Prediction of risk of hypertension in offspring of hypertensive subjects

The offspring of hypertensive patients has a tendency to develop hypertension, so the question of prediction of susceptible individuals is unclear. This Cross-sectional comparative study was designed to clarify some predictors of hypertension in offspring of hypertensive patients. The study included 100 subjects [12 to 18 year old, male and female]; 50 offspring of hypertensive parents [group I] and 50 offspring of normotensive parents [Group II]. They were subjected to full medical history and clinical examination including blood pressure record at rest and after exercise. Also anthropometric assessment was performed. Biochemical assessment for fasting C-peptide insulin level, and plasma level of norepinephrin [NE] were recorded. In group I. the mean resting systolic blood pressure [SBP] was 101.8 +/- 9mmHg, the mean peak SBP 197.2 +/- 27mmHg, the mean resting distolic blood pressure [DBP] was 76.5 +/- 7.5mmHg, the mean peak DBP 71 +/- 9.5mmHg. The mean resting heart rate [HR] was 83.6 +/- 8.7 Beat/min. the mean peak HR was 193.5 +/- 9.I Beat/min. The mean metabolic equivalent [METs] was 12.5 +/- 1.8 MEq. The mean body mass index [BMI] was 30 +/- 5.1 kg/m2. The mean serum insulin level was 23.5 +/- 15.7 micro U/dl and the mean serum NE level was 344.7 +/- 57.1 ng/dl. In group II, the mean resting SBP was 95.1 +/- 16.22mmHg, the mean peak SBP was 172.5 +/- 17.8mmHg; the mean resting DBP was 66.7 +/- 7.7mmHg, the mean peak DBP was 63.4 +/- 6.9mmHg. The mean resting HR was. 80.1 +/- 11.4 Beat/min, the mean peak HR was 188.7 = 6.2 Beat/min. The mean METs was 13.2 +/- 1.8 MEq. The mean BMI was 26.8 +/- 3.6 +/- 5.8 kg/m[2]. The mean serum insulin was 14.7 +/- 15.7 micro U/dl, and mean serum NE was 286.3 +/- 57.1 ng/dl. Both SBP and DBP were within normal limits but were significantly greater in group I than group II. Function capacity was significantly lesser in group I than group II. BMI was significantly greater in group 1 than group II. Serum insulin and NE were significantly increased in group I than group II. However the long-term effect of these risk factors on the cardiovascular system including the coronary arteries need more research

Dobutamine-transesophageal echocardiography versus dipyridamole thallium-201 scintigraphy for assessment of myocardial viability

Dipyridamole Thallium-201 scintigraphy have been widely used to differentiate between scar tissue and viable but not functioning myocardium and showed superiority over dobutamine stress echo-cardiography. The development of transesophageal echocardiogram [TEE] may overcome many of transthoracic limitations. To compare dobutamine stress TEE and Dipyridamole thallium scintigraphy in detection of myocardial viability. The study included 27 patients with coronary artery disease [CAD] and severe segmental wall motion abnormalities [SWMA] on resting echocardiogram who were scheduled for revascularization either through angioplasty or bypass surgery [CABG]. Dobutamine-TEE and dipyridamole thallium scintigraphies were done within 5 to 7 days before revascularization. Post-revascularization resting echocardiography was done 14 to 21 days to assess any improvement of SWMA as a sign of myocardial viability. Although the sensitivity of dobutamine TEE to detect myocardial viability was higher than that of thallium scintigraphy [89% vs. 72% respectively] but it did not reach statistical significance [P=0.06]. However, the specificity of TEE was significantly higher than that of scintigraphy [83% vs. 67%, P=0.04] and the total diagnostic accuracy of dobutamine TEE to detect myocardial viability was significantly higher than that of dipyridamole thallium scintigraphy [88% vs. 71% p = 0.05]. In the presence of severe SWMA, dobutamine TEE could detect myocardial viability more frequently than dipyridamole thallium scintigraphy

Pro-collagen peptides in essential hypertension and its relation to cardiac structure and functions before and after antihypertensive therapy

A significant increase in fibrillar collagen content, type I and type III, has been observed in the cardiac ventricles of both animals and humans with arterial hypertension. The serum concentrations of procollagen type I carboxy terminal peptide [PIP] and procollagen type III amino terminal peptide [PIIIP] have been proposed as a useful markers of collagen types I and III synthesis. We evaluated fibrogenic activity in patients with essential hypertension by measuring serum concentrations of PIP and PIIIP as markers of tissue synthesis of collagen type I and type III, and its relation to parameters of left ventricular [LV] structure and functions in those patients. The effect of treatment with ACE inhibitor [captopril] for 6 months on serum concentrations of both PIP and PIIIP was also studied. The study included 79 patients with newly diagnosed mild to moderate hypertension and 50 normotensive subjects. Ages ranged between 35 to 60 years. Careful blood pressure measurement was obtained in all subjects. M-mode, two dimensional, and pulsed Doppler were performed to get baseline LV anatomy and function. Serum PIP and PIIIP were measured by radioimmunoassay. Both echocardiography and biochemical studies were repeated for all hypertensives after 6 months treatment with captopril. Serum PIP and PIIIP were significantly higher in hypertensive patients compared with normotensive subjects. PIP was 258 +/- 57mg/L in hypertensives vs. 167 +/- 70mg/L in normotensives. PIIIP was 3.73 +/- 2.2mg/L in hypertensives vs. 1.9 +/- 1.4mg/L in normotensives. In addition, PIP and PIIIP were significantly higher in hypertensives with LV hypertrophy [LVH] than those with normal LV mass. Moreover, serum concentration of PIP was directly correlated with LV mass index. On the other hand, PIIIP was inversely correlated with VE/VA ratio. After treatment, significant echocardiographic and biochemical improvements were observed. LVH regressed in 13 out of 68 patients [19%], LV mass index was normalized in 17 out of 58 patients [29%], and diastolic dysfunction was normalized in 10 out of 44 patients [23%]. Serum PIP and PIIIP were significantly reduced in hypertensives. Serum concentrations of both PIP and PIIIP are significantly increased in hypertensives and this was more pronounced among patients with LVH. This was correlated with structural and functional LV changes in the form of LVH and diastolic dysfunction. All changes demonstrated significant improvement after treatment with captopril

Evaluation of lipoprotein [a] as a risk factor for myocardial infarction: relations to common hypercholesterolemia

The incidence of coronary heart disease [CHD] is increasing in Egypt. There is a need for identification of some risk factors that could predict the occurrence of myocardial infarction [MI] in susceptible persons such as those with hypercholesterolemia. This case control study was done to define whether increased serum lipoprotein [a] [Lp [a]] is a risk factor for developing MI and its relation to common hypercholesterolemia. Lp [a] was estimated in a group of middle aged men [n = 17] with a past history of MI within the past two years and another age matched group of men [n = 18] with no history of CHD. Both groups were showing the criteria of having common hypercholesterolemia [low density lipoprotein [LDL] cholesterol between 135-277 mg/dl, triglycerides < 337 mg/d1 and with no family history of hypercholesterolemia and/or CHD]. The Lp [a] levels also measured in a group of healthy middle aged medical staff with no history of CHD and with normal LDL cholesterol [< 135 md/d1]. The Lp [a] serum levels were significantly higher in the group with MI [geometric mean 0.62 [95% confidence interval 0.35 to 1.14] vs 0.28 [0.2 to 0.41] g/L, p = 0.02], but there were no significant differences in other variables. Logistic regression analysis showed that Lp [a] was the only significant predictor of MI [p 0.02]. The odds ratio of MI, adjusted for age, smoking, blood presure, and apolipoprotein B, for an Lp [a] of > 0.57 g/L was 16.4, 95% confidence interval 2.2 to 125.4 [p = 0.001]. It was concluded that Lp [a] is an independent and satisfying index for risk of developing MI and could be used as a laboratory tool for identifying persons prone to suffer from the disease