Anxiety disorders are associated with increased plasma adrenomedullin level and left ventricular hypertrophy in patients with hypertension.

OBJECTIVE: To investigate the association between anxiety disorders and left ventricular hypertrophy in patients with essential hypertension. METHODS: Left ventricular structure and function were assessed with echocardiography in 56 patients with essential hypertension and anxiety disorder (study group) and in 56 patients with hypertension only (control group). Serum adrenomedullin levels were also measured in these patients. RESULTS: There was no statistically significant difference in the left ventricular ejection fraction between the study and the control group (54.21 ± 88.81% versus 56.01 ± 7.85%, p>0.05). The left ventricular mass index (LVMI) in study group was higher than in control group (137.05 ± 9.42 versus 123.57 ± 7.01 g/m(2), p=0.001). The plasma levels of adrenomedullin in study group was higher than in control group (25.97 ± 5.48 versus 18.32 ± 6.97 ng/L, p=0.001). Levels of plasma adrenomedullin were positively correlated with LVMI in the study (r=0.734, p<0.05) and control group (r=0.592, p<0.05). CONCLUSION: Anxiety disorders are associated with elevated plasma adrenomedullin levels and increased left ventricular hypertrophy in patients with essential hypertension. The clinical significance of these changes requires further investigation.

Comparison of oral and intravenous hydration strategies for the prevention of contrast-induced nephropathy in patients undergoing coronary angiography or angioplasty: a randomized clinical trial.

OBJECTIVE: The efficacy of oral hydration in the prevention of contrast-induced nephropathy in patients undergoing elective coronary intervention is unclear. METHODS: A total of 120 patients were randomly assigned to three groups. Group A (n = 40) received intravenous hydration before and after coronary angiography or angioplasty. Group B (n = 40) received oral tap water before and after the procedures, whereas group C (n = 40) received only postprocedural drinking water. Levels of serum creatinine and urea nitrogen were measured before, 12 hours after, 2 and 3 days after the coronary angiography or angioplasty. RESULTS: : There was no statistically significant difference in the age, sex, baseline renal function and the volume of contrast medium used during the coronary procedures among the three groups (P > 0.05).There was no statistically significant difference in the mean serum creatinine or urea nitrogen among the three groups 12 hours, and 3 days after the coronary procedures ( P > 0.05).The incidence of contrast-induced nephropathy in group A, B and C was 5.0% (2/40), 7.5% (3/40) and 5.0% (2/40), respectively (P = 0.86). Renal function in the seven patients who experienced contrast-induced nephropathy recovered within a week following rehydration treatment. CONCLUSIONS: Pre- and post-procedural oral hydration was as effective as intravenous rehydration in the prevention of contrast-induced nephropathy in patients undergoing coronary angiography or angioplasty.

Plasma nitric oxide and left ventricular function in rabbits after cardiac lymphatic obstruction.

This study was designed to investigate the effect of cardiac lymphatic obstruction on plasma nitric oxide (NO) and left ventricular function. The plasma NO was measured in study group (n = 21) and control group rabbits (n = 12) before, and 3, 7, 14, 30 and 90 days after the obstruction of cardiac lymphatic vessels. Left ventricular ejection fraction was measured with echocardiography. There was a significant reduction in the left ventricular ejection fraction following the lymphatic obstruction (0.72±0.02 vs. 0.61±0.02, p<0.01). Plasma NO in the control group remained unchanged during the observation period (54.2±4.4 vs. 52.0±4.2 µmol/L, p>0.05). In the study group, there was a small but significant increase in the plasma NO on day 3, 7 and 14 following the lymphatic obstruction (52.3±4.1 vs. 73.4±5.9 µmol/L, p<0.01). The plasma NO returned to the baseline levels on day 30 but reduced to 44.9±3.6 µmol/L on 90 days after the lymphatic obstruction (p<0.05). In conclusion, cardiac lymphatic obstruction was associated with a significant reduction in left ventricular function. It was also associated with an increase in the plasma NO in the first 2 weeks but there was a significant reduction in the NO levels three months after the lymphatic obstruction.

Generalized anxiety disorder and the circadian rhythm of blood pressure in patients with hypertension.

Objective. To investigate the impact of generalized anxiety disorder (GAD) on the circadian rhythm of blood pressure in patients with hypertension. Methods. The 24-h ambulatory blood pressure was compared between patients with hypertension and GAD, and patients with hypertension only. Results. The mean day- and night-time systolic (SBP, 156.6±11.0 and 149.6±12.4 mmHg, respectively) blood pressure in patients with GAD was greater than in the no-GAD group (143.2±15.0 and 126.0±10.8 mmHg, respectively, P<0.01). The mean day- and night-time diastolic blood pressure (DBP, 101.5±10.1 and 96.9±17.6 mmHg, respectively) in the GAD group was also greater than in the no-GAD group (94.1±10.9 and 77.4±10.2 mmHg, respectively, P<0.01). SBP and DBP dipping was found in 87.5 and 80.1% of the hypertension only patients, as compared with 16.6 and 21.4% respectively, of the hypertension and GAD patients (P<0.01). Conclusions. The presence of GAD is associated with a higher level of blood pressure in hypertensive patients. GAD is also associated with a diminished circadian rhythm of blood pressure. The clinical significance of the reduced blood pressure dipping at night requires further investigation.