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Effect of naproxen and celecoxib on left ventricular diastolic function and arterial compliance in older hypertensives with osteoarthritis
126A
POSTERS: Arterial Structure and Compliance
P-256 IMPACT OF ACUTE MAXIMAL EXERCISE ON LEFT VENTRICULAR DIASTOLIC FUNCTION AND ARTERIAL COMPLIANCE IN OLDER HYPERTENSIVES Kunihiko Aizawa, Pooja Sahasrabudhe, Robert Petrella. School of Kinesiology, The University of Western Ontario, London, ON, Canada. Impaired left ventricular diastolic function (LVDF) and arterial compliance (AC) are seen with aging and hypertension and can lead to impaired exercise (EX) responses. EX training improves age-related cardiac impairment and is a treatment for hypertension; however, impact of a maximal exercise session on LVDF and AC in older hypertensives and subsequent training effects are unclear. The purpose of this study was to evaluate the impact of maximal EX session on LVDF and AC. Eight older hypertensive subjects (1 M and 7 F, 68.5⫾5.7 yrs) participated in the study. Measures of LVDF (early filling flow velocity (E), late filling flow velocity (A), E/A ratio, isovolumic relaxation time (IVRT) and deceleration time (DT)) and arterial compliance (C) in carotid and brachial arteries were assessed using a 2D echocardiography at rest before, immediately after and 24 hours after maximal treadmill EX. E and A flow velocities increased after the EX and returned to baseline values 24 hours after the EX (p⬍0.05). Similar responses in IVRT and DT were observed immediately after the EX; however, these indices remained faster 24 hours later (p⬍0.05). C in carotid and brachial arteries was unaltered throughout the study. In older hypertensives, impaired AC was compensated by the improved LVDF with a maximal EX session. Continued impairment of AC may lead to chronic changes in LVDF, leading to impaired compensation of LV function and EX responses. Whether chronic EX training and blood pressure lowering alter this relationship is subject to further research. Supported by A.M Anderson Award, Lawson Health Research Institute.
Baseline
After EX.
24 hours After EX.
E (m/s) 0.68 ⫾ 0.12 0.90 ⫾ 0.20* 0.68 ⫾ 0.13‡ A (m/s) 0.83 ⫾ 0.17 0.97 ⫾ 0.11* 0.89 ⫾ 0.17 E/A 0.80 ⫾ 0.22 0.95 ⫾ 0.25 0.79 ⫾ 0.22 IVRT (msec) 93.5 ⫾ 9.4 56.9 ⫾ 12.6* 81.8 ⫾ 2.7†‡ DT (msec) 284.2 ⫾ 55.9 215.7 ⫾ 29.4* 243.8 ⫾ 50.0† 0.70 ⫾ 0.32 0.64 ⫾ 0.21 0.78 ⫾ 0.37 C (Carotid) (cm2/mmHg⫻10⫺3) 2 ⫺3 0.16 ⫾ 0.09 C (Brachial) (cm /mmHg⫻10 ) 0.19 ⫾ 0.05 0.21 ⫾ 0.06 * p ⬍ 0.05 vs Baseline. † p ⬍ 0.05 vs Baseline. ‡ p ⬍ 0.05 vs After EX.
Key Words: Arterial Compliance, Acute Maximal Exercise, Older Hypertensives
P-257 LEFT VENTRICULAR DIASTOLIC FUNCTION AND ARTERIAL COMPLIANCE IN OLDER HYPERTENSIVES: 8 WEEK AEROBIC EXERCISE TRAINING STUDY Kunihiko Aizawa, Pooja Sahasrabudhe, Robert Petrella. School of Kinesiology, The University of Western Ontario, London, ON, Canada. Impaired left ventricular diastolic function (LVDF) and arterial compliance (AC) may be subtle, early indices of vascular dysfunction with aging and hypertension. Impaired LVDF and AC may lead to impaired exercise performance in those at risk who engage in therapeutic exercise training; while exercise testing may “unmask” impaired LVDF and AC among those starting such training programs and be used as a marker of risk improvement in addition to blood pressure lowering. The purpose of this study was to evaluate the effect of aerobic exercise on LVDF and AC in older hypertensive patients prior to starting and following an 8 week exercise training program. Eight subjects participated in the study. Mea0895-7061/04/$30.00
AJH–May 2004 –VOL. 17, NO. 5, PART 2
sures of LVDF (early filling flow velocity (E), late filling flow velocity (A), E/A ratio, isovolumic relaxation time (IVRT) and deceleration time (DT)) and AC (compliance (C) and distensibility (D) in carotid and brachial arteries) were assessed using a 2D echocardiography at rest before and following an 8 week exercise training program. LVDF indices (E, A, E/A, IVRT and DT) remained unaltered throughout the study (0.68⫾.13 vs 0.68⫾.15m/s, 0.82⫾.19 vs 0.89⫾.16m/s, 0.81⫾.24 vs 0.76⫾.05, 92.6⫾1.0 vs 86.9⫾7.6msec and 288.9⫾59.6 vs 279.7⫾75.1msec, respectively). None of AC indices (C and D) in carotid artery changed during the exercise program (0.70⫾.12 vs 0.77⫾.08 cm2/mmHgx10-3, 0.18⫾.02 vs 0.24⫾.03 1/mmHgx10-2, respectively); however, AC indices (C and D) in brachial artery changed significantly following the exercise program (0.20⫾.02 vs 0.29⫾.05 cm2/mmHgx10-3, 0.18⫾.02 vs 0.22⫾.02 1/mmHgx10-2, p⬍.05, respectively). In conclusion, these data suggest that in older hypertensives 8 week exercise training significantly improves the peripheral (brachial artery) artery compliance whereas no improvement in more “central” (left ventricle and carotid artery) artery compliance. Supported by A.M Anderson Award, Lawson Health Research Institute. Key Words: Arterial Compliance, Aerobic Exercise, Older Hypertensives
P-258 EFFECT OF NAPROXEN AND CELECOXIB ON LEFT VENTRICULAR DIASTOLIC FUNCTION AND ARTERIAL COMPLIANCE IN OLDER HYPERTENSIVES WITH OSTEOARTHRITIS Pooja Sahasrabudhe, Kunihiko Aizawa, Robert Petrella. School of Kinesiology, The University of Western Ontario, London, ON, Canada. Osteoarthritis and hypertension are the most prevalent medical conditions associated with aging. COX-2 selective inhibitors have been shown effective in the treatment of osteoarthritis with less GI (COX-1) related effects compared to conventional NSAIDs. Whether these differences could also impact on cardiovascular functioning and concomitant hypertension is unclear. The purpose of this study was to evaluate the effect of a 16 week treatment of either a COX-1 selective inhibitor (naproxen) or a COX-2 selective inhibitor (celecoxib) on left ventricular diastolic function (LVDF) and arterial compliance in older hypertensives with OA. Fifteen older hypertensives with OA have participated in the preliminary analysis of the study cohort. Seven subjects were randomized to naproxen (NG) (500mg/d) and 8 subjects were randomized to celecoxib (CG) (200mg/d). Before, 4 weeks and 16 weeks after the randomization, measures of LVDF (early filling flow velocity (E), late filling flow velocity (A), E/A ratio, isovolumic relaxation time (IVRT) and deceleration time (DT)) and arterial compliance using VingMed-5 cardiac imaging system, blood pressure, and exercise capacity (VO2max) determined by exercise treadmill test were assessed at rest. 24h ambulatory blood pressure (BP) was also recorded using a Spacelabs ABPM. At baseline, there were no significant differences in subject’s characteristics, clinic BP, LVDF indices, arterial compliance, VO2max and 24h BP indices between the groups. At 4 week, percentages of SBP above 140mmHg and of DBP above 90mmHg in 24h BP were significantly lower in CG than those in NG (35.8⫾7.5 vs 81.5⫾12.3 %, 9.9⫾4.0 vs 53.4⫾6.5 %, p⬍.05, respectively) and the latter index tended to be lower in CG than in NG at 16 week. Within each group and between the groups, no changes were observed in LVDF indices, arterial compliance, VO2max and mean 24h SBP/DBP throughout the study. In conclusion, these preliminary data suggest that a COX-2 selective inhibitor may be preferable in terms of 24h blood pressure control to older hypertensives with osteoarthritis. Supported by Pharmacia Canada. Key Words: Left Ventricular Diastolic Function, Arterial Compliance, Osteoarthritis © 2004 by the American Journal of Hypertension, Ltd. Published by Elsevier Inc.
POSTERS: Arterial Structure and Compliance
P-256 IMPACT OF ACUTE MAXIMAL EXERCISE ON LEFT VENTRICULAR DIASTOLIC FUNCTION AND ARTERIAL COMPLIANCE IN OLDER HYPERTENSIVES Kunihiko Aizawa, Pooja Sahasrabudhe, Robert Petrella. School of Kinesiology, The University of Western Ontario, London, ON, Canada. Impaired left ventricular diastolic function (LVDF) and arterial compliance (AC) are seen with aging and hypertension and can lead to impaired exercise (EX) responses. EX training improves age-related cardiac impairment and is a treatment for hypertension; however, impact of a maximal exercise session on LVDF and AC in older hypertensives and subsequent training effects are unclear. The purpose of this study was to evaluate the impact of maximal EX session on LVDF and AC. Eight older hypertensive subjects (1 M and 7 F, 68.5⫾5.7 yrs) participated in the study. Measures of LVDF (early filling flow velocity (E), late filling flow velocity (A), E/A ratio, isovolumic relaxation time (IVRT) and deceleration time (DT)) and arterial compliance (C) in carotid and brachial arteries were assessed using a 2D echocardiography at rest before, immediately after and 24 hours after maximal treadmill EX. E and A flow velocities increased after the EX and returned to baseline values 24 hours after the EX (p⬍0.05). Similar responses in IVRT and DT were observed immediately after the EX; however, these indices remained faster 24 hours later (p⬍0.05). C in carotid and brachial arteries was unaltered throughout the study. In older hypertensives, impaired AC was compensated by the improved LVDF with a maximal EX session. Continued impairment of AC may lead to chronic changes in LVDF, leading to impaired compensation of LV function and EX responses. Whether chronic EX training and blood pressure lowering alter this relationship is subject to further research. Supported by A.M Anderson Award, Lawson Health Research Institute.
Baseline
After EX.
24 hours After EX.
E (m/s) 0.68 ⫾ 0.12 0.90 ⫾ 0.20* 0.68 ⫾ 0.13‡ A (m/s) 0.83 ⫾ 0.17 0.97 ⫾ 0.11* 0.89 ⫾ 0.17 E/A 0.80 ⫾ 0.22 0.95 ⫾ 0.25 0.79 ⫾ 0.22 IVRT (msec) 93.5 ⫾ 9.4 56.9 ⫾ 12.6* 81.8 ⫾ 2.7†‡ DT (msec) 284.2 ⫾ 55.9 215.7 ⫾ 29.4* 243.8 ⫾ 50.0† 0.70 ⫾ 0.32 0.64 ⫾ 0.21 0.78 ⫾ 0.37 C (Carotid) (cm2/mmHg⫻10⫺3) 2 ⫺3 0.16 ⫾ 0.09 C (Brachial) (cm /mmHg⫻10 ) 0.19 ⫾ 0.05 0.21 ⫾ 0.06 * p ⬍ 0.05 vs Baseline. † p ⬍ 0.05 vs Baseline. ‡ p ⬍ 0.05 vs After EX.
Key Words: Arterial Compliance, Acute Maximal Exercise, Older Hypertensives
P-257 LEFT VENTRICULAR DIASTOLIC FUNCTION AND ARTERIAL COMPLIANCE IN OLDER HYPERTENSIVES: 8 WEEK AEROBIC EXERCISE TRAINING STUDY Kunihiko Aizawa, Pooja Sahasrabudhe, Robert Petrella. School of Kinesiology, The University of Western Ontario, London, ON, Canada. Impaired left ventricular diastolic function (LVDF) and arterial compliance (AC) may be subtle, early indices of vascular dysfunction with aging and hypertension. Impaired LVDF and AC may lead to impaired exercise performance in those at risk who engage in therapeutic exercise training; while exercise testing may “unmask” impaired LVDF and AC among those starting such training programs and be used as a marker of risk improvement in addition to blood pressure lowering. The purpose of this study was to evaluate the effect of aerobic exercise on LVDF and AC in older hypertensive patients prior to starting and following an 8 week exercise training program. Eight subjects participated in the study. Mea0895-7061/04/$30.00
AJH–May 2004 –VOL. 17, NO. 5, PART 2
sures of LVDF (early filling flow velocity (E), late filling flow velocity (A), E/A ratio, isovolumic relaxation time (IVRT) and deceleration time (DT)) and AC (compliance (C) and distensibility (D) in carotid and brachial arteries) were assessed using a 2D echocardiography at rest before and following an 8 week exercise training program. LVDF indices (E, A, E/A, IVRT and DT) remained unaltered throughout the study (0.68⫾.13 vs 0.68⫾.15m/s, 0.82⫾.19 vs 0.89⫾.16m/s, 0.81⫾.24 vs 0.76⫾.05, 92.6⫾1.0 vs 86.9⫾7.6msec and 288.9⫾59.6 vs 279.7⫾75.1msec, respectively). None of AC indices (C and D) in carotid artery changed during the exercise program (0.70⫾.12 vs 0.77⫾.08 cm2/mmHgx10-3, 0.18⫾.02 vs 0.24⫾.03 1/mmHgx10-2, respectively); however, AC indices (C and D) in brachial artery changed significantly following the exercise program (0.20⫾.02 vs 0.29⫾.05 cm2/mmHgx10-3, 0.18⫾.02 vs 0.22⫾.02 1/mmHgx10-2, p⬍.05, respectively). In conclusion, these data suggest that in older hypertensives 8 week exercise training significantly improves the peripheral (brachial artery) artery compliance whereas no improvement in more “central” (left ventricle and carotid artery) artery compliance. Supported by A.M Anderson Award, Lawson Health Research Institute. Key Words: Arterial Compliance, Aerobic Exercise, Older Hypertensives
P-258 EFFECT OF NAPROXEN AND CELECOXIB ON LEFT VENTRICULAR DIASTOLIC FUNCTION AND ARTERIAL COMPLIANCE IN OLDER HYPERTENSIVES WITH OSTEOARTHRITIS Pooja Sahasrabudhe, Kunihiko Aizawa, Robert Petrella. School of Kinesiology, The University of Western Ontario, London, ON, Canada. Osteoarthritis and hypertension are the most prevalent medical conditions associated with aging. COX-2 selective inhibitors have been shown effective in the treatment of osteoarthritis with less GI (COX-1) related effects compared to conventional NSAIDs. Whether these differences could also impact on cardiovascular functioning and concomitant hypertension is unclear. The purpose of this study was to evaluate the effect of a 16 week treatment of either a COX-1 selective inhibitor (naproxen) or a COX-2 selective inhibitor (celecoxib) on left ventricular diastolic function (LVDF) and arterial compliance in older hypertensives with OA. Fifteen older hypertensives with OA have participated in the preliminary analysis of the study cohort. Seven subjects were randomized to naproxen (NG) (500mg/d) and 8 subjects were randomized to celecoxib (CG) (200mg/d). Before, 4 weeks and 16 weeks after the randomization, measures of LVDF (early filling flow velocity (E), late filling flow velocity (A), E/A ratio, isovolumic relaxation time (IVRT) and deceleration time (DT)) and arterial compliance using VingMed-5 cardiac imaging system, blood pressure, and exercise capacity (VO2max) determined by exercise treadmill test were assessed at rest. 24h ambulatory blood pressure (BP) was also recorded using a Spacelabs ABPM. At baseline, there were no significant differences in subject’s characteristics, clinic BP, LVDF indices, arterial compliance, VO2max and 24h BP indices between the groups. At 4 week, percentages of SBP above 140mmHg and of DBP above 90mmHg in 24h BP were significantly lower in CG than those in NG (35.8⫾7.5 vs 81.5⫾12.3 %, 9.9⫾4.0 vs 53.4⫾6.5 %, p⬍.05, respectively) and the latter index tended to be lower in CG than in NG at 16 week. Within each group and between the groups, no changes were observed in LVDF indices, arterial compliance, VO2max and mean 24h SBP/DBP throughout the study. In conclusion, these preliminary data suggest that a COX-2 selective inhibitor may be preferable in terms of 24h blood pressure control to older hypertensives with osteoarthritis. Supported by Pharmacia Canada. Key Words: Left Ventricular Diastolic Function, Arterial Compliance, Osteoarthritis © 2004 by the American Journal of Hypertension, Ltd. Published by Elsevier Inc.