The relationship between the autonomic nervous function and early renal dysfunction in elderly patients with mild-to-moderate essential hypertension.

OBJECTIVE: This study investigated the relationship between autonomic nervous function and early renal dysfunction in elderly patients with mild-to-moderate essential hypertension (EH). DESIGN: A total of 223 elderly patients with mild-to-moderate EH were enrolled. Urinary albumin excretion (UAE) and urinary creatinine (UCr) were measured in all elderly patients with mild-to-moderate EH, and urinary albumin to creatinine ratio (ACR) was calculated (ACR = UAE/UCr × 0.113). All patients were divided into two groups such as ACR normal group (109 cases) and abnormal ACR group (114 cases) according to the results of ACR. Synchronic 24-hour ambulatory blood pressure monitoring and 24-hour ambulatory electrocardiogram were detected for all patients to simultaneously monitor heart rate variability (HRV) and blood pressure variability (BPV). RESULTS: The level of 24-hour SSD, dSSD, and nSSD and 24-hour PP (parameters of BPV) increased significantly (P < 0.028, P < 0.023, P < 0.027 and P < 0.019, respectively), while the level of RMSSD, pNN50, SDNN, and SDANN (parameters of HRV) decreased significantly(P < 0.048, P < 0.029, P < 0.025 and P < 0.022, respectively) in abnormal ACR group than in normal ACR group. Multiple logistic regression analysis showed that ACR was closely correlated with 24-hour SSD, 24-hour PP, SDANN, and SDNN (ß = 1.261, P = 0.000; ß = 1.121, P = 0.003; ß = -1.741, P = 0.000 and ß = -1.231, P = 0.002, respectively). CONCLUSIONS: HRV (SDANN, SDNN) and BPV (24-hour SSD, dSSD, nSSD) were significantly correlated to ACR in patients with mild-to-moderate EH. This result suggested that sympathetic activation was closely related with early renal dysfunction in elderly patients with mild-to-moderate EH.

The association between oxidative stress, activator protein-1, inflammatory, total antioxidant status and artery stiffness and the efficacy of olmesartan in elderly patients with mild-to-moderate essential hypertension.

This study investigated the change of oxidative stress, activator protein-1 (AP-1), inflammatory, total antioxidant status (TAS) and artery stiffness, and explored the relationship between these characteristics and the efficacy of olmesartan intervention in elderly patients with mild-to-moderate essential hypertension (EH). In total, 386 elderly patients with EH and 353 normotensive controls were recruited. All study subjects had oxidative stress markers, AP-1, inflammatory factors, TAS and brancial-ankle artery pulse wave velocity (ba-PWV) measured. In total, 193 elderly patients with EH were randomized to olmesartan and were matched with 193 normotensive controls to observe the change of index above mentioned before and after the treatment. Compared with the controls, superoxide dismutase (SOD) and TAS were significantly reduced in patients with EH, and malondialdehyde (MDA), AP-1, high-sensitivity C-reactive protein (Hs-CRP), Monocyte Chemoattractant Protein-1 (MCP-1), heart rate， endothelin-1 (ET-1), TAS and ba-PWV were significantly increased (P < 0.01 for all). Pearson's correlation analysis showed that SOD and TAS were negatively related to AP-1 (P < 0.05 for all), and that blood pressure (BP), age, MDA, Hs-CRP, MCP-1, ET-1 were positively related to AP-1 (P < 0.01 for all). Multivariate linear regression analysis showed that BP, SOD, MDA, AP-1, Hs-CRP, MCP-1, ET-1, TAS, heart rate and age were independent risk factors for ba-PWV. After treatment with olmesartan, SOD and TAS were increased, while BP, heart rate, AP-1 and inflammatory factors were reduced with significant improvement in ba-PWV (P < 0.05 for all). More increase of arterial stiffness was reported in elderly hypertensive patients with greater oxidative stress, inflammatory, AP-1, heart rate, and lower TAS. Higher oxidative stress, AP-1 and inflammatory may predict higher arterial stiffness. Olmesartan may increase TAS, yet inhibit oxidative stress, AP-1, inflammatory, and heart rate with improved artery stiffness in elderly hypertensive patients.