ABSTRACT
Recent studies indicate that the pro-inflammatory action of aldosterone (ALDO) or the activation of mineralocorticoid receptors contribute to the increased risk of cardiovascular disease (CVD). The aim of the present study was to investigate the grade of the inflammatory activation, in relation to ALDO levels, in a large cohort of essential hypertensive patients. The study included 3770 consecutive essential hypertensive patients who attended our outpatient clinics. Patients were evaluated with medical history, repeated office blood pressure and 24-h ambulatory blood pressure monitoring (ABPM), physical examination and full laboratory assessment including ALDO in 24-h urine collection, plasma renin activity (PRA), high-sensitivity C-reactive protein (hsCRP), total fibrinogen, serum homocysteine (Hcy), serum amyloid A (SAA) and white blood cells (WBC) measurements in morning blood samples. Patients were divided according to PRA (high PRA >1 ng ml(-1) h(-1), low PRA <1 ng ml(-1) h(-1)) and ALDO levels (high ALDO >12 but <24 µg per 24 h, low ALDO <12 µg per 24 h) in four groups. The hsCRP (P<0.022) and SAA (P<0.001) levels increased in parallel with the ALDO metabolism. Similar differences were observed for Hcy (P<0.001), fibrinogen (P=0.001) and WBC (P<0.02). High ALDO levels within normal range are related to the presence of subclinical inflammation in essential hypertension. These data indicate that ALDO and PRA influence the process of subclinical inflammation involved in the increased risk of CVD.
Subject(s)
Aldosterone/urine , Hypertension/metabolism , Hypertension/physiopathology , Inflammation/metabolism , Inflammation/physiopathology , Adult , Aged , Biomarkers/metabolism , Blood Pressure/physiology , C-Reactive Protein/metabolism , Cardiovascular Diseases/epidemiology , Cohort Studies , Essential Hypertension , Female , Fibrinogen/metabolism , Homocysteine/blood , Humans , Leukocyte Count , Male , Middle Aged , Renin/blood , Risk FactorsABSTRACT
BACKGROUND AND AIM: Metabolic syndrome (MS) has been recently associated with an increased risk for the development of atrial fibrillation (AF) in the general population. Whether this relation is also apparent in patients with arterial hypertension remains to be clarified. In the present study we sought to investigate the independent association of the MS with the AF in a large cohort of hypertensive patients. MATERIAL AND METHODS: The study comprised 15,075 consecutive, non-diabetic patients with essential hypertension (age range: 40-95 years, 51.1% males). All subjects underwent a complete clinical and lipidemic profile assessment as well as a standard 12-lead ECG at drug free baseline. MS was diagnosed by using five different definitions, including the National Cholesterol Education Program Third Adult Treatment Panel (ATPIII) and the GISSI Score. RESULTS: The prevalence of the MS varied from 31.7% to 47.8% according to the each time definition used. In multiple logistic regression analysis, MS was associated with the presence of AF (odds ratio from 1.61 to 1.99, p < 0.001 for all), independenty of the definition used. All ATPIII MS components were found to be independently associated with an increased incidence of AF. The prevalence of AF increased progressively with the severity of the metabolic syndrome as assessed by the number of the metabolic syndrome components (p < 0.001). CONCLUSION: In non-diabetic patients with essential hypertension, the MS is directly and independently related to the AF prevalence.
Subject(s)
Atrial Fibrillation/epidemiology , Hypertension/physiopathology , Metabolic Syndrome/epidemiology , Adult , Aged , Atrial Fibrillation/complications , Blood Pressure , Electrocardiography , Female , Humans , Hypertension/complications , Incidence , Male , Metabolic Syndrome/complications , Middle Aged , Prevalence , Retrospective Studies , Risk FactorsABSTRACT
The aim of this study was to determine cardiovascular (CV) risk factors (RFs) and target organ damage clustering in 21280 Greek hypertensives stratified by gender and age. Glycemic and lipid profile were determined, left ventricular mass index, estimated gromerular filtration rate (eGFR), 10-years CV risk according to Framingham risk score (FRS) and HeartScore (HS) were calculated. Only 10.2% of patients had no concomitant RFs, 53.1% had one (48.8% dyslipidemia, 3.4% smoking, 0.9% diabetes), 32.9% had two (26% dyslipidemia and smoking, 6.6% dyslipidemia and diabetes, 0.3% smoking and diabetes) and 3.7% had all four traditional RFs. Obesity was present in 30%, metabolic syndrome in 38%, low eGFR in 24% and left ventricular hypertrophy in 49%. Mean FRS risk was 35% for males, 24.1% for females whereas in high risk (>20%) were 68.7 and 50.7%, respectively (P<0.0001). Mean HS risk was 8.4% for males, 6.2% for females whereas in high risk (>5%) were 48.6 and 36.2%, respectively (P<0.0001). Age was correlated to pulse pressure, eGFR, left ventricular mass index and CV risk (P<0.0001). Ageing increased the risk difference between genders for total (P=0.001) but not for fatal events (P=nonsignificant). In conclusion, as RFs cluster in hypertensives, CV risk calculation should guide treatment decisions.
Subject(s)
Cardiovascular Diseases/etiology , Adult , Age Factors , Aged , Aged, 80 and over , Female , Glomerular Filtration Rate , Greece , Humans , Male , Middle Aged , Prevalence , Retrospective Studies , Risk Factors , Sex Factors , Smoking/adverse effectsABSTRACT
The purpose of the present study was to investigate whether there is a relationship between anemia and day-night blood pressure variations in essential hypertensive patients. We found that anemic hypertensives had significantly elevated nocturnal BP, and decreased mean 24-h BP and daytime BP.
