34 research outputs found
Is Arterial Hypertension Control Enough to Improve Aortic Stiffness in Untreated Patients with Hypertension? A 3-Year Follow-Up Study
No full textAortic stiffness is an important determinant of cardiovascular risk. We studied the long-term influence of successful antihypertensive treatment after a 3-year follow-up, regarding aortic stiffness improvement from baseline evaluation in never treated middle-aged patients with mild to moderate essential hypertension. In 132 patients with hypertension, aortic stiffness was evaluated by carotid-femoral artery pulse wave velocity (PWV). Patients with 24-hour mean systolic and diastolic blood pressure ‰130/80 mm Hg after treatment at reevaluation were considered as well controlled. The PWV after treatment was significantly increased in all patients with hypertension (P <.01) and uncontrolled patients with hypertension (P <.001), remained unchanged in controlled patients with hypertension, and decreased in controlled patients with hypertension with baseline PWV ‰12.4 m/s (P =.004), independent of the corresponding blood pressure (BP) decrease. Our study provides evidence that successful antihypertensive treatment leads to PWV improvement when baseline aortic stiffness level is at least moderately increased. The magnitude of observed PWV decrease is independent of the corresponding BP decrease. © The Author(s) 2014
Reference values for aerobic capacity estimated by cardiopulmonary exercise test on a cycle ergometer in a healthy Greek population
No full textObjective: Aerobic capacity (AC) is inversely associated with a high risk of cardiovascular morbidity and mortality as well as all-cause mortality. Cardiopulmonary exercise testing (CPET) represents the gold standard for assessing exercise capacity based on maximum oxygen uptake (VO2max). The purpose of our study was to provide for the first time CPET-derived normative reference values in a Greek cohort of apparently healthy men and women on a cycle ergometer to evaluate their AC, and to compare our results with similar studies from other countries. Methods: A cohort of 194 apparently healthy subjects (118 males and 76 females, age range, 15-69 years) was submitted to CPET using a cycle ergometer. Mean ± SD values for several exercise parameters, VO2max included, were determined. We compared our results with existing data derived from USA and North Europe cohorts. Results: Male subjects achieved significantly higher levels of relative and absolute VO2max (p &lt; 0.001) across all ages compared to female subjects. A decline in relative and absolute VO2max among older participants was observed in both sexes. Greek subjects had lower AC than the North Europe cohort and almost similar to the USA cohort. Conclusion: We provide the first reference data for AC in apparently healthy Greek subjects based on CPET using cycle ergometer. Our findings will allow for more accurate interpretation of CPET in several groups of healthy subjects or patients with CV diseases. The differences found between our reference values and those reported from the USA and northern European countries, underscore the need for individual countries to develop their own AC reference values. © 2019 Hellenic Society of Cardiolog
Hypertension-mediated organ damage regression associates with blood pressure variability improvement three years after successful treatment initiation in essential hypertension
No full textBlood pressure variability (BPV) has been associated with the development, progression, and severity of cardiovascular (CV) organ damage and an increased risk of CV morbidity and mortality. We aimed to explore any association between short-term BPV reduction and hypertension-mediated organ damage (HMOD) regression in hypertensive patients 3-year post-treatment initiation regarding BP control. 24-h ambulatory blood pressure monitoring (24 h ABPM) was performed at baseline in 180 newly diagnosed and never-treated hypertensive patients. We measured 24 h average systolic (24 h SBP) and diastolic BP (24 h DBP) as well as 24 h systolic (sBPV) and diastolic BPV (dBPV). Patients were initially evaluated and 3 years later regarding arterial stiffness (PWV), left ventricular hypertrophy (LVMI), carotid intima-media thickness (cIMT), 24 h microalbumin levels (MAU), and coronary flow reserve (CFR). Successful BP treatment was defined as 24 h SBP/DBP < 130/80 mm Hg based on 2nd ABPM and subsequently, patients were characterized as controlled (n = 119, age = 53 ± 11 years) or non-controlled (n = 61, age = 47 ± 11 years) regarding their BP levels. In the whole population and the controlled group, 24 h SBP/DBP, sBPV/dBPV, LVMI, and IMT were decreased. Additionally, LVMI improvement was related with both sBPV (p <.001) and dBPV reduction (r =.18, p =.02 and r =.20, p =.03, respectively). In non-controlled hypertensives, PWV was increased. In multiple linear regression analysis, sBPV and dBPV reduction predicted LVMI improvement in total population and controlled group independently of initial office SBP, mean BP, and 24 h-SBP levels. In middle-aged hypertensive patients, a 3-year antihypertensive treatment within normal BP limits, confirmed by 24-h ABPM, leads to CV risk reduction associated with sBPV and dBPV improvement. © 2021 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC
Severity of Alopecia Predicts Coronary Changes and Arterial Stiffness in Untreated Hypertensive Men
No full textAn association between androgenic alopecia (AGA), coronary artery disease, and hypertension has been reported in previous epidemiological studies. The authors evaluated the relationship of target organ damage caused by hypertension with AGA in 101 newly diagnosed and untreated hypertension men with mild to moderate AGA (AGAm), severe AGA (AGAs), and non-AGA. Pulse wave velocity (PWV), office and 24-hour pulse pressure (PP), carotid intima-media thickness (IMT), left ventricular hypertrophy (LVH), coronary flow reserve (CFRd), and AGA severity by Hamilton-Norwood scale were estimated. CFRd was significantly impaired in AGAs patients compared with AGAm (P=.007) and non-AGA patients (P=.02). No differences were found within groups regarding PWV, PP, IMT, and LVH. AGA severity was related to CFRd (independently) and PP while AGA duration and age of onset were related to CFRd and PP, respectively. The authors conclude that impaired coronary microcirculation and aortic stiffness might precede the appearance of significant stenotic coronary lesions in hypertensive patients with severe AGA. In addition, hypertensive patients with severe and early AGA onset seem to be exposed to an augmented cardiovascular risk. ©2016 Wiley Periodicals, Inc
The association of elevated HDL levels with carotid atherosclerosis in middle-aged women with untreated essential hypertension
No full textHigh-density lipoprotein cholesterol (HDL-C), a negative risk factor, is positively associated with a decreased risk of coronary heart disease. We investigated the association between high HDL-C levels and target organ damage (TOD) in never treated women with hypertension. We measured HDL-C levels in 117 women followed by estimation of TODs, that is, pulse wave velocity, microalbuminuria, left ventricular mass index, coronary flow reserve, and carotid intima-media thickness (cIMT). Women were divided into 2 groups (HDLH and HDLL), regarding HDL-C quartiles (upper quartile vs the first 3 lower quartiles). In HDLH group (HDL ≥70 mg/dL), cIMT was nonindependently, negatively related to HDL-C (ρ = -.42, P &lt;.05). Using receiver -operating characteristic curve (ROC) analysis in the HDLH group, we concluded that the cutoff value of HDL ≥76.5 mg/dL moderately predicted the absence of carotid atherosclerosis (area under the curve: 0.77, P =.02; confidence interval: 0.57-0.97; sensitivity 73% and specificity 67%). Increased HDL-C may predict the absence of carotid atherosclerosis in middle-age women with untreated essential hypertension and consequently contribute to total cardiovascular risk estimation and treatment planning. © 2015 SAGE Publications
Association of abnormal coronary microcirculatory function with impaired response of longitudinal left ventricular function during adenosine stress echocardiography in untreated hypertensive patients
No full textAims: Coronary microcirculation is disturbed in hypertensive patients. We investigated the association of coronary flow reserve (CFR) with the response of left ventricular (LV) function as assessed by tissue Doppler imaging (TDI) during adenosine stress echocardiography in never-treated hypertensive patients.Methods and resultsWe studied 90 hypertensive patients and 30 control subjects, matched for age and sex, by adenosine stress echocardiography. We measured: (i) CFR, E and A Doppler, S′, E′, A′ mitral annulus velocities with TDI, as well as the E′/A′ ratio and the E/E′ ratio before and during adenosine infusion (ii) the changes of the measured indices between baseline and adenosine infusion. After adenosine infusion, there was an increase in S′, E′, and A′ in all patients and controls (P < 0.05). Compared with controls and patients with CFR <2.5, patients with CFR <2.5 showed a smaller increase in S′ (28.6 vs. 30.0 vs. 11.1, F for interaction 14.592) and E′ (33.3 vs. 33.3 vs.1.5, F 28.927) as well as a decrease in E′/A′ (9.2 vs. 6.4 vs.-20.0, F 5.128) and an increase in E/E′ (-6.1 vs.-1.6 vs. 30.5. F 12.780) after adenosine infusion (P < 0.05 for all comparisons). CFR was independently related to changes of TDI parameters (regression coefficient b 0.576 for S′; b 0.517 for E′; b 0.473 for E′/A′; b-0.520 for E/E′, respectively, P < 0.001). By the receiver operating curve, a CFR <2.5 predicted the median changes of all measured TDI markers, with a sensitivity and specificity over 70 (AUC >75, P < 0.05).ConclusionAn abnormal response of the LV longitudinal function during adenosine stress echocardiography is related to impaired CFR in untreated hypertensive patients.© 2012 Author
Reference values for aerobic capacity estimated by cardiopulmonary exercise test on a cycle ergometer in a healthy Greek population
No full textObjective: Aerobic capacity (AC) is inversely associated with a high risk of cardiovascular morbidity and mortality as well as all-cause mortality. Cardiopulmonary exercise testing (CPET) represents the gold standard for assessing exercise capacity based on maximum oxygen uptake (VO2max). The purpose of our study was to provide for the first time CPET-derived normative reference values in a Greek cohort of apparently healthy men and women on a cycle ergometer to evaluate their AC, and to compare our results with similar studies from other countries. Methods: A cohort of 194 apparently healthy subjects (118 males and 76 females, age range, 15-69 years) was submitted to CPET using a cycle ergometer. Mean ± SD values for several exercise parameters, VO2max included, were determined. We compared our results with existing data derived from USA and North Europe cohorts. Results: Male subjects achieved significantly higher levels of relative and absolute VO2max (p < 0.001) across all ages compared to female subjects. A decline in relative and absolute VO2max among older participants was observed in both sexes. Greek subjects had lower AC than the North Europe cohort and almost similar to the USA cohort. Conclusion: We provide the first reference data for AC in apparently healthy Greek subjects based on CPET using cycle ergometer. Our findings will allow for more accurate interpretation of CPET in several groups of healthy subjects or patients with CV diseases. The differences found between our reference values and those reported from the USA and northern European countries, underscore the need for individual countries to develop their own AC reference values
Cognitive impairment is related to increased arterial stiffness and microvascular damage in patients with never-treated essential hypertension
No full textBackground: It is known that essential hypertension may be implicated in the development of cognitive impairment that is associated to microvascular disease of the brain. It has been hypothesized that increased arterial stiffness of the large arteries may lead to microvascular changes due to increased pulsatile flow. Our study tests the hypothesis that large artery stiffness and microvascular damage are related to brain microcirculation changes as reflected by impaired cognitive function.MethodsWe studied 110 nondiabetic patients aged 40-80 years (mean age 53.8 ± 11.2 years, 57 men) with recently diagnosed stage I-II essential hypertension. Mini-Mental State Examination (MMSE) was used as a screening test for global cognitive impairment. We performed both 2-D echocardiography and carotid-femoral pulse wave velocity (PWV) in order to evaluate arterial stiffness. Twenty-four hour urine microalbumin excretion was measured as a marker of microvascular damage.ResultsIn the entire population, MMSE was negatively correlated with age (r=-0.42, P < 0.001), 24-h pulse pressure (PP) (r =-0.18, P < 0.05), and PWV (r=-0.3, P ≤ 0.003). Additionally, MMSE was not independently correlated with microalbuminuria in patients aged over 65 years (r=-0.58, P ≤ 0.003).ConclusionsImpaired cognitive function is associated with increased large artery stiffness and microalbumin excretion in newly diagnosed, untreated hypertensive patients. These findings support the hypothesis that cognitive impairment induced by impaired microcirculation is linked to large artery stiffness and microvascular damage. © 2009 American Journal of Hypertension, Ltd
The interplay between renin-angiotensin system activation, abnormal myocardial deformation and neurohumoral activation in hypertensive heart disease: a speckle tracking echocardiography study
No full textAngiotensin converting enzyme (ACE) promotes cardiac fibrosis. LV myocardial deformation and torsion are markers of subclinical myocardial dysfunction. We investigated the association of serum ACE levels with LV deformation markers in untreated hypertensives. In 120 untreated patients (age: 53.5 ± 11.2 years) with essential hypertension and 60 healthy controls, we measured (a) LV longitudinal, circumferential and radial strain (S), peak torsion and the percentage changes between peak twisting and untwisting at the end of early diastolic filling (%dpTw-UtwEDF) using speckle tracking echocardiography and (b) serum levels of ACE and NTproBNP. Compared to controls, patients had decreased longitudinal strain (−19.1 ± 2.9 vs. −21.7 ± 1.8%), increased peak twisting (19.1 ± 4.6 vs.14.0 ± 3.7 deg) but decreased %dpTw-UtwEDF (78 ± 8 vs. 86 ± 8%) and higher serum ACE levels (27.6 ± 8.0 vs 20.9 ± 7.1 U/ml) (p &lt; 0.05 for all comparisons). Increasing serum ACE levels were related to impaired radial strain and longitudinal systolic SR (b = −0.41 and b = 0.31 respectively, p &lt; 0.01), as well as to reduced %dpTw-UtwEDF (b = −0.37, p &lt; 0.05). Furthermore, increasing serum ACE levels were related to increasing NTproBNP levels (b = 0.41, p &lt; 0.01). In multivariate analysis, the above relations of serum ACE levels and LV function parameters remained significant after adjustment for other confounding factors (p &lt; 0.01). The close link between serum ACE levels and impaired LV deformation suggests that activation of renin-angiotensin system is involved in the impairment of LV function resulting in elevated LV filling pressures causing the concomitant elevation of BNP levels in untreated hypertensive patients. © 2016, Springer Science+Business Media Dordrecht
Association of impaired left ventricular twisting-untwisting with vascular dysfunction, neurohumoral activation and impaired exercise capacity in hypertensive heart disease
No full textAims We investigated the association between left ventricular (LV) torsional deformation and vascular dysfunction, fibrosis, neurohumoral activation, and exercise capacity in patients with normal ejection fraction Methods and results In 320 newly-diagnosed untreated hypertensive patients and 160 controls, we measured: pulse wave velocity (PWV); coronary flow reserve (CFR) by Doppler echocardiography; global longitudinal strain and strain rate, peak twisting, the percentage changes between peak twisting, and untwisting at mitral valve opening (%dpTw - UtwMVO), at peak (%dpTw - UtwPEF), and the end of early LV diastolic filling (%dpTw - UtwEDF) by speckle tracking imaging; transforming growth factor (TGFb-1), metalloproteinase-9 (MMP-9), tissue inhibitor of matrix metalloptoteinase-1(TIMP-1), markers of collagen synthesis, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Oxygen consumption (VO2), measured by means of cardiopulmonary exercise test, was assessed in a subset of 80 patients. The PWV, CFR, longitudinal strain and strain rate, %dpTw-UtwMVO, %dpTw-UtwPEF, and %dpTw-UtwEDF were impaired in hypertensive patients compared with controls. In multivariable analysis, CFR, PWV, LV mass, and systolic blood pressure were independent determinants of longitudinal strain, strain rate, and untwisting markers (P &lt; 0.05). Increased TGFb-1 was related with increased collagen synthesis markers, TIMP-1 and MMP-9 and these biomarkers were associated with impaired longitudinal systolic strain rate, untwisting markers, CFR and PWV (P &lt; 0.05). Delayed untwisting as assessed by reduced %dpTw - UtwEDF was related with increased NT-proBNP and reduced VO2 (P &lt; 0.05). Conclusions Impaired LV untwisting is associated with increased arterial stiffness and coronary microcirculatory dysfunction, and is linked to reduced exercise capacity and neurohumoral activation in hypertensive heart disease. A fibrotic process may be the common link between vascular dysfunction and abnormal myocardial deformation. © 2015 The Authors European Journal of Heart Failure
