Małgorzata Brzozowska-Kiszka

Comparison of aortic pulse wave velocity measured by three techniques: Complior, SphygmoCor and Arteriograph.

Background New 2007 European Society of Hypertension guidelines recommend measuring arterial stiffness in patients with arterial hypertension, suggesting a carotid–femoral pulse wave velocity over 12 m/s as an estimate of subclinical organ damage. Considering this cutoff point, it is worth exploring whether or not there are significant differences in results obtained using various techniques for measuring aortic pulse wave velocity. The aim of the study was to compare aortic pulse wave velocity measurements using Complior, SphygmoCor, and Arteriograph devices, and to assess the effect of pulse wave transit time and traveled distance on pulse wave velocity values. Methods Aortic pulse wave velocity was measured on a single visit, using these devices, in randomized order, in a group of 64 patients with grade 1 or 2 arterial hypertension. Results Aortic pulse wave velocity measured using Complior (10.1 ± 1.7 m/s) was significantly higher than that obtained using SphygmoCor (8.1 ± 1.1 m/s) or Arteriograph (8.6 ± 1.3 m/s). No differences were noted between pulse wave velocity measurements using SphygmoCor and Arteriograph. Between-method comparison revealed that differences in traveled distance were significant: Complior versus Arteriograph [0.09 m, Confidence interval (CI): 0.08–0.12 m, P < 0.05], Complior versus SphygmoCor (0.15 m, CI: 0.13–0.16 m, P < 0.05), Arteriograph versus SphygmoCor (0.05 m, CI: 0.03–0.07 m, P < 0.05). No between-method differences were found for transit times. Conclusion Differences in pulse wave velocity obtained by compared devices resulted primarily from using various methods for measuring traveled distance. It appears reasonable to establish uniform principles for the measurement of traveled distance. Because a large number of prognosis/survival studies used direct distance between carotid and femoral sites of pulse wave recording, this distance should be mostly recommended.

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.

THE INFLUENCE OF ANTIHYPERTENSIVE TREATMENT ON ARTERIAL STIFFNESS, SHEAR STRESS AND METALLOPROTEINASES ACTIVITY: PP.10.409

The aim of the study was to compare the effects of 5 drugs representing different antihypertensive classes on arterial stiffness, arterial wall shear stress and selected metalloproteinases (MMPs) activity among patients with essential arterial hypertension as well as to evaluate the relationship between changes in above mentioned parameters during antihypertensive treatment. Material and Methods: 95 pts. with hypertension stage 1 and 2, (N = 19 in each treatment group) were treated for 6 months by: quinapril 20–40 mg/d (group-1), amlodipine 5–10 mg/d (group-2), hydrochlorothiazide 12,5–25 mg/d (group-3), losartan 50–100 mg/d (group 4), bisoprolol 5–10 mg/d (group-5). Before and then after 1,3 and 6 months of treatment wall shear stress in common carotid artery (CCA) was calculated using whole blood viscosity measured by Brookfield DV-III pro and maximal blood flow velocity measured ultrasonographically. At the same visits carotid femoral pulse wave velocity (PWV) was measured using 3 devices Complior®, Sphygmocor® and ArteriographTM, office BP was measured using Omron M5-I in standard conditions. Plasma concentration of (MMP-s): MMP1, MMP2, MMP3, MMP9 and MMPs tissue inhibitor (TIMP-1) was measured twice i.e. before and after 6 month of treatment. Results: At the baseline no differences between groups were observed in BP, PWV, CCA-shear stress and MMPs activity. ANOVA for repeated measurements revealed for all groups during treatment period significant decrease in SBP(p < 0.001), DBP(p < 0.001), PWV measured by three different devices (p < 0.001),MMP2 (p < 0.05) and MMP3 (p < 0.001) plasma concentration. Significant increase was observed in CCA-shear stress (p < 0.001) and TIMP-1 (p < 0.001). No between groups differences were observed in above mentioned effects. In multiple regression analysis decrease of arterial stiffness (ÄPWV) was in significant relation to its baseline value (B = 0.449, p = 0.0051), increase of TIMP-1 (B = 0.271, p = 0.0009) decrease of MMP3 plasma concentration (B = - 0.210, p = 0.001) and increase of CCA- wall shear stress (B = 0.169, p = 0.0029).

AMBULATORY OR HOME MEASUREMENT OF BLOOD PRESSURE? - EFFECT OF TREATMENT IN PATIENTS WITH ESSENTIAL HYPERTENSION: PP.14.38

Introduction: Ambulatory blood pressure monitoring (ABPM) and home blood pressure (HBPM) monitoring have been shown to be superior to conventional measurement of blood pressure (BP) in terms of reproducibility, relationship to the impact of high BP on target organs, and the prediction of cardiovascular events. The aim of study was a comparison between office BP measurement, HBPM and ABPM in patients with essential hypertension during antihypertensive treatment. Method: We randomized 80 patients with primary mild or moderate hypertension (mean age: 51,3 ± 9.8 yrs.). BP measurements were performed by OMRON M5-I device or TensioPhone device. On each visit (after 1, 4, 7, 10 month) office BP and ABPM was performed. Treatment regime was the same in whole group. Results: Reduction in BP was observed in group in office (-23.5/-11.8 mmHg), HBPM (-11,7/-8.2 mmHg) and ABPM (-14.7/-7.4 mmHg) measurements. When we correlate measurement from baseline and visits after 1, 4, 7 and 10 months of treatment we found closer correlation between ABPM and HBPM, ABPM with office measurement (table 1). Correlation of HBPM with office measurement was lower (table 1). Figure 1. No caption available. Conclusions: ABPM and HBPM are equally effective method in diagnosis and management of hypertension and could be an alternative to office BP.

CHANGES IN QUALITY OF LIFE IN HYPERTENSIVE PATIENTS DURING HOME BLOOD PRESSURE TELEMONITORING: PP.25.18

Aim: To assess changes in quality of life (QoL) during self-measurement of BP at home and combination of self home BP monitoring with teletransmission during antihypertensive treatment. Material and Methods: Eighty hypertensive patients never treated (age: 18-65 yrs.). We randomized 40 pts for telemonitoring (TELE - by TensioCare® system) and 40 patients for self home BP monitoring (SDOM - by OMROM M5-I device). The study lasted 10 months. In both groups the antihypertensive treatment was the same and was intensified during follow-up visits, if BP was > 130/85 mmHg. At baseline and after 9 months assessment of QoL by the Psychological General Well-being index (PGWB) was performed. Results: At baseline, the TELE and the SDO M groups did not differ in relation to age, gender, BMI, prevalence of diabetes, dyslipidemia, smoking, cholesterol, as well as to office BP and ABPM values. During treatment a decrease in BP was observed in both groups: at office (p < 0.01), at home (p < 0.05) and at ABPM (p < 0.05). The ANOVA analysis did not show any BP differences between groups during consecutive follow-up visits. At baseline total index of the PGWB was the same in both groups (TELE: 91,9 vs SDOM: 85,6 points, p > 0.05). At 9 month no differences in quality of life between two groups were found (TELE: 95.6 vs SDOM: 90.7 points, p > 0.05). However in all patients analyzed together (80 subjects), despite of the method of home BP monitoring, a significant improvement in QoL was observed, from 88.8 +/-15.5 points at baseline to 93.1 +/- 14.2 points at 9 month, respectively (p < 0.01). Only 2 factors were associated with improvement of QoL at the end of observation, i.e. lower SBP and DBP values (p < 0.05). Conclusions: Method of home BP monitoring does not influence the QoL of patients undergoing pharmacotherapy due to hypertension. The improvement in QoL observed in all patients was an effect of better BP control obtained during treatment.