Yonggu Lee

The beneficial effects of Tai Chi exercise on endothelial function and arterial stiffness in elderly women with rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) has been known to be associated with increased risk of cardiovascular disease (CVD). The aim of this study was to investigate the effects of Tai Chi exercise on CVD risk in elderly women with RA.MethodIn total, 56 female patients with RA were assigned to either a Tai Chi exercise group (29 patients) receiving a 3-month exercise intervention once a week or a control group (27 patients) receiving general information about the benefits of exercise. All participants were assessed at baseline and at 3 months for RA disease activity (Disease Activity Score 28 and Routine Assessment of Patient Index Data 3), functional disability (Health Assessment Questionnaire), CVD risk factors (blood pressure, lipids profile, body composition, and smoking), and three atherosclerotic measurements: carotid intima-media thickness, flow-mediated dilatation (FMD), and brachial-ankle pulse wave velocity (baPWV).ResultsFMD, representative of endothelial function, significantly increased in the Tai Chi exercise group (initial 5.85 ± 2.05 versus 3 months 7.75 ± 2.53 %) compared with the control group (initial 6.31 ± 2.12 versus 3 months 5.78 ± 2.13 %) (P = 1.76 × 10−3). Moreover, baPWV, representative of arterial stiffness, significantly decreased in the Tai Chi exercise group (initial 1693.7 ± 348.3 versus 3 months 1600.1 ± 291.0 cm/s) compared with the control group (initial 1740.3 ± 185.3 versus 3 months 1792.8 ± 326.1 cm/s) (P = 1.57 × 10−2). In addition, total cholesterol decreased significantly in the Tai Chi exercise group compared with the control group (−7.8 ± 15.5 versus 2.9 ± 12.2 mg/dl, P = 2.72 × 10−2); other changes in RA-related characteristics were not significantly different between the two groups. Tai Chi exercise remained significantly associated with improved endothelial function (FMD; P = 4.32 × 10−3) and arterial stiffness (baPWV; P = 2.22 × 10−2) after adjustment for improvement in total cholesterol level.ConclusionTai Chi exercise improved endothelial dysfunction and arterial stiffness in elderly women with RA, suggesting that it can be a useful behavioral strategy for CVD prevention in patients with RA.

Erratum to: Relationship between nocturnal blood pressure and 24-h urinary sodium excretion in a rural population in Korea

Background The relationship between sodium intake and blood pressure (BP) is affected by many factors such as absolute level of sodium intake, salt sensitivity, and the accuracy or the timing of the BP measurement. There is no epidemiologic study using both ambulatory BP monitoring (ABPM) and 24-h urine sample in a middle-aged general population.

Revised definition of predicted left ventricular mass using ambulatory blood pressure in healthy Korean adults

BackgroundLeft ventricular hypertrophy is influenced by both hemodynamic and non-hemodynamic factors. Ambulatory blood pressure is correlated with left ventricular hypertrophy. We established the influences of hemodynamic and non-hemodynamic factors, including ambulatory blood pressure, on variation in left ventricular mass in healthy Korean adults.MethodWe included 172 subjects (male = 71, female = 101), with normal body mass index and blood pressure, in an analysis of data from the Yangpyung and Yeoju cohort studies and a tertiary cardiovascular center. Left ventricular mass was calculated using the equation: [1.04 × (IVSd + LVDd + PWTd) 3-(LDVs3)] × 0.8 + 0.6. Stroke volume was calculated (mL/beat) using Teichholz’s formula. Stroke work (SW in gram-meters/beat [g-m/beat]) was computed as ambulatory systolic BP × stroke volume × 0.0144.ResultsStroke work was the most important determinant associated with left ventricular mass (adjusted R2 = 0.442, p < 0.001), independent of height2.7 and sex. In a regression model including stroke work, height,2.7 and sex, the left ventricular mass was predicted by the equation: 43.11 + 0.61 × SW (g-m/beat) + 9.21 × height2.7-13.99 × sex (male = 1, female = 2) (constant = 43.11 ± 25.88, adjusted R2 = 0.532, p < 0.001).ConclusionWe examined ambulatory blood pressure, as in previous studies, and identified stroke work, height2.7, and sex as important determinants of left ventricular mass in Korean adults of normal weight and normal blood pressure. Ambulatory blood pressure is superior to clinical blood pressure for determining stroke work and predicted left ventricular mass.

OS 03-01 HIGHER SALT INTAKE ATTENUATES NOCTURNAL DIPPING IN BLOOD PRESSURE AND HEART RATE.

Objective: Objective: It is now established that “dippers” whose blood pressure (BP) falls at night have lower cardiovascular risks than nondippers without nocturnal BP fall. Our previous study on the middle-aged general population in Korea indicated increased 24-hour urinary (24U) sodium excretion was associated with increased nighttime BPs. Therefore, we further analyzed the association of salt intakes estimated by 24U analysis with dipping in nocturnal BP and heart rate. Design and Method: Design and method: In the rural area in South Korea 218 subjects aged 30 to 59 years were measured with casual and ambulatory BP monitoring (ABPM) (TM2430, A&D, Tokyo, Japan) and their 24U samples collected by aliquot cups were analyzed. Results: For both ABPM and 24U analyses, 148 subjects, aged 47.4 ± 8.3 years in average and female rates 57.4%, were accepted for data analysis by the 24U creatinine equation. Salt intake, previously proven to be associated with nighttime systolic and diastolic BP but not with casual and daytime BP, was further analyzed to be significantly inversely associated not only with nocturnal dipping in systolic and diastolic BP (P < 0.01, 0.001), but also in heart rate (P < 0.01). Correlations of the dipping of systolic (Fig) and diastolic BPs with heart rate were significant (P < 0.001, 0.01). Conclusions: Conclusion: Higher salt intake attenuates dipping not only in BP but also in heart rate. Nocturnal heart rate monitoring, more easily available than ABPM, may be useful for detecting nocturnal BP rise and salt sensitivity related to cardiovascular risks.

MPS 04-04 THE ASSOCIATION OF MASKED HYPERTENSION AND TARGET ORGAN DAMAGES IN TWO KOREAN POPULATIONS IN RURAL AREAS

Objective: Masked hypertension (MH) in hypertension (HT) management is marked with poor prognosis regardless of the drug therapy. But the physiology or pathogenesis behind is not well understood. Clinical study results have been focused on the neglected pressure overload which could result in more subclinical organ damage. But epidemiologic study on MH showed highly variable results regarding the prevalence and the associated factor with MH. Design and Method: For the subject participated in ambulatory blood pressure monitoring (ABPM) examination during epidemiologic survey performed in Yangpyeong and Yeojoo counties in year 2009 and 2011, respectively. Subjects in Yangpyeong was relatively older (56.3 ± 10.4 (n = 133) vs 46.3 ± 8.5 (n = 180), p = <0.0001). MH was defined as normal clinic BP and elevated daytime ABPM 3 135/85 mmHg. Asymptomatic target organ damage such as echocardiographic left ventricular mass index (LVMI), brachial ankle pulse wave velocity (baPWV), ankle brachial index (ABI), and estimated GFR (eGFR) related to MH were investigated. Results: Age was 50.5 ± 10.5 and the female was 54%. The overall prevalence of MH was 29.7% (n = 81/273) whereas whitecoat HT and sustained HT were 6.2% (n = 17/273) and 14.3% (n = 39/273), respectively. Compared to normotension, MH showed significantly higher baPWV (1442.8 vs 1332.7 cm/sec, p = 0.0002) but there were no differences in LVMI (73.3 ± 21.4 vs 76.4 ± 21.5 gm/m2, p = 0.3179), ABI, or eGFR. Compared to normotensive or MH, sustained HT group showed significantly higher LVMI (73.3 ± 21.4 vs 91.9 ± 19.6 gm/m2, p < 0.0001) and baPWV (1332.7 ± 215.5 vs 1704.1 ± 289.3 cm/s, p < 0.0001). Compared to MH, sustained HT showed significantly higher baPWV (p < 0.0001) and LVMI (p = 0.0002). Conclusions: In our population study including relatively young subjects, it was shown that vascular stiffness was more sensitive marker to demonstrate the difference in the organ damage between normotensive and masked hypertension.

PS 06-20 THE INTERACTION BETWEEN GENDER AND HEIGHT IN THE RELATIONSHIP WITH CENTRAL BLOOD PRESSURE AND BRACHIAL ANKLE PULSE WAVE VELOCITY

Objective: It has been reported that pulse pressure amplification (PPa) in elderly hypertensive subjects is larger in females than in males. Because the gender difference in heights remains, while other biological differences between genders decrease in the elderly, the gender difference in PPa may be confounded by heights. Therefore, we investigated the influence of heights on the PPa and brachial ankle pulse wave velocity (baPWV). Design and Method: A cross-sectional study was performed with a general population in two rural areas of South Korea. PPa was defined as the difference between brachial systolic blood pressure (BSBP) and central systolic blood pressure (CSBP). Results: A total of 473 (292 females; the mean age, 58.1 ± 11.8 years) subjects were analyzed. Male subjects were taller than female subjects (166.8 ± 6.1 cm vs. 154.1 ± 5.7 cm, p < 0.001). BSBPs were higher in male subjects, whereas there were no differences in CSBPs between genders. PPa was larger in male subjects than in female subjects (−3.8 ± 7.9 mmHg vs. −8.2 ± 4.6 mmHg, p < 0.0001). baPWVs were marginally higher in male subjects than in female subjects (1525.8 ± 315.8 cm/s vs. 1468.9 ± 319.9 cm/s, p = 0.0597). Stepwise general linear modeling showed that height (adjusted R2 [adjR2] = 0.1738), age (adjR2 = 0.1984), the product of gender and height (adjR2 = 0.2090), gender (adjR2 = 0.2242) and drinking (adjR2 = 0.2329) were included in the model for PPa, and that age (adjR2 = 0.3455), metabolic syndrome (adjR2 = 0.3539), the product of gender and height (adjR2 = 0.3615) and gender (adjR2 = 0.3679) were included in the model for baPWV, in the orders appeared. Conclusions: The association of heights with PPa and arterial stiffness was stronger than that of gender, and the interaction between height and gender should be considered in studies for gender differences in vascular aging.

OS 03-03 POSSIBLE DETECTION OF INDIVIDUAL SALT-SENSITIVE BLOOD PRESSURE ELEVATION BY 24-HOUR URINARY SODIUM EXCRETION AND NIGHTTIME HEART RATE.

Objective: Detection of individual difference in salt-induced blood pressure (BP) elevation is important to know who should reduce salt intake for preventing hypertension, but the diagnosis of salt sensitivity requires a time-consuming protocol for testing BP changes in response to salt loading and depletion. Since WHO-CARDIAC Study indicated BP was higher in the people excreting more 24-hour urinary (24U) salt with higher heart rate (HR), ambulatory BP was monitored in a Korean population to investigate the association of nighttime BP and HR with 24-hour urinary salt excretion for detecting salt sensitivity. Design and method: Total 101 males and females aged 30 to 61 years were examined for ambulatory BP (by TM2430, A&D, Tokyo, Japan) and 24U collected by aliquot cups. Results: In the participants excreting 24U salt equal to or higher than (≥) the mean, 10.8 g, nighttime systolic and diastolic BP (SBP, DBP), in the group with HR ≥ the mean, 64.7 beats/min (18) were 119.8/77.1 mmHg, significantly higher than 109.2/67.8 mmHg in the group with HR. Conclusions: Significant nighttime BP elevation could be detected by 24U salt ≥ 10 g and nighttime HR ≥ 65 in this Korean population. Collecting 24U by using a simple aliquot cup and monitoring nighttime HR by a wrist watch-type HR detector are expected to detect salt sensitivity also in other populations, as noted in significantly higher BP in 50 CARDIAC Study populations with higher 24U salt and HR than their means.

PS 18-22 Relationship of nocturnal BP and dipping according to 24-hour urinary sodium excretion and nocturnal heart rate

Objective: Blood pressure (BP) normally decreases during the night. Non-dipping is associated with increased cardiovascular risk. Altered autonomic and endocrine function is suspected to play a role. On the other hand, urinary sodium excretion is mainly controlled by pressure-natriuresis. However, relation between urinary sodium excretion and nocturnal dipping is complex and uncertain. Therefore, this study investigates the relation of 24hour urinary salt excretion and nocturnal dipping according to nighttime heart rate (HR). Design and Method: From 2011 to 2012, data from 315 patients hospitalizing tertiary referral center in Korea were analyzed. These patients underwent ambulatory blood pressure monitoring (ABPM) and 24-hour urine collection. Results: Mean nocturnal HR is 65.9 bpm. Mean 24-hour urine sodium excretion is 135.0 mEq/day. In the group with HR < the mean, nocturnal systolic and diastolic BP in patients excreting ≥ mean 24 hour urine sodium are 120.9/72.2 mmHg, significantly higher than 113.5/67.4 mmHg in patients excreting < mean 24 hour urine sodium. In the group with HR ≥ the mean, nocturnal dipping in patients excreting ≥ mean 24 hour urine sodium is 9.0%, significantly higher than 6.2% in patients excreting < mean 24 hour urine sodium. Conclusions: According to nocturnal HR and 24-hour urine sodium excretion, nocturnal dipping, systolic BP and diastolic BP show different feature. We wish to draw attention to differences in the relationship of nocturnal BP to nocturnal HR and sodium excretion and to how pressure–natriuresis, autonomic function, and sodium sensitivity of blood pressure interact.

926 WITHIN-VISIT BLOOD PRESSURE VARIABILITY AND RELEVANT FACTORS IN THE GENERAL POPULATION

Objectives: In this, study, we aimed to investigate within-visit BP variability and its relevant factors in a nationwide epidemiologic survey. Design & Methods: We analyzed the Korean National Health and Nutrition Examination Survey (KNHNES) data for 2005 (n = 5488). BP was measured three times in KNHNES. We examined three within-visit BP variability parameters: the alarm reaction (AR), within-visit BP discrepancy (&Dgr;BPmax) and standard deviation (BPSD). Results: First BP, age, estimated glomerular filtration rate (eGFR) and female gender were associated with AR. Moreover, age, fasting glucose, eGFR, total cholesterol, LDL cholesterol, and the metabolic syndrome (MetS) score were relevant factors for systolic AR, &Dgr;SBPmax and SBPSD. Multiple linear regression models revealed that age (&bgr; = 0.043, p < 0.0001), official systolic BP level (&bgr; = - 0.022, p < 0.0001), the MetS score (&bgr; = 0.290, p < 0.0001), female gender (&bgr; = 0.674, p = 0.007) and eGFR (&bgr; = 0.017, p = 0.049) were independently associated with systolic AR, while age (&bgr; = 0.031 and 0.017, p < 0.0001), official systolic BP level (&bgr; = 0.035 and 0.018, p < 0.0001), and female gender (&bgr; = 0.455 and 0.246, p = 0.024 and 0.022) were independently associated with &Dgr;SBPmax and SBPSD, respectively. Conclusions: Within-visit BP variability, especially in systolic BP is significantly associated with greater age, female gender and cardiovascular risk factors such as hypertension, low eGFR, and adverse glucose and lipid profiles. In addition, greater age, female gender, eGFR and MetS score were independently relevant factors for systolic AR.

743 THE PREVALENCE AND THE PREDICTORS OF RENAL ARTERY STENOSIS IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHY.

Background: Patients undergoing coronary angiography (CAG) often have risk factors of systemic atherosclerosis, which includes coronary artery disease (CAD) as well as renal artery stenosis (RAS). RAS is an important and sometimes correctable, yet underestimated contributor to refractory hypertension and ischemic nephropathy, which may lead to acute coronary syndrome and end stage renal disease. Renal angiography (RAG) could be considered as an easy additional test followed by CAG. So we investigated the prevalence and predictors of RAS in patients undergoing CAG. Methods: From Jan. 2007 to Dec. 2008, 306 patients were examined with CAG and renal angiography simultaneously. A RAS ≥50% was considered as significant. A CAD with at least one stenotic lesion ≥70% was considered as significant. Results: RAS and significant RAS were found in 42 patients (13.7%) and 16 patients (5.2%) respectively. Patients with RAS were more likely to be older, to have significant CAD, hypertension, low estimated glomerular filtration rate (eGFR) and carotid atheroma (CA). Multivessel CAD was more common in patients with significant RAS. In univariate analysis, CAD, hypertension, age ≥70, CA were predictors of RAS and significant RAS, and eGFR ⩽60 was a predictor of significant RAS. In multivariate analysis, CAD was the only independent predictor of RAS, while CAD, hypertension, and eGFR⩽60 were independent predictors of significant RAS. Conclusions: Presence of CAD is an independent predictor of RAS. It is feasible and reasonable to perform simultaneous RAG during CAG, in order to screen RAS, in patients with significant CAD, hypertension and low eGFR.