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Blood pressure variability, collagen metabolism and large artery stiffness in diabetic and non-diabetic hypertensives
AJH–May 2004 –VOL. 17, NO. 5, PART 2
POSTERS: Arterial Structure and Compliance
Results Daao
STRAIN
EP
Group A VMA r ⫽ ⫺0.150 p ⫽ 0.022 r ⫽ ⫺0.154 p ⫽ 0.018 r ⫽ 0.192 Group B VMA r ⫽ 0.344 Group C VMA r ⫽ 0.366 NOR r ⫽ 0.278
p p p p
⫽ ⫽ ⫽ ⫽
0.033 0.034 0.003 0.046
P-282 BLOOD PRESSURE VARIABILITY, COLLAGEN METABOLISM AND LARGE ARTERY STIFFNESS IN DIABETIC AND NON-DIABETIC HYPERTENSIVES Marek Rajzer, Marek Jastrzebski, Marek Klocek, Kalina KaweckaJaszcz. I-st. Cardiac Department, Medical College of Jagiellonian University, Krakow, Poland. Background: arterial hypertension among diabetic patients is one of the most important factors determining CV- prognosis mainly due to arterial damage. Carotid- femoral pulse wave velocity (PWV-f) is considered as an independent risk factor for CV-mortality in various hypertensive populations and depends on collagen turnover in arterial wall. Objectives: to compare blood pressure profiles, PWV-f, and plasma collagen markers between healthy controls, hypertensives and diabetic hypertensives. Methods: We compared three groups: G1- 24 healthy controls, (Male: Female - 11:13), mean age 53.3 ⫾ 9.5 yrs, G2- 43 essential hypertensives (stage 1 acc.to JNC 7), (M:F- 19:23), mean age 55.3 ⫾ 8.6 yrs and mean duration of hypertension 12.8 ⫾ 2.8 yrs and G3 – 20 diabetic hypertensives, (M:F - 11:9) mean duration of hypertension- 11.6 ⫾ 2.0 yrs, mean duration of DM t. 2 – 12. 3 ⫾ 3.8 yrs. 24- hour ABPM using SpaceLabs 90207, carotid femoral PWV using Complior ® device and plasma levels of collagen metabolites: PICP- carboxyterminal propeptide of procollagen type I, PINP- aminoterminal propeptide of procollagen type I , and PIIINP- aminoterminal propeptide of procollagen type III were determined. ANOVA was used for statistical analysis. Conclusions: Blood pressure variability and collagen metabolism determine large artery stiffness in diabetic hypertensives. Results
SBP 24 (mmHg) DBP 24 (mmHg) SD- SBP (mmHg) SD- DBP (mmHg) Age (years) BMI (kg/m2) PWV-f (m/s) PICP (g/l) PINP (g/l) PIIINP (g/l)
Group 1 (G1)
Group 2 (G2)
Group 3 (G3)
ANOVA Main Effect, p-level
118.0 ⫾ 6.9
132.4 ⫾ 7.2
135.3 ⫾ 8.2
0.01
NS
75.7 ⫾ 5.1
81.1 ⫾ 6.4
85.4 ⫾ 9.9
0.01
NS
13.0 ⫾ 2.6
12.3 ⫾ 2.7
17.7 ⫾ 6.4
0.01
0.01
10.6 ⫾ 2.7
10.2 ⫾ 3.0
15.4 ⫾ 3.1
0.05
0.05
0.05 0.05 0.01 0.05 0.05 NS
NS NS 0.05 0.05 NS NS
53.3 ⫾ 9.5 55.3 ⫾ 8.6 60.5 ⫾ 10.2 25.5 ⫾ 2.8 26.1 ⫾ 3.1 28.4 ⫾ 2.5 8.8 ⫾ 1.2 9.7 ⫾ 1.5 12.3 ⫾ 1.2 132.5 ⫾ 23.2 138.4 ⫾ 28.4 149.5 ⫾ 28.4 43.7 ⫾ 12.3 50.5 ⫾ 13.4 64.7 ⫾ 14.7 3.44 ⫾ 0.75 4.0 ⫾ 0.88 4.9 ⫾ 1.1
P-283 ARTERIAL COMPLIANCE DECREASES DURING THE ISOMETRIC EXERCISE GRIP TEST IN NORMAL SUBJECTS: DISASSOCIATION BETWEEN PULSE WAVE VELOCITY AND HEART RATE Ciaran F. Reid, Michael A. Conway. Department of Cardiology, St. Luke’s Hospital, Kilkenny, Ireland.
Key Words: SNS, Aorta Function Indexes,
Variable
135A
Post-hoc, Scheffe test, plevel
SBP 24 - mean systolic BP from 24 h ABPM, DBP 24 - mean diastolic BP from 24 h ABPM, SD-SBP - standard deviation of SBP in ABPM (BP variability index), SD-DBP standard deviation of DBP in ABPM, BMI- body mass index, NS- non significant
Key Words: Pulse Wave Velocity, Collagen Metabolites, Diabetes and Hypertension
Objective: Arterial compliance, a key determinant of cardiovascular function, is assessed using resting pulse wave velocity (PWV). The PWV response and interaction with blood pressure (BP) and heart rate (HR) during stress testing is largely unknown. We propose that measurement during isometric exercise (ISOMEX) may have important diagnostic potential and hypothesize that increased PWV responses to ISOMEX will highlight altered compliance. Design and Methods: PWV (carotid – radial), BP and HR were recorded in the relaxed right arm of 23 healthy subjects (8 male, 15 female, mean age 32.8 ⫾7 yrs) during 3 minute non-dominant left arm handgrip exercise (30% maximum voluntary contraction). Results: Compared to rest, ISOMEX elicited significant elevations in all hemodynamics, except pulse pressure (table). During exercise, PWV correlated strongly with DBP (r ⫽0.69, p ⬍ 0.01), SBP (r ⫽ 0.45, p ⬍ 0.05), mean arterial pressure (r ⫽ 0.61, p ⬍ 0.01) and rate pressure product (r ⫽ 0.41, p ⬍ 0.05). Exercise PWV and HR failed to correlate. All indices returned to baseline within 120 secs of recovery. Conclusions: Amplified sympathetic responses to ISOMEX cause decreased compliance and elevated PWV which strongly relate to DBP and MAP during ISOMEX in healthy subjects. The relationship with DBP suggests that, as in hypertension, altered compliance rather than increased HR determines elevated PWV. The carotid - radial PWV stress test may have potential for the assessment of hypertension and other vascular disease.
PWV (m/sec) SBP (mmHg) DBP (mmHg) MAP (mmHg) PP (mmHg) HR (bpm) RPP
Rest
Exercise
%Change Recovery
7.64 ⫾ 0.82 112 ⫾ 10 65 ⫾ 6 80 ⫾ 7 47 ⫾ 7 62 ⫾ 6 6950 ⫾ 1024
8.49 ⫾ 0.95* 122 ⫾ 9* 76 ⫾ 9* 91 ⫾ 10* 46 ⫾ 8.3 70 ⫾ 8* 8524 ⫾ 1711*
11.6 ⫾ 8.3 7.76 ⫾ 0.89 9⫾7 110 ⫾ 112 17 ⫾ 10 66 ⫾ 6 13 ⫾ 8 81 ⫾ 8 ⫺1 ⫾ 13 44 ⫾ 8 12 ⫾ 8 61 ⫾ 7 23 ⫾ 15 6768 ⫾ 1135
Values are means ⫾ SD. * p ⱕ 0.01
Key Words: Pulse Wave Velocity, Isometric Exercise, Hypertension
P-284 EFFECT OF ISOMETRIC EXERCISE ON LARGE AND SMALL ARTERIAL COMPLIANCE IN HEALTHY, NORMOTENSIVE MEN AND WOMEN Wirasat Hasnain, Bong Hee Sung, Atika Faiz, Michael F Wilson. Medicine, State University of New York at Buffalo, Buffalo, NY; Medicine, State University of New York at Buffalo, Buffalo, NY; Medicine, Kaleida Health-Millard Fillmore Hospital, Buffalo, NY; Medicine, Kaleida Health-Millard Fillmore Hospital, Buffalo, NY. Decreased arterial compliance contributes to various cardiovascular diseases and it is a significant indicator of major cardiovascular outcomes. Different factors have been known to influence arterial compliance. Isometric exercise such as weight lifting and lifting heavy objects are common daily activities. The hemodynamic response to isometric exercise is well established but its effect on arterial compliance has not been studied. The purpose of our study was to examine the effect of isometric exercise on arterial compliance. Fifty-six healthy, normotensive volunteers were studied. The study group consisted of 21 males and 35 females. None of the study subject was on any medication. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), stroke volume, cardiac output and large artery elasticity index (LAEI), small artery elasticity index (SAEI) were measured non-invasively using
POSTERS: Arterial Structure and Compliance
Results Daao
STRAIN
EP
Group A VMA r ⫽ ⫺0.150 p ⫽ 0.022 r ⫽ ⫺0.154 p ⫽ 0.018 r ⫽ 0.192 Group B VMA r ⫽ 0.344 Group C VMA r ⫽ 0.366 NOR r ⫽ 0.278
p p p p
⫽ ⫽ ⫽ ⫽
0.033 0.034 0.003 0.046
P-282 BLOOD PRESSURE VARIABILITY, COLLAGEN METABOLISM AND LARGE ARTERY STIFFNESS IN DIABETIC AND NON-DIABETIC HYPERTENSIVES Marek Rajzer, Marek Jastrzebski, Marek Klocek, Kalina KaweckaJaszcz. I-st. Cardiac Department, Medical College of Jagiellonian University, Krakow, Poland. Background: arterial hypertension among diabetic patients is one of the most important factors determining CV- prognosis mainly due to arterial damage. Carotid- femoral pulse wave velocity (PWV-f) is considered as an independent risk factor for CV-mortality in various hypertensive populations and depends on collagen turnover in arterial wall. Objectives: to compare blood pressure profiles, PWV-f, and plasma collagen markers between healthy controls, hypertensives and diabetic hypertensives. Methods: We compared three groups: G1- 24 healthy controls, (Male: Female - 11:13), mean age 53.3 ⫾ 9.5 yrs, G2- 43 essential hypertensives (stage 1 acc.to JNC 7), (M:F- 19:23), mean age 55.3 ⫾ 8.6 yrs and mean duration of hypertension 12.8 ⫾ 2.8 yrs and G3 – 20 diabetic hypertensives, (M:F - 11:9) mean duration of hypertension- 11.6 ⫾ 2.0 yrs, mean duration of DM t. 2 – 12. 3 ⫾ 3.8 yrs. 24- hour ABPM using SpaceLabs 90207, carotid femoral PWV using Complior ® device and plasma levels of collagen metabolites: PICP- carboxyterminal propeptide of procollagen type I, PINP- aminoterminal propeptide of procollagen type I , and PIIINP- aminoterminal propeptide of procollagen type III were determined. ANOVA was used for statistical analysis. Conclusions: Blood pressure variability and collagen metabolism determine large artery stiffness in diabetic hypertensives. Results
SBP 24 (mmHg) DBP 24 (mmHg) SD- SBP (mmHg) SD- DBP (mmHg) Age (years) BMI (kg/m2) PWV-f (m/s) PICP (g/l) PINP (g/l) PIIINP (g/l)
Group 1 (G1)
Group 2 (G2)
Group 3 (G3)
ANOVA Main Effect, p-level
118.0 ⫾ 6.9
132.4 ⫾ 7.2
135.3 ⫾ 8.2
0.01
NS
75.7 ⫾ 5.1
81.1 ⫾ 6.4
85.4 ⫾ 9.9
0.01
NS
13.0 ⫾ 2.6
12.3 ⫾ 2.7
17.7 ⫾ 6.4
0.01
0.01
10.6 ⫾ 2.7
10.2 ⫾ 3.0
15.4 ⫾ 3.1
0.05
0.05
0.05 0.05 0.01 0.05 0.05 NS
NS NS 0.05 0.05 NS NS
53.3 ⫾ 9.5 55.3 ⫾ 8.6 60.5 ⫾ 10.2 25.5 ⫾ 2.8 26.1 ⫾ 3.1 28.4 ⫾ 2.5 8.8 ⫾ 1.2 9.7 ⫾ 1.5 12.3 ⫾ 1.2 132.5 ⫾ 23.2 138.4 ⫾ 28.4 149.5 ⫾ 28.4 43.7 ⫾ 12.3 50.5 ⫾ 13.4 64.7 ⫾ 14.7 3.44 ⫾ 0.75 4.0 ⫾ 0.88 4.9 ⫾ 1.1
P-283 ARTERIAL COMPLIANCE DECREASES DURING THE ISOMETRIC EXERCISE GRIP TEST IN NORMAL SUBJECTS: DISASSOCIATION BETWEEN PULSE WAVE VELOCITY AND HEART RATE Ciaran F. Reid, Michael A. Conway. Department of Cardiology, St. Luke’s Hospital, Kilkenny, Ireland.
Key Words: SNS, Aorta Function Indexes,
Variable
135A
Post-hoc, Scheffe test, plevel
SBP 24 - mean systolic BP from 24 h ABPM, DBP 24 - mean diastolic BP from 24 h ABPM, SD-SBP - standard deviation of SBP in ABPM (BP variability index), SD-DBP standard deviation of DBP in ABPM, BMI- body mass index, NS- non significant
Key Words: Pulse Wave Velocity, Collagen Metabolites, Diabetes and Hypertension
Objective: Arterial compliance, a key determinant of cardiovascular function, is assessed using resting pulse wave velocity (PWV). The PWV response and interaction with blood pressure (BP) and heart rate (HR) during stress testing is largely unknown. We propose that measurement during isometric exercise (ISOMEX) may have important diagnostic potential and hypothesize that increased PWV responses to ISOMEX will highlight altered compliance. Design and Methods: PWV (carotid – radial), BP and HR were recorded in the relaxed right arm of 23 healthy subjects (8 male, 15 female, mean age 32.8 ⫾7 yrs) during 3 minute non-dominant left arm handgrip exercise (30% maximum voluntary contraction). Results: Compared to rest, ISOMEX elicited significant elevations in all hemodynamics, except pulse pressure (table). During exercise, PWV correlated strongly with DBP (r ⫽0.69, p ⬍ 0.01), SBP (r ⫽ 0.45, p ⬍ 0.05), mean arterial pressure (r ⫽ 0.61, p ⬍ 0.01) and rate pressure product (r ⫽ 0.41, p ⬍ 0.05). Exercise PWV and HR failed to correlate. All indices returned to baseline within 120 secs of recovery. Conclusions: Amplified sympathetic responses to ISOMEX cause decreased compliance and elevated PWV which strongly relate to DBP and MAP during ISOMEX in healthy subjects. The relationship with DBP suggests that, as in hypertension, altered compliance rather than increased HR determines elevated PWV. The carotid - radial PWV stress test may have potential for the assessment of hypertension and other vascular disease.
PWV (m/sec) SBP (mmHg) DBP (mmHg) MAP (mmHg) PP (mmHg) HR (bpm) RPP
Rest
Exercise
%Change Recovery
7.64 ⫾ 0.82 112 ⫾ 10 65 ⫾ 6 80 ⫾ 7 47 ⫾ 7 62 ⫾ 6 6950 ⫾ 1024
8.49 ⫾ 0.95* 122 ⫾ 9* 76 ⫾ 9* 91 ⫾ 10* 46 ⫾ 8.3 70 ⫾ 8* 8524 ⫾ 1711*
11.6 ⫾ 8.3 7.76 ⫾ 0.89 9⫾7 110 ⫾ 112 17 ⫾ 10 66 ⫾ 6 13 ⫾ 8 81 ⫾ 8 ⫺1 ⫾ 13 44 ⫾ 8 12 ⫾ 8 61 ⫾ 7 23 ⫾ 15 6768 ⫾ 1135
Values are means ⫾ SD. * p ⱕ 0.01
Key Words: Pulse Wave Velocity, Isometric Exercise, Hypertension
P-284 EFFECT OF ISOMETRIC EXERCISE ON LARGE AND SMALL ARTERIAL COMPLIANCE IN HEALTHY, NORMOTENSIVE MEN AND WOMEN Wirasat Hasnain, Bong Hee Sung, Atika Faiz, Michael F Wilson. Medicine, State University of New York at Buffalo, Buffalo, NY; Medicine, State University of New York at Buffalo, Buffalo, NY; Medicine, Kaleida Health-Millard Fillmore Hospital, Buffalo, NY; Medicine, Kaleida Health-Millard Fillmore Hospital, Buffalo, NY. Decreased arterial compliance contributes to various cardiovascular diseases and it is a significant indicator of major cardiovascular outcomes. Different factors have been known to influence arterial compliance. Isometric exercise such as weight lifting and lifting heavy objects are common daily activities. The hemodynamic response to isometric exercise is well established but its effect on arterial compliance has not been studied. The purpose of our study was to examine the effect of isometric exercise on arterial compliance. Fifty-six healthy, normotensive volunteers were studied. The study group consisted of 21 males and 35 females. None of the study subject was on any medication. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), stroke volume, cardiac output and large artery elasticity index (LAEI), small artery elasticity index (SAEI) were measured non-invasively using