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1.
J Cardiovasc Med (Hagerstown) ; 20(5): 284-289, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30865135

RESUMO

BACKGROUND: B-thalassemia carrier state or thalassemia minor confers cardiovascular protection through favorable lipidemic and blood pressure profile. However, its impact on inflammatory status-a common denominator of the above conditions-has not been addressed. METHODS: We investigated a wide range of inflammatory markers [white blood cell (WBC) count, homocysteine, C-reactive protein (CRP), serum amyloid A (SAA), fibrinogen, plasminogen, fibronectin, plasminogen activator inhibitor-1 (PAI-1), and uric acid] in a large cohort of 15 805 newly diagnosed hypertensive patients (8299 men, 7506 women); 626 of them (4.0%) had thalassemia minor. RESULTS: The levels of WBC, homocysteine, CRP, SAA, fibrinogen, and PAI-1 were significantly lower in thalassemia minor patients, but not of plasminogen, fibronectin, and uric acid. In multivariate linear regression analyses, the lower values of WBC (<0.001), CRP (<0.001), homocysteine (<0.001), fibrinogen (<0.001), and PAI-1 (0.008), but not of SAA, were independently associated with thalassemia minor. The interaction between thalassemia minor and body mass index had a significant impact only on WBC and CRP (P for the interaction 0.010 and 0.005, respectively), whereas the interaction between thalassemia minor and sex had a significant impact only on fibrinogen (P for the interaction 0.007). CONCLUSION: Thalassemia minor is followed by a favorable inflammatory profile that may contribute to the overall better cardiovascular health of the carriers.


Assuntos
Hipertensão/sangue , Mediadores da Inflamação/sangue , Inflamação/sangue , Talassemia beta/sangue , Idoso , Biomarcadores/sangue , Índice de Massa Corporal , Proteína C-Reativa/análise , Feminino , Fibrinogênio/análise , Nível de Saúde , Homocisteína/sangue , Humanos , Hipertensão/diagnóstico , Inflamação/diagnóstico , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Inibidor 1 de Ativador de Plasminogênio/sangue , Proteína Amiloide A Sérica/análise , Talassemia beta/diagnóstico , Talassemia beta/genética
2.
J Clin Hypertens (Greenwich) ; 17(12): 938-43, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26234405

RESUMO

Intrarenal hemodynamics depend on blood pressure (BP), heart rate (HR), and smoking. Although BP levels have been associated with kidney function, the effect of HR levels, BP, and HR variability on renal function are less well clarified. This cross-sectional study sought to determine the association of 24-hour BP and HR variability with kidney function in hypertensive patients, stratified by smoking. The study comprised 9600 nondiabetic, never-treated hypertensive individuals without evident renal impairment examined from 1985 to 2014 (aged 53.3±13.4 years, 55.3% males). The 24-hour systolic BP (SBP) and HR variability were estimated via their coefficient of variation (CV =standard deviation×100/mean value) derived from ambulatory recording. The CV SBP-to-CV HR ratio (CV R) was used as a marker of the interplay between 24-hour SBP and HR variability. Renal function was estimated via 24-hour urine creatinine clearance (CrCl), estimated glomerular filtration rate (eGFR), albumin-to-creatinine ratio (ACR), and 24-hour urine α1 -microglobulin. After adjustment for age, sex, and smoking, CV SBP was found to be weakly correlated to eGFR (r=-0.017, P=.1) and somewhat more strongly to CrCl, ACR, and α1 -microglobulin (r=-0.032, 0.072, and 0.065; P=.002, <.001 and <.001, respectively). CV HR was much better related to renal function, with stronger adjusted correlations to CrCl, eGFR, ACR, and α1 -microglobulin (r=0.185, 0.134, -0.306, -0.247; all P<.001, respectively). CV R also showed equally good adjusted correlations (r=-0.175, -0.125, 0.336, 0.262; all P<.001, respectively). Most adjusted correlations for CV HR and CV R were even better in smokers (r=0.213, 0.158, -0.332, -0.272 and -0.183, -0.118, 0.351, 0.275, respectively; all P<.001). CV HR and CV R emerge as better related to kidney function than CV SBP, especially in smokers. The correlation of CV HR and CV SBP to renal function is inverse to each other. ACR and α1 -microglobulin are better related to variability indices than CrCl and eGFR. However, causal relations cannot be proved.


Assuntos
Pressão Sanguínea/fisiologia , Frequência Cardíaca/fisiologia , Hipertensão/fisiopatologia , Fumar/fisiopatologia , Adulto , Idoso , Monitorização Ambulatorial da Pressão Arterial/métodos , Creatinina/sangue , Estudos Transversais , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Hipertensão/sangue , Hipertensão/diagnóstico , Testes de Função Renal/métodos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco , Albumina Sérica/metabolismo , Fumar/efeitos adversos , Fumar/sangue
3.
J Am Soc Hypertens ; 7(4): 294-304, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23562108

RESUMO

Arterial hypertension (AH) and diabetes mellitus (DM) are established cardiovascular risk factors. Impaired glucose homeostasis (IGH; impaired fasting glucose or/and impaired glucose tolerance) or pre-diabetes, obesity, and DM family history identify individuals at risk for type 2 DM in whom preventive interventions are necessary. The aim of this study was to determine the glycemic profile in non-diabetic Greek adult hypertensive men and women according to DM family history and the obesity status. Diabetes family history, obesity markers (waist-to-hip ratio, WHR; body mass index, BMI), glycemic parameters (fasting and 2-hour post-load plasma glucose, if necessary; glycated hemoglobin, HbA1c; fasting insulin), insulin resistance indices (homeostasis model assessment, HOMA; quantitative insulin sensitivity check index, QUICKI; Bennett; McAuley), and IGH prevalence were determined in a large cohort of 11,540 Greek hypertensives referred to our institutions. Positive DM family history was associated with elevated fasting glucose (98.6 ± 13.1 vs 96.5 ± 12.3 mg/dL), HbA1c (5.58% ± 0.49% vs 5.50% ± 0.46%), fasting insulin (9.74 ± 4.20 vs 9.21 ± 3.63 µU/mL) and HOMA (2.43 ± 1.19 vs 2.24 ± 1.01) values, lower QUICKI (0.342 ± 0.025 vs 0.345 ± 0.023), Bennett (0.285 ± 0.081 vs 0.292 ± 0.078) and McAuley (6.73 ± 3.43 vs 6.95 ± 3.44) values, and higher IGH prevalence (45.3% vs 38.7%); P < .01 for all comparisons. The difference in the prevalence of IGH according to DM family history was significant (P < .01) in both genders and every WHR and BMI subgroup (except for women with BMI <20 kg/m(2)). Non-diabetic hypertensives with positive DM family history present with higher IGH prevalence and worse glycemic indices levels compared with those with negative family history, especially in the higher WHR/BMI subgroups.


Assuntos
Glicemia/metabolismo , Intolerância à Glucose/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Estado Pré-Diabético/epidemiologia , Adulto , Idoso , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/metabolismo , Saúde da Família , Feminino , Intolerância à Glucose/metabolismo , Índice Glicêmico/fisiologia , Grécia/epidemiologia , Homeostase/fisiologia , Humanos , Hipertensão/metabolismo , Masculino , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Obesidade/metabolismo , Estado Pré-Diabético/metabolismo , Prevalência , Fatores de Risco
5.
Int J Cardiol ; 138(2): 119-25, 2010 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-18804878

RESUMO

BACKGROUND: Arterial stiffness and wave reflections are independent predictors of cardiovascular disease. Metabolic syndrome (MS) is related to increased aortic stiffness in several populations. However, it is unclear whether the association of MS with aortic stiffness differs according to the considered definition. Moreover, data regarding the association of wave reflections with MS are limited. For this purpose, we examined the relationship of arterial stiffness and wave reflections with MS by using four current definitions and a score. METHODS: We studied 732 never treated, non-diabetic hypertensive patients. Metabolic syndrome was defined by Adult Treatment Panel III, American Heart Association, World Health Organization (WHO), International Diabetes Federation criteria and MS (GISSI) score. Arterial stiffness was assessed by measuring carotid-femoral pulse wave velocity (PWVc-f). Heart rate-corrected augmentation index (AIx(75)) was estimated as a measure of wave reflections. RESULTS: By all definitions, hypertensive patients with MS had higher PWVc-f compared to hypertensives without MS. On the contrary, no significant difference was observed in AIx(75) between patients with and those without MS except when MS was defined by WHO criteria. An independent association emerged between PWVc-f and GISSI score and MS components (p=0.038 and 0.033 respectively) in patients with MS, after adjustment for age, gender, LDL cholesterol and smoking. Nevertheless, after further adjustment for systolic blood pressure or body mass index, the strength of this association was reduced to a non-significant level. CONCLUSION: Arterial stiffness is increased in patients with metabolic syndrome irrespective of the definition criteria. On the contrary, metabolic syndrome has no effect on wave reflections, except when this is defined by WHO criteria. Regarding the high prognostic significance of both arterial stiffness and wave reflections, these findings might have important clinical implications.


Assuntos
Artérias/fisiopatologia , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Adulto , Doenças da Aorta/epidemiologia , Doenças da Aorta/fisiopatologia , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Artérias Carótidas/fisiopatologia , Feminino , Artéria Femoral/fisiopatologia , Frequência Cardíaca/fisiologia , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fluxo Pulsátil/fisiologia , Análise de Regressão , Fatores de Risco
6.
Int J Cardiol ; 126(2): 268-72, 2008 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-18384897

RESUMO

INTRODUCTION: The myocardial performance index, Tei index, is a relatively new echocardiography indice which is related to parameters which express both the systolic and diastolic myocardial function. The purpose of the present study was to investigate the possible correlation of Tei index to microalbuminuria, which is an indice of kidney target-organ damage in hypertensive patients. MATERIALS AND METHODS: We evaluated 9680 consecutive patients (mean age 55.2 years, 5144 male and 4536 female) with chronic uncomplicated essential hypertension and the correlation between Tei index, defined as the sum of the isovolumetric relaxation and contraction time divided by the ejection time, and kidney target damage (microalbuminuria) was evaluated. RESULTS: In univariate analysis we noticed a positive correlation of Tei index with microalbuminuria (r=0.353 p<0.001). Furthermore, a significant difference was found in each Tei quartile for microalbumin levels (p<0.001). In multivariate analysis with Tei index as a dependent variable (high versus low quartile) and independent variables gender, age, body mass index, plasma glucose, heart rate, blood pressure, kidney function indices and lipids, the independent prognostic correlation to microalbuminuria was noticed (OR: 1.002 p<0.001). CONCLUSIONS: In the present study we found that Tei index correlates with microalbuminuria in essential hypertensive patients. Thus we can assume that this index could be used not only for the evaluation of the global myocardial performance of hypertensive patients but also for the assessment of the cardiovascular risk in arterial hypertension since it correlates with kidney damage.


Assuntos
Albuminúria/fisiopatologia , Função Atrial/fisiologia , Hipertensão/fisiopatologia , Função Ventricular/fisiologia , Adulto , Idoso , Albuminúria/complicações , Pressão Sanguínea/fisiologia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Hipertensão/complicações , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Contração Miocárdica/fisiologia
7.
J Clin Hypertens (Greenwich) ; 10(3): 201-7, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18326960

RESUMO

The purpose of the present study was to assess angiotensin receptor blocker (ARB) treatment on arterial stiffness in select hypertensive patients and define possible differences between smokers and nonsmokers. The authors evaluated 81 consecutive, nondiabetic patients (mean age, 52 years; 47 men) with uncomplicated essential hypertension with high plasma renin activity who were administered monotherapy with irbesartan, an ARB, at maximal dose. Patients were divided into smokers (n=24) and nonsmokers (n=57). Carotid-radial pulse wave velocity (PWVc-r), carotid-femoral pulse wave velocity (PWVc-f), and augmentation index (AIx) were measured before and 6 months after ARB antihypertensive treatment. All mean values of elastic effect indices were decreased after irbesartan monotherapy (AIx, from 26.3%to 21.2% [P<.01;] PWVc-f, from 7.7 m/s to 7.3 m/s [P<.05], and PWVc-r, from 8.9 m/s to 8.3 m/s [P<.001]). When comparing smokers vs nonsmokers, no difference was noted in AIx and PWVc-f change (P=not significant), while PWVc-r change was greater in smokers compared with nonsmokers (P<.05). Chronic ARB treatment may favorably affect arterial stiffness and wave reflections in hypertensive chronic smokers with elevated plasma renin levels.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Aterosclerose/tratamento farmacológico , Compostos de Bifenilo/uso terapêutico , Hipertensão/tratamento farmacológico , Tetrazóis/uso terapêutico , Resistência Vascular/efeitos dos fármacos , Adulto , Idoso , Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Compostos de Bifenilo/efeitos adversos , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Estudos de Coortes , Elasticidade , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Irbesartana , Masculino , Pessoa de Meia-Idade , Músculo Liso Vascular/efeitos dos fármacos , Renina/sangue , Método Simples-Cego , Fumar/efeitos adversos , Tetrazóis/efeitos adversos
9.
Blood Press Monit ; 12(6): 351-6, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18004102

RESUMO

BACKGROUND: Data relating dipping status to metabolic syndrome (MS) scores are not available. The purpose of this study is to investigate any possible association of different dipping patterns to MS scores in untreated patients with essential hypertension. METHODS: The study included 6256 consecutive, treatment-naive patients with essential hypertension who attended our outpatient clinics. All underwent repeated office blood pressure measurements, 24-h ambulatory blood pressure monitoring, and full clinical and laboratory evaluation. The diagnosis of MS was made according to the Adult Treatment Panel III criteria and patients were classified into five groups: group I (hypertension), group II (hypertension+any one component), group III (hypertension+any two components), group IV (hypertension+any three components), and group V (all five components). Dipping pattern was defined as 'dippers' with nocturnal systolic blood pressure (NSBP) falling >or=10 but <20%, 'nondippers' with NSBP falling >or=0% but <10%, 'extreme dippers' with NSBP falling >or=20%, and 'reverse dippers' with NSBP increasing. RESULTS: Hypertensive patients with MS (n=2573) had higher clinical and ambulatory blood pressure values (P<0.001), whereas the dominant dipping pattern in the non-MS group was nondippers (47.6%), and in the MS group, extreme dippers (37.8%). Furthermore, a considerable decrease in the prevalence of dippers was noticed with the increasing number of MS components (21.1 vs. 19.2 vs. 14.5 vs. 8.4 vs. 7.2%, P<0.001). In contrast, a significant rise in the prevalence of reverse dippers was observed with the increasing number of MS components (7.4 vs. 10.1 vs. 14.9 vs. 20.4 vs. 31.2%, P<0.001). CONCLUSIONS: It seems that hypertensive patients have an increased prevalence of abnormal dipping patterns as the number of MS components rises.


Assuntos
Ritmo Circadiano , Hipertensão/fisiopatologia , Síndrome Metabólica/complicações , Sono/fisiologia , Adulto , Idoso , Monitorização Ambulatorial da Pressão Arterial , Estudos de Coortes , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade
10.
Blood Press Monit ; 12(2): 87-94, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17353651

RESUMO

OBJECTIVES: Left ventricular hypertrophy is a major risk predictor in hypertensive patients and its regression is beneficial in terms of prognosis. The aim of this observational, open-labeled study was to investigate the effect of left ventricular geometry and dipping pattern on left ventricular mass reduction after chronic treatment with angiotensin-converting enzyme inhibitors, in a large population of hypertensive patients. METHODS: We evaluated untreated patients with mild to moderate essential hypertension, before and 6 months after treatment with angiotensin-converting enzyme inhibitor monotherapy or angiotensin-converting enzyme inhibitor-low-dose thiazide combination. Left ventricular mass index, relative wall thickness and geometry pattern were derived from echocardiography. Dipping state was determined with 24-h ambulatory blood pressure monitoring at enrollment. RESULTS: Overall, left ventricular mass index decrease in the 1400 patients (mean age 52.5 years) who completed the study was 12.9% of baseline value (P<0.00001). After adjusting for pretreatment value, left ventricular mass index reduction was similar with all angiotensin-converting enzyme inhibitors used [P= NS (not significant)], but it was higher in nondippers than dippers (14.1 vs. 12.3%, P<0.0001) and in patients with than without baseline left ventricular hypertrophy (14.6 vs. 11.3%, P<0.0001). We observed a stepwise augmentation of left ventricular mass index decrease with worsening left ventricular geometry (P<0.001). In multivariable analysis, impaired left ventricular geometry and blunted nocturnal blood pressure fall before treatment were independent predictors of a high left ventricular mass index reduction after treatment, independent of blood pressure fall, pretreatment left ventricular mass index, and other potential confounders. CONCLUSION: In essential hypertension, left ventricular geometry and dipping state are independent determinants of left ventricular mass reduction with angiotensin-converting enzyme inhibitor treatment. All angiotensin-converting enzyme inhibitors are efficient in decreasing left ventricular mass.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Hipertensão/tratamento farmacológico , Hipertrofia Ventricular Esquerda/tratamento farmacológico , Inibidores de Simportadores de Cloreto de Sódio/administração & dosagem , Adulto , Pressão Sanguínea/efeitos dos fármacos , Monitorização Ambulatorial da Pressão Arterial , Quimioterapia Combinada , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertrofia Ventricular Esquerda/epidemiologia , Hipertrofia Ventricular Esquerda/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Análise de Regressão , Fatores de Risco
11.
J Clin Hypertens (Greenwich) ; 9(1): 21-7, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17215655

RESUMO

The effect of long-term angiotensin II type 1 receptor blocker (ARB) therapy on inflammation indices has not been fully investigated in a hypertensive population. The authors evaluated 323 consecutive nondiabetic patients (mean age, 57 years; 176 men; 92 smokers) with high renin activity and uncomplicated essential hypertension whose blood pressure levels normalized (from 163.9/100.7 mm Hg to 131.6/82.8 mm Hg) after 4 weeks of ARB or ARB/diuretic treatment. All patients underwent full laboratory evaluation (routine examination of blood and urine, liver, kidney, thyroid function, and lipid and glucose profiles), including measurement of high-sensitivity C-reactive protein and serum amyloid A levels, at drug-free baseline, which was repeated after 6 months of ARB or ARB/diuretic treatment. A significant (P<.001) overall decrease was noted in both high-sensitivity C-reactive protein (-0.41+/-1.56 mg/dL) and serum amyloid A (-0.62+/-2.03 mg/dL), but a smaller decrease in high-sensitivity C-reactive protein and serum amyloid A change was seen in the smoker subgroup compared with nonsmokers (P<.05), indicating that the ARB or ARB/diuretic anti-inflammatory effect may be adversely affected by smoking status.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Proteína C-Reativa/metabolismo , Hipertensão/tratamento farmacológico , Inflamação/sangue , Proteína Amiloide A Sérica/metabolismo , Fumar/efeitos adversos , Biomarcadores/sangue , Pressão Sanguínea/efeitos dos fármacos , Proteína C-Reativa/efeitos dos fármacos , Feminino , Humanos , Hipertensão/sangue , Hipertensão/complicações , Inflamação/complicações , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Proteína Amiloide A Sérica/efeitos dos fármacos , Resultado do Tratamento
12.
Hellenic J Cardiol ; 47(1): 21-8, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16532712

RESUMO

INTRODUCTION: Dyslipidaemia is associated with high risk for cardiovascular disease and lipid management is arguably necessary, especially in hypertensive subjects. There is an implication that angiotensin receptor blockers (ARB) are characterised by a beneficial effect on lipid profile in addition to their blood pressure lowering properties. This study was conducted to evaluate blood pressure control and the plasma lipid profile in hypertensive patients after six months' treatment with ARB. METHODS: We studied 2438 consecutive, untreated patients with uncomplicated essential hypertension (mean blood pressure [BP] 167/100 mmHg). All patients underwent full lab and echo examination at drug-free baseline, which was repeated after at least 6 months of ARB monotherapy. RESULTS: Overall, ARB treatment reduced BP levels significantly (p<0.0001). Evaluating lipid profile changes, a significant (p<0.0001) reduction was noted in total cholesterol (TC: from 220 +/- 39 to 216 +/- 36 mg/dL), low density lipoprotein cholesterol (LDL: from 146 +/- 35 to 141 +/- 33 mg/dL), ratio of TC to high density lipoprotein cholesterol (HDL) (from 4.80 +/- 1.35 to 4.64 +/- 1.25), apolipoprotein (Apo) B (from 129 +/- 32 to 124 +/- 28 mg/dL), and triglyceride levels (from 130 +/- 63 to 128 +/- 61 mg/dL, p=0.015), while ApoA1 and lipoprotein(a) levels were not significantly affected (149 +/- 23 vs. 149 +/- 22 and 24.9 +/- 26.3 vs. 24.7 +/- 26.4 mg/ dL, respectively, p=NS). Additionally, HDL levels increased from 48.2 +/- 12.2 to 48.8 +/- 11.9 mg/ dL, p<0.0001. According to the individual agent used, a different effect on lipid indices was observed. CONCLUSIONS: ARB antihypertensive therapy may have a uniquely beneficial metabolic effect in addition to blood pressure lowering.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Anti-Hipertensivos/farmacologia , Hipertensão/sangue , Hipertensão/tratamento farmacológico , Lipoproteínas/sangue , Acrilatos/farmacologia , Idoso , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Benzimidazóis/farmacologia , Benzoatos/farmacologia , Compostos de Bifenilo/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Feminino , Humanos , Imidazóis/farmacologia , Irbesartana , Estilo de Vida , Losartan/farmacologia , Masculino , Pessoa de Meia-Idade , Telmisartan , Tetrazóis/farmacologia , Tiofenos/farmacologia , Valina/análogos & derivados , Valina/farmacologia , Valsartana
13.
Am J Hypertens ; 17(7): 582-9, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15233977

RESUMO

BACKGROUND: The significance of beta-blockers in the treatment of cardiovascular diseases is well established. The effect of vasodilating beta-blockers on endothelial function and prothrombotic state has not been investigated. METHODS: The study comprised 550 consecutive patients with uncomplicated essential hypertension. They were treated with celiprolol, carvedilol or nebivolol monotherapy (171, 179, and 200 patients, respectively), achieving comparable blood pressure reduction. Plasma levels of fibrinogen and homocystine and serum levels of plasminogen activator inhibitor-1 (PAI-1) were obtained before and 6 months after initiation of treatment. RESULTS: The three drugs differentiated in regard to homocystine (P <.00001) and fibrinogen level changes (P =.00003), but not (P = NS) in PAI-1 change. In smokers, differentiation was found in all three parameters (P =.0002, P =.001, and P =.006 for fibrinogen, PAI-1, and homocystine, respectively), but in nonsmokers differentiation was found only in homocystine change (P =.00003). In smokers, fibrinogen, PAI-1, and homocystine were reduced more (P =.002, P =.0009, and P <.0001, respectively) than in nonsmokers in the whole study cohort. The effect of nebivolol was more prominent in smokers than nonsmokers in reducing all three parameters (P =.0001,.003, and.003, respectively), whereas in celiprolol and carvedilol-treated groups, differentiation between smokers and nonsmokers was significant (P =.00003 and.01, respectively) only in homocystine level change. CONCLUSIONS: In hypertensive smokers, nebivolol resulted in a significant decrease of plasma PAI-1, fibrinogen and homocystine. Celiprolol also significantly affected these parameters but to a lesser degree, whereas carvedilol had no significant favorable action. In nonsmokers, homocystine was reduced significantly by nebivolol. We conclude that smoking status should be a determinant of antihypertensive treatment choice.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/fisiopatologia , Benzopiranos/uso terapêutico , Biomarcadores/sangue , Pressão Sanguínea/efeitos dos fármacos , Carbazóis/uso terapêutico , Carvedilol , Celiprolol/uso terapêutico , Endotélio Vascular/metabolismo , Etanolaminas/uso terapêutico , Feminino , Fibrinogênio/efeitos dos fármacos , Fibrinogênio/metabolismo , Homocistina/sangue , Homocistina/efeitos dos fármacos , Humanos , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Nebivolol , Inibidor 1 de Ativador de Plasminogênio/sangue , Propanolaminas/uso terapêutico , Fumar/sangue , Resultado do Tratamento , Vasodilatação/efeitos dos fármacos
14.
Am J Hypertens ; 16(3): 209-13, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12620699

RESUMO

BACKGROUND: It is well known that nondipping pattern of arterial hypertension has a harmful effect on target organs such as the brain, heart, and kidneys. However, it remains uncertain whether abnormal dipping patterns of nocturnal blood pressure (BP), such as extreme and reverse dipping, influence vascular function. METHODS: This study comprised consecutive 2800 individuals (1554 men and 1246 women). All were nondiabetic and had uncomplicated, untreated essential sustained hypertension based on office measurements. After a 2-week wash-out period, 24-h ambulatory BP recordings were obtained and patients were classified by their nocturnal systolic BP fall (132 extreme dippers with >20% nocturnal systolic BP fall; 1235 dippers with >10% but <20% fall; 1146 nondippers with >0% but <10% fall; and 287 reverse dippers with <0% fall). Microalbumin, ACR (albumin/creatinine ratio), and microglobulin values were measured in all groups. RESULTS: Extreme dippers did not differ from dippers with regard to microalbumin, microglobulin excretion, or ACR. On the contrary, reverse dippers had significantly (P <.0001) higher values, compared with nondippers, for microalbumin (49.5 v 37.2 mg/dL), microglobulin (10.33 v 8.71 mg/dL), ACR (104.9 v 65.2), and percentages of abnormal values for these parameters. CONCLUSIONS: Microalbuminuria, an index of vascular function, differentiates reverse dippers from nondippers, but not extreme dippers from dippers among hypertensive patients.


Assuntos
Pressão Sanguínea/fisiologia , Ritmo Circadiano/fisiologia , Hipertensão/fisiopatologia , Adulto , Idoso , Albuminúria/fisiopatologia , Albuminúria/urina , Monitorização Ambulatorial da Pressão Arterial , Creatinina/urina , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/urina , Masculino , Pessoa de Meia-Idade
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