Carotid Plaques Correlates in Patients With Familial Hypercholesterolemia.

Patients with familial hypercholesterolemia (FH) are at increased risk of premature cardiovascular disease. We compared factors associated with the presence of carotid plaques and carotid intima-media thickness (cIMT), markers of subclinical atherosclerosis, in 241 patients with FH (98, 40.7% men; mean age 41 ± 18.4 years). Patients with FH having carotid plaques (36.5%) had mean age, apolipoprotein (apo) B, glucose, apoA1, systolic blood pressure (SBP) and diastolic BP, waist/hip ratio (WHR), and body mass index higher than patients without plaques. Logistic regression revealed that apoB (odds ratio [OR] per 1 unit change 1.03,P= .005), high-density lipoprotein cholesterol (HDL-C; OR per 1 standard deviation [SD] change 0.59,P= .015), and non-HDL-C (OR per 1SD change 1.53,P= .04) were significantly associated with the presence of plaques. The cIMT correlated with obesity parameters, BP, apoB, glucose, high-sensitivity C-reactive protein, creatinine, γ-glutamyl transpeptidase, and alanine transaminase (P< .001). Regression analysis revealed that cIMT was significantly associated with apoB, SBP, and WHR. These results confirm the role of apoB-containing lipoproteins and low HDL-C with the presence of carotid plaques and apoB, BP, and WHR with cIMT.

Benefits of a fixed-dose combination of bisoprolol and amlodipine in the treatment of hypertension in daily practice: results of more than 4000 patients.

OBJECTIVE: The study objective was assessing patient adherence to a fixed-dose combination (FDC) of bisoprolol and amlodipine in daily practice in patients who had been switched from the free to the fixed-dose combination prior to recruitment. MATERIAL AND METHODS: The non-investigational study was carried out in Poland. Patients over 18 years of age with essential hypertension were recruited if they had already been switched from a free combination to the FDC at least 4 weeks prior to recruitment. Exclusion criteria included pregnancy, lactation, any contraindication to the FDC, and other antihypertensive treatment. Adherence was measured by tablet count (tablets taken divided by tablets prescribed, times 100) and defined as follows: excellent >90%, good 76-90%, moderate 51-75%, bad ≤50%. Other patient data, clinical findings and laboratory values were recorded upon availability at study start, after 3 months (voluntary) and after 6 months. RESULTS: Data of 4288 patients (mean age: 59 years; gender: 50% each) were documented. The average daily doses of the FDC were 5.8 mg bisoprolol and 6.4 mg amlodipine. These doses differ only slightly from those of the free combination. After 3 months' treatment with the FDC, a dose increase was carried out in 113 patients for bisoprolol and in 126 for amlodipine. After 6 months of FDC treatment, 82% of the participants of the study showed excellent adherence and for a further 15% the adherence could be considered good. This strong adherence may have led to the observed reduction in systolic and diastolic blood pressure of 11% (Cohen's D efficient size 1.23). In addition, pulse pressure decreased from 58.8 mm to 52.2 mm. Also in diabetic patients (21% of the cohort), further reduction of systolic blood pressure values could be achieved (mean before 150 mm, after 133), wherein the initial differences compared to patients without diabetes had disappeared. The pulse rate also changed from 75 b/min to 68 b/min under the FDC. CONCLUSION: These study results clearly show that the FDC leads to excellent patient adherence and therefore may result in better blood pressure control. Blood pressure control is crucial in the risk reduction of cardiovascular events. The key limitation of this study is that the study design does not allow a direct comparison of patient adherence under the free and the fixed-dose combination.

Blood pressure, cardiovascular outcomes and sodium intake, a critical review of the evidence.

Consideration of the role of NaCl (salt) in the pathogenesis and treatment of essential hypertension is one of the overriding research themes both in experimental and clinical medicine. The evidence relating blood pressure to salt intake in humans originates from population studies and randomized clinical trials of interventions on dietary salt intake. Estimates from meta-analyses of trials in normotensive subjects generally are similar to estimates derived from prospective population studies (+ 1.7-mmHg increase in systolic blood pressure per 100 mmol increment in 24­hour urinary sodium). This estimate, however, does not translate into an increased risk of incident hypertension in subjects consuming a high-salt diet. Prospective studies relating health outcomes to 24­h urinary sodium excretion produced inconsistent results. Taken together, available evidence does not support the current recommendations of a generalized and indiscriminate reduction of salt intake at the population level. The public should be properly educated about the pros and cons of a decrease in sodium intake, in particular if they are healthy.

Ambulatory blood pressure, left ventricular mass and vascular phenotypes in relation to the endothelial nitric oxide synthase gene Glu298Asp and intron 4 polymorphisms in a population-based family study.

Reduced nitric oxide production is associated with pathological changes in the cardiovascular system. In a study of randomly chosen families, we analysed the relationship between two polymorphisms (Glu298Asp and intron 4) of the endothelial nitric oxide synthase (eNOS) and ambulatory blood pressure (ABP), left ventricular mass index (LVMI) and vascular phenotypes. The study population consisted of 127 parents and 167 offspring. All subjects underwent 24 h ABP monitoring using a SpaceLabs 90207 device. 2D and M-mode echocardiograms were obtained. Pulse wave velocity between the common carotid and femoral artery was measured with the Complior device, and the carotid intima-media thickness (IMT) was assessed by ultrasound. For statistical analysis, covariables and correlations between relatives were taken into account. The frequency of genotypes was as follows: for Glu298Asp: 55.1%-Glu/Glu, 40.1%-Glu/Asp and 4.8%-Asp/Asp; for intron 4: 65.0%-4 b/b, 33.3%-4 b/a and 1.7%-4 a/a, being in Hardy-Weinberg equilibrium (P > or = 0.29). There was no relationship between the eNOS gene polymorphisms and ABP or LVMI either in parents or their offspring. Among parents, carriers of the 298Asp allele had higher IMT values as compared with Glu/Glu homozygotes (0.94 vs 0.70 mm; P = 0.007). Among offspring, there was a similar tendency (0.60 vs 0.53 mm; P = 0.10), which was confirmed by transmission disequilibrium tests for quantitative variables (P > or = 0.07). Our findings indicate that the Glu298Asp polymorphism of eNOS identifies patients with larger carotid IMT, also in younger subjects.

Ascending aortic blood pressure waveform may be related to the risk of coronary artery disease in women, but not in men.

Recent studies have demonstrated that fractional pulse pressure and fractional diastolic pressure are related to the risk of coronary artery disease. However, the effect of the ascending aortic pressure waveform on the risk of coronary artery disease in men and women analyzed separately has not been reported. The objective of the study was to assess the relation between ascending aortic blood pressure waveform and the presence of coronary artery disease in men and in women. The study group consisted of 447 patients (302 men and 145 women; mean age: 57.6+/-9.8 years) with preserved left ventricular function who were undergoing first diagnostic coronary angiography. After multivariate stepwise adjustments, the odds ratio (OR) and confidence interval (CI) of having coronary artery disease in women was (OR are reported for standard deviation increase in each variable): pulse pressure OR 1.61 (95% CI 1.06-2.46); fractional systolic pressure OR 1.72 (95% CI 1.08-2.71); fractional diastolic pressure OR 0.58 (95% CI 0.37-0.92); fractional pulse pressure OR 1.72 (95% CI 1.08-2.71); and pulsatility index OR 1.74 (95% CI 1.09-2.78). None of the studied variables was independently related to the presence of coronary artery disease in men. In conclusion, fractional systolic and diastolic pressure, pulse pressure, fractional pulse pressure and the ratio of pulse pressure to diastolic pressure may be independently related to the risk of coronary artery disease in women, but not in men.

The effect of hormone replacement therapy on arterial blood pressure and vascular compliance in postmenopausal women with arterial hypertension.

Arterial pathology is a major contributor to cardiovascular disease, morbidity and mortality. Women are at higher risk of cardiovascular disease after menopause. Arterial stiffness determined by pulse wave velocity, increases with age both in men and women, whereas arterial compliance in premenopausal women is greater than in men of similar age. This difference is lost in the postmenopausal years, with evidence of rapid decline in arterial compliance in the perimenopausal period. Loss of hormonal modulation is a likely explanation for reduced arterial compliance in postmenopausal women. Long-term treatment with hormone replacement therapy (HRT) may be expected to partially reverse the increase in arterial stiffness. The aim of the study was to analyse the effect of HRT on blood pressure and arterial compliance in postmenopausal women with arterial hypertension receiving hypotensive drugs. The results in the present study of postmenopausal women with mild to moderate arterial hypertension receiving HRT showed only a transient tendency towards lower blood pressure. In our study HRT was found to improve arterial compliance at 3 months after HRT, and the effect was maintained throughout 12 months. The increased arterial compliance in women receiving HRT was independent of blood pressure. In parallel with decreasing pulse wave velocity women receiving HRT had lower total and low-density lipoprotein cholesterol. The conclusions were that after 1 year HRT in postmenopausal women with arterial hypertension improves circadian blood pressure pattern, but it does not affect significantly blood pressure values and variability. The present study also shows that HRT significantly inhibits age-related rigidity of large arteries.

Impact of gender on the left ventricular cavity size and contractility in patients with hypertrophic cardiomyopathy.

BACKGROUND: The aim of the study was to assess gender-specific differences in left ventricular cavity size, contractility and left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy. METHODS: We studied retrospectively 129 referred patients with hypertrophic cardiomyopathy (77 males and 52 females). The echocardiographically measured left ventricular end-systolic, end-diastolic dimensions, fractional shortening and occurrence of left ventricular outflow tract gradient > or =30 mmHg were compared between sexes. Logistic regression analysis was used to calculate the predictive values of left ventricular dimensions and contractility for left ventricular outflow tract obstruction for each gender separately. RESULTS: Left ventricular end-diastolic and end-systolic dimensions were significantly smaller in females than males (41.7+/-5.3 vs. 45.1+/-4.9 mm, P=0.0003; 23.1+/-44 vs. 25.6+/-5.3 mm, P=0.007 respectively). On the contrary, the value of fractional shortening was comparable in both sexes (44.7+/-7.3 vs. 43.6+/-7.9%, P>0.05). The left ventricular outflow tract gradient occurred in females as frequently as in males (28.8 vs. 33.8%, P>0.05). By logistic regression analysis the predictors of left ventricular outflow tract gradient in females were left ventricular end-systolic diameter (relative risk=0.74; confidence interval (CI) 0.61 to 0.91; P=0.0038), left ventricular end-diastolic diameter (relative risk=0.82; CI 0.72 to 0.96; P=0.0061) and fractional shortening (relative risk=1.11; CI 1.01 to 1.22; P=0.036). The most potent predictor appeared to be left ventricular end-systolic dimension. In males none of these parameters identified patients with left ventricular outflow tract obstruction. CONCLUSIONS: Females with hypertrophic cardiomyopathy featured smaller left ventricular cavity size, which predisposed to left ventricular outflow tract obstruction (the most potent predictor of left ventricular outflow tract obstruction was left ventricular end-systolic dimension). Higher left ventricular contractility also determined left ventricular outflow tract gradient occurrence in females with hypertrophic cardiomyopathy. In males despite a larger left ventricular cavity size the left ventricular outflow tract obstruction occurred with a similar frequency as in females. Left ventricular outflow tract obstruction was not predicted by left ventricular cavity size or contractility in males.

[Pulse pressure as a predictor of restenosis after percutaneous transluminal coronary angioplasty]. / Wartosc cisnienia tetna w przewidywaniu czestosci wystepowania restenozy po zabiegach angioplastyki wiencowej.

UNLABELLED: The tension of the arterial wall increases the proliferation of the vascular smooth muscle cells which is one of the basic mechanisms of the reocclusion after percutaneous coronary intervention (PCI). The aim of the study was to evaluate the significance of the pulse pressure (PP) in predicting the restenosis after PCI. METHODS: We retrospectively studied 84 patients (average age 53.9 +/- 10.1; 69 males and 15 females)--35 patients with angiographically proved restenosis and 49 patients without restenosis matched according to age and gender. The pulse pressure in the ascending aorta was measured before PCI. The standard angiographic measurements took place before PCI and immediately after it. The restenosis was defined as recurrent stenosis > 50% on the follow-up angiogram which was performed up to 9 months after PCI. RESULTS: The mean pulse pressure was significantly higher in patients with restenosis (76.9 +/- 24.2 mmHg vs 61.3 +/- 17.5 mmHg, p < 0.001). The incidence rate of restenosis was 28.6% for the patients with the lowest PP and 55.2% for the patients with the highest PP (p < 0.05). The odds ratio after adjustment for sex, age, smoking status, hypercholesterolemia, diabetes mellitus, the type of lesions that underwent the PCI, maximal inflation pressure, time of inflation, minimal lumen diameter before and after the PCI, reference lumen diameter, stent implantation and mean blood pressure was 1.0, 2.83 (0.59-13.72) and 7.36 (1.12-68.11) for the patients with the lowest, middle and highest PP, respectively. The multiple-adjusted analysis showed that 10 mmHg increase in PP is associated with 72% increase in risk of restenosis (OR 1.72, CI 1.14-2.60, p < 0.01). CONCLUSION: Ascending aortic pulse pressure is an independent predictive factor for restenosis after percutaneous coronary intervention.

[Influence of hormone replacement therapy on the quality of life in postmenopausal women with hypertension]. / Wplyw hormonalnej terapii zastepczej na jakosc zycia kobiet z pierwotnym nadcisnieniem tetniczym w okresie pomenopauzalnym.

AIM: The effect of hormone replacement therapy (HRT) on the quality of life in women with hypertension is still not clear. Thus, the aim of the study was to assess the effect of hormone replacement therapy on quality of life in postmenopausal women with essential hypertension by using a battery of standardized questionnaires. MATERIAL AND METHODS: The study population consisted of 53 women (mean age 50.9 +/- 6.3 years) with mild and moderate essential hypertension (mean duration 6.4 +/- 6.4 years). The postmenopausal status was defined as the absence of menstrual blood loss during > 6 months and blood estradiol concentration < 50 pg/ml, accompanied by follicle-stimulating hormone (FSH) levels > 21 U/I. Twenty seven women were blindly randomised to transdermal hormone replacement therapy (HRT) and received 17-beta-estradiol and noretisterone acetate, TTS. Twenty six women were randomly selected as controls. The subjects were evaluated at baseline (after 2 weeks' wash-out from hypotensive drug period) and after three months of HRT using self-administered standardized quality of life questionnaires: the Psychological General Well-being Index (PGWB) and the Subjective Symptoms Assessment Profile (SSA-P). RESULTS: No differences were found in blood pressure values, heart rate, body mass index and distribution of body fat tissue between women receiving HRT and controls at baseline and after 3 months of follow-up. There were no significant differences in the baseline total PGWB score as well as in its subscale between two groups. Similarly, the frequency and intensity of subjective symptoms assessed by SSA-profile were the same in both groups at baseline. After 3 months, a significant improvement in PGWB total score was observed in women receiving HRT. This effect was due to improvement in anxiety, positive well-being and vitality. Moreover, emotional distress, symptoms of flushing, sweating and trembling hands also diminished and sexual capacity improved in women treated with HRT. CONCLUSION: A three-month hormone replacement therapy in hypertensive postmenopausal women slightly improves the general well-being, seems to decrease emotional tension, increase sexual capacity and markedly relieves some vasomotor symptoms.

QT dispersion and hypertensive heart disease in the elderly.

AIM: To determine the predictors and risk of increased QT dispersion in the elderly hypertensive patients. METHODS: A 12-lead electrocardiogram (ECG), M-mode echocardiography and ambulatory blood pressure as well as Holter monitoring were performed for 67 patients over 60 years of age with essential hypertension (I and II(o) WHO). The presence of ischaemic changes on ECG was evaluated based on the Minnesota Code. QT intervals were corrected with Bazett's formulae and QT dispersion was determined as the difference between maximal and minimal QTc intervals. Interventricular septal thickness (IVSTd), left ventricular internal diameter (LVDd) and posterior wall thickness (PWTd) were measured and left ventricular mass index (LVMI) was calculated. Subjects were divided according to the median of QTc dispersion (0.10 s). The differences between groups were assessed using chi-squared and Student's t-test. RESULTS: Subjects with increased QTc dispersion did not differ from those with low QTc dispersion when age, gender and body mass index were analysed. Similarly, the average systolic blood pressure, diastolic blood pressure and blood pressure variability were comparable in both groups. The mean QTc interval was similar in both groups. In patients with increased QT dispersion, left ventricular hypertrophy (LVH) and ischaemic changes on ECG were more frequently recognized (respectively 41.2 versus 18.2%, P < 0.001; 47.1 versus 21.2%, P < 0.05). Moreover, these subjects presented a significantly greater number of premature ventricular beats (317.1 +/- 665.6 versus 64.88 +/- 188.6, P < 0.05) and higher classes of Lown's arrhythmia scale (classes III-IV, 23.35% versus 9.1%). LVMI was insignificantly higher in the group with greater QTc dispersion (165.82 +/- 54.5 versus 145.07 +/- 36.47 g/ m2). Other echocardiographic indices of LVH were similar in both groups. On the other hand, the analysis of regression indicated positive correlation between the dispersion of QTc interval and thickness of left ventricle walls (for IVSd - r = 0.37; for PWd - r = 0.31), relative wall thickness (r = 0.28) and LVMI (r = 0.28). CONCLUSIONS: QTc dispersion is increased in the elderly hypertensive individuals, with the presence of LVH and myocardial ischaemia on ECG. These patients are more likely to demonstrate severe ventricular dysrhythmias.

Silent myocardial ischaemia in patients with essential arterial hypertension and non-insulin dependent diabetes mellitus.

The concomitant presence of diabetes mellitus and arterial hypertension significantly impairs myocardial function through a direct negative effect on cardiac myocytes, coronary microvessels and precipitation of atherosclerosis in major coronary arteries. The purpose of the present study was to establish to what extent non-insulin dependent diabetes mellitus (NIDDM) modified silent myocardial ischaemia (SMI) in patients with essential hypertension and without documented coronary artery disease (CAD). The study population consisted of 41 patients with essential arterial hypertension associated with NIDDM, treated with diet and oral hypoglycaemic agents (group I) and 40 patients with essential arterial hypertension without diabetes mellitus (group II). Both groups were comparable with respect to age, gender, duration, severity and complications of hypertension. A mean duration of diabetes mellitus in group I was 6.8 years. Conventional and automatic blood pressure and heart rate measurements, continuous ECG recordings, echocardiograms and laboratory tests were obtained in all patients. SMI was more frequent in group I than in group II (29.3% vs 12.5%, P < 0.05). In group I the total duration of SMI was longer (37.3 vs 2.8 min, P < 0.001) and the total number of silent episodes was larger (15.5 vs 2.6, P < 0.001). No inter-group differences were seen in conventional and automatic blood pressure and heart rate measurements. Both groups did not differ significantly in left ventricular mass index (LVMI) or the proportion of patients with left ventricular hypertrophy (LVH) (75.6% vs 60%). Lipid profile in both groups indicated an increased risk of CAD, but without significant differences. In conclusion, in patients with essential arterial hypertension and diabetes mellitus, the incidence and severity of SMI were clearly higher than in hypertensives with normal carbohydrate metabolism. Employment of modern diagnostic techniques in hypertensives permits identification of those at greater risk, which may have further clinical implications.

Aortic pulse wave velocity in young normotensives with a family history of hypertension.

OBJECTIVE: To assess the effect of selected clinical and biochemical parameters, with particular consideration of familial hypertension, on the pulse wave velocity (PWV) in young normotensives. SUBJECTS AND METHODS: Seventy voluntary students were enrolled (mean age 22.3+/-2.1 years), 39 men and 31 women, with normal blood pressure. A history was obtained with respect to diabetes mellitus, ischaemic heart disease, lipid disorders and arterial hypertension in the family. The subjects were subdivided into two groups: those with (n = 33) and without (n = 37) a family history of arterial hypertension, and blood pressure and heart rate were measured three times and total cholesterol and its subfractions determined in plasma. The carotid to femoral PWV was measured using an automatic computerized recorder and analysed by the Complior program. RESULTS: The subjects with a family history of arterial hypertension had higher blood pressure levels (systolic and diastolic blood pressure, pulse pressure and mean arterial pressure), as well as mean body mass index and low-density lipoprotein (LDL) cholesterol. The PWV in this group did not differ from that in the subjects without a family history of arterial hypertension (9.69+/-2.8 versus 9.32+/-2.0). However, the PWV was significantly higher in males than females (10.62+/-2.2 versus 7.86+/-1.13, P < 0.0001) and there was a significant positive correlation between male gender and PWV. CONCLUSIONS: Familial arterial hypertension does not significantly affect aortic stiffness in terms of PWV. Male gender in this population of young healthy subjects is one of the most important factors associated with central arterial stiffness.

Comparison of left ventricular hypertrophy expression in patients with hypertrophic cardiomyopathy on the basis of sex.

BACKGROUND AND AIM: In the face of evidence concerning the cardioprotective effects of estrogen, we decided to examine whether left ventricular hypertrophy (LVH) expression in patients with hypertrophic cardiomyopathy is dependent on sex. To determine the postulated inhibitive influence of estrogen on the extent of LVH, we compared women and men in age-matched subgroups, respectively, according to the premenopausal and combined peri- and postmenopausal period. METHODS: The study population included 112 patients with hypertrophic cardiomyopathy (65 men and 47 women) and was divided into two groups according to age: younger, < or = 40 years, and older, > 40 years. In each group, the ventricular septum and posterior wall thickness measured by echocardiography in the men were compared with those in the women. RESULTS: The ventricular septum and posterior wall thickness were similar in men and women both among the younger and older patient subgroups. The extent of LVH in the premenopausal women was also comparable with that in the peri- and postmenopausal women. CONCLUSION: Premenopausal women with hypertrophic cardiomyopathy presented with a comparable extent of LVH to age-matched men. Moreover, LVH did not progress in peri- and postmenopausal women. Thus, the hypothesized antihypertrophic effect of estrogen in hypertrophic cardiomyopathy premenopausal women is probably not strong enough to modify genetically determined LVH in hypertrophic cardiomyopathy patients.

The frequency and functional impact of hypertension overlapping on hypertrophic cardiomyopathy: comparison between older and younger patients.

BACKGROUND AND AIM: In a previous report, when hypertension (HT) overlapped on hypertrophic cardiomyopathy (HTHCM), the decreased survival rate was associated with higher NYHA classes. The study concerned only elderly patients and therefore we decided to extend it by: (1) assessment of the frequency and age-distribution of HTHCM in HCM population; and (2) the comparison of NYHA class between HTHCM and HCM both in younger and older patients. PATIENTS AND METHODS: We retrospectively viewed 123 HCM patients with regard to the presence of hypertension as a concomitant disease. The HTHCM and HCM patients were compared with regard to NYHA functional classes within younger (<50 years of age) and older (>50 years of age) subgroups. RESULTS: Of the 123 HCM patients, 24 (19.5%) had associated hypertension. Among younger patients, 15.7% had concomitant hypertension, while in older patients the percentage of HTHCM significantly increased to 38%. In younger patients, the mean values of the NYHA class were significantly higher in HTHCM in comparison to HCM patients (2.19 +/- 0.37 vs 1.94 +/- 0.56, P < 0.05), whereas in the older patients, the mean values of NYHA class were comparable between HTHCM and HCM patients (2.13 +/- 0.33 vs 2.23 +/- 0.42, P > 0.05). CONCLUSION: Hypertension associated with HCM is not rare in young patients, and this coincidence significantly increases in older patients. Hypertension overlapping on HCM additionally deteriorates functional status in younger patients whereas in the older patients NYHA class the difference between HTHCM and HCM narrows and becomes insignificant.

Progression of asymmetric pattern of left ventricular hypertrophy in patients with hypertrophic cardiomyopathy accompanied by hypertension in the elderly.

OBJECTIVE: The aim of the study was to determine the potential influence of hypertension overlapping hypertrophic cardiomyopathy (HCM) on left ventricular hypertrophy (LVH) pattern. We compared the magnitude of LVH asymmetry between younger and older patients with HCM and concomitant hypertension. MATERIAL AND METHODS: We studied 18 patients (age range from 18 to 77 years) in whom HCM was accompanied by mild-to-moderate hypertension. Patients were subdivided into two groups: (I) <50 years of age (11 patients); and (II) >50 years of age (seven patients). The thickness of ventricular septum and posterior wall was assessed by M-mode echocardiography. The pattern of LVH was determined based on the value of ventricular septum/posterior wall thickness (VS/PW) ratio and LVMI was calculated according to Devereux formula. RESULTS: The more asymmetric LVH pattern was revealed in older HCM with hypertension patients than in younger patients (VS/PW thickness ratio 2.62 +/- 0.81 vs 1.58 +/- 0.56, P < 0.05). The LVMI was similar in both groups (210 + 87 vs 191 + 30 g/m2, P > 0.5). CONCLUSION: Asymmetric pattern of LVH aggravated with increasing age in HCM with hypertension patients while LVMI was comparable between younger and older patients. Thus, the primary myocardial disease, ie, HCM, so significantly determined the asymmetric LVH pattern with aging that coexistent hypertension was not a sufficiently strong stimulus to alter LVH pattern into a more concentric one in the elderly.

Blood pressure profile and variability in hypertensives treated with L-arginine infusion.

BACKGROUND: The role of nitric oxide (NO) in regulation of systemic blood pressure both in normotensives and in hypertensives remains unknown. OBJECTIVE: To investigate the influence of L-arginine (the substrate for generation of NO) on blood pressure in 30 men (aged 51.5 +/- 7.3 years) with established primary arterial hypertension that was not well controlled. METHODS: The antihypertensive therapy was not discontinued and the patients were administered beta-blockers and calcium antagonists only. On day '0' the patients were administered 250 ml 0.9% NaCl during 180 min intravenously. Then we infused 250 mg/kg L-arginine diluted in 250 ml 0.9% NaCl over 180 min into the antecubital vein for four consecutive days (days 'I'-'IV'). Conventional blood pressure and heart rate measurementws were performed before infusion and every 30 min during infusion. Twenty-four-hour ambulatory blood pressure monitoring (with a SpaceLabs 90207 device) with half-hourly recordings during the daytime and during the night-time was performed on the day of NaCl infusion ('0') and repeated on the day of L-arginine infusion ('II') for all patients. As indicators of generation of NO, blood level of cyclic GMP and urinary concentration of nitrite/nitrate were measured. RESULTS: On all days of L-arginine infusion we found significant falls in systolic and diastolic blood pressures (P < 0.0001) with an accompanying significant increase in heart rate (P < 0.001). The most potent hypertensive effect during infusion of L-arginine was observed on day 'I'. Mean systolic blood pressure decreawsed from 152.1 +/- 20.0 mmHg to a minimum of 123.3 +/- 16.2 mmHg after 60 min of the infusion (by about 19%). The maximal percentage fall in systolic blood pressure was consecutively lower on each day oif L-arginine infusion. It was 14.3% on day 'II', 11.9% on day 'III' and 10.1% on day 'IV'. Similarly, the greatest reduction of diastolic blood pressure was observed during infusion of L-arginine on day 'I'. Mean diastolic blood pressure decreased from 95.9 +/- 13.6 to 80 +/- 9.7 mmHg after 120 min of infusion (by about 17%). On the consecutive days maximal falls in diastolic blood pressure compared with its initial value were 13.5% on day 'II', 10.4% on day 'III' and 9.8% on day 'IV'. Twenty-four-hour ambulatory blood pressure monitoring revealed a significant decrease in diastolic blood pressure during infusion of L-arginine compared with day 0 when 0.9% NaCl was infused. Systolic and diastolic blood pressure variabilities were significantly decreased and the day-night differences in systolic and diastolic blood pressures were increased after infusion of L-arginine. We found a significant correlation between heart rate and systolic blood pressure both during the daytime and during night-time on the day of infusion of L-arginine. An increase in urinary concentration of nitrite/nitrate was observed after administration of L-arginine.CONCLUSION: The present results demonstrate that infusion of L-arginine can influence the systemic blood pressure in hypertensives through NO synthesis. By using ambulatory blood pressure monitoring we documented that the hypotensive effect of L-arginine seems to be limited to the infusion period itself. A decrease in blood pressure variability might imply an increase in sensitivity of baroreceptors or an improvement of autonomic functioning.

Blood pressure, insulin resistance and left ventricular function in alcoholics.

OBJECTIVE: To estimate the arterial blood pressure, left ventricular function and insulin secretion in alcoholics. DESIGN: We examined hospitalized patients between the second and seventh day of acute alcohol withdrawal and after a month of abstinence by 24 h ambulatory blood pressure monitoring, a standard oral glucose-tolerance test with determination of insulinaemia, two-dimensional and M-mode echocardiography and pulsed-wave Doppler statistical analysis was performed using Student's t test P < 0.05 was considered statistically significant PATIENTS: Fifty alcoholics aged 36.3 +/- 5.4 years with a history of alcohol abuse for a mean of 12 years. MAIN OUTCOME: We expected the cessation of drinking to exert an influence by lowering the blood pressure and left ventricular function with a concomitant lowering of the insulin resistance. RESULTS: During acute alcohol withdrawal the systolic (121.6 +/- 7.7 versus +115.8 +/- 8.7 mmHg) and diastolic blood pressures (74.5 +/- 6.3 versus 72.0 +/- 7.9 mmHg) were significantly higher. The nocturnal fall in blood pressure was smaller and the variability of the blood pressure was blunted. This period was characterized by hyperinsulinaemia detected by the glucose-tolerance test [In (SUMins) 8957 +/- 0.47 versus 8558 +/- 0.651] correlated to hyperdynamic circulation (cardiac index 3.38 +/- 0.86 versus 3.09 +/- 0.69 I/min per m2). The early: late atrial filling ratio had increased significantly after 1 month of abstinence (1.98 +/- 0.43 versus 2.08 +/- 0.50). CONCLUSIONS: One month of abstinence from drinking decreases the blood pressure and improves the diurnal profile of the blood pressure and the left ventricular diastolic function. Hyperinsulinaemia, which is observed during acute restriction of alcohol consumption, could be one of the causes responsible for hyperdynamic circulation.

Sex differences in age at onset of symptoms in patients with hypertrophic cardiomyopathy.

BACKGROUND: We hypothesized that, in hypertrophic cardiomyopathy, endogenous estrogen may delay the development of symptoms in females as compared with males by several cardiovascular protective mechanisms. We examined this by assessing the sex distribution in relation to age at onset of symptoms in patients with hypertrophic cardiomyopathy. METHODS: The study population of 94 patients (55 men and 39 women) was subdivided into four groups according to age at onset of symptoms; < 15 years, 15-29 years, 30-39 years and > 40 years. In the first group, comprising the youngest patients, all the girls were pre-menarche. The age of 40 years was chosen as the lower limit for the last group because of the possible influence of pre- and perimenopausal decrease in estrogen levels on the onset of symptoms in women in their fifth decade of life. RESULTS: In general, females with hypertrophic cardiomyopathy developed symptoms later than did males (31.3 +/- 11.9 compared with 26.7 +/- 9.9 years; P < 0.05). Among adolescents, similar percentages of girls and boys developed the condition. Among young adult patients (between 15 and 29 years of age), it was predominantly men who developed symptoms. Men predominated, albeit insignificantly, among patients with onset of symptoms in the fourth decade of life, but there was a significant dominance of women over men in the group who became symptomatic after 40 years of age. CONCLUSION: Delayed onset of symptoms in women with hypertrophic cardiomyopathy compared with men resulted in nearly one-third of women remaining asymptomatic until 40 years of age, symptoms developing in the fifth decade of life.

Circadian blood pressure changes and cardiac geometry in essential arterial hypertension.

To study a relationship between ambulatory blood pressure (BP) and left ventricular geometry in mild to moderate arterial hypertension, 24 h ambulatory blood pressure monitoring (ABPM) at half-hourly intervals in the daytime and hourly at night (Spacelabs 90207) and echocardiographic examinations were performed in 60 hypertensives aged 42 +/- 7.9 years and in eight normotensives. The patients were subdivided into four groups according to the relative wall thickness (RWT) and left ventricular mass index (LVMI). Concentric remodelling was identified on the basis of increased RWT, eccentric hypertrophy in case of increased left ventricular mass, and concentric hypertrophy when both parameters were increased. Group I consisted of 15 patients with normal left ventricle; group II, 19 patients with concentric remodelling; group III, 7 patients with eccentric hypertrophy; and group IV, 19 patients with concentric hypertrophy. Analysis of correlations of maximal and mean systolic (SBP) and diastolic BP (DBP) values and BP variability with left ventricular mass and relative wall thickness revealed the strongest correlation in group IV between concentric hypertrophy and peak SBP in the entire 24 h and in the daytime, mean SBP in the daytime and SBP variability in the entire 24 h. No significant correlations were found in groups I, II, III or controls. In conclusion, SBP variability assessed non-invasively with ABPM correlates positively with left ventricular mass. BP variability seems insignificant for left ventricular geometry.

Effects of prolonged L-arginine administration on blood pressure in patients with essential hypertension (EH).

L-arginine (L-Arg) was administered intravenously through 4 consecutive days to 20 males (40-63 years old) with essential hypertension (EH). Significant decrease (p < 0.02) of systolic blood pressure (SBP) was observed only during the first day of the therapy and tachyphylaxis against L-Arg was noticed. The reduction of diastolic blood pressure (DBP) was more marked (p < 0.001). Significant changes in cGMP plasma level and the nitrite/nitrate urine concentration were not observed. L-Arg caused a significant activation of fibrinolysis (p < 0.005). The decrease of platelet activity, measured by the ADP-induced aggregation, after L-Arg administration was not statistically significant. Therefore, L-Arg may play only a secondary role in the treatment of EH.