in resting heart rate, there were no group differences in augmented pressure. In conclusion, older ET persons with pre-hypertension have reduced carotid artery stiffness, but similar carotid SBP and carotid IMT when compared to SED. The lack of change in carotid SBP and IMT in older ET may be related to the inability of chronic exercise training to reduce bradycardia-related augmented pressure from wave reflections with aging.

Inverse Relationship between Birth Weight and Blood Pressure in Growth-Retarded but Not in Appropriate for Gestational Age Infants during the First Week of Life

Background: Various studies have shown an association between low birth weight and the prevalence of elevated blood pressure later in life. However, a relationship between birth weight and blood pressure in the neonatal period has not been investigated yet. Objective: To study the relationship between birth weight and blood pressure during the first week of life. Methods: Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MBP) were measured every 8 h during days 1, 2, 3, 4 and 7 in 44 small for gestational age (SGA) infants and compared with those of infants born with a birth weight appropriate for gestational age (AGA). The infants were matched for gestational age and gender. Results: Meanbirth weight (range) in the SGA group was 778 (460–1,400) g versus 1,524 (960–2,730) g in the AGA group, and mean (range) gestational age of both groups was 30.5 (27.3–35.5) weeks. In the first week of life, SGA and AGA infants had similar SBP, DBP and MBP. Also, after adjustment for confounders (maternal medication, smoking), SBP, DBP and MBP rose equally in SGA and AGA infants during the first week of life. AGA infants showed a positive correlation between birth weight and blood pressure, but SGA infants showed an inverse correlation. Conclusions: Although differences in blood pressure were found between SGA and AGA infants in the first week of life, the inverse relationship between birth weight and blood pressure in SGA infants warrants follow-up studies to investigate a possible link with late cardiovascular disease.

Abstract 4423: The AGELESS Study: The Effect of Aliskiren vs Ramipril Alone or in Combination with Hydrochlorothiazide and Amlodipine in Patients ≥ 65 Years of Age with Systolic Hypertension

Background: Indirect renin-angiotensin blockade by ACE-inhibition has shown to be effective in lowering blood pressure (BP) in the elderly hypertensive patient. In contrast, the benefits of direct renin inhibition (DRI) on BP has not been extensively studied in an older hypertensive population. Aim of the study: The primary aim was to demonstrate non-inferiority between the DRI, aliskiren and ACE-I, ramipril on the change from baseline in systolic BP (SBP) after 12 weeks (w) of treatment with monotherapy among patients ≥ 65 years of age. If non-inferiority was demonstrated, then an analysis for superiority of aliskiren compared with ramipril would be conducted. The secondary aim was to compare aliskiren-based therapy to ramipril-based therapy after 36 w on SBP. Methods: In this double-blind parallel multi-center study, hypertensive patients with an age ≥ 65 years with a SBP ≥ 160 mmHg either untreated or after a wash-out period were randomized either to aliskiren 150 mg/day or ramipril 5 mg/day for 4 w. If SBP was not at goal at 4 w (&lt; 140 mmHg), study medication doses were doubled to aliskerin 300 mg/day or ramipril 10 mg/day and SBP was evaluated at 12 w. If SBP was not at goal (&lt;140 mmHg), HCTZ (12.5 → 25mg/day) followed by amlodipine (5→10mg/day) regimen were added and SBP was evaluated at 36 w. In the aliskiren group, 457 patients with a mean age of 72.0 years, (51 % females) and in the ramipril group 444 patients with a mean age of 72.2 years, (53 % females) were enrolled. Patients ≥ 75 years of age made up 32.5% of the total population. Results : Table 1 summarizes the results. Conclusion: In an elderly population with systolic hypertension, DRI monotherapy with aliskiren provided a greater reduction in SBP than ramipril after 12 w of treatment and was well tolerated. After 36 w an aliskiren-based regimen provided similar SBP lowering efficacy, compared with a ramipril-based regimen. The incidence of adverse and serious events was similar between the two groups. Table 1: Change from baseline in SBP at week 12 and 36 between the Aliskiren and Ramipril group

Central blood pressure measurement may improve risk stratification

Central systolic blood pressure (SBP) may differ between individuals with similar brachial SBP, which may have implications for risk assessment. This study aimed to determine the variation and potential clinical value of central SBP between patients with similar brachial SBP. Brachial SBP was measured by sphygmomanometer and central SBP by radial tonometry in 675 people (430 men), comprising healthy individuals (n = 222), patients with known or suspected coronary artery disease (n = 229) and diabetes (n = 224). Individuals were stratified by brachial SBP in accordance with European Society of Hypertension guidelines (optimal, normal, high-normal, grades 1, 2 and 3 hypertension). The potential clinical value of central SBP was determined from the percentage of patients re-classified into different brachial SBP groups due to the difference between brachial and aortic SBP (defined as brachial SBP-central SBP). Central SBP increased with each brachial SBP level (optimal to grade 3 hypertension; P < 0.001 for all). However, large variation in brachial-aortic SBP difference occurred within each brachial SBP group (range 2-33 mm Hg), resulting in sizeable overlap of central SBP between brachial SBP groups. For patients with normal brachial SBP, 96% had central SBP within the range of patients with high-normal brachial SBP, as well as 64% within the range of patients with grade 1 hypertension. We conclude that wide variation in brachial-aortic SBP difference occurs between patients with similar brachial SBP. This results in a significant overlap of central SBP scores between brachial SBP risk groups. This is likely to have treatment implications but remains to be tested.

Left atrial systolic force in hypertensive patients with left ventricular hypertrophy: the LIFE study

In hypertensive patients without prevalent cardiovascular disease, enhanced left atrial systolic force is associated with left ventricular hypertrophy and increased preload. It also predicts cardiovascular events in a population with high prevalence of obesity. Relations between left atrial systolic force and left ventricular geometry and function have not been investigated in high-risk hypertrophic hypertensive patients. Participants in the Losartan Intervention For Endpoint reduction in hypertension echocardiography substudy without prevalent cardiovascular disease or atrial fibrillation (n = 567) underwent standard Doppler echocardiography. Left atrial systolic force was obtained from the mitral orifice area and Doppler mitral peak A velocity. Patients were divided into groups with normal or increased left atrial systolic force (>14.33 kdyn). Left atrial systolic force was high in 297 patients (52.3%), who were older and had higher body mass index and heart rate (all P < 0.01) but similar systolic and diastolic blood pressure, in comparison with patients with normal left atrial systolic force. After controlling for confounders, increased left atrial systolic force was associated with larger left ventricular diameter and higher left ventricular mass index (both P < 0.01). Prevalence of left ventricular hypertrophy was greater (84 vs. 64%; P < 0.001). Participants with increased left atrial systolic force exhibited normal ejection fraction; higher stroke volume, cardiac output, transmitral peak E velocities and peak A velocities; and lower E/A ratio (all P < 0.01). Enhanced left atrial systolic force identifies hypertensive patients with greater left ventricular mass and prevalence of left ventricular hypertrophy, but normal left ventricular chamber systolic function with increased transmitral flow gradient occurring during early filling, consistent with increased preload.