- Email: [email protected]
Hemodynamic determinants of carotid artery structure in essential hypertension
AJH–May 2004 –VOL. 17, NO. 5, PART 2
POSTERS: Arterial Structure and Compliance
valvulopathy, smoking habit, excess alcool intake, renal failure and epatic failure. Patients, who performed blood pressure self monitoring with an automatic digital device validated with a solid state memory (AND®), underwent an ambulatory blood pressure monitoring (ABPM) and a tonometry applanation at baseline and after six months. In 24 patients the ABPM blood pressure values were significantly higher, over the normal range (136/86⫾ 2/6 mmHg) while in 21 patients were in normal range (125/79⫾ 3/2 mmHg). 22 patients were hypertensive at the self monitoring (138/88⫾ 5/3 mmHg) while 23 were normotensive (131/82⫾ 4/3 mmHg). In 22 hypertensives (both at the ABPM and at SBPM) the tonometry applanation has shown a reduction of the arterial compliance both for large (C1: 16.3⫾1.4 ml/mmHgx10) and small arteries (C2: 4.3⫾1.2 ml/mmHgx100), high arterial resistance (1535⫾72 dinexsecxcm-5) and systemic vascular impedance (98⫾13 dinexsecxcm-5). In 21 isolated clinic hypertensive (normotensives at the ABPM and at the SBPM) C1 was 16.9⫾0.7ml/mmHgx10 and C2 was 4.5⫾1.3ml/mmHgx100, arterial resistance was 1502⫾65 dinexsecxcm-5 and systemic vascular impedance was 97⫾13 dinexsecxcm-5 . 45 normotensives subjects (C1: 19.2⫾1.4 mlxmmHgx10, C2: 5.4⫾1.3 ml/ mmHgx100, RVS: 1358⫾ 86, IVS : 77⫾13dinexsecxcm-5). The decrease of the arterial compliance in patients with isolated clinical hypertension was demonstrated in our study, confirming that this “reactive” form of hypertension couldn’t be underestimated. Key Words: Self Monitoring, ABPM, Tonometry Applanation
P-271 HYPERTENSION AND AORTIC CALCIFICATION IN A RETIRED WORKER COHORT Amanda R Harmon, Dan T Lackland, Brent Egan, David Hoel, James Thomas, Joyce Nicholas, Stuart Lipsitz. Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston, SC; General Internal Medicince/ Hypertension, Medical University of South Carolina, Charleston, SC; General Internal Medicine, Medical University of South Carolina, Charleston, SC. Aortic calcification is an emerging risk factor in the assessment of cardiovascular disease. However, information regarding this measure is less evident out of research study cohorts. A retired worker cohort of 1589 individuals was assessed with a physical examination and chest x-ray. X-rays were evaluated by a team of radiologists. Hypertension was defined as a BP measurement ⱖ 140/90 mmHg or the participant’s report of being told they have high blood pressure. Presence of aortic calcification was determined based upon the chest x-ray results. The BP measurement and chest radiograph results were entered into a Microsoft Access database and analyzed using SAS for Windows V8. A Chi-Square test was performed on the results testing the significance of the association between aortic calcification and hypertension among these retired workers. The results reveal a 55.3% prevalence of hypertension and 15.7% with aortic calcification of the 1,589 participants. A two-by-two frequency table showed that 10.4% of participants have both hypertension and aortic calcification. The Chi-Square test results were statistically significant with a p-value ⬍ .0001. These results identified a significant association of aortic calcification and hypertension suggesting the effects of multiple risk factors, and also identifying this simple measure as a potential valuable resource in the diagnosis of disease progression. Evidence of Aortic Calcification Hypertensive Not Hypertensive
Positive
Negative
165 (10.4%) 84 (5.3%)
713 (44.9%) 627 (39.5%)
Key Words: Hypertension, Aortic Calcification, Worker Cohort
131A
P-272 A NOVEL ARTERIAL STIFFNESS INDEX (ASI) AS A MARKER OF ARTERIOSCLEROSIS Kunihide Hiramatsu, Ako Oiwa, Satoshi Shigematsu, Minoru Nagai, Masafumi Katakura, Toru Aizawa, Kiyoshi Hashizume. Department of Aging Medicine and Geriatrics, Shinshu University Graduate School of Medicine, Matsumoto, Nagano, Japan. BACKGROUND: Arterial Stiffness Index (ASI) is a novel quantitative estimate directly calculated from the relation between transmural pressure and arterial volumetric change. Functional changes in arterial stiffness have been investigated by pulse wave velocity (PWV). However, these measures have limitations for clinical application because of their dependence on arterial pressure. In the present study, to test the ability for ASI to act as a marker of arteriosclerosis, we determined and compared the distensibility of brachial artery in normotensive non-diabetic subjects with those in subjects with hypertension(HT) and/or diabetes mellitus(DM). METHODS: Data of 231 subjects were analyzed: men/women 111/ 120, the mean age 67 yrs, and BP 136 /78 mmHg. One hundred and thirty-four (61%) patients were hypertensive and were receiving antihypertensive drugs. Seventy-five (32%) patients were diabetic and were receiving oral hypoglycemic agents and/or insulin. ASI was obtained directly through computerized oscillometry (CardioVision, IMDP, Inc.). CardioVision utilizes the Oscillometric method of blood pressure measurement and generates information on the elasticity or flexibility of the brachial artery. To identify the variables correlated with ASI and PWV, multiple regression analysis was used. RESULTS: ASI was correlated with pulse pressure (PP) (beta⫽.579, p⬍.0001), mean blood pressure (MBP) (beta⫽-.208, p⬍.01), and the presence of HT (beta⫽.147, p⬍.03). PWV was correlated with MBP (beta⫽.460, p⬍.0001), age (beta⫽.334, p⬍.0001), body mass index (BMI) (beta⫽-.300, p⬍.0001) and PP (beta⫽.146, p⬍.05). ASI and PWV significantly increased with age. When ASI and PWV were plotted as a function of age, the regression line was significantly steeper in HT group than in non-HT group only for ASI. ASI was significantly higher in diabetic subjects than in non-diabetic subjects (mean ⫹/- SE ; 102 ⫹/⫺ 8 vs. 134 ⫹/⫺ 13, p⬍0.05). ASI was significantly higher in subjects with both HT and DM than in subjects with HT or DM (mean ⫹/- SE ; 153 ⫹/⫺ 16 vs. 114 ⫹/⫺ 11, p⬍0.05). CONCLUSIONS: Acceleration of age-related increase in arterial stiffness in subjects with hypertension was detectable by ASI, but not by PWV. Furthermore, HT-related arterial stiffness was enhanced in subjects with diabetes mellitus. Thus ASI provides reliable a quantitative measure of arterial stiffness. Key Words: Arterial Stiffness, Arterial Stiffness Index, Arteriosclerosis
P-273 HEMODYNAMIC DETERMINANTS OF CAROTID ARTERY STRUCTURE IN ESSENTIAL HYPERTENSION Ben Ariff, Andrew Zambanini, Vamadeva Sarita, Dean Barratt, Yun Xu, Peter Sever, Nish Chaturvedi, Alice Stanton, Simon Thom, Alun Hughes. National Heart & Lung Institute, Imperial College London, , United Kingdom; Chemical Engineering and Chemical Technology, Imperial College London, , United Kingdom; Primary Care and Population Health Sciences, Imperial College London, , United Kingdom. The carotid artery undergoes structural changes in hypertension, and a recent study [1] suggested that wall thickening was independently related to local pulse pressure in the carotid artery. However blood flow is also an important influence on the arterial wall and previous studies have not taken this factor into account. 88 subjects (55 male, age 38 - 78yr) with essential hypertension (BP ⫽ 158⫾20 / 91⫾11 mmHg ) were studied. Common carotid artery lumen diameter (LD) and intima media thickness
132A
POSTERS: Arterial Structure and Compliance
AJH–May 2004 –VOL. 17, NO. 5, PART 2
(IMT) were measured in diastole using B-mode ultrasonography. Carotid blood flow velocity was measured using Doppler ultrasound and mean carotid blood flow (CBF) calculated. Blood pressure was measured in the brachial artery using a validated automated sphygmomanometer and in the carotid artery using applanation tonometry and mean (MAP), brachial (BPP) and carotid (CPP) pulse pressure calculated. Relationships between lumen diameter, wall structure (IMT, intima media area (IMA)) and hemodynamic parameters were studied by univariate and multivariate analysis with age as a forced covariate. IMT correlated significantly with MAP ( ⫽ 0.004), BPP ( ⫽ 0.004) and CPP ( ⫽ 0.003) and, in a multivariate model, age ( ⫽ 0.004, F ⫽ 5.1, p ⫽ 0.03) and MAP ( ⫽ 0.004, F ⫽ 11.4, p ⫽ 0.001) were independent predictive variables. IMA correlated significantly with MAP ( ⫽ 0.120), BPP ( ⫽ 0.087) and CBF ( ⫽ 0.052). In a multivariate model MAP ( ⫽ 0.142, F ⫽ 12.7,p ⫽ 0.0007) and CBF ( ⫽ 0.701, F ⫽ 13.4, p ⫽ 0.0005) were significant predictors. In contrast LD correlated only with CBF (b ⫽ 0.146), but in a multivariate model CBF ( ⫽ 0.144, F ⫽ 17.08, p ⫽ 0.0001), MAP ( ⫽ 0.02, F ⫽ 8.4, p ⫽ 0.005) and CPP ( ⫽ ⫺0.014, F ⫽ 6.4, p ⫽ 0.01) were significant predictors. Local pulse pressure is not an independent determinant of carotid IMT, although it affects arterial diameter. Blood flow has a major influence on carotid lumen diameter. Changes in carotid blood flow resulting from alterations in cerebrovascular resistance are likely to be an important additional determinant of carotid artery remodelling in response to antihypertensive treatment. Reference 1. Boutouyrie P, Bussy C, Lacolley P, Girerd X, Laloux B, Laurent S. Association between local pulse pressure, mean blood pressure, and large-artery remodeling. Circulation 1999; 100: 1387-93.
Key Words: Carotid Artery, Blood Flow, Remodelling
P-274 VASCULAR DAMAGE IN HYPERTENSIVE SUBJECTS Roberto A Ingaramo. Hypertension, CEHTA Cardiovascular, Trelew, Chubut, Argentina. A great prevalence of atheromatous carotid (CP) and femoral (FP) plaques, an increase in carotid intima-media thickness (IMT) and in the renal resistive index (RRI), are some of the vascular changes showed by hypertensive patients (HT). The aim of our study was to evaluate the arterial structural wall changes in a never treated HT group. For this purpose, 51 HT, 34 men, aged 46 ⫾ 10, and 20 normotensive subjects (NT), 8 men, aged 46 ⫾ 11 (p ⫽0.875), underwent a renal, carotid and lower extremities ultrasonic duplex scanning and rest and post-exercise ankle brachial index (ABI_ABIX). Besides, we analized the pulse pressure (PP) and the diurnal blood pressure values obtained by 24hs (ABPM). The HT showed a significative difference in the ABPM (p ⬍.0001),the PP (p ⬍.012), the ABIX in both legs (p ⬍.044 and ⬍.04) and a great prevalence of carotid and femoral plaques (43.1% vs. 5% of NT). We could not demostrate a statistical difference in the RRI of both kidneys (p ⬍.0018 and ⬍.043), the ABI (p ⫽.574 and ⫽.581) and the IMT (p ⫽.218). Nevertheless, HT showed an increase of: IMT ⬎8, 17% vs. 5% of NT; PP ⬎53, 23,5% vs. 5%; RRI ⬎.70, 27,5% vs. 0% and ABIX ⬍.90, 31,4% vs. 5%. These results confirm the greater damage and prevalence of structural changes , developed in the arteries of hypertensive subjects. Parameters
HT
NT
ABPM SBP ABPM DBP PP RRI (right)
138.7 ⫾ 12
119.9 ⫾ 8.42 ⬍ .00001
RRI (left)
p
Parameters
HT
NT
p
IMT
6.90 ⫾ 1.43
6.44 ⫾ 1.12
⫽ .218 NS
91.2 ⫾ 7.52
77.8 ⫾ 4.82 ⬍ .00001
ABI (right)
1.19 ⫾ .21
1.18 ⫾ .08
⫽ 574 NS
47.6 ⫾ 8.58 .53 ⫾ .098
41.8 ⫾ 6.43 ⬍ .012 .62 ⫾ .69 ⬍ .0018
ABI (left) ABIX (right) ABIX (left)
1.18 ⫾ .12 1.05 ⫾ .21
1.16 ⫾ .08 1.18 ⫾ .15
⫽ .581 NS ⬍ .581
1.08 ⫾ .14
1.16 ⫾ .15
⬍ .04
.55 ⫾ .14
.58 ⫾ .06
⬍ .043
Key Words: Vascular Damage, Ultrasound Duplex Scanning, Hypertension
P-275 THE DETRIMENTAL EFFECT OF STEROID TREATMENT ON VASCULAR ELASTICITY OF PATIENTS THAT SUFFER FROM SYSTEMIC LUPUS ERYTHEMATOSUS IS ATTENUATED BY HYDROXYCHLOROQUINE CO-ADMINISTRATION Eyal Leibovitz, Angela Frayman, Reuven Zimlichman, Amir Tanai, Itzhak Elly, Marina Shargorodsky, Dov Gavish. Internal Medicine, Wolfson Medical Center, Holon, Israel; Institute for Immune Diseases & Rheumatology, Wolfson Medical Center, Holon, Israel. Aim: Systemic lupus erythematosus (SLE) is associated with reduced arterial elasticity. We studied the effect of the treatment on large and small artery elasticity (AE) and systemic vascular resistance (SVR) in SLE patients and compared it to healthy controls. Methods: We analysed 41 SLE patients (90% females) at a mean age 48.7⫾2.4 years, and compared them to 96 healthy age and sex-matched controls. Large and small AE & SVR were derived from radial artery waveforms, obtained using a calibrated tonometer (model CR-2000, HDI Inc., Eagan, MN). Patients were categorized into groups: steroid treatment (n⫽12), HCQ treatment (n⫽9), steroid⫹HCQ treatment (n⫽16) and no steroids or HCQ (n⫽4). Results: Patients that received steroid treatment had reduced large AE and elevated SVR. Large AE and SVR values of the HCQ-treated SLE patients were similar to that of the controls. HCQ treatment attenuated the detrimental effects of steroids on large AE and SVR when given in combination. Blood pressure levels as well as CRP and anti-DNA results were similar between the different SLE treatment groups. After adjusting the results for age, sex, different risk factors and treatmened status, we found that large AE was influenced by age, sex and HCQ treatment, whereas SVR was influenced by age, the presence of hypertension, BMI and steroid treatment. Small AE where similar between the groups and was not reduced in SLE patients. Conclusions: Steroid treatment has detrimental effects on vascular parameters of SLE patients, and might be responsible in part to the increased large-vessel manifestations observed in these patients. HCQ seems to have a protective effect on arterial elasticity, and might even attenuate the detrimental effects steroids.
Key Words: Systemic Lupus Erythematosus, Steroids, Hydrochloroquine
P-276 DETERMINANTS OF CENTRAL PULSE PRESSURE IN HYPERTENSIVE AND NORMOTENSIVE PATIENTS Lisong Liu, Qi Hua, Jian Zhang, Beilei Pang, Yungao Wan, Wenwu Ren. Department of Cardiology, Beijing Xuanwu Hospital, Beijing, Beijing, China. To evaluate the determinants of central pulse pressure(PP) in hypertensive and normatensive patients via intra-arterial blood pressure measurement. Totally 190 inpatients who underwent coronary angiography were enrolled in this study. Before the end of the procedure, ascending aorta pressure was measured through graphic catheter, peripheral artery pressure was measured through femoral artery sheath and heart rate was logged simultaneously. Readings of smooth blood pressure curve were noted. All subjects underwent echocardiography. They were divided into hypertensive group and normotensive group according to the diagnostic standard of WHO/ISH published in 1999 or history of hypertension. We
POSTERS: Arterial Structure and Compliance
valvulopathy, smoking habit, excess alcool intake, renal failure and epatic failure. Patients, who performed blood pressure self monitoring with an automatic digital device validated with a solid state memory (AND®), underwent an ambulatory blood pressure monitoring (ABPM) and a tonometry applanation at baseline and after six months. In 24 patients the ABPM blood pressure values were significantly higher, over the normal range (136/86⫾ 2/6 mmHg) while in 21 patients were in normal range (125/79⫾ 3/2 mmHg). 22 patients were hypertensive at the self monitoring (138/88⫾ 5/3 mmHg) while 23 were normotensive (131/82⫾ 4/3 mmHg). In 22 hypertensives (both at the ABPM and at SBPM) the tonometry applanation has shown a reduction of the arterial compliance both for large (C1: 16.3⫾1.4 ml/mmHgx10) and small arteries (C2: 4.3⫾1.2 ml/mmHgx100), high arterial resistance (1535⫾72 dinexsecxcm-5) and systemic vascular impedance (98⫾13 dinexsecxcm-5). In 21 isolated clinic hypertensive (normotensives at the ABPM and at the SBPM) C1 was 16.9⫾0.7ml/mmHgx10 and C2 was 4.5⫾1.3ml/mmHgx100, arterial resistance was 1502⫾65 dinexsecxcm-5 and systemic vascular impedance was 97⫾13 dinexsecxcm-5 . 45 normotensives subjects (C1: 19.2⫾1.4 mlxmmHgx10, C2: 5.4⫾1.3 ml/ mmHgx100, RVS: 1358⫾ 86, IVS : 77⫾13dinexsecxcm-5). The decrease of the arterial compliance in patients with isolated clinical hypertension was demonstrated in our study, confirming that this “reactive” form of hypertension couldn’t be underestimated. Key Words: Self Monitoring, ABPM, Tonometry Applanation
P-271 HYPERTENSION AND AORTIC CALCIFICATION IN A RETIRED WORKER COHORT Amanda R Harmon, Dan T Lackland, Brent Egan, David Hoel, James Thomas, Joyce Nicholas, Stuart Lipsitz. Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston, SC; General Internal Medicince/ Hypertension, Medical University of South Carolina, Charleston, SC; General Internal Medicine, Medical University of South Carolina, Charleston, SC. Aortic calcification is an emerging risk factor in the assessment of cardiovascular disease. However, information regarding this measure is less evident out of research study cohorts. A retired worker cohort of 1589 individuals was assessed with a physical examination and chest x-ray. X-rays were evaluated by a team of radiologists. Hypertension was defined as a BP measurement ⱖ 140/90 mmHg or the participant’s report of being told they have high blood pressure. Presence of aortic calcification was determined based upon the chest x-ray results. The BP measurement and chest radiograph results were entered into a Microsoft Access database and analyzed using SAS for Windows V8. A Chi-Square test was performed on the results testing the significance of the association between aortic calcification and hypertension among these retired workers. The results reveal a 55.3% prevalence of hypertension and 15.7% with aortic calcification of the 1,589 participants. A two-by-two frequency table showed that 10.4% of participants have both hypertension and aortic calcification. The Chi-Square test results were statistically significant with a p-value ⬍ .0001. These results identified a significant association of aortic calcification and hypertension suggesting the effects of multiple risk factors, and also identifying this simple measure as a potential valuable resource in the diagnosis of disease progression. Evidence of Aortic Calcification Hypertensive Not Hypertensive
Positive
Negative
165 (10.4%) 84 (5.3%)
713 (44.9%) 627 (39.5%)
Key Words: Hypertension, Aortic Calcification, Worker Cohort
131A
P-272 A NOVEL ARTERIAL STIFFNESS INDEX (ASI) AS A MARKER OF ARTERIOSCLEROSIS Kunihide Hiramatsu, Ako Oiwa, Satoshi Shigematsu, Minoru Nagai, Masafumi Katakura, Toru Aizawa, Kiyoshi Hashizume. Department of Aging Medicine and Geriatrics, Shinshu University Graduate School of Medicine, Matsumoto, Nagano, Japan. BACKGROUND: Arterial Stiffness Index (ASI) is a novel quantitative estimate directly calculated from the relation between transmural pressure and arterial volumetric change. Functional changes in arterial stiffness have been investigated by pulse wave velocity (PWV). However, these measures have limitations for clinical application because of their dependence on arterial pressure. In the present study, to test the ability for ASI to act as a marker of arteriosclerosis, we determined and compared the distensibility of brachial artery in normotensive non-diabetic subjects with those in subjects with hypertension(HT) and/or diabetes mellitus(DM). METHODS: Data of 231 subjects were analyzed: men/women 111/ 120, the mean age 67 yrs, and BP 136 /78 mmHg. One hundred and thirty-four (61%) patients were hypertensive and were receiving antihypertensive drugs. Seventy-five (32%) patients were diabetic and were receiving oral hypoglycemic agents and/or insulin. ASI was obtained directly through computerized oscillometry (CardioVision, IMDP, Inc.). CardioVision utilizes the Oscillometric method of blood pressure measurement and generates information on the elasticity or flexibility of the brachial artery. To identify the variables correlated with ASI and PWV, multiple regression analysis was used. RESULTS: ASI was correlated with pulse pressure (PP) (beta⫽.579, p⬍.0001), mean blood pressure (MBP) (beta⫽-.208, p⬍.01), and the presence of HT (beta⫽.147, p⬍.03). PWV was correlated with MBP (beta⫽.460, p⬍.0001), age (beta⫽.334, p⬍.0001), body mass index (BMI) (beta⫽-.300, p⬍.0001) and PP (beta⫽.146, p⬍.05). ASI and PWV significantly increased with age. When ASI and PWV were plotted as a function of age, the regression line was significantly steeper in HT group than in non-HT group only for ASI. ASI was significantly higher in diabetic subjects than in non-diabetic subjects (mean ⫹/- SE ; 102 ⫹/⫺ 8 vs. 134 ⫹/⫺ 13, p⬍0.05). ASI was significantly higher in subjects with both HT and DM than in subjects with HT or DM (mean ⫹/- SE ; 153 ⫹/⫺ 16 vs. 114 ⫹/⫺ 11, p⬍0.05). CONCLUSIONS: Acceleration of age-related increase in arterial stiffness in subjects with hypertension was detectable by ASI, but not by PWV. Furthermore, HT-related arterial stiffness was enhanced in subjects with diabetes mellitus. Thus ASI provides reliable a quantitative measure of arterial stiffness. Key Words: Arterial Stiffness, Arterial Stiffness Index, Arteriosclerosis
P-273 HEMODYNAMIC DETERMINANTS OF CAROTID ARTERY STRUCTURE IN ESSENTIAL HYPERTENSION Ben Ariff, Andrew Zambanini, Vamadeva Sarita, Dean Barratt, Yun Xu, Peter Sever, Nish Chaturvedi, Alice Stanton, Simon Thom, Alun Hughes. National Heart & Lung Institute, Imperial College London, , United Kingdom; Chemical Engineering and Chemical Technology, Imperial College London, , United Kingdom; Primary Care and Population Health Sciences, Imperial College London, , United Kingdom. The carotid artery undergoes structural changes in hypertension, and a recent study [1] suggested that wall thickening was independently related to local pulse pressure in the carotid artery. However blood flow is also an important influence on the arterial wall and previous studies have not taken this factor into account. 88 subjects (55 male, age 38 - 78yr) with essential hypertension (BP ⫽ 158⫾20 / 91⫾11 mmHg ) were studied. Common carotid artery lumen diameter (LD) and intima media thickness
132A
POSTERS: Arterial Structure and Compliance
AJH–May 2004 –VOL. 17, NO. 5, PART 2
(IMT) were measured in diastole using B-mode ultrasonography. Carotid blood flow velocity was measured using Doppler ultrasound and mean carotid blood flow (CBF) calculated. Blood pressure was measured in the brachial artery using a validated automated sphygmomanometer and in the carotid artery using applanation tonometry and mean (MAP), brachial (BPP) and carotid (CPP) pulse pressure calculated. Relationships between lumen diameter, wall structure (IMT, intima media area (IMA)) and hemodynamic parameters were studied by univariate and multivariate analysis with age as a forced covariate. IMT correlated significantly with MAP ( ⫽ 0.004), BPP ( ⫽ 0.004) and CPP ( ⫽ 0.003) and, in a multivariate model, age ( ⫽ 0.004, F ⫽ 5.1, p ⫽ 0.03) and MAP ( ⫽ 0.004, F ⫽ 11.4, p ⫽ 0.001) were independent predictive variables. IMA correlated significantly with MAP ( ⫽ 0.120), BPP ( ⫽ 0.087) and CBF ( ⫽ 0.052). In a multivariate model MAP ( ⫽ 0.142, F ⫽ 12.7,p ⫽ 0.0007) and CBF ( ⫽ 0.701, F ⫽ 13.4, p ⫽ 0.0005) were significant predictors. In contrast LD correlated only with CBF (b ⫽ 0.146), but in a multivariate model CBF ( ⫽ 0.144, F ⫽ 17.08, p ⫽ 0.0001), MAP ( ⫽ 0.02, F ⫽ 8.4, p ⫽ 0.005) and CPP ( ⫽ ⫺0.014, F ⫽ 6.4, p ⫽ 0.01) were significant predictors. Local pulse pressure is not an independent determinant of carotid IMT, although it affects arterial diameter. Blood flow has a major influence on carotid lumen diameter. Changes in carotid blood flow resulting from alterations in cerebrovascular resistance are likely to be an important additional determinant of carotid artery remodelling in response to antihypertensive treatment. Reference 1. Boutouyrie P, Bussy C, Lacolley P, Girerd X, Laloux B, Laurent S. Association between local pulse pressure, mean blood pressure, and large-artery remodeling. Circulation 1999; 100: 1387-93.
Key Words: Carotid Artery, Blood Flow, Remodelling
P-274 VASCULAR DAMAGE IN HYPERTENSIVE SUBJECTS Roberto A Ingaramo. Hypertension, CEHTA Cardiovascular, Trelew, Chubut, Argentina. A great prevalence of atheromatous carotid (CP) and femoral (FP) plaques, an increase in carotid intima-media thickness (IMT) and in the renal resistive index (RRI), are some of the vascular changes showed by hypertensive patients (HT). The aim of our study was to evaluate the arterial structural wall changes in a never treated HT group. For this purpose, 51 HT, 34 men, aged 46 ⫾ 10, and 20 normotensive subjects (NT), 8 men, aged 46 ⫾ 11 (p ⫽0.875), underwent a renal, carotid and lower extremities ultrasonic duplex scanning and rest and post-exercise ankle brachial index (ABI_ABIX). Besides, we analized the pulse pressure (PP) and the diurnal blood pressure values obtained by 24hs (ABPM). The HT showed a significative difference in the ABPM (p ⬍.0001),the PP (p ⬍.012), the ABIX in both legs (p ⬍.044 and ⬍.04) and a great prevalence of carotid and femoral plaques (43.1% vs. 5% of NT). We could not demostrate a statistical difference in the RRI of both kidneys (p ⬍.0018 and ⬍.043), the ABI (p ⫽.574 and ⫽.581) and the IMT (p ⫽.218). Nevertheless, HT showed an increase of: IMT ⬎8, 17% vs. 5% of NT; PP ⬎53, 23,5% vs. 5%; RRI ⬎.70, 27,5% vs. 0% and ABIX ⬍.90, 31,4% vs. 5%. These results confirm the greater damage and prevalence of structural changes , developed in the arteries of hypertensive subjects. Parameters
HT
NT
ABPM SBP ABPM DBP PP RRI (right)
138.7 ⫾ 12
119.9 ⫾ 8.42 ⬍ .00001
RRI (left)
p
Parameters
HT
NT
p
IMT
6.90 ⫾ 1.43
6.44 ⫾ 1.12
⫽ .218 NS
91.2 ⫾ 7.52
77.8 ⫾ 4.82 ⬍ .00001
ABI (right)
1.19 ⫾ .21
1.18 ⫾ .08
⫽ 574 NS
47.6 ⫾ 8.58 .53 ⫾ .098
41.8 ⫾ 6.43 ⬍ .012 .62 ⫾ .69 ⬍ .0018
ABI (left) ABIX (right) ABIX (left)
1.18 ⫾ .12 1.05 ⫾ .21
1.16 ⫾ .08 1.18 ⫾ .15
⫽ .581 NS ⬍ .581
1.08 ⫾ .14
1.16 ⫾ .15
⬍ .04
.55 ⫾ .14
.58 ⫾ .06
⬍ .043
Key Words: Vascular Damage, Ultrasound Duplex Scanning, Hypertension
P-275 THE DETRIMENTAL EFFECT OF STEROID TREATMENT ON VASCULAR ELASTICITY OF PATIENTS THAT SUFFER FROM SYSTEMIC LUPUS ERYTHEMATOSUS IS ATTENUATED BY HYDROXYCHLOROQUINE CO-ADMINISTRATION Eyal Leibovitz, Angela Frayman, Reuven Zimlichman, Amir Tanai, Itzhak Elly, Marina Shargorodsky, Dov Gavish. Internal Medicine, Wolfson Medical Center, Holon, Israel; Institute for Immune Diseases & Rheumatology, Wolfson Medical Center, Holon, Israel. Aim: Systemic lupus erythematosus (SLE) is associated with reduced arterial elasticity. We studied the effect of the treatment on large and small artery elasticity (AE) and systemic vascular resistance (SVR) in SLE patients and compared it to healthy controls. Methods: We analysed 41 SLE patients (90% females) at a mean age 48.7⫾2.4 years, and compared them to 96 healthy age and sex-matched controls. Large and small AE & SVR were derived from radial artery waveforms, obtained using a calibrated tonometer (model CR-2000, HDI Inc., Eagan, MN). Patients were categorized into groups: steroid treatment (n⫽12), HCQ treatment (n⫽9), steroid⫹HCQ treatment (n⫽16) and no steroids or HCQ (n⫽4). Results: Patients that received steroid treatment had reduced large AE and elevated SVR. Large AE and SVR values of the HCQ-treated SLE patients were similar to that of the controls. HCQ treatment attenuated the detrimental effects of steroids on large AE and SVR when given in combination. Blood pressure levels as well as CRP and anti-DNA results were similar between the different SLE treatment groups. After adjusting the results for age, sex, different risk factors and treatmened status, we found that large AE was influenced by age, sex and HCQ treatment, whereas SVR was influenced by age, the presence of hypertension, BMI and steroid treatment. Small AE where similar between the groups and was not reduced in SLE patients. Conclusions: Steroid treatment has detrimental effects on vascular parameters of SLE patients, and might be responsible in part to the increased large-vessel manifestations observed in these patients. HCQ seems to have a protective effect on arterial elasticity, and might even attenuate the detrimental effects steroids.
Key Words: Systemic Lupus Erythematosus, Steroids, Hydrochloroquine
P-276 DETERMINANTS OF CENTRAL PULSE PRESSURE IN HYPERTENSIVE AND NORMOTENSIVE PATIENTS Lisong Liu, Qi Hua, Jian Zhang, Beilei Pang, Yungao Wan, Wenwu Ren. Department of Cardiology, Beijing Xuanwu Hospital, Beijing, Beijing, China. To evaluate the determinants of central pulse pressure(PP) in hypertensive and normatensive patients via intra-arterial blood pressure measurement. Totally 190 inpatients who underwent coronary angiography were enrolled in this study. Before the end of the procedure, ascending aorta pressure was measured through graphic catheter, peripheral artery pressure was measured through femoral artery sheath and heart rate was logged simultaneously. Readings of smooth blood pressure curve were noted. All subjects underwent echocardiography. They were divided into hypertensive group and normotensive group according to the diagnostic standard of WHO/ISH published in 1999 or history of hypertension. We