Fibrinolytic/hemostatic variables in arterial hypertension: response to treatment with irbesartan or atenolol.

Essential hypertension is often accompanied by abnormalities of the coagulation/fibrinolytic system, predisposing to a procoagulant state. The aim of the present study was to compare the effects of atenolol (beta1-blocker agent) and irbesartan (angiotensin II type 1 receptor antagonist) on plasma levels of hemostatic/fibrinolytic and endothelial function markers in a cohort of previously untreated hypertensives. Fifty-four patients were randomly assigned to atenolol 25 to 150 mg (26 patients) or irbesartan 75 to 300 mg (28 patients). The plasma levels of plasminogen activator inhibitor-1 antigen, thrombomodulin, tissue factor pathway inhibitor antigen, fibrinogen, and factor XII were determined before and after 6 months of therapy. Age, gender distribution, body mass index, lipid profile, and baseline values of the measured markers were similar in both groups. Baseline values for systolic and diastolic blood pressure, as well as the reduction after treatment, were not significantly different between the two groups. Treatment with irbesartan was associated with a significant decrease in the levels of all the parameters. Similar findings were observed in the atenolol group, except for factor XII and tissue factor pathway inhibitor levels, which were not significantly decreased in this group. The reduction, however, of fibrinogen, plasminogen activator inhibitor-1, and thrombomodulin was significantly greater in the irbesartan than in the atenolol group. In conclusion, the results indicated that, despite an equally controlled blood pressure, 6-month therapy with irbesartan was associated with a more favorable modification of hemostatic/fibrinolytic status than atenolol.

Resistance to activated protein C and FV leiden mutation in patients with a history of acute myocardial infarction or primary hypertension.

This study was designed to investigate both resistance to activated protein C (APC-R) and the factor FV Q506 mutation incidence in patients with a history of acute myocardial infarction (AMI) and patients with primary hypertension (PH), a high-risk group for arterial thrombosis. Eighty patients with a history of AMI (group A), 160 patients with a history of PH (group B), and 124 age-matched controls without arterial disease (group C) were studied. APC-R was determined using the Coatest APC Resistance Kit of Chromagenix, Sweden. The prevalence of the FV Q506 mutation was estimated by DNA analysis (Bertina method). The prevalence of the FV Q506 mutation was 20%, 13.75%, and 8% in groups A, B, and C, respectively (A v C P = .0466). The prevalence of APC-R was 47.5% in group A v 13% in group C (P < .0001) and 36.25% in group B v 13% in group C (P < .0001). The response to activated protein C expressed as mean value +/- SD was 2.05 +/- 0.33 in group A v 2.56 +/- 0.46 in group C (P < .05) and 2 +/- 0.22 in group B v 2.56 +/- 0.46 in group C (P < .05). These findings suggest that patients with a history of AMI or PH have a significantly increased incidence of both APC-R and FV Q506 mutation compared with the control group. These findings support the hypothesis that these anticoagulant defects may be risk factors for arterial thrombosis.

Elevated plasma immunoreactive leptin levels preexist in healthy offspring of patients with essential hypertension.

BACKGROUND: Plasma leptin levels and plasma insulin levels have been found to be elevated in patients with essential hypertension (EH) and have been suggested to be components of the metabolic syndrome. Increased heart rate (HR) may predict the development of EH in normal or borderline-hypertensive individuals. The aim of our study was to test the hypothesis that elevated plasma leptin and insulin levels as well as systolic blood pressure (SBP) and diastolic blood pressure (DBP) and increased resting HR preexist in the healthy offspring of patients with EH. METHODS AND RESULTS: Twenty-six (12 male, 14 female) healthy offspring of hypertensive patients, mean age 16 +/- 2.5 years and body mass index (BMI) of 21.5 +/- 2.8 kg/m(2) (group A), and 30 (14 male, 16 female) healthy offspring of normotensive patients, mean age 17 +/- 2.3 years and BMI of 21.9 +/- 2.4 kg/m(2) (group B), were studied. (The two groups were matched for sex, age, and BMI). Mean SBP, DBP, resting HR, plasma leptin, and plasma insulin levels (radioimmunoassay method) were determined in the whole study population. Mean SBP, DBP, and resting HR were significantly higher in group A than in group B (120 +/- 12 vs 112 +/- 9.5 mm Hg, 77 +/- 9 vs 72 +/- 7 mm Hg, 79 +/- 8 vs 75 +/- 5 beats/min, P <.01, P <.05, and P <.05, respectively). Plasma leptin and insulin levels were significantly higher in group A than in group B (9 +/- 5.06 vs 5.6 +/- 2.5 ng/mL and 20.11 +/- 11.3 vs 14.8 +/- 5.2 microIU/mL, P <.01 and P <.05, respectively). CONCLUSIONS: Our findings support the hypothesis that hyperleptinemia, hyperinsulinemia, and elevated blood pressure and resting HR preexist in the healthy offspring of patients with EH.

New coronary artery disease index based on exercise-induced QRS changes.

Exercise-induced changes in Q, R, and S wave amplitudes have been reported to detect coronary artery disease but with low specificity, low sensitivity, or both; it was hypothesized that their incorporation into a composite index (Athens QRS score) might improve specificity and sensitivity. For this purpose 246 patients were analyzed retrospectively and 160 prospectively. All patients underwent maximal exercise testing with a standard Bruce protocol and coronary arteriography as part of the diagnostic evaluation for possible or definite coronary artery disease. The Athens QRS score was decreased as the number of obstructed coronary arteries increased (normal coronary arteries = 7.85 +/- 5.23 mm, one-vessel disease = 5.2 +/- 5.3 mm, two-vessel disease = -0.85 +/- 5.4 mm, three-vessel disease = -3.5 +/- 5.8 mm; p less than 0.0001); the score was unrelated to exercise-induced ST segment depression, and negative (less than 0) scores were always associated with coronary artery disease. An Athens QRS score of 5 mm predicted coronary artery disease with sensitivity ranging from 75% to 86% and a specificity ranging from 73% to 79%, values higher than those of the Q wave (75% and 50%, respectively), R wave (65% and 55%), and S wave (70% and 10%) and of the ST segment depression (62% and 70%). It is concluded that exercise-induced changes in the QRS complex provide a useful index not only for the diagnosis but also for the assessment of severity of coronary artery disease.

Significance of ST segment depression in exercise-induced supraventricular extrasystoles.

The significance of exercise-induced ST segment depression in supraventricular extrasystoles (STx), in the preceding sinus beats (STs), as well as the significance of the difference between the two of them (STx-s), was studied in 96 patients with angiographically documented coronary artery disease (CAD) (group A)--34 with myocardial infarction (group A1) and 62 without (group A2)--compared to 37 subjects with normal coronary arteries (group B). All patients had supraventricular extrasystoles during exercise testing, the results of which were positive in 72 (75%) patients in group A and six (16.2%) patients in group B (sensitivity 75%, specificity 84%). Among patients in group A STx was greater than STs (1.7 +/- 1.0 vs 1.2 +/- 0.8 mm; p less than 0.001), and STx-s was positive in 70 (sensitivity 73%), whereas in group A2 there were 44 patients with these values (sensitivity 71%). Among patients in group B no statistically significant difference was found between STx and STx (0.4 +/- 0.6 vs 0.6 +/- 0.7 mm; p = NS), whereas STx-s was positive in three (specificity 92%). Among the 24 patients in group A with false negative results of exercise tests, 15 (62.5%) had a positive STx-s, whereas of the 17 patients in group A2 with false negative results, 10 (58.8%) had a positive STx-s. Among the six patients in group B with false positive exercise test results, the STx-s was positive in two.(ABSTRACT TRUNCATED AT 250 WORDS)