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Is there organ damage in white-coat hypertension?
AJR-APRIL 199.5-VOL.8, NO.4, PART 2
G5
POSTERS: Patient Evaluation and Management 83A
G6 INFLUENCE OF lEFT VENTRICULAR HYPERTROPHY ON SENSITIVITY AND SPECIFICITY OF EXERCISE THALLIUM·201 (± DIPYRIDAMOLE ) TOMOSCINTIGRAPHY IN HYPERTENSIVE PATIENTS. P. Bruneau, P. Ambrosi, B. vaisse, J. F. Renucci, G. Faugere, P.J. Bernard, L. Poggi.
AMBULATORY BLOOD PRESSURE MONITORING IN PATIENTS WITH EXAGGERATED RISE OFDIASTOLIC BLOOD PRESSURE DURING TREADMILL TEST. C. A. Murad: B. Luna; L, Ruivo; M.Boldrini; 1. Anoyo; E. Martinez; A. Murad. PREVCOR and Escola Paulista deMedicina. Silo Paulo, SP, Brazil The ambulatolY blood pressure moniloring (ABPM) is importanl in the identification of labile hypertension, borderline hypertension or situations where there arc centroversles about the drug trc.'luuent. Besides, it is a tool for the comprehension of the blood pressure (BP) behavior during work or stressing activities. In the present s!lldy. we evaluated the BP behavior through ABPM from patients who presented an exaggerated riseof diastolic BP (OBP) during exercise testing (BTl). We studied 26 patients with nonnal resting BP, that during ETT had exaggerated rise in OBP up to 100 Itut\Hg, (0 I). This group was compared wit1J another of 31 palients with nonnal resting and exercise 8P, (0 11). They were paired for sex, age and body mass index and submitted to ABPM through 24 hours and echocardiography 10quantify the leftventricular mass index (LVMl). The results were compared by the Mann·Whitney and Qui-Square tests. The mean BP in 24 h were differents for thetwo groups bcil1g greater for 01. 131 nun Hg I Sl.5 mm Hg (01) VB 121 mm Hg 175.7 nun Hg(Gil), p 140 mm Hg) and 29.6% vs 14,4 % (for diastolic load, % ofrcadings > 90 mm Hg), p
Our results suggest that TI-201 tomoscintigraphy hasa high sensitivity in the diagnosis of CAD in hypertensive pts.The presence of moderato LVH does not markedly influence the diagnostic value ofthetest
Key Words: Blood Pressure.Ambulatol}' Blood Pressure Monitoring, Measurement of BIOO'J Pressure, Exercise Tests
Key Words : essential hypertension, left ventricular hypertrophy, thallium stress test, coronary artery disease.
G7
G8
NEW 3·DlMENSIONAL (3·D) ULTRASOUND METHOD FOR THE QUANTITATIVE MEASUREMENT OF SIZE AND VOLUME OF SOFT PLAQUES IN SUPERF1CIAL LARGE ARTERIES M.M. LUDWIG, U. JORGER, J. REDEl, K.O. STUMPE"'
THERE ORGAN DAMAGE IN WHITE·COAT HYPERTENSION ? S,D,pierdomenicQ, M.D.Guglielmi, D.Lapenna, L.Salvatorc. T.Anridormi, C.Schiavone, F.Cuccurullo, A.Mezzetti. Hypenension Unit, Chair ofInternal Medicine, University ofChicti, Italy
La Timone Hospital and Marseille School of Medicine, Marseille, France. Our purpose was to assess the potential effect of left ventricular hypertrophy ( LVH ) on the results of exercise TI -ZOl imaging in hypertensive patients ( pts ) and we studied 81 ots with moderate ( 60% ) to severe ( <·0% ) essential hypertension who underwent coronary arteriography, ZD-guided TM echocardiography , and exercise TI-201 scintigraphy within 3 months. The pts ( mean age::: 69,1 ± 8,Z years, 74M17F ) were referred to the scintigraphy for a history of typical or atypical chest pain. Pts with myocardial infraction, prior revascularization procedure or valvular disease were excluded. 44 pts ( 54%) had echocardiographic IVH ( LVH+ group ). 32 pts (39%) had significant ( 70% luminal diameter narrowing ) epicardial CAD at catheterization. Mean left ventricular mass index ( LVMI ) was 146g/m2 in the LVH+ group, 112g/mZ in the LVH· group. n lVH+
LVH-
44 37
sensitivity
speclficity
78,4 % 59,2 %
IS
Medical University Polldlnic, BODn, Ckrm:my
2-dimensional ultrasonography does not allow for quantitation of size and volume of intruding formative stages of atherosclerosis such as soft plaques {PL). Using a newly developed 3·D ultrasound system (3·DUS) we studied accuracy and reproducibility of volume measurements (VM) on 10 artificial PL consisting of polystyrene cubes and on soft PLin common carotid (CA) and femoral (FA) arteries in60 patients. The equipement used was a new 3·DUS (Voluson 3D530, Kretztechnik AG, A·4871 Zipf) with 11 mechanically driven, IO·Mhz transducer providing an axial )Olllt;.." d' 0.15 mm. It enables acquisition, storage and lilspl'ly of plaque anatomy within 3·6seconds. VM computed from thepolystyrene cubes correlated closely with the physical VM of the artificial PL (r=0,9; n=40) with an intra- and inter-observer variability (OV) of 2.6% and 3.2% respectively, VM of CA and FA soft PL in patients were performed with an intra- and inter-Ov for the CA of 2.8% (pO.9) and 4.2 % (FO.9), and for the FA of 2.6% (r=O.9) and 3.6% (r=0.9), respectively. The new 3-DUS allows for the quantitative assessement of soft PL and is suitable for serial measuremests of rates of progression or regression of these superficial artery lesions with great accuracy end reproducibilty over time.
Key Words: 3-dimensional ultrasound, volume measurements, soft plaques
Aim of thestudy was toevaluate organ damage and serum lipids in whitecoat hypertensives (WCHs) in comparison with normotenslves (Ns) and sustained hYJ;crtcnsivcs (SHs). Two hundred and fifty-five pIS with casual systolic and diastolic BP(cSBP andeDBP) > 140/90 mlllHg and 100 Ns underwent ambulatory BP monitoring (Spacelabs) to evaluate 24·hour systolic and diastolic BP (24hSBP and 24hDBP). Among subjects with cSBP/eDBP ;. 140/90 mmHg, those with 24hSBP124hDBP > 135/85 mmHg (upper limits of Ns) were defined as 5Hs and those with. 24hSBP124hDBP < 135/85 mmHg as WCHs. Weselected three groups matched forsex,age, body mas. index and smoking habit: 50 SHs, 25 WCHs and 25 Ns. These pLS underwent echocardiographic examination (HP77030A) toassess LV mass index (i... VMI). carotid ulb'asonography to evaluate intima-media thickness (lMT) and atherosclerotic lesions (AL), venous occlusion plethysmography (Hokanson EC-5R) to record minimal forearm vascular resistance (mFVR), measurement of total cholesterol (TC), BDL cholesterol (HDL-C), triglycertdes (TG), creatinine (Cr), and 24-hour urinary albumin excretion (UAE). Data are reported inthetahle: SHs(l) WCHs(2) No(3) eSBP 159.1±1O.9* 149.2±4.5§ 129.8±5.3 cDBP 101.7±3.S* 95.7±2§ 80.4±5.3 24hSBP 150±12.6* 123.4±6.6 122.5±5.9 24hDBP 95±6.3" 15.5±5.1 75.2±5.8 LVMJ(g/m2) 125.9±20* 97.6±11.5 93.9±1l IMT(mm) 0.85±O.IS* O.71±O.lS 0.7O±O.l4 mFVR(UR) 2.33±0.1I* 2.04±O.08 2.03±O.06 Ptswith AL 13(26%) 4(16%) 3(12%) TC(mg/dl) 202.3±36° 18·7.4±32 182.2±22 TG(mgldl) 159.8±83* 112.6±26 109127 HDL.C(mg/dl) 42.3±5.2 43.7±5.3 44.6±5.8 Cr(mg/dl) O.85±0.16 O.83±O.13 0.82±O.12 UAE(mr/24h) IS.l±13.8* 4,45±1.48 4.31±1.l Means ± SD;* p<:0.05 vs 2 and3,§ p<0.05 vs 3, 0 p< 0.05 vs 3, We conclude that WCHs do notdevelop organ damage and have a lipid prome similar to ihat of Ns. Thus, they represent a low-risk group for whom pharmacologicalll'c..ument may be withheld ordelayed. Key Words: ambulatory BPmonitoring, while-coat hypertension, organ damage.
G5
POSTERS: Patient Evaluation and Management 83A
G6 INFLUENCE OF lEFT VENTRICULAR HYPERTROPHY ON SENSITIVITY AND SPECIFICITY OF EXERCISE THALLIUM·201 (± DIPYRIDAMOLE ) TOMOSCINTIGRAPHY IN HYPERTENSIVE PATIENTS. P. Bruneau, P. Ambrosi, B. vaisse, J. F. Renucci, G. Faugere, P.J. Bernard, L. Poggi.
AMBULATORY BLOOD PRESSURE MONITORING IN PATIENTS WITH EXAGGERATED RISE OFDIASTOLIC BLOOD PRESSURE DURING TREADMILL TEST. C. A. Murad: B. Luna; L, Ruivo; M.Boldrini; 1. Anoyo; E. Martinez; A. Murad. PREVCOR and Escola Paulista deMedicina. Silo Paulo, SP, Brazil The ambulatolY blood pressure moniloring (ABPM) is importanl in the identification of labile hypertension, borderline hypertension or situations where there arc centroversles about the drug trc.'luuent. Besides, it is a tool for the comprehension of the blood pressure (BP) behavior during work or stressing activities. In the present s!lldy. we evaluated the BP behavior through ABPM from patients who presented an exaggerated riseof diastolic BP (OBP) during exercise testing (BTl). We studied 26 patients with nonnal resting BP, that during ETT had exaggerated rise in OBP up to 100 Itut\Hg, (0 I). This group was compared wit1J another of 31 palients with nonnal resting and exercise 8P, (0 11). They were paired for sex, age and body mass index and submitted to ABPM through 24 hours and echocardiography 10quantify the leftventricular mass index (LVMl). The results were compared by the Mann·Whitney and Qui-Square tests. The mean BP in 24 h were differents for thetwo groups bcil1g greater for 01. 131 nun Hg I Sl.5 mm Hg (01) VB 121 mm Hg 175.7 nun Hg(Gil), p
Our results suggest that TI-201 tomoscintigraphy hasa high sensitivity in the diagnosis of CAD in hypertensive pts.The presence of moderato LVH does not markedly influence the diagnostic value ofthetest
Key Words: Blood Pressure.Ambulatol}' Blood Pressure Monitoring, Measurement of BIOO'J Pressure, Exercise Tests
Key Words : essential hypertension, left ventricular hypertrophy, thallium stress test, coronary artery disease.
G7
G8
NEW 3·DlMENSIONAL (3·D) ULTRASOUND METHOD FOR THE QUANTITATIVE MEASUREMENT OF SIZE AND VOLUME OF SOFT PLAQUES IN SUPERF1CIAL LARGE ARTERIES M.M. LUDWIG, U. JORGER, J. REDEl, K.O. STUMPE"'
THERE ORGAN DAMAGE IN WHITE·COAT HYPERTENSION ? S,D,pierdomenicQ, M.D.Guglielmi, D.Lapenna, L.Salvatorc. T.Anridormi, C.Schiavone, F.Cuccurullo, A.Mezzetti. Hypenension Unit, Chair ofInternal Medicine, University ofChicti, Italy
La Timone Hospital and Marseille School of Medicine, Marseille, France. Our purpose was to assess the potential effect of left ventricular hypertrophy ( LVH ) on the results of exercise TI -ZOl imaging in hypertensive patients ( pts ) and we studied 81 ots with moderate ( 60% ) to severe ( <·0% ) essential hypertension who underwent coronary arteriography, ZD-guided TM echocardiography , and exercise TI-201 scintigraphy within 3 months. The pts ( mean age::: 69,1 ± 8,Z years, 74M17F ) were referred to the scintigraphy for a history of typical or atypical chest pain. Pts with myocardial infraction, prior revascularization procedure or valvular disease were excluded. 44 pts ( 54%) had echocardiographic IVH ( LVH+ group ). 32 pts (39%) had significant ( 70% luminal diameter narrowing ) epicardial CAD at catheterization. Mean left ventricular mass index ( LVMI ) was 146g/m2 in the LVH+ group, 112g/mZ in the LVH· group. n lVH+
LVH-
44 37
sensitivity
speclficity
78,4 % 59,2 %
IS
Medical University Polldlnic, BODn, Ckrm:my
2-dimensional ultrasonography does not allow for quantitation of size and volume of intruding formative stages of atherosclerosis such as soft plaques {PL). Using a newly developed 3·D ultrasound system (3·DUS) we studied accuracy and reproducibility of volume measurements (VM) on 10 artificial PL consisting of polystyrene cubes and on soft PLin common carotid (CA) and femoral (FA) arteries in60 patients. The equipement used was a new 3·DUS (Voluson 3D530, Kretztechnik AG, A·4871 Zipf) with 11 mechanically driven, IO·Mhz transducer providing an axial )Olllt;.." d' 0.15 mm. It enables acquisition, storage and lilspl'ly of plaque anatomy within 3·6seconds. VM computed from thepolystyrene cubes correlated closely with the physical VM of the artificial PL (r=0,9; n=40) with an intra- and inter-observer variability (OV) of 2.6% and 3.2% respectively, VM of CA and FA soft PL in patients were performed with an intra- and inter-Ov for the CA of 2.8% (pO.9) and 4.2 % (FO.9), and for the FA of 2.6% (r=O.9) and 3.6% (r=0.9), respectively. The new 3-DUS allows for the quantitative assessement of soft PL and is suitable for serial measuremests of rates of progression or regression of these superficial artery lesions with great accuracy end reproducibilty over time.
Key Words: 3-dimensional ultrasound, volume measurements, soft plaques
Aim of thestudy was toevaluate organ damage and serum lipids in whitecoat hypertensives (WCHs) in comparison with normotenslves (Ns) and sustained hYJ;crtcnsivcs (SHs). Two hundred and fifty-five pIS with casual systolic and diastolic BP(cSBP andeDBP) > 140/90 mlllHg and 100 Ns underwent ambulatory BP monitoring (Spacelabs) to evaluate 24·hour systolic and diastolic BP (24hSBP and 24hDBP). Among subjects with cSBP/eDBP ;. 140/90 mmHg, those with 24hSBP124hDBP > 135/85 mmHg (upper limits of Ns) were defined as 5Hs and those with. 24hSBP124hDBP < 135/85 mmHg as WCHs. Weselected three groups matched forsex,age, body mas. index and smoking habit: 50 SHs, 25 WCHs and 25 Ns. These pLS underwent echocardiographic examination (HP77030A) toassess LV mass index (i... VMI). carotid ulb'asonography to evaluate intima-media thickness (lMT) and atherosclerotic lesions (AL), venous occlusion plethysmography (Hokanson EC-5R) to record minimal forearm vascular resistance (mFVR), measurement of total cholesterol (TC), BDL cholesterol (HDL-C), triglycertdes (TG), creatinine (Cr), and 24-hour urinary albumin excretion (UAE). Data are reported inthetahle: SHs(l) WCHs(2) No(3) eSBP 159.1±1O.9* 149.2±4.5§ 129.8±5.3 cDBP 101.7±3.S* 95.7±2§ 80.4±5.3 24hSBP 150±12.6* 123.4±6.6 122.5±5.9 24hDBP 95±6.3" 15.5±5.1 75.2±5.8 LVMJ(g/m2) 125.9±20* 97.6±11.5 93.9±1l IMT(mm) 0.85±O.IS* O.71±O.lS 0.7O±O.l4 mFVR(UR) 2.33±0.1I* 2.04±O.08 2.03±O.06 Ptswith AL 13(26%) 4(16%) 3(12%) TC(mg/dl) 202.3±36° 18·7.4±32 182.2±22 TG(mgldl) 159.8±83* 112.6±26 109127 HDL.C(mg/dl) 42.3±5.2 43.7±5.3 44.6±5.8 Cr(mg/dl) O.85±0.16 O.83±O.13 0.82±O.12 UAE(mr/24h) IS.l±13.8* 4,45±1.48 4.31±1.l Means ± SD;* p<:0.05 vs 2 and3,§ p<0.05 vs 3, 0 p< 0.05 vs 3, We conclude that WCHs do notdevelop organ damage and have a lipid prome similar to ihat of Ns. Thus, they represent a low-risk group for whom pharmacologicalll'c..ument may be withheld ordelayed. Key Words: ambulatory BPmonitoring, while-coat hypertension, organ damage.