Plasma renin activity and metabolic risk factors in essential hypertension

AJH–April 2001–VOL. 14, NO. 4, PART 2

groups (subgroup [“A”] - patients with development of SCD and subgroup [“B”]- patients without development of SCD). All patient were evalueted after clinical stabilization by daily monitoring of arterial hypertension. Arterial hypertension was compared to other SCD risk factors by multivariate regression analysis of Cox. Results: during 2 years observations, SCD occured at 22 patients (33,3 %) in group I. At comparison of parameters of daily average systolic arterial, diastolic arterial and pulse hypertension between subgroups IA and IB of authentic differences was not observed. In group II SCD was developed at 20 patients (15,0 %). The patients of subgroup IIA, at which was developed SCD had authentically more high level daily average sistolic hypertension (145,0⫾9,6 mmhg), than patients without development of SCD (122⫾7,5 mmhg, p ⬍ 0,05, OR⫽2,3(1,5-2,7)). Conclusion: the increased level of systolic arterial hypertension is an independent risk factor of development of SCD at the patients of elderly age, who had unstable angina. Key Words: unstable angina, age, arterial hypertension, sudden cardiac death

P-643 CARDIOVASCULAR RISK PROFILE OF A SPANISH HYPERTENSIVE POPULATION IN PRIMARY CARE MEDICINE. DIORISK STUDY Vivencio Barrios, Inmaculada Bosch, Anna Ylla, Jordi Eixarch, Alberto Calderon, Luis M. Ruilope. 1on Behalf of DIORISK Investigators, Spain DIORISK is an ongoing study designed to know the cardiovascular profile of a Spanish hypertensive population attending primary care outpatient clinic. For cardiovascular risk stratification we follow the WHO/ISH 1999 classification in: low, medium, high and very high risk. The study is now finishing the enrolment and we present the preliminary data of the first included patients. To date, 6500 patients have been enrolled. Age: 63.5⫾10 years; 51% females. Weight: 75⫾12 kg, height: 165⫾8 cm. 51% of the patients exhibits a BMI ⬎27 kg/m2 and in 22% the BMI was ⬎30. Blood pressure: 161⫾15/ 93⫾9 mmHg. Accordingly to WHO/ISH, 88% presented cardiovascular risk factors (cholesterol ⬎6.5 mmol/l was the most frequent). 25% of patients with target organ damage (mainly left ventricular hypertrophy) and 24% had suffered from associated clinical conditions (ischemic heart disease and heart failure were the most common). With these data, 5% were low risk subjects, 36.5% medium, 22.3% high and 36.2% very high risk patients. In conclusion, very few hypertensive patients (only 5%) who nowadays attend an outpatient clinic of primary care medicine in Spain exhibit a low cardiovascular risk. On the contrary, most of hypertensive patients (58.5%) present high or very high cardiovascular risk in daily clinical practice. These data may provide important information to optimize the goals for antihypertensive treatment in our country. Grant/Research Support: Novartis Key Words: Cardiovascular Risk, WHO/ISH guidelines ,Epidemiology in Hypertension

P-644 HEALTH-RELATED QUALITY OF LIFE AMONG PATIENTS WITH LEFT VENTRICULAR HYPERTROPHY: BASELINE CHARACTERISTICS FROM THE LIFE STUDY Linda M. Nelsen, Carr A. Carr, Steven M. Snapinn, Jonathan M. Edelman. 1Epidemiology, Merck & Co., Inc., West Point, PA, United States, 2Augusta Preventive Cardiology, PC, Augusta, GA, United States Both hypertension and left ventricular hypertrophy (LVH) are associated with increased risk of cardiovascular events. Antihypertensive therapies,

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which can lower this risk, may impose treatment-related symptoms that impact on health-related quality of life (HRQOL) and can affect adherence and persistence with therapy. The LIFE Study is a double-blind, randomized trial to compare losartan and atenolol on reduction of cardiovascular events in hypertensive patients with ECG-documented LVH. In the HRQOL substudy, HRQOL and symptom bother were measured at baseline, and over the first 12 months to evaluate treatment-related effects of therapy, especially on the domain of vitality and symptom bother related to fatigue. HRQOL was measured with the Hypertension Battery of Scales (reduced) with domains of general health, psychological general well-being (including a vitality subdomain), sleep disturbance, social function, sexual function, cognitive function and a symptom bother inventory (SBI). LVH was measured with the ECG Cornell voltage-duration product and the Sokolow-Lyon criteria and categorized based on the number of criteria positive at baseline. We compared baseline HRQOL for demographic, baseline study measures (SBP, DBP, LVH), and comorbidities. Among 465 subjects, 54% were female, 14% reported smoking, 11% had a history of an MI, 3% had a history of stroke, and 22% were diabetic. At baseline, the mean (SD) age was 66 (7), SBP was 171 (14) and DBP was 96 (9) mm Hg. All patients met CP or SL criteria on the pre-study ECG. At baseline, 7% were positive for both, 70% for 1 criteria and 22% were negative for both criteria. There were no significant differences between patients in the QOL Substudy and the remainder of the US patients. SBP, DBP and LVH were not associated with vitality at baseline, or with other HRQOL domain scores. Baseline HRQOL was significantly lower for women and patients with a history of MI, stroke or diabetes. Of 33 items in the SBI, the most frequently reported at baseline included: nocturia (46%), tiredness, feeling weary or fatigue (31%), blocked or runny nose (25%), pain in joints of hands (23%) and dry mouth (23%). Fatigue was more prevalent in women, and those with baseline comorbidities but was not associated with baseline SBP, DBP or LVH. While HRQOL and symptom bother were not associated with baseline LVH or blood pressures they were related to gender and baseline comorbidities. Understanding patterns of baseline HRQOL and symptom burden will help to elucidate the relationships of hypertensive therapy and treatment-related changes in HRQOL. Other Financial or Material Support: Merck & Co., Inc. Employee Key Words: Health-related Quality of Life ,Clinical Trial, Losartan

P-645 PLASMA RENIN ACTIVITY AND METABOLIC RISK FACTORS IN ESSENTIAL HYPERTENSION Giuseppe Regolisti, Franco Perazzoli, Aurelio Negro, Carlo Sani, Simona Davoli, Ermanno Rossi. 1II Division of Internal Medicine, Arcispedale S. Maria Nuova, Reggio Emilia, Italy Elevated plasma renin activity (PRA) has been shown to be associated with enhanced cardiovascular morbidity. In small series of patients (pts), high PRA levels have been observed in subjects with clustering of classical risk factors. Aim of the present study was to investigate the relationshipS between PRA and plasma lipids, glucose (G), insulin (I) and uric acid (UA) in a population of essential hypertensives (EH). Records of 487 EH, either untreated or whose treatment with diuretics, betablockers or ACE-inhibitors had been withdrawn at least 4 weeks before, were reviewed for baseline PRA, total, LDL- and HDL-cholesterol, triglycerides, serum G and UA and plasma I. All pts were on controlled Na intake; they were grouped according to quartiles of PRA (ngAI/ml/h)(I quart., median 0.15, range 0.05-0.25; II quart., median 0.40, range 0.30-0.60; III quart., median 0.90, range 0.65-1.30; IV quart., median 2.1, range 1.35-6.75). Sex distribution, body mass index (BMI), systolic and diastolic blood pressure values and 24-hour urinary Na were similar across quartiles of PRA. The pts in the highest quartile were slightly but significantly younger than those in the lowest quartile (46⫾11 vs 53⫾11, P⬍0.01). There were no significant differences in

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plasma lipids and serum G, whereas plasma I was highest in the highest quartile (Table). HOMA-IR, an index of insulin resistance, was also significantly higher in the IV compared with the I quartile (2.50⫾2.12 vs 2.05⫾1.35, P⫽0.016), even after correction for age and BMI. Serum UA was also significantly higher in the highest compared with the lowest PRA quartile. We conclude that in middle-aged, nondiabetic EH moderately elevated PRA levels are not associated with an unfavourable plasma lipid pattern; however, insulin resistance and UA levels appear to increase with increasing PRA values. Variable

II quartile

II quartile

III quartile IV quartile ANOVA

(n⫽111) (n⫽143) (n⫽124) (n⫽109) (P) Total cholesterol 203.6 ⫾ 35.9 203.0 ⫾ 38.9 207.6 ⫾ 32.8 200.2 ⫾ 36.7 ns (mg/dl) LDL cholesterol 131.2 ⫾ 31.2 134.5 ⫾ 34.4 136.3 ⫾ 29.0 128.3 ⫾ 32.0 ns (mg/dl) HDL cholesterol 51.1 ⫾ 13.0 47.8 ⫾ 13.0 57.4 ⫾ 60.5 50.0 ⫾ 15.6 ns (mg/dl) Triglycerides 102.6 ⫾ 48.5 101.4 ⫾ 40.4 109.8 ⫾ 45.9 106.7 ⫾ 41.3 ns (mg/dl) Uric acid (mg/dl) 5.1 ⫾ 1.4 5.2 ⫾ 1.2 5.3 ⫾ 1.3 5.9 ⫾ 1.2 0.042 Glucose (mg/dl) 90.1 ⫾ 19.8 88.6 ⫾ 16.6 89.3 ⫾ 14.4 89.0 ⫾ 16.7 ns 9.0 ⫾ 5.1 9.2 ⫾ 6.9 10.8 ⫾ 8.3 11.4 ⫾ 4.2 0.024 Insulin (␮U/ml)

Key Words: hypertension, renin profile, risk factors

P-646 QT DISPERSION IN ARTERIAL HYPERTENZION Tinatin T. Akhobadze, Vakhtang B. Chumburidze, Ramaz B. Kurashvili, Maia G. Khelashvili, Tamar T. Khidesheli, Nana A. Nacopia, Lela C. Dzneladze, Mzia R. Dundua. 1Cardiology, National Center of Therapy, Tbilisi, Georgia, 2 Diabetes, Georgian Diabetes Center, Tbilisi, Georgia Increased Qt dispersion, as a marker of ventricular repolarization inhomogenety, has been associated with propensity to ventricular tachyarrhythmias and sudden death in a variety heart diseases. Its clinical and predictive value in-patients (pts) with hypertension (HT) are still controversial. The aim of the study was to evaluate the relationship between accurance of left ventricular hypertrophy (LVH) and QT parameters in HT. Study group included 56 pts with HT (age 56.3⫾ 11.9.years 33 men and 23 women) without clinical signs of coronary artery disease. Pts were divided into two groups: with (I gr) and without (II gr.) LVH. LVH was diagnosed by echocardiography when left ventricular mass index (LVMI) was⬎131 g/m2 for men and ⬎ 108 g/m2 for women. Left ventricular mass (LVM) was calculated by Devereux formula Bazett formula was used to correct QT interval (QTc) for heart rate. QTc dispersions determined as the difference between the maximum and minimum values of the QTc intervals in different leads of surface ECG. 28 healthy individuals (age 54.6 ⫾11.8 years, 17 men and 11 women) served as a control group (III gr.). No significant difference in QTc intervals and QTc dispersion between gr.II and gr.III was observed. (Mean QTc; 0.408⫾0.029 vs 0.401⫾0.028 s, mean QTcd: 0.043⫾0.012 vs 0.036⫾0.011 s respectively). In-group with LVH there was significantly prolonged QTc intervals and increased QTc dispersion comparable to the group without LVH (mean QTc; 426⫾0.031vs, 0.408⫾0.029 s P⬍0.05; mean QTcd 0.059⫾0.021 vs 0.043⫾0.012 s P⬍0.01 respectively) and control group (p⬍0.05; p⬍0.001 respectively). QT parameters were also correlated with the age of pts. The level to blood pressure was higher in pts with increased QTc dispersion, but no significantly. In HT pts increased QTc dispersion is associated with LVH. It may be explain LVH in course of HT is found as risk factor for ventricular arrhythmias and sudden cardiac death. Key Words: Left Ventricular Hypertrophy, QT dispersion, Hypertension

AJH–April 2001–VOL. 14, NO. 4, PART 2

P-647 ENDOTHELIAL DAMAGE AND ANGIOGENESIS IN HIGH-RISK HYPERTESIVE PATIENT: RELATION TO RISK FACTORS Dirk C. Felmeden, Charles G.C. Spencer, Funmi Belgore, Andrew D. Blann, Gareth D. Beevers, Gregory Y.H. Lip. 1University Department of Medicine, Haemostasis, Thrombosis and Vascular Biology Unit, City Hospital NHS Trust, Dudley Road, Birmingham, United Kingdom High-risk hypertensive patients are at particular risk of vascular complications, which may be related to endothelial damage or abnormal angiogenesis as assessed by measurements of von Willebrand factor (vWF) and vascular endothelial growth factor (VEGF) respectively. Methods: We studied 138 consecutive hypertensive patients (103 males, mean age 59.5 (SD6.6) years), who were assessed for their coronary heart disease (CHD) and cerebrovascular (CVA) risk according to the Framingham equation. Hypertensive patients were divided into a “high-risk” group with more than ⱖ3 risk factors and a “low-risk” group with ⬍3 risk factors. The risk factors assessed were age⬎55, male, smoking, cholesterol ⬎6.5 mmol/l, diabetes mellitus, family history of CHD, previous stroke, peripheral vascular disease, left ventricular hypertrophy on ECG, and Q wave or T wave inversion on ECG. Baseline VEGF and vWF plasma levels (both by ELISA) were compared with 21 healthy normotensives controls.

N Age [years] 5 year CHD risk [%] 5 year CVA risk [%] systolic BP [mmHg] diastolic BP [mmHg] VEGF [pg/ml] vWF [IU/ml]

All hypertensives

Low risk

High risk

p-value

136 59.5 23.4 (10.9)1) 9.0 (6.5) 161 (17.1) 91 (10.0) 20 (140-410) 129 (36)

25 57.7 (7.3) 13.1 (4.9) 4.8 (3.2) 15919.4 90 (9.9) 160 (120-350) 119 (27)

111 61.3 (6.2) 25.0 (10.9) 9.6 (6.6) 162 (16.8) 91 (10.1) 200 (140-452) 135 (38)

0.03 ⬍0.01 ⬍0.01 NS NS NS 0.02

Values are expressed as mean and SD, except VEGF as median and IQR. Statistical analysis for comparison of low vs. high risk: unpaired T-Test and Mann-Whitney Test as appropriate. VEGF or vWF were not significantly correlated with risk factors, apart from a weak correlation between VEGF and total cholesterol (Spearman Correlation R⫽0.189, p⫽0.046). High-risk hypertensives demonstrate abnormal endothelial damage (vWF) but not angiogenesis (VEGF), although both indices are abnormal compared with normotensive controls. These processes appear to be independent of each other, but might individually contribute to the pathogenesis of cardiovascular risk in hypertension. Key Words: VEGF, endothelium, vWF

P-648 CORRELATION BETWEEN PULSE PRESSURE AND LDL-CHOLESTEROL IN PATIENTS WITH RESISTANT HYPERTENSION Giovanni Gaudio, Luigina Guasti, Alberto Schizzarotto, Piermario Bossi, Sergio Masnaghetti, Ivano Cosini, Marco Scaltritti, Adriano Daverio, Danilo Zanotta, Franco Rotolo, Pietro Margaroli. 1Internal Medicine, Bellini Hospital, Somma Lombardo, Italy, 2Internal Medicine, Insubria University, Varese, Italy It is well known that hypertension and hypercholesterolemia are two of the most important risk factors for cardiovascular diseases. The pulse pressure (PP) is related to arterial stiffness. The aim of this study was to investigate the possible relationship between pulse pressure and plasma lipids in a selected population of resistant hypertensive patients. In 99 consecutive patients (49M, 50F; mean age 60⫹/-12 years) with resistant hypertension (failure to achieve blood pressure values ⬍140/90 mm Hg or ⬍160/90 mm Hg in patients over 60 years; despite maximal doses of at least 3 drugs, one of which was a diuretic) the following plasma