I008 Endothelium dependent vasodilation is reduced in middle aged non-dipper hypertensive patients

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DIFFUSE SEVERE EPICARDIALCONSTRIC1’ION AFTER ACETYLCHOLINE: A GLOBAL BUT REVERSIBLE DEFICIENCYOFNITRIC OXIDE ~*, MTTorWsov,EFPhilbirt,PAKuhner,AA Cm*. AlbartyMedicatCollege, Albany,NY. hitraeorottaryacetylchohe(ACh) isthegoldstaudad for diagnosisof coronaryetrdothelialdysfunction,though indicationsforthiatestingandtheclinicalrelevaneearestill evolving.However,eororraryvasomotionduringexercise appe.arstocofiebxewithACh. T@urpaeofthisstudywasto investigateclinicaf andtnicrocirculationcorrelates ofdiffise epicardialconatrictionafterACh. Patierttareferredforeardiae cath becauseof chest pain were recmited for ettdotbelial functiontesting of conduit(CON) and resistance(RIM) cormtaryarteriesafterexcluaimtofsigrdficantCAD. Ir219pts, severediffuseCONvaaospaamatlerACh(definedas <50% but>20%diametermnstriction)wasfoundwitharraverage diameterreductionof 26~ 2%. Thiswasassociatedwith depressedMS arteryrelaxationafter ACh withcoronary bloodflow(CBF)inereaaea ofortly56*9%. RESarteries damwati&-tismitivi~ ~IC~Gwitimavmge CBFincreaaeof189A24%. CBFafteradenosinewaaM9~ 15%. Pertinentclinieaifindingsin tbis groupwereHTN (74%),LVH(42%),hyperIipidemia(42%),btaekrace(3 l%), andferttalegender(37 %). Conclusions:SeverediffuseepicardialspasmafterAChis aasrxiated with depressedRES artery relaxationand a frequentlyhyperaenaitivekqrmtaetoICNTGssggeatistga globalbutreversibledeficiency ofNO. DiffiseCONspaam atterAChmaycorrelatewithnon-atheroacleroticmyeoardial &##&uchsrJ@tfo~intheaettin80fHTNjLVH. Endothelium,vaanecmatriction, vaaoapasm, hypertension

O P E ( NR I R OO EE O A ET F T H Y P O P E R F S I P B T A AA I UE T N F FDI F C R S S C L A OO R E H L Se M T k eA 8 Ht K hr b @ r r ro O o M U oe W n a e M Ui u v i ea e P U o o S G n l i i e c ve le r E m p a r i t p a o a Tt r h o a cm b f t r o w aa c u mf i ca h a p i ai r o aa T e tu r o av r rd d a g ae iel u e i a en mw d f a i 2 o e rp a t -a a ee rr u s no t a ad u w bi eo n rd o r f o gg c f a a lt p o 4 r a vv p e m i ee le o pr E c (o En AR r c p Tm f e T an I l e t r ( P e a g b f R l ma ( ii m r l P n a A nGt c o t dl p a 2 h a e o d a a a r r u f a h i 2 p a i ra m p m E a t a m l i e ui f w o f 9 ~ 0b( t 1 ~ 0 s( . 0 r S e a 4 w m t 1 ~0 p o t t dh a a N m w 2u l f adh i tR f ve o t 2 p i 4 % ma i . e e e e returned to 4 + t 3 m m ( ic 0 8 w l m 9 ,4 3ih 439~ 64r m n e t d a i h( <0 fa t 7 m R i , af I 4 patienta piaarna u f ~7m m ona l d a m l rr r E d f 1 ~ 0e t 8 ~ 1 a 2 h a e rT r r0 e t 1 + 1 p o d a s O m o o t0u t or . p a da i R f t 2 ta 2 a i i G e rn f 6 t 3 r r nW p ! a r hJi d n lm gn e i i cla v m as n c p a hn d ma na o d na ar r e 2i h a s g i a pn ob u ni fa f r ti d r f i b p w oa w ei a i r ti tn m iw tp p w n eT a o t ra o a u w f bh e turd o i e n r i a fo i > 8a ‘ ao rp aa a -a o rd w e i r i ma p Em y o i o m al i n e t e W o 2 % o p w n h pa E a n ot l i i i a s ad ui mnaifunotion, h appreximetady e r half eo g of tha patbntawithelevatedplasmaE a t h a p T riskof acutemnai h yi c oencluaion, the p p a i n m o rise of ET-1is a markerof reducedmnaiperfuaiond t i a c n r f o e a r a a- r c r K w e r e H y - e p pd eo o t af - an o c r er e s t e e h o l

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DEPENDENT VASODILATION 1S GEND13RANDRACIALDIFFEREIQCESINEFFICACYOF ENDCYI’HELIUM REDUCED IN MIDDU3AGED NON-DIPPER INTRACORONARYL-ARG fNINE.&Htu@fm*$AFeizL HYPERTENSIVE A.Mivoshi, H.Suzuki,M. e MTToroasov,PA K DSStrogatz,AuAC*. Albany h r PATIENTS. r Masai,M.FujiwaraandT.iwasaki.HyogoCollegeof MedicalCollege, Albany,NY. Medicine,Nishinomiya,Hyogo,Japan. Intraeorortary(IC)infusionof L-arginine(L-arg)is Manystudieshaveshownthatnon-dippertype effeetiveinshort-term treatmetztofendothelial dysfimctionin hypertensioninelderlypatientsis frequentlyaccompanied by somepatients.Thepurposeofthisstudywaatoexaminethe tergetorgandamageandthatendothelialdysfunctionexistsin modulatinginfluenceof genderandraceonL-ergmediated hypmtensivepatienta.In thisstudy,weexaminedwhetheror improvementinmicrovascularendothelial function.Thiswas nottheresponseof endothelium-depezrdent vasodilstionis testedutilizinggradedIC infusionsofaeetylcholine(ACh), differentindipperandnon-dippertypehypertensivepatients Doppler wire measurementsof coronary veloeity, and withoutapparenttargetorgandamage.Methoda;Subjects angiographiceatimatesofcoronaryarea. L-arg(3200mcmoles) were1Suntreatedhypertensivepatients(age29-56)diagnosed waathenintizaad foliowedbyrepeatAChinfu$ion. Taatingwes as stage1in WHOclassification.Accordingto thechangesof eorrductedin44womenand60 menofwhom41vmreblackand averageof meanarterialpressure(MAP)betweenthedaytime 63white. Significantimprovementin coronarybloodflow (8-18)andthenighttime(22-6),whichwasevaluatedwith (CBF)detlnedasZ25%rmitsoecurredin36(26men(p=O/348) ambulatorybbod pressuremonitoring,subjeetsweredivided and 10women). In thosewho improved,CBFafterACh intonon-dippers(ND;thereductionof MAP<1Oof meanof increased fi’om91 ~ 12 to 158 t 15Y0,p=o.0008. No 24 hoursMAI?n=rlt)anddippers(D;~10;n=lO). improvementoecurredin34 menand34women(120f 1ltol 10 Meaauraments of forearmvascularresponsesto drugs(ACh; t 1OO/O). Tenpatients(9 menand 1woman)demonstrated 3,6,12,24,ug / m SNP;0.15,0.3,0.6,1.2 ,ug/rein.)were i markedimprovement(275% units)ahrL-arg(1051 23t0241 doneusingstrain-gaugevenousplethysmography.Results; f28°/o,p=0.0r)l).0fthese,40fthe5 greatestresponseswerein Therewasno significantdifferencein anyclinicaldata bkwkmales.ThecombinationofmalegenderandbaaelineCBF (includingT-Choi,TG, FBS, s-Cr), leftventricularmass afterAChSl2O%washighlypredictiveofimprovemcntsfkrLindex,ageanddaytimemeanarterialpressurebetweenND arg(p=o.ol). aridD T vaaodilation byAChwas loweredinND Conclusions:Gender and subtleracial differences exist in compamdwithD(~0.05). Therewas nodifferencein the men arc morelikelyto responseto IC L-arg. In general, responsesto SNP. Conclusion;BluntedendotheliumdemonstrateimprovedCBFatbrL-arg. Asubsetofblackmen dependentvaaodilationexistsin NDwithoutanyappsmnt displayedmarkedimprovement.Thesefindingssuggesta targetorgandamage.Thisendothelialdysfunctionmaybe d relativedeficiencyofnitricoxideamongmenandapossible to highbloodpsvssursin nighttime. therapeuticapproaeh. KeyWords: Endothelimn,vaaodilation,L-arginine,gender, KeyW D N Endothelial oo i dysfunction n r

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