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Inverse association between type 2 diabetes and aortic root dimension in hypertensive patients

BACKGROUNDnSome data support the concept that aortic root diameter (ARD) in hypertension may be regarded as a marker of subclinical organ damage. The impact of type 2 diabetes mellitus (DM) on cardiac structure and function is known, although the relationship between DM and ARD is not clear. The aim of our study was to evaluate the influence of DM on ARD in hypertensive patients.nnnMETHODSnWe enrolled 1693 hypertensive patients (aged 63.7±9.6years). The population was divided into two groups: the first one with DM (n=747) and the second one without DM (n=946). ARD was measured by echocardiography at level of Valsalvas sinuses using echocardiography M-mode tracings. It was considered as absolute measure and normalized to height (ARD/H) and body surface area (ARD/BSA). Left ventricular mass index (LVMI) and some parameters of systolic and diastolic function have been valued by means of echocardiography and tissue Doppler imaging.nnnRESULTSnThe DM group was characterized by more elevated values of LVMI and a worst systolic and diastolic function. ARD value was significantly lower in DM group in comparison to patients without DM only when indexed for BSA (ARD/BSA=18.7±2.3mm/m2 vs 18.3±2.0mm/m2, p=0.01). This difference remained statistically significant, even after correction by age, sex and BMI (p=0.01). A multivariate linear regression analysis demonstrated an inverse relationship between DM and ARD/BSA after correction for potential confounders (β=0.10, p<0.001).nnnCONCLUSIONSnOur results confirm the hypothesis of a protective role of DM on aortic root dilatation.

[OP.4B.03] CIRCULATING ALDOSTERONE LEVELS ARE ASSOCIATED WITH CONCENTRIC LEFT VENTRICULAR GEOMETRY IN ESSENTIAL HYPERTENSIVE PATIENTS

Objective: Sound evidence indicates that aldosterone has a fundamental role in determining functional and structural changes in the heart. Moreover, it has been observed that high plasma aldosterone concentration (PAC) is related to the development of congestive heart failure and to cardiovascular mortality. However, previous studies on the association between circulating aldosterone levels and left ventricular (LV) mass (LVM) and LV geometry, in subjects without primary aldosteronism yielded conflicting results. The aim of our study was to evaluate in patients with essential hypertension the relationships of PAC with LV mass and geometry, and to asses the influence of gender on these relationships. Design and method: A total of 478 subjects (men: 63%; mean age 44u200a±u200a12 years) with untreated essential hypertension were enrolled. The measurements included 24-h blood pressure (BP) readings, plasma renin activity (PRA) and PAC, obtained by radioimmunoassay and an echocardiogram. For its skewed distribution PAC was log transformed and expressed as median value and interquartile range. Results: PAC was significantly lower (pu200a<u200a0.01) in subjects with normal LVM indexed for body surface area (BSA) (nu200a=u200a272) [7.5 (5.3–12.4)], as compared to those with concentric remodeling (nu200a=u200a61) [10.2 [7.95–14.5)], to the patients with eccentric LV hypertrophy (LVH) (nu200a=u200a90) [9.8 (6.9–12.9)], and to the subjects with concentric LVH (nu200a=u200a61) [11.3 (7.7–16.6u200ang/ml)]. Significant correlations of Log (PAC) with LVM, either indexed for BSA (ru200a=u200a0.20; pu200a<u200a0.0001), or for height 2.7 (ru200a=u200a0.21; pu200a<u200a0.0001) and with relative wall thickness (RWT) (ru200a=u200a0.18; pu200a<u200a0.0001) were found. These correlations were similar in men and in women and remained statistically significant in multiple regression analyses, even after adjustment for potential confounding factors (all pu200a<u200a0.01). Conclusions: Our results seem to suggest that in essential hypertensive patients circulating aldosterone levels are independently associated with concentric LV geometry, without gender-related differences.

[OP.2D.05] RELATIONSHIP OF OXIDATIVE STRESS WITH CARDIAC HYPERTROPHY IN HYPERTENSIVE PATIENTS

Objective: Left ventricular hypertrophy is common in hypertensive patients. In these subjects increased oxidative stress has been observed. Our aim was to evaluate the association of biomarkers of both oxidative stress and inflammation with markers of cardiovascular damage in a large group of hypertensives with different stages of renal function. Design and method: In 517 hypertensives we analyzed left ventricular mass indexed for body surface area, and we assayed plasma levels of 8-isoprostaglandin F2&agr; and high sensitivity C reactive protein. Results: Multivariate analysis carried out considering left ventricular mass as dependent variable, and including 8-isoprostaglandin F2&agr;, high sensitivity C reactive protein, age, sex, body mass index, estimated glomerular filtration rate, serum glucose, (log)triglycerides, hemoglobin, pulse pressure or systolic blood pressure, mean or diastolic blood pressure, and antihypertensive treatment showed that in hypertensives plasma levels of 8-isoprostaglandin F2&agr; were correlated with left ventricular mass (&;=0.269, pu200a<u200a0.0001). The bivariate relationship of left ventricular mass with 8-isoprostaglandin F2&agr; in hypertensives with estimated glomerular filtration rate higher and lower than 60u200aml/min/1.73m2 was also calculated separately, demonstrating no significant differences in both correlations coefficients and slopes of the regression lines (ru200a=u200a0.254, pu200a<u200a0.001 and ru200a=u200a0.226, pu200a<u200a0.002; respectively). In the overall group, receiver operating characteristic curves showed that 8-isoprostaglandin F2&agr; and high sensitivity C reactive protein were predictors of left ventricular hypertrophy, pu200a<u200a0.0001. Conclusions: To the best of our knowledge, this is the first demonstration that in hypertensives oxidative stress is correlated to left ventricular hypertrophy independently of other confounding factors. Oxidative stress might participate in the development of hypertensive cardiac hypertrophy.