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P) evaluation of antihypertensive treatment by ambulatory blood pressure monitoring (ABPM). Is there a clinically useful estimate?
AJH-APRIL 1999-VOL. 12, NO. 4, PART 2
POSTERS:
Blood
Pressure
Measurement
(Including
ABPM)
A009
A010
G PROTEIN ~3 SUBUN1T GENE VARIANT. 24-HOUR BLOOD PRESSURE, AND HYPERTENSIVE CEREBROVASCULAR DISEASE 1N A JAPANESE POPULATION. K Kario*, M Fujiwara, Y Sone, K Saiki, S Hoshide, K Shimada, M Matsuo. Division of Genetics, ICMR, Kobe University School of Medicine; Department of Cardiology, Jichi Medical School; Kobe Pharmaceutical University, Japan; Hypertension Center, Weill Medical College of Cornell University, NY.
ANGIOTENSINOGEN AND ANGIOTENSIN-CONVERTING ENZYME GENOTYPES AND DAYTIME AND NIGHTTIME BLOOD PRESSURES IN JAPANESE HYPERTENSIVES. K Kario** S Nishitmm, S Hoshide, Y Umeda, M Matsuo, K Shimada. Department of Cardiology, J iehi Medical School; Division of Genetics, International Center of Medical Research, Kobe University School of Medicine, Kobe, Japan; Hypertension Center, Weill Medical College of Cornell University; NY..
Recently, a G protein ~3 subunit gene variant, a C to T change at nucleotide 825 of exon 10 (GNB3 T825) was reported to be associated with enhanced intracellular signal transduction and hypertension and to exhibit marked racial difl~ences in gene frequency. We investigated the association of GNB3 T825 with hypertension and isehemic stroke in Japanese. We studied 189 hypertensive patients ( 120 asymptomatic end 69 with cerebral infarction) and 106 normotensive healthy control subjects. Silent hypertensive cerebrovaseular disease was assessed by brain MRI in all 120 asymptomatic hypertensives and patients were classified into a hypertensive non-infarction group without any lacunae (n=8 I), or a hypertensive silent infarctien groep with one or more lacunae (n=39). We also performed 24-hr ambulatory BP monitoring in the 267 subjects who were normotensive, untreated hypertensive, or whose antihypertensive therapy could be stopped. GNB3 "1"825was identified by PCR (Nai Genet 1998). The gene frequency of the GNB3 T825 allele in the normotensives was 0.55, which is similar to that in a Canadian Oji-Cree population (0.50) end much higher than that in a German population (0.25), suggesting that the mutation ending the T825 allele spread as a founder effect. We found no differences in the gene frequency of the T825 allele among the normotensive group (0.55), the hypertensive uon-infarction group (0.53), the hypertensive silent infarction group (0 49), and the cerebral infarction group (0.54). There were also no differences in office BP, average 24-hr BP, average daytime BP, and average nighttime BP among the three genotype groups, nor any differences in the prevalences of hypertension (defined using office BP), sustained hypertension (defined as 24-hr systolic BP > 135 mmHg and/or 24-hr diastolic 13P > 80 rmnHg), left ventrieular hypertrophy, or cardiovascular risk factors among the three genotype groups. In conclusion, the GNB3 "I'825 allele seems to have a less important influence on hypertension, hypertensive target organ damage and cerebrovaseular events in Japanese.
Key Words:
G protein 133 subunit gene variant, 24-hr blood pressure, hypertension, hypertensive cerebrovaseular disease, Japanese
There are inconsistent reports that angiotensinogen (ATG) variant Met23~---PThr (T235) allele and angiotensin-converting enzyme (ACE) insertion/deletion (I/D) variants are associated with hypertension and related target organ damage. Both high blood pressure (BP) and abnormal diurnal BP variation patterns are related to target organ damage, but it is not "known whether the above genetic variants of the renin-angiotensin system are related to 24-h BP and the diurnal BP pattern in Japanese. We studied the association of the ATG T235 and ACE D alleles with 24-h BP and diurnal BP variation in 235 of 262 consecutively untreated (or offmedications) elderly Japanese hypertensives who uoderwent 24-h ambulatory BP monitoring. There was no significant association of the T235 or ACE D alleles with office BP, but the T235 allele was significantly associated with increased 24-h BP and day BP, and the D allele was significantly associated with increased 24-h BP, day BP, and night BP. There were no interaction effects of the T235 and D alleles on any BP parameters. Those with white-coat hypertension had a significantly lower T235 allele frequency (0.68) than those with sustained hypertension (0.79, p=0.010), but the difference in D allele frequency was marginal (0.30 vs 0.38, p=0.057). In the sustained hypertension group, there was no significant difference in the frequencies ofT235 allele and D allele between the dippers with appropriate nocturnal BP fall find the non-dippers without nocturnal BP fall. In conclusion, in elderly Japanese hypertensive individuals, both the ATG T 235 and ACE D alleles are associated with elevated 24-h BP and day BP, while only the ACE D allele is associated with elevated night BP.
Key Words:
angiotensinogen gene, angiotensin-converting enzyme gene, 24-hour blood pressure, diurnal blood pressure variation, elderly Japanese, white-coat hypertension
A011
A012
AMBULATORY BLOOD PRESSURE MONITORING AND CLINICAL CHARACTERISTICS O F T H E T R U E A N D WHITE COAT RESISTANT HYPERTENSION, F. Veglio, F. Rabbis, P.
TROUGH:PEAK RATIO (T/P) EVALUATION OF ANTIHYPERTENSIVE TREATMENT BY A M B U L A T O R Y B L O O D PRESSURE MONITORING (ABPM). IS THERE A CLINICALLY USEFUL ESTIMATE? C.Olennone. A.VIIlamll; H.Bagtlvo*, F.Martine~ Y.Plotquln, M.Dlaz, H.Senra, E.Beaada, A.Alvarez Roche, W.Cabrera, D.Clflano, R.Sanchez'. GAETHA Multicenfrtc Study. Buenos Aires. Argentina. A TIP ratio global assessment obtained by ABPM, such as a single hourly means blood pressure (BP) decrease profile for all the patients, does not considers intersubject and intrasabject BP variability. In this study,we propose an alternative approach, that includes the intersubject BP variability. MATERIAL AND METHODS: 171 essential mild to moderate hypertensive patients (56.7 % men, mean age: 55.3 yr.) were included in a double blind, randomized trial o1 t2 weeks active treatment. Patlents(pts) received one 013 drugs, single daily dose, with dose titration (18.7 % an angtatenein-converhng enzime inhibitor, 20.5 % a calcium channel blocker dyhydropiridine and 51.5 % a new calcium blocker). ABPM(SpaceLabs) was applied at baseline and after 12 weeks, individual T/P ratios were obtained for each pt. with 3 different smoothing models. The rough diastolic BP decrease (ADBP) 24 hours profile, obtained subtracting the baseline DBP profile from the week 12 profile, was smoothed by hourly means (H), bihoudy means (B) and Fourier model with 4 harmonics(F). Trough was defined as the DBP decrease 24 h. post-dose and peak as the maximum decrease in 24 hours. ADBP, std.devlefion (S.D.) and the SmOothness index ( &OBP over 24 hours / S.D. of hourly changes) were evaluated for each pt. RESULTS: 24h. DBP mean reduction was the same with any model ( -11.1 rrcn Hg). Responders were represented by patients with T/P >0 obtained from the hourly means ~DBP smoothed )rofiles. Trough:PealtMean(95%Cl) [H] Hourly [B]Bi-houdy I [F]Fourier Global TIP ratio. N=171 0.79 (0.58;1) 0.75 (0.56;1) 038 (0.60;1) Individual TIP ratio, N=171 0,31 (0.25;0.37) 0.34 (0.28;0.39) 0.39 (0.33;0.45) Pts.with [1t] TIP >0. N=134 0.47 (0.42;0.51) 0.46 (0.40;0.51) 0.52 {0.47;0,57) 2411.ADEP vadability [H| Houdy [B]BI-houdy [F]Fouder Median (P25%;P75%). S.D {rnm Hg): 10.4 (8.5;IZ6} 8.4 (6.3;10.7) 7.8 (5.6;10.5) Smoothness index: -1.0(-1.5;- 0.5) -1.3(.1.9;- 0.7) .1.5(-2.1 ;- 0.7) Global and Individual assessment of T/p ratios showed strong differences P
Riva, G. Martini, G Cat Genova, S. Mona di Celia, A. Milan, L. Chiandussi. Dept of Medicine and Exp Oncology, University of Tudn-ltaly The resistant hypertension has been differenziated in true resistant hypertension and white-coat resistant hypertension by using ambulatory blood pressure monitodng.The aim of this study was to evaluate whether are present different clinical characteristics between the two types of resistant hypertension.The study group consisted of 49 patients with essential hypertension resistant to standard triple-drug therapy that had persistently elevated clinic blood pressure (>140190 mm Hg), for at least 3 months.They represented the 1.9 % of 2 5 0 0 hypertensive outpatients that referred at our Hypertension Unit. Patients with white-coat resistant hypertension were older (p<0.05) than those with tree resistant hypertension. The sodium intake and alcohol intake were significantly (p<0.05) higher in patients with true resistant hypertension than those with white-coat resistant hypertension.The renin plasma activity was higher (p<0.05) in patients with true resistant hypertension than in those with whitecoat resistant hypertension with normal plasma electrolyte balance. Day-time and nighttime ambulatory 24-h-head rate was significantly higher in the true resistant hypertensive patients when compared with white-coat resistant hypertensives (p
Key Words: Troughpeakratio, ambulatoryblood pressure monitoring, Fourier anatyals
149A
POSTERS:
Blood
Pressure
Measurement
(Including
ABPM)
A009
A010
G PROTEIN ~3 SUBUN1T GENE VARIANT. 24-HOUR BLOOD PRESSURE, AND HYPERTENSIVE CEREBROVASCULAR DISEASE 1N A JAPANESE POPULATION. K Kario*, M Fujiwara, Y Sone, K Saiki, S Hoshide, K Shimada, M Matsuo. Division of Genetics, ICMR, Kobe University School of Medicine; Department of Cardiology, Jichi Medical School; Kobe Pharmaceutical University, Japan; Hypertension Center, Weill Medical College of Cornell University, NY.
ANGIOTENSINOGEN AND ANGIOTENSIN-CONVERTING ENZYME GENOTYPES AND DAYTIME AND NIGHTTIME BLOOD PRESSURES IN JAPANESE HYPERTENSIVES. K Kario** S Nishitmm, S Hoshide, Y Umeda, M Matsuo, K Shimada. Department of Cardiology, J iehi Medical School; Division of Genetics, International Center of Medical Research, Kobe University School of Medicine, Kobe, Japan; Hypertension Center, Weill Medical College of Cornell University; NY..
Recently, a G protein ~3 subunit gene variant, a C to T change at nucleotide 825 of exon 10 (GNB3 T825) was reported to be associated with enhanced intracellular signal transduction and hypertension and to exhibit marked racial difl~ences in gene frequency. We investigated the association of GNB3 T825 with hypertension and isehemic stroke in Japanese. We studied 189 hypertensive patients ( 120 asymptomatic end 69 with cerebral infarction) and 106 normotensive healthy control subjects. Silent hypertensive cerebrovaseular disease was assessed by brain MRI in all 120 asymptomatic hypertensives and patients were classified into a hypertensive non-infarction group without any lacunae (n=8 I), or a hypertensive silent infarctien groep with one or more lacunae (n=39). We also performed 24-hr ambulatory BP monitoring in the 267 subjects who were normotensive, untreated hypertensive, or whose antihypertensive therapy could be stopped. GNB3 "1"825was identified by PCR (Nai Genet 1998). The gene frequency of the GNB3 T825 allele in the normotensives was 0.55, which is similar to that in a Canadian Oji-Cree population (0.50) end much higher than that in a German population (0.25), suggesting that the mutation ending the T825 allele spread as a founder effect. We found no differences in the gene frequency of the T825 allele among the normotensive group (0.55), the hypertensive uon-infarction group (0.53), the hypertensive silent infarction group (0 49), and the cerebral infarction group (0.54). There were also no differences in office BP, average 24-hr BP, average daytime BP, and average nighttime BP among the three genotype groups, nor any differences in the prevalences of hypertension (defined using office BP), sustained hypertension (defined as 24-hr systolic BP > 135 mmHg and/or 24-hr diastolic 13P > 80 rmnHg), left ventrieular hypertrophy, or cardiovascular risk factors among the three genotype groups. In conclusion, the GNB3 "I'825 allele seems to have a less important influence on hypertension, hypertensive target organ damage and cerebrovaseular events in Japanese.
Key Words:
G protein 133 subunit gene variant, 24-hr blood pressure, hypertension, hypertensive cerebrovaseular disease, Japanese
There are inconsistent reports that angiotensinogen (ATG) variant Met23~---PThr (T235) allele and angiotensin-converting enzyme (ACE) insertion/deletion (I/D) variants are associated with hypertension and related target organ damage. Both high blood pressure (BP) and abnormal diurnal BP variation patterns are related to target organ damage, but it is not "known whether the above genetic variants of the renin-angiotensin system are related to 24-h BP and the diurnal BP pattern in Japanese. We studied the association of the ATG T235 and ACE D alleles with 24-h BP and diurnal BP variation in 235 of 262 consecutively untreated (or offmedications) elderly Japanese hypertensives who uoderwent 24-h ambulatory BP monitoring. There was no significant association of the T235 or ACE D alleles with office BP, but the T235 allele was significantly associated with increased 24-h BP and day BP, and the D allele was significantly associated with increased 24-h BP, day BP, and night BP. There were no interaction effects of the T235 and D alleles on any BP parameters. Those with white-coat hypertension had a significantly lower T235 allele frequency (0.68) than those with sustained hypertension (0.79, p=0.010), but the difference in D allele frequency was marginal (0.30 vs 0.38, p=0.057). In the sustained hypertension group, there was no significant difference in the frequencies ofT235 allele and D allele between the dippers with appropriate nocturnal BP fall find the non-dippers without nocturnal BP fall. In conclusion, in elderly Japanese hypertensive individuals, both the ATG T 235 and ACE D alleles are associated with elevated 24-h BP and day BP, while only the ACE D allele is associated with elevated night BP.
Key Words:
angiotensinogen gene, angiotensin-converting enzyme gene, 24-hour blood pressure, diurnal blood pressure variation, elderly Japanese, white-coat hypertension
A011
A012
AMBULATORY BLOOD PRESSURE MONITORING AND CLINICAL CHARACTERISTICS O F T H E T R U E A N D WHITE COAT RESISTANT HYPERTENSION, F. Veglio, F. Rabbis, P.
TROUGH:PEAK RATIO (T/P) EVALUATION OF ANTIHYPERTENSIVE TREATMENT BY A M B U L A T O R Y B L O O D PRESSURE MONITORING (ABPM). IS THERE A CLINICALLY USEFUL ESTIMATE? C.Olennone. A.VIIlamll; H.Bagtlvo*, F.Martine~ Y.Plotquln, M.Dlaz, H.Senra, E.Beaada, A.Alvarez Roche, W.Cabrera, D.Clflano, R.Sanchez'. GAETHA Multicenfrtc Study. Buenos Aires. Argentina. A TIP ratio global assessment obtained by ABPM, such as a single hourly means blood pressure (BP) decrease profile for all the patients, does not considers intersubject and intrasabject BP variability. In this study,we propose an alternative approach, that includes the intersubject BP variability. MATERIAL AND METHODS: 171 essential mild to moderate hypertensive patients (56.7 % men, mean age: 55.3 yr.) were included in a double blind, randomized trial o1 t2 weeks active treatment. Patlents(pts) received one 013 drugs, single daily dose, with dose titration (18.7 % an angtatenein-converhng enzime inhibitor, 20.5 % a calcium channel blocker dyhydropiridine and 51.5 % a new calcium blocker). ABPM(SpaceLabs) was applied at baseline and after 12 weeks, individual T/P ratios were obtained for each pt. with 3 different smoothing models. The rough diastolic BP decrease (ADBP) 24 hours profile, obtained subtracting the baseline DBP profile from the week 12 profile, was smoothed by hourly means (H), bihoudy means (B) and Fourier model with 4 harmonics(F). Trough was defined as the DBP decrease 24 h. post-dose and peak as the maximum decrease in 24 hours. ADBP, std.devlefion (S.D.) and the SmOothness index ( &OBP over 24 hours / S.D. of hourly changes) were evaluated for each pt. RESULTS: 24h. DBP mean reduction was the same with any model ( -11.1 rrcn Hg). Responders were represented by patients with T/P >0 obtained from the hourly means ~DBP smoothed )rofiles. Trough:PealtMean(95%Cl) [H] Hourly [B]Bi-houdy I [F]Fourier Global TIP ratio. N=171 0.79 (0.58;1) 0.75 (0.56;1) 038 (0.60;1) Individual TIP ratio, N=171 0,31 (0.25;0.37) 0.34 (0.28;0.39) 0.39 (0.33;0.45) Pts.with [1t] TIP >0. N=134 0.47 (0.42;0.51) 0.46 (0.40;0.51) 0.52 {0.47;0,57) 2411.ADEP vadability [H| Houdy [B]BI-houdy [F]Fouder Median (P25%;P75%). S.D {rnm Hg): 10.4 (8.5;IZ6} 8.4 (6.3;10.7) 7.8 (5.6;10.5) Smoothness index: -1.0(-1.5;- 0.5) -1.3(.1.9;- 0.7) .1.5(-2.1 ;- 0.7) Global and Individual assessment of T/p ratios showed strong differences P
Riva, G. Martini, G Cat Genova, S. Mona di Celia, A. Milan, L. Chiandussi. Dept of Medicine and Exp Oncology, University of Tudn-ltaly The resistant hypertension has been differenziated in true resistant hypertension and white-coat resistant hypertension by using ambulatory blood pressure monitodng.The aim of this study was to evaluate whether are present different clinical characteristics between the two types of resistant hypertension.The study group consisted of 49 patients with essential hypertension resistant to standard triple-drug therapy that had persistently elevated clinic blood pressure (>140190 mm Hg), for at least 3 months.They represented the 1.9 % of 2 5 0 0 hypertensive outpatients that referred at our Hypertension Unit. Patients with white-coat resistant hypertension were older (p<0.05) than those with tree resistant hypertension. The sodium intake and alcohol intake were significantly (p<0.05) higher in patients with true resistant hypertension than those with white-coat resistant hypertension.The renin plasma activity was higher (p<0.05) in patients with true resistant hypertension than in those with whitecoat resistant hypertension with normal plasma electrolyte balance. Day-time and nighttime ambulatory 24-h-head rate was significantly higher in the true resistant hypertensive patients when compared with white-coat resistant hypertensives (p
Key Words: Troughpeakratio, ambulatoryblood pressure monitoring, Fourier anatyals
149A