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0.40 0.45 0.50 0.55 0.60 0.65 0.70 0.75 0.80 0.85 0.90 0.95 mm Abstract Intima-media thickness - IMT László Csiba 1, Katalin Réka Kovács 2 , Csilla-Cecília Szekeres 2 , Zoltán Bajkó 2 , Krisztina Csapó 1 , Sándor Molnár 1 , László Oláh 1 , Mária Tünde Magyar 1 , Dániel Bereczki 3 , Renáta Laczik 4 , Pál Soltész 4 , László Kardos 5 1 Department of Neurology, University Of Debrecen Medical and Health Science Center, Debrecen, Hungary, 2 Department of Neurology, Mures County Clinical Emergency Hospital, Targu-Mures, Romania, 3 Department of Neurology, Semmelweis University, Budapest, Hungary, 4 3rd Department of Medicine, Institute for Internal Medicine, University Of Debrecen Medical and Health Science Center, Debrecen, Hungary, 5 Contract 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 rate proteinuria/albuminuria glomerulosclerosis aldosterone release LVH fibrosis remodelling apoptosis vasoconstriction vascular hypertrophy endothelial dysfunction atherosclerosis Stroke hypertension thrombosis arrhythmia heart failure MI vascular remodelling 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: 0.9 n=76 smoker diabetes C n=38 ↑LDL n=38 HT n=25 HT+ ↑LDL n=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) p normotensiv e hypertensi ve normotensiv e hypertensi ve HR - b/min 68.9±9.2 76.0±9.7 <0.000 1 79.7±15.5 86.4±12.1 0.0094 sBP - mmHg 117.6±9.9 136.0±17.5 <0.000 1 122.3±17.4 143.6±16.5 <0.000 1 dBP - mmHg 78.3±8.7 91.6±12.0 <0.000 1 85.9±12.8 100.8±12.0 <0.000 1 mBP - mmHg 89.6±8.9 103.8±12.4 <0.000 1 96.7±14.1 113.2±12.1 <0.000 1 CI - l/min/m 2 2.9±9.2 2.9±0.86 NS 2.6±0.72 2.5±0.55 NS SI - ml/m 2 43.0±11.4 38.6±10.0 0.0209 32.4±7.5 29.1±5.6 0.0043 TPR -dyn*s/cm 5 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 MCA CBF_r: cerebral blood flow - right MCA HR: heart rate sBP: systolic blood pressure dBP: diastolic blood pressure mBP: mean blood pressure CI: cardiac index SI: stroke index TPR: 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 ±2.0 9.1 ±2.6 0 -10 10 elevated high % norma l 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±1.9 9.2±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±10.3 50.4±9.1 C ↑LDL HT score adjusted for age, gender, education C ↑LDL HT HT+↑LDL 33.1±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. 0 7.0±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 norma l m/s HT+↑LDL ** ** C HT+↑LDL C HT *** C HT+↑LDL 11.8±2.1 *** HT+↑LDL C HT *** HT+↑LDL HT ↑LDL C C ↑LDL *** p<0.0001 p=0.0013 p=0.0006 *** score 40.4±10.7 *** HT+↑LDL HT C C p=0.0172 HT+↑LDL ↑LDL p=0.0005 HT+↑LDL • State anxiety: a transitory emotional response involving unpleasant feelings of tension and apprehensive thoughts. HT+↑LDL HT C C p=0.0018 *** HT+↑LDL C p=0.0239 NS
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Vascular morphological and functional impairments in symptom-free, non-treated hypertensive patients. - PowerPoint PPT Presentation
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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
