Diurnal blood pressure profile in patients with hypertension and coronary artery disease confirmed by angiography

Wstęp Nadciśnienie tętnicze jest uznanym, klasycznym czynnikiem ryzyka choroby wieńcowej. Ambulatoryjny pomiar ciśnienia tętniczego krwi (ABPM, ambulatory blood pressure monitoring) ma udowodnione znaczenie w oszacowaniu ryzyka zdarzeń sercowo-naczyniowych u pacjentów z rozpoznanym nadciśnieniem tętniczym. Celem pracy była analiza dobowego profilu ciśnienia tętniczego krwi (BP, blood pressure) w grupie pacjentów ze stabilną, potwierdzoną koronarograficznie chorobą wieńcową. Materiał i metody Badaniem objęto grupę 279 pacjentów przyjętych do kliniki w celu wykonania planowej koronarografii. Badaną grupę podzielono na dwie podgrupy: A - z istotnymi hemodynamicznie zmianami tętnic wieńcowych i B - bez istotnych zwężeń tętnic wieńcowych. Dwa tygodnie po wykonanej koronarografii przeprowadzano pomiar BP metodą tradycyjną oraz ABPM. Dzienne wartości BP były rejestrowane co 20 minut w godzinach 6.00-22.00, nocne natomiast co 30 minut w godzinach 22.00-6.00. Jako non-dippers określono pacjentów, u których spadek średniej wartości BP w nocy nie przekraczał 10% w stosunku do średniej wartości dziennej. Wyniki Statystycznie istotne różnice średnich wartości BP między grupami A i B zaobserwowano jedynie w nocy w zakresie średniego ciśnienia skurczowego (124 &#177; 14 vs. 117 &#177; 14 mm Hg, p < 0,01) oraz rozkurczowego (68 &#177; 9 vs. 65 &#177; 8 mm Hg, p < 0,02). W grupie A odnotowano większy odsetek non-dippers w porównaniu z grupą B (72% vs. 54%, p < 0,05). Prawidłowe nocne wartości BP osiągnęło znacząco mniej pacjentów w podgrupie A w porównaniu z podgrupą B (36% vs. 51, p < 0,02). Średnia wartość rozkurczowego ciśnienia tętniczego (DBP, dystolic blood pressure) zmierzonego metodą tradycyjną, była statystycznie niższa w podgrupie A niż w podgrupie B (78 &#177; 13 mm Hg vs. 81 &#177; 11 mm Hg, p < 0,05). Wnioski Występowanie istotnych hemodynamicznie zmian w tętnicach wieńcowych ma związek z nieprawidłowym profilem ciśnienia tętniczego. Pomiary w warunkach gabinetu lekarskiego mogą być niewystarczające w podejmowaniu decyzji o terapii hipotensyjnej u chorych z nadciśnieniem tętniczym i współistniejącą chorobą wieńcową.Background Hypertension is a common risk factor of coronary artery disease. Ambulatory blood pressure monitoring (ABPM) is a recognized predictive method of risk evaluation of cardiovascular events in patients with history of hypertension. The aim of present study was the analysis of diurnal blood pressure (BP) profile in patients with coronary artery disease (CAD) confirmed by coronary angiography. Material and methods The study was performed in group of 279 patients who underwent coronary angiography. Enrolled patients were divided into two groups: A group - with significant coronary artery stenosis (stenosis > 70%) (n = 196) and B - without coronary artery stenosis (n = 83). Two weeks after coronary angiography office BP measurement and ABPM were performed. Day records were performed every 20 minutes between 8.00 and 20.00 and night records every 30 minutes between 22.00 and 6.00. Patients with night dip of blood pressure < 10% of day values was classify as non-dippers. Abnormal value of blood pressure was &#8805; 135/80 mm Hg for 24 hour measurement, &#8805; 135/85 mm Hg for day and &#8805; 120/70 mm Hg for night. Results Significant differences between group A and groups B were observed only in night systolic BP (124 &#177; 14 vs. 117 &#177; 14 mm Hg, p < 0,01) and diastolic BP (68 &#177; 9 vs. 65 &#177; 8 mm Hg, p < 0,02). In group A in comparison with group B there were more non-dippers (72% vs. 54%, p < 0,05). In group A less patients reached normal BP values at night than in group B (36% vs. 51, p < 0,02). Mean value of diastolic BP measured in office was lower in group A than in B (78 &#177; 13 mm Hg vs. 81 &#177; 11 mm Hg, p < 0,05). Conclusions CAD can play significant role in disruption of diurnal blood pressure profile. Office BP measurements cannot be sufficient in optimal regulation of BP in patients with CAD

Diurnal blood pressure profile and coronary atherosclerosis extent are related to cardiovascular complications

<p>The aim of this study was to assess the relationship between 24 h blood pressure (BP) profile, extent of significant coronary artery stenosis, confirmed by coronary angiography, and cardiovascular events in patients with coronary artery disease. Coronary angiographies were performed for all included subjects and significant coronary artery stenosis was considered as ≥ 50% stenosis by atherosclerotic plaque. Twenty-four-hour ambulatory BP monitoring was performed. Major advanced cardiovascular events (MACE) included revascularization, cardiovascular mortality, total mortality, acute coronary syndromes and stroke. BP analysis revealed higher night-time systolic blood pressure (SBP) values in patients with three or more significant coronary artery stenoses than in those without significant stenosis (120.7 ± 16.4 vs 116.7 ± 14.3 mmHg, <i>p</i> < 0.001), lower night-time SBP dip in patients with three or more significant coronary artery stenoses than in those without significant stenosis (5.7 ± 3.2 vs 7.4 ± 6.8 mmHg, <i>p</i> < 0.001) and lower night-time diastolic blood pressure dip in patients with three or more significant stenoses than in patients without significant stenosis (9.4 ± 7.4 vs 11.9 ± 7.4 mmHg, <i>p</i> < 0.001). Night-time SBP values, night-time/daytime SBP dip and extent of significant coronary artery stenosis were risk factors for MACE, revascularization and cardiovascular mortality. In conclusion, the study shows that advanced coronary artery disease is related to blunted night-time BP dipping and cardiovascular complications.</p

The Relationship Between Gene Polymorphisms and Dipping Profile in Patients With Coronary Heart Disease

Background: The aim of this study is to report the relationship between certain single-nucleotide polymorphisms (SNPs) and blunted nighttime blood pressure (BP) fall in patients with coronary artery disease confirmed by coronary angiography. Methods: According to the percentage decrease in mean systolic BP (SBP) and diastolic BP (DBP) during the nighttime period, subjects were classified as dippers or nondippers (nighttime relative SBP or DBP decline ≥10% and <10%, respectively). Genetic risk score (GRS18) was constructed to evaluate additive effect of 18 SNPs for nondipping status. Results: In the present study, 1,345 subjects with coronary heart disease (CHD) were included. During follow-up period (median 8.3 years, interquartile range 5.3-9.0 years), there were 245 all-cause deaths (18.2%) including 114 cardiovascular deaths (8.5%). There were significant differences in the number of revascularizations between nondippers SBP and DBP and dippers SBP and DBP (48.0% vs. 36.4%, P < 0.01). SNPs of the genes, MIA3, MRAS, PCSK9, SMG6, and ZC3HC1, were related to a higher risk of nondipping SBP and DBP status. Conclusions: In the present study, polymorphisms of genes related to CHD (MIA3, MRAS, PCSK9, SMG6, and ZC3HC1) were associated with nondipping SBP and DBP profile, and GRS18 was associated with nondipping status. In addition, this profile was related to a higher risk of revascularization

Relationship between selected DNA polymorphisms and coronary artery disease complications

Background Coronary heart disease (CHD) development is complex in origin, with contributions from well-defined lifestyle and not well-determined genetic risk factors. The aim of this study is to report the relationship between certain SNPs and the risk of cardiovascular (CV) complications in patients with CAD confirmed by coronary angiography. Methods In the present study, 1345 subjects with CHD were included. The median follow-up period was 8.6 years. 19 SNPs were investigated for any association with Major Advanced CV Events (MACE), Acute Coronary Syndromes (ACS) and Revascularizations. We modeled the 19 SNPs as a multilocus genetic risk score (GRS19). Results During follow-up period, 245 participants died; 114 due to CV causes. A fatal or non-fatal CV event occurred in 882 participants including 214 ACS, 578 revascularizations and 90 strokes. The alleles of the following SNPs: rs1746048 (CXCL12), rs9818870 (MRAS) and rs17114036 (PPAP2B) were associated with a higher risk of MACE and the alleles of SNPs rs1746048 (CXCL12) and rs1122608 (LDLR) were associated with a higher risk of revascularization. The alleles of rs12190287 (MRAS), rs121902287 (TCF21) and rs2259816 (HNF1a) were associated with a higher risk of ACS. Despite the lack of relationship between significant CAD and GRS19, in the top quartile of GRS19 there was significant relationship between GRS19 and combined endpoint, MACE, ACS, and revascularization. Conclusions Conclusions. The SNPs of CXCL12 and LDLR were associated with risk of revascularization and CXCL12, LPA, MRAS, and PPAP2B were associated with the risk of MACE. GRS19 determines CV complications in CAD patients with the highest genetic risk score values

Związek między częstością rytmu serca i podwójnym iloczynem a insulinoopornością u pacjentów z nadciśnieniem tętniczym i chorobą wieńcową

Background: Elevated values of heart rate (HR) and insulin resistance (IR) reflect enhanced sympathetic nervous system activity and may be connected to the development of coronary artery disease (CAD) and diabetes.Aim: To evaluate the relationship between HR, blood pressure (BP), double product and IR in nondiabetic hypertensive patients with stable CAD.Methods: There were 73 patients included in the study. Ambulatory BP monitoring was recorded in all patients by a Spacelabs 90207 device. Homeostasis model assessment (HOMA-IR) was used to estimate IR. Double product was calculated by multiplying systolic BP and HR.Results: In the study population (mean age 67.1 ± 8.4 years, 52% males) there was a positive correlation between HOMAIR and 24-h double product (r = 0.35, p &lt; 0.01) and body mass index (BMI) (r = 0.45, p &lt; 0.001). The receiver operating characteristic analysis of 24-h double product and BMI as predictive markers of IR did not reveal statistical differences between AUC (0.72 ± 0.09 vs. 0.72 ± 0.08, 24-h double product and BMI, respectively, p = NS). The best cut-off points in predicting IR were 8,978 mm Hg/min for 24-h double product and 33.02 kg/m2 for BMI. There were differences between the non obese (n = 44, mean age 67.9 ± 9.2 years) and obese (n = 29, mean age 65.8 ± 6.9 years) groups in: serum insulin level (7.3 ± 2.3 µU/mL vs. 12.0 ± 7.3 µU/mL, p &lt; 0.01), HOMA-IR (1.8 ± 0.7 µU/mL × mmol/L vs. 3.0 ± 2.0 µU/mL × mmol/L, p &lt; 0.01), and day systolic BP (128.0 ± 10.8 mm Hg vs. 134.1 ± 10.1 mm Hg, p &lt; 0.02).Conclusions: 24-h double product and BMI may be complementary parameters in the prediction of IR in hypertensive nondiabetics with CAD confirmed by percutaneous coronary interventions in history and/or at least one coronary artery stenosis ? 70% in elective coronary angiography.Wstęp: Częstość rytmu serca (HR) oraz insulinooporność są wykładnikami wzmożonej aktywności współczulego układu nerwowego i mogą istotnie wpływać na rozwój choroby wieńcowej i cukrzycy. Cel: Celem badania była ocena zależności między HR, wartościami ciśnienia tętniczego krwi, podwójnego iloczynu a insulinoopornością u pacjentów bez cukrzycy, z nadciśnieniem tętniczym i chorobą wieńcową.Metody: Do badania włączono 73 osób; 24-godzinny pomiar ciśnienia tętniczego wykonano z zastosowaniem aparatów SpacLabs 90207. Ocenę isulinooporności przeprowadzono przy użyciu wskaźnika insulinooporności (HOMA-IR). Podwójny iloczyn wyliczono jako iloczyn wartości skurczowego ciśnienia tętniczego i HR. Wyniki: W badanej grupie (średni wiek 67,1 ± 8,4 roku, 52% mężczyzn) zaobserwowano dodatnią korelację między HOMAIR i 24-godzinną wartością podwójnego iloczynu (r = 0,35; p &lt; 0,01) i wskaźnikiem masy ciała (BMI; r = 0,45; p &lt; 0,001). Analiza ROC 24-godzinnego podwójnego iloczynu i BMI nie wykazała statystycznie istotnej różnicy między AUC (0,72 ± ± 0,09 vs. 0,72 ± 0,08, 24-godzinny podwójny iloczyn i BMI, odpowiednio, p = NS). W analizie ROC insulinooporności punkt odcięcia dla 24-godzinnego podwójnego iloczynu wynosił 8978 mm Hg/min, natomiast dla BMI 33,02 kg/m2. Zaobserwowano również istotne różnice między pacjentami bez otyłości (n = 44, średni wiek 67,9 ± 9,2 roku) i z otyłością (n = 29, średni wiek 65,8 ± 6,9 roku) w stężeniu insuliny (7,3 ± 2.3 μU/ml vs. 12,0 ± 7,3 μU/ml; p &lt; 0,01), HOMA-IR (1,8 ± ± 0,7 μU/ml × mmol/l vs. 3,0 ± 2,0 μU/ml × mmol/l; p &lt; 0,01) i dziennym skurczowym ciśnieniu tętniczym (128,0 ± 10,8 mm Hg vs. 134,1 ± 10,1 mm Hg; p &lt; 0,02).Wnioski: 24-godzinny podwójny iloczyn oraz BMI może być parametrem uzupełniającym ocenę insulinooporności u pacjentów bez cukrzycy, z nadciśnieniem tętniczym i chorobą wieńcową potwierdzoną angioplastyką tętnic wieńcowych lub obecnością ≥ 70% zwężenia w co najmniej jednej tętnicy wieńcowej

Elevated ambulatory systolic-diastolic pressure regression index is genetically determined in hypertensive patients with coronary heart disease

Objectives: Ambulatory systolic-diastolic pressure regression index (ASDPRI) as a composite marker of cardiovascular (CV) properties is related to CV complications. However, genetic determinants of ASDPRI are not known. The aim of this study is to report the relationship between certain single nucleotide polymorphisms (SNP) and ASDPRI in hypertensive patients with CAD confirmed by coronary angiography. Methods: A total of 1345 hypertensive subjects with CAD were included. SNPs were selected from genome-wide association studies. SNPs were reported to be associated with coronary artery disease risk. There were significant differences in 24 h and daytime and nighttime ASDPRIs for PHCTR1, LPA and ADAMTS7 polymorphisms. Genetic risk score (GRS18) was constructed to evaluate additive effect of 18 SNPs for ASDPRI. Results: Analysis of covariance revealed a significant relationship between the PPAB2B (β − 0.85; 95 CI −1.85–−0.16, p < 0.02), WDR12 (β − 1.31; 95 CI −2.19–−0.43, p < 0.01) polymorphisms and nighttime ASDPRI dipping. Analysis of covariance revealed a significant relationship between GRS 18 and 24-h ASDPRI (β 0.34; 95 CI 0.16–0.31, p < 0.01). Conclusions: In conclusion, ADAMTS7 and LPA polymorphisms are related to 24-h ASDPRI but PPAB2B and WDR12 gene polymorphisms are associated with nighttime ASDPRI dipping. A total of 24-h ASDPRI is determined by GRS18

Association of Genes Related to Oxidative Stress with the Extent of Coronary Atherosclerosis

Oxidative stress is believed to play a critical role in atherosclerosis initiation and progression. In line with this, in a group of 1099 subjects, we determined eight single nucleotide polymorphisms (SNPs) related to oxidative stress (PON1 c.575A&gt;G, MPO c.&minus;463G&gt;A, SOD2 c.47T&gt;C, GCLM c.&minus;590C&gt;T, NOS3 c.894G&gt;T, NOS3 c.&minus;786T&gt;C, CYBA c.214C&gt;T, and CYBA c.&minus;932A&gt;G) and assessed the extent of atherosclerosis in coronary arteries based on Gensini score. An increased risk of having a Gensini score in the higher half of the distribution was observed for the PON1 c.575G allele (odds ratio (OR) = 1.27, 95% confidence interval (CI): 1.004&ndash;1.617, p = 0.046). Next, the genetic risk score (GRS) for the additive effect of the total number of pro-oxidative alleles was assessed. We noted an increase in the risk of having a Gensini score above the median with the maximum number of risk alleles (OR = 2.47, 95% CI: 1.19&ndash;5.23, p = 0.014). A univariate Spearman&rsquo;s test revealed significant correlation between the total number of pro-oxidant alleles (GRS) and the Gensini score (&rho; = 0.068, p = 0.03). In conclusion, the PON1 c.575A&gt;G variant and the high number of risk alleles (GRS) were independent risk factors for a high Gensini score. We suggest, however, that GRS might occur as a more valuable component in adding a predictive value to the genetic background of atherosclerosis