Nitric oxide and its relation to blood pressure control and target organ damage in hypertensive patients

Patient with essential hypertension have reduced endothelium dependent vasodilatation, this abnormality has been related to decreased activity of endothelium nitric oxide. To estimate nitric oxide level in hypertensive patients to verify its role in relation to blood pressure control and target organ damage in hypertensive patients. Sixty hypertensive patients participated in this study, 40 of whom without clinical evidence of target organ damage of whom 20 had uncontrolled blood pressure and the other 20 were controlled with antihypertensive therapy. Study also included 20 hypertensives with evidence of target organ damage. Ten normal non-hypertensive subjects volunteered as controls. They were all subjected to full clinical assessment and estimation of nitric oxide levels. Each of the hypertensive groups including controlled hypertensives, uncontrolled hypertensives and hypertensives with evidence of target organ damage had statistically significant lower nitric oxide levels compared to normotensive control subjects [p<0.000]. Controlled hypertensive group when compared to the uncontrolled hypertensive group still had a statistically significant difference of nitric oxide [p value 0.000] While hypertensive patients with evidence of target organ damage had a statistically significant low nitric oxide levels compared the controlled hypertensive group [p value < 0.001], they did not have a statistically significant difference in NO levels when compared to the uncontrolled hypertensive group [p value 0.5]. Hypertensive patients whether controlled or not; whether with target organ damage or not have low NO denoting an underlying endothelial dysfunction. Controlled hypertensives with acceptable blood pressure measurements still have evidence of endothelial dysfunction with low NO. Current antihypertensive therapy, though attaining acceptable blood pressure levels does not seem to tackle endothelial dysfunction in hypertensive patients. NO seems to be playing a crucial role in target organ damage in hypertensive patients

Aortic root distensibility in patients with coronary artery disease

An important determinant of myocardial performance, namely cardiac afterload is largely dependent upon aortic root distensibility [AD], peripheral arterial resistance and end systolic wall stress. The latter can be reliably measured by using m-mode and 2-D echo whereas AD used to be a neglected parameter. In patients with ischaemic heart disease, the question always arises whether AD could in a way or another predict coronary arterial pathology /= 200 and /or LDL >130mg/dl in 21pts and HTN in 17pts. Following clinical evaluation including 12 lead ECG, m-mode and 2-D echocardiography, all pts underwent diagnostic CA and were subjected to transoesophageal echocardiography [TEE] using phased array multiplane 32 elements transducer [5MHz] mounted on the tip of 100cm gastroscope with Acuson Sequoia C256 system. Transoesophageal [TEE] was done while the pts in the left lateral position. The studies were recorded on videotapes for off-lines analysis. Images of the aortic root were obtained in an angle of about 120 degrees. Aortic root was measured in systole [maximal diameter] and diastole [electrocardiographic Q-wave] 3cm from cusps insertion using the trailing edge-to-leading edge method. Measurements were taken in 3 cycles and the mean value was taken, with the difference in diameter delta d as a measurement of aortic root excursion, delta p as the pulse pressure, and d=diastolic aortic root diameter. AD was expressed as =2xdelta d / delta pxd. According to CA, pts were divided into those with diseased coronary arteries 74.4% and those with a normal CA 25.6%. Compared to the normal CA group, AD was insignificantly different from that into pts with diseased CA 23.9 vs 21.4, p value = 0.573. Patients were then stratified into two groups with an age of 50yrs, SBP of 130mmHg, DBF of 80mmHg, serum cholesterol >200 and /or LDL >/= 130mg/dl and presence of DM serving as arbitrary dividing limits

Blood glucose level as a risk predictor of non-diabetic patients admitted with acute myocardial infarction

Hyperglycemia is associated with increased levels of inflammatory markers in patients with acute myocardial infarction and in acutely ill patients in general. The aim of the study is to determine whether admission blood glucose level can be used as a risk predictor in acute myocardial infarction in non-diabetic patients. Follow up of all non-diabetic patients admitted to I.C.U, with a definitive diagnosis of acute myocardial infarction between December 2002 to February 2005 was carried out. A total of 90 patients were studied and followed for six months. Glycosated haemoglubin was done to exclude previously high blood sugar. The studied patients were randomized according to the outcome trying to correlate it with the level of blood sugar during admission. The mean age was 55 years [range 36-83 years], and male to female ratio was 6.5:1. Admission blood glucose level was significantly higher in patients who developed heart failure, reinfarction and those who died, 8.9 mmol/l versus 7.3 mmol/l, 8.3 mmol/l versus 7.1 nomol/l and 9.4 mmol/l versus 7.7 mmol/l [P=0.01, .13, .003 respectively]. Old age was also significantly associated with poor outcome, at the same time there was significant relation between the peak cardiac enzyme [creatinine phosphokinase] level and worse outcome. Admission blood glucose level after acute myocardial infarction [AMI] is an independent predictor of long term mortality and morbidity without known diabetes. Patients with unknown diabetes and high glucose level in admission with AMI have higher rate of complication, a point that may serve to identify subjects at high risk