Arterial stiffness in masked hypertension and true hypertension

Young-Soo Lee, Kee Sik Kim, Myung Jun Seung, Jung Hyun Kim, So-Yeon Kim, Jin-Bae Lee, Jae-Kean Ryu, Ji-Yong Choi, Kee-Sik Kim, Sung-Gug Chang
2009 Artery Research  
Individuals with a systolic BP of 120 to 139 mmHg or a diastolic BP of 80 to 89 mmHg should be considered as pre-hypertensive. however limited evidence exists on whether the early drug intervention is needed according to identification of other cardiovascular risk factors except diabetes. Aortic pulse wave velocity (PWV) as an index of aortic stiffening is known recently as a new predictor for future cardiovascular events. We examined the relation between PWV and blood pressure response during
more » ... xercise in the patients with pre-hypertension, because exaggerated blood pressure response during exercise even in asymptomatic normotensive individuals is associated with other established cardiovascular risk factors. Methods: 96 consecutive patients with pre-hypertension were monitored during symptom-limited incremental exercise testing with treadmill. Cuff blood pressure was measured every minute during exercise testing with automatic indirect manometer. Results: Although there were no significant differences in diastolic blood pressure at rest and at the peak exercise between the patients with high PWV (!15% higher than age-matched average value, nZ39) and those with low PWV(<15% than average value, nZ57), the former reached a higher systolic blood pressure at peak exercise (194.7AE28.7 versus 170.0AE25.3 mmHg, PZ0.021). However, there were no differences in the age, sex, total cholesterol, and glucose between two groups. Conclusion: We found that those with high PWV had significantly higher systolic blood pressure response during exercise than those without high PWV among the patients with pre-hypertension. This suggests strongly that a high PWV in pre-hypertension is associated with greater likelihood of developing hypertensive complications and may be an important factor in early evaluation of pre-hypertension related to target organ damage. 9. Background: Carotid intima-media thickness (CIMT) is a surrogate marker of cardiovascular disease (CVD). CIMT values ‡75th percentile of normal subjects are considered high and indicative of increased CVD risk. It is a rare data about normal CIMT values in Asian subjects without conventional CVD risk factors, coronary artery disease and cerebrovascular disease. So, we evaluate the normal CIMT values in a community cohort and the relationship between CVD risk factors and CIMT. Methods: We measured CIMT with B-mode ultrasound (Vivid 7, GE Healthcare) in 1,759 subjects aged 40-70 years from ARIRANG study. The normal healthy subject was defined as 1)whom without history of cerebrovascular disease, coronary artery disease, congestive heart failure, dyslipidemia and diabetes mellitus, 2) who was not smoking, 3) whose body mass index <25 kg/m2, 4) whose fasting blood glucose and 2-hour postprandial glucose level were <126 mg/dl and <200mg/dl, respectively, 5) whose total cholesterol level was <220mg/dl, 6) whose systolic blood pressure and diastolic blood pressure was <140/90mmHg. Results: In 1759 subjects, there were 335 of normal healthy subjects (male: 81, female: 254). Mean CIMT and 75% CIMT values showed in table. The mean CIMT values were significantly increased with age (male p trend Z 0.002; female p trend <0.001). Mean CIMT showed significantly correlated with age (r Z 0.52, p <0.001), abdominal circumference(r Z 0.26, p <0.001), systolic blood pressure(r Z 0.18, p Z 0.001), triglyceride(r Z 0.12, p Z 0.037) and Framingham's risk score(r Z 0.156, p Z 0.000). Table Mean CIMT and 75% CIMT value (mm) Male (nZ81) Female (nZ254) Age Mean IMT 75% Mean IMT 75% 40w49 0.546 AE 0.071 0.602 0.482 AE 0.073 0.520 50w59 0.566 AE 0.133 0.610 0.535 AE 0.105 0.572 60w70 0.654 AE 0.129 0.710 0.632 AE 0.115 0.687. Conclusion: We defined the normal CIMT values of healthy subjects more strict criteria than other studies and the relationships between risk factors of atherosclerosis and CIMT. Our data suggested that the normal CIMT value of a Korean community cohort is thinner than previously published data from western countries.
doi:10.1016/j.artres.2009.06.013 fatcat:cdhrtzqddbf7nckidl6hc6ivz4