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Left ventricular structure and function predict clinical cardiovascular risk in prehypertension: the strong heart study
AJH–May 2004 –VOL. 17, NO. 5, PART 2
Results: Office BP was 134.2⫾17.6/81.1⫾9.7 mmHg, daytime ambulatory BP was 132.8⫾13.8/78.3⫾8.7 mmHg. Based on office BP 77 (40,5%) had BP above reference levels (140/90 mmHg). Based on daytime BP 81 (42,6%) were above reference levels. Medications were as follows: -blockers 102 (53,7%), calcium antagonists 38 (20,0%), ACEinhibitors 48 (25,3%), diuretics 73 (38,4%), other antihypertensives 31(16,3%). For comparison 176 (92,6%) were on aspirin, 161 (84,7%) were on statins. The total cholesterol level was 4.75⫾0.65 mmol/L; 66 (34,7%) had cholesterol levels above 5,0 mmol/L (the european reference level during the period of inclusion). Before revascularisation 116 (61,0%) were smokers and after the procedure 54 (28,0%) were still smoking. BMI were 27,3⫾4,1 and 136 (71,0%) had a BMIⱖ25 and 45 (23,7%) had a BMIⱖ30. Conclusion: Inadequate blood pressure control in patients after coronary revasularisation is a problem af a magnitude exceeding that of poor cholesterol control. Patients whith ischemic heart disease, who undergo revascularisation therapy, need more attention to blood pressure control and more aggressive medical threatment. The same considerations might be done regarding hypercholesterolemia, tobacco consumption and overweight. Key Words: Ambulatory BP, Revascularisation, Coronary Heart Disease
OR-67 HYPERTENSIVE CHRONIC HEART FAILURE – VALUE OF PLASMA SEMICARBAZIDE-SENSITIVE AMINE OXIDASE AS AN USEFUL TOOL FOR THE DIAGNOSIS AND FOLLOW-UP OF PATIENTS WITH LEFT VENTRICULAR SYSTOLIC DYSFUNCTION Luiz F. Menezes Falcao, Fausto Pinto, Fatima Veiga, Luciano P. Ravara, Peter A. van Zwieten. Cardiology/Internal Medicine, University Hospital Santa Maria, Lisbon, Portugal; Cardiology, University Hospital Santa Maria, Lisbon, Portugal; Cardiology, University Hospital Santa Maria, Lisbon, Portugal; Cardiology/Internal Medicine, University Hospital Santa Maria, Lisbon, Portugal; Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands. The purpose of the study was to assess the importance of plasma semicarbazide-sensitive amine oxidase (SSAO) as a diagnostic tool in hypertensive CHF in a sample of P with LV systolic dysfunction and to perform a 6 month follow-up of two sub-groups of 34 P for evaluating the meaning of the SSAO modification throughout this period. Plasma SSAO was measured by HPLC in a controlled hypertensive sample of 68 P with dilated cardiomyopathy in NYHA class III-IV and EF ⱕ 40%, measured by echocardiography (Simpson’s method) [mean age (⫾SD) 65.79⫾11.78 y ; M: 55 (88.88%); F:13 (19.12%)] and 26 normal controls [mean age (⫾SD) 58.15⫾14.07 y; M: 10 (38.46%) F:16 (61.54%)]. ANP and BNP were measured with commercial IRMA kits and ET-1 by RIA. To determine the relation between these variables a statistical analysis was done by Student’s t test and Pearson’s correlation.The sample was randomly subdivided in 2 subgroups of 34 P, submitted either to an ARB-AT 1 or an ACE inhibitor. SSAO was measured in both subsamples and correlated with clinical, functional and neurohormonal parameters through a follow-up period of 6 M. In the patients’ sample, the mean EF was 33.43⫾6.52% and in the C was 61.96 ⫾3.53% (p⫽0.000). A statistically significant difference was found between P. and C. The mean SSAO (mU/l) was 563.9 ⫾ 241.82 in P and 454.92⫾166.35 in the C(p⫽0.03). The difference was also statistically significant. The mean ANP (pmol/l) in the patients was 30.32 ⫾ 25.97 and in the C was 11.18 ⫾ 7.92(p⫽0.000). The mean BNP (pmol/l) was 44.78 ⫾ 54.36 and in the C was 7.12 ⫾ 8.28 (p⫽0.000).The mean ET-1 (pg/ml) in the P.was 5.02 ⫾ 2.88 and in the controls 2.37 ⫾1.49
ORALS: Hypertension and the Heart
29A
(p⫽ 0.000). Plasma SSAO was correlated with ANP (r⫽0.347; p⫽0.004), BNP (r⫽0.343; p⫽0.004) and ET-1 (r⫽0.386; p⫽0.001). At the 6 months a lower value of SSAO was verified in the ARB group (-165.88 mU/l), (p⫽0.0001), and no consistent correlations were found. The increase of the plasma SSAO values reached statistically significant difference between P and C. A positive correlation was found between SSAO and ANP, BNP and ET-1 in the baseline. SSAO can be considered as an useful tool for the diagnosis of hypertensive CHF with LV systolic dysfunction. Key Words: Plasma Semicarbazide-Sensitive Amine Oxidase, Brain Natriuretic Peptide, Endothelin-1
OR-68 LEFT VENTRICULAR STRUCTURE AND FUNCTION PREDICT CLINICAL CARDIOVASCULAR RISK IN PREHYPERTENSION: THE STRONG HEART STUDY Marilyn B Lawrence Wright, Richard B Devereux, Mary J Roman, Marcello Chinali, Lyle G Best, James M Galloway, Richard R Fabsitz, Ying Zhang, Elisa T Lee, Barbara V Howard. Medicine/Cardiology, Weill Cornell Medical Center, New York, NY; Missouri Breaks Industries Research, Inc., Timber Lake, SD; University of Arizona, Flagstaff, AZ; National Heart Lung and Blood Institute, Bethesda, MD; University of Oklahoma Health Sciences Center, Oklahoma City, OK; MedStar Research Institute, Hyattsville, MD. Available data suggest that clinical cardiovascular (CV) risk is increased in adults with prehypertension as defined by JNC 7. Data is limited on whether abnormalities of left ventricular (LV) structure and function are of prognostic significance in prehypertension. We assessed LV structure and function, arterial stiffness and incident CV morbidity and mortality in 859 Strong Heart Study participants with prehypertension but no overt clinical CV disease, over 36 ⫾ 14 months. Participants were 59⫾8 in age, 62% female, 49% diabetic, 31% current smokers. Mean body mass index was 31⫾6, blood pressure 128/75 ⫾ 6/8, LDL 120⫾35 and HDL 41⫾14. 21% had LV hypertrophy (LV mass/height2.7 ⬎49.2g/m2.7 in men, ⬎46.7g/m2.7 in women), 11% low ejection fraction (⬍54.5%), 9% low myocardial contractility (stresscorrected midwall shortening ⬍89.2%) and 11% high arterial stiffness (pulse pressure/stroke index ⬎1.88 mmHg/ml/m2). Controlling for age, gender, diabetes, body mass index, smoking and study center, fatal and nonfatal CV event rates were higher in participants with LV hypertrophy and those with low ejection fraction. CV death rates were higher in participants with LV hypertrophy and those with high arterial stiffness. All-cause mortality was higher in participants with LV hypertrophy (Table). Echocardiographic abnormalities of LV structure and systolic function and arterial stiffness, predict higher CV mortality and less so higher CV morbidity and all-cause mortality in Strong Heart Study participants with prehypertension. Preclinical Disease and Cardiovascular Morbidity and Mortality in Prehypertension LV hypertrophy HR
Myocardial contractility HR
Ejection fraction HR
Arterial stiffness HR
1.13 [0.54–2.38] CV event 1.97 ␣[1.09–3.55] 1.41 [0.71–2.81] 2.25 ␣ [1.22–4.15] (N ⫽ 67) 2.36 [0.87–6.42] 2.79 ␣ [1.08–7.25] CV death 2.88 ␣[1.15–7.24] 1.86 [0.63–5.44] (N ⫽ 30) 1.18 [0.61–2.27] 1.64 [0.93–2.88] All-cause death 1.89 ␣[1.13–3.16] 1.04 [0.53–2.06] (N ⫽ 95)
* 95% CI ␣: p ⬍ 0.05, : p ⬍ 0.01, ␦: p ⬍ 0.001
Key Words: Prehypertension, Cardiac Structure and Function, Cardiovascular Morbidity and Mortality
Results: Office BP was 134.2⫾17.6/81.1⫾9.7 mmHg, daytime ambulatory BP was 132.8⫾13.8/78.3⫾8.7 mmHg. Based on office BP 77 (40,5%) had BP above reference levels (140/90 mmHg). Based on daytime BP 81 (42,6%) were above reference levels. Medications were as follows: -blockers 102 (53,7%), calcium antagonists 38 (20,0%), ACEinhibitors 48 (25,3%), diuretics 73 (38,4%), other antihypertensives 31(16,3%). For comparison 176 (92,6%) were on aspirin, 161 (84,7%) were on statins. The total cholesterol level was 4.75⫾0.65 mmol/L; 66 (34,7%) had cholesterol levels above 5,0 mmol/L (the european reference level during the period of inclusion). Before revascularisation 116 (61,0%) were smokers and after the procedure 54 (28,0%) were still smoking. BMI were 27,3⫾4,1 and 136 (71,0%) had a BMIⱖ25 and 45 (23,7%) had a BMIⱖ30. Conclusion: Inadequate blood pressure control in patients after coronary revasularisation is a problem af a magnitude exceeding that of poor cholesterol control. Patients whith ischemic heart disease, who undergo revascularisation therapy, need more attention to blood pressure control and more aggressive medical threatment. The same considerations might be done regarding hypercholesterolemia, tobacco consumption and overweight. Key Words: Ambulatory BP, Revascularisation, Coronary Heart Disease
OR-67 HYPERTENSIVE CHRONIC HEART FAILURE – VALUE OF PLASMA SEMICARBAZIDE-SENSITIVE AMINE OXIDASE AS AN USEFUL TOOL FOR THE DIAGNOSIS AND FOLLOW-UP OF PATIENTS WITH LEFT VENTRICULAR SYSTOLIC DYSFUNCTION Luiz F. Menezes Falcao, Fausto Pinto, Fatima Veiga, Luciano P. Ravara, Peter A. van Zwieten. Cardiology/Internal Medicine, University Hospital Santa Maria, Lisbon, Portugal; Cardiology, University Hospital Santa Maria, Lisbon, Portugal; Cardiology, University Hospital Santa Maria, Lisbon, Portugal; Cardiology/Internal Medicine, University Hospital Santa Maria, Lisbon, Portugal; Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands. The purpose of the study was to assess the importance of plasma semicarbazide-sensitive amine oxidase (SSAO) as a diagnostic tool in hypertensive CHF in a sample of P with LV systolic dysfunction and to perform a 6 month follow-up of two sub-groups of 34 P for evaluating the meaning of the SSAO modification throughout this period. Plasma SSAO was measured by HPLC in a controlled hypertensive sample of 68 P with dilated cardiomyopathy in NYHA class III-IV and EF ⱕ 40%, measured by echocardiography (Simpson’s method) [mean age (⫾SD) 65.79⫾11.78 y ; M: 55 (88.88%); F:13 (19.12%)] and 26 normal controls [mean age (⫾SD) 58.15⫾14.07 y; M: 10 (38.46%) F:16 (61.54%)]. ANP and BNP were measured with commercial IRMA kits and ET-1 by RIA. To determine the relation between these variables a statistical analysis was done by Student’s t test and Pearson’s correlation.The sample was randomly subdivided in 2 subgroups of 34 P, submitted either to an ARB-AT 1 or an ACE inhibitor. SSAO was measured in both subsamples and correlated with clinical, functional and neurohormonal parameters through a follow-up period of 6 M. In the patients’ sample, the mean EF was 33.43⫾6.52% and in the C was 61.96 ⫾3.53% (p⫽0.000). A statistically significant difference was found between P. and C. The mean SSAO (mU/l) was 563.9 ⫾ 241.82 in P and 454.92⫾166.35 in the C(p⫽0.03). The difference was also statistically significant. The mean ANP (pmol/l) in the patients was 30.32 ⫾ 25.97 and in the C was 11.18 ⫾ 7.92(p⫽0.000). The mean BNP (pmol/l) was 44.78 ⫾ 54.36 and in the C was 7.12 ⫾ 8.28 (p⫽0.000).The mean ET-1 (pg/ml) in the P.was 5.02 ⫾ 2.88 and in the controls 2.37 ⫾1.49
ORALS: Hypertension and the Heart
29A
(p⫽ 0.000). Plasma SSAO was correlated with ANP (r⫽0.347; p⫽0.004), BNP (r⫽0.343; p⫽0.004) and ET-1 (r⫽0.386; p⫽0.001). At the 6 months a lower value of SSAO was verified in the ARB group (-165.88 mU/l), (p⫽0.0001), and no consistent correlations were found. The increase of the plasma SSAO values reached statistically significant difference between P and C. A positive correlation was found between SSAO and ANP, BNP and ET-1 in the baseline. SSAO can be considered as an useful tool for the diagnosis of hypertensive CHF with LV systolic dysfunction. Key Words: Plasma Semicarbazide-Sensitive Amine Oxidase, Brain Natriuretic Peptide, Endothelin-1
OR-68 LEFT VENTRICULAR STRUCTURE AND FUNCTION PREDICT CLINICAL CARDIOVASCULAR RISK IN PREHYPERTENSION: THE STRONG HEART STUDY Marilyn B Lawrence Wright, Richard B Devereux, Mary J Roman, Marcello Chinali, Lyle G Best, James M Galloway, Richard R Fabsitz, Ying Zhang, Elisa T Lee, Barbara V Howard. Medicine/Cardiology, Weill Cornell Medical Center, New York, NY; Missouri Breaks Industries Research, Inc., Timber Lake, SD; University of Arizona, Flagstaff, AZ; National Heart Lung and Blood Institute, Bethesda, MD; University of Oklahoma Health Sciences Center, Oklahoma City, OK; MedStar Research Institute, Hyattsville, MD. Available data suggest that clinical cardiovascular (CV) risk is increased in adults with prehypertension as defined by JNC 7. Data is limited on whether abnormalities of left ventricular (LV) structure and function are of prognostic significance in prehypertension. We assessed LV structure and function, arterial stiffness and incident CV morbidity and mortality in 859 Strong Heart Study participants with prehypertension but no overt clinical CV disease, over 36 ⫾ 14 months. Participants were 59⫾8 in age, 62% female, 49% diabetic, 31% current smokers. Mean body mass index was 31⫾6, blood pressure 128/75 ⫾ 6/8, LDL 120⫾35 and HDL 41⫾14. 21% had LV hypertrophy (LV mass/height2.7 ⬎49.2g/m2.7 in men, ⬎46.7g/m2.7 in women), 11% low ejection fraction (⬍54.5%), 9% low myocardial contractility (stresscorrected midwall shortening ⬍89.2%) and 11% high arterial stiffness (pulse pressure/stroke index ⬎1.88 mmHg/ml/m2). Controlling for age, gender, diabetes, body mass index, smoking and study center, fatal and nonfatal CV event rates were higher in participants with LV hypertrophy and those with low ejection fraction. CV death rates were higher in participants with LV hypertrophy and those with high arterial stiffness. All-cause mortality was higher in participants with LV hypertrophy (Table). Echocardiographic abnormalities of LV structure and systolic function and arterial stiffness, predict higher CV mortality and less so higher CV morbidity and all-cause mortality in Strong Heart Study participants with prehypertension. Preclinical Disease and Cardiovascular Morbidity and Mortality in Prehypertension LV hypertrophy HR
Myocardial contractility HR
Ejection fraction HR
Arterial stiffness HR
1.13 [0.54–2.38] CV event 1.97 ␣[1.09–3.55] 1.41 [0.71–2.81] 2.25 ␣ [1.22–4.15] (N ⫽ 67) 2.36 [0.87–6.42] 2.79 ␣ [1.08–7.25] CV death 2.88 ␣[1.15–7.24] 1.86 [0.63–5.44] (N ⫽ 30) 1.18 [0.61–2.27] 1.64 [0.93–2.88] All-cause death 1.89 ␣[1.13–3.16] 1.04 [0.53–2.06] (N ⫽ 95)
* 95% CI ␣: p ⬍ 0.05, : p ⬍ 0.01, ␦: p ⬍ 0.001
Key Words: Prehypertension, Cardiac Structure and Function, Cardiovascular Morbidity and Mortality