Effects of physical training and potassium supplementation on blood pressure, glucose metabolism and albuminuria of spontaneously hypertensive rats.

INTRODUCTION: It is still controversial whether there are synergistic effects among different non-pharmacological interventions used in the treatment of hypertension. OBJECTIVES: To evaluate the effect of aerobic exercise, oral supplementation of potassium and their combination on blood pressure, glucose metabolism, urinary albumin excretion and glomerular morphology in spontaneously hypertensive rats (SHR). METHODS: SHR were divided into groups: Control Group (SHR; standard diet and sedentary, n = 10), Exercise Group (SHR + E; trained on a treadmill, standard diet, n = 10), Potassium Group (SHR + K; sedentary, potassium supplementation, n = 10) and Group Exercise + Potassium (SHR + E + K, exercise, potassium supplementation n = 10). Weekly, body weight (BW) and tail blood pressure (TAP) were measured. At the end of 16 weeks, a Oral Glucose Tolerance Test was performed. Albuminuria was determined in the baseline period, at 8th and at 16th week. After sacrifice, the analysis of glomerular sclerosis index and visceral fat weight was performed. RESULTS: The TAP and BW did not change significantly. There was improvement in insulin sensitivity in SHR + E and SHR + K, but not in SHR + E + K. At week 16, albuminuria in all groups was significantly lower than the SHR control. The glomerular sclerosis index and visceral fat content were also significantly lower in all groups compared to control. CONCLUSION: An oral supplementation of potassium and exercise led to an improvement in glucose metabolism, in albuminuria and glomerular morphology, however, the overlap of the treatments did not show synergism.

Efficacy and safety of two ramipril and hydrochlorothiazide fixed-dose combination formulations in adults with stage 1 or stage 2 arterial hypertension evaluated by using ABPM.

BACKGROUND: Fixed-dose combinations of antihypertensive agents demonstrate advantages in terms of efficacy, tolerability, and treatment adherence. OBJECTIVE: This study was designed to compare the efficacy and safety of 2 ramipril and hydrochlorothiazide (HCTZ) fixed-dose combinations in patients with hypertension stage 1 or 2. Patients' blood pressure (BP) profiles were evaluated by using 24-hour ambulatory BP monitoring (ABPM). METHODS: This was a multicenter, prospective, randomized, open-label, parallel-group, noninferiority trial of adult patients (age ≥18 years) with hypertension stage 1 or 2 and systolic blood pressure (SBP) within 140 to 179 mm Hg or diastolic blood pressure (DBP) 90 to 109 mm Hg. After a 2-week washout period, eligible patients were randomized to receive 1 of 2 ramipril/HCTZ fixed-dose combination formulations (5/25 mg/d) for 8 weeks. The primary end point was the difference in 24-hour ABPM SBP/DBP mean reductions between groups after 8 weeks of treatment. The secondary end points were the changes in daytime and nighttime ABPM and in office BP. Safety profile and tolerability assessments included monitoring of adverse events. RESULTS: A total of 102 patients with hypertension (54 in group A [test formulation] and 48 in group B [reference formulation]), aged 27 to 85 years, completed the 8-week treatment period. The decreases in SBP and DBP according to 24-hour ABPM from baseline to week 8 were significant and similar in both groups. SBP decreased from 149.1 to 133.0 mm Hg (-16.1 mm Hg) in group A and from 146.2 to 130.6 mm Hg in group B (-15.6 mm Hg) (P = 0.8537); DBP was reduced by 8.8 mm Hg in group A and by 8.5 mm Hg in group B (P = 0.8748). Because the lower 95% CI limit for the difference between groups A and B of 3.96 mm Hg in SBP and 3.54 mm Hg in DBP was lower than that preestablished by the trial protocol (4 mm Hg), noninferiority of the test formulation was demonstrated compared with the reference formulation. For the secondary end points, there was no significant difference between groups in SBP and DBP during daytime or nighttime at the end of week 8. Office BP was significantly reduced in both treatment groups, with no significant differences between groups. The incidence of adverse events was 23.7% in group A and 21.7% in group B. CONCLUSIONS: Both treatment options were well tolerated and equally reduced BP. The results support the conclusion that group A (new fixed-dose combination of ramipril/HCTZ) was noninferior to group B (reference medication in Brazil). ISRCTN Register: ISRCTN05051235.

Effects of different degrees of insulin sensitivity on endothelial function in obese patients.

BACKGROUND: Obesity derived from intra-abdominal fat deposition tends to increase hormonal and cytokine production, thus worsening insulin sensitivity and leading to endothelial dysfunction. Hyperinsulinemia is considered an independent risk factor for ischemic heart disease and cause of endothelial dysfunction in healthy individuals. OBJECTIVE: To assess the impact of different degrees of insulin resistance, measured by HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), on endothelial function in obese, non-diabetic patients without prior history of cardiovascular events and different metabolic syndrome components. METHODS: Forty obese individuals were submitted to anthropometric measurements, BP measurements at office and ABPM and laboratory tests, in addition to non-invasive ultrasound assessment of endothelial function. Patients were divided into 3 groups according to the level of insulin resistance: patients with HOMA-IR values from 0.590 to 1.082 were assigned to Group 1 (n=13), from 1.083 to 1.410 to Group 2 (n=14) and from 1.610 to 2.510 to Group 3 (n=13). RESULTS: We found a significant difference in flow-mediated dilation in group 3 compared to group 1 (9.2 ± 7.0 vs 18.0 ± 7.5 %, p=0.006). There was a negative correlation between endothelial function and insulin, HOMA-IR and triglycerides. CONCLUSION: Our data suggest that mild changes in insulin resistance levels assessed by HOMA-IR may have an impact on vasodilatatory endothelial function in uncomplicated obese individuals with different cardiovascular risk factors.

[Effects of the overlapping between an experimental model of neuroendocrine obesity with arterial hypertension under blood pressure, body weight and metabolic and renal parameters in rats]. / Efeito da sobreposição de um modelo de obesidade neuroendócrina experimental e hipertensão arterial sobre a pressão arterial, peso corporal e parâmetros metabólicos e renais de ratos.

INTRODUCTION: Increased body mass index and the metabolic syndrome are associated with decreased renal function and the development of end-stage kidney disease. OBJECTIVE: To evaluate the effect of the overlap between an experimental model of obesity and genetic hypertension on the blood pressure, body weight and metabolic and kidney parameters of rats. METHODS: We studied male rats of the Wistar (WST) and spontaneously hypertensive rats (SHR) strains. Monosodium glutamate (MSG) was administered in the neonatal period to both strains, to make up two groups: WST + MSG and SHR + MSG. Animals in the control groups (WST and SHR) received saline. After completing three months of life, a 12-week follow-up period ensued, during which bi-weekly measurements of body weight (BW) and tail-cuff blood pressure (TCBP) were obtained. Microalbuminuria was analyzed at weeks 0, 4, 8 and 12. At the end of the follow-up period, blood was obtained for fasting glucose, plasma creatinine, and lipid profile determinations. The kidneys were removed, stained, and the glomerular sclerosis index was calculated. RESULTS: The administration of MSG produced higher percentage body weight gain, higher fasting blood glucose and a higher degree of glomerular injury in WST-MSG and MSG-SHR rats, compared to their controls. Greater urinary albumin excretion was observed in SHR + MSG rats, when compared to SHR. There was no statistical difference in the TCBP, creatinine, and lipid profile. CONCLUSIONS: The association of neuroendocrine obesity and arterial hypertension promoted morphological and functional changes in the glomerulus. These changes were more severe than those observed in hypertensive-only rats.

[Systemic hemodynamic and left ventricular function of diabetic-induced hypertensive rats]. / Hemodinâmica sistêmica e função ventricular esquerda de ratos hipertensos tornados diabéticos.

OBJECTIVE: To analyze the effects of type-1 diabetes mellitus (DM1) induction on systemic hemodynamic and ventricular function of normotensive and hypertensive rats. MATERIALS AND METHODS: DM1 was induced by streptozotocin in Wistar rats (WST), borderline hypertensive rats (BHR) and spontaneously hypertensive rats (SHR). The systemic hemodynamic was evaluated by thermodilution and ventricular function by Langendorff preparation. RESULTS: DM1-induction increased tail arterial pressure of WST and BHR. DM1 also increased total peripheral resistance in WST and decrease in cardiac output stroke volume in WST and BHR. Systolic function indexes were reduced and ventricular stiffness increased in all WST-diabetic rats. All of these effects were more prominent on diabetic WST rats. CONCLUSION: The DM1 in rats was accompanied by important changes in both systolic and diastolic heart function leading to significant changes in the systemic hemodynamics that were not significantly enhanced by hypertension.

[Metformin effects upon blood pressure and glucose metabolism of monossodium glutamate induced-obese spontaneously hypertensive rats]. / Efeitos da administração de metformina sobre a pressão arterial e o metabolismo glicídico de ratos espontaneamente hipertensos tornados obesos pela injeção neonatal de glutamato monossódico.

OBJECTIVES: To make available experimental model for the metabolic syndrome (MS) and verify effects of chronic oral treatment with metformin upon blood pressure (BP), body weight (BW), glucose metabolism, epididimal fat content (EF). METHOD: Males SHR received monossodium glutamate (MSG, 2 mg/kg/day/sc) during first 11 days of life. Control animals received saline. After 12 weeks, animals were separated in two groups, treated either with metformin 500 mg/ kg/day or vehicle during 12 weeks. PA and BW were determined. At the end of the follow-up, animals underwent an oral glucose tolerance test (OGTT) and insulin sensitivity index was determined. Upon sacrifice EF was measured. RESULTS: MSG worsened insulin resistance and induced visceral obesity in SHR, without change BP. Treatment with metformin improved glucose metabolism and reduces EF and BP. CONCLUSIONS: These observations emphasize the role of hepatic insulin resistance on MS and point out for beneficial cardiovascular effects with improvement in the insulin sensitivity.

Fixed-dose manidipine/delapril versus losartan/hydrochlorothiazide in hypertensive patients with type 2 diabetes and microalbuminuria.

INTRODUCTION: Patients with diabetes complicated by hypertension and microalbuminuria have elevated cardiovascular risk, and controlling blood pressure in these patients is an urgent clinical priority. The present study aimed to examine the effects of a fixed-dose combination of antihypertensives on blood pressure and microalbuminuria. METHODS: Patients with type 2 diabetes, mild-to-moderate hypertension (diastolic blood pressure 85-105 mmHg, systolic blood pressure <160 mmHg, and 24-hour mean systolic blood pressure >130 mmHg), and microalbuminuria were randomized to 1 year of doubleblind treatment with fixed-dose manidipine/delapril (n=54) or losartan/hydrochlorothiazide (HCTZ) (n=56). RESULTS: Blood pressure was significantly reduced at 1 year in both groups (-22.2/-14.6 mmHg and -19.5/-14.3 mmHg, for systolic and diastolic blood pressure respectively, P<0.001 for each), with no significant between-group difference. Reductions in microalbuminuria occurred in both groups, with mean changes at 1 year of -3.9 mg/mmol creatinine (95% CI -5.3, -2.5) for manidipine/delapril (P<0.001 vs. baseline) and -2.7 mg/mmol creatinine (95% CI -4.0, -1.3) for losartan/HCTZ (P<0.001 vs. baseline and P=0.199 between groups). Glycemia over the 1-year study was largely unaffected; the blood glucose concentration was reduced from baseline with manidipine/delapril, although not statistically significant (mean change -0.2 mmol/L, P=0.064). Both treatments were well tolerated, with discontinuation for adverse events for one (1.9%) patient in the manidipine/delapril group and two (3.6%) in the losartan/HCTZ group. CONCLUSIONS: A fixed-dose manidipine/delapril combination represents a useful addition to the treatment options available to control hypertension complicated by diabetes and microalbuminuria.

Efficacy of manidipine/delapril versus losartan/hydrochlorothiazide fixed combinations in patients with hypertension and diabetes.

BACKGROUND: Hypertension markedly increases the already high risk for cardiovascular complications in patients with diabetes mellitus. Less than one in eight patients with hypertension and type 2 diabetes have adequately controlled blood pressure. As a result, antihypertensive combinations are now widely used in management of hypertension associated with diabetes. METHODS: This double-blind study investigated efficacy of a new fixed dose combination of a calcium antagonist, manidipine 10 mg, and an angiotensin-converting enzyme inhibitor, delapril 30 mg, compared with a combination of an angiotensin receptor blocker, losartan 50 mg, and a diuretic, hydrochlorothiazide 12.5 mg. Patients with hypertension (blood pressure > or = 130/80 mmHg) with controlled type 2 diabetes (HbA1c < or = 7.5%) were randomized to manidipine/delapril (n = 153) or losartan/hydrochlorothiazide (n = 161), administered once daily for 12 weeks. Patients underwent ambulatory blood pressure monitor evaluation at baseline and end of treatment. RESULTS: Mean decreases in 24-h systolic blood pressure were seen with both manidipine/delapril (-9.3 mmHg) and losartan/hydrochlorothiazide (-10.7 mmHg) combinations. The mean (95% confidence interval) treatment difference was -1.4 (-4.5/1.8) mmHg, demonstrating noninferiority of the manidipine/delapril combination. Reduction in 24-h diastolic blood pressure (-4.6 versus -4.5 mmHg) and daytime (systolic blood pressure -10.5 versus -11.1 mmHg) and night-time (systolic blood pressure -7.1 versus -9.3 mmHg) blood pressure were also not significantly different between treatments. Compliance and adverse events were comparable for both groups. CONCLUSION: The study demonstrated that the combination of manidipine and delapril is as effective as losartan and hydrochlorothiazide in treatment of hypertension in type 2 diabetes.

[Effects of neuroendocrine obesity induction on systemic hemodynamics and left ventricular function of normotensive rats]. / Efeito da indução de obesidade neuroendócrina sobre a hemodinâmica sistêmica e a função ventricular esquerda de ratos normotensos.

UNLABELLED: The aim of this study was to evaluate the effects of obesity induced by neonatal Monosodium Glutamate (MSG) administration upon body weight, tail blood pressure, systemic hemodynamics and left ventricular function of Wistar rats. Two groups of Wistar rats were prepared: a) 18 animals made obese through the administration of 2 mg/Kg/SC of MSG during the first 11 days of the neonatal period and b)16 control animals (vehicle treated for the same period). Adults animals were followed from the 3rd up the 6th month of life with blood pressure and body weight being measured twice a week. At the end of this period, in part of animals from both groups, we evaluated the left ventricular function through the Langendorff isolated heart preparation whereas the remainders were used to evaluate the systemic hemodynamics through a termodilution method. RESULTS: MSG animals showed significant increases in heart rate (WST=235.0+/-35.1; MSG=312.0+/-90.8 bpm), total peripheral resistance (WST=0.312+/-0.100; MSG=0.535+/-0.195 mmHg.ml(-1).min) and in relative epididymal adipose tissue content (WST=2.076+/-0.622; MSG=2.731+/-0.722 g/100 g) and a reduction of systolic volume (WST=1.020+/-0.364; MSG=0.748+/-0.455 microl/bat). An increase in mean arterial pressure was also detected in obese animals during the hemodynamic evaluation. The increases in HR and TPR and the reduction in SV suggest an augmentation in the sympathetic activation of those obese normotensive rats associated with an increased visceral fat deposition.

Blood pressure and cardiorenal responses to antihypertensive therapy in obese women.

OBJECTIVE: Blood pressure (BP) and target organ responses to antihypertensive drugs are not well established in hypertensive obese patients. This study is aimed at evaluating the effects of obesity and adiposity distribution patterns on these responses. METHODS: 49 hypertensive obese women were designated to different groups according to waist to hip ratio measurements--37 with troncular and 12 with peripheral obesity. Patients were treated for 24-weeks on a stepwise regimen with cilazapril alone or a cilazapril/hydrochlorothiazide/amlodipine combination therapy to achieve a BP lower than 140/90 mmHg. Ambulatory blood pressure monitoring (ABPM), echocardiography, and albuminuria were assessed before and after the intervention. RESULTS: After 24 weeks, weight loss was less than 2% in both groups. ABPM targets were achieved in 81.5% of patients upon a combination of 2(26.5%) or 3(55.1%) drugs. Similar reductions in daytime-SBP/DBP: -22.5/-14.1(troncular obesity)/-23.6/-14.9 mmHg (peripheral obesity) were obtained. Decrease in nocturnal-SBP was greater in troncular obesity patients. Upon BP control, microalbuminuria was markedly decreased, while only slight decrease in left ventricular mass was observed for both groups. CONCLUSIONS: In the absence of weight loss, most patients required combined antihypertensive therapy to control their BP, regardless of their body fat distribution pattern. Optimal target BP and normal albuminuria were achieved in the group as a whole and in both obese patient groups, while benefits to cardiac structure were of a smaller magnitude.

Hipertensão arterial sistêmica na mulher / Hypertension in women

A característica dos níveis pressóricos nas mulheres varia de acordo com a faixa etária. Durante a fase fértil, mecanismos hormonais ligados à ação estrogênica parecem exercer um efeito protetor contra a elevação dos níveis pressóricos. Algumas condições que podem cursar com elevação dos níveis pressóricos durante a fase fértil são o uso de contraceptivos orais ou o desenvolvimento de hipertensão arterial durante a gestação. Na pós-menopausa, a falta da ação estrogênica, ou uma discutida ação androgênica e a maior prevalência de obesidade ou sobrepeso são os fatores mais comumente envolvidos na elevação dos níveis pressóricos. Outros fatores também amplamente estudados são a interferência da idade e ação dos hormônios sexuais na resistência vascular periférica, sensibilidade ao sal, e no sistema renina angiotensina. Neste artigo também são apresentadas as indicações para resolução da gravidez pelo parto, alguns aspectos da terapia de reposição hormonal e o tratamento anti-hipertensivo nesta população de hipertensos.

[The "LOTHAR" study: evaluation of efficacy and tolerability of the fixed combination of amlodipine and losartan in the treatment of essential hypertension]. / Estudo "LOTHAR": avaliação de eficácia e tolerabilidade da combinação fixa de anlodipino e losartana no tratamento da hipertensão arterial primária.

OBJECTIVE: The LOTHAR study evaluated medium and long term (one year) efficacy, tolerability and metabolic effects of the fixed combination of amlodipine and losartan compared to amlodipine or losartan alone. METHODS: Brazilian multicenter, randomized, double-blind and comparative trial performed with 198 patients in stage 1 and 2 essential hypertension. RESULTS: The fixed combination has a high antihypertensive efficacy that is sustained in the long term with very low percentage of loss of blood pressure control. This percentage is incidentally lower than that of the two monotherapy comparative regimens. In the long term, more than 60% of the patients treated with the fixed combination remained with DBP < or = 85 mmHg, and the antihypertensive effect, when assessed by ABPM persisted for 24 hours with a trough-to-peak ratio of 76.7%. The frequency of adverse events was quite low in this group, and the long-term incidence of leg edema was approximately four-fold lower than that observed with amlodipine alone. The fixed combination did not change glucose and lipid metabolism in the medium or in the long term. CONCLUSION: Based on these results, we can say that the combination of amlodipine and losartan--the first fixed combination of a calcium channel blocker and an angiotensin II receptor blocker available in the pharmaceutical market, is an excellent option for the treatment of a wide range of hypertensive patients.

Relationship among end-stage renal disease, hypertension, and sleep apnea in nondiabetic dialysis patients.

BACKGROUND: Cardiovascular diseases (CVD) are responsible for more than 50% of the deaths in patients with end-stage renal disease (ESRD). Sleep apnea (SA) has been recognized as a risk factor for CVD. Previous studies have shown a higher prevalence of SA among patients on dialysis. METHODS: Forty-five nondiabetics patients with ESRD underwent a polysomnographic analysis with concomitant clinical evaluation and laboratory tests. Fourteen patients (31.1%) presented with an apnea/hypopnea index (AHI) more than 5, confirming a high prevalence of SA. We observed abnormal sleep pattern with high percentages of sleep stage 1 and low percentages of sleep stages 3 and 4. RESULTS: Patients with AHI more than 5 presented higher levels of systolic, diastolic, and mean blood pressures (MBP) as compared with those with AHI less than 5 (P < .05). When other variables were compared (age, time of dialytic treatment, cause of ESRD, use of antihypertensive drugs, body mass index, serum levels of hemoglobin, hematocrit, creatinine, KT/V index, pH, bicarbonate, parathormone, and alkaline phosphatase), no differences were found between the two groups. In a logistic regression model, MBP and age more than 40 years were positively related to the presence of SA. CONCLUSIONS: Our study is in agreement with previous works and shows that patients with ESRD have a higher SA index compared to those with normal renal function. In spite of having higher levels of BP no other parameter was different among apneic and nonapneic patients. Hypertension may play a pivotal role linking SA and CVD.

Amlodipine 2.5 mg once daily in older hypertensives: a Brazilian multi-centre study.

OBJECTIVES: The use of low-dose amlodipine has not yet been well established in the elderly. This study therefore aimed to evaluate the efficacy and tolerability of low-dose amlodipine in elderly patients with Joint National Committee VI stage I or II hypertension. PATIENTS AND METHODS: Sixty-five hypertensive individuals (aged 66.3 +/- 5.3 years) received amlodipine 2.5 mg per day for 12 weeks before and after two periods of 4 weeks of placebo. At weeks 0, 12 and 16, patients were submitted to office, 24 h ambulatory blood pressure monitoring and home blood pressure measurement. RESULTS: Office systolic and diastolic blood pressure showed decreases at weeks 8 (153 +/- 17, 90 +/- 9 mmHg) and 12 (152 +/- 16, 90 +/- 9 mmHg) compared with weeks 0 (164 +/- 16, 99 +/- 6 mmHg) and 16 (162 +/- 19, 95 +/- 9 mmHg). During ambulatory monitoring, a decrease was observed in the average 24 h systolic and diastolic pressure at week 12 (143 +/- 13, 86 +/- 7 mmHg) compared with weeks 0 (155 +/- 15, 93 +/- 6 mmHg) and 16 (152 +/- 16, 92 +/- 8 mmHg). A daytime and night-time reduction in systolic and diastolic pressure was observed on home blood pressure monitoring at week 12 (146 +/- 16/88 +/- 8, 144 +/- 16/93 +/- 8 mmHg) compared with weeks 0 (159 +/- 17/94 +/- 8, 161 +/- 19/93 +/- 8 mmHg) and 16 (153 +/- 16/93 +/- 8, 154 +/- 17/92 +/- 8 mmHg). Adverse reactions were infrequent. CONCLUSIONS: Amlodipine at a dose of 2.5 mg per day showed efficacy and good tolerability in elderly hypertensives.

Cross-sectional study on blood pressure control in the department of nephrology of the Escola Paulista de Medicina - UNIFESP.

OBJECTIVE: To assess hypertension control rates in a specialized university-affiliated medical department, the influence of sex, diabetes, and obesity on that control, and the strategies for the treatment of hypertension. METHODS: We carried out a cross-sectional study with 1,210 patients followed up for at least 6 months. Information was gathered from medical and nursing records and comprised the following data: sex, age, weight, height, abdominal and hip circumferences, blood pressure, and class and number of the antihypertensive drugs prescribed. To assess obesity, we used body mass index and waist/hip ratio. Blood pressure was considered under control when its levels were below 140/90 mmHg. RESULTS: The study consisted of 73% females and 27% males. Most females (31.7%) were 50 to 59 years of age, and most males (28.3%) were 60 to 69 years. The blood pressure control rate found was 20.9% for the 1,210 patients and 23.4% for the hypertensive diabetic patients (n=290). Despite the low control rates found, 70% of the patients used 1 or 2 antihypertensive medications. A high prevalence of obesity (38%) was observed, and females had a greater abdominal obesity index than males did (90% vs 82%, p<0.05). Patients with a greater body mass index had less control of blood pressure. CONCLUSION: The percentage of hypertensive patients with controlled blood pressure levels was low and was associated with a high prevalence of obesity. These data indicate the need for reviewing the strategies of global treatment for hypertension.

Left ventricular diastolic function in essential hypertensive patients: influence of age and left ventricular geometry.

PURPOSE: To evaluate diastolic dysfunction (DD) in essential hypertension and the influence of age and cardiac geometry on this parameter. METHODS: Four hundred sixty essential hypertensive patients (HT) underwent Doppler echocardiography to obtain E/A wave ratio (E/A), atrial deceleration time (ADT), and isovolumetric relaxation time (IRT). All patients were grouped according to cardiac geometric patterns (NG - normal geometry; CR - concentric remodeling; CH- concentric hypertrophy; EH - eccentric hypertrophy) and to age (<40; 40 - 60; >60 years). One hundred six normotensives (NT) persons were also evaluated. RESULTS: A worsening of diastolic function in the HT compared with the NT, including HT with NG (E/A: NT - 1.38+/-0.03 vs HT - 1.27+/-0.02, p<0.01), was observed. A higher prevalence of DD occurred parallel to age and cardiac geometry also in the prehypertrophic groups (CR). Multiple regression analysis identified age as the most important predictor of DD (r2=0.30, p<0.01). CONCLUSION: DD was prevalent in this hypertensive population, being highly affected by age and less by heart structural parameters. DD is observed in incipient stages of hypertensive heart disease, and thus its early detection may help in the risk stratification of hypertensive patients.