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Ethnicity and blood pressure control in patients with diabetes and coronary artery disease
194A
POSTERS: Obesity, Insulin Resistance, Diabetes
P-449 THE SYMPATHETIC NERVOUS SYSTEM ACTIVITY, AS EVALUATED BY ARTERIAL AND POSTEXERCISE VENOUS CATHECOLAMINES, IN OBESE HYPERTENSIVE PATIENTS. RELATIONSHIP WITH LEPTIN LEVES A. F. Sanjuliani, V. Genelhu-Fagundes, S. G. Barroso, M.L. G. Rodrigues, A. V.B. Duarte, R. S.P. Castro, C. A. Bazhuni, E. A. Francischetti. Hypertension Clinic, Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil. We studied a group of 40 obese hypertensive patients (7 males and 33 females, BMI⫽35.7⫾1.1; SBP⫽160.0⫾1.8 mmHg; DBP⫽103.4⫾0.9 mmHg, age 48.7⫾1.5yrs, in order to investigate the possible pathophysiological relationships of the venous and arterial cathecolamines levels to the lipid profile, blood pressure, leptin and insulin concentrations. Patients admitted to the study were on no drug therapy for at least 2 weeks. Leptin and insulin levels were determined by RIA, and cathecolamines by HPLC. Regression analysis was performed to account colinearity among variables. Concentrations of venous and arterial epinephrine (E) were 49.5⫾5.1 and 52.7⫾5.6 pg/dl, respectively, and venous concentration post-exercise was 53.7⫾4.0pg/dl. Venous and arterial concentrations of nor-epinephrine (NE) were 186.7⫾11.9 and 177.8⫾10.4 pg/dl , respectively, and venous concentration post-exercise was 191.7 ⫾11.2pg/dl. Concentrations of insulin and leptin were 26.6⫾3.0 U/ml and 28.9⫾2.4 ng/ml, respectively. Glucose, triglycerides (TG), total cholesterol and HDL levels were 102.0⫾2.84, 161.0⫾13.7, 222.5⫾ 7.6 and 45.5⫾2.1mg/dl, respectively. Venous supine NE was positively correlated to leptin levels (r⫽0.63, p⫽0.02) and to TG (r ⫽0.39, p ⬍ 0.05). Arterial NE concentrations were positively associated to: BMI (r ⫽ 0.35, p ⬍ 0.05); leptin (r ⫽ 0.34, p ⬍0.05); TG (r⫽0.39, p⬍0.03) and to fasting insulin (r⫽0.41, p⫽0.02). Leptin also correlated to fasting insulin (r ⫽ 0.37, p ⬍ 0.04) as well as to BMI (r ⫽ 0.46, p ⫽ 0.003), and each correlation was independent of each other. Fasting insulin was correlated to triglycerides: r ⫽ 0.39, p ⫽ 0.002. In obese hypertensive patients, serum cathecolamines might be an important link among, obesity, insulin, leptin and the derangements of lipid abnormalities.
AJH–April 2002–VOL. 15, NO. 4, PART 2
non-diabetics. Despite the use of ⱖ 2 drugs in ⱖ 76% of diabetic patients and the use of an ACE-I, goal SBP (⬍135) has been achieved in ⬍50% of all ethnicities.
% SBP ⬍ 140 % DBP ⬍ 90 % SBP ⬍ 130 % DBP ⬍ 85 Mean SBP drop (mmHg) Mean DBP drop (mmHg) % receiving trandolapril % receiving 2 strategy drugs % receiving 3 strategy drugs
Blacks
Hispanics
Caucasians
59 80 32 72 13 7 75 29 52
73 91 49 85 17 9 74 40 40
65 94 36 87 16 9 69 36 40
Key Words: Ethnicity, Coronary Artery Disease, Hypertension
P-451 HYPERGLYCAEMIA ALTERS THE ENDOTHEL DEPENDENT VASODILATATION IN THE CANINE CORONARY VASCULAR BED IN VIVO Erzsebet Kocsis, Ildiko Posa, Ferenc Horkay, Zsofia M. Koltai, Gabor Pogatsa. Department of Experimental Cardiology, Gyorgy Gottsegen National Institute of Cardiology, Budapest, Hungary.
P-450 ETHNICITY AND BLOOD PRESSURE CONTROL IN PATIENTS WITH DIABETES AND CORONARY ARTERY DISEASE
Vascular reactivity is known to be altered in diabetes mellitus (DM), however little is known about the direct effect of hyperglycaemia per se in this phenomenon in the coronary arteries in vivo. To address this question we investigated 4 different experimental groups of pentobarbital anesthetized mongrel dogs of either sex. DM (n⫽6) was generated by a single iv injection of alloxan (560 micromol/kg) three weeks prior to the acute experiments, another group of DM dogs (ITDM, n⫽5) were treated with insulin (0.5-1.0 IU/kg/day), acute regional hyperglycaemia (HG, n⫽6) was induced by infusing glucose (25 mmol/l) into the left anterior descending coronary artery (LAD), finally healthy control dogs (n⫽5) were investigated. Coronary vascular reactivity was tested by infusing acetilcholine (ACh, 2.25-36 pmol/kg/min) into the LAD. Coronary blood flow (CBF) was measured by an electromagnetic flow probe. ACh induced a dose dependent rise in CBF in all groups. Comparison of the dose response curves revealed that ACh vasodilation is smaller in both the DM and HG groups (p⬍0.05)as compared to control dogs. When DM dogs were kept normoglycaemic with insulin treatment, the endothel dependent vasodilation was similar to those of the healthy dogs. We conclude that hyperglycaemia alone is partly responsible for the altered vascular reactivity in the coronary circulation in vivo in dogs. The effect of chronic (DM) and acute (HG) hyperglycaemia is similar in this respect. The mechanism of this in vivo phenomenon needs further investigations.
Rhonda M. Cooper-DeHoff, Eileen M. Handberg, Heather A. Bristol, Carl J. Pepine, the INVEST Investigators. Cardiovascular Medicine, University of Florida, Gainesville, Florida, United States.
Key Words: Endothel Dependent Vasodilatation, Hyperglycaemia, Coronary Circulation
Key Words: Sympathetic Nervous Activity, Leptin, Insulin Resistance
Objective: To characterize BP control in a population of racially diverse hypertensive diabetic patients with CAD. Methods: An analysis of 6,231 diabetic CAD patients enrolled in the INternational VErapamil/trandolapril STudy (INVEST) was undertaken. INVEST compares strategies containing either verapamil SR or atenolol and/or trandolapril and HCTZ, relative to BP control (JNC VI goal of ⬍130/⬍85 mmHg in diabetics) and adverse outcomes. Results: Demographics of this cohort exhibit an elderly, female, obese population (73% ⬎ 60yo, 54% female, 47% BMI ⬎ 30). Coronary artery disease is documented by prior MI or abnormal angiogram (55%), prior revascularization (31%) and angina (67%). Sixteen percent are Black, 40% are Hispanic and 44% are Caucasian. BP and prescribing data in diabetic patients treated for 12 months are described in the Table. Conclusion: BP control in diabetics with CAD, according to JNC VI guidelines, is difficult to achieve in Blacks, Hispanics, and Caucasians. However SBP ⬍ 140 and DBP ⬍ 90 are achieved in a majority of the diabetics, and these percentages do not differ significantly from the
P-452 EFFECTS OF GLUCOSE METABOLISM ON THE RELATION OF PLASMA HOMOCYSTEINE TO AORTIC ROOT FUNCTION IN ESSENTIAL HYPERTENSION Gregory P. Vyssoulis, Eva A. Karpanou, Athina N. Arapogianni, Dionysios A. Belegrinos, G. P. Tasios, Marina A. Toutouza, D. V. Cokkinos, P. K. Toutouzas. Cardiology Department, Athens University, Athens, Greece. Elevated plasma homocysteine levels (HOM) have been proposed as an independent cardiovascular risk factor. The relationship with other cardiovascular parameters, in particular with aortic root function indices has not been investigated. The study comprised 1000 consecutive untreated patients with uncomplicated essential hypertension. Diabetes mellitus (DM) was documented
POSTERS: Obesity, Insulin Resistance, Diabetes
P-449 THE SYMPATHETIC NERVOUS SYSTEM ACTIVITY, AS EVALUATED BY ARTERIAL AND POSTEXERCISE VENOUS CATHECOLAMINES, IN OBESE HYPERTENSIVE PATIENTS. RELATIONSHIP WITH LEPTIN LEVES A. F. Sanjuliani, V. Genelhu-Fagundes, S. G. Barroso, M.L. G. Rodrigues, A. V.B. Duarte, R. S.P. Castro, C. A. Bazhuni, E. A. Francischetti. Hypertension Clinic, Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil. We studied a group of 40 obese hypertensive patients (7 males and 33 females, BMI⫽35.7⫾1.1; SBP⫽160.0⫾1.8 mmHg; DBP⫽103.4⫾0.9 mmHg, age 48.7⫾1.5yrs, in order to investigate the possible pathophysiological relationships of the venous and arterial cathecolamines levels to the lipid profile, blood pressure, leptin and insulin concentrations. Patients admitted to the study were on no drug therapy for at least 2 weeks. Leptin and insulin levels were determined by RIA, and cathecolamines by HPLC. Regression analysis was performed to account colinearity among variables. Concentrations of venous and arterial epinephrine (E) were 49.5⫾5.1 and 52.7⫾5.6 pg/dl, respectively, and venous concentration post-exercise was 53.7⫾4.0pg/dl. Venous and arterial concentrations of nor-epinephrine (NE) were 186.7⫾11.9 and 177.8⫾10.4 pg/dl , respectively, and venous concentration post-exercise was 191.7 ⫾11.2pg/dl. Concentrations of insulin and leptin were 26.6⫾3.0 U/ml and 28.9⫾2.4 ng/ml, respectively. Glucose, triglycerides (TG), total cholesterol and HDL levels were 102.0⫾2.84, 161.0⫾13.7, 222.5⫾ 7.6 and 45.5⫾2.1mg/dl, respectively. Venous supine NE was positively correlated to leptin levels (r⫽0.63, p⫽0.02) and to TG (r ⫽0.39, p ⬍ 0.05). Arterial NE concentrations were positively associated to: BMI (r ⫽ 0.35, p ⬍ 0.05); leptin (r ⫽ 0.34, p ⬍0.05); TG (r⫽0.39, p⬍0.03) and to fasting insulin (r⫽0.41, p⫽0.02). Leptin also correlated to fasting insulin (r ⫽ 0.37, p ⬍ 0.04) as well as to BMI (r ⫽ 0.46, p ⫽ 0.003), and each correlation was independent of each other. Fasting insulin was correlated to triglycerides: r ⫽ 0.39, p ⫽ 0.002. In obese hypertensive patients, serum cathecolamines might be an important link among, obesity, insulin, leptin and the derangements of lipid abnormalities.
AJH–April 2002–VOL. 15, NO. 4, PART 2
non-diabetics. Despite the use of ⱖ 2 drugs in ⱖ 76% of diabetic patients and the use of an ACE-I, goal SBP (⬍135) has been achieved in ⬍50% of all ethnicities.
% SBP ⬍ 140 % DBP ⬍ 90 % SBP ⬍ 130 % DBP ⬍ 85 Mean SBP drop (mmHg) Mean DBP drop (mmHg) % receiving trandolapril % receiving 2 strategy drugs % receiving 3 strategy drugs
Blacks
Hispanics
Caucasians
59 80 32 72 13 7 75 29 52
73 91 49 85 17 9 74 40 40
65 94 36 87 16 9 69 36 40
Key Words: Ethnicity, Coronary Artery Disease, Hypertension
P-451 HYPERGLYCAEMIA ALTERS THE ENDOTHEL DEPENDENT VASODILATATION IN THE CANINE CORONARY VASCULAR BED IN VIVO Erzsebet Kocsis, Ildiko Posa, Ferenc Horkay, Zsofia M. Koltai, Gabor Pogatsa. Department of Experimental Cardiology, Gyorgy Gottsegen National Institute of Cardiology, Budapest, Hungary.
P-450 ETHNICITY AND BLOOD PRESSURE CONTROL IN PATIENTS WITH DIABETES AND CORONARY ARTERY DISEASE
Vascular reactivity is known to be altered in diabetes mellitus (DM), however little is known about the direct effect of hyperglycaemia per se in this phenomenon in the coronary arteries in vivo. To address this question we investigated 4 different experimental groups of pentobarbital anesthetized mongrel dogs of either sex. DM (n⫽6) was generated by a single iv injection of alloxan (560 micromol/kg) three weeks prior to the acute experiments, another group of DM dogs (ITDM, n⫽5) were treated with insulin (0.5-1.0 IU/kg/day), acute regional hyperglycaemia (HG, n⫽6) was induced by infusing glucose (25 mmol/l) into the left anterior descending coronary artery (LAD), finally healthy control dogs (n⫽5) were investigated. Coronary vascular reactivity was tested by infusing acetilcholine (ACh, 2.25-36 pmol/kg/min) into the LAD. Coronary blood flow (CBF) was measured by an electromagnetic flow probe. ACh induced a dose dependent rise in CBF in all groups. Comparison of the dose response curves revealed that ACh vasodilation is smaller in both the DM and HG groups (p⬍0.05)as compared to control dogs. When DM dogs were kept normoglycaemic with insulin treatment, the endothel dependent vasodilation was similar to those of the healthy dogs. We conclude that hyperglycaemia alone is partly responsible for the altered vascular reactivity in the coronary circulation in vivo in dogs. The effect of chronic (DM) and acute (HG) hyperglycaemia is similar in this respect. The mechanism of this in vivo phenomenon needs further investigations.
Rhonda M. Cooper-DeHoff, Eileen M. Handberg, Heather A. Bristol, Carl J. Pepine, the INVEST Investigators. Cardiovascular Medicine, University of Florida, Gainesville, Florida, United States.
Key Words: Endothel Dependent Vasodilatation, Hyperglycaemia, Coronary Circulation
Key Words: Sympathetic Nervous Activity, Leptin, Insulin Resistance
Objective: To characterize BP control in a population of racially diverse hypertensive diabetic patients with CAD. Methods: An analysis of 6,231 diabetic CAD patients enrolled in the INternational VErapamil/trandolapril STudy (INVEST) was undertaken. INVEST compares strategies containing either verapamil SR or atenolol and/or trandolapril and HCTZ, relative to BP control (JNC VI goal of ⬍130/⬍85 mmHg in diabetics) and adverse outcomes. Results: Demographics of this cohort exhibit an elderly, female, obese population (73% ⬎ 60yo, 54% female, 47% BMI ⬎ 30). Coronary artery disease is documented by prior MI or abnormal angiogram (55%), prior revascularization (31%) and angina (67%). Sixteen percent are Black, 40% are Hispanic and 44% are Caucasian. BP and prescribing data in diabetic patients treated for 12 months are described in the Table. Conclusion: BP control in diabetics with CAD, according to JNC VI guidelines, is difficult to achieve in Blacks, Hispanics, and Caucasians. However SBP ⬍ 140 and DBP ⬍ 90 are achieved in a majority of the diabetics, and these percentages do not differ significantly from the
P-452 EFFECTS OF GLUCOSE METABOLISM ON THE RELATION OF PLASMA HOMOCYSTEINE TO AORTIC ROOT FUNCTION IN ESSENTIAL HYPERTENSION Gregory P. Vyssoulis, Eva A. Karpanou, Athina N. Arapogianni, Dionysios A. Belegrinos, G. P. Tasios, Marina A. Toutouza, D. V. Cokkinos, P. K. Toutouzas. Cardiology Department, Athens University, Athens, Greece. Elevated plasma homocysteine levels (HOM) have been proposed as an independent cardiovascular risk factor. The relationship with other cardiovascular parameters, in particular with aortic root function indices has not been investigated. The study comprised 1000 consecutive untreated patients with uncomplicated essential hypertension. Diabetes mellitus (DM) was documented