Intra-arterial blood pressure monitoring in the evaluation of the hypertensive athlete.

To compare the blood pressure (BP) changes during a long-distance run with those during bicycle ergometry, nine normotensive and 18 hypertensive joggers were studied by means of ambulatory intra-arterial monitoring. In all subjects the ergometric test caused a progressive increase in systolic and little change in diastolic BP. Exertional BP levels were closely related to pre-exercise baseline values (P less than 0.001). A different BP pattern was observed during track running, as a sharp rise in systolic BP reaching maximum values 2-4 min after the start was recorded. Subsequently, systolic BP progressively declined throughout the run, only to increase again during the final sprint. Diastolic BP fell markedly at the onset of the run and then remained substantially stable throughout. A poor relationship was observed between the BP values at peak exercise and baseline levels (P less than 0.05) as the normotensives showed a significantly higher BP response than the hypertensives. On the contrary, during the ergometric test a parallel increase in BP was recorded in the normotensive and the hypertensive joggers. No correlation was found between the BP response to track running and to bicycle ergometry. These results indicate that the BP response to a standard stress test is not predictive of the BP changes determined by a long-distance run. The BP increase with strenuous effort seems to be reduced in hypertensive individuals, probably because of latent impairment of cardiac performance.

Prevalence of atherosclerotic involvement of the internal carotid artery in hypertensive patients.

The prevalence of atherosclerotic involvement of the internal carotid arteries, as diagnosed through an echo-Doppler imaging system with pulsed Doppler spectral analysis was evaluated in 49 hypertensives who had a negative history for neurological symptoms and 49 matched controls. The prevalence was 24.5% in the hypertensive group and 10.2% in the controls with a statistically significant difference (chi-square = 6.07, P less than 0.01). Two hypertensives had severe stenosis (above 50% diameter reduction) and 7 had potentially embolic lesions (irregular surface, inhomogeneous appearance). No one of the matched controls was as severely involved. We conclude that arterial hypertension can account for enhanced prevalence of carotid artery disease in asymptomatic patients.

Prospective evaluation of combined carotid and coronary surgery.

In order to evaluate the effectiveness of combined carotid and coronary surgery in reducing the incidence of neurological disturbances after coronary artery bypass grafting (CABG), 144 consecutive candidates for CABG (group I) were screened for carotid disease noninvasively with Doppler ultrasonography (duplex). Twenty-six (18%) were considered at risk for stroke because of a severe (above 50% diameter reduction) stenosis; 20 (4 symptomatic and 16 asymptomatic) underwent combined surgery. Forty-seven other patients (group II) underwent CABG surgery without previous Doppler investigation. Only three patients (1.5% of the survivors) developed transient neurological disturbances after surgery; two who had normal internal carotid arteries belonged to group I, and one to group II. None of the six patients at risk for stroke who underwent only CABG developed neurological symptoms. The incidence of intra- and postoperative cardiac complications of the group who had CABG only compared to that of the group with combined surgery. We conclude that, although safe, combined surgery is not to be performed systematically on candidates for CABG with a significant internal carotid artery stenosis.

[Prevalence of atherosclerotic lesions of the carotid bifurcation found with echo-doppler (duplex) technic in patient candidates for aortocoronary bypass]. / Prevalenza di lesioni aterosclerotiche della biforcazione carotidea rilevate con tecnica eco-doppler (duplex) in pazienti candidati ad intervento di by-pass aortocoronarico.

The association of an overt coronary artery disease with a cerebrovascular disease is frequently reported. However the real prevalence of atherosclerotic lesions at the carotid bifurcation in coronary patients is not well established. The aim of our study was to evaluate the prevalence of atherosclerotic involvement of the extracranial carotid arteries in a group of 141 patients undergoing coronary artery by-pass graft (CABG) and to verify whether any correlations between coronary and carotid artery disease exist. The extracranial carotid arteries have been studied by means of an echo-doppler (duplex) system, which combines a B-mode images with a pulsed doppler. A high prevalence (17.02%) of patients with a severe (greater than 50% diameter reduction) carotid involvement was detected (Tab. II). However, no correlations between the coronary and the carotid disease were found in terms of extension and severity (Tab. V). In conclusion, a systematic evaluation of the carotid arteries is recommendable in the coronary patients, candidates to CABG, even in the absence of cerebrovascular symptoms.