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Racial and gender differences in coronary vasoreactivity among normotensive nondiabetic subjects with chest pain
AJH–APRIL 2000 –VOL. 13, NO. 4, PART 2
POSTERS: Epidemiology/Special Populations
hypertension control and therefore increased attention should be given to these patients. Key Words: Predictor; hypertension; control G003 CARDIOVASCULAR RISK FACTORS, DRUG TREATMENT AND HYPERTENSION CONTROL AMONG PHARMACOLOGICALLY TREATED HYPERTENSIVE PATIENTS IN SPANISH PRIMARY CARE CENTERS R. Jimenez, M.J. Sierra, T. Saez, and P. Carrasco, and A. Gil.
Table 1.
%*
Angiotensin-converting Enzyme Inhibitors
56
Calcium Antagonists
31.5
Diuretics
29.2
Beta-blockers Alfa-blockers
11.2 2.5
More frequently used drugs Enalapril Captopril Lisinopril Nifedipine Amlodipine Hydrochlorothiazide Hydrochlorothiazide ⫹ amiloride Atenolol Doxazosin
*The sum is more of a 100% as some patients take more than one drug.
Conclusions: The prevalence of CVRF is high among Spanish hypertensive patients. Modern antihypertensive drugs like ACE inhibitors and calcium antagonist are the more frequently used, most of the times as monotherapy. Hypertension control is only reached by 30% of the treated patients. Possibly the Spanish primary care physician is not sufficiently aggressive in the management of this pathology. Key Words: Risk factors; antihypertensive drugs; hypertension; control
To assess the prevalence of cardiovascular risk factors, the antihypertensive drugs used and the blood pressure control among pharmacologically treated hypertensive patients in Spanish Primary Care Centers. This study has a cross-sectional design. Information was collected by means of a postal questionnaire sent to 24.000 physicians working in Spanish Primary Care Centers during 1996. We solicited each physician data about two, randomly selected, of his hypertensive patients that were receiving antihypertensive drugs. The variables included in the questionnaire were: gender, age, educational and socioeconomic status and the presence of cardiovascular risk factors (obesity, smoking habits, diabetes, dyslipidemia and physical activity). Information was also collected about the blood pressure and antihypertensive drugs used by the time the questionnaire was filled and other relevant items of the medical history (duration of HBP, comorbid conditions, organ damage, family history). Hypertension control is defined as SBP ⬍ 140 mmHg and DBP ⬍ 90 mmHg. Results: 2036 (8.49%) physicians answered the questionnaire, so finally 4052 patients were analyzed. The mean age is 59.9 (SD 11.6), 2045 are females and 1963 males. 11.7% of the patients had none of the cardiovascular risk factors (CVRF) studied, 33.8% had one, 35.3% two, and 29.2% three or more. The most prevalent CVRF was sedentarismo (71.2%), followed by obesity (44.8%), smoking (24.1%), diabetes (16.1%) and dyslipidemia (10.8%). Most of the hypertensive patients (77%) reduced the sodium intake in the diet. The drugs used are described in Table 1. 82.8% of the patients were treated with a single drug, 14.9% with two and 2.3% with three or more. Only 29.9% of the patients reached blood pressure control.
Type of antihypertensive drug
253A
% 36.7 25.6 12.1 29.6 21.1 41.2
70 96
G004 RACIAL AND GENDER DIFFERENCES IN CORONARY VASOREACTIVITY AMONG NORMOTENSIVE NONDIABETIC SUBJECTS WITH CHEST PAIN J.L. Houghton*, S.A. Fein, M.T. Torosoff, P.A. Kuhner, V.E. Smith. Albany Medical College, Albany, NY Work in the forearm circulation has shown that, compared with whites, healthy blacks have reduced vasodilation in response to NO-dependent and -independent stimuli. The purpose of our study was to investigate whether such differences exist in the coronary circulation among normotensive, nondiabetic subjects. Using acetylcholine (ACh) and adenosine (Aden), coronary blood flow (CBF) responses were studied in 8 female and 11 male African Americans (AA) and in 16 female and 27 male Caucasians (CA). Dose response curves and the peak ACh response as a % of the peak Aden response were compared. In response to ACh, women had greater peak (215 ⫾ 13 vs 182 ⫾ 19%, p⫽0.04) and submaximal (10⫺7) (74 ⫾ 10 vs 48 ⫾ 6%, p⫽0.015) increases in CBF when compared with men. No significant racial differences were found though white women had the highest (255 ⫾ 27%) and black men had the lowest responses (171 ⫾ 33%, p⫽0.055). There were no gender differences in CBF responses to Aden (215 ⫾ 13 vs 223 ⫾ 10%) though black subjects had greater responses when compared with white (244 ⫾ 16 vs 209 ⫾ 9%, p⫽0.04). CBF responses to ACh as a % of responses to Aden were increased among women as compared to men (108 ⫾ 10 vs 86 ⫾ 10%, p⫽0.016). There were no significant racial differences in this parameter though white women had the highest (113 ⫾ 10%) and black men had the lowest comparative responses (77 ⫾ 10%). In conclusion, we found that among normotensive, nondiabetic subjects, women display better absolute and comparative CBF responses to ACh. Black subjects demonstrate greater responses to Aden. Thus, race and gender differentially affect NO-dependent andindependent pathways involved in control of the coronary microcirculation. Key Words: Microcirculation; vasoreactivity; gender; ethnicity
POSTERS: Epidemiology/Special Populations
hypertension control and therefore increased attention should be given to these patients. Key Words: Predictor; hypertension; control G003 CARDIOVASCULAR RISK FACTORS, DRUG TREATMENT AND HYPERTENSION CONTROL AMONG PHARMACOLOGICALLY TREATED HYPERTENSIVE PATIENTS IN SPANISH PRIMARY CARE CENTERS R. Jimenez, M.J. Sierra, T. Saez, and P. Carrasco, and A. Gil.
Table 1.
%*
Angiotensin-converting Enzyme Inhibitors
56
Calcium Antagonists
31.5
Diuretics
29.2
Beta-blockers Alfa-blockers
11.2 2.5
More frequently used drugs Enalapril Captopril Lisinopril Nifedipine Amlodipine Hydrochlorothiazide Hydrochlorothiazide ⫹ amiloride Atenolol Doxazosin
*The sum is more of a 100% as some patients take more than one drug.
Conclusions: The prevalence of CVRF is high among Spanish hypertensive patients. Modern antihypertensive drugs like ACE inhibitors and calcium antagonist are the more frequently used, most of the times as monotherapy. Hypertension control is only reached by 30% of the treated patients. Possibly the Spanish primary care physician is not sufficiently aggressive in the management of this pathology. Key Words: Risk factors; antihypertensive drugs; hypertension; control
To assess the prevalence of cardiovascular risk factors, the antihypertensive drugs used and the blood pressure control among pharmacologically treated hypertensive patients in Spanish Primary Care Centers. This study has a cross-sectional design. Information was collected by means of a postal questionnaire sent to 24.000 physicians working in Spanish Primary Care Centers during 1996. We solicited each physician data about two, randomly selected, of his hypertensive patients that were receiving antihypertensive drugs. The variables included in the questionnaire were: gender, age, educational and socioeconomic status and the presence of cardiovascular risk factors (obesity, smoking habits, diabetes, dyslipidemia and physical activity). Information was also collected about the blood pressure and antihypertensive drugs used by the time the questionnaire was filled and other relevant items of the medical history (duration of HBP, comorbid conditions, organ damage, family history). Hypertension control is defined as SBP ⬍ 140 mmHg and DBP ⬍ 90 mmHg. Results: 2036 (8.49%) physicians answered the questionnaire, so finally 4052 patients were analyzed. The mean age is 59.9 (SD 11.6), 2045 are females and 1963 males. 11.7% of the patients had none of the cardiovascular risk factors (CVRF) studied, 33.8% had one, 35.3% two, and 29.2% three or more. The most prevalent CVRF was sedentarismo (71.2%), followed by obesity (44.8%), smoking (24.1%), diabetes (16.1%) and dyslipidemia (10.8%). Most of the hypertensive patients (77%) reduced the sodium intake in the diet. The drugs used are described in Table 1. 82.8% of the patients were treated with a single drug, 14.9% with two and 2.3% with three or more. Only 29.9% of the patients reached blood pressure control.
Type of antihypertensive drug
253A
% 36.7 25.6 12.1 29.6 21.1 41.2
70 96
G004 RACIAL AND GENDER DIFFERENCES IN CORONARY VASOREACTIVITY AMONG NORMOTENSIVE NONDIABETIC SUBJECTS WITH CHEST PAIN J.L. Houghton*, S.A. Fein, M.T. Torosoff, P.A. Kuhner, V.E. Smith. Albany Medical College, Albany, NY Work in the forearm circulation has shown that, compared with whites, healthy blacks have reduced vasodilation in response to NO-dependent and -independent stimuli. The purpose of our study was to investigate whether such differences exist in the coronary circulation among normotensive, nondiabetic subjects. Using acetylcholine (ACh) and adenosine (Aden), coronary blood flow (CBF) responses were studied in 8 female and 11 male African Americans (AA) and in 16 female and 27 male Caucasians (CA). Dose response curves and the peak ACh response as a % of the peak Aden response were compared. In response to ACh, women had greater peak (215 ⫾ 13 vs 182 ⫾ 19%, p⫽0.04) and submaximal (10⫺7) (74 ⫾ 10 vs 48 ⫾ 6%, p⫽0.015) increases in CBF when compared with men. No significant racial differences were found though white women had the highest (255 ⫾ 27%) and black men had the lowest responses (171 ⫾ 33%, p⫽0.055). There were no gender differences in CBF responses to Aden (215 ⫾ 13 vs 223 ⫾ 10%) though black subjects had greater responses when compared with white (244 ⫾ 16 vs 209 ⫾ 9%, p⫽0.04). CBF responses to ACh as a % of responses to Aden were increased among women as compared to men (108 ⫾ 10 vs 86 ⫾ 10%, p⫽0.016). There were no significant racial differences in this parameter though white women had the highest (113 ⫾ 10%) and black men had the lowest comparative responses (77 ⫾ 10%). In conclusion, we found that among normotensive, nondiabetic subjects, women display better absolute and comparative CBF responses to ACh. Black subjects demonstrate greater responses to Aden. Thus, race and gender differentially affect NO-dependent andindependent pathways involved in control of the coronary microcirculation. Key Words: Microcirculation; vasoreactivity; gender; ethnicity