Structural remodeling of large arteries in patients with hypertensive myocardiopathy is correlated to the ventricular geometry and renal dysfunction

Objectives: To study structural and functional parameters of large arteries in hypertensive subjects (sbjs) with different patterns of hypertensive myocardiopathy. Material and Methods: 45 hypertensive sbjs (PA > 140/90 mmHg or under treatment) were evaluated and hypertensive myocardiopathy was defined by left ventricular hypertrophy (LVH) (LVMi >125 g/m²) and/or systolic dysfunction (SD) (FE < 0.50) at the echocardiogram and divided into2 groups: 1) LVH without SD, 16 sbjs; 2) LVH with DS, 18 sbjs. Data was compared to 11 hypertensive sbjs without LVH or SD. Arterial parameters (intimal-medial thickness-IMT, internaldiameter, distensibility) were assessed at the right carotid by a high-resolution “echo-tracking”equipment and the aortic stiffness was assessed through carotid-femoral pulse wave velocity(PWV) by Complior method. Results: The patients of the group LVH with SD showed a larger carotid diameter (8,02 ± 0,88mm) and a larger IMT (0,88 ± 0,21mm) than those from the control group (7,04 ± 0,73mm e 0,68 ± 0,13mm)(p < 0.01). The sbjs from the LVH without SDgroup showed no differences among the other groups. The PWV and the carotid distensibility were similar among the 3 groups. At multivariate analysis, the IMT was significatively correlated to the LVMi (r = 0,44, p < 0,005), while the carotid diameter was correlated to age and serumcreatinine (r = 0.54). Conclusion: In hypertensive subjects with LVH and systolic dysfunction there is a structural remodeling in large arteries. This remodeling is correlated to ventricular geometry and renal failure, without alterations in vascular function.Objetivo: Estudar parâmetros funcionais e estruturais de grandes artérias em pacientes hipertensos com diferentes graus de miocardiopatia hipertensiva. Material e métodos:Foram estudados 45 pacientes hipertensos (PA > 140/90mmHg ou em tratamento) e miocardiopatia hipertensiva definida por hipertrofia ventricular esquerda (HVE) (IMVE > 125g/m²) e/ou disfunção sistólica (DS) (FE < 0,50) ao ecocardiograma divididos em 2 grupos: 1)HVE sem DS, 16 pacientes; 2) HVE com DS, 18 pacientes. Dados foram comparados a 11pacientes hipertensos sem HVE ou DS. Parâmetros arteriais (espessura intima-medial-EIM,diâmetro interno, distensibilidade) foram avaliados em artéria carótida direita por equipamento“echo-tracking” e a rigidez aórtica pela medida da velocidade de onda de pulso (VOP) carótidofemoral pelo Complior. Resultados: Os pacientes do grupo HVE com DS apresentaram maior diâmetro de carótida (8,02 ± 0,88mm) e maior EIM (0,88 ± 0,21mm) que os pacientes do grupo controle (7,04 ± 0,73mm e 6,8 ± 0,13mm, p < 0.01), e os pacientes do grupo HVE semDS não apresentaram diferenças em relação aos demais grupos. A VOP e a distensibilidade de carótida foram similares nos 3 grupos de pacientes. Na análise multivariada, a EIM secorrelacionou significativamente com o IMVE (r = 0,44, p < 0,005), enquanto o diâmetro de carótida se correlacionou com a idade e à creatinina sérica (r = 0.54). Conclusão: Em hipertensos com hipertrofia ventricular e disfunção ventricular sistólica há um remodelamento estrutural de grandes artérias. Este remodelamento é relacionado à geometria ventricular e à disfunção renal, sem modificações da função vascular

Arterial stiffness and atrial fibrillation: A review

Arterial stiffness has been investigated as part of the physiopathology of arterial hypertension since the 1970s. Its role in increasing the “pulsatile load” imposed over the Left Ventricle (LV) has been intensely studied recently and has helped in understanding the mechanisms of Atrial Fibrillation (AF) in hypertensive patients. This paper aims to review the main evidence on this issue and establish possible mechanisms involved in the development of AF in patients with arterial stiffness. A PubMed search was performed, and selected articles were searched for references focusing on this topic. In the long term, lower blood pressure levels allow for arterial wall remodeling, leading to a lower stiffness index. To this day, however, there are no available treatments that directly promote the lowering of arterial wall stiffness. Most classes of anti-hypertensive drugs ‒ with stronger evidence for beta-blockers and diuretics ‒ could be effective in reducing arterial stiffness. There is strong evidence demonstrating an association between arterial stiffness and AF. New studies focusing on arterial stiffness and pre-fibrillatory stages would strengthen this causality relation

Glomerular Filtration Rate Measured by 51Cr-EDTA Clearance: Evaluation of Captopril-Induced Changes in Hypertensive Patients with and without Renal Artery Stenosis

INTRODUCTION: Renal artery stenosis can lead to renovascular hypertension; however, the detection of stenosis alone does not guarantee the presence of renovascular hypertension. Renovascular hypertension depends on activation of the renin-angiotensin system, which can be detected by functional tests such as captopril renal scintigraphy. A method that allows direct measurement of the baseline and post-captopril glomerular filtration rate using chromium-51 labeled ethylenediamine tetraacetic acid (51Cr-EDTA) could add valuable information to the investigation of hypertensive patients with renal artery stenosis. The purposes of this study were to create a protocol to measure the baseline and post-captopril glomerular filtration rate using 51Cr-EDTA, and to verify whether changes in the glomerular filtration rate permit differentiation between hypertensive patients with and without renal artery stenosis. METHODS: This prospective study included 41 consecutive patients with poorly controlled severe hypertension. All patients had undergone a radiological investigation of renal artery stenosis within the month prior to their inclusion. The patients were divided into two groups: patients with (n=21) and without renal artery stenosis, (n=20). In vitro glomerular filtration rate analysis (51Cr-EDTA) and 99mTc-DMSA scintigraphy were performed before and after captopril administration in all patients. RESULTS: The mean baseline glomerular filtration rate was 48.6±21.8 ml/kg/1.73 m² in the group wuth renal artery stenosis, which was significantly lower than the GFR of 65.1±28.7 ml/kg/1.73m² in the group without renal artery stenosis (p=0.04). Captopril induced a significant reduction of the glomerular filtration rate in the group with renal artery stenosis (to 32.6±14.8 ml/kg/1.73m², p=0.001) and an insignificant change in the group without RAS (to 62.2±23.6 ml/kg/1.73m², p=0.68). Scintigraphy with technetium-99m dimercapto-succinic acid (DMSA) did not show significant differences in differential renal function from baseline to post-captopril images in either group. CONCLUSIONS: Captopril induced a decrease in the GFR that could be quantitatively measured with 51Cr-EDTA. The reduction is more pronounced in hypertensive patients with RAS

Intermittent claudication and severe renal artery stenosis are independently associated in hypertensive patients referred for renal arteriography

OBJECTIVE: The purpose of this study was to evaluate the association between the presence of clinical symptoms of peripheral artery disease and severe renal artery stenosis in patients referred for renal angiography. METHOD: We included 82 patients with clinical suspicion of renovascular hypertension and performed an imaging investigation (renal Doppler ultrasound and/or renal scintigraphy) for possible renal artery stenosis. All patients underwent renal arteriography and were examined for peripheral artery disease based on the presence of intermittent claudication and ankle-brachial index test results. Severe renal artery stenosis was defined as a lesion causing 70% obstruction. RESULTS: Severe renal artery stenosis was present in 32 of 82 (39%) patients. Patients with severe renal artery stenosis were older (63±12 vs 56±12 years, p=0.006), had more intermittent claudication (55 vs 45%, p=0.027), and had a greater prevalence of an ankle-brachial inde

Severity of sleep apnea impairs adipose tissue insulin sensitivity in individuals with obesity and newly diagnosed obstructive sleep apnea

IntroductionObstructive sleep apnea (OSA) is a common sleep disorder associated with increased risk for the development of type 2 diabetes. While studies have examined the effects of sleep on whole-body insulin sensitivity, little is known about the effects of sleep on adipose tissue insulin sensitivity in patients with OSA. We analyzed if the severity of OSA, measured by apnea-hypopnea index (AHI), is associated with adipose tissue insulin sensitivity.MethodsWe examined the relationship between sleep parameters and adipose tissue insulin sensitivity in non-diabetic participants with obesity and newly diagnosed OSA who underwent overnight polysomnography and a 2 h oral glucose tolerance test during which circulating free fatty acids were measured. In total, 16 non-diabetic participants with obesity and newly diagnosed OSA (sex, 81.3% males; mean age, 50.9 ± 6.7 y; BMI, 36.5 ± 2.9 kg/m2; AHI, 43 ± 20 events/h) were included in the analysis.ResultsIn our study participants, AHI is inversely associated with free-fatty acid suppression during oral glucose challenge (R = −0.764, p = 0.001). This relationship persisted even after statistical adjustment for age (R = −0.769, p = 0.001), body mass index (R = −0.733, p = 0.002), waist-to-hip ratio (R = −0.741, p = 0.004), or percent body fat mass (R = −0.0529, p = 0.041). Furthermore, whole-body insulin sensitivity as determined by the Matsuda index was associated with percent REM sleep (R = 0.552, p = 0.027) but not AHI (R = −0.119, p = 0.660).ConclusionIn non-diabetic patients with OSA, the severity of sleep apnea is associated with adipose tissue insulin sensitivity but not whole-body insulin sensitivity. The impairments in adipose tissue insulin sensitivity may contribute to the development of type 2 diabetes

Distances walked in the six-minute walk test: suggestion of defining characteristic for the nursing diagnosis Ineffective Peripheral Tissue Perfusion

Distâncias percorridas em testes de marcha são importantes marcadores funcionais, porém, não são aceitos como características definidoras de Perfusão Tissular Periférica Ineficaz. Os objetivos foram verificar as distâncias percorridas no teste de caminhada de seis minutos, por participantes com e sem esse diagnóstico de enfermagem, e se tais medidas podem ser consideradas características definidoras desse fenômeno. A amostra foi composta por sujeitos com (grupo A, n=65) e sem (grupo B, n=17) Perfusão Tissular Periférica Ineficaz, avaliados quanto ao exame físico, à função vascular periférica e à capacidade funcional. Os participantes do grupo A apresentaram pior função vascular e capacidade funcional do que os do grupo B. Verificou-se que a distância percorrida livre de dor foi preditiva para a ocorrência do diagnóstico de enfermagem. Os resultados deste estudo são importantes para o refinamento desse diagnóstico. Conclui-se que as distâncias percorridas no teste de caminhada de seis minutos podem ser características definidoras de Perfusão Tissular Periférica Ineficaz.Las distancias en pruebas de marcha son importantes marcadores funcionales, pero no son aceptados como características de definición de la Perfusión Tisular Periférica Inefectiva. Los objetivos fueron determinar las distancias recorridas en la prueba de caminata de los seis minutos por los participantes con e sin el diagnóstico de enfermería y si esas medidas se pueden considerar características de definición de este fenómeno. Los participantes con (grupo A, n=65) y sin (grupo B, n=17) el diagnóstico fueron evaluados mediante examen físico, función vascular periférica y capacidad funcional. Los participantes del grupo A ha presentado peor función vascular y desempeño en la prueba de marcha do que aquellos del grupo B. La distancia recorrida libre de dolor fue predictiva del diagnóstico de enfermería. Los resultados de este estudio pueden contribuir para el refinamiento de este diagnóstico. Las distancias recorridas en la prueba de marcha se pueden considerar características de definición de este diagnóstico.Distances walked in walking tests are important functional markers, although they are not accepted as defining characteristics of Ineffective Peripheral Tissue Perfusion. The aims of this study were to verify the distances participants with and without this nursing diagnosis walked in the six-minute walk test and if these measures may be considered defining characteristics of this phenomenon. Participants with (group A; n=65) and without (group B; n=17) this nursing diagnosis were evaluated regarding physical examination, vascular function and functional capacity. Participants of group A seemed to have worse vascular function and functional capacity compared with those of group B. Pain-free travelled distance was predictive of the nursing diagnosis. These results are important for the refinement of this diagnosis. In conclusion, this study provides evidences that the distances walked in the six-minute walk test may be considered defining characteristics of Ineffective Peripheral Tissue Perfusion

Pressão arterial e indicadores de função vascular de corredores com diferentes níveis de desempenho no teste cardiopulmonar

O objetivo deste estudo foi comparar os valores de pressão arterial sistólica e diastólica periférica (PASp e PADp) e central (PASc e PADc) e o índice de função vascular em corredores de rua de diferentes desempenhos. A amostra foi composta por 48 participantes, 20-40 anos, 32 corredores de rua com diferentes níveis de desempenho, e 16 indivíduos sedentários. Avaliou-se a aptidão cardiorrespiratória e a velocidade máxima de corrida, através do teste cardiopulmonar de exercício (TCPE). A pressão central e periférica foi investigada por tonometria de aplanação e a velocidade da onda de pulso (VOP) pelo equipamento Complior. O ecocardiograma foi usado para avaliar a estrutura cardíaca. ANOVA de uma via foi utilizada considerando p <0,05. A ANCOVA foi usada para ajustar fatores de confusão. Corredores com desempenho superior apresentaram menor PASp que os demais grupos (120±7 vs 127±8 vs 130 ±8 mmHg). A duração da diástole foi maior nos corredores com desempenho superior (845±92 ms) em relação aos corredores com desempenho inferior (786±174 ms e controle (641±128 ms). O índice de amplificação (AI) não foi diferente entre os grupos (109 ± 21%; 109 ± 11%; 110 ± 1%) assim como a VOP (7,1 ± 1ms. 7,6 ± 1.1ms. 8,0 ± 1,1ms). Corredores com desempenho superior apresentaram maior massa do ventrículo esquerdo (MVE g/m²) em relação aos demais (116±12 g/m² vs 100±18 g/m² vs 86±13 g/m²), e menor débito cardíaco em comparação ao grupo controle (4,8±1 l/ min. vs 6,0±1 l/min). Portanto corredores com desempenho superior apresentaram maior MVE g/m², menor débito cardíaco, menor PASc e PASp, e melhor duração da diástole que seus pares sedentários, mas não apresentam melhores indicadores de função vascular na mesma comparação

Idade, tabagismo, hipertensão arterial, altura e sexo feminino são determinantes de envelhecimento vascular avaliados pela segunda derivada da fotopletismografia digital

OBJETIVO: Avaliar os fatores de risco cardiovascular (RCV) determinantes dos índices de função arterial obtidos pela segunda derivada da fotopletismografia digital (SDPTG) em uma população de funcionários de uma instituição de ensino privado da cidade de São Paulo. MÉTODOS: Foram obtidos dados antropométricos e clínicos, medidas de pressão arterial (PA) com aparelho automático Microlife em 238 indivíduos de 23 a 72 anos (média 40,1 ± 9), 105 mulheres / 133 homens. A SDPTG foi registrada automaticamente pelo dispositivo Dynapulse, com o sensor localizado no 2º dígito da mão direita; da SDPTG obtivemos ondas a, b, c e d na sístole e e na diástole, e foram calculados as relações b/a, d/a e o índice de envelhecimento vascular (AGI) = [(b-c-d-e)/a], respectivamente, marcadores de distensibilidade arterial, intensidade das ondas de reflexão e envelhecimento vascular. A idade vascular (IVS) foi estimada a partir de dados comparativos do AGI obtido e valores de uma população normal. Os indivíduos foram considerados com índices vasculares piores, se tivessem valores superiores à média mais o desvio padrão. Hipertensão arterial (HA) foi definida como PA>140x90mmHg ao exame ou referida pelo paciente. RESULTADOS: Na análise de regressão logística, a possibilidade de AGI elevado relacionou-se positiva e independentemente com idade > 50anos (Odds Ratio-OR = 17,24), tabagismo (O.R. = 3,82) e sexo feminino (O.R. = 6,05); menor relação b/a com idade > 50 anos (O.R. = 6,37), enquanto a relação d/a relacionou-se com sexo feminino (O.R. = 3,90). A maior IVS relaciona-se à idade (OR = 8,85), sexo feminino (OR= 4,0) e HAS (OR = 2,42). A análise multivariada mostrou que altura se relaciona com AGI (Mean Square – MS = 0,701) e D/A (MS = 0,279), enquanto que este último parâmetro também é influenciado pela PA diastólica (MS = 0,168) e PA média. CONCLUSÕES: Os índices vasculares obtidos pela SDPTG têm influência dos principais fatores de RCV e outros fatores a serem considerados em sua análise. A distensibilidade arterial (b/a) é relacionada à idade enquanto a intensidade da reflexão das ondas de pulso (d/a) tem influência do sexo feminino, altura e PA. O envelhecimento vascular sofre influências da HA, do tabagismo, idade e altura.Objectives: To evaluate the cardiovascular risk (CR) determinants of the arterial function indices obtained by the second derivative photopletysmogram (SDPTG) in a agent population from a private teaching institution of São Paulo. Methods: antropometric and clinical data, arterial pressure (AP) by na automatic device Microlife were obtained from 238 individuals from 28 to 72 years (mean 40,1 ± 9), 105 women / 133 men. The SDPTG was automatically registered by the Dynapulse device through its sensor placed on the 2nd finger of the right hand; from SDPTG were obtained the a, b, c and e waves during the systole and the e wave during diastole and were calculated the b/a, d/a and the aging index (AGI) = [(b-c-d-e)/a], respectively, markers of arterial distensibility, wave reflection intensity and vascular aging. The vascular age (IVS) was estimated from comparison of the AGI data obtained and values of a normal population. The individuals were considered as worse vascular indices if their analysed values were higher than mean plus standard deviation. Arterial hypertension (AH) was defined as AP > 140x90mmHg at the examination or referred by the patient. Results: at the logistic regression, the possibility of high AGI was positively and independently related to age > 50 years (Odds Ratio-OR = 17,24), tabagism (O.R. = 3,82) and feminine sex (O.R. = 6,05); low b/a relation with age> 50 years (O.R. = 6,37), while high d/a was related to feminine sex (O.R. = 3,90). Higher IVS was related to age (OR = 8,85), feminine sex (OR = 4,0), and AH (OR = 2,42). At multivariate analysis, height was related to AGI (Mean Square – MS = 0,701) and D/A (MS = 0,279), while this last parameter was also influenced by diastolic AP (MS = 0,168) and mean AP. Conclusions: the vascular indices obtained by SDPTG are influenced by main CR and other factors to be considered at their analysis. The arterial distensibility (b/a) is related to age, while the intensity of pulse wave reflection to feminine Sex, height and AP. Vascular aging is influenced by AH, tabagism and height