Piibe Muda

Differential Effects of Nebivolol and Metoprolol on Central Aortic Pressure and Left Ventricular Wall Thickness

The aim of this study was to investigate the effects of the vasodilating &bgr;-blocker nebivolol and the cardioselective &bgr;-blocker metoprolol succinate on aortic blood pressure and left ventricular wall thickness. We conducted a randomized, double-blind study on 80 hypertensive patients. The patients received either 5 mg of nebivolol or 50 to 100 mg of metoprolol succinate daily for 1 year. Their heart rate, central and brachial blood pressures, mean arterial pressure, augmentation index, carotid-femoral pulse wave velocity, and left ventricular wall thickness were measured at baseline and at the end of the study. Nebivolol and metoprolol significantly reduced heart rate, brachial blood pressure, and mean arterial pressure to the same degree. However, reductions in central systolic and diastolic blood pressures, central pulse pressure, and left ventricular wall thickness were significant only in the nebivolol group. The change in left ventricular septal wall thickness was significantly correlated with central systolic blood pressure change (r=0.41; P=0.001) and with central pulse pressure change (r=0.32; P=0.01). No significant changes in augmentation index or carotid-femoral pulse wave velocity were detected in either treatment group. This proof-of-principle study provides evidence to suggest that &bgr;-blockers with vasodilating properties may offer advantages over conventional &bgr;-blockers in antihypertensive therapy; however, this remains to be tested in a larger trial.

Augmentation index and carotid intima-media thickness are differently related to age, C-reactive protein and oxidized low-density lipoprotein

Objective Ageing, plasma circulating C-reactive protein (CRP), oxidized low-density lipoprotein (OxLDL) and homocysteine (Hcy) are associated with atherosclerosis. The aim of this study was to evaluate the relationship between age, inflammatory and oxidative stress-related markers with functional and structural changes of the arteries in asymptomatic persons. Methods CRP, OxLDL and Hcy were measured in 175 clinically healthy subjects, aged 40–70 years. Ultrasonography and pulse wave analysis were used to measure carotid intima–media thickness (IMT) and augmentation index (AIx). Results OxLDL was correlated with IMT (r = 0.24, P = 0.003), whereas CRP was correlated with AIx (r = 0.21, P = 0.005). No correlation was detected between Hcy and AIx or age-adjusted IMT. There was a significant association between AIx and age ≤50 years (r = 0.33; P = 0.001) and between IMT and age > 50 years (r = 0.40; P = 0.001). In stepwise regression analysis age, weight, white blood cell count, OxLDL, heart rate and timing of the reflected waveform adjusted for height were significantly and independently associated with IMT (R2 = 0.41; P < 0.001). At the same time, AIx as the dependent variable correlated positively with age, gender, CRP and mean arterial pressure, and negatively with heart rate, weight and height, in stepwise regression analysis (R2 = 0.63; P < 0.001). Conclusion The results of the present study showed that CRP, OxLDL, Hcy and age are not similarly related to AIx and IMT in asymptomatic persons. The results suggest that CRP and younger age are related to arterial stiffness, whereas OxLDL and older age become more important determinants of structural changes of the arteries in asymptomatic persons.

Acute phase proteins and oxidised low-density lipoprotein in association with ischemic stroke subtype, severity and outcome.

Objectives: The goal of our study was to investigate the associations of oxidized LDL (apoB100 aldehyde-modified form) and acute phase proteins (fibrinogen, CRP) with acute ischemic stroke severity and outcome. Materials and Methods: The study included 61 ischemic stroke patients and 64 controls. Strokes were subtyped according to TOAST criteria, the severity and outcome of stroke (at 1 year) were measured. Results: The mean triglyceride, fibrinogen, CRP and glucose values were significantly higher among cases. The median oxLDL value for patients with large artery atherosclerosis (LAA) type of stroke was significantly higher than for other subtypes. The oxLDL values did not correlate with age, stroke severity and outcome. Conclusions: Inflammatory markers (fibrinogen and CRP) predicted the stroke severity and outcome whereas elevation of oxLDL levels did not. Our data refer to possibility that there may exist some links between the LAA subtype of stroke and elevated oxLDL (apoB100 aldehyde-modified form).

Effect of antihypertensive treatment with candesartan or amlodipine on glutathione and its redox status, homocysteine and vitamin concentrations in patients with essential hypertension.

Objective To compare the effect of candesartan or amlodipine on concentrations of cellular markers of oxidative stress, plasma homocysteine and vitamins in hypertensive patients. Methods Forty-nine middle-aged patients with untreated stage I–II essential hypertension were recruited in a randomized double-blind double-dummy study to receive a daily dose either of 8 mg candesartan (n = 25) or 5 mg amlodipine (n = 24) for 16 weeks. Blood pressure, reduced glutathione (GSH) and oxidized glutathione (GSSG), glutathione redox ratio (GSSG : GSH) in red blood cells, plasma homocysteine, vitamin B12 and folic acid status were measured at baseline, at week 2 and at week 16. The same parameters were measured in 32 healthy age- and sex-matched controls. An increase in homocysteine of at least 2 μmol/l was considered significant. Results Hypertensive patients had significantly greater oxidative stress and homocysteine concentrations than controls. In addition to a significant decrease in blood pressure, in both treatment groups GSSG decreased (P < 0.03), GSSG : GSH had a tendency to decrease (P = 0.054), but homocysteine did not change. An increase in homocysteine concentration of at least 2 μmol/l was found in 12 patients (five in the candesartan group, seven in the amlodipine group), with a significant decrease in folic acid concentration and no changes in cellular oxidative stress. In patients with no increase in homocysteine concentration, both GSSG (P < 0.02) and GSSG : GSH (P = 0.051) decreased. GSH and vitamin B12 did not change in any of the groups studied. Conclusion: Untreated hypertension is associated with disturbed glutathione redox status and increased plasma homocysteine concentrations. Both candesartan and amlodipine had favourable effects on cellular oxidative stress, but the oxidative stress status did not decrease in patients with adverse changes in homocysteine.

Association between asymmetric dimethylarginine and indices of vascular function in patients with essential hypertension.

Abstract Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase and is associated with endothelial dysfunction. The aim of the present study was to investigate the relationship between ADMA, indices of arterial stiffness, endothelial function and carotid artery intima-media thickness (IMT) in hypertension patients. Eighty middle-aged (47 ± 10 years) untreated patients with mild to moderate essential hypertension underwent routine physical examination, pulse wave analysis (PWA), measurement of aortic pulse wave velocity (PWV) and IMT. In PWA, administration of salbutamol and nitroglycerine was used to assess endothelium-dependent (EDV) and endothelium-independent vasodilation, respectively. In univariate analysis, ADMA was correlated with EDV (r = −0.26; p = 0.02) and IMT (r = 0.32; p = 0.007). In multiple regression analysis, ADMA was independently associated with the female gender, EDV, IMT and total cholesterol (R2 = 0.30; p < 0.001). No correlation was detected between ADMA and augmentation index, central/brachial blood pressure or aortic PWV. In hypertension patients, ADMA is independently correlated with IMT and EDV. Thus, ADMA is a marker of endothelial dysfunction and intima-media thickening in patients with hypertension.

Effects of amlodipine and candesartan on oxidized LDL level in patients with mild to moderate essential hypertension

Objective. To compare the effects of amlodipine and candesartan on oxidized low‐density lipoprotein (OxLDL), conjugated dienes (CD) and baseline diene conjugation in circulating low‐density lipoproteins (LDL‐BDC) level during antihypertensive treatment. Methods. Forty‐nine patients with untreated mild to moderate essential hypertension were recruited in a randomized double‐blind study to receive a daily dose either of 8 mg candesartan or 5 mg amlodipine for 16 weeks. Blood pressure, OxLDL, CD, LDL‐BDC, triglycerides (TG), total cholesterol and lipoprotein cholesterol were measured at baseline, at week 2 and at week 16. Results. During treatment, in addition to a significant decrease in systolic and diastolic blood pressure, high level of OxLDL decreased significantly reaching practically upper kit reference values. Both treatment groups were similar with regard to the studied parameters at all time points. At the same time serum TG, lipoprotein and total cholesterol levels as well as LDL‐BDC did not change and CD levels did not exceed endemic normal. Decrease in both systolic and diastolic blood pressure was associated with decrease in LDL‐BDC/LDL. Conclusions. Besides their antihypertensive effects, both candesartan and amlodipine are efficient drugs for reducing OxLDL level, being neutral with regard to serum lipids.

NEBIVOLOL BUT NOT METOPROLOL DECREASES CENTRAL BLOOD PRESSURE AND LEFT VENTRICULAR WALL THICKNESS IN PATIENTS WITH ESSENTIAL HYPERTENSION: PP.10.411

Objective: It has been demonstrated that the vasodilating β-blocker nebivolol (NEB) significantly reduces central blood pressure (BP) compared to atenolol, despite their similar effects on peripheral BP. However, no such data has been published on metoprolol (MET), which is a more widely used cardioselective β-blocker in our region. The main aim of the present study was to compare the effects of the β-blocker NEB and MET succinate on central BP, arterial stiffness and left ventricular wall thickness in patients with essential hypertension. Methods: A total of 80 patients (41 male and 39 female) aged 30–65 years, who had never been treated for mild to moderate essential hypertension, were randomized into two treatment groups receiving either NEB 5 mg or MET succinate 50–100 mg daily for 12 months. Central BP, augmentation index (AIx) and carotid-femoral pulse wave velocity (PWV) were measured (Sphygmocor Px, AtCor) and echocardiographic examination was performed (Sonos 7500, Philips) at baseline and at the end of the study. Results: NEB and MET significantly reduced heart rate, brachial systolic BP and diastolic BP to the same degree. However, reduction in central systolic BP (p = 0.0006), central diastolic BP (p = 0.01) and central pulse pressure (p = 0.0025) was significant only in the NEB group. Moreover, there was a significant reduction of left ventricular posterior wall thickness (p = 0.0002) and a trend for reduction of left ventricular septal wall thickness (p = 0.06) only in the NEB group. No significant changes in AIx or PWV were detected in either treatment group. Conclusion: Our study expands earlier observations and shows that despite the similar effect of both drugs on brachial BP and arterial stiffness, NEB has a greater impact on central BP and left ventricular wall thickness than MET. Thus, β-blockers with vasodilating properties, such as NEB, may offer a clear advantage over conventional β-blockers in antihypertensive therapy.

Vasaku vatsakese massi ehhokardiograafilise hindamise metoodika ja ehhokardiograafia näidustused hüpertooniatõvega patsientidel

Uheks oluliseks kardiovaskulaarse riski naitajaks on vasaku vatsakese hupertroofia, mida on voimalik hinnata ehhokardiograafiliselt. Vaatamata nailisele lihtsusele ning pika ajalisele kasutuskogemusele tuleb ehhokardiograafilisel vasaku vatsakese massi hindamisel silmas pidada teatavaid metodoloogilisi aspekte, mille ignoreerimine kahandab meetodi kliinilist vaartust. Artiklis on antud ulevaade vasaku vatsakese massi hindamise metoodikast ehhokardiograafial ning ehhokardiograafia naidustustest hupertooniatovega patsientidel. Eesti Arst 2006; 85 (4): 235–242