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Exaggerated blood pressure response and arterial stiffness
Abstracts / Journal of the American Society of Hypertension 8(4S) (2014) e35–e43
e38
decreased (P<0.05), but there is no significant decline in 45-year-old group (P¼ 0.078). Conclusion: Hypertensive patients improved arterial function, blood pressure significantly after antihypertensive treatment and standardized management
increase of 4.8% (p<0.001). No major determinants for AS (hypertension, old age, renal insufficiency and diabetes) reach statistical significance. We found AS enhanced and ED in EBPR group (structural and functional vascular impact) and could be, among others, one of the mechanism for increase CV risk in this group.
Table 1 Comparison of blood pressure of each group before and after treatment Index
> 65y 45-65y <45y
SBP
(mmHg)
DBP
(mmHg)
PP
(mmHg)
Before
After
Before
After
Before
After
169.86 10.46 167.47 9.58 157.88 11.98
135.51 6.43 135.26 7.85 134.4 7.42
91.34 11.49 96.75 9.32 97.57 7.01
78.878.17 82.51 7.54 83.02 5.09
78.52 17.87 70.72 13.19 60.31 13.3
56.54 8.9 52.74 8.9 51.39 7.18
Table 2 Comparison of PWV, CAVI, ABI values of each group before and after treatment Index
PWV
After
CAVI
10.74 0.94 9.96 1.00 9.13 0.8
7.49 1.19 6.93 1.15 6.38 0.99
Before >65y 45-65y <45y
11.8 1.09 10.78 1.29 9.77 1.21
After
ABI
7.12 1.04 6.63 1.07 6.05 0.86
1.05 0.12 1.10 0.11 1.14 0.08
Before
Keywords: hypertension; antihypertensive; standardized management; vascular function
After
Before 1.11 0.13 1.15 0.09 1.18 0.07
Keywords: exaggerated blood pressure response; arterial stiffness; exercise; endothelial dysfunction
P-30 P-29 Exaggerated blood pressure response and arterial stiffness Mariano Duarte, Maria Ines Alonso, Manuel Vazquez Blanco, Maria Elena Poyatos, Mariela Arioni, Analia Aquieri, Javier Coyle, Pablo Grosso, Mercedes Ortiz, Claudia Bucay. Hospital de Clinicas UBA, Buenos Aires, Argentina Exaggerated blood pressure response (EBPR) to exercise stress test is often present in hypertensive patients but the clinical significance in normotensive subjects is unclear and poorly studied. We consider that this group may advance to future cardiovascular (CV) complications such as hypertensive crises and target organ damage for no development of vascular buffer mechanism. Pulse wave velocity (PWV) is nowadays the gold standard and the simplest way to asses arterial stiffness (AS) and has been used as a predictive value of aortic stiffness for cardiovascular events. PWV variation pre and post induced ischemia of brachial artery has been validated for evaluate endothelial dysfunction (ED). The purpose of this study was to examine AS and ED in normotensive subjects with EBPR on a graded treadmill test and compared with healthy people free of CV disease, with normal blood pressure response. We tested 40 normotensive patients (51.416.4 years old, 15 males) with EBPR to exercise test and 25 controls. Exercise was performed on a treadmill. For AS we used carotid-femoral PWV (Complior SystemÒ, Artech, France), and PWV variation for ED. All patients were non smokers and were tested at the same morning times with 4 hours without foods or drinks, with 20 minutes previous rest. Baseline characteristics and biochemistry are shown on table 1. All the patients were studied with ambulatory blood pressure monitoring (ABPM) (Spacelabs Health care USA 90217A) for rule out masked hypertension. We observed a PWV of 8.7 1.8 m/s in EBPR and 7.0 0.9 m/s in control group (p<0,01) and a decrease of 8.2% in PWV post induced ischemia for control subjects versus a paradoxical response in EBPR group with an
Predicting the development of resistant hypertension with noninvasive hemodynamic measures Keyona N. King-Medina, Lowell Hedquist, Phillip Levy, Brian Ference, John M. Flack. Wayne State University and the Detroit Medical Center, Detroit, MI, United States There is no proven method to predict the development of resistant hypertension (RH) in adults with uncontrolled hypertension (HTN) who do not meet the RH diagnostic criteria initially. In our clinic more patients satisfy RH criteria during follow-up than do at their initial clinic visit. We previously showed that systemic vascular resistance (SVR) was markedly higher and total arterial compliance index (TACI) was much lower in adults with RH compared to those with hypertension not meeting diagnostic criteria for RH. We examined our HTN clinic database to identify a cohort of adults (N ¼ 160) with systolic and/or diastolic blood pressure (BP) above their JNC goal who also had non-invasive hemodynamic (HD) measurements with the BioZ device at their index visit; two follow-up clinic visits over a period of at least one-hundred and fifty (150) days were also required to determine RH status. RH was defined as BP > JNC 7 goal BP while taking > 3 adequately dosed antihypertensive drugs, one of which is a diuretic or BP < JNC 7 BP goal while taking > 4 adequately does antihypertensive drugs, one of which is a diuretic. Adequate drug dosing was defined as > 50% of the maximum FDA approved daily dose. Receiver operating characteristic (ROC) curves were constructed for SVR and TACI to assess their ability to discriminate between those who did and did not develop RH over follow-up. Areas under the curve (AUC) and optimal threshold (OT) values were determined. Analyses were stratified by diuretic use at the index visit and contrasts were made between the AUC’s of the hemodynamic measures by diuretic treatment status. In all patients the AUC for SVR was 0.68 and the AUC for TACI was 0.65. When analyses were stratified by diuretic use at the index visit, the AUC in diuretic-treated individuals (N ¼59) for SVR was 0.798 (OT ¼ 2279 dyne-sec-cmL5) compared to 0.596 (OT ¼ 1809 dyne-sec-cmL5) in non-diuretic treated individuals (N ¼ 101) (p ¼ 0.06). The contrast of the AUC’s for TACI in diuretic compared to non-
e38
decreased (P<0.05), but there is no significant decline in 45-year-old group (P¼ 0.078). Conclusion: Hypertensive patients improved arterial function, blood pressure significantly after antihypertensive treatment and standardized management
increase of 4.8% (p<0.001). No major determinants for AS (hypertension, old age, renal insufficiency and diabetes) reach statistical significance. We found AS enhanced and ED in EBPR group (structural and functional vascular impact) and could be, among others, one of the mechanism for increase CV risk in this group.
Table 1 Comparison of blood pressure of each group before and after treatment Index
> 65y 45-65y <45y
SBP
(mmHg)
DBP
(mmHg)
PP
(mmHg)
Before
After
Before
After
Before
After
169.86 10.46 167.47 9.58 157.88 11.98
135.51 6.43 135.26 7.85 134.4 7.42
91.34 11.49 96.75 9.32 97.57 7.01
78.878.17 82.51 7.54 83.02 5.09
78.52 17.87 70.72 13.19 60.31 13.3
56.54 8.9 52.74 8.9 51.39 7.18
Table 2 Comparison of PWV, CAVI, ABI values of each group before and after treatment Index
PWV
After
CAVI
10.74 0.94 9.96 1.00 9.13 0.8
7.49 1.19 6.93 1.15 6.38 0.99
Before >65y 45-65y <45y
11.8 1.09 10.78 1.29 9.77 1.21
After
ABI
7.12 1.04 6.63 1.07 6.05 0.86
1.05 0.12 1.10 0.11 1.14 0.08
Before
Keywords: hypertension; antihypertensive; standardized management; vascular function
After
Before 1.11 0.13 1.15 0.09 1.18 0.07
Keywords: exaggerated blood pressure response; arterial stiffness; exercise; endothelial dysfunction
P-30 P-29 Exaggerated blood pressure response and arterial stiffness Mariano Duarte, Maria Ines Alonso, Manuel Vazquez Blanco, Maria Elena Poyatos, Mariela Arioni, Analia Aquieri, Javier Coyle, Pablo Grosso, Mercedes Ortiz, Claudia Bucay. Hospital de Clinicas UBA, Buenos Aires, Argentina Exaggerated blood pressure response (EBPR) to exercise stress test is often present in hypertensive patients but the clinical significance in normotensive subjects is unclear and poorly studied. We consider that this group may advance to future cardiovascular (CV) complications such as hypertensive crises and target organ damage for no development of vascular buffer mechanism. Pulse wave velocity (PWV) is nowadays the gold standard and the simplest way to asses arterial stiffness (AS) and has been used as a predictive value of aortic stiffness for cardiovascular events. PWV variation pre and post induced ischemia of brachial artery has been validated for evaluate endothelial dysfunction (ED). The purpose of this study was to examine AS and ED in normotensive subjects with EBPR on a graded treadmill test and compared with healthy people free of CV disease, with normal blood pressure response. We tested 40 normotensive patients (51.416.4 years old, 15 males) with EBPR to exercise test and 25 controls. Exercise was performed on a treadmill. For AS we used carotid-femoral PWV (Complior SystemÒ, Artech, France), and PWV variation for ED. All patients were non smokers and were tested at the same morning times with 4 hours without foods or drinks, with 20 minutes previous rest. Baseline characteristics and biochemistry are shown on table 1. All the patients were studied with ambulatory blood pressure monitoring (ABPM) (Spacelabs Health care USA 90217A) for rule out masked hypertension. We observed a PWV of 8.7 1.8 m/s in EBPR and 7.0 0.9 m/s in control group (p<0,01) and a decrease of 8.2% in PWV post induced ischemia for control subjects versus a paradoxical response in EBPR group with an
Predicting the development of resistant hypertension with noninvasive hemodynamic measures Keyona N. King-Medina, Lowell Hedquist, Phillip Levy, Brian Ference, John M. Flack. Wayne State University and the Detroit Medical Center, Detroit, MI, United States There is no proven method to predict the development of resistant hypertension (RH) in adults with uncontrolled hypertension (HTN) who do not meet the RH diagnostic criteria initially. In our clinic more patients satisfy RH criteria during follow-up than do at their initial clinic visit. We previously showed that systemic vascular resistance (SVR) was markedly higher and total arterial compliance index (TACI) was much lower in adults with RH compared to those with hypertension not meeting diagnostic criteria for RH. We examined our HTN clinic database to identify a cohort of adults (N ¼ 160) with systolic and/or diastolic blood pressure (BP) above their JNC goal who also had non-invasive hemodynamic (HD) measurements with the BioZ device at their index visit; two follow-up clinic visits over a period of at least one-hundred and fifty (150) days were also required to determine RH status. RH was defined as BP > JNC 7 goal BP while taking > 3 adequately dosed antihypertensive drugs, one of which is a diuretic or BP < JNC 7 BP goal while taking > 4 adequately does antihypertensive drugs, one of which is a diuretic. Adequate drug dosing was defined as > 50% of the maximum FDA approved daily dose. Receiver operating characteristic (ROC) curves were constructed for SVR and TACI to assess their ability to discriminate between those who did and did not develop RH over follow-up. Areas under the curve (AUC) and optimal threshold (OT) values were determined. Analyses were stratified by diuretic use at the index visit and contrasts were made between the AUC’s of the hemodynamic measures by diuretic treatment status. In all patients the AUC for SVR was 0.68 and the AUC for TACI was 0.65. When analyses were stratified by diuretic use at the index visit, the AUC in diuretic-treated individuals (N ¼59) for SVR was 0.798 (OT ¼ 2279 dyne-sec-cmL5) compared to 0.596 (OT ¼ 1809 dyne-sec-cmL5) in non-diuretic treated individuals (N ¼ 101) (p ¼ 0.06). The contrast of the AUC’s for TACI in diuretic compared to non-