0.400.450.500.550.600.650.700.750.800.850.900.95

mm

Abstract

Intima-media thickness - IMT

László Csiba1, Katalin Réka Kovács2, Csilla-Cecília Szekeres2, Zoltán Bajkó2, Krisztina Csapó1, Sándor Molnár1, László Oláh1, Mária Tünde Magyar1, Dániel Bereczki3, Renáta Laczik4, Pál Soltész4,

László Kardos5

1Department of Neurology, University Of Debrecen Medical and Health Science Center, Debrecen, Hungary, 2Department of Neurology, Mures County Clinical Emergency Hospital, Targu-Mures, Romania, 3Department of Neurology, Semmelweis University,  Budapest, Hungary, 43rd Department of Medicine, Institute for Internal Medicine, University Of Debrecen Medical and Health Science Center, Debrecen, Hungary, 5Contract medical statistician, Debrecen, Hungary

Vascular morphological and functional impairments in symptom-free, non-treated hypertensive patients

Background: Chronic hypertension (HT) results in morphological and functional changes in the vessels. Our aim was to verify these initial subclinical alterations in early stage hypertension. Methods: The diagnosis of HT was based on ambulatory blood pressure monitoring. Diabetic patients were excluded and all HT patients had normal CT. 78 HT patients (mean age: 44,8+/-10,1 years, male/female: 0,85) were compared with 85 age-matched controls (mean age: 43,5+/- 9,3 years, male/female: 1). In both groups blood tests, intima-media thickness (IMT) and vascular stiffness parameters were measured. Attention and memory skills, anxiety and depression state were also determined by twelve neuropsychological tests. Continuous, non-invasive and simultaneous monitoring of cerebral (MCA velocity) and cardiac haemodynamical parameters were analyzed during head-up tilt table testing (HUTT).

Results: No significant differences were observed between the blood values of the two groups. The IMT was significantly thicker in the HT patients compared to the control group (0,62+/-0,11 mm vs. 0,54+/-0,08 mm, p<0,0001). Significant differences were also found in stiffness parameters: brachial augmentation index (AIx-br) was -7,69+/-29,63% in the HT group and -21,23+/-26,28% in the control group (p=0,0031), aortic pulse wave velocity (PWVao) was 10,06+/-2,38 m/s in the HT group and 8,64+/-1,96 m/s in the control group (p<0,0001). Alterations of neuropsychological performances of HT patients were also observed in some tests (WAIS Digit Span Test-forward recall p<0,0001, WAIS Digit Symbol Test p<0,0054). Anxiety was significantly more often present in the HT patients. The results of the parameters obtained by HUTT are under evaluation.Conclusion: Early morphological and functional impairments of the CNS could be detected in the symptom-free non-treated hypertensive patients.

death

glomerular filtration rateproteinuria/albuminuriaglomerulosclerosis

aldosterone release

LVHfibrosisremodellingapoptosis

vasoconstrictionvascular hypertrophyendothelial dysfunctionatherosclerosis

Stroke

hypertensionthrombosis

arrhythmiaheart failureMI

vascularremodelling

attention and memory deficit!untreated hypertension

cardio- and cerebrovascular complications!

Complex assessment of: morphological and hemodynamical alterations in early stage hypertensive patients

hypertensive pts. 44.6 ± 9.9 yrs

male/female: 0.9 n=61

recently diagnosed, untreated

controls 45.3±9.5 yrs

male/female: 0.9n=76

smoker

diabetes

C n=38

↑LDL n=38

HTn=25

HT+ ↑LDLn=36

healthy controls

hyperlipidemic persons

hypertensive patients

hypertensive + hyperlipidemic patients

LDL-cholesterol<3,4 mmol/L>

renal failure

• ABPM (ambulatory blood pressure monitoring)

• blood tests (biochemistry, complete blood count, sedimentation rate, HbA1C, etc.)

• IMT - intima-media thickness: common carotid arteries

• arterial stiffness (Arteriograph)

• HUTT - head-up tilt table testing (CNSystem Task Force Monitor)

• neuropsychological testing (memory, attention, reaction time, anxiety, depression)

C ↑LDL HT HT+↑LDL

0.54±0.8

0.61±0.1

0.65±0.1

0.56±0.7

- right and left common carotid arteries

- 6 measurement on each side → mean **

*** Flow mediated vasodilatation - FMD

Conclusions

• significantly ↑ intima-media thickness - IMT of common carotid arteries due to hypertension• significantly ↑ stiffness parameters: AIx and PWV in association with hypertension • during HUTT remarkable differences in haemodynamical parameters (HR, sBP, dBP, mBP, TPR, SI, etc.) both in supine position and after tilt-up due to

hypertension• significantly lower neuropsychological performance in association with hypertension (i.e. Digit Span Test, Digit Symbol Test)• significantly ↑ anxiety due to hypertension

Head-up tilt table testing - HUTT

• continuous

• noninvazive

• simultaneous!

ECG

oscillometric BP

beat-to beat BP

ICG

TCD: CBF

10’ tilt

10’ supine 5’ supine (pretilt) (posttilt)

supine position 10’

(pretilt) p

after tilt-up 10’

(tilt) pnormotensive hypertensive normotensive hypertensive

HR - b/min 68.9±9.2 76.0±9.7 <0.0001 79.7±15.5 86.4±12.1 0.0094

sBP - mmHg 117.6±9.9 136.0±17.5 <0.0001 122.3±17.4 143.6±16.5 <0.0001

dBP - mmHg 78.3±8.7 91.6±12.0 <0.0001 85.9±12.8 100.8±12.0 <0.0001

mBP - mmHg 89.6±8.9 103.8±12.4 <0.0001 96.7±14.1 113.2±12.1 <0.0001

CI - l/min/m2 2.9±9.2 2.9±0.86 NS 2.6±0.72 2.5±0.55 NS

SI - ml/m2 43.0±11.4 38.6±10.0 0.0209 32.4±7.5 29.1±5.6 0.0043

TPR -dyn*s/cm5 1377.8±394.4 1577.6±426.4 0.0143 1633.2±463.8 1959.3±411.9 0.0001

CBF_l - cm/s 60.7±25.5 58.1±26.0 NS 52.2±25.5 51.8±24.0 NS

CBF_r - cm/s 63.9±20.7 59.8±21.7 NS 55.6±20.4 52.1±22.5 NS

CBF_l: cerebral blood flow - left MCACBF_r: cerebral blood flow - right MCA

HR: heart ratesBP: systolic blood pressure dBP: diastolic blood pressure mBP: mean blood pressure

CI: cardiac indexSI: stroke indexTPR: total peripheral resistance

ECG, beat-to beat blood pressure ICG- Impedance cardiograph TCD- Transcranial Doppler

0

10

20

m/s

-100

-50

0

50

%

Augmentation index - AIx Pulse wave velocity - PWV

C ↑LDL HT HT+↑LDL

-28.4±23.4

C ↑LDL HT

-16.5±30.8

-14.3±27.7

-8.1±25.2

8.11±1.5

9.8±2.5

10.0±2.09.1

±2.6

0-10 10

elevated high

%

normal elevated high

9.7 12

** p=0.0012 *** p=0.0003 ** p=0.0016

• Simple and Choice Reaction Time - reaction time• Rey Auditory Verbal Learning Test - memory function• Pieron Test - attention, spatial orientation, psychomotor

tempo• Trail Making Test - attention, visual searching, mental

processing speed• Digit Span Test - short-term memory, attention• Block Design Test - visuospatial and motor skills• Digit Symbol Test - attention, perceptual speed, motor

speed, visual scanning and memory

• Spielberger State -Trait Anxiety Inventory - anxiety• Beck Depression Inventory – 21-question multiple-

choice, self-report inventory

Neuropsychological testing WAIS Digit Span Test WAIS Digit Symbol Test

ability to recall a sequence of numbers- forward, backward -

C ↑LDL HT HT+↑LDL

9.5±1.99.2±1.6

11.6±2.6

the patient is given 90 sec to fill in as many boxes as possible with the appropriate symbol

53.4±10.3

47.1±10.350.4±9.1

C ↑LDL HT

sco

re

adjusted for age, gender, education

C ↑LDL HT HT+↑LDL33.1±7.5

39.7±8.8

44.9±10.8

37.7±10.5

Spielberger State – Trait Anxiety Inventory

C ↑LDL HT HT+↑LDL

38.8±10.9

41.6±10.3

45.0±10.1

40.0±12.1

Beck - Depression Inventory

C ↑LDL HT HT+↑LDL

5.0±5.0 5.1±6.5 5.8±7.07.0±6.9

• Personality trait of anxiety: individual differences in the likelihood that a person would experience state anxiety in a stressful situation.

Introduction & Purpose

Methods Results

C HT+↑LDL

C HT

↑LDL HT+↑LDL*

* p=0.0126 ** p=0.0085

*** p=0.0009

0.0

2.5

5.0

7.5

10.0

12.5

%

6.1±5.2

5.0±5.5 5.1±5.5

5.6±0.7

NS

C ↑LDL HT HT+↑LDL

Parameters during HUTT Stiffness parameters

normal

m/s

HT+↑LDL

**** C HT+↑LDL C HT

*** C HT+↑LDL

11.8±2.1

*** HT+↑LDLC

HT***

HT+↑LDL

HT↑LDL

C

C

↑LDL

*** p<0.0001

p=0.0013

p=0.0006

***

sco

re

40.4±10.7

*** HT+↑LDL

HT

C

Cp=0.0172

HT+↑LDL↑LDLp=0.0005

HT+↑LDL

• State anxiety: a transitory emotional response involving unpleasant feelings of tension and apprehensive thoughts.

HT+↑LDL

HT

C

Cp=0.0018

*** HT+↑LDLCp=0.0239

NS