Transvascular albumin leakage and urinary albumin excretion in uncomplicated essential hypertensive subjects

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AJH-APRIL 1999-VOL. 12, NO. 4, PART 2

ASH XIV ABSTRACTS

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HUMORAL AND HEMODYNAMIC CORRELATES OF HEPATOCYTE GROWTH FACTOR IN END STAGE RENAL DISEASE CREED INVESTIGATORS : L.S. Malafino*, G. Tripopi, F.A. Bencdatto, F. Mallamaci, C. MatinG, M. Oarozzo, F. Di Vince~o, C. Arena, A. Cataliotti, I. Bdlenuova, F. Rapisarda, P. Fatuzzo, O. Semmare, B. Stancanelli, C. Zoccali*, Isfituto di Clinica Medico "L.Condoralli", Istituto di Medicina Intema e Gerintrla, Divisione Clmiczzzata di Nefrohigia Chimrgica, Universi~ di Catania; Divisione di Cardiologia Ospedale Moreni, Servizio Dialisi USL l lCentro Fisiologia Clinica CNR-Divisione di Nefrohigis, Reggio Calabria, Indy

OF PULSE WAVE VELOCITY AMONG NORMOTENSIVES, WHITE COAT AND SUSTAINED HYPERTENSIVES DISLIPIDEMIA.

WITH L.

AND WITHOUT

Ribeiro,

A.

Santos,

DIABETES G.

Gama,

OR R.

A s m a r * , J. Pol6nia* Clin Pharmacol Unit, Faculty Med Porto, Portugal. Stiffness o f aortic walls has been considered a m a r k e r o f coronary and cerebral atherosclerotic disease. Arterial distensibility was assessed by automatic pulse w a v e velocity (PWV) measurement (Complior) in 19 healthy normotensives (NT), in 46 white-coat hypertensives, W C H (clinic BP > 1 4 0 / 9 0 and daytime B P < 1 3 0 / 8 5 m m H g ) and in 81 ambulatory H T patients (clinic B P > 1 4 0 / 9 0 m m H g and daytime B P > 1 4 0 / 9 0 m m H g ) all matched for a g e (range 28-65y), gender and BM1. Twenty-eight W C H ( W C H - A ) and 37 H T (HT-A) w e r e free o f other m a j o r cardiovascular risk factors whereas 18 W C H ( W C H - B ) and 44 H T (HT-B) had also N I D diabetes and /or dyslipidemia. * p < 0 . 0 2 v N T ; # p < 0 . 0 2 vs WCH-A. WCH-A NT

n= 19

WCH-B HT-A HT-B

28 18 37 44

Clink BP

Daytime BP

125+4/82+2 123+2/79+2 148+5/91+3" 125+5/81+3 150+4/94+2" 127+2/82+2" 157+3/99+4"# 150+6/98+4"# 160+3/98+2"# 146+3/95+2"#

Aim and Methods: Hepatocyte growth factor (HGF), a potent endothelial and epithelial mitogen, plays a crucial role in tissue damage repair. Within the arosssectional phase of CREED Study (Cardiovascular Risk Extended Evaluation in Dialyisis patients), we assessed relationships between serum HGF concentration, vascular damage, blood pressure (BP) and markers of inflammation in a series of 244 dialysis patients (age range: 17-70 years; 136M, 108F) on chronic dialysis from at least 6 months. Fasting serum samples fur HGF assay (EL]SA, R&D, U.K.; mean control values in our laboratory: 0.85±0.25 ng/ml), lipids, albumin, immonoghibulins, C-Reactive Protein (CRP), RA test were drawn unmedlately before an Echo-color-Doppler evaluation (n=105) of both carotid arteries. Mean values of pre-and post-dialysis systulic, diastolic and pulse BP measured dunng the month before the study were used for statistical analysis. Results: Serum HGF levels (median: 1.93; interquarfile range: 1.42-2.58 ng/ml) showed significant correlations at univariate analysis as follows: Age

PWV (m/s)

9.2+0.3 9.3+0.5 11.6+0.3" 10.94-0.6" 12.8+_.0.3"#

Although P W V values did not correlate with glicemia, Hb A1C , colesterolemia and H D L - C , similarly to the H T , the W C H with diabetes/dislipidemia show an impaired arterial distensibility and m a y entail an increased cardiovascular risk which might dictate a m o r e a g g r e s s i v e antihypertensive therapy. In contrast, in W C H - A the P W V values did not differ f r o m N T reinforcing the concept o f a benign cardiovascular Key Words: outcome. Pulse wave velocity, white-coat hypertension, diabetes.

Dyalitic CRP IgG IgA Plaques ase (ranks) (ranks) HGF r=0.20 r = 0 . 4 1 r,=0.21 r=0.19 r = 0 . 1 5 r,=0.25 p=0.002 p<0.0001 p=0.001 p=0004 p=0.02 P=0.03 Additionally, senan HGF levels were inversely related to systolic (r= -0.22; p=0.0005), diastolic (r= -0.22; p=0.0005) and pulse (r= -0.14; p=0.03) BP values. Only in hemedialysis patients HGF levels were directly related to the number of atherosclerotic plaques (r= 0.25; p=0 03). However, in a model of multiple regression analysis, dialytic age ([3= 0.39; p=0.00001 ), PCR ([3= 023; p=0.014), age (~= 0.22; p=0.014), pulse BP ([5= -0.21; p=0.017) and IgG (13= 0.17; !0=0.05) were independent predictors of serum HGF levels (multiple R=0.62; p<0.0001). Conclusions: In patients with end stage renal disease circulating levels of HGF are elevated and closely related to dialytic age. Furthermore, the positive correlation between HGF and markers of inflammation would suggest that HGF release depends, at least in part, on chronic inflammatory processes. This hypothesis seems to be further supported by the diverse relationship between HGF and BP, that may be indirect evidence of cytokine-induced vasodilation secondary to chronic inflammation. HGF, cytokines, atherosclerosis, blood pressure, dialysis, PCR.

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EXERCISE BLOOD PRESSURE AS A DETERMINANT OF' I,EFT VENTRICUI.AR MASS AND GEOMETRY IN PATIENTS WITH HYPERTEN SIGN. L Francescbim, A Gallo, A Zamboni. A Albani. R Tomei. L Rossi. L 7amolla. P 7ardiffL b*stitute qf Cardiologv-Unirersi O"qfl'erom: (ITALF) Left venkicular ilypertrophy m patients with hypertension is more closely related to blood pressare during actwtty or stress, than to basal blood presaure, ttowever, the stress of cliruc visils, work elwtroment and other daily activities are variable and c~mnot be accurately quanhfied. On the other hand. exercise is a standardized method of stress testing that can be readily quanlified and reproduced This study ex,amnes the relation between blood pressme at rest or dulmg bycMe exercise testing, and left ventucuhr mass and geomet~ measured by two dimensional echocaldiognlphy in palients with mild to moderate hypertension. Of 301 patients, 135 iN) had both ventricular mass and relative wall ttuckness withiii nomlul hmits t "~t('R) exhibited concentnc remodeling. 127 (Ell) imd eccentric hypertrophy and 22 (CH) presented concentlJc hypertropiry ?dl patients tmdelwenl s3~nptoms lmfiled multistage byeide exercise testing Data from our slud', are sulnlnarized m tile followin~a table r i i t Duraretl test) I

Tmnsvasculur Albumin Leakage and Urinary Albumin Excretion in Uncomplicated Essential Hypertensive Subjects R.Pednnelli 1, G. DelrOmo 1, G. Penno 2 S. Bandinelli 2 D. Giorgi 3, V. ~ M . Mariani 1. Departments of Cardiologia, Angiologia, 2 Medicina Pneumologia,1 Endocrinologia & Malattie Mataboliche, Intema 3, Universitb di Pica, Pisa, Italy Micmalbuminuria fMA) Albuminuria between 20-2001ag/min) may reflect an abnormal capillary permeability due to systemic vascular damage which may lead to eady atherosclamsis, thus explaining why MA predicts cardiovascular events in non diabetic subjects. However, this hypothesis has never been tested in essential hypertensive patients (EH). We assessed the albumin transcapillary escape rate (the 1-hr decay rate of ~251-albumin,5-71~C ev,TERalb), a measure of albumin permeation through systemic capillaries, and unnary albumin excretion (UAE, nephelometry, three ovemight collections) in 60 glucose-tolerant (pest-load 2-hr plasma glucose< 140mg/dl), dipstick-negative male EH (creatinine clearance:117+32ml/min, ejection fraction:65:L-6%) categonzed as normo-(NORMO, n=45, 54+9 yrs) and micro-(MICRO, n=15, 51+16yrs)albuminudc, and 14 age-(51+14yrs), sex-matched controls (CON). TERalb was similar between NORMO and MICRO EH (9.3:t2.4 vs 9.4+3.1%/hr), even though UAE was, by definition, elevated in these latter [6.9 (2.1-14) vs 27 (22-198) lag/min]. Both groups showed higher (p
i

'. . . . . .

LHRe.xe,cise SBPrest

~. . . . . .

+. . . .

................. . , 1 4 ] [2!5A+ . _!13 i I J0 ~_ ! 143 157" [ 1~3 Ilg [

_ ES _ *: 00q

_~1 ]

SBPcxercise ~ 199 ] 213" I 211" 203 } * 0.001 DBP . . . . . ise : OS 7 1 0 6 " L 95 i 100 ~ .... 005 ] qtsus, m palients with essential hypertension, lel~ ventricular mass and geometry are poorly related to blood pressure at rest. but they are related to exercise systolic and partially to diastolic blood pressure

Key Words: Hvpe~ell~,ion, Exercise blood pressure. Lel~ ventiicular ll'~qgerhol~hv.