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Borderline hypertension: early alterations of carotid artery mechanical properties and left ventricular diastolic dysfunction. a possible relationship?
AJH–April 2002–VOL. 15, NO. 4, PART 2
POSTERS: Arterial Structure and Compliance
depression, as the care of these patients should be tailered to adress their unique needs. Key Words: Depression, Substance Use, Adherence
P-111 MARKERS OF LARGE-VESSEL COMPLIANCE IN HYPERTENSIVES AND YOUNG ADULTS WITH SEVERE AORTIC ATHEROSCLEROSIS EVALUATED BY NON-INVASIVE METHODS Pavel J. Levy, Karen Sigmon Smith, John Wilkins, Ralph Barnes, Abdelhamed I. Abdelhamed, Ronald D. Smith, Carlos M. Ferrario. Hypertension and Vascular Disease Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States. Young adults (⬍55 yrs) with premature peripheral arterial disease (PAD) have high prevalence of severe distal aortic atherosclerosis (AO-ASO) and hypertension. In this cross-sectional study we used non-invasive monitoring (HDI/Pulse Wave™ CR2000 and radial applanation tonometry/ShygmoCor, PWV Medical™) to evaluate central aortic pulse pressure (CPP), augmentation (Aug), augmentation index (AI) and large artery elasticity (C1) in 16 patients [49 ⫾ 7 yrs (M ⫾ SD); 63% females] with angiographically severe AO-ASO (⬎90% stenosis) and 38 hypertensive subjects (54 ⫾ 15 yrs; 58% females) without clinical PAD. Reference data was obtained from 19 healthy volunteers (25.1 ⫾ 1.0 yrs). By ANOVA, all studied variables (Table) were similar when patients with AO-ASO were compared to hypertensive subjects, but parameters differed significantly (p⬍0.0001) when compared to those found in healthy volunteers. We conclude that similarities in non-invasive markers of vascular compliance in the study groups may indicate a potential contribution of severe distal aortic disease to pathogenesis of hypertension (T32-HL07868 and the North Carolina Baptist Hospital). Variable
AO-ASO
Hypertensive
Normal
CPP mm Hg Aug mm Hg AI %
52.5 ⫾ 17.1 17.3 ⫾ 10.4 31.9 ⫾ 13.3
60.4 ⫾ 22.0 19.3 ⫾ 13.6 29.9 ⫾ 13.6
33.7 ⫾ 6.8 ⫺0.7 ⫾ 3.7 ⫺2.3 ⫾ 11.8
C1 mL/mm Hg ⫻ 10
12.6 ⫾ 4.8
10.7 ⫾ 4.4
19.1 ⫾ 5.6
SPHYG
HDI
Key Words: Hypertension, Arterial Compliance, Atherosclerosis
P-112 BORDERLINE HYPERTENSION: EARLY ALTERATIONS OF CAROTID ARTERY MECHANICAL PROPERTIES AND LEFT VENTRICULAR DIASTOLIC DYSFUNCTION. A POSSIBLE RELATIONSHIP? Hugo P. Baglivo, Laura Brandani, Alejandra Christen, Ricardo L. Armentano, Sebastian Graf, Agustin J. Ramirez, Ramiro A. Sanchez. Seccio´ n Hipertensio´ n Arterial, ICYCC, Fund. Favaloro, Buenos Aires, Argentina; Universidad Favaloro, Buenos Aires, Argentina. We sought to compare arterial mechanical variables in borderline hypertensives (BH, 135-139/85-89 mmHg, n⫽29) with those with essential hypertension (EH:⬎135/ 85mmHg, n⫽42) and normotensive subjects (NT: ⬍135/85mmHg, n⫽27), classified according to mean diurnal ambulatory BP values. All subjects were 18 to 50 years old and free from any antihypertensive drug for at least 7 days before the study. Mean age and BMI were not significantly different in any group. Pulse wave velocity (PWV. carotid-femoral) was measured. Effective arterial compliance (EC) was obtained from end-systolic carotid internal diameter and PWV2 calculated according to the Branwell-Hill equation. Peak E and A velocities of transmitral valve flow was measured by Ecodoppler technique. Statistical differences were determined by the ANOVA test, with subsequent Bonferroni analysis. Mean day-time BP was 123.0⫾8.0/77.0⫾5.7 mmHg in NT, 131.0 ⫾5.0/85.0⫾3.9mmHg in BH and 145.0 ⫾9.6/100.0⫾7.8mmHg in EH
71A
(p⫽0.0001). As shown in the table, PWV was significantly higher in BH and EH patients (p⫽0.005). The EC reduction observed in EH was dependent on the BP increase since the isobaric compliance (IC) was similar in all groups. Reflection coefficient (RC) was significantly higher in EH (p⫽0.01) but, when it was associated to PWV, (reflection index, RI) there was a significant difference among the three groups (p⫽0.0001). According to the 95% CI of the normal subjects, the RI was abnormal in 66% of BH and 83% of EH (chi2: 19.09, p⫽0.0001). There was a positive association between PWV and peak A velocity (r⫽0.27, p⫽0.008) and a negative one with either EC (r⫽-0.34, p⫽0.0008) and IC (r⫽-0.29, p⫽0.004), both adjusted by age. Left ventricular mass index and pulse pressure were both normal and not significantly different in the 3 groups studied. It remains to be determined if the left ventricular diastolic dysfunction is a consequence of the altered mechanical vascular behavior and if these alterations are due to functional and/or structural modifications of the carotid wall mechanical properties. Variable
NT
BH
HT
pⴝ
PWV (m/sec) EC (10⫺4 cm/mmHg) IC (10⫺4 cm/mmHg) RC RI (m/sec)
7.79 ⫾ 1.06 6.86 ⫾ 1.99
8.37 ⫾ 1.33 6.11 ⫾ 1.77
9.06 ⫾ 1.96 5.34 ⫾ 2.0
0.005 0.007
5.62 ⫾ 1.77
5.39 ⫾ 1.81
5.26 ⫾ 1.93
ns
0.6 ⫾ 0.09 4.76 ⫾ 0.66
0.64 ⫾ 0.07 5.27 ⫾ 0.74
0.68 ⫾ 0.11 6.11 ⫾ 1.41
0.01 0.001
Key Words: Left Ventricular Diastolic Dysfunction, Borderline Hypertension, Carotid Artery Compliance
P-113 THE INFLUENCE OF QUINAPRIL AND AMLODIPINE ON PULSE WAVE VELOCITY AND COLLAGEN METABOLISM Marek Rajzer, Marek Klocek, Anna Stochmal, M. Nowacka, A. Obloza, A. Slabon. I Cardiac Department, Jagiellonian University Medical College, Cracow, Poland. Aim: to compare the effect of quinapril and amlodipine on blood pressure, arterial compliance and collagen metabolism in mild to moderate hypertensives. Material and Methods: 53 mild to moderate hypertensive patients, 31 women and 22 men (mean age 53.4⫾9.9 yrs.), after 2 weeks washout from previous therapy were randomized to treatment with quinapril 20 mg/d or amlodipine 10 mg/d. Before randomization and after 3 months of therapy the following examinations were performed: 24h ABPM (SpaceLabs 90202), carotid to femoral (PWVF) and carotid to radial (PWVR) pulse wave velocity using Complior device, plasma aldosterone and plasma renin activity (PRA) and the marker of collagen synthesis carboxy- terminal of procollagen type I (PICP). Results: In quinapril group (QUIN) as well as in amlodipine group (AML), after 3 months of therapy decrease in systolic blood pressure (24h-SBP), without significant reduction of diastolic blood pressure (24h-DBP) was observed. In both groups no significant differences were observed in plasma aldosterone, PRA, and PWVF before and after 3 months of therapy. In quinapril group PWVR and PICP decreased significantly after 3 months. Conclusions: The hypotensive effect of quinapril coexists with a reduction of muscular artery stiffness and collagen synthesis. Those effects are independent of plasma RAA system. Parameter
SBP mmHg
p<
PICP mol/l
p<
PWVR m/s
p<
QUIN before Quin after 3 months AML before AML after 3 months
129 ⫾ 15.1 121 ⫾ 11.4
***
276.5 ⫾ 151.1 153.9 ⫾ 29.3
*
10.5 ⫾ 1.7 9.4 ⫾ 1.1
**
127 ⫾ 11.2 119 ⫾ 8.2
**
170.6 ⫾ 115.4 157.5 ⫾ 44.7
NS
9.8 ⫾ 1.6 9.1 ⫾ 1.3
NS
* 0.05, **0.01, ***0.001
Key Words: Pulse Wave Velocity, Collagen Synthesis, Quinapril
POSTERS: Arterial Structure and Compliance
depression, as the care of these patients should be tailered to adress their unique needs. Key Words: Depression, Substance Use, Adherence
P-111 MARKERS OF LARGE-VESSEL COMPLIANCE IN HYPERTENSIVES AND YOUNG ADULTS WITH SEVERE AORTIC ATHEROSCLEROSIS EVALUATED BY NON-INVASIVE METHODS Pavel J. Levy, Karen Sigmon Smith, John Wilkins, Ralph Barnes, Abdelhamed I. Abdelhamed, Ronald D. Smith, Carlos M. Ferrario. Hypertension and Vascular Disease Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States. Young adults (⬍55 yrs) with premature peripheral arterial disease (PAD) have high prevalence of severe distal aortic atherosclerosis (AO-ASO) and hypertension. In this cross-sectional study we used non-invasive monitoring (HDI/Pulse Wave™ CR2000 and radial applanation tonometry/ShygmoCor, PWV Medical™) to evaluate central aortic pulse pressure (CPP), augmentation (Aug), augmentation index (AI) and large artery elasticity (C1) in 16 patients [49 ⫾ 7 yrs (M ⫾ SD); 63% females] with angiographically severe AO-ASO (⬎90% stenosis) and 38 hypertensive subjects (54 ⫾ 15 yrs; 58% females) without clinical PAD. Reference data was obtained from 19 healthy volunteers (25.1 ⫾ 1.0 yrs). By ANOVA, all studied variables (Table) were similar when patients with AO-ASO were compared to hypertensive subjects, but parameters differed significantly (p⬍0.0001) when compared to those found in healthy volunteers. We conclude that similarities in non-invasive markers of vascular compliance in the study groups may indicate a potential contribution of severe distal aortic disease to pathogenesis of hypertension (T32-HL07868 and the North Carolina Baptist Hospital). Variable
AO-ASO
Hypertensive
Normal
CPP mm Hg Aug mm Hg AI %
52.5 ⫾ 17.1 17.3 ⫾ 10.4 31.9 ⫾ 13.3
60.4 ⫾ 22.0 19.3 ⫾ 13.6 29.9 ⫾ 13.6
33.7 ⫾ 6.8 ⫺0.7 ⫾ 3.7 ⫺2.3 ⫾ 11.8
C1 mL/mm Hg ⫻ 10
12.6 ⫾ 4.8
10.7 ⫾ 4.4
19.1 ⫾ 5.6
SPHYG
HDI
Key Words: Hypertension, Arterial Compliance, Atherosclerosis
P-112 BORDERLINE HYPERTENSION: EARLY ALTERATIONS OF CAROTID ARTERY MECHANICAL PROPERTIES AND LEFT VENTRICULAR DIASTOLIC DYSFUNCTION. A POSSIBLE RELATIONSHIP? Hugo P. Baglivo, Laura Brandani, Alejandra Christen, Ricardo L. Armentano, Sebastian Graf, Agustin J. Ramirez, Ramiro A. Sanchez. Seccio´ n Hipertensio´ n Arterial, ICYCC, Fund. Favaloro, Buenos Aires, Argentina; Universidad Favaloro, Buenos Aires, Argentina. We sought to compare arterial mechanical variables in borderline hypertensives (BH, 135-139/85-89 mmHg, n⫽29) with those with essential hypertension (EH:⬎135/ 85mmHg, n⫽42) and normotensive subjects (NT: ⬍135/85mmHg, n⫽27), classified according to mean diurnal ambulatory BP values. All subjects were 18 to 50 years old and free from any antihypertensive drug for at least 7 days before the study. Mean age and BMI were not significantly different in any group. Pulse wave velocity (PWV. carotid-femoral) was measured. Effective arterial compliance (EC) was obtained from end-systolic carotid internal diameter and PWV2 calculated according to the Branwell-Hill equation. Peak E and A velocities of transmitral valve flow was measured by Ecodoppler technique. Statistical differences were determined by the ANOVA test, with subsequent Bonferroni analysis. Mean day-time BP was 123.0⫾8.0/77.0⫾5.7 mmHg in NT, 131.0 ⫾5.0/85.0⫾3.9mmHg in BH and 145.0 ⫾9.6/100.0⫾7.8mmHg in EH
71A
(p⫽0.0001). As shown in the table, PWV was significantly higher in BH and EH patients (p⫽0.005). The EC reduction observed in EH was dependent on the BP increase since the isobaric compliance (IC) was similar in all groups. Reflection coefficient (RC) was significantly higher in EH (p⫽0.01) but, when it was associated to PWV, (reflection index, RI) there was a significant difference among the three groups (p⫽0.0001). According to the 95% CI of the normal subjects, the RI was abnormal in 66% of BH and 83% of EH (chi2: 19.09, p⫽0.0001). There was a positive association between PWV and peak A velocity (r⫽0.27, p⫽0.008) and a negative one with either EC (r⫽-0.34, p⫽0.0008) and IC (r⫽-0.29, p⫽0.004), both adjusted by age. Left ventricular mass index and pulse pressure were both normal and not significantly different in the 3 groups studied. It remains to be determined if the left ventricular diastolic dysfunction is a consequence of the altered mechanical vascular behavior and if these alterations are due to functional and/or structural modifications of the carotid wall mechanical properties. Variable
NT
BH
HT
pⴝ
PWV (m/sec) EC (10⫺4 cm/mmHg) IC (10⫺4 cm/mmHg) RC RI (m/sec)
7.79 ⫾ 1.06 6.86 ⫾ 1.99
8.37 ⫾ 1.33 6.11 ⫾ 1.77
9.06 ⫾ 1.96 5.34 ⫾ 2.0
0.005 0.007
5.62 ⫾ 1.77
5.39 ⫾ 1.81
5.26 ⫾ 1.93
ns
0.6 ⫾ 0.09 4.76 ⫾ 0.66
0.64 ⫾ 0.07 5.27 ⫾ 0.74
0.68 ⫾ 0.11 6.11 ⫾ 1.41
0.01 0.001
Key Words: Left Ventricular Diastolic Dysfunction, Borderline Hypertension, Carotid Artery Compliance
P-113 THE INFLUENCE OF QUINAPRIL AND AMLODIPINE ON PULSE WAVE VELOCITY AND COLLAGEN METABOLISM Marek Rajzer, Marek Klocek, Anna Stochmal, M. Nowacka, A. Obloza, A. Slabon. I Cardiac Department, Jagiellonian University Medical College, Cracow, Poland. Aim: to compare the effect of quinapril and amlodipine on blood pressure, arterial compliance and collagen metabolism in mild to moderate hypertensives. Material and Methods: 53 mild to moderate hypertensive patients, 31 women and 22 men (mean age 53.4⫾9.9 yrs.), after 2 weeks washout from previous therapy were randomized to treatment with quinapril 20 mg/d or amlodipine 10 mg/d. Before randomization and after 3 months of therapy the following examinations were performed: 24h ABPM (SpaceLabs 90202), carotid to femoral (PWVF) and carotid to radial (PWVR) pulse wave velocity using Complior device, plasma aldosterone and plasma renin activity (PRA) and the marker of collagen synthesis carboxy- terminal of procollagen type I (PICP). Results: In quinapril group (QUIN) as well as in amlodipine group (AML), after 3 months of therapy decrease in systolic blood pressure (24h-SBP), without significant reduction of diastolic blood pressure (24h-DBP) was observed. In both groups no significant differences were observed in plasma aldosterone, PRA, and PWVF before and after 3 months of therapy. In quinapril group PWVR and PICP decreased significantly after 3 months. Conclusions: The hypotensive effect of quinapril coexists with a reduction of muscular artery stiffness and collagen synthesis. Those effects are independent of plasma RAA system. Parameter
SBP mmHg
p<
PICP mol/l
p<
PWVR m/s
p<
QUIN before Quin after 3 months AML before AML after 3 months
129 ⫾ 15.1 121 ⫾ 11.4
***
276.5 ⫾ 151.1 153.9 ⫾ 29.3
*
10.5 ⫾ 1.7 9.4 ⫾ 1.1
**
127 ⫾ 11.2 119 ⫾ 8.2
**
170.6 ⫾ 115.4 157.5 ⫾ 44.7
NS
9.8 ⫾ 1.6 9.1 ⫾ 1.3
NS
* 0.05, **0.01, ***0.001
Key Words: Pulse Wave Velocity, Collagen Synthesis, Quinapril