Role of cardiovascular magnetic resonance in the prognosis of patients with myocardial infarction with non-obstructive coronary arteries.

BACKGROUND: It is estimated that 5% to 10% of patients with myocardial infarction (MI) present with no obstructive coronary artery lesions. Until now, most studies have focused on acute coronary syndrome, including different clinical entities with a similar presentation encompassed under the term MINOCA (MI with non-obstructive coronary arteries). The aim of this study is to assess the prognosis of patients diagnosed with true infarction, confirmed by cardiovascular magnetic resonance (CMR), in the absence of significant coronary lesions. METHODS: Prospective multicenter registry study, including 120 consecutive patients with a CMR-confirmed MI without obstructive coronary artery lesions. The primary clinical outcome was major adverse cardiovascular events (MACE: death, non-fatal infarction, stroke, or cardiac readmission), assessed over three years. RESULTS: Seventy-six patients (63.3%) were admitted with a diagnosis of acute coronary syndrome, and 44 (36.6%) for other causes (mainly heart failure); the definitive diagnosis was established by CMR. Most patients (64.2%) were men, and the mean age was 58.8 ± 13.5 years. Patients presented with small infarcts: 83 (69.1%) showed late gadolinium enhancement (LGE) in one or two myocardial segments, mainly transmural (in 77.5% of patients) and with a preserved left ventricular ejection fraction (median 54.8%, interquartile range 37-62). The most frequent infarct location was inferolateral (n = 38, 31.7%). During follow-up, 43 patients (35.8%) experienced a MACE, including 9 (7.5%) who died. In multivariable analysis, LGE in two versus one myocardial segment doubled the risk of adverse cardiac events (hazard ratio [HR] 2.32, 95% confidence interval [CI] 0.97-5.83, p = 0.058). Involvement of three or more myocardial segments almost tripled the risk (HR 2.71, 95% CI 1.04-7.04, p = 0.040 respectively). CONCLUSIONS: Patients with true MI but without significant coronary artery lesions predominantly had small infarcts. Myocardial 3-segment LGE involvement is associated with a significantly higher risk of adverse cardiac events.

Inflammatory status and uricaemia determine HDL-cholesterol levels in hypertensive adults over 65: an analysis of the FAPRES register.

In inflammatory disease, the levels of high-density lipoprotein cholesterol (HDL-C) decrease, and the composition of HLD-C changes. Data from the "non-inflammatory" general population indicate the presence of the same phenomenon, albeit to a smaller extent. Levels of uricaemia contribute to the overall inflammatory state of patients. The aim of this study was to analyse the association between inflammatory state, levels of uricaemia, and levels of HLD-C in a hypertensive Spanish population aged 65 or older. This was a retrospective analysis of the FAPRES database. We compared lipid levels [HDL-C, low-density lipoprotein cholesterol (LDL-C), total cholesterol, and triglycerides] in terciles of patients according to their leukocyte counts and uricaemia. When we observed statistically significant differences at a 95% confidence level, we constructed a multivariable linear regression model to adjust for possible confounders. We analysed 860 patients (52.7% women) with a mean age of 72.9 years (±5.8). Participants in the highest tercile for leukocytes or uricaemia presented with significantly lower levels of HDL-C and higher levels of triglycerides, but there was no difference in total cholesterol or LDL-C. The multivariable analysis confirmed an independent and inverse association between HDL-C and both leukocytes (ß = -0.001, p = 0.025) and uricaemia (ß = -1.054, p = 0037) as well as an independent, direct association between triglycerides and both leukocytes (ß = 0.004, p = 0.049), and uricaemia (ß = 8.411, p = 0.003). In hypertensive adults aged 65 or older, inflammatory state, and uricaemia independently operate to decrease HDL-C-these findings confirm those described in studies in people with inflammatory disease. This phenomenon could help to define a proatherogenic profile in people without inflammatory disease.

Uso de la escala CHADS 2 como predictor de riesgo de mortalidad en pacientes hipertensos. El estudio FAPRES / Use of the CHADS 2 score as a predictor of the risk of mortality in hypertensive patients. The FAPRES study

Fundamentos y objetivo: El objetivo del estudio es analizar la escala CHADS2 como marcador de riesgo de mortalidad en pacientes hipertensos, independientemente de la presencia o no de fibrilación auricular. Métodos: Se incluyó a 1.003 pacientes hipertensos ≥ 65 años, recogiendo factores de riesgo y puntuación CHADS2. Se realizó un seguimiento clínico de la mortalidad. Resultados: La media de edad de la población fue 72,8 ± 5,8 años; el 47,5% eran varones. Durante el seguimiento hubo 41 muertes, 20 de origen cardiovascular. Los pacientes con mayor CHADS2 tuvieron una mayor mortalidad: 1,5% en CHADS2 = 1; 4,7% en CHADS2 = 2; 9,1% en CHADS2 = 3, y 7,8% en CHADS2 ≥ 4. Conclusiones: La puntuación CHADS2 puede ser un instrumento clínico de sencilla aplicación para identificar pacientes hipertensos con alto riesgo de mortalidad (AU)

Foundations and aim: The aim of this study is to analyze the CHADS2 score as a marker of the risk of mortality in hypertensive patients, with and without the presence of atrial fibrillation. Methods: We included 1,003 hypertensive patients ≥ 65 years. Risk factors, and CHADS2 score were recorded among other factors, as well as clinical follow-up of number and type of deaths. Results: Mean age was 72.8 ± 5.8 years, and 47.5% were men. During follow-up there were 41 deaths, 20 were of cardiovascular origin. Patients with higher CHADS2 had a higher mortality: 1.5% CHADS2 = 1; 4.7% in CHADS2 = 2; 9.1% in CHADS2 = 3, and 7.8% in CHADS2 ≥ 4. Conclusions: The CHADS2 score can be a clinical instrument of easy application to identify hypertensive patients with a high risk of mortality (AU)

[Use of the CHADS2 score as a predictor of the risk of mortality in hypertensive patients. The FAPRES study]. / Uso de la escala CHADS2 como predictor de riesgo de mortalidad en pacientes hipertensos. El estudio FAPRES.

FOUNDATIONS AND AIM: The aim of this study is to analyze the CHADS2 score as a marker of the risk of mortality in hypertensive patients, with and without the presence of atrial fibrillation. METHODS: We included 1,003 hypertensive patients≥65 years. Risk factors, and CHADS2 score were recorded among other factors, as well as clinical follow-up of number and type of deaths. RESULTS: Mean age was 72.8±5.8 years, and 47.5% were men. During follow-up there were 41 deaths, 20 were of cardiovascular origin. Patients with higher CHADS2 had a higher mortality: 1.5% CHADS2=1; 4.7% in CHADS2=2; 9.1% in CHADS2=3, and 7.8% in CHADS2≥4. CONCLUSIONS: The CHADS2 score can be a clinical instrument of easy application to identify hypertensive patients with a high risk of mortality.

La puntuación CHADS2 como predictor de riesgo de ictus en ausencia de fibrilación auricular en pacientes hipertensos de 65 o más años / The CHADS2 score to predict stroke risk in the absence of atrial fibrillation in hypertensive patients aged 65 years or older

Introducción y objetivos: La puntuación CHADS2 es una demostrada herramienta fundamental para identificar el riesgo cardioembólico, fundamentalmente el ictus, de pacientes con fibrilación auricular no valvular, con el propósito de indicar la terapia anticoagulante. El objetivo del presente estudio es analizar la utilidad de dicha puntuación para pacientes hipertensos sin fibrilación auricular conocida en una zona mediterránea. Métodos: Se incluyó a 887 pacientes hipertensos de edad ≥ 65 años, no anticoagulados y sin fibrilación auricular, que acudieron a la consulta médica. Se recogieron los principales factores de riesgo, la historia cardiovascular, el tratamiento farmacológico, una analítica básica y un electrocardiograma y se calculó la puntuación CHADS2 (insuficiencia cardiaca, hipertensión, edad ≥ 75 años, diabetes mellitus e ictus previo o accidente isquémico transitorio). Se realizó un seguimiento clínico con recogida de los ingresos hospitalarios por ictus o accidente isquémico transitorio. La mediana del seguimiento fue 804 días. Resultados: La media de edad era 72,5 ± 5,7 años, con el 46,6% de varones, el 27,8% de diabéticos y el 8,6% de fumadores. Durante el seguimiento, 40 pacientes fueron ingresados por ictus o accidente isquémico transitorio (4,5%). El análisis de supervivencia libre de eventos mostró diferencias significativas en función de la puntuación CHADS2 (log rank test, p < 0,001). En el análisis multivariable, el tabaquismo y un CHADS2 ≥ 3 fueron predictores independientes de ictus o accidente isquémico transitorio. Conclusiones: La puntuación CHADS2 puede ser una herramienta útil para identificar el riesgo de ictus o accidente isquémico transitorio de los pacientes hipertensos sin fibrilación auricular conocida (AU)

Introduction and objectives: The CHADS2 score is a proven, essential tool for estimating cardioembolic risk (mainly stroke) in patients with nonvalvular atrial fibrillation, with the purpose of determining the indication for anticoagulant therapy. In this study we analyzed the use of CHADS2 in hypertensive patients without known atrial fibrillation in a Mediterranean population. Methods: The study included 887 hypertensive patients aged 65 years or older without atrial fibrillation or anticoagulant therapy, who attended a medical consultation. Data on the patients’ main risk factors, cardiovascular history, and medication were collected, basic laboratory analyses and electrocardiography were performed, and the CHADS2 score (heart failure, hypertension, age ≥ 75 years, diabetes mellitus, and previous stroke or transient ischemic attack) was calculated. A clinical follow-up was carried out, recording hospital admissions for a stroke or transient ischemic attack. The median duration of follow-up was 804 days. Results: Mean age was 72.5 (SD,5.7) years, 46.6% were men, 27.8% had diabetes, and 8.6% were smokers. During follow-up, 40 patients were hospitalized for a stroke or transient ischemic attack (4.5%). The event-free survival analysis showed significant differences according to the CHADS2 score (log rank test, P < .001). On multivariate analysis, smoking and CHADS2 ≥3 were independent predictors of stroke or transient ischemic attack. Conclusions: The CHADS2 may be useful for estimating the risk of stroke or transient ischemic attack in hypertensive patients without known atrial fibrillation (AU)

The CHADS2 Score to Predict Stroke Risk in the Absence of Atrial Fibrillation in Hypertensive Patients Aged 65 Years or Older.

INTRODUCTION AND OBJECTIVES: The CHADS2 score is a proven, essential tool for estimating cardioembolic risk (mainly stroke) in patients with nonvalvular atrial fibrillation, with the purpose of determining the indication for anticoagulant therapy. In this study we analyzed the use of CHADS2 in hypertensive patients without known atrial fibrillation in a Mediterranean population. METHODS: The study included 887 hypertensive patients aged 65 years or older without atrial fibrillation or anticoagulant therapy, who attended a medical consultation. Data on the patients' main risk factors, cardiovascular history, and medication were collected, basic laboratory analyses and electrocardiography were performed, and the CHADS2 score (heart failure, hypertension, age ≥ 75 years, diabetes mellitus, and previous stroke or transient ischemic attack) was calculated. A clinical follow-up was carried out, recording hospital admissions for a stroke or transient ischemic attack. The median duration of follow-up was 804 days. RESULTS: Mean age was 72.5 (SD,5.7) years, 46.6% were men, 27.8% had diabetes, and 8.6% were smokers. During follow-up, 40 patients were hospitalized for a stroke or transient ischemic attack (4.5%). The event-free survival analysis showed significant differences according to the CHADS2 score (log rank test, P < .001). On multivariate analysis, smoking and CHADS2 ≥3 were independent predictors of stroke or transient ischemic attack. CONCLUSIONS: The CHADS2 may be useful for estimating the risk of stroke or transient ischemic attack in hypertensive patients without known atrial fibrillation.

Gender differences related to the presence of atrial fibrillation in older hypertensive patients.

AIM: To determine whether there are gender differences in the epidemiological profile of atrial fibrillation (AF) and to characterise the clinical, biochemical, and therapeutic factors associated with AF. METHODS: Each investigator (primary care physicians or physicians based in hospital units for hypertension treatment) recruited the first 3 patients with an age of ≥ 65 years and a clinical diagnosis of hypertension (ambulatory blood pressure monitoring and an electrocardiogram, were performed) on the first working day of the week for 5 wk and identified those individuals with atrial fibrillation. A binary logistic regression was performed, including all of the variables that were significant in the univariate analysis, to establish the variables that were associated with the presence of arrhythmia. RESULTS: A total of 1028 patients were included in the study, with a mean age of 72.8 ± 5.8 years. Of these patients, 47.3% were male, 9% were smokers, 27.6% were diabetics, 48.3% had dyslipidaemia, 10.9% had angina, and 6.5% had experienced a myocardial infarction. Regarding gender differences, the men exhibited a larger waist circumference, a lower body mass index, less obesity, and a more extensive history of diabetes, smoking, ischaemic heart disease, kidney failure, peripheral arterial disease and carotid disease than the women. There were no differences, however, in the prevalence of AF between the men and the women (11.5% vs 9.2%, respectively; P = no significant). Regarding treatment, the women received antiplatelet agents and diuretics less frequently, but there were no other differences in the use of antihypertensive and antithrombotic therapies. In the multivariate analysis, AF in the total study population was associated with age, alcohol consumption, the presence of heart disease, and decreased glomerular filtration. In the women, AF was associated with all of the factors included in the overall analysis, as well as the presence of left ventricle hypertrophy. In contrast, in the men, the only risk factors associated with AF were age, the presence of heart disease and alcohol consumption. CONCLUSION: In patients with hypertension over 65 years of age, there are relevant gender differences in the factors associated with AF.

Circulating biomarkers of collagen metabolism in arterial hypertension: relevance of target organ damage.

OBJECTIVE: Increasing experimental evidence indicates that alterations in the extracellular matrix are implicated in hypertension and its chronic complications. Selected markers of extracellular matrix metabolism were investigated as potential biomarkers for hypertensive remodelling and correlated with the severity and extent of target organ damage (TOD) in patients with essential hypertension. METHODS: We studied 159 consecutive patients being treated for essential hypertension. An exhaustive evaluation of the heart, kidney and blood vessel damage was performed, and plasma levels of plasma procollagen type I (PICP), matrix metalloproteinase-1 (MMP-1) and its inhibitor (tissue inhibitor metalloproteinase-1, TIMP-1) were determined. Patients were categorized into four groups: no TOD (33 patients), level 1 TOD (52 patients), level 2 TOD (44 patients) and level 3 TOD (30 patients). RESULTS: The serum levels of MMP-1 and TIMP-1 were higher in patients with TOD than in hypertensive patients without TOD. Increasing levels of these molecules were progressively associated with an increase in the number of organs damaged, with highest levels of markers in patients with level 3 TOD (heart, kidney and blood vessels). There were no differences in PICP levels between groups. We found a slight but significant correlation between TIMP-1 and all hypertensive organ damage. Logistic regression analysis showed that age, smoking, diabetes mellitus, abdominal perimeter, MMP-1 and TIMP-1 were independently related to the level of TOD. CONCLUSION: Circulating concentration of MMP-1 and TIMP-1 is associated with an extended hypertensive disease, with more TOD. TIMP-1 may have a role as a biomarker of total remodelling burden in hypertensive patients.

Inflamación y apoptosis en la hipertensión arterial. Importancia de la extensión de la lesión de órgano diana / Inflammation and apoptosis in hypertension. Relevance of the extent of target organ damage

Introducción y objetivos. Analizar la relación entre parámetros inflamatorios y marcadores de apoptosis con la gravedad y la extensión de la lesión de órgano diana en pacientes con hipertensión arterial esencial. Métodos. Se ha reclutado, de manera consecutiva, a 159 pacientes hipertensos tratados, a los que se realizó un estudio exhaustivo de daño orgánico cardiaco, renal y vascular, y se determinaron las concentraciones plasmáticas de diferentes moléculas relacionadas con la inflamación (interleucina 6 y receptor soluble tipo 2 del factor de necrosis tumoral alfa) y apoptosis (receptor soluble tipo 1 del factor de necrosis tumoral alfa y receptor soluble Fas). Se dividió a los pacientes en cuatro grupos: a) sin lesión de órgano diana (33 pacientes); b) lesión a un nivel (52 pacientes); c) lesión a dos niveles (44 pacientes) y d) lesión a tres niveles (30 pacientes). Resultados. Los pacientes con lesión de órgano diana presentaban valores plasmáticos significativamente más elevados de interleucina 6, receptor soluble tipo 1 del factor de necrosis tumoral alfa y receptor soluble tipo 2 del factor de necrosis tumoral alfa que los pacientes hipertensos sin lesión orgánica. Además se objetivó un incremento progresivo de estos marcadores a medida que aumentaba el número de lesiones con las cifras plasmáticas más elevadas en los pacientes con lesión de órgano diana a tres niveles (cardiaco, renal y vascular). No hubo diferencias en el receptor soluble Fas entre las diferentes poblaciones. El análisis de regresión logística mostró que los valores plasmáticos de interleucina 6 y receptor soluble tipo 1 del factor de necrosis tumoral alfa, junto con edad, diabetes, tabaquismo y perímetro abdominal, se asociaban de manera independiente con el número de lesiones de órgano diana. Conclusiones. Una enfermedad hipertensiva más generalizada y con mayor número de órganos diana afectados se asocia a mayor activación inflamatoria y apoptótica en pacientes hipertensos (AU)

Introduction and objectives. To investigate the relationship between inflammatory and apoptotic parameters and the severity and extent of target organ damage in patients with essential hypertension. Methods. We studied 159 consecutive patients with treated essential hypertension. An exhaustive evaluation of damage to heart, kidney, and blood vessels was performed and plasma levels of inflammatory (interleukin 6 and soluble receptor of tumor necrosis factor-alpha type 2) and apoptotic markers (soluble receptor of tumor necrosis factor-alpha type 1 and soluble Fas receptor) were determined. Patients were categorized into four groups: a) no organ damage (33 patients); b) 1 organ damaged (52 patients); c) 2 organs damaged (44 patients), and d) 3 organs damaged (30 patients). Results. Serum levels of interleukin 6, soluble receptor of tumor necrosis factor-alpha type 1 and soluble receptor of tumor necrosis factor-alpha type 2 were higher in patients with target organ damage than in hypertensive patients without organ damage. Increasing levels of these molecules were progressively associated with an increase in the number of organs damaged, and the highest levels were observed in the group with damage to 3 organs (heart, kidney, and blood vessels). There were no differences in soluble Fas receptor levels between groups. Logistic regression analysis showed that age, smoking, diabetes mellitus, abdominal circumference, interleukin 6, and soluble receptor of tumor necrosis factor-alpha type 1 were independently related to the number of target organs damaged. Conclusions. Extensive hypertensive disease with involvement of more target organs was associated with greater inflammatory and apoptotic activation in these hypertensive patients (AU)

Inflammation and apoptosis in hypertension. Relevance of the extent of target organ damage.

INTRODUCTION AND OBJECTIVES: To investigate the relationship between inflammatory and apoptotic parameters and the severity and extent of target organ damage in patients with essential hypertension. METHODS: We studied 159 consecutive patients with treated essential hypertension. An exhaustive evaluation of damage to heart, kidney, and blood vessels was performed and plasma levels of inflammatory (interleukin 6 and soluble receptor of tumor necrosis factor-alpha type 2) and apoptotic markers (soluble receptor of tumor necrosis factor-alpha type 1 and soluble Fas receptor) were determined. Patients were categorized into four groups: a) no organ damage (33 patients); b) 1 organ damaged (52 patients); c) 2 organs damaged (44 patients), and d) 3 organs damaged (30 patients). RESULTS: Serum levels of interleukin 6, soluble receptor of tumor necrosis factor-alpha type 1 and soluble receptor of tumor necrosis factor-alpha type 2 were higher in patients with target organ damage than in hypertensive patients without organ damage. Increasing levels of these molecules were progressively associated with an increase in the number of organs damaged, and the highest levels were observed in the group with damage to 3 organs (heart, kidney, and blood vessels). There were no differences in soluble Fas receptor levels between groups. Logistic regression analysis showed that age, smoking, diabetes mellitus, abdominal circumference, interleukin 6, and soluble receptor of tumor necrosis factor-alpha type 1 were independently related to the number of target organs damaged. CONCLUSIONS: Extensive hypertensive disease with involvement of more target organs was associated with greater inflammatory and apoptotic activation in these hypertensive patients.

Carotid resistive index in treated hypertensive patients: relationship with target organ damage.

AIM: The resistive index (RI) is a hemodynamic parameter that reflects local wall extensibility and related vascular resistance. We analyze the relationship between common carotid RI and target organ damage in treated hypertensive patients. METHODS: We analyzed 265 consecutive hypertensive patients. Risk factors, cardiovascular history and treatments were collected; blood test, urinary albumin excretion (UAE), echocardiography to determine left ventricular mass index (LVMI), ankle-brachial index (ABI) and carotid echo-Doppler ultrasound to calculate the carotid intima-media thickness (IMT) and RI of both common carotids arteries were performed. RESULTS: A positive correlation was found between carotid RI and age, systolic blood pressure, heart rate, carotid IMT, LVMI, UAE and a negative correlation was found with diastolic blood pressure and ABI. Subjects at the top quartile of carotid RI showed a higher prevalence of left ventricular hypertrophy and peripheral artery disease (increased IMT, carotid plaques and lower ABI) compared with those with low RI (p < 0.05). Multiple regression analysis demonstrated that age, systolic and diastolic blood pressure and LVMI independently influence carotid RI. CONCLUSION: Carotid RI is related with age, systolic-diastolic blood pressure and LVMI in hypertensive patient. This evaluation could predict the presence of early cardiovascular damage and provide an accurate estimation of overall risk in this population.

Impacto del control de las cifras de presión arterial sobre el índice tobillo-brazo en el paciente hipertenso / Impact of blood pressure control on the ankle-brachial index in hypertensive patients

Fundamento y objetivo: Las guías de hipertensión arterial recomiendan la determinación sistemática del índice tobillo-brazo (ITB) en la estratificación inicial del riesgo en pacientes hipertensos, si bien no indican si deben de realizarse controles evolutivos. Nuestro objetivo fue analizar la evolución del ITB a un año de seguimiento en pacientes hipertensos según el control clínico de la presión arterial (PA). Pacientes y método: Se han incluido 209 pacientes hipertensos a los que se les determinó el ITB a nivel basal y tras un año de tratamiento antihipertensivo. Los pacientes fueron divididos en 2 grupos según presentaran buen/mal control clínico de la PA al año (<140/90mmHg). Resultados: El 82,8% de la población presentó un buen control de la PA al año y ello se asoció a un incremento significativo del ITB (1,081 frente a 1,046 basal, p=0,002). Por el contrario, no se encontraron diferencias del ITB en los pacientes con mal control de PA (1,054 al año frente a 1,093 basal). Conclusión: Un adecuado control de la PA se asocia con un aumento del valor del ITB tras un año de seguimiento (AU)

Background and objective: The guidelines for arterial hypertension recommend a systematic determination of ankle-brachial index (ABI) in the initial risk stratification in hypertensive patients, while not indicating whether controls should be evolutionary. Our aim was to analyze the evolution of the ABI value in hypertensive patients in terms of control of blood pressure (BP) after one year follow-up. Patients and methods: We included 209 hypertensive patients, in whom ABI was determined at baseline and after one year of antihypertensive treatment. Patients were divided into 2 groups in terms of good/poor clinical control of BP (<140/90mmHg). Results: A total of 82.8% of the population showed a good control of the BP after one year of treatment and it was associated with significant increase in the ABI value (1.081 versus 1.046 at baseline, P=.002). By contrast, there was no difference of ABI value in patients with poor BP control (1.054 versus 1.093 at baseline). Conclusions: A good clinical control of BP is associated with an increase in the value of the ABI (AU)

[Impact of blood pressure control on the ankle-brachial index in hypertensive patients]. / Impacto del control de las cifras de presión arterial sobre el índice tobillo-brazo en el paciente hipertenso.

BACKGROUND AND OBJECTIVE: The guidelines for arterial hypertension recommend a systematic determination of ankle-brachial index (ABI) in the initial risk stratification in hypertensive patients, while not indicating whether controls should be evolutionary. Our aim was to analyze the evolution of the ABI value in hypertensive patients in terms of control of blood pressure (BP) after one year follow-up. PATIENTS AND METHODS: We included 209 hypertensive patients, in whom ABI was determined at baseline and after one year of antihypertensive treatment. Patients were divided into 2 groups in terms of good/poor clinical control of BP (<140/90 mmHg). RESULTS: A total of 82.8% of the population showed a good control of the BP after one year of treatment and it was associated with significant increase in the ABI value (1.081 versus 1.046 at baseline, P=.002). By contrast, there was no difference of ABI value in patients with poor BP control (1.054 versus 1.093 at baseline). CONCLUSIONS: A good clinical control of BP is associated with an increase in the value of the ABI.

Variability of NT-proBNP and its relationship with inflammatory status in patients with stable essential hypertension: a 2-year follow-up study.

BACKGROUND: The variability of NT-proBNP levels has been studied in heart failure, yet no data exist on these changes over time in hypertensive patients. Furthermore, studies on the relationship between natriuretic peptides and inflammatory status are limited. METHODOLOGY/PRINCIPAL FINDINGS: 220 clinically and functionally asymptomatic stable patients (age 59 ± 13, 120 male) out of 252 patients with essential hypertension were followed up, and NT-proBNP was measured at baseline, 12 and 24 months. No differences in NT-proBNP were found with respect to the basal stage in the hypertrophic group, but significant changes were found in non-hypertrophic subjects. The reproducibility of NT-proBNP measurements was better in patients with hypertrophy than in the non-hypertrophic group for the three intervals (stage I-basal; stage II-stage I; stage II-basal) with a reference change value of 34%, 35% and 41%, respectively, in the hypertrophic group. A more elevated coefficient of correlation was obtained in the hypertrophic group than in patients without hypertrophy: basal versus stage I (r = 0.79, p < 0.0001 and r = 0.59, p < 0.0001) and stage I versus stage II (r = 0.86, p < 0.0001 and r = 0.56, p < 0.0001). Finally, levels of NT-proBNP significantly correlated with sTNF-R1 (p < 0.0001) and IL-6 (p < 0.01) during follow-up. A multivariate linear regression analysis showed that sTNF-R1 is an independent factor of NT-proBNP. CONCLUSIONS/SIGNIFICANCE: This work shows that there is good stability in NT-proBNP levels in a follow-up study of asymptomatic patients with stable hypertension and left ventricular hypertrophy. As a consequence, assessment of NT-proBNP concentrations may be a useful tool for monitoring the follow-up of hypertensive patients with hypertrophy. Measured variations in peptide levels, exceeding 35% in a 12-month follow-up and 41% in a 24-month follow-up, may indicate an increase in cardiovascular risk, and therefore implies adjustment in the medical treatment. In addition, this study shows a link between neurohormonal and inflammatory activation in these patients.

Prognostic significance of heart rate in hospitalized patients presenting with myocardial infarction.

AIM: To investigate the prognostic significance of resting heart rate in patients with acute coronary syndrome (ACS), independent of other known factors. METHODS: Patients 40 years of age or older who had been admitted with acute coronary syndrome (ACS) to one of the 94 hospitals participating in the Prevalence of Peripheral Arterial Disease in Patients with Acute Coronary Syndrome (PAMISCA) study were included. Patients were divided into two groups based on their resting heart rate (HR ≥ or < 70 bpm). Complications were recording during a follow-up period of 1 year. RESULTS: There were 1054 ACS patients analyzed (43.5% with ST segment elevation and 56.5% without elevation). Mean age was 66.6 ± 11.7 years, 70.6% were male and 29.4% of subjects were female. During follow-up, more patients in the HR ≥ 70 bpm group were hospitalized for heart failure and they also had a higher mortality rate. In the multivariate analysis, a heart rate of ≥ 70 bpm was independently related to overall mortality during the follow-up period (hazard ratio 2.5; 95% confidence interval, 1.26-4.97, P = 0.009). CONCLUSION: A resting heart rate ≥ 70 bpm in patients who survive an ACS is an indicator of a high risk of suffering cardiovascular events during follow-up.

Impact of cardiovascular risk factors and inflammatory status on urinary 8-OHdG in essential hypertension.

BACKGROUND: The urinary concentrations of 8-hydroxy-2'-deoxyguanosine (8-OHdG) reflect the oxidation status of hypertensive subjects and it can be used for monitoring oxidative stress changes. However, the influence of cardiovascular risk factors and inflammation on the urinary levels of this marker in hypertension (HT) has never evaluated. The purpose of this study was to analyze the impact of cardiovascular risk factors, and established inflammatory markers on 8-OHdG in essential HT. METHODS: We studied 149 asymptomatic hypertensive patients (61 ± 14 years). A routine physical examination, laboratory analyses, and echo-Doppler study were performed. Urinary 8-OHdG and plasma tumor necrosis factor-α (TNF-α), soluble TNF receptor 1 (sTNF-R1), soluble TNF receptor 2 (sTNF-R2), and interleukin-6 (IL-6) were determined. RESULTS: 8-OHdG/creatinine levels were higher in hypertrophic patients (P = 0.022) and correlated with left ventricular mass index (P < 0.01). When 8-OHdG/creatinine was compared according to obesity and diabetes in our hypertensive subjects, no significant differences were found. 8-OHdG/creatinine was increased in hypertensive smokers (P = 0.032) and women (P = 0.006). Furthermore, 8-OHdG/creatinine correlated with TNF-α, sTNF-R1, sTNF-R2 (P < 0.0001), and with IL-6 (P < 0.05). A multivariate linear regression analysis showed that gender, smoking, and TNF-α were independent factors of 8-OHdG/creatinine. CONCLUSIONS: Urinary 8-OHdG was increased in hypertensive patients with hypertrophy even under medical treatment. The presence of other cardiovascular risk factors on top of HT do not alter the concentrations of this oxidative stress marker, only smoking increasing its levels. TNF-α is an independent factor of 8-OHdG. These data suggest that this urinary marker gives specific additional information, further than blood pressure control alone, when evaluating hypertensive patients.