922
Hypertension: vessels and kidney
P5006 | BEDSIDE
Changes of central hemodynamics and pulse wave velocity after
isometric handgrip exercise
S.-J. Joo, J.-H. Choi, S.-Y. Kim, K.-S. Kim. Jeju National Unversity Hospital, Jeju,
Korea, Republic of
Purpose: Dynamic changes of central hemodynamic parameters and arterial
stiffness indexes after isometric handgrip exercise may be more sensitive indicators of the arterial stiffness. We investigated the changes of them after 3 minhandgrip exercise.
Methods: Forty one subjects who underwent coronary angiography (CAG) were
enrolled. After CAG, baseline arterial waveforms were traced at the aortic root
and external iliac artery using right coronary catheters. Arterial waveforms were
recorded at 1, 2 and 3 min in the aortic root and at 3 min in the external iliac artery
after the isometric handgrip exercise at 30∼40% of the maximal handgrip power.
AP and AI were measured at the central aortic waveforms. PWV was calculated
using the ECG-gated time difference of the upstroke of the arterial waveforms
and the distance between the aortic root and the common iliac artery measured
by a catheter.
Results: Central systolic BP (SBP), pulse pressure (PP), augmentation pressure (AP) and augmentation index (AI) increased from 1 min after exercise and
reached peak values at 2 min after exercise. Changes of pulse wave velocity
(PWV) showed a diverse pattern. PWV of 22 subjects (54%, 63.4±8.6 years)
increased ≥0.5 m/sec, but 19 subjects (46%, 63.1±10.2 years) showed a little increase (<0.5 m/sec) or even decrease after exercise. SBP, PP, and forward pressure increased similarly after exercise, but AP and AI increased only in subjects
with PWV ≥0.5 m/sec after exercise.
PWV ≥0.5 m/sec
Baseline
Exercise 3 min
Heart rate (/min)
Central SBP (mmHg)
Central PP (mmHg)
Augmentation P (mmHg)
Augmentation index (%)
PWV (m/sec)
64.0±9.9
114.5±17.4
54.1±15.0
9.7±7.3
17.9±11.9
10.05±1.97
70.2±14.0*
138.9±21.0*
68.1±19.9*
16.6±9.3*
24.3±12.4*
11.95±0.51*
PWV <0.5 m/sec
Baseline
Exercise 3 min
66.1±9.3
122.7±22.4
56.3±19.8
9.6±5.9
16.8±9.2
9.88±1.58
72.7±11.9*
140.1±25.4*
65.3±19.5*
11.7±7.3
18.3±10.3
9.53±1.41*
*p<0.01. SBP, systolic BP; DBP, diastolic BP; PP, pulse pressure; PWV, pulse wave velocity.
Conclusions: Isometric handgrip exercise was a simple and easy method to
evaluate the dynamic changes of arterial stiffness indexes. Changes of central
hemodynamic parameters were correlated with a change of PWV after handgrip
exercise.
P5007 | BEDSIDE
Unfavourable effect of androgen deficiency on aortic stiffness in
hypertensive males at low and moderate cardiovascular risk
N. Ioakeimidis, C. Vlachopoulos, A. Aggelis, P. Xaplanteris, D. Terentes-Printzios,
A. Aggelakas, M. Abdelrasoul, P. Pietri, G. Lazaros, C. Stefanadis. Hippokration
General Hospital, Athens, Greece
Purpose: Increased aortic stiffness identify hypertensive patients at high CV risk,
independently of systematic coronary risk evaluation (SCORE). Testosterone is
associated with aortic stiffness, however whether this association is different in
hypertensive patients with low or intermediate SCORE compared to high SCORE
subjects is unknown.
Methods: Total testosterone (TT) levels were measured in 311 non-diabetic hypertensive men with no evidence of clinical atherosclerosis. Carotid-femoral Pulse
Wave Velocity (PWVc-f) was measured as an index of aortic stiffness. Hypogonadism (HypG) was defined when TT levels were below 3.4 ng/ml.
Results: The prevalence of hypogonadism in hypertensive patients with low,
moderate and high SCORE was 12.5, 15.2 and 28.2%, respectively. PWVc-f was
significantly associated with TT in patients with low (r=-0.289, P<0.001) and patients with moderate SCORE (r=-0.274, P<0.001) but not in patients with high
SCORE (r=-0.092, P=0.33). Subjects were then categorized by SCORE and further subdivided according to presence/absence of HypG (TT<3.4 ng/ml). PWVcf values of each SCORE/testosterone category are shown in figure. In low and
SCORE, low TT and aortic stiffness
moderate SCORE categories, patients with HypG had higher PWVc-f (by 0.92
m/s, P<0.01 and 0.55 m/s, P<0.05, respectively) compared to subjects with
TT concentration above the cut off level for biochemical definition of HypG. On
the contrary, in high SCORE category, PWVc-f between patients with HypG and
men with normal levels did not differ. It can be noted also that low and moderate SCORE hypertensive patients with HypG had already elevated PWVc-f as
compared to high SCORE men with normal TT.
Conclusion: The effect of low testosterone concentration on aortic stiffness is
emphasized in hypertensive patients with low and moderate SCORE.
P5008 | BEDSIDE
The impact of high-normal blood pressure and hypertension on
left ventricular function: a three-dimensional speckle tracking
echocardiography study
M. Tadic 1 , V.C. Celic 2 , B.P. Pencic 2 , A.M. Majstorovic 2 , J.S. Suzic 2 , A.S. Sljivic 2 ,
B.I. Ivanovic 1 , B.S. Stojcevski 2 , S.B. Backovic 2 , I.I. Ilic 2 . 1 Institute for
Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, Serbia; 2 University
hospital "Dr Dragisa Misovic", Cardiology Department, Belgrade, Serbia
Objective: The aim of this study was to investigate subclinical left ventricular
damage estimated by three-dimensional echocardiography and functional capacity in subjects with high-normal blood pressure and with untreated arterial hypertension.
Methods: This cross-sectional study included 74 newly diagnosed untreated hypertensive patients, 48 subjects with high-normal blood pressure and 46 subjects
with optimal blood pressure adjusted by sex and age. Data were analyzed by 24h
systolic blood pressure (cut-off values were 120 and 130 mmHg, respectively),
thus dividing subjects with optimal blood pressure from those with high-normal
blood pressure and hypertensive patients. All subjects underwent 24h blood pressure monitoring, complete two and three-dimensional echocardiography examination, as well as cardiopulmonary exercise testing. All echocardiographic parameters were obtained before cardiopulmonary exercise test.
Results: Global longitudinal strain (GLS) significantly decreased from group with
optimal blood pressure, across high-normal blood pressure group, to hypertensive patients (-21.3±2.4 vs. -19.1±1.9 vs. -17.8±1.7%, p<0.01). Similar results
were obtained for global circumferential strain (GCS) (-18.2±1.9 vs. -17.1±1.8
vs. -16.3±1.7%, p<0.01), as well for global area strain (GAS) (-35.1±2.4 vs.
-33.2±2.1 vs. -32.3±2.2%, p<0.01), and global radial strain (48.3±3.4 vs.
46.5±3.1 vs. 43.1±3.3%, p<0.01). Left ventricular torsion significantly deteriorated from controls, across high-normal blood pressure, to hypertensive patients
(2.82±0.41 vs. 2.55±0.5 vs. 2.27±0.47°/cm, p<0.01). Peak oxygen consumption was significantly lower in hypertensive patients, but similar between optimal
and high-normal blood pressure groups (26.3±4.2 vs. 25.2±3.9 vs. 24.3±3.7
ml/min/beat, p=0.03). Peak oxygen uptake was associated with mean blood pressure (β=-0.45, p<0.01), three-dimensional left ventricular mass index (β=-0.52,
p<0.01), GLS (β =0.48, p<0.01), GAS (β =0.43, p=0.02) and left ventricular torsion (β =0.35, p=0.04) in whole study population.
Conclusion: Subjects with high-normal blood pressure, as well as hypertensive patients, suffer subclinical left ventricular damage which could be assessed
by three-dimensional echocardiography. Functional capacity is associated with
global longitudinal and area strain, as well with left ventricular torsion, mass index
and mean blood pressure.
P5009 | BEDSIDE
Low plasma testosterone and increased aortic stiffness:
Importance of low-grade inflammation in hypertensive men
N. Ioakeimidis, C. Vlachopoulos, A. Aggelis, A. Aggelakas, K. Rokkas,
M. Abdelrasoul, I. Iona, D. Terentes-Printzios, A. Synodinos, C. Stefanadis.
Hippokration General Hospital, Athens, Greece
Purpose: Aortic stiffness is a marker of subclinical vascular damage in patients with essential hypertension. Low testosterone has been associated with
increased aortic stiffness. We investigated whether this association could be mediated or modified by hypertension severity as well as inflammatory status.
Methods: Total testosterone (TT) levels were measured in 211 non-diabetic hypertensive men (mean age 58±10 yrs) with no evidence of clinical atherosclerosis. Hypogonadism (HypG) was defined when TT levels were below 3.4 ng/ml.
Carotid-femoral Pulse Wave Velocity (PWVc-f) was measured as an index of aortic stiffness.
Results: Analysis with and without adjustment for age and mean pressure
showed that PWVc-f was inversely and significantly correlated with total TT. This
association depended on C-reactive protein (CRP) levels (p for interaction <0.05).
Subjects were categorized according to tertiles of hsCRP level [Group 1: first tertile (0.20–0.92 mg/L), Group 2: second tertile (0.94–1.78 mg/L), Group 3: third
tertile (1.82–8.15 mg/L)]. Among men in high CRP tertile, patients with HyG had
significantly higher PWVc-f compared to subjects with TT concentration above the
cut off level for biochemical definition of HypG (9.56 m/s vs 8.74 m/s respectively,
p<0.01, figure). The difference remained significant after adjustment for age and
mean pressure (F=4.651, P=0.015). By contrast, among men in the low and intermediate tertile, mean PWVc-f was similar between HypG patients and subjects
with normal TT (p=NS, Figure 1).
Conclusions: In hypertensive men, low plasma testosterone is associated with