Self-Measured Blood Pressure and Target Organ Damage in Newly Detected Hypertension in South Gujarat, India

Introduction: Blood pressure transient spikes have been considered to be noise and only a hindrance to a proper assessment of typical blood pressure, which is defined as the actual underlying average blood pres-sure over a long period of time. The current study aimed to see if the highest Self measured Systolic blood Pressure could be utilized to forecast the occurrence of Target organ damage and evaluate the independent association between the maximum Self measured Systolic blood Pressure and Target organ damage in indi-viduals with untreated hypertension. Method: We evaluated the urine albumin/creatinine ratio (UACR) and carotid intima-media thickness (IMT) using ultrasonography in 462 hypertensive individuals who had never taken treatment for their hypertension. Residential blood pressure was recorded. Result: The maximal Self measured Systolic blood Pressure had considerably higher association coefficients with left ventricular mass index (LVMI) and carotid intima-media thickness than the mean Self measured Sys-tolic blood Pressure. Irrespective of the mean Self measured Blood pressure level, multivariate regression studies showed that the maximal Self measured Systolic blood Pressure was independently related with left ventricular mass index and carotid intima-media thickness. Conclusion: Transiently high blood pressure measurements recorded at Self measured shouldn't be dis-missed as noise but rather taken seriously as significant warning signs of hypertensive Target organ damage in the heart and arteries.

Evaluación del Compromiso Cardiovascular en niños en diálisis mediante el Índice de Masa Ventricular Izquierdo / Left Ventricular Mass Index and Cardiovascular Compromise in children on dialysis

INTRODUCCIÓN: Existe una estrecha relación entre enfermedad renal crónica (ERC) y enfermedad cardiovascular. Una de sus manifestaciones clínicas es la hipertrofia de ventrículo izquierdo (HVI), expresada como Indice de Masa Ventricular Izquierda (IMVI, gr/m27). En pacientes portadores de ERC con retraso de creci miento, el cálculo de IMVI debería ajustarse corrigiendo la edad para la talla. OBJETIVO: Comparar el IMVI corregido por edad para la talla, con el valor calculado por edad cronológica en niños con ERC en diálisis. PACIENTES Y MÉTODO: Estudio de corte transversal. Se analizan ecocardiografías de pacientes portadores de ERC en diálisis entre 1-18 años, enero de 2016 a julio 2017. Se evalúa IMVI ajustando el valor expresado a gr/m27 al percentil para la edad cronológica del niño, y luego se ajusta el valor a la edad corregida por la talla. Se usa estadística descriptiva y estudio de concordancia para las evaluacio nes de IMVI calculado por edad cronológica y para edad corregida por talla. RESULTADOS: Se incluyeron 26 pacientes, 75 ecocardiogramas. Un 56% presentó HVI usando IMVI calculado por edad cronoló gica vs un 46,6% al corregir la edad para la talla. Al comparar los grupos de percentiles de IMVI-edad cronológica vs IMVI ajustado a la edad para la talla real, se observó que el 18,6% de la muestra cambia de grupo de percentil, el 100% de ellos a un grupo de percentil inferior. La concordancia evaluada en base a coeficiente Kappa fue de 0,72 (concordancia perfecta > 0,8), confirmando diferencias al ajustar el IMVI para la edad corregida por la talla. CONCLUSIÓN: El cálculo de IMVI por edad cronológica so breestima el compromiso cardiovascular en niños con ERC que característicamente tienen un retraso de talla. Los resultados sugieren que el cálculo de IMVI ajustado a la edad corregida por talla otorga mayor precisión al diagnóstico de hipertrofia ventricular izquierda en este grupo de pacientes.

INTRODUCTION: There is a close relationship between chronic kidney disease (CKD) and cardiovascular disease. One of its clinical manifestations is left ventricular hypertrophy (LVH), expressed as Left Ventricular Mass Index (LVMI gr/m27). In CKD patients with growth retardation, the LVMI calculation should be adjusted by correcting age for length/height. OBJECTIVE: To compare the age-corrected LVMI for length/height with the value calculated by chronological age in CKD children on dialysis. PATIENTS AND METHOD: Cross-sectional study. We analyzed echocardiographies of CKD children on dialysis aged between 1 and 18, from January 2016 to July 2017. LVMI was evaluated by adjusting the value expressed in gr/m27 to the percentile for the chronological child's age, and then the value was adjusted to the age-corrected length/height. We used descriptive statistics and concordance study for LVMI assessments calculating by chronological age and for age-corrected length/height. RESULTS: 26 patients were included and 75 echocardiograms. 56% had left ventricular hypertrophy using chronological age versus 46.6% age-corrected LVMI for length/height. When comparing the percentile groups of LVMI-chronological age vs. age-adjusted LVMI for actual length/height, it was observed that 18.6% of the sample changed percentile groups, 100% of them to a lower percentile group. The agreement evaluated based on the Kappa coefficient was 0.72 (perfect agreement > 0.8), confirming differences when adjusting the LVMI for age-corrected length/height. CONCLUSION: Calculating LVMI by chro nological age overestimates the cardiovascular involvement in children with CKD who are charac teristically stunted. The results suggest that the age-adjusted, length/height-corrected calculation of LVMI gives greater accuracy to the diagnosis of left ventricular hypertrophy in this group of patients.

Study of the correlation of epicardial adipose tissue with left ventricular mass and left ventricular mass index in patients with essential hypertension

Background: Epicardial Adipose Tissue (EAT) is recognized to be a cardiovascular risk factor. In addition to providing fuel to heart, it plays a pivotal role in the pathogenesis of atherosclerosis though the secretion of adipokines. This study aims to find the correlation of EAT with Left Ventricular Mass (LVM) and Left Ventricular Mass Index (LVMI) in patients with essential hypertension. Increasing LVM and LVMI are predictors of poor cardiovascular outcome. So, if we find a positive correlation, we can say that measurement of epicardial fat in essential hypertension may help us identify high risk hypertensive patients.Methods: This study was carried out in SMS Hospital, Jaipur, after approval from the Ethics Committee. 100 consecutive eligible patients were included in the study after application of inclusion and exclusion criteria and taking proper informed consent. After history, examination and routine laboratory investigations, all patients underwent transthoracic 2D and Doppler echocardiography. EAT thickness, LVM and LVMI were measured and correlated using Spearman correlation coefficient.Results: The mean LVM was 139±42.12 g and mean LVMI was 35.76±11.28 g/m2.7. The spearman correlation coefficient (r) was calculated to be 0.691 between EAT and LVM and 0.677 between EAT and LVMI, indicating strong positive correlation between EAT and both LVM and LVMI. This implies that as; EAT increases, LVM and LVMI increases significantly.Conclusions: Thus, authors have found that EAT is positively correlated with LVM and LVMI. So, we can say that increase in EAT may lead to adverse cardiovascular outcome in patients with essential hypertension.

Evaluation of echocardiographic variables in patients of chronic renal failure: pre and post hemodialysis-a single center prospective study

Background: Cardiovascular disease is the leading cause of morbidity and mortality at each stage of Chronic Kidney Disease (CKD) around 30%-45% of patients of stage 5 CKD have advanced cardiovascular complications. Congestive Heart Failure is responsible for approximately 15% death in hemodialysis patients. Hence this study was done with the aim to evaluate the effects of Hemodialysis on various Cardiac parameters detected by 2D Echocardiography in patients with Chronic Kidney Disease.Methods: In this prospective cohort study, 54 patients with Stage 4 and 5 CKD were evaluated for various cardiac parameters by 2D Echocardiography before and after Hemodialysis and detailed characteristics of the patients were analyzed using SPSS version 16 and paired student t-test.Results: Among 54 patients with CKD, 9% (5/54) patients had stage 4 CKD while 91% (49/54) had stage 5 CKD. Hypertension was present in 81.48% (44/54) of patients and Left ventricular hypertrophy was present in 77.77% (42/54). 6 (11%) patients had associated pericardial effusion. Mean Pre and Post Hemodialysis Left ventricular end diastolic diameter (LVIDed) and Left ventricular end systolic diameter (LVIDes) was 50.38±4.16mm and 48.91±4.14mm; 33.54±3.29 mm and 32.58±2.80 mm respectively which was statistically significant (p <0.001). Pre-HD Left atrial diameter was 34.20±3.81mm and it became 33.19±3.30mm Post-HD (p <0.001). Left ventricular mass index (LVMI) was 136.70±35.91 g/m2 pre-HD and 125.54±29.35 g/m2 post-HD which is significant. Left Ventricular Ejection Fraction was 47.34±5.72% before HD and it became 48.82±4.56% after 6 session of Hemodialysis over 3 weeks which is statistically significant (p<0.038).Conclusions: The present findings suggest patients with Stage 4 and 5 CKD who were on hemodialysis there was significant improvement in various cardiac parameters apart from increase in left ventricular ejection fraction, which may lead to decrease morbidity and mortality in these patients.

Relationship between serum uric acid level and subclinical target organ damage / 上海交通大学学报（医学版）

Objective: To explore the correlation between serum uric acid level and subclinical target organ damage. Methods: A cohort of 333 patients were recruited at the Department of Examination Center of Ruijin Hospital North in July 2017, who were divided into two groups, normal (n=248) and high levels (n=85, males >420 µmol/L, females >360 µmol/L) of serum uric acid. Subclinical target organ damage indexes included glomerular filtration rate (eGFR), left ventricular mass index (LVMI) and other indicators. Results: Systolic pressure (P=0.006), diastolic pressure (P=0.000), serum creatinine (P=0.000) and LVMI (P=0.028) in the high uric acid group were significantly higher than those in the normal uric acid group, and eGFR was significantly lower than that of the control group (P=0.000). Pearson correlation analysis showed that the serum uric acid level was significantly correlated with systolic pressure (r=0.149, P=0.007), diastolic pressure (r=0.269, P=0.000), LVMI (r=0.172, P=0.002) and serum creatinine (r=0.569, P=0.000), and negatively correlated with glomerular filtration rate (r=-0.383, P=0.000). After adjusting to sex, age, and BMI, there was a significant positive correlation with diastolic pressure (r=0.170, P=0.013), and a significant negative correlation with glomerular filtration rate (r=-0.332, P=0.000). After further adjusting to blood pressure, there was a significant negative correlation with glomerular filtration rate (r=-0.291, P=0.000). Multivariate linear regression analysis showed that serum uric acid was independent of diastolic pressure and glomerular filtration rate (β=0.162, P=0.000; β=-0.058, P=0.004). Conclusion: Serum uric acid is positively correlated with diastolic blood pressure, and is negatively correlated with glomerular filtration rate.

Correlation of blood pressure variability with brachial ankle pulse wave velocity and left ventricular mass index / 上海交通大学学报（医学版）

Objective: To explore the association of blood pressure variability (BPV), especially diurnal blood pressure rhythm with brachial ankle pulse wave velocity (baPWV) and left ventricular mass index (LVMI). Methods: A total of 184 hypertensive patients participated this cross sectional study. Patients were divided into dippers, non-dippers, inverted dippers and extreme dippers groups according to nocturnal systolic blood pressure (SBP) decline. baPWV and LVMI in different groups were compared. Correlation of baPWV and LVMI with blood pressure and BPV variables were analyzed by univariate and multivariate regression analysis. Results: After adjusted by age, BMI, hypertension duration, blood pressure in consulting room, SBP and diastolic blood pressure (DBP) in 24 h, total cholesterol, low density lipoprotein cholesterin, brain natriuretic peptide and ejection fraction, baPWV in non-dippers group and inverted-dippers group were significantly higher than that in dippers group and extreme dippers group (P=0.000), and LVMI was significantly higher in non-dippers group than in dippers group (P=0.001) and extreme-dippers group (P=0.022). baPWV and LVMI were both significantly correlated to age, 24 h SBP and 24 h DBP, SD value of 24 h SBP and 24 h DBP, daytime SBP and DBP, nocturnal SBP and DBP, SD values of daytime SBP and DBP, SD values of nocturnal SBP and DBP in univariate linear regression models (P<0.05). In multivariate linear regression model, baPWV was independently associated to SD value of nocturnal SBP (β=0.289, P=0.000), nocturnal SBP decline (β=-0.398, P=0.000), daytime SBP (β=0.214, P=0.001) and SD value of daytime DBP (β=0.207, P=0.002), while LVMI was independently associated to 24 h SBP (β=0.348, P=0.000) and SD value of nocturnal SBP (β=0.196, P=0.026). Conclusion: baPWV was independently correlated to SD value of nocturnal SBP, nocturnal SBP decline, daytime SBP and SD value of daytime DBP, while LVMI was independently correlated to 24 h SBP and SD value of nocturnal SBP.

Clinical value of plasma NT－proBNP and left ventricular mass index in the diagnosis of elderly patients with normal left ventricular ejection fraction / 中国基层医药

Objective To investigate the clinical value of plasma NT －proBNP and left ventricular mass index in the diagnosis of heart failure (HF) with normal left ventricular ejection fraction (LVEF) in elderly patients. Methods From August 2014 to August 2017,82 patients with congestive heart failure in the People's Hospital of Yinzhou were enrolled .According to the results of LVEF in echocardiography ,the patients were divided into HFNEF group (41 cases) and HFREF group (41 cases),another 40 patients with normal heart function were selected as the control group.The relative indicators of echocardiography were compared among the three groups .The plasma NT－proBNP levels were compared among the three groups .The ROC curve of plasma NT －proBNP was used to diagnose HFNEF,and the sensitivity and specificity of HFNEF were calculated .The ROC curve of left ventricular mass index (LVMI)was drawn and its sensitivity and specificity were calculated .The plasma NT－proBNP level was used as an indirect indicator of left ventricular filling pressure ,the correlation of LVMI and plasma NT －proBNP in the HFNEF group was compared .Results The LVMI in the control group was significantly lower than that in the HF group [(86.95 ±8.72)g/m2vs.(130.53 ±15.18)g/m2,t ＝20.078,P＝0.000),but there was no statistically significant difference between the HFNEF group and HFREF group (P＞0.05).The NT－proBNP was the lowest in the control group,followed by the HFNEF group and HFREF group ,the difference was statistically significant among the three groups [(72.56 ±7.81)ng/mL vs.(182.55 ±18.45)ng/mL vs.(653.58 ±55.95)ng/mL,F＝8.254, P＝0.000).The sensitivity,specificity,positive predictive value and negative predictive value of HFNEF were 0.94, 0.83,0.95 and 0.21,respectively,when NT－proBNP 131pg/mL was used as the cut －off value.The sensitivity and specificity of HFNEF were 0.62 and 0.99,respectively,when LVMI＞125 g/m2was used as the standard .The corre－lation between plasma NT－proBNP and LVMI in the HFNEF group was r＝0.513 (P＜0.01).Conclusion Plasma NT－proBNP and LVMI in elderly patients with HFNEF are significantly higher than those in elderly patients with HFNEF,which may be useful for the diagnosis of HFNEF ,independent use of NT －proBNP or LVMI for diagnosis , there may be some defects ; if applied together,may improve the accuracy of diagnosis .

Correlation of blood pressure variability with brachial ankle pulse wave velocity and left ventricular mass index / 上海交通大学学报（医学版）

Objective·To explore the association of blood pressure variability (BPV),especially diurnal blood pressure rhythm with brachial ankle pulse wave velocity (baPWV) and left ventricular mass index (LVMI).Methods· A total of 184 hypertensive patients participated this cross sectional study.Patients were divided into dippers,non-dippers,inverted dippers and extreme dippers groups according to nocturnal systolic blood pressure (SBP) decline.baPWV and LVMI in different groups were compared.Correlation of baPWV and LVMI with blood pressure and BPV variables were analyzed by univariate and multivariate regression analysis.Results· After adjusted by age,BMI,hypertension duration,blood pressure in consulting room,SBP and diastolic blood pressure (DBP) in 24 h,total cholesterol,low density lipoprotein cholesterin,brain natriuretic peptide and ejection fraction,baPWV in non-dippers group and inverted-dippers group were significantly higher than that in dippers group and extreme dippers group (P=0.000),and LVMI was significantly higher in non-dippers group than in dippers group (P=0.001) and extreme-dippers group (P=0.022).baPWV and LVMI were both significantly correlated to age,24 h SBP and 24 h DBP,SD value of 24 h SBP and 24 h DBP,daytime SBP and DBP,nocturnal SBP and DBP,SD values of daytime SBP and DBP,SD values of nocturnal SBP and DBP in univariate linear regression models (P＜0.05).In multivariate linear regression model,baPWV was independently associated to SD value of nocturnal SBP (β=0.289,P=0.000),nocturnal SBP decline (β=0.398,P=0.000),daytime SBP (β=0.214,P=0.001) and SD value of daytime DBP (β=0.207,P=0.002),while LVMI was independently associated to 24 h SBP (β=0.348,P=0.000) and SD value of nocturnal SBP (β=0.196,P=0.026).Conclusion· baPWV was independently correlated to SD value of nocturnal SBP,nocturnal SBP decline,daytime SBP and SD value of daytime DBP,while LVMI was independently correlated to 24 h SBP and SD value of nocturnal SBP.

Assessment of left ventricular mass index on left ventricular remodeling and reversion in patients after aortic valve replacement / 中华超声影像学杂志

Objective To evaluate the reverse of the left ventricular remodeling by left ventricular mass index(LVMI) from real-time three-dimensional echocardiography (RT-3DE) in patients after aortic valve replacement (AVR).Methods Sixty-three patients included 36 moderate or severe aortic insufficiency (Group AI) and 27 moderate or severe aortic stenosis (Group AS) who accepted aortic valve replacement and 32 healthy subjects were enrolled.LVMI,left ventricular end-diastolic volume index (LVEDVI),left ventricular end-systolic volume index (LVESVI),and left ventricular ejection fraction (LVEF) were measured and compared with RT-3DE during 1 week pre-,1 week post-,1 month post-and 6 months post-operation.Results LVMI in Group AI and Group AS were significantly higher than those in healthy subjects during 1 week pre-,1 week post-,1 month post-and 6 months post operation (all P ＜0.05).Compared with pre-operation,LVEDVI,LVESVI,LVMI in Group AI and LVMI in Group AS were significantly decreased during 1 week post-operation(all P ＜0.05).LVMI in Group AI was significantly decreased during 1 month post-operation compared with those during 1 week post-operation(all P ＜0.05).Negative correlation between LVMI and LVEF in patients group after 1 week,1 month and 6 month postAVR (r =-0.69,-0.74,-0.86;P ＜0.05).Conclusions AVR can reverse left ventricular remodeling in patients with moderate or severe aortic insufficiency or aortic stenosis,which can be quantitatively evaluated by LVMI on RT-3DE.

Compromiso cardiovascular en pacientes pediátricos en diálisis peritoneal crónica / Cardiovascular disease in pediatric patients under chronic peritoneal dialysis

La diálisis peritoneal (DP) es la terapia de reemplazo renal más usada en niños portadores de enfermedad renal crónica terminal. La enfermedad cardiovascular es la principal causa de mortalidad en estos pacientes. OBJETIVO: Caracterizar pacientes pediátricos en DP crónica desde el punto de vista cardiovascular. PACIENTES Y MÉTODO: Estudio de corte transversal en pacientes en DP, estables según criterios DOQI. Se registraron variables epidemiológicas, dialíticas, bioquímicas y cardiovasculares. Se evaluó hipertrofia ventricular izquierda (HVI) por ecocardiografía. El índice de masa ventricular izquierda (IMVI) se calculó por índice talla/edad (g/m2.7). Se consideró HVI > 38,6 g/m2.7, y severa HVI > 51 g/m2.7. Se analizaron las variables continuas mediante ANOVA, y categóricas por χ2 o método exacto de Fisher. Se analizaron los datos en STATA 11.0. RESULTADOS: Se incluyeron 21 pacientes, 11 varones, edad 9,2 ± 3,5 años. El diagnóstico más frecuente fue displasia renal (52%). El KtV residual promedio fue de 0,8, y peritoneal 1,9. En la ecocardiografía, un 52% presentó HVI, un 91% de ellos en rango severo. Se demostró una relación significativa entre ultrafiltración y presión arterial sistólica, y entre IMVI y hemoglobina (p < 0,05). CONCLUSIONES: En este estudio reportamos una incidencia de HVI mayor al 50%, en su mayoría grado severo, lo cual evidencia el importante compromiso cardiovascular en estos pacientes. La hipertensión arterial y falla de ultrafiltración destacan como importantes factores relacionados a la hipertrofia ventricular izquierda.

Peritoneal dialysis (PD) is the most common renal replacement therapy used in pediatric patients with end stage renal disease. This population has a mortality rate 1,000 times greater compare to pediatric population, mainly due to cardiovascular causes. OBJECTIVE: To characterize pediatric patients on chronic PD in relation to dialysis and cardiovascular outcome. PATIENTS AND METHODS: Cross sectional study. Patients in stable PD according to DOQI criteria were selected. Epidemiological, dialytic, biochemical and cardiovascular variables were registered. Left Ventricular Mass Index (LVMI) was calculated by height/age (g/m2.7). Left Ventricular Hypertrophy (LVH) was diagnosed with > 38.6 g/m2.7, severe LVH > 51 g/m2.7. Data were analyzed using STATA 11.0. continuous variables using ANOVA test and categorical variables were analyzed using χ2 test or Fisher's exact test. RESULTS: 21 patients, 11 males. Mean age 9.2 ± 3.52 years. The most frequent diagnosis was renal dysplasia (52%). Residual and Peritoneal KtV were 0.8 and 1.9 respectively. Fifty-two percent of patients showed LVH, 91% in severe range. A significant relationship between ultrafiltration/m2 and systolic blood pressure was depicted. Also a significant relationship between left ventricular mass index and hemoglobin (p < 0.05) was founded. CONCLUSIONS: The majority of the population showed left ventricular hypertrophy -particularly severe LVH-, which confirms an increased CV risk in this population. Blood pressure and loss of ultrafiltration were founded to be correlated to LVH.

Dispersión de la onda P incrementada en niños dependiendo de la presión arterial, del peso, talla, de la estructura y función cardiaca / P wave dispersion increased in childhood depending on blood pressure, weight, height, and cardiac structure and function

Introducción: La dispersión de onda P incrementada se señala como predictor de fibrilación auricular, existiendo asociación entre hipertensión arterial, dispersión de onda P y variables ecocardiográficas y constitucionales. Estas relaciones han sido poco estudiadas en pediatría. Objetivo: Determinar la relación de la dispersión de la onda P con presión arterial, variables ecocardiográficas y constitucionales, y determinar las variables más influyentes en los incrementos de la dispersión de la onda P en pediatría. Método: Se estudiaron en el marco del proyecto PROCDEC II niños de 8 a 11 años. Se midió presión arterial, se realizó electrocardiograma de superficie y ecocardiograma. Resultados: Los valores de media del índice de masa ventricular izquierda para normotensos (25.91 ± 5.96 g/m2.7) e hipertensos (30.34 ± 8.48 g/m2.7) mostraron diferencias significativas (p = 0.000). Un 50.38% de prehipertensos más hipertensos presentan índice de masa ventricular normal y dispersión de la onda P incrementada versus normotensos (13.36%). La presión arterial media, la duración de la onda A, el peso y la talla presentan un valor de r = 0.88 al relacionarlo de forma múltiple con la dispersión de la onda P. Conclusiones: El índice de masa ventricular y la dispersión de la onda P demuestran ser mayores en pacientes prehipertensos e hipertensos que en normotensos. Se encontraron pacientes prehipertensos e hipertensos con índice de masa ventricular normal y dispersión de la onda P incrementada. Las variables que demostraron mayor influencia en los aumentos de la dispersión de la onda P fueron la presión arterial media, la duración de la onda A del flujo mitral, el peso y la talla.

Introduction: Increased P wave dispersion are identified as a predictor of atrial fibrillation. There are associations between hypertension, P wave dispersion, constitutional and echocardiographic variables. These relationships have been scarcely studied in pediatrics. Objective: The aim of this study was to determine the relationship between P wave dispersion, blood pressure, echocardiographic and constitutional variables, and determine the most influential variables on P wave dispersion increases in pediatrics. Method: In the frame of the PROCDEC II project, children from 8 to 11 years old, without known heart conditions were studied. Arterial blood pressure was measured in all the children; a 12-lead surface electrocardiogram and an echocardiogram were done as well. Results: Left ventricular mass index mean values for normotensive (25.91 ± 5.96 g/m2.7) and hypertensive (30.34 ± 8.48 g/m2.7) showed significant differences P = .000. When we add prehypertensive and hypertensive there are 50.38% with normal left ventricular mass index and P wave dispersion was increased versus 13.36% of normotensive. Multiple regression demonstrated that the mean blood pressure, duration of A wave of mitral inflow, weight and height have a value of r = 0.88 as related to P wave dispersion. Conclusions: P wave dispersion is increased in pre- and hypertensive children compared to normotensive. There are pre- and hypertensive patients with normal left ventricular mass index and increased P wave dispersion. Mean arterial pressure, duration of the A wave of mitral inflow, weight and height are the variables with the highest influence on increased P wave dispersion.

Relationship Between the Ambulatory Arterial Stiffness Index and Left Ventricular Mass Index, Left Atrial Diameter in Patients With Hypertension / 中国循环杂志

Objective: To explore the relationship between ambulatory arterial stiffness indexes (AASI), AASI-blood pressure variability (AASI-BPVR) and left ventricular mass index (LVMI) left atrium diameter (LAD) in patients with hypertension. Methods: A total of 286 hypertensive patients were enrolled in this study. The AASI, AASI-BPVR were calculated from 24-hour ambulatory blood pressure monitoring. Left ventricular internal dimension in diastole (LVIDd), interventricular septal thickness in diastole (IVSd), posterior wall thickness in diastole (PWd), LAD were detected by echocardiography and LVMI, relative wall thickness (RWT) were calculated. The fasting blood glucose, blood lipids were examined. According to 24 h AASI, the patients were divided into 2 groups, Group A, the patients with AASI > 0.51, n=133 and Group B, the patients with AASI ≤ 0.51,n=153. Pearson and multi regression analysis were conducted to analyze the relevant correlations. Results: Group A had increased LVMI than that in Group B,P Conclusion: AASI and AASI-BPVR were not the independent factors for left ventricular hypertrophy and left atrial enlargement, therefore, they were not the predictors for cardiac damage in patients with hypertension at present time.

Relación entre la dispersión de la onda P, el índice de masa ventricular izquierda y la tensión arterial / Relationship between P wave dispersion, left ventricular mass index and blood pressure

Introducción. El estudio de los factores de riesgo para padecer hipertensión arterial en los niños garantiza establecer políticas de salud a fin de evitar futuras complicaciones asociadas a esta enfermedad. Los mayores valores de dispersión de la onda P, mientras el paciente está en ritmo sinusal, se señalan como predictores de fibrilación auricular en el adulto, ya que existe una asociación entre la hipertensión arterial, la dispersión de la onda P y la hipertrofia ventricular izquierda. Nuestro objetivo fue determinar la relación entre la tensión arterial, el índice de masa ventricular izquierda y la dispersión de la onda P en pediatría. Población y métodos. Se estudiaron, en el marco del proyecto PROCDEC II, niños de 8 a 11 años, sin cardiopatías conocidas. En todos se midió la tensión arterial y se realizó un electrocardiograma de superficie de 12 derivaciones y un ecocardiograma. Resultados. Los valores de la media del índice de masa ventricular izquierda para normotensos (25,21 ± 5,96 g/m²) e hipertensos (30,38 ± 7,39 g/m²) mostraron diferencias significativas (p= 0,000). La media del área auricular izquierda mostró diferencias significativas (p= 0,000) al comparar los prehipertensos (10,98 ± 2,23 cm²) e hipertensos (12,21 ± 1,27 cm²) con los normotensos (10,66 ± 2,38 cm²). La correlación entre la dispersión de la onda P y el índice de masa ventricular izquierda mostró r= 0,87 y p= 0,000. Conclusiones. La dispersión de la onda P está incrementada en los prehipertensos e hipertensos en relación con los normotensos. Se encontró una dependencia de la dispersión de la onda P del índice de masa ventricular izquierda en los hipertensos.

Introduction. The study of arterial hypertension risk factors in children guarantees the establishment of health policies to avoid complications associated with this illness in the future. The highest values of P-wave dispersion during sinus rhythm are pointed as predictors of atrial fibrillation in adulthood since there is an association between arterial hypertension, P-wave dispersion and left ventricular hypertrophy. The aim of this study was to determine the relationship between blood pressure, left ventricular mass index and P-wave dispersion in the pediatric population. Population and methods. In the frame of the PROCDEC II project, children from 8 to 11 years old, without known heart conditions were studied. Arterial blood pressure was measured in all the children; a 12-lead surface ECG and an echocardiogram were done as well. Results. Left ventricular mass index mean values for normotensive (25.21 ± 5.96 g/m²) and hypertensive (30.38 ± 7.39 g/m²) children showed significant differences (p= 0.000). The mean value of the left atrial area was significantly different (p= 0.000) when comparing prehypertensive (10.98 ± 2.23 cm2) and hypertensive (12.21 ± 1.27 cm²) children to normotensive ones (10.66 ± 2.38 cm²). The correlation of P-wave dispersion and the left ventricular mass index showed an r= 0.87 and p= 0.000. Conclusions. P-wave dispersion is increased in pre- and hypertensive children compared to normotensive ones. A dependence of the P-wave dispersion of the left ventricular mass index was found in hypertensive children.

Correlation among Ambulatory Blood Pressure, Ankle Brachial Index and Left Ventricular Mass Index in Hypertensive Patients / 中国康复理论与实践

@#To analyze the relationship among ambulatory blood pressure (AMBP), ankle brachial index (ABI) and left ventricular mass index (LVMI) in hypertensive patients. Methods 578 hypertensive inpatients were reviewed. Results The general clinical dataof selected patients, their ABI, LVMI were not different significantly between male and female. The correlation analysis showed that LVMI was positively correlated with the 24-hour average systolic (r=0.245, P=0.000) or diastolic (r=0.158, P=0.000) blood pressure, whereas negatively correlated with percent of systolic (r=－0.104, P=0.012) or diastolic (r=－0.132, P=0.001) blood pressure declining at night. No significant correlation was found between LVMI and BMI. Multiple regression analysis revealed that LVMI was significant independently positive correlated with 24-hour average systolic blood pressure (P=0.000). Conclusion LVMI does not correlate with ABI, but independent positive related with 24-hour average systolic blood pressure.

Relationship between N-terminal-pro-B-type Natriuretic Peptide and Left Ventricular Mass Index in Elderly Hypertension Patients / 中国康复理论与实践

@#Objective To investigate the N-terminal-pro-B-type natriuretic peptide (NT-proBNP) concentration in the difference myocardial wall motion after essential hypertension. Methods 326 patients with essential hypertension and normal heart function and 265 control subjects were measured with their NT-proBNP. According to Canau's categories, the ventricle geometries of patients with high left ventricular mass index were divided into 2 groups. Results NT-proBNP was significantly higher in patients with hypertension than in controls. After grouped by different myocardial wall motion, the patients with concentric hypertrophy were highest among all the groups; the groups with eccentric hypertrophy was secondly highest; concentric remodeling and normal geometric pattern were not significantly higher than the controls. Conclusion NT-proBNP is different in patients with different myocardial wall motion before heart failure, which may play an important role in myocardial remodeling.

Comparison of Blood Pressure Control and Left Ventricular Hypertrophy in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD)

This study aimed to investigate the influence of different peritoneal dialysis regimens on blood pressure control, the diurnal pattern of blood pressure and left ventricular hypertrophy in patients on peritoneal dialysis. Forty-four patients undergoing peritoneal dialysis were enrolled into the study. Patients were treated with different regimens of peritoneal dialysis: 26 patients on continuous ambulatory peritoneal dialysis (CAPD) and 18 patients on automated peritoneal dialysis (APD). All patients performed 24-hour ambulatory blood pressure monitoring (ABPM) and echocardiography. Echocardiography was performed for measurement of cardiac parameters and calculation of left ventricular mass index (LVMI). There were no significant differences in average of systolic and diastolic blood pressure during 24-hour, daytime, and nighttime between CAPD and APD groups. There were no significant differences in diurnal variation of blood pressure, systolic and diastolic blood pressure load, and LVMI between CAPD and APD groups. LVMI was associated with 24 hour systolic blood pressure load (r = 0.311, P < 0.05) and daytime systolic blood pressure load (r = 0.360, P < 0.05). In conclusion, this study found that there is no difference in blood pressure control, diurnal variation of blood pressure and left ventricular hypertrophy between CAPD and APD patients. The different peritoneal dialysis regimens might not influence blood pressure control and diurnal variation of blood pressure in patients on peritoneal dialysis.

Association of angiotensin-converting enzyme activity and polymorphism with echocardiographic measures in familial and nonfamilial hypertrophic cardiomyopathy

Angiotensin-converting enzyme (ACE) activity and polymorphism contribute significantly to the prognosis of patients with cardiomyopathy. The aim of this study was to determine the activity and type of ACE polymorphism in patients with familial and nonfamilial hypertrophic cardiomyopathy (HCM) and to correlate these with echocardiographic measurements (echo-Doppler). We studied 136 patients (76 males) with HCM (69 familial and 67 nonfamilial cases). Mean age was 41 ¡À 17 years. DNA was extracted from blood samples for the polymerase chain reaction and the determination of plasma ACE levels. Left ventricular mass, interventricular septum, and wall thickness were measured. Mean left ventricular mass index, interventricular septum and wall thickness in familial and nonfamilial forms were 154 ¡À 63 and 174 ¡À 57 g/m2 (P = 0.008), 19 ¡À 5 and 21 ¡À 5 mm (P = 0.02), and 10 ¡À 2 and 12 ¡À 3 mm (P = 0.0001), respectively. ACE genotype frequencies were DD = 35%, ID = 52%, and II = 13%. A positive association was observed between serum ACE activity and left ventricular mass index (P = 0.04). Logistic regression showed that ACE activity was twice as high in patients with familial HCM and left ventricular mass index ¡Ý190 g/m2 compared with the nonfamilial form (P = 0.02). No other correlation was observed between ACE polymorphisms and the degree of myocardial hypertrophy. In conclusion, ACE activity, but not ACE polymorphisms, was associated with the degree of myocardialhypertrophy in the patients with HCM.

Descenso espontáneo de la frecuencia cardíaca y regresión de la hipertrofia ventricular izquierda / Descenso espontâneo da frequência cardíaca e regressão da hipertrofia ventricular esquerda / Spontaneous decrease of heart rate and left ventricular hypertrophy regression

Antecedentes. El análisis de la frecuencia cardíaca ha demostrado tener impacto pronóstico en sujetos sanos, pacientes hipertensos, y portadores de insuficiencia cardíaca o cardiopatía isquémica. El objetivo del presente trabajo es determinar si existe una relación, y de qué tipo, entre los cambios espontáneos en la frecuencia cardíaca durante el tratamiento en pacientes hipertensos y el índice de masa ventricular izquierda. Material y métodos. Se incluyeron 40 pacientes hipertensos tratados 1 año sin drogas que interfieran sobre la frecuencia ni el ritmo cardíaco. Análisis estadístico. Se aplicó test de correlación, y se consideró significación estadística un valor de p < 0,05. Resultados. Veintidós pacientes (54%) eran de sexo masculino; la edad media de la muestra fue de 53,8 ± 13,1 años; el índice masa corporal promedio basal fue de 28,9 ± 34,8 kg/m² y al final del seguimiento de 27,7 ± 3,9 kg/m². La presión arterial promedio basal fue de 154,2 ± 19,9 / 89,5 ± 10,8 mm Hg y la final de 137,3 ± 21,6 / 81 ± 10,6 mm Hg; la frecuencia cardíaca promedio basal de 75,3 ± 11,2 lat/min y la final de 76,8 ± 10,4 lat/min. Se observó una correlación estadísticamente significativa entre las presiones arteriales sistólica y diastólica obtenidas al final del seguimiento, y el índice de masa ventricular izquierda: r = 0,36 p < 0,01 y r = 0,29 p < 0,02; respectivamente; por otra parte, se demostró una correlación estadísticamente significativa entre el descenso de la frecuencia cardíaca y la regresión del índice de masa ventricular izquierda al final del seguimiento: r = 0,27 p < 0,05. Conclusiones. Nuestro estudio coincide con hallazgos previos de la literatura en mostrar una relación positiva, continua y estadísticamente significativa entre los valores de presión arterial obtenidos con el tratamiento antihipertensivo y la regresión de la hipertrofia ventricular izquierda, y establece como hecho novedoso la existencia de una relación continua, positiva, y estadísticamente significativa entre la evolución de la frecuencia cardíaca y el índice de masa ventricular izquierda, de modo tal que en pacientes hipertensos, un descenso espontáneo de la frecuencia cardíaca se asoció a regresión de hipertrofia ventricular izquierda, y por el contrario, un ascenso espontáneo a progresión del daño en órgano blanco.

Background. The analysis of heart rate has been shown to have prognostic impact in healthy subjects, and in hypertensive, heart failure or ischemic heart disease patients. The aim of this study is to determine if a relationship exists, and what kind, between the spontaneous changes in heart rate during treatment in patients with hypertension and left ventricular mass index. Material and methods. We included 40 hypertensive patients treated during 1 year without drugs that interfere on heart rate. Statistical analysis. Correlation test was applied, and statistical significance was considered p < 0.05. Results. Twenty-two patients (54%) were males, the average age of the patients was 53.8 ± 13.1 years, the average baseline body mass index was 28.9 ± 34.8 kg/m² and at follow-up 27.7 ± 3.9 kg/m². The average baseline blood pressure was 154.2 ± 19.9 / 89.5 ± 10.8 mm Hg and the final 137.3 ± 21.6 / 81 ± 10.6 mm Hg. Baseline heart rate averaged was 75.3 ± 11.2 beats/min and at follow up was 76.8 ± 10.4 beats/min. There was a statistically significant correlation between systolic and diastolic blood pressures achieved at the end of follow up, and left ventricular mass index: r = 0.36 p <0.01 and r = 0.29 p < 0.02, respectively; on the other hand, a statistically significant correlation was shown between the decrease in heart rate and regression of left ventricular mass index at the end of follow up: r = 0.27 p < 0.05. Conclusions. Our study agrees with previous findings in the literature showing a positive, continuous and statistically significant correlation between blood pressure values obtained with antihypertensive treatment and regression of left ventricular hypertrophy, and establishes as fact the existence of a novel relationship, positive and statistically significant, between changes in heart rate and left ventricular mass index, so that in hypertensive patients, a spontaneous decrease of heart rate was associated with regression of left ventricular hypertrophy, and otherwise, a spontaneous rise in heart rate to progression of target organ damage.

Antecedentes. A análise da frequência cardíaca demonstrou ter impacto prognóstico em sujeitos sãos, pacientes hipertensos, e portadores de insuficiência cardíaca ou cardiopatia isquêmica. O objetivo do presente trabalho é determinar se existe uma relação, e de que tipo, entre as mudanças espontâneas na frequência cardíaca durante o tratamento de pacientes hipertensos e o índice de massa ventricular esquerda. Material e métodos. Incluíram-se 40 pacientes hipertensos tratados durante 1 ano sem drogas que interferissem na frequência e no ritmo cardíaco. Análise estatística. Aplicou-se test de correlação, e considerou-se de significação estatístico um valor de p < 0,05. Resultados. Vinte e dois pacientes (54%) eram do sexo masculino; a idade média da amostra foi de 53,8 ± 13,1 anos; o índice de massa corporal médio basal foi de 28,9 ± 34,8 kg/m² e ao final do seguimento de 27,7 ± 3,9 kg/m². A pressão arterial média basal foi de 154,2 ± 19,9 / 89,5 ± 10,8 mm Hg e ao final de 137,3 ± 21,6 / 81 ± 10,6 mm Hg; a frequência cardíaca média basal de 75,3 ± 11,2 lat/min. e ao final de 76,8 ± 10,4 lat/min. Observou-se uma correlação estatisticamente significativa entre as pressões arteriais sistólicas e diastólicas obtidas ao final do seguimento, e o índice de massa ventricular esquerda: r = 0,36 p < 0,01 y r = 0,29 p < 0,02, respectivamente; por outra parte, demonstrou-se uma correlação estatisticamente significativa entre o descenso da frequência cardíaca e a regressão do índice de massa ventricular esquerdo ao final do seguimento: r = 0,27 p < 0,05. Conclusões. Nosso estudo coincide com achados prévios da literatura em mostrar uma relação positiva, contínua e estatisticamente significativa entre os valores de pressão arterial obtidos com o tratamento antihipertensivo e a regressão da hipertrofia ventricular esquerda, e estabelece como fato novo a existência de uma relação contínua, positiva, e estatisticamente significativa entre a evolução da frequência cardíaca e o índice de massa ventricular esquerda, de modo tal que em pacientes hipertensos, um descenso espontâneo da frequência cardíaca associou-se a regressão de hipertrofia ventricular esquerda, e pelo contrário, um ascenso espontâneo associou-se a progressão do dano no órgão branco.

Evaluation of Left Ventricular Structures in Normotensive and Hypertensive Subjects by Two-Dimensional Echocardiography: Anthropometric Correlates in Hypertension

This study was conducted with the objective to establish a nomogram for some left ventricular structures and their alterations in hypertension. Correlations between left ventricular structures and anthropometric variables in hypertension were also established. A sample of 320 normotensive and 80 hypertensive subjects were studied. Echocardiograhic end diastolic diameter; posterior wall thickness and septal wall thickness were obtained. Subject height; weight; age and blood pressures were obtained. Blood pressures were measured in sitting position. The values of left ventricular mass (LVM); left ventricular mass index (LVMI) and left relative wall thickness (RWT) were computed. Parametric tests were conducted. Tests were two tailed with P 0.05 indicating statistical significance. Normal values of left ventricular structures were established; LVM: 63.72g - 336.18g; LVMI: 38.16g/m - 222.64g/m; and RWT: 0.25 - 0.52. Significant differences (P 0.05) were established in LVM; LVMI and RWT between normotensive and hypertensive subjects. Positive and significant correlations were noted between these variables and systolic blood pressure in hypertensive subjects. A simple linear regression of RWT on Body surface area gives RWT

Left Ventricular Hypertrophy in Patients with Primary Aldosteronism / 中华高血压杂志

Objective To analysis the parameters of left ventricular hypertrophy(LVH) in patients with primary aldosteronism(PA).Methods Two hundred fifty patients were diagnosed as primary aldosteronsim in this study.One hundred fouty two PA patients undergone the adrenal venous sampling(AVS).Adenomas) APA) were diagnosed in 68 patients and idiopathic hyperaldosteronism(IHA) in 74 patients.During the same period, clinical characteristics and cardiovascular events of this group were compared with those of 246 patients with essential hypertension(EHT) randomly matched for age,gender,and systolic and diastolic blood pressure.Echocardiographic examinations and biochemical and hormonal assays were conducted in all subjects.Results 1) Left ventricular end-diastolic dimension(LVEDd) was increased in PA patients compared with values in EHT patients(PA;49.6?4.3 vs EHT:48.3?4.2 mm,P0.05);however,in grade 2 and 3 hypertension,the LVMI in patients with PA was increased compared with values in patients with EHT(P