Importance Of Non–dipping Pattern In Chronic Kidney Disease Patients

Introduction: Hypertension was prevalent in 80 to 90% of patients with chronic kidney disease (CKD), Hypertension was widely known to accelerate the progression of CKD and increase the risk of cardiovascular (CV) events. In essential hypertension, it was observed that 24hr ambulatory BP and a non–dipping profile were closely associated with increased target–organ damage and a worsened CV outcome than clinic BP. Objective: The purpose of this study was to evaluate the relation between non dipping pattern, traditional risk factors such as age, gender, cholesterol, asymptomatic atherosclerosis markers (LVMI, Carotid IMT, ABI) and cardiovascular mortality in CKD patients. Methodology: Patients attending hemodialysis unit and the outpatient department of the Osmania General Hospital were formed as the material of study. Results: According to the Sleep /Awake BP ratio> 0.9 in their ambulatory BP recordings; The percentage of non dipping pattern was observed in 72% and the remaining 28% had dipping phenomenon. The estimated glomerular filtration rate (eGFR) calculated by Modification of diet in renal disease study (MDRD) equation has ranged around 4.8 to 77 ml/mim/1.73m2 and was negatively correlated with sleep/awake BP ratio. The percentage of diabetes was observed to be higher in the non–dippers. The non–dipping phenomenon was significantly associated with asymptomatic atherosclerosis markers (LVMI, Carotid IMT, and ABI). There was a high prevalence of CV events (1 in dipper and 17 in non–dippers) and CV related deaths (1 in dipper and 9 in non–dippers) in non dippers.

Relationship between Left Ventricular Mass Index and Insulin Resistance in Obese Subjects

Obesity is an underestimated condition of clinical and public health importance across the world. Obesity has been associated with Left ventricular hypertrophy and insulin resistance, both of which are associated with cardiovascular morbidity and mortality. The aim of present study to determine relationship between left ventricular mass index and Insulin resistance in obese subjects. Methods: The present study is a observational study conducted in Guru Nanak Dev Hospital attached to Govt. Medical college Amritsar. Total 50 normotensive nondiabetic obese subjects of both genders were included in the study. Results: There was strong positive correlation of Left Ventricular Mass Index (LVMI) with HOMA-IR. Pearson’s correlation coefficient (r) = 0.298 and P value was < 0.05. Left ventricular hypertrophy was present in 38% and 70% of obese subjects when left ventricular mass was indexed to body surface area and height respectively. Conclusion: The present study concludes that left ventricular mass index is strongly related with insulin resistance in normotensive nondiabetic obese subjects. So their earlier detection will reduce cardiovascular morbidity and mortality.

Assessment of cardiovascular hemodynamics in gestational hypertension and preeclampsia.

Preeclampsia is a multisystem disease complicating 5-10% of pregnancies and remains in the top three causes of maternal morbidity and mortality globally. During pregnancy mean arterial pressure and vascular resistance decrease, while blood volume and basal metabolic rate increase resulting in increased cardiac output In hypertensive disorders of pregnancy there is currently no consensus on the systolic and diastolic parameters of cardiac function and the literature is conflicting regarding whether there is increased, decreased or any change in cardiac output. Women with a history of preeclampsia/eclampsia have approximately double the risk of early cardiac, cerebrovascular, and peripheral arterial disease, and cardiovascular mortality. This study was undertaken to evaluate cardiovascular hemodynamic alterations in hypertensive disorders of pregnancy in comparison with appropriately age, parity and gestational age matched control normotensive pregnancies. In women with preeclampsia cardiac work index and left ventricular mass index are increased as a result of increased workload on heart to maintain cardiac output against increased after load. Systolic function is well preserved. Diastolic function is reduced and those with global diastolic function are at increased risk of developing pulmonary edema. Advanced techniques like speckle tracking echocardiography can better identify those with compromised cardiovascular function.

Relation Between Level of CA125 and Heart Function as well as Myocardial Remodeling in Patients with Congestive Heart Failure / 医学研究杂志

Objective To study the relation between the level of serum carbohydrate antigen-125 (CA125) and heart function as well as the myocardial remodeling in patients with congestive heart failure(CHF). Methods 79 patients with CHF were divided into three groups based on the standard of New York Heart Association Classification. 25 healthy persons were served as control group. Level of CA125 was measured by MEIA. NT-proBNP was detected by Roche Cardiac Reading instrument. TNF-? was measured by radioimmunoassay. Left ventricular mass index (LVMI),left atrial volume index (LAVI) and left ventricular ejection fraction (LVEF) were detected by echocardiography. The levels of CA125,NT-proBNP,TNF-?,LVMI,LAVI and LVEF in different groups were compared.The relationship between CA125 and NT- proBNP,TNF-?,LVMI,LAVI and LVEF was evaluate.Results Levels of CA125,NT-proBNP,TNF-?,LVMI and LAVI in patients with CHF were much higher than those without CHF. The LVEF was much lower in NYHA Ⅲ and NYHA Ⅳ group than that in without CHF and NYHAⅠgroup. Conclusion CA125 was positively associated with the NT-proBNP,TNF-? and LVMI.

Interrlationship between Left Ventricular Mass and Diurnal Variations of Blood Pressure in Patients with Esssntial Hypertension

BACKGROUND: In hypertensive patients, the left ventricular hypertrophy(LVH) is very important as an independent risk factor along with developing complications. The present study was attempted to assess whether LVE assessed by echocardiography is related to diurnal variations of blood pressure in patiens with essential hypertension. METHOD: After 24hr ambulatory blood pressure monitoring, echocardiographic parameters were investigated in 30 healthy normotensive subjects and 17 patients with diurnal variation of blood pressure and 19 patients without diurnal variation respectively. RESULTS: Left ventricular mass index was higher in essential hypertensive patients than normotensive subjects. In patients without nocturnal fall in systolic blood pressure, left ventricular mass tended to be higher than in patients with a nocturnal fall without statistic significance. In the hypertensive patients with nocturnal fall, there was a correlationship between LVMI and changes in systolic blood pressure, but no correlation between left ventricular mass index and changes in diastolic blood pressure. In the hypertensive patients without nocturnal fall, changes of both systolic and diastolic pressure did not affect LVMI. CONCLUSION: It is suggested strongly that left ventricular hypertrophy may occur highly in the hypertensive patients without nocturnal(diurnal) variation in blood pressure and may be associated with changes in diastolic and systolic blood pressure. But in hypertensive patient with nocurnal fall, left ventricular hypertrophy may be associated with changes in systolic blood pressure.