The association of A1166C gene polymorphism of angiotensin receptors with the parameters of central pulse wave in normotensive persons and patients with hypertension

Introduction. Available information about the impact of the polymorphic structure of type 1 angiotensin receptor (ATR1) gene on the central pulse wave is scarce and contradictory. The aim of the study was to establish a possible association of A1166C polymorphism of ATR1 gene with the pulse wave parameters obtained by applanation tonometry. Material and metods. We examined male and female persons aged 25 to 76 years. They were divided into two groups: the basic consisting of 150 hypertensive patients and the control group presented by 128 individuals with normal blood pressure. In addition to the general clinical exam three-fold measurements of systolic and diastolic blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP], respectively) with the automatic blood pressure monitor Omron M3 were provided mandatory. The structure of the polymorphic receptor gene ATR1 was defined in all participants by polymerase chain reaction on the thermocycler PHC (Techne, UK). Pulse wave analysis was provided with applanation tonometry. For this purpose we used Sphygmocor XCEL equipment (AtCor Medical, Australia). Results. Analysis of mean SBP and DBP in dependence on ATR1 genotype and existence of arterial hypertension showed that there was a tendency to rise with increasing number of C alleles, but statistical significance of the trend had been confirmed by ANOVA only for SBP in patients with hypertension. Also it was shown a significant difference in central diastolic blood pressure (CDBP) and pulse pressure augmentation (PPA) in hypertensive patients compared with normotensive. It was found a tendency to decrease CDBP and PPA with increasing number of C alleles. The subjects of the control group demonstrated the same trend of PPA as in the group of hypertensive patients. Conclusion. Thus, we established the association between decrease of PPA and increase of C alleles number in the ATR1 gene

Implementation of the “Vascular Age Index” for the interpretation of applanation tonometry

Background The application of pulse wave analysis in clinical practice is significantly limited due to the difficulties with evaluation of obtained data. The aim of the study was to propose the new index named “Vascular Age Index” for the improvement and simplification of pulse wave analysis. Material and methods We examined male and female persons aged from 25 to 76. 128 normotensive participants (the control group, CG) and 150 patients with essential hypertension (EH) were subdivided into subgroups of 25–44, 45–64 and 65 or more years. Each of them included 50 patients. The exception was the oldest subgroup of CG consisting of 28 persons. All participants underwent office blood pressure measurement by automatic blood pressure monitor “Omron 3” and pulse wave analysis carried out with «Sphygmocor XCEL» equipment (AtCor Medical, Australia). Besides common parameters of pulse wave such as augmentation index (AIx) and pulse wave velocity (PWV) the new indicator — “Vascular Age Index” was determined in all persons by the formula: VAI (year) = PWV × AIx ÷ 20. Results All studied parameters of pulse wave showed strong relationship with age, but the relationship of VAI with age was superior in its strength and significance. It was especially strong (r = 0.90; p < 0.001) in normotensive patients. The values of VAI obtained in subjects of the control group were approaching to the calendar age, and in patients with hypertension — often exceeded it. Conclusions Our data confirmed the relationship between AIx and PWV on the one hand, and age and blood pressure on the other. It was shown that in patients of 25–44 years pathological changes of central pulse wave parameters could serve as an additional argument for the diagnosis of hypertension. VAI significantly simplifies the interpretation of central pulse wave study and increases the compliance. Moreover, the diagnostic accuracy of VAI application is rather high. Thus, the implementation of VAI in the routine practice may be recommended

The inappropriateness of left ventricular mass and echoreflectivity in males with essential hypertension and different CYP11B2 gene polymorphisms

Background. The CYP11B2 gene as the main controller of aldosterone plasma activity is likely to be responsible as for the BP level as for the expression of different traits of hypertensive cardiac remodeling such as increased left ventricular mass and myocardial fibrosis. The main objective of our study was to define the differences in myocardial remodeling depending on CYP11B2 gene polymorphism. It was shown that some special techniques of echocardiography such as the assessment of inappropriate left ventricular mass and myocardial echoreflectivity proved additional information in patients with hypertensive heart disease. That’s why these techniques were used for a more precise assessment of hypertensive cardiac remodeling. Material and methods. Our study involved 150 males aged 45–60 years. They were divided into three groups: Group 1–50 patients with normal BP without any echocardiographic abnormalities, Group 2–52 patients with essential hypertension without left ventricular hypertrophy, and Group 3–48 patients with essential hypertension and left ventricular hypertrophy. Results. It was found that in patients with inappropriate LVM the prevalence of CC genotype was almost twice higher than among those with appropriate LVM. On the other hand, hypertensive patients with CC genotype and LVH demonstrated higher echoreflectivity parameters. Conclusions. We assume that CC polymorphism of CYP11B2 may be an indicator of more expressed signs of hypertensive cardiac remodeling, in particular myocardial hypertrophy and myocardial fibrosis, in males with essential hypertension

Characteristics of changes and clinical and instrumental predictors of the severity of structural remodelling of carotid arteries in hypertensive patients

Background. Mechanisms of activation of the process of vascular wall remodelling in patients affected by arterial hypertension have not been studied in depth and require clarification. Materials and methods. The study included 381 patients with hypertension — 212 men and 169 women of the average age 53.0 (47; 60) years. The structural-functional vessel status was determined by the method of duplex scanning and colour duplex mapping of blood flow with the Logiq 500 MO apparatus (GE, USA). Statistical analyses were made using Microsoft Excel software kit, Statistica for Windows 6.0. Results. The patients with hypertension presented some left-right asymmetry of remodelling extracranial carotid arteries. Unlike the impact of remodelling of the right carotid artery, the most essential effect on the left carotid artery was the impact of daytime pulse arterial pressure and variability of the nocturnal systolic arterial pressure (the strength of impact 25.0 and 13.9%, respectively. The processes of remodelling of the right carotid artery are more sensible to the impact of high values of nocturnal diastolic arterial pressure (the strength of impact 16.4%). The beginning of some brain complication is associated with the significant increase in atherosclerotic affection not only of the left, but also of the right carotid artery. Conclusions. Remarkable remodelling of the right carotid artery is often associated with the severity of the disease and to some extent reflects the severity of the flow of the disease and can be regarded as an additional unfavourable feature

Peculiarities Of Changes Of Apelin-13 Concentration In Patients With Essential Hypertension And Extrasystole

Introduction. Hypertension is one of the leading causes of disability and mortality among cardiovascular diseases, so today new metabolic markers of cardiovascular risk are being actively studied. One of them is apelin-13. Objective: to assess the concentration of apelin-13 in patients with essential hypertension and frequent extrasystole. Materials and methods. 156 patients with stage II essential hypertension were examined. 124 of them had frequent symptomatic extrasystoles, 32 patients had no arrhythmias and were considered to the comparison group. 30 practically healthy normotensive persons were considered to the control group. All patients underwent a complete clinical and anthropometric examination, blood pressure measurement, automatic daily blood pressure monitoring, daily electrocardiogram monitoring, echocardiography and the assessment of serum apelin-13 concentration. Results. It was found that the concentration of apelin-13 in patients with hypertension was significantly lower compared to the control group. Moreover, the average content of apelin-13 was significantly (p = 0.02) lower in patients with extrasystole than in those without arrhythmia. The lowest concentration of apelin-13 was noticed in patients with ventricular arrhythmias. Conclusion. The results confirm the existing assumptions about the protective role of apelin-13 in preventing the progression of cardiovascular diseases due to counteracting the increase in blood pressure and life-threatening arrhythmias. Keywords: essential arterial hypertension, apelin-13, extrasystole, smoking, obesity

Charakterystyka zmian oraz klinicznych i instrumentalnych czynników prognostycznych ciężkości przebudowy strukturalnej tętnic szyjnych u pacjentów z nadciśnieniem

Wstęp. Mechanizmy aktywacji procesu przebudowy ścian naczyń u pacjentów chorujących na nadciśnienie tętnicze nie były dogłębnie zbadane i wymagają wyjaśnienia. Materiał i metody. Badaniem objęto 381 pacjentów z nadciśnieniem tętniczym — 212 mężczyzn i 169 kobiet w średnim wieku 53,0 (47; 60) lat. Stan strukturalno- funkcjonalny naczyń określono, stosując metodę badania za pomocą skanowania dupleksowego oraz kolorowego mapowania dupleksowego przepływu krwi za pomocą urządzenia Logiq 500 MO (GE, USA). Wykonano analizy statystyczne za pomocą zestawu oprogramowania Microsoft Excel, Statistica dla Windows 6.0. Wyniki. Pacjenci z nadciśnieniem tętniczym wykazywali pewną asymetrię lewo- i prawostronną przebudowy tętnic szyjnych zewnątrzczaszkowych. Inaczej niż w przypadku przebudowy prawej tętnicy szyjnej, na lewą tętnicę szyjną wpływały wartość ciśnienia tętniczego pulsu dziennego oraz zmienność nocnego skurczowego ciśnienia tętniczego (siła oddziaływania odpowiednio 25,0 i 13,9%). Procesy przebudowy prawej tętnicy szyjnej są bardziej wrażliwe na wpływ wysokich wartości nocnego rozkurczowego ciśnienia tętniczego (siła oddziaływania 16,4%). Początek pewnych komplikacji związanych z mózgiem wiąże się ze znacznym wzrostem choroby miażdżycowej nie tylko lewej, ale także prawej tętnicy szyjnej. Wnioski. Znaczna przebudowa prawej tętnicy szyjnej jest często związana z ciężkością choroby i do pewnego stopnia odzwierciedla ciężkość przebiegu choroby i może być postrzegana jako dodatkowa niekorzystna cecha