L28 Hypertension and other risk factors in patients with lacunar (single or multiple) and non-lacunar cerebral infarcts

AJH-APRIL 1997-VOL, 10, NO. 4, PART 2

POSTERS: Epidemiology

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METABOLIC CARDIOVASCULAR RISK FACTORS IN OBESE(Ob)ANDNON-OBESE (nOb)BRAZILIAN HYPERTENSIVES.

HYPERTENSIONAS A CAUSE OF DEATH IN GREECE. G Boudoms, N. L&os, A. Efthimiadis,D Psirropoulos,K. Paletas*, I.G, Stvlisdis,E. L4mu, G, Tsapas. CardiologyUnit of Z“d Dept. of Internal Medicine. ,4ristotle University of Tbem&miki and National Statistic Semice, Population Division -Local Office of Thessaloniki,Greece. The aim of the study was to investigatethe frequencyof deaths causedby ‘hypertensivedisease’,as a principalcause, in Greece. fn this term included : sudden deaths in patients with essential or secondary hypertension, hypertensive cardiopathy, hypertensive nepbropstbysnd bothhypertensivecardiopatbysnd nephropathy.In this study deaths caused by amte mywsrdial infarctionand amte cerebrovs.wularattacks, where the contributionof hypertensionis possible, are not included. The dsts were given by the National Statistic Service of Greece. Statistical analysis was done for the years 1956, 1960, 1970, 19S0and 1990-95,concerningthe total numberof deaths, age, sex and type of population. There wss a gradusl increase in of deaths caused by hypertension (absolute numberand desthsper ICOOOO people)duringthe years 1956,1960, 1970and 1980while there were no characteristicschangesduring the years 1990-1995.‘f%emost commoncsuse of death was the hypertensivecardiopatbywith or witbout nephmpsthy, while the hypertensivenepbmpatby alone held onfy a srrudl proportion. Suddendeath in pstientswith secondaryhypertensionwera rare or absent while there was a certain proportion of sudden destbs in patients with essential hypatension, particularly in elderly. This distributionwss not substantiallycbangedduringall snalysedyears. AUtypesof ‘hypertensive’destbswere more frequentin the women md tle elderly, but in younger men all these types were. more frequentcomparedto the women. On the contrary, there were no significant differences in the number of desths, caused by ‘hypertensivedisease’,concerningthe type of population(urbanor nml). Weconcludethst in Greece thers were a) a smsll increasein deaths from hypertensionbetween 1956-1980snd a platesu after this, b) no differencesrelated with the typs of populationsnd c) deaths fromhyprtmsion were more frequentin the elderly and in the womenwhile, in youngerpeople,in men.

FaEundesVGA*, SanjuIianiAF, MaccarielloER*, Torres MRSG,RodriguezMLG, NogueiraJF,BazhurriD~ Esteves VF, Sturm A, Francischetti EA*. Hypertension Clinic, CLINEX,Rio de JaneiroState University,RJ, Brazil. The aim of this study was to analyse in Ob and nOb hypertensive, therelashionshipbetweenseromlipids,fasting insulirrernia(Ins) and hypertension.Twentynine Ob and 20 nObhypertemives,age 54.5f2.9y(nOb)and50.3f2.1y(Ob), were evaluated afier 2 weeks of washout. The BMJ was 32~0,9vs24f0.3, @.0001forObandnOb, respectively.DBP and MBP were bigherin Ob than innOb (102fl.4 vs 96~1.5 mmHg, p<.01; 12ltl.6 VS116fl .5mmHg, p=.02, respectively).The serumlipids(Ob vs nOb)were: 236f12 vs 230fll nrg/dlfor total cholest;43f2.1 vs 51f3.3 mg/dlfor HDL-C(p<.Ol); 15~11 vs 151f9mg/dlfor LDL-Cand 155 vs 121rng/dlfor triglycerides(Trig]). ApoAwas 129f4mg/ dl in Ob and 144f6 mgldl in nOb, p=.03. ApoB and Lp(a) weregmxderinObthaninnOb(126~8vs 104f6mg/dl,p=,04; 30f4 vs 20f2 nrg/dl, p=.o5, respectively). There was no dir%rencein oral glucosetolerancetest betweenthe groups, whereasfastinginsulirtetniahas showed higherlevelsin Ob (11.4fl.3mU/ml) when compared to nOb (7.8~.9mU/ ml,p<.01). TherewaspositivecomelationsbctweenBMIand Ins levels(r =0.5;p<.001),ketween Ins and Trigl (r =.5, p=. 01), and betweenIns vs Apo B and Lp(a) (r =.4, p=.02; r =.5, p<.01, respectively). Weconcludedthat our Obhypertertsiveshavemultiplelipid disordersincludinghypmtriglyceridert@greater Lp(a) and Apo B levelsand reduction in HDL-C and Apo ~ when comparedto nOb hypertensive. Fasting insulinemia may playa causalrelationshipm some of these lipiddisorders. KeyWords: o-, bW’=@=J“ q Lp(a), ApoB, insulim

KeyWords:

Hyptmsion,

Sudden desth,

Hypertensive

cardiopstby

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UWULR4SENSITIVITYAND 24-HOURBLOODPRESSURE PROFILE ff! LEAN AND OBESE NORMOTENStVES:

HYPERTENSION AND OTHERRfSK FACTORSfN PATfENT!j WITH LACUNAR (SINGLE OR MULTIPLE) AND NON: LACUNARCEREBRALfNFARCTS. S. Scolveri,MC. BarufE,A. Fortini,C. Cap@letti. Hypertensionand StrokeUnit, San Giovannidi Dio Hospital,Firenzei Italy. Pathogemesisof cerebralIacunarinfarctsis still incompletel~ established.We investigatedwbether vasculsr risk factors differed amongpatientswith Iacunarand non-lacunarinfarcts.Moreover,wd examinedthe hypthcsis that multiplelacunar infarctshave different pathogenesisfrom single Iacunsrand nrm-lacunarinfarcts. For this purpose,we evaluated136patientsconsecutivelyadmittedfor a firstever episodeof minor stroke to our communityHospital.Univariate and multivariate logistic regression snalysis were performed on vascularrisk factorsin the 62 patientswith non Iacunsrand in the 74 patients with Iacunarinfarcts,both definedon clinical and CT scan data. The 35 patients with multiple Iacunar infarcts were further compared with those with single infarct (n=97). No significant differencesin the variablesexamined wereobservedlwtweenpatients with Iacumrand non-lacunarinfarcts.Univariateanalysisshowedthat patients with multiple Iacunar infarcts had a significantly bigher prevalenceof familyhistoryfor hypertension,RX cardiomegaly,CT Ieukoaraiosisand higher values of admission DBP and SBP than patients with single Iacunsr or non-lacunar infarct. Multivariate logistic regression analysis selected CT Ieukoaraiosis, RX cardiomegalyand admission DBP as independent predictors of multipleIacumr infarcts. The present data indicatethat in patients with first-everminorstrokethe risk factorsprofilediffersaccordingto the evidenceof single or multiple Iacunar infarcts on CT scan. In particular, the higher values of admission DBP and the higher prevalenceof organ-damagesstrictly linked to hypertension(RX cardiomegalyand CT Ieukoaraiosis)suggestthat hypertensionplays a more importantrole in the pathogenesisof multiplelacumr infarcts (probablythrough a “pure” small vessel hypertensivevasculopathy) than in singlecerebralinfarct

fNFLUENCE OF FAMfLY HISTORYOF HYPERTENSION. AM_Gmdi*, G.Gaudio, P.Zanzi, A.Facbinetti, L.Ceriani, A. Bertolini,L.Guasti,A.Venco.Depmtmentof Clinicsl snd Biologicsf Sciences-U Facultyof Medicine- Universityof Pavia- Varese-Italy In order to evafuate the possible influence of family history of hypertensionon insulin sensitivityin nornrotensives(N),we studied insulin(1)and C-peptide(Cp) respomwsto an orsl glucosetolerance test (OGTT) in Iesn (L, BMIs 2SK#m2))and obese (O, BMI? 30 Kg/m2,sO with upper bodyobesity)N (mesn age 41-Myears) with (1?+,1 or 2 parents hypertensive)and without (F-, both parents normotensive)familybistoryof hypertension:30 LNF-, 35 LNF+, 22 ONF-, 25 ONF+. The 4 groupswere comparableas regardsex, age and BMI (LNF- 23.3?1.3, LNF+ 23.l~L5, ONF- 3t.4fi.4, ONF+ 31.6+1.2Kglm2;LN vs ON p
insulinsensitivity,familyhistoryof hypertension, obesity,24-brmrbloodpressure

KeyWords:

Hypertension,Stroke,Lacunarcerebralinfarcts

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