Aortic stiffness in patients undergoing hemodialysis is positively related to antigen presenting cell-dependent T-lymphocyte reactivity.

BACKGROUND: Aortic stiffness is increased in patients undergoing hemodialysis (HD), and it is associated with an increased cardiovascular mortality. Among others, aortic stiffness has been correlated with serum markers of inflammation, indicating a role of the immune system in its pathogenesis. The aim of this study was to evaluate the impact of antigen-presenting cell-dependent T-lymphocyte reactivity on aortic stiffness in HD patients. PATIENTS AND METHODS: Twenty patients were enrolled in the study. Exclusion criteria were medications or conditions, other than HD, that are known to influence the immune response or aortic stiffness. Antigen-presenting cell-dependent T-lymphocyte reactivity was assessed by cell proliferation of peripheral blood mononuclear cells cultured with or without stimulation with Staphylococcal enterotoxin B (SEB). Cell proliferation was estimated by immunoenzymatic measurement of bromodeoxyuridine uptake. Aortic stiffness was assessed by carotid-femoral pulse wave velocity (PWV) measurement. RESULTS: Linear regression analysis revealed a strong positive relation between carotid-femoral PWV and antigen-presenting cell-dependent T-lymphocyte reactivity, when SEB at concentrations of 1 ng/mL or 10 ng/mL was used as stimulant. CONCLUSION: The present study confirms that aortic stiffness in HD patients is positively related to antigen-presenting cell-dependent T-lymphocyte reactivity. The greater the ability of the immune system to react to a monocyte-dependent stimulant and, consequently, to provoke an inflammatory response, the greater the stiffness of the aorta. This is in agreement with the observation that aortic stiffness in HD patients is positively related to various serum inflammation markers.

Assessment of quality of life in a randomized clinical trial of candesartan only or in combination with DASH diet for hypertensive patients.

OBJECTIVES: A randomized clinical trial was used to compare the effects of an angiotensin II type 1 receptor inhibitor, candesartan, singly or in combination with a reducing sodium diet, the DASH diet, on the quality of life (QOL) in outpatients with hypertension. METHODS: After a 2-week wash out period with placebo, 102 patients with mild to moderate hypertension were randomly assigned to receive candesartan (8 to 16mg per day), and 99 patients were assigned to follow the DASH diet in addition to the same dose of candesartan, both for 16 weeks. Patients completed the Subjective Symptoms Assessment Profile questionnaire, just before treatment and at the end of treatment. ANOVA was used to analyze the QOL-score changes over time and compare treatments. RESULTS: Resting blood pressures were significantly reduced by the combination of candesartan and DASH diet (p < 0.005). Significant improvement was demonstrated for the mental component scores after 16 weeks of treatment with the combination of candesartan and DASH diet (p < 0.03). CONCLUSIONS: Angiotensin II type 1 receptor blockade with a therapeutic dosage of candesartan maintains significant control of blood pressure and may improve QOL-scores, especially when combined with a reducing sodium diet.

Effect of cold, isometric exercise, and combination of both on aortic pulse in healthy subjects.

The aortic pulse-wave velocity (PWV) and augmentation index were measured in 24 healthy adults at baseline, during a cold pressor test (CPT), during hand-grip isometric exercise test (HIE), and during a combination of CPT plus HIE. The PWV and augmentation index increased significantly during CPT and HIE compared with baseline (p <0.01). The combined effect of CPT and HIE on PWV and augmentation index was greater compared with the effect of each intervention alone.