Pulse pressure and age at menopause

BACKGROUND: The objective of this study was to study the association of early age at menopause with pulse pressure (PP), a marker of arterial stiffness, and PP change. METHODS: The effect of natural menopause was studied in 2484 women from the Atherosclerosis Risk in Communities (ARIC) Study who had not used hormone replacement therapy and who had not had a hysterectomy. The cross-sectional association of age with PP was evaluated in the entire cohort. The cross-sectional association of recalled age at menopause was evaluated in the 1688 women who were postmenopausal at baseline. PP change over 6 years was assessed in relation to menopausal age separately in women who were postmenopausal at baseline and in those whose menopause occurred during the 6-year interval. RESULTS: Chronological age was strongly and positively associated with PP in cross-sectional analyses, but not independently associated with PP change. While menopausal age was not associated cross-sectionally with PP, early age at menopause (age<45) was significantly and independently associated with a slightly larger increase in PP (8.4, 95% CI 7.0–9.8) than later menopause (6.5, 95% CI 5.8;7.2). However, among normotensive women the difference was not statistically significant (p = 0.07, 6.1 vs 4.7). CONCLUSIONS: Early age at menopause may be related to a greater increase in arterial stiffness, but the effect appears to be small and further evidence is needed

LEFT-VENTRICULAR AND AORTIC ROOT STRUCTURE AND FUNCTION CHANGES WITH BETA-BLOCKER ANTIHYPERTENSIVE THERAPY - A ONE-YEAR DOUBLE-BLIND-STUDY OF CELIPROLOL AND METOPROLOL

Using echocardiographic and Doppler methodology, we evaluated the effects of celiprolol 200-400 mg/day and metoprolol 100-200 mg/day, given for one year, on haemodynamics, left ventricular structure and function, and aortic root distensibility in 40 hypertensive patients. Total peripheral resistance was unchanged with metoprolol (-1.7%) but decreased with celiprolol (-11.2%), a significant difference between the two treatments (P = 0.01). Left ventricular mass index was reduced by 5.7% in those patients receiving metoprolol and by 11.8% in those receiving celiprolol (P &lt; 0.001). Cardiac index fell significantly with metoprolol and marginally with celiprolol (-13.9% vs. 5.9%, P = 0.003). Left ventricular diastolic function - as shown by the transmitral early to late peak filling velocity ratio - was not altered with metoprolol, but a significant increase (17%, P = 0.2) was seen with celiprolol, Both metoprolol and celiprolol increased aortic root distensibility, with celiprolol having a significantly greater effect (80% vs. 30%, P &lt; 0.01). We conclude that, in comparison to metoprolol, long term antihypertensive therapy with celiprolol improves left ventricular diastolic and aortic root function, whilst reducing total peripheral resistance and left ventricular hypertrophy

INDEPENDENCE OF BLOOD-PRESSURE RESPONSE TO EXERCISE AND AMBULATORY BLOOD-PRESSURE VALUES IN ESSENTIAL-HYPERTENSION

Ambulatory blood pressure (ABP) recordings over 24 h are used in the diagnosis and evaluation of arterial hypertension severity, while blood pressure response to exercise may unmask hypertensive patients. To evaluate the relationship of the two methods, 40 medication-free patients with mild and moderate essential hypertension underwent symptom-limited treadmill stress test (TST) within 48 h of ABP. TST time, blood pressure increase, decrease, mode of increase and decrease, were independent of ABP systolic (SBP) and diastolic blood pressure (DBP) over 24 h, daytime and nighttime (p = NS). SBP fall immediately postexercise were independent of ABP data. TST-achieved heart rate was related to both 24-hour SBP (r = -0.65, p = 0.00005) and DBP (r = -0.57, p = 0.0002) in both day (r = -0.65, p = 0.00001 and r = -0.57, p 0.0002) and night (r = -0.56, p = 0.0002 and r = -0.47, p = 0.003) time periods. Thus, patients with achieved heart rate &lt;100% (n = 15) had higher 24-hour SBP (144 vs. 130 mm Hg, p = 0.0007) and DBP (93 vs. 86 mm Hg, p 0.007), day and night. It is concluded that there is no overlap of diagnostic information using blood pressure values in TST or ABP, although achieved heart rate in exercise is inversely related to hypertension severity

Effects of menopause an aortic root function in hypertensive women

Objectives. This study sought to determine whether the natural decrease in sex hormones that occurs during menopause in hypertensive women plays a role in aortic root stiffness. Background. The effect of menopause-induced sex hormone deprivation on aortic root function is not known; however, it is of special interest in hypertensive subjects, whose aortic elastic properties are already compromized. Methods. Eighteen women with essential hypertension were followed-up for 3 years, during which time they went through menopause (group A) and were compared with 22 age-matched hypertensive women with normal menses (group B) and 20 hypertensive men (group C). Blind echocardiographic tracings and simultaneous blood pressure measurements were obtained after at least 30 medication-free days, both at baseline and 3.5 years later. Results. Aortic root function tended to be aggravated in both groups B and C, but not significantly so, with no between-group differences (p = NS), whereas it deteriorated in group A, Thus, in menopausal hypertensive subjects, aortic root systolodiastolic percent change decreased (from 6.7% to 4.9%, p &lt; 0.0001 [p = 0.002 vs, group B; p = 0.006 vs. group C]); cross-sectional compliance decreased (from 18 to 13 cm(2)/mm Hg, p &lt; 0.0001 [p = 0.002 vs. group B; p = 0.03 vs. group C]); Peterson’s elastic modulus increased (from 1.2 to 1.9 dynes/cm(2), p = 0.0006 [p = 0.003 vs. group B; p = 0.005 vs. group C]); aortic stiffness index increased (from 7.0 to 10.8, p = 0.0008 [p = 0.004 vs. group B; p = 0.007 vs. group C]); and aortic root distensibility decreased (from 1.8 to 1.2 dynes/cm(2), p &lt; 0.0001 [p = 0.0003 vs. group B; p = 0.007 vs, group C]). Serum lipids did not change significantly in any group (p = NS). Conclusions. In hypertensive women, the effect of menopause on the elastic properties of the aortic root is abrupt and devastating

REGRESSION OF LEFT-VENTRICULAR HYPERTROPHY WITH ISRADIPINE ANTIHYPERTENSIVE THERAPY

To assess left ventricular (LV) structural and functional changes, 45 hypertensive patients were studied by echocardiography after 2 weeks of placebo and 6 months of isradipine monotherapy. Although LV cavity size did not change, LV wall thickness decreased dramatically (P &lt; .0001), producing a significant decrease in LV mass index (from 158 g/m2 to 136 g/m2; P &lt; .0001). In addition, LV fractional shortening (FS) did not change (1.2%; P = NS) whereas the cardiac index increased (6.4%; P = .0007) due to a modest tachycardia accompanied by a reduction in total peripheral resistance (-22.1 %; P &lt; .0001). The magnitude of the reduction of LV mass was related to the degree of FS increase (r = -0.70; P &lt; .0001), an indication of beneficial LV remodeling. It can be concluded that isradipine antihypertensive therapy leads to regression of LV hypertrophy without depression of LV pump function

DYSLIPIDEMIC EFFECTS OF CIGARETTE-SMOKING ON BETA-BLOCKER-INDUCED SERUM-LIPID CHANGES IN SYSTEMIC HYPERTENSION

To assess the effects of beta-blockers on lipids and apolipoproteins in cigarette smokers and non-smokers, 330 patients with systemic hypertension received 1 month of placebo and 6 months of beta-blocker monotherapy. Serum total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and apolipoproteins A1 and B were measured. Total cholesterol increased with propranolol (smokers vs nonsmokers, 8 vs 2%); increased for smokers and decreased for nonsmokers with atenolol (8 vs -3%), metoprolol (6 vs - 1%) and pindolol (7 vs -6%); and decreased for both groups with celiprolol (-3 vs -10%). HDL cholesterol decreased with propranolol (smokers vs nonsmokers, -8 vs -18%), atenolol (-7 vs -2%) and metoprolol (-12 vs -1%); increased for smokers and decreased for nonsmokers with pindolol (11 vs -2%); and increased for both groups with celiprolol (5 vs 6%). Similar trends were observed with LDL cholesterol and the total/HDL cholesterol ratio. It is concluded that early noncardioselective beta-blockers such as propanolol have significant dyslipidemic effects in both smokers and nonsmokers. Cardioselective drugs such as atenolol and metoprolol, or drugs with partial agonist activity such as pindolol, have variable effects. Celiprolol, a new, highly cardioselective beta-1 blocker with partial beta-2 agonist activity and vasodilatory properties, has favorable effects on lipids and minimizes the dyslipidemic effects associated with smoking