Magdalena Loster

Pulsatile but Not Steady Component of Blood Pressure Predicts Cardiovascular Events in Coronary Patients

Although the differences between central and peripheral blood pressure (BP) values have been known for decades, the consequences of decision making based on peripheral rather than central BP have only recently been recognized. There are only a few studies assessing the relationship between intraaortic BP and cardiovascular risk. In addition, the relationship between central BP and the risk of cardiovascular events in a large group of coronary patients has not yet been evaluated. Therefore, the aim of the study was to determine the prognostic significance of central BP-derived indices in patients undergoing coronary angiography. Invasive central BPs were taken at baseline, and study end points were ascertained during over a 4.5-year follow-up in 1109 consecutive patients. The primary end point (cardiovascular death or myocardial infarction or stroke or cardiac arrest or heart transplantation or myocardial revascularization) occurred in 246 (22.2%) patients. Central pulsatility was the most powerful predictor of the primary end point (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.14 to 1.48). Central pulse pressure was also independently related to the primary end point (HR 1.25, 95% CI 1.09 to 1.43). Central mean BP as well as peripheral BP parameters were not independently related to the primary end point risk. Central pulsatility was also related to risk of cardiovascular death or myocardial infarction or stroke. The pulsatile component of BP is the most important factor related to the cardiovascular risk in coronary patients. It is more closely associated with cardiovascular risk than steady component of BP.

Tissue Doppler indexes of left ventricular systolic function in relation to the pulsatile and steady components of blood pressure in a general population

Objectives: To our knowledge, no population study described the association of the radial and longitudinal components of left ventricular strain with blood pressure (BP) components in continuous analyses. We therefore investigated these associations in participants randomly recruited from the general population in the framework of the family-based European Project on Genes in Hypertension. Methods: In 334 participants (55.4% women; mean age, 43.6 year), using tissue Doppler imaging (TDI), we measured the end-systolic longitudinal strain (mean 20.9%) and peak systolic strain rate (1.29 s−1) from the basal portion of the left ventricular inferior and posterior free walls and radial stain (51.1%) and strain rate (3.40 s−1) of the left ventricular posterior wall. Models included in addition to covariables and confounders both SBP and DBP or both pulse pressure (PP) and mean arterial pressure (MAP). Effect sizes were expressed per 1-SD increase in BP. Results: Longitudinal strain (−0.62%; P = 0.04 and −0.64%; P = 0.007), but not strain rate, decreased with DBP and MAP. Radial strain (4.0 and −3.4%; P ⩽ 0.001) and strain rate (0.38 and −0.18 s−1; P ⩽ 0.04) independently increased with SBP and decreased with DBP. Accordingly, radial strain (2.9%; P < 0.0001) and strain rate (0.22 s−1; P = 0.0005) increased with higher PP, but were not related to MAP. Conclusion: In the general population, BP is an independent determinant of left ventricular systolic function as measured by TDI. Radial function increased with PP, the pulsatile BP component, whereas longitudinal function decreased with the steady component of BP as expressed by MAP or DBP.

Half of coronary patients are not instructed how to respond to symptoms of a heart attack

BACKGROUND The delayed treatment of acute coronary syndrome has a significant impact on survival. Due to improved organization and the use of reperfusion therapies, inhospital delay has been shortened in recent years. However, the time between the onset of chest pain and the call for medical help is still too long. The aim of this study was to assess the proportion of coronary patients instructed how to behave in case of chest pain and to find what factors relate to a lower probability of being counselled. METHODS Patients aged < 80 years, hospitalized due to coronary artery disease (CAD) were identified retrospectively on the basis of a medical records review and were invited for a follow-up examination. Two hundred and nineteen patients agreed to participate in the study. Data on the prehospital delay was obtained using a standard questionnaire. RESULTS The study group consisted of 149 men and 70 women. The mean time between discharge and the follow-up examination was 1.1 ± 0.4 years. Of 219 study participants, 106 (48.4%) declared they had been instructed about the symptoms of a heart attack and how to respond to it. Men, smokers, non-diabetics, and those with previously diagnosed CAD had been instructed more frequently. The independent predictors of being instructed were: percutaneous coronary intervention during the index hospitalization, diabetes, smoking, male sex and previously diagnosed CAD. CONCLUSIONS About half of patients after hospitalization due to CAD are not instructed how to respond to heart attack symptoms. This has not changed over the last decade and may contribute to the lack of shortening of prehospital delay.

CONTROL OF BLOOD PRESSURE IN CORONARY HYPERTENSIVES OVER THE DECADE FROM 1997 TO 2007: PP.7.273

The European guidelines for preventive cardiology give the highest priority to patients with established coronary artery disease. The aim of the analysis was to assess trend of blood pressure control in hypertensive subjects with coronary artery disease from 1997 to 2007. Methods: Consecutive patients hospitalized due to acute coronary syndrome or for myocardial revascularization procedures, below the age of < 71 years in five hospitals serving the area of the city of Krakow and surrounding districts inhabited by 1 200 000 population were identified and then followed up, interviewed and examined 6–18 months after discharge in 1997/1998, 1999/2000 and 2006/2007. Results: The number of hypertensives who participated in the surveys were: 229 in the first, 274 in the second and 346 in the third survey. The study groups differ in respect of mean age (57.2 ± 7.7 vs 58.7 ± 7.6 vs 59.4 ± 7.1 years; p < 0.01) but not in respect of sex distribution (men: 65% vs 66% vs 71%; p=NS) nor education. Proportion of uncontrolled blood pressure (BP >=140/90 mmHg) did not change from 1997/1998 to 1999/2000 (60% vs 61%; p=NS), but decreased in 2006/2007 (49%; p < 0.05 vs 1997/1998 and p < 0.01 vs 1999/2000). Mean systolic BP was lower in 2006/2007 (137.4 ± 20.7 mmHg) when compared with 1997/1998 (143.5 ± 22.4 mmHg; p < 0.001) and 1999/2000 (145.4 ± 21.8 mmHg; p < 0.001). Mean diastolic BP did not differ significantly (85.7 ± 10.8 mmHg vs 87.1 ± 12.0 mmHg vs 85.6 ± 11.2 mmHg; p=NS). The prescription rate of beta-blockers (68% vs 62% vs 89%; p < 0.001), ACE inhibitors/sartans (60% vs 61% vs 81%; p < 0.001), and diuretics (20% vs 27% vs 36%; p < 0.001) increased whereas prescription rate of calcium antagonists decreased (32% vs 39% vs 24%; p < 0.001). Conclusion: A significant improvement in the blood pressure control in coronary hypertensives could be observed in 2006/07.

RELATION OF PARENTAL HISTORY OF HYPERTENSION AND FOLLOW-UP CHANGES OF ARTERIAL STIFFNESS PARAMETERS: PP.10.397

Objectives: Central aortic blood pressure and aortic augmentation index (AI) are independent risk factor for cardiovascular events. Cross-sectional data confirms the relationship between family history of hypertension and parameters of structure and function of the large arteries in adult offspring. The objective of the present study was to assess differences in 5-years follow - up changes in BP parameters and AI in relation to parental history of hypertension. Methods: We recruited 201 members from random families (100 parent and 101 offspring (age at baseline: 58.5 and 28.9 years). From 75 normotensive descendants 9 were with a negative family history of hypertension, 36 with one hypertensive parents and 30 with both hypertensive parents. Initially and after follow up 4.8 ± 0.4 years we recorded the radial arterial waveform using the SphygmoCor device and evaluated peripheral AI (pAI) and central AI (cAI). Significance levels of between-group comparisons of the change from baseline were assessed by a general linear model that adjusted for baseline value and post-hoc Tukey test for multiple comparison. Results: In both groups with parental history of hypertension we observed significant increase in peripheral and central systolic blood pressure (SBP) during follow-up. We found higher increase in central SBP with lesser decrease in central diastolic BP in offspring with both hypertensive parents in comparison to participants with negative family history of hypertension (pTukey < 0.05). We observed significant elevation of brachial AI only in offspring with both hypertensive parents. Changes in central AI were more pronounced in both groups with parental history of hypertension, however this increase in cAI was higher in offspring with both hypertensive parents in comparison to those without hypertension in family (6.6 vs -3.0 (%); pTukey < 0.05). Conclusions: Parental history of hypertension enhances follow-up changes in BP and augmentation index. Our findings indicate that central parameters more effectively indicate differences in changes of systolic BP and arterial wall stiffening in relation to parental history of hypertension than brachial one.

CAROTID INTIMA-MEDIA THICKNESS IN RELATION TO GENETIC VARIATION IN RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM IN PROSPECTIVE OBSERVATION: PP.35.450

Objective: The essential role of the renin-angiotensin-aldosterone system (RAAS) in controlling blood pressure has been well established. Genes encoding components of the RAAS have been proposed as candidate genes that determine genetic predisposition to hypertension and the risk of developing cardiovascular complications. The aim of the study was to evaluate follow-up changes in carotid intima-media thickness (IMT) in relation to genetic polymorphisms in 5 genes of the RAAS: angiotensin-converting enzyme (ACE I/D), angiotensinogen (AGT, A-6G), aldosterone synthase (CYP11B2, T-344C), angiotensin II receptors type 1 (ATR1, A1166C) and type 2 (ATR2, G1675A). Design and Methods: We examined 147 subjects, members of 45 nuclear families, enrolled in the population-based study in Krakow. The subjects underwent at baseline and on follow-up (6.4+/−0.5 yrs) conventional BP measurement during two separate visits, 5 times on each visit. Anthropometric data were collected with standardized protocol. Peripheral blood was sampled for genotyping. Carotid IMT was measured by carotid ultrasound (Hewlett Packard Sonos 2000 - baseline and VIVID 7 GE Pro - follow-up). In our analyses, we adjusted for covariables and non-independence among related subjects. Results: The study group included 71 M/76F, at baseline mean age was 37.6+/−14.2 yrs, BMI 26.0+/−5.2 kg/m2, BP 128.1+/−17.6/80.0+/−11.2 mmHg. In multivariate analyses, the change in IMT on follow-up was significantly associated with ACE I/D polymorphism (p = 0.008). The ACE II homozygotes showed higher increase in IMT as compared to D-allele carriers (change in IMT 0.252+/−0.043 vs. 0.093+/−0.022 mm, p = 0.002). The results were consistent among male and female, and among parents and offspring. The genetic polymorphisms in CYP11B2, AGT, ATR1 or ATR2 did not associate with phenotype under study. Conclusion: Insertion/deletion (I/D) polymorphism of the ACE gene associates with prospective increase in carotid intima-media thickness. However, the present findings need further confirmation in a larger/multicentre cohort.

EFFECTIVENESS OF TREATMENT OF HYPERTENSION AMONG CORONARY PATIENTS IN POLAND: PP.19.232

Background: Control of hypertension (HT) in Polish general population is poor. However, achievement of treatment goal for hypertension is considered as a basis of secondary prevention of coronary heart disease (CAD). Methods: Consecutive patients in age <80 years hospitalized in years 2005–2006 due to acute coronary syndrome, PCI or CABG in Cracow province(1.2 mln. inhabitants) were included. Data for analysis were taken from subsamples examined in Euroaspire III- Poland (2006–2007). During the control visit, 6–18 months after hospitalization, blood pressure (BP) was measured twice and the rate of antihypertensive drugs was assessed. Treatment of HT among patients <65 and > = 65 years of age was compared. Results: There were 640 patients (455 men and 185 women) recruited in the hospital phase. Six - 18 month after hospitalization 513 patients were examined (80.1%). Systolic BP in patients <65 years of age (n = 305) was 133.8 ± 18.7 mmHg and among elderly patients (n = 208) 142.2 ± 21.9 mmHg (p < 0.05). Diastolic BP was found in both groups, respectively 85.5 ± 10.7 mmHg and 83.9 ± 11.6 mmHg (p = NS). Mean number of antihypertensive drugs in younger patients amount to 2.2 0.9, and in elderly patients 2.4 ± 0.9 (p < 0.05) (Table). Treatment target of BP (<140/90 mmHg or <130/80 mmHg in diabetic patients) was achieved in 44.4% younger patients and in 35.7% elderly. Conclusion: Although, combined antihypertensive treatment is commonly used, achievement of BP control is still insufficient, especially among patients with CAD > = 65 years of age. Figure 1. No caption available.