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Small artery compliance improves with comprehensive cardiac rehabilitation program in deconditioned men with coronary artery disease
144A
POSTERS: Arterial Structure and Compliance
AJH–May 2003–VOL. 16, NO. 5, PART 2
P-297 IS INCREASED ARTERIAL STIFFNESS THE MAIN CARDIOVASCULAR ABNORMALITY IN PATIENTS WITH “WHITE COAT NORMOTENSION”?
P-298 RELATIONSHIP BETWEEN HEMOGLOBLIN A1C AND ARTERIAL ELASTICITY INDICES AMONG DIABETIC WOMEN
Olivier Ormezzano, Jean-Philippe Baguet, Patrice Franc¸ ois, Jean-Louis Quesada, He´ le`ne Pierre, Jean-Michel Mallion. Cardiology and Hypertension Department, University Hospital, Grenoble, France; Public Health Department, University Hospital, Grenoble, France.
Puja K Mehta, Vishal Arora, Mindy Gentry, Dena Jupin, Katarzyna Sadurska, L. Michael Prisant. Hypertension & Clinical Pharmacology, Department of Medicine, Medical College of Georgia, Augusta, GA.
Some studies have shown that patients with “ white coat normotension” (WCNT) (i.e. high ambulatory blood pressure but normal office blood pressure) present target organe damage. The aim of this study was to compare the cardiovascular characteristics between patients with sustained normotension (normal office and ambulatory BP) (NT) with patients with WCNT, taking the level of the office BP into account. Sixty nine healthy subjects with normal office BP (BP ⬍ 140/90 mmHg) were recruited. A 24-hour ambulatory BP monitoring (ABPM) was assessed. A 135/85 mmHg threshold was chosen to define ambulatory daytime hypertension (JNC VI). ABPM results distinguished 18 WCNT and 50 NT with no difference for age and sex. WCNT patients have an increased arterial stiffness evaluated by carotid-femoral pulse wave velocity measurement (PWV) in comparison with NT (respectively 9.58 ⫾1.55 m/s vs. 8.59 ⫾1.38 m/s p⫽0.02), but a similar left ventricular mass index (LVMI) and carotid intima-media thickness (IMT) evaluated by ultrasonography. Systolic and diastolic BP (SBP and DBP) of WCNT were significantly higher than those of NT: 94% of WCNT have an office SBP of over 120 mmHg as against just 43% of NT. When NT and WCNT with office BP readings of over 120 mm Hg were compared, no differences were detected; in particular, these two groups had the same PWV (respectively 9.1⫾1.6 m/s vs. 9.6⫾1.6 m/s, p⫽0.25). In contrast, the PWV was significantly lower in normotensive subjects with an office SBP lower than 120 mmHg (PWV ⫽ 8.1⫾0.9 m/s) than in those with an office SBP of over 120 mm Hg (either NT or WCNT, p⬍0.05). In conclusion, when WCNT were compared with NT with a comparable office BP, their degree of cardiovascular damage is actually similar.
Diabetes mellitus is an important risk factor among women. Elevated glucose alters blood vessels and impairs nitric oxide bioactivity. Vascular diseases account for 80% of all diabetic mortality. Arterial compliance should be decreased in diabetes, but it is unclear as to whether there is a relationship between glycosylated hemoglobin and arterial elasticity in diabetic women. To evaluate this question, 60 women with diabetes mellitus had a hemoglobin A1c and arterial elasticity determined. Three measurements of arterial elasticity indices after a period of rest were acquired at one minute intervals supine using the HDI/Pulsewave™ Cardiovascular Profiling System Model CR-2000, Hypertension Diagnostics Inc., Eagan, MN). This device utilizes a modified Windkessel model for determining large and small elasticity indices. Blood pressure was measured in the left arm using an appropriate size cuff. The arterial sensor was placed over the right radial artery using a wrist stabilizer, and the arterial wave adjusted to the highest relative signal strength. The study population consisted of 31 black and 29 white women. Population characteristics included: age, 50.6 ⫾ 12.7 years; duration of diabetes, 11.1 ⫾ 8.1 years; hemoglobin A1c, 8.9 ⫾ 2.5%; BMI, 33.5 ⫾ 8.2 kg/m2; systolic BP, 146 ⫾ 18 mmHg; diastolic BP, 82 ⫾ 11 mmHg; large artery elasticity (C1), 10.6 ⫾ 3.4 ml/mmHg X 10; and small artery elasticity (C2), 3.8 ⫾ 1.3 ml/mmHg X 100. 85% were hypertensive, 57% had a lipid disorder, and 15% smoked. Treatment included an ACE inhibitor (57%), an HMG Co-A reductase inhibitor (43%), insulin (72%), and aspirin (14%). Age significantly correlated with large artery elasticity (r⫽-0.385, p⫽ 0.002) and small artery elasticity (r⫽-0.259, p⫽0.046). Self-reported duration of diabetes or hypertension did not show a relationship with either large or small artery elasticity. Hemoglobin A1c correlated with small artery elasticity (r⫽-0.279, p⫽ 0.031), but not large artery elasticity (r⫽-0.044, p⫽ 0.74). The strongest association was between weight and small artery elasticity (r⫽⫹0.45, p⫽0.0003). Thus, among diabetic women, age, weight, and hemoglobin A1c correlate with small artery elasticity.
Key Words: Hypertension, White coat normotension, Ambulatory blood pressure monitoring
Key Words: Diabetes mellitus, Hypertension, Arterial elasticity
P-299 SMALL ARTERY COMPLIANCE IMPROVES WITH COMPREHENSIVE CARDIAC REHABILITATION PROGRAM IN DECONDITIONED MEN WITH CORONARY ARTERY DISEASE Mohammad A Rafey, Jonathan P Greenblatt, Patricia Brownstein, Lorene Bruno, Robert A Phillips. Cardiovascular Institute, The Mount Sinai School of Medicine, New York, NY; Department of Medicine, Lenox Hill Hospital, New York, NY. Objective: Small artery compliance (SAC) is an earlier and more reliable predictor of cardiovascular events. We examined the effects of a comprehensive Cardiac Rehabilitation Program on SAC in deconditioned patients with coronary artery disease. Methods: Patients with recent history of coronary artery disease and referred to the Cardiac Rehabilitation Program were enrolled in the study. The patients underwent 8-12 weeks of aerobic exercise (20-30 min/day 3 times a week; target heart rate (HR) of 70-80% of maximal HR) nutritional and behavioral modification counseling on modification of risk factors. Large and small artery compliance were measured non-invasively with HDI Pulsewave CR2000 device at the beginning and upon the completion of the program. Deconditioned patients were identified as
AJH–May 2003–VOL. 16, NO. 5, PART 2
POSTERS: Arterial Structure and Compliance
those who did not do any exercise before being referred to the Cardiac Rehabilitation Program. Results: 32 men ( mean age 67⫹/-11 yrs), 20 were hypertensives, 8 had diabetes, only 3 patients were currently smoking. There was no change in the mean arterial pressure, pulse pressure or large artery compliance. There was significant improvement in the small artery compliance. This became insignificant when those patients who were already doing intense workout before the acute coronary events were added. Conclusion: A comprehensive cardiac rehabilitation program improves the small artery compliance significantly in deconditioned male patients with coronary artery disease.This improvement becomes insignificant when those who were following intense exercise program were added. Endothelial dysfunction plays an important role in the pathogenesis of coronary artery disease. We speculate that endothelial function improves with comprehensive cardiac rehabilitation program in deconditioned men. Further studies are needed to test this hypothesis.
Mean Arterial Pressure (mmHg) Pulse Pressure (mmHg) Small Artery Elasticity Index (ml/mmHg ⫻ 100) Large Artery Elasticity Index (ml/mmHg ⫻ 10)
Baseline
Final
p
94 ⫾ 15 56 ⫾ 17 4.7 ⫾ 3 16 ⫾ 6
93 ⫾ 15 58 ⫾ 15 6⫾3 15 ⫾ 6
NS 0.02 NS NS
Key Words: arterial compliance, coronary artery disease, exercise
P-300 EARLY RENAL DAMAGE AND COLLAGEN METABOLISM DETERMINES ARTERIAL STIFFNESS IN DIABETIC HYPERTENSIVES Marek W Rajzer, Marek Klocek, Kalina Kawecka-Jaszcz. I-st. Cardiac Department, Medical College of Jagiellonian University, Krakow, Poland. The purpose of the present study was to analyse the differences in large artery stiffness, microalbuminuria and plasma collagen markers between diabetic and non diabetic hypertensives. Study population consisted of 98 patients (55 women and 43 men, age 56.1⫾9.3 years) with mild to moderate primary arterial hypertension: Group-1 ( N ⫽ 35) with diabetes mellitus t.2 on oral agents (duration of diabetes 8.2⫾4.3 years)], and Group-2( N ⫽ 63) without diabetes. Standard BP measurements, 24-h ambulatory blood pressure monitoring ( ABPM) SpaceLabs 90207,carotid-femoral pulse wave velocity (PWV) using automatic Complior® device were performed. Microalbuminuria was defined as 30-300g / 24h. Plasma collagen markers C-( PICP) and N-terminal (PINP) propeptides were obtained using RIA kits ( Orion Diagnostica). Statistical analysis was performed using Statistica 5.1 ( StatSoft Inc.). Between group differences are shown in the table. No significant differrences between group G-1 and G-2 were observed for SBP and DBP in standard measurements: SBP ( 147⫾8.5 vs.141⫾10.5 mmHg) and DBP ( 93⫾ 6.2 vs. 89⫾5.7mmHg) as well as for 24h-ABPM. In the multiple regression model for diabetic group at R⫽0.71 PWV was significantly related to age (B⫽ 0.471, p⫽0.0012), PICP concentration (B⫽0.976,p⫽0.002) and presence of microalbuminuria (B⫽0.213, p⫽0.024). Among non diabetic hypertensives at R⫽0.53 PWV was significantly related to age (B⫽0.421, p⫽ 0.012) and SBP in 24-h ABPM (B⫽0.397, p⫽0.023).
Variables/Groups age (years) men/women 24h-SBP (mmHg) 24h-DBP (mmHg) % of microalbuminuria PWV (m/s) PICP (g/l) PINP (g/l)
G-1
G2
62.1 ⫾ 9.6 25/10 137 ⫾ 7.7 86 ⫾ 4.7 38.2% 12.6 ⫾ 2.1 187.4 ⫾ 45.5 121.5 ⫾ 51.3
56.4 ⫾ 10.5 33/30 135 ⫾ 8.1 84 ⫾ 6.3 6.4% 10.5 ⫾ 1.5 98.6 ⫾ 33.2 106.1 ⫾ 38.3
P level: below 0.05-* ,⬍0.01-* * ,0.001-* * * .
P Level/ Test */t-Student **/-square NS NS **/-square */t-Student */Wilcoxon NS
145A
Diabetic patients with hypertension had a higher rate of microalbuminuria and plasma level of PICP as well as stiffer large arteries determined by PWV. PWV in diabetic patients is related to age, early signs of renal damage and activated collagen metabolism. Key Words: arterial hypertension and diabetes, pulse wave velocity, microalbuminuria and plasma collagen markers
P-301 MONITORING COMPLIANCE FOR PATIENTS ON ANTIHYPERTENSIVE MEDICATION WITH THE NEW INSTRUMENT OF COMPLIANCE PRAXIS SURVEY (COMPASS) Rudolf Schoberberger, Monika Janda, Walter Pescosta, Gernot Sonneck. Social Medicine, University of Vienna, Vienna, Austria; Public Health Research, Queensland University of Technology, Kelvin Grove, Queensland, Australia; Herz Jesu Hospital, Vienna, Austria; Medical Psychology, University of Vienna, Vienna, Austria. Low compliance is suspected as a major reason for treatment failure in hypertensive patients. To identify patients with low compliance at the commencement of antihypertensive treatment, the compliance praxis survey (COMPASS) was utilised. A total of 161 physicians identified 2389 hypertensive patients treated by ACE-inhibitor. The physicians rated the compliance of the patients at baseline and at 6-month follow-up prospectively. Standard care was given. The mean age of patients was 64.5 years (54.4% women). The baseline overall score of compliance was medium to high in 97.3% of patients. A quarter of all patients (24.7%) were described as having difficulties to follow lifestyle changes, 22.3% lacked sufficient social support, and 31.0% were unwilling to obtain additional information about illness and treatment. Patients who had received prior treatment for cardiovascular disease were less compliant than those who received first treatment within this study (P⫽0.05). Younger (P⬍0.01), male patients (P⬍0.01), and those without prior cardiovascular disease (P⬍0.001) were significantly more likely to stop the antihypertensive treatment without a doctor’s recommendation. Doctors’ rating of compliance at baseline correlated well with ongoing treatment at 6-month follow-up. In conclusion, the COMPASS survey questionnaire is a useful instrument for doctors to differentiate between patients who lack resources and to then counsel patients based on their individual needs. Key Words: compliance, compliance estimates, lifestyle
P-302 METABOLIC SYNDROME AMPLIFIES THE AGEASSOCIATED INCREASES IN VASCULAR THICKNESS AND STIFFNESS Angelo Scuter, Samer Najjar, Denis Muller, Reubin Andres, Edward G Lakatta. Gerontology Research Center, National Institute on Aging, NIH, Baltimore, MD; U.O. Geriatria, INRCA, Rome, Italy. Background: Intimal medial thickness (IMT) and vascular stiffness have been shown to be independent predictors of adverse cardiovascular events. The metabolic syndrome (MS) is defined as the clustering of 3 or more of the cardiovascular risk factors of dysglycemia, hypertension, dyslipidemia, and obesity. We sought to evaluate whether the clustering of multiple components of the MS has a greater impact on these vascular parameters than individual components of the MS. Methods and Results: Carotid arterial IMT and stiffness were derived via B-mode ultrasonography in 471 participants from the Baltimore Longitudinal Study on Aging who were without clinical cardiovascular disease and not on antihypertensive therapy. MS conferred a disproportionate increase in carotid IMT (⫹16%, p⬍ 0.0001) and stiffness (⫹32%, p⬍ 0.0001) compared to controls, and predicted simultaneous excessive
POSTERS: Arterial Structure and Compliance
AJH–May 2003–VOL. 16, NO. 5, PART 2
P-297 IS INCREASED ARTERIAL STIFFNESS THE MAIN CARDIOVASCULAR ABNORMALITY IN PATIENTS WITH “WHITE COAT NORMOTENSION”?
P-298 RELATIONSHIP BETWEEN HEMOGLOBLIN A1C AND ARTERIAL ELASTICITY INDICES AMONG DIABETIC WOMEN
Olivier Ormezzano, Jean-Philippe Baguet, Patrice Franc¸ ois, Jean-Louis Quesada, He´ le`ne Pierre, Jean-Michel Mallion. Cardiology and Hypertension Department, University Hospital, Grenoble, France; Public Health Department, University Hospital, Grenoble, France.
Puja K Mehta, Vishal Arora, Mindy Gentry, Dena Jupin, Katarzyna Sadurska, L. Michael Prisant. Hypertension & Clinical Pharmacology, Department of Medicine, Medical College of Georgia, Augusta, GA.
Some studies have shown that patients with “ white coat normotension” (WCNT) (i.e. high ambulatory blood pressure but normal office blood pressure) present target organe damage. The aim of this study was to compare the cardiovascular characteristics between patients with sustained normotension (normal office and ambulatory BP) (NT) with patients with WCNT, taking the level of the office BP into account. Sixty nine healthy subjects with normal office BP (BP ⬍ 140/90 mmHg) were recruited. A 24-hour ambulatory BP monitoring (ABPM) was assessed. A 135/85 mmHg threshold was chosen to define ambulatory daytime hypertension (JNC VI). ABPM results distinguished 18 WCNT and 50 NT with no difference for age and sex. WCNT patients have an increased arterial stiffness evaluated by carotid-femoral pulse wave velocity measurement (PWV) in comparison with NT (respectively 9.58 ⫾1.55 m/s vs. 8.59 ⫾1.38 m/s p⫽0.02), but a similar left ventricular mass index (LVMI) and carotid intima-media thickness (IMT) evaluated by ultrasonography. Systolic and diastolic BP (SBP and DBP) of WCNT were significantly higher than those of NT: 94% of WCNT have an office SBP of over 120 mmHg as against just 43% of NT. When NT and WCNT with office BP readings of over 120 mm Hg were compared, no differences were detected; in particular, these two groups had the same PWV (respectively 9.1⫾1.6 m/s vs. 9.6⫾1.6 m/s, p⫽0.25). In contrast, the PWV was significantly lower in normotensive subjects with an office SBP lower than 120 mmHg (PWV ⫽ 8.1⫾0.9 m/s) than in those with an office SBP of over 120 mm Hg (either NT or WCNT, p⬍0.05). In conclusion, when WCNT were compared with NT with a comparable office BP, their degree of cardiovascular damage is actually similar.
Diabetes mellitus is an important risk factor among women. Elevated glucose alters blood vessels and impairs nitric oxide bioactivity. Vascular diseases account for 80% of all diabetic mortality. Arterial compliance should be decreased in diabetes, but it is unclear as to whether there is a relationship between glycosylated hemoglobin and arterial elasticity in diabetic women. To evaluate this question, 60 women with diabetes mellitus had a hemoglobin A1c and arterial elasticity determined. Three measurements of arterial elasticity indices after a period of rest were acquired at one minute intervals supine using the HDI/Pulsewave™ Cardiovascular Profiling System Model CR-2000, Hypertension Diagnostics Inc., Eagan, MN). This device utilizes a modified Windkessel model for determining large and small elasticity indices. Blood pressure was measured in the left arm using an appropriate size cuff. The arterial sensor was placed over the right radial artery using a wrist stabilizer, and the arterial wave adjusted to the highest relative signal strength. The study population consisted of 31 black and 29 white women. Population characteristics included: age, 50.6 ⫾ 12.7 years; duration of diabetes, 11.1 ⫾ 8.1 years; hemoglobin A1c, 8.9 ⫾ 2.5%; BMI, 33.5 ⫾ 8.2 kg/m2; systolic BP, 146 ⫾ 18 mmHg; diastolic BP, 82 ⫾ 11 mmHg; large artery elasticity (C1), 10.6 ⫾ 3.4 ml/mmHg X 10; and small artery elasticity (C2), 3.8 ⫾ 1.3 ml/mmHg X 100. 85% were hypertensive, 57% had a lipid disorder, and 15% smoked. Treatment included an ACE inhibitor (57%), an HMG Co-A reductase inhibitor (43%), insulin (72%), and aspirin (14%). Age significantly correlated with large artery elasticity (r⫽-0.385, p⫽ 0.002) and small artery elasticity (r⫽-0.259, p⫽0.046). Self-reported duration of diabetes or hypertension did not show a relationship with either large or small artery elasticity. Hemoglobin A1c correlated with small artery elasticity (r⫽-0.279, p⫽ 0.031), but not large artery elasticity (r⫽-0.044, p⫽ 0.74). The strongest association was between weight and small artery elasticity (r⫽⫹0.45, p⫽0.0003). Thus, among diabetic women, age, weight, and hemoglobin A1c correlate with small artery elasticity.
Key Words: Hypertension, White coat normotension, Ambulatory blood pressure monitoring
Key Words: Diabetes mellitus, Hypertension, Arterial elasticity
P-299 SMALL ARTERY COMPLIANCE IMPROVES WITH COMPREHENSIVE CARDIAC REHABILITATION PROGRAM IN DECONDITIONED MEN WITH CORONARY ARTERY DISEASE Mohammad A Rafey, Jonathan P Greenblatt, Patricia Brownstein, Lorene Bruno, Robert A Phillips. Cardiovascular Institute, The Mount Sinai School of Medicine, New York, NY; Department of Medicine, Lenox Hill Hospital, New York, NY. Objective: Small artery compliance (SAC) is an earlier and more reliable predictor of cardiovascular events. We examined the effects of a comprehensive Cardiac Rehabilitation Program on SAC in deconditioned patients with coronary artery disease. Methods: Patients with recent history of coronary artery disease and referred to the Cardiac Rehabilitation Program were enrolled in the study. The patients underwent 8-12 weeks of aerobic exercise (20-30 min/day 3 times a week; target heart rate (HR) of 70-80% of maximal HR) nutritional and behavioral modification counseling on modification of risk factors. Large and small artery compliance were measured non-invasively with HDI Pulsewave CR2000 device at the beginning and upon the completion of the program. Deconditioned patients were identified as
AJH–May 2003–VOL. 16, NO. 5, PART 2
POSTERS: Arterial Structure and Compliance
those who did not do any exercise before being referred to the Cardiac Rehabilitation Program. Results: 32 men ( mean age 67⫹/-11 yrs), 20 were hypertensives, 8 had diabetes, only 3 patients were currently smoking. There was no change in the mean arterial pressure, pulse pressure or large artery compliance. There was significant improvement in the small artery compliance. This became insignificant when those patients who were already doing intense workout before the acute coronary events were added. Conclusion: A comprehensive cardiac rehabilitation program improves the small artery compliance significantly in deconditioned male patients with coronary artery disease.This improvement becomes insignificant when those who were following intense exercise program were added. Endothelial dysfunction plays an important role in the pathogenesis of coronary artery disease. We speculate that endothelial function improves with comprehensive cardiac rehabilitation program in deconditioned men. Further studies are needed to test this hypothesis.
Mean Arterial Pressure (mmHg) Pulse Pressure (mmHg) Small Artery Elasticity Index (ml/mmHg ⫻ 100) Large Artery Elasticity Index (ml/mmHg ⫻ 10)
Baseline
Final
p
94 ⫾ 15 56 ⫾ 17 4.7 ⫾ 3 16 ⫾ 6
93 ⫾ 15 58 ⫾ 15 6⫾3 15 ⫾ 6
NS 0.02 NS NS
Key Words: arterial compliance, coronary artery disease, exercise
P-300 EARLY RENAL DAMAGE AND COLLAGEN METABOLISM DETERMINES ARTERIAL STIFFNESS IN DIABETIC HYPERTENSIVES Marek W Rajzer, Marek Klocek, Kalina Kawecka-Jaszcz. I-st. Cardiac Department, Medical College of Jagiellonian University, Krakow, Poland. The purpose of the present study was to analyse the differences in large artery stiffness, microalbuminuria and plasma collagen markers between diabetic and non diabetic hypertensives. Study population consisted of 98 patients (55 women and 43 men, age 56.1⫾9.3 years) with mild to moderate primary arterial hypertension: Group-1 ( N ⫽ 35) with diabetes mellitus t.2 on oral agents (duration of diabetes 8.2⫾4.3 years)], and Group-2( N ⫽ 63) without diabetes. Standard BP measurements, 24-h ambulatory blood pressure monitoring ( ABPM) SpaceLabs 90207,carotid-femoral pulse wave velocity (PWV) using automatic Complior® device were performed. Microalbuminuria was defined as 30-300g / 24h. Plasma collagen markers C-( PICP) and N-terminal (PINP) propeptides were obtained using RIA kits ( Orion Diagnostica). Statistical analysis was performed using Statistica 5.1 ( StatSoft Inc.). Between group differences are shown in the table. No significant differrences between group G-1 and G-2 were observed for SBP and DBP in standard measurements: SBP ( 147⫾8.5 vs.141⫾10.5 mmHg) and DBP ( 93⫾ 6.2 vs. 89⫾5.7mmHg) as well as for 24h-ABPM. In the multiple regression model for diabetic group at R⫽0.71 PWV was significantly related to age (B⫽ 0.471, p⫽0.0012), PICP concentration (B⫽0.976,p⫽0.002) and presence of microalbuminuria (B⫽0.213, p⫽0.024). Among non diabetic hypertensives at R⫽0.53 PWV was significantly related to age (B⫽0.421, p⫽ 0.012) and SBP in 24-h ABPM (B⫽0.397, p⫽0.023).
Variables/Groups age (years) men/women 24h-SBP (mmHg) 24h-DBP (mmHg) % of microalbuminuria PWV (m/s) PICP (g/l) PINP (g/l)
G-1
G2
62.1 ⫾ 9.6 25/10 137 ⫾ 7.7 86 ⫾ 4.7 38.2% 12.6 ⫾ 2.1 187.4 ⫾ 45.5 121.5 ⫾ 51.3
56.4 ⫾ 10.5 33/30 135 ⫾ 8.1 84 ⫾ 6.3 6.4% 10.5 ⫾ 1.5 98.6 ⫾ 33.2 106.1 ⫾ 38.3
P level: below 0.05-* ,⬍0.01-* * ,0.001-* * * .
P Level/ Test */t-Student **/-square NS NS **/-square */t-Student */Wilcoxon NS
145A
Diabetic patients with hypertension had a higher rate of microalbuminuria and plasma level of PICP as well as stiffer large arteries determined by PWV. PWV in diabetic patients is related to age, early signs of renal damage and activated collagen metabolism. Key Words: arterial hypertension and diabetes, pulse wave velocity, microalbuminuria and plasma collagen markers
P-301 MONITORING COMPLIANCE FOR PATIENTS ON ANTIHYPERTENSIVE MEDICATION WITH THE NEW INSTRUMENT OF COMPLIANCE PRAXIS SURVEY (COMPASS) Rudolf Schoberberger, Monika Janda, Walter Pescosta, Gernot Sonneck. Social Medicine, University of Vienna, Vienna, Austria; Public Health Research, Queensland University of Technology, Kelvin Grove, Queensland, Australia; Herz Jesu Hospital, Vienna, Austria; Medical Psychology, University of Vienna, Vienna, Austria. Low compliance is suspected as a major reason for treatment failure in hypertensive patients. To identify patients with low compliance at the commencement of antihypertensive treatment, the compliance praxis survey (COMPASS) was utilised. A total of 161 physicians identified 2389 hypertensive patients treated by ACE-inhibitor. The physicians rated the compliance of the patients at baseline and at 6-month follow-up prospectively. Standard care was given. The mean age of patients was 64.5 years (54.4% women). The baseline overall score of compliance was medium to high in 97.3% of patients. A quarter of all patients (24.7%) were described as having difficulties to follow lifestyle changes, 22.3% lacked sufficient social support, and 31.0% were unwilling to obtain additional information about illness and treatment. Patients who had received prior treatment for cardiovascular disease were less compliant than those who received first treatment within this study (P⫽0.05). Younger (P⬍0.01), male patients (P⬍0.01), and those without prior cardiovascular disease (P⬍0.001) were significantly more likely to stop the antihypertensive treatment without a doctor’s recommendation. Doctors’ rating of compliance at baseline correlated well with ongoing treatment at 6-month follow-up. In conclusion, the COMPASS survey questionnaire is a useful instrument for doctors to differentiate between patients who lack resources and to then counsel patients based on their individual needs. Key Words: compliance, compliance estimates, lifestyle
P-302 METABOLIC SYNDROME AMPLIFIES THE AGEASSOCIATED INCREASES IN VASCULAR THICKNESS AND STIFFNESS Angelo Scuter, Samer Najjar, Denis Muller, Reubin Andres, Edward G Lakatta. Gerontology Research Center, National Institute on Aging, NIH, Baltimore, MD; U.O. Geriatria, INRCA, Rome, Italy. Background: Intimal medial thickness (IMT) and vascular stiffness have been shown to be independent predictors of adverse cardiovascular events. The metabolic syndrome (MS) is defined as the clustering of 3 or more of the cardiovascular risk factors of dysglycemia, hypertension, dyslipidemia, and obesity. We sought to evaluate whether the clustering of multiple components of the MS has a greater impact on these vascular parameters than individual components of the MS. Methods and Results: Carotid arterial IMT and stiffness were derived via B-mode ultrasonography in 471 participants from the Baltimore Longitudinal Study on Aging who were without clinical cardiovascular disease and not on antihypertensive therapy. MS conferred a disproportionate increase in carotid IMT (⫹16%, p⬍ 0.0001) and stiffness (⫹32%, p⬍ 0.0001) compared to controls, and predicted simultaneous excessive