Neither losartan nor atenolol reduce collagen markers beyond blood pressure reduction in hypertension. A LIFE substudy

AJH–May 2005–VOL. 18, NO. 5, PART 2

P-459 SYSTOLIC BLOOD PRESSURE DURING MYOCARDIAL INFARCTION WITHOUT HEART FAILURE IS INDEPENDENTLY ASSOCIATED TO 5YEAR NON SUDDEN CARDIOVASCULAR MORTALITY Giuseppe Berton, Rocco Cordiano, Rosa Palmieri, Stefania Petucco, Attilio Biagini, Paolo Mormino, Paolo Palatini. Cardiology, Conegliano General Hospital, Conegliano, TV, Italy; Cardiology, Adria General Hospital, Adria, RO, Italy; Cardiology, Bassano General Hospital, Bassano, VI, Italy; Cardiology, Cairo Montenotte General Hospital, Cairo Montenotte, SV, Italy; Clinica Medica IV, University of Padova, Padova, PD, Italy. Since presence of heart failure (HF) is crucial for treatment and prognosis of myocardial infarction (MI), we investigated whether blood pressure (BP) influences mortality in the patients with and without HF during MI. This is a prospective study on 505 consecutive, unselected patients admitted to 3 coronary care units for definite MI. HF was evaluated according to Killip classification on the first week from admission. BP was measured using a mercury sphygmomanometer on the 1st, 3rd and 7th day after admission. The mean of 9 recordings (3 each day) was used in the present analysis and entered the survival Cox models as tertiles. All patients completed 5 years follow up [global mortality (GM), non sudden cardiovascular mortality (non-SCVM), sudden death (SD) and non-CV mortality (non-CVM) were considered as the outcomes]. Baseline variables were age, gender, diabetes, history of hypercholestolemia, history of angina or MI, CK-MB peak, BP, revascularization, ACE-I and ␤-blocker therapy, Threehundred and ten patients (mean age 63.1⫾11.9 years) had no HF and BP was 122⫾14/76⫾8 mmHg. The other 195 patients (mean age 71.9⫾10.2 years) had signs of HF and BP was 120⫾15/74⫾8 mmHg. Among no-HF patients, GM was 17% in the lowest, 20% in the middle and 31% in the highest tertile (p⫽0.04) and non-SCVM was 6%, 5% and 20% in the 3 tertiles (p⬍0.0001). Among HF-patients, GM was 58%, 55% and 65% respectively (ns) and nonSCVM was 37%, 38% and 43% respectively (ns). At bivariate analysis, among no-HF patients, systolic BP was associated to both GM (RR by tertile ⫽1.4,CL⫽1.1-1.9, p⫽0.01) and non-SCVM (RR by tertile ⫽2.3,CL⫽1.4-3.8, p⫽0.0004) while no association was observed toward SD and non-CVM. Diastolic BP was not associated to any of the outcomes. After adjustment, systolic BP remained independently associated to non-SCVM (RR by tertile⫽1.7,CL⫽1.1-3.0, p⫽0.02) along with age (p⫽0.0001) and diabetes (p⫽0.0004). Conclusion: High systolic BP during MI is independently associated to 5-year non-SCVM. Key Words: Mortality, Myocardial Infarction and Heart Failure, Systolic Blood Pressure

P-460 NEITHER LOSARTAN NOR ATENOLOL REDUCE COLLAGEN MARKERS BEYOND BLOOD PRESSURE REDUCTION IN HYPERTENSION. A LIFE SUBSTUDY Marina K Christensen, Michael H Olsen, Lars T Jensen, Hans Ibsen. Clinical Physiology and Nuclear Medicine, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark. Background: We have reported that collagen markers (CMs) were reduced during 1 year of losartan- and atenolol-based antihypertensive treatment, and reductions were related to blood pressure (BP) lowering in the atenolol group. We hypothesized that losartan, independent of BP, would reduce the level of circulating CMs further during an additional 2 years of treatment. Methods: In 204 patients with hypertension and left ventricular hypertrophy (LVH) we measured serum carboxy-terminal telopeptide of © 2005 by the American Journal of Hypertension, Ltd. Published by Elsevier Inc.

POSTERS: Coronary Artery Disease

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type I procollagen (ICTP), carboxy-terminal propeptide of type I procollagen (PICP), serum amino-terminal propeptide of type III procollagen (P3NP), serum amino-terminal propeptide of type I procollagen (PINP) and LV mass by echocardiography at baseline and annually during 3 years of losartan- or atenolol-based antihypertensive treatment. We got CMs throughout the studie in 133 patients. Results: There were no significant differences in CMs, BP or LV mass index (LVMI) between groups at baseline. During treatment, systolic and diastolic BP was reduced significantly and comparably in the groups. Within the first year circulating CMs were reduced in patients treated with losartan- and atenolol-based regimens, and then stabilized comparably (PINP (mg/L): 2.year: 34.0⫾15 vs. 34.0⫾17, 3.year: 34.0⫾16 vs. 34.6⫾18; P3NP (mg/L): 2.year: 3.8⫾1.2 vs. 3.8⫾1.7, 3.year: 3.6⫾1.1 vs. 3.4⫾0.8; PICP (mg/L): 2.year: 128⫾48 vs. 123⫾37, 3.year: 125⫾41 vs. 120⫾35; ICTP (mg/L): 2.year: 4.3⫾2.1 vs. 4.5⫾2.6, 3.year: 4.0⫾1.3 vs. 4.4⫾1.7). Even in patients with high baseline levels of CMs, there were no treatment differences in CMs or LV mass index (LVMI). Changes in PICP during first year of treatment were related to changes in LVMI after two and three years of treatment in the losartan group (both r⫽0.25, p⬍0.05), but not in the atenelol group. Change in PICP between second and third year was related to changes in systolic blood pressure (r⫽0.18, p⬍0.05) and pulse pressure (r⫽0.15, p⬍0.05), more strongly in the atenolol group (r⫽0.20 and r⫽0.24). Conclusion: In this LIFE substudy in patients with hypertension and LVH, Losartan- and atenolol treatment produced comparable reductions in CMs. Changes in PICP were related to blood pressure changes in the atenolol group and to LV regression in the losartan group suggesting a different mechanism. Key Words: Collagen Markers, Fibrosis, Hypertension

P-461 THE INTERRELATIONSHIPS BETWEEN LIPID METABOLISM, BODY MASS INDEX AND GLUCOSE IN PATIENTS WITH ISCHAEMIC HEART DISEASE AND METABOLIC SYNDROME S. A. Matveeva. Medical University, Ryazan, Russian Federation. The lipid disturbances, obesity, type 2 diabetes mellitus are of the risk factors for cardiovascular diseases. The purpose consisted to studying the interrelationships between lipid metabolism, body mass index and glucose in patients with ischaemic heart disease and metabolic syndrome. We examined 100 patients (47 males, 53 females, mean age 52.37⫾0.88). The present investigation included clinical data (obesity, blood pressure and other risk factors), laboratory analysis (lipid spectrum, carbohydrate metabolism, enzymes, functional tests of liver and kidneys) and instrumental methods (ECG, EchoCG, US of internal organs, vessels). The comparative analysis showed that 80 (80%) of the patients had body mass index (BMI) 30.72⫾0.36 cg/m2. We found a high correlation between BMI and the concentrations in blood serum of: total cholesterol (r⫽⫹0.99, P⬍0.001), high density lipoproteins-cholesterol (r⫽⫹0.99, P⬍0.001), triglycerides (r⫽⫹0.97, P⬍0.001), very low density lipoproteins-cholesterol (r⫽⫹0.97, P⬍0.001), low density lipoproteins-cholesterol (r⫽⫹0.99, P⬍0.001). The parameters of glucose 6.85⫾0.26 mmol/L had a high correlation with total cholesterol (r⫽⫹0.98, P⬍0.001), high density lipoproteins-cholesterol (r⫽⫹0.98, P⬍0.001), triglycerides (r⫽⫹0.97, P⬍0.001), very low density lipoproteins-cholesterol (r⫽⫹0.97, P⬍0.001), low density lipoproteins-cholesterol (r⫽⫹0.96, P⬍0.001). It was shown that BMI 30.72⫾0.36 cg/m2 had a high correlation (r⫽⫹0.96, P⬍0.001) between mean parameters of glucose also. Thus, we suggest a high functional the interrelationships were found: between the parameters of the lipid spectrum and BMI, between the parameters of the lipid spectrum and glucose, between 0895-7061/05/$30.00