Endothelial dysfunction and sympathetic nervous system activation in young patients with essential arterial hypertension and without hypercholesterolaemia.

OBJECTIVE: The aim of the study was to evaluate whether measurements of hs-C-reactive protein (hs-CRP), endothelin-1 (ET-1), epinephrine (E) and norepinephrine (NE) would provide useful information for the assessment of endothelial dysfunction and sympathetic nervous system activation in a selected group of young, properly treated patients with essential arterial hypertension (HTN) and without hypercholesterolaemia. METHODS AND RESULTS: Serum hs-CRP and ET-1 as well as plasma epinephrine and norepinephrine concentrations were measured in 134 subjects (62 patients with diagnosed HTN and 72 healthy subjects from a reference group). In patients the concentrations of hs-CRP, ET-1 and NE were significantly higher, than in healthy subjects. The highest diagnostic sensitivity (87%; 95% CI 76.1-94.2) was found for serum hs-CRP; the highest diagnostic specificity (96%; 95% CI 88.3-99.1) and positive predictive value (89%) were found for ET-1 measurements. The analysis of logistic regression showed that the highest risk of HTN was found for the patients with high levels of ET-1, hs-CRP and NE, but not epinephrine. CONCLUSIONS: These results indicate that measurements of hs-CRP, ET-1 and NE may be useful in the identification of endothelial dysfunction and sympathetic activation in young patients with properly controlled essential arterial hypertension and without hyperlipidaemia.

Hypotensive effect of atorvastatin is not related to changes in inflammation and oxidative stress.

We sought to determine if atorvastatin lowers blood pressure in patients with previously diagnosed and well-controlled essential arterial hypertension and if this effect could be related to anti-inflammatory and anti-oxidative effects. Among 92 patients with essential arterial hypertension, we studied 56 non-smoking and normolipemic: 39 were randomized to receive 80 mg atorvastatin daily for 3 months (statin-treated patients, ST), and the rest continued a previous hypotensive therapy (statin-free patients, SF). Blood pressure was measured using a 24-h ambulatory blood pressure measurement device. Serum levels of high-sensitivity C-reactive protein (hs-CRP), total antioxidant status (TAS) and plasma peroxides (assessed by Oxystat) were measured in both groups. The mean change in systolic BP (SBP) for atorvastatin was -5.7 mmHg (95% confidence interval CI, -4.1 to -7.2 mmHg), and the mean change in diastolic BP (DBP) was -3.9 mmHg (95% CI, -2.7 to -5.0 mmHg). No change in BP in SF patients was observed. In the ST group, hs-CRP and peroxides did not significantly decrease. In the SF group, concentrations of hs-CRP proceeded to decrease while peroxides increased. In the ST group, changes in hs-CRP correlated with changes in total cholesterol and low-density lipoprotein cholesterol (r = 0.41, p = 0.013 and r = 0.35, p = 0.04, respectively) but did not correlate with changes in BP. The hypotensive statin effect was independent of the hypolipemic effect. During three months of observation, TAS concentrations in both groups remained stable. In this randomized study, additionally administered atorvastatin to non-smoking and normolipemic patients with well-controlled essential arterial hypertension resulted in reduction of BP. This effect was not followed by significant changes in hs-CRP, TAS or Oxystat concentrations. The hypotensive effect of atorvastatin did not depend on anti-inflammatory, anti-oxidative or hypolipemic actions.

Apelin: a novel marker for the patients with first ST-elevation myocardial infarction.

To date, only animal studies have been concerned with apelin involvement in acute myocardial ischemia. The aim of this study was to investigate apelin measurements in low-risk patients with first ST-elevation myocardial infarction (STEMI) and to assess if apelin may feature as a marker of left ventricular (LV) injury and prognosis. In 78 consecutive patients (mean age 67 +/- 11.5 years, 24 women) with first STEMI treated with primary percutaneous coronary intervention, plasma apelin-36 concentrations were measured twice: on admission and on the 5th day of hospitalization. Left ventricle ejection fraction (LVEF) was applied as marker of LV injury. Composite endpoint (CEP), which included death, stroke, and recurrent ischemic event, was assessed after 1 year follow-up. On the first day, median apelin-36 concentration was 2138.5 pg/ml and on the 5th day was significantly lower, 2008.3 pg/ml (P = 0.002). There were no significant differences found in apelin-36 concentrations between patients with normal and low LVEF. In both groups significant reductions were found in apelin-36 concentrations measured in 5-day intervals (P = 0.04 and P = 0.008, respectively). After a 1-year follow-up, only one patient died and 19 patients (24.3%) had reached CEP. No difference in baseline apelin-36 concentrations were found in the group of patients who reached CEP compared with those without CEP. However, in both groups concentrations significantly decreased after 5 days (P = 0.04 and P = 0.013, respectively). Apelin-36 concentrations are reduced in low risk first STEMI patients during the first days regardless of the degree of LV dysfunction and prognosis.

Influence of atorvastatin on blood pressure control in treated hypertensive, normolipemic patients - An open, pilot study.

AIMS: The aim of the study was to determine whether a high dose of atorvastatin lowers blood pressure (BP) in normolipemic patients with well controlled primary arterial hypertension and if this effect is associated with alteration of biomarkers of endothelial function and oxidative stress. In this open-label study, normolipemic patients (n=56) were randomized in the proportion of 2:1 to receive atorvastatin 80 mg daily for 3 months (statin-treated, ST n=39), or to previous therapy (statin-free, SF). BP was measured using a 24-h ambulatory BP measurement device. Plasma levels of 6-keto-PGF(1alpha) (prostacyclin metabolite), serum nitric oxide (NO) and levels of autoantibodies immunoglobulin G against oxidatively modified low-density lipoprotein (ox-LDL) were measured. MAJOR FINDINGS: The mean change in systolic BP and diastolic BP for ST was - 5.7 mmHg (95% CI -4.1 to -7.2 mmHg) and -3.9 mmHg (95% CI -2.7 to -5.0 mmHg), respectively. Hypotensive statin effect was independent of lipid lowering. No change of BP in SF patients was observed. In ST, prostacyclin metabolites and NO concentrations were not significantly increased and autoantibodies against ox-LDL concentrations did not change. In ST, the decrease in BP correlated with increase in NO and decrease in autoantibodies against ox-LDL. PRINCIPAL CONCLUSION: High-dose atorvastatin resulted in reduction of BP independently of lipid-lowering effect, changes in endothelial function and oxidative stress, but it was related to the increase in NO and decrease in autoantibodies against ox-LDL. However, because of the open design of the study, these results should be carefully debated.

Diagnostic biomarkers of essential arterial hypertension: the value of prostacyclin, nitric oxide, oxidized-LDL, and peroxide measurements.

Endothelial function is impaired in hypertensive patients. Decreased nitric oxide and prostacyclin production as well as increased oxidative stress are involved in this abnormality. The aim of the present study was to evaluate whether biomarkers of endothelial dysfunction and oxidative stress have diagnostic value in patients with essential hypertension. We measured nitric oxide, prostacyclin, and oxidized-LDL levels and assessed oxidative status in 62 patients with diagnosed essential arterial hypertension and 45 healthy controls. In the hypertensive group, among measured parameters, the median prostacyclin level was significantly lower, when compared to healthy controls (125.57 pg/mL, 25%; 75% quartile range: 84.99; 275.93 and 462.9 pg/mL, 25%; 75% quartile range: 107.69; 849.3, respectively, P = 0.009). The largest area under the ROC curve was found for prostacyclin; 0.647 (95% C.I. 0.549 to 0.737). In the analysis of logistic regression, the prostacyclin and oxidized-LDL cut-off values were associated with a 4.9 higher significant risk of hypertension (O.R. 4.91 and 4.99, respectively; P = 0.0008 and P = 0.00065, respectively). Oxidized-LDL, a biomarker of endothelial damage, was the only one that had a significant negative correlation with protective prostacyclin in hypertensive patients (r = -0.29, P = 0.02). Of all the biomarkers prostacyclin and oxidized-LDL had the best diagnostic value for patients with hypertension.

Prognostic significance of the admission plasma B-type natriuretic peptide measurement in patients with first ST-elevation myocardial infarction in comparison with C-reactive protein and TIMI risk score.

BACKGROUND: In ST-elevation myocardial infarction (STEMI) B-type natriuretic peptide (BNP) holds promise for risk stratification. Aim of this study was to assess prognostic value of plasma BNP measurement and to compare with other powerful prognostic markers -- TIMI Risk Score (TRS) and C-reactive protein (CRP) in patients with first STEMI treated with primary PCI (pPCI). METHODS: 86 patients, admitted within initial 12 h of the first STEMI. Admission plasma levels of BNP were measured by MEIA method. Serum levels of CRP were measured using immunoturbidimetric assays. Composite end point (CEP) was assessed after 7 months. RESULTS: Median plasma BNP value was higher in patients with CEP, compared with those without CEP (p<0.001). Patients with plasma BNP >99.2 pg/mL were at significantly higher risk for CEP (the highest sensitivity and specificity). CRP level >10.6 mg/dL was also associated with poor outcome. TRS has not influenced the occurrence of CEP. In the analysis of logistic regression the BNP value >99.2 pg/mL was the strongest predictor of CEP. ROC analysis identified BNP measurement as significant to estimate adverse outcome 0.950 in the prediction of CEP (95% Confidence interval=0.878-0.985). CONCLUSION: Admission plasma BNP concentrations provide incremental prognostic information in patients with first STEMI treated with pPCI.

The benefits of repeated measurements of B-type natriuretic peptide in patients with first ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.

BACKGROUND: Elevated B-type natriuretic peptide levels in patients with acute myocardial infarction are useful in the prediction of poor outcome. It is still not established how often and when assessment of neurohormonal activation provides the best prognostic information. AIM: To evaluate whether repeated measurements of B-type natriuretic peptide provide additional clinical information in patients with first ST-elevation myocardial infarction. METHODS: In 96 consecutive patients with first ST-elevation myocardial infarction, treated with primary percutaneous coronary intervention, B-type natriuretic peptide concentrations were measured twice: on admission and 24 hours later. A clinical composite endpoint was assessed during hospital stay. RESULTS: The median B-type natriuretic peptide concentration obtained on admission was 62.9 pg/mL and 24 hours later was 223.6 pg/mL. Thirty-five patients (36.4%) reached composite endpoint, including 3 deaths (3.1%). Both B-type natriuretic peptide levels were related to the clinical and echocardiographic variables, which refer to the large infarct expansion and acute left ventricular dysfunction. The first measurement was better correlated with current patient status (ie, TIMI Risk Score, admission Killip class). B-type natriuretic peptide 24 hours after admission was significantly higher in patients who had an adverse cardiovascular event during hospitalization (P = 0.02). ROC analysis also identified the second B-type natriuretic peptide measurement as significant to estimate adverse outcome (c = 0.64 CI 0.527 - 0.756 P = 0.007). CONCLUSIONS: Despite there being a time interval of only 24 hours between the two sets of B-type natriuretic peptide sampling, both measurements provide important and different information. Only B-type natriuretic peptide measurement 24 hours after admission identifies patients with a high in-hospital event rate risk.

[Massive haematoma following rescue coronary angioplasty in a patient with acute myocardial infarction - a case report]. / Masywne krwiaki jako powiklanie ratunkowej angioplastyki u chorej ze swiezym zawalem serca.

A case of a 79 year old female with acute myocardial infarction, treated with rescue coronary angioplasty, is presented. The patient received also thrombolysis, followed by heparin and IIb/IIIa platelet receptor blocker. The hospital stay was complicated by a massive groin haematoma and ecchymoses in the other parts of the lower and upper limbs, requiring blood transfusion.