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Prevalence and determinants of left ventricular geometric abnormalities in hypertensive patients: A study based on the updated classification system of left ventricular geometry. Hellenic J Cardiol 2017; 58:124-132. [PMID: 28179146 DOI: 10.1016/j.hjc.2016.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/15/2016] [Accepted: 12/23/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE This study was to determine whether different risk factors were associated with different type of left ventricular (LV) geometric abnormalities. METHODS This retrospective analysis included 2290 hypertensive participants without other cardiovascular disease, valve disease and with ejection fraction ≥50%. The type of LV geometric abnormality was defined on the basis of the new classification system. RESULTS LV geometric abnormalities were detected in 1479 subjects (64.6%), wherein concentric LV remodeling is the most common LV geometric abnormality (40.3%). Large waist circumference (WC) and neck circumference (NC) were positively associated with concentric LV remodeling, whereas body mass index (BMI) [odds ratio (OR) 0.89, 95% CI 0.85∼0.92, P < 0.001] and systolic blood pressure (SBP) (OR 0.99, 95% CI 0.98∼0.99, P = 0.018) were inversely associated with concentric abnormalities. SBP and age were positively associated with eccentric dilated LVH, while male was inversely associated with eccentric dilated left ventricular hypertrophy (LVH). Age was the strongest risk factor for eccentric dilated LVH (OR 1.05, 95% CI 1.03∼1.07, P < 0.001). Age, NC, SBP, hyperuricemia, and alcohol use were positively associated with concentric LVH, whereas BMI (OR 0.95, 95% CI 0.90∼0.99, P = 0.033) and male (OR 0.12, 95% CI 0.07∼0.18, P < 0.001) were negatively associated with concentric LVH. CONCLUSION The prevalence of hypertensive LV geometric abnormality in rural area of Southern China was obvious higher. Compared with eccentric LV geometric abnormalities, there were more risk factors, including large WC and NC, age, NC, SBP, hyperuricemia, alcohol use, BMI and gender, which were associated with concentric LV geometric abnormalities.
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Leiria LF, Severo MD, Ledur PS, Becker AD, Aguiar FM, Massierer D, Freitas VC, Schaan BD, Gus M. White coat effect and masked uncontrolled hypertension in treated hypertensive-diabetic patients: Prevalence and target organ damage. J Diabetes 2015; 7:699-707. [PMID: 25327439 DOI: 10.1111/1753-0407.12231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 09/18/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The association between hypertensive phenotypes of controlled hypertension (CH), white-coat effect (WCE), masked uncontrolled hypertension (MUH) and sustained hypertension (SH) with target organ damage have not been clearly established in diabetic hypertensive treated patients. The present study aims to evaluate the prevalence of the four phenotypes considering the current cut-off points for office and 24 h-ambulatory blood pressure monitoring (ABPM) and the association with left ventricle hypertrophy (LVH), diastolic function and nephropathy. METHODS Cross-sectional study with 304 patients on anti-hypertensive treatment aged 57.6 ± 6.1 years, who were submitted to ABPM and echocardiography. They were classified into CH (normal office BP and ABPM), WCE (high office BP and normal ABPM), MUH (normal office BP and high ABPM), and SH (high office BP and ABPM). RESULTS Median HbA1c and diabetes duration were 7.9% (6.8-9.2), and 10 years (5-16), respectively. Prevalences of CH, WCE, MUH and SH were 27.3%, 17.1%, 18.8%, and 36.8%. MUH prevalence was higher than previously described. There was a significant increasing trend across the four groups in variables related to LVH (P < 0.001 for trend). There was not a clear "dose-response" relationship of the four hypertensive phenotypes with nephropathy and diastolic function. CONCLUSION The use of ABPM beyond the traditional cardiovascular risk stratification tools has limitations, but is still useful in high-risk patients. Longitudinal studies could better evaluate the role of the use of ABPM in this scenario. Cut-off points for normality of office and ABPM influence the prevalences of WCH and MUH.
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Affiliation(s)
- Liana F Leiria
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Mateus D Severo
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Priscila S Ledur
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Alexandre D Becker
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Fernanda M Aguiar
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Daniela Massierer
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Valéria C Freitas
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Beatriz D Schaan
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Miguel Gus
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Papadopoulos DP, Mourouzis I, Faselis C, Perrea D, Makris T, Tsioufis C, Papademetriou V. Masked hypertension and atherogenesis: the impact of apelin and relaxin plasma levels. J Clin Hypertens (Greenwich) 2013; 15:333-336. [PMID: 23614848 PMCID: PMC8033921 DOI: 10.1111/jch.12075] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 12/15/2012] [Accepted: 12/25/2012] [Indexed: 08/30/2023]
Abstract
Recent evidence demonstrates that masked hypertension (MH) is a significant predictor of cardiovascular disease, while apelin and relaxin are two novel factors with a significant role in vascular regulation. Apelin is an adipokine that elicits endothelium-dependent vasorelaxation and reduces arterial blood pressure, while relaxin is a protein hormone that induces the production of nitric oxide and vascular endothelial growth factor and inhibits endothelin and angiotensin II. This study aimed to investigate whether apelin and relaxin plasma levels are affected in patients with MH and compare the findings with those of healthy normotensives. One hundred-thirty (60 men, 70 women) healthy patients with a mean age of 45±12 years who had clinic blood pressure <140/90 mmHg were studied. The whole study population underwent 24-hour ambulatory blood pressure monitoring (ABPM). According to the ABPM recordings, 24 individuals (8 men, 16 women) had MH and the remaining 106 patients (52 men, 54 women) had normal ABPM recordings. Apelin and relaxin plasma levels were determined in both groups (enzyme-linked immunosorbent assay method). The apelin (220±121 vs 315±147 pg/mL, P=.001) and relaxin (35.2±6.7 vs 56.8±13.6 pg/mL, P<.001) plasma levels were significantly lower in the masked hypertensive group compared with normotensive controls. Our findings suggest that patients with masked hypertension have significantly lower apelin and relaxin levels. This observation may have prognostic significance for future cardiovascular events in patients with MH and needs further investigation.
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Sincer I, Aktürk E, Akkaya E, Vuruşkan E, Küçükosmanoğlu M, Zorlu A. Effect of Masked Hypertension on Aortic Elastic Properties. Clin Exp Hypertens 2012; 35:396-400. [DOI: 10.3109/10641963.2012.739234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Papadopoulos DP, Thomopoulos C, Mourouzis I, Kotrotsou A, Sanidas E, Papazachou U, Daskalaki M, Makris TK. Masked hypertension unfavourably affects haemostasis parameters. Blood Press 2011; 20:218-21. [PMID: 21388252 DOI: 10.3109/08037051.2011.565551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE. Recent evidence demonstrates that masked hypertension (MH) is a significant predictor of cardiovascular disease. The aim of our study was to examine the impact of MH on haemostasis parameters and to compare the findings to those of healthy normotensives matched for age, sex, body mass index and the rest of risk factors. DESIGN AND METHOD. 130 (60 male, 70 female) healthy subjects mean age 45 ± 12 years who had clinic blood pressure < 140/90 mmHg were studied. The whole study population underwent 24-h ambulatory blood pressure monitoring (ABPM). According to the ABPM recordings, 24 individuals (eight males, 16 females) had MH (daytime systolic blood pressure ≥ 135 mmHg or daytime diastolic blood pressure ≥ 85 mmHg - group A) and the remaining 106 subjects (52 males, 54 females) had normal ABPM recordings - group B. Fibrinogen, thrombomodulin ™, the antigens of plasminogen activator inhibitor 1 (PAI-1Ag) and tissue plasminogen activator (tPA-Ag) were determined in the two groups. Results. The PAI-1 Ag, tPA-Ag, fibrinogen and TM levels were significantly higher in the masked hypertensive group than to normotensive control group. CONCLUSIONS. Our findings suggest that subjects with MH have significantly higher fibrinogen, TM, PAI-1Ag and tPA-Ag plasma levels compared with normotensives. This observation may have prognostic significance for future cardiovascular events in subjects with MH and needs further investigation.
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Affiliation(s)
- D P Papadopoulos
- ESH Excellent Center of Hypertension, Laiko Univesity Hospital, Athens, Greece.
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Association of insulin-like growth factor-1 receptor gene polymorphisms with left ventricular mass and geometry in essential hypertension. J Hum Hypertens 2009; 24:320-6. [DOI: 10.1038/jhh.2009.73] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Papadopoulos DP, Perrea D, Thomopoulos C, Sanidas E, Daskalaki M, Papazachou U, Votteas V, Makris T. Masked hypertension and atherogenesis: the impact on adiponectin and resistin plasma levels. J Clin Hypertens (Greenwich) 2009; 11:61-5. [PMID: 19222669 DOI: 10.1111/j.1751-7176.2008.00070.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent evidence suggests that masked hypertension (MH) is a predictor of cardiovascular disease and that hypoadiponectinemia and hyperesistinemia may contribute to chronic inflammatory process, insulin resistance, endothelial dysfunction, and accelerated atherogenesis. The aim of this study was to examine the adiponectin and resistin plasma levels in patients with MH and compare the findings with those of healthy normotensive persons matched for age, sex, body mass index, and other risk factors. Overall, 130 (60 men and 70 women) healthy persons (mean age, 45+/-12 years) who had clinic blood pressure values <140/90 mm Hg were studied. The study population underwent 24-hour ambulatory blood pressure monitoring (ABPM). According to the ABPM recordings, 24 individuals (8 men and 16 women) had MH (daytime systolic blood pressure >or=135 mm Hg or daytime diastolic blood pressure >or=85 mm Hg; group A) and the remaining 106 participants (52 men and 54 women) had normal ABPM findings (group B). Adiponectin and resistin plasma levels were determined in both groups by enzyme-linked immunosorbent assay. Significantly higher (P<.01) resistin levels (12+/-4 vs 6.8+/-3.6 ng/mL) were found in group A compared with group B, while the adiponectin plasma levels were significantly lower (P<.01) in group A compared with group B (6+/-2.3 vs 11+/-2.7 microg/mL). Findings suggest that patients with MH have lower adiponectin levels and higher resistin levels compared with normotensive individuals. This observation may have prognostic significance for future cardiovascular events in patients with MH.
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Papadopoulos D, Thomopoulos C, Perrea D, Papazachou U, Daskalaki M, Bourantas C, Votteas V, Makris T. Changes of Metalloproteinases Profile in Patients With Masked Hypertension. Angiology 2008; 60:757-62. [DOI: 10.1177/0003319708326451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. The aim of our study was to investigate whether collagen degradation is altered in participants with masked hypertension and whether this alteration could be related to disturbances in the matrix metalloproteinases plasma concentration and to compare the findings with those participants with normal blood pressure levels matched for age, sex, and body mass index. Methods. Twenty-four (11 men, 13 women) participants with masked hypertension [mean age 46 ± 7 years and body mass index 25.9 ± 2.1 kg/m2 (group A)] and 106 healthy normotensives (49 men, 57 women) with normal blood pressure [mean age 44 ± 6 years and body mass index 25.5 ± 2.4 kg/m2 (group B)]. Results. The plasma levels of matrix metalloproteinase-9 were significantly higher, while the levels of tissue inhibitors of metalloproteinases-1 and -4 were significantly lower in group A compared with group B (matrix metalloproteinase-9: 569 ± 135 vs. 282 ± 117 ng/mL, TIMP-1: 169 ± 42 vs. 230 ± 37 ng/mL, P < .01, and TIMP-4: 2.1 ± 1.3 vs. 4.2 ± 1.98 ng/mL, P < .04, respectively). Conclusions. Patients with masked hypertension had significantly increased matrix metalloproteinase-9 plasma levels and significantly decreased plasma levels of tissue inhibitors of metalloproteinases-1 and -4 compared with participants with normal blood pressure. These findings need further investigation.
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Affiliation(s)
- D.P. Papadopoulos
- Department of Cardiology, Hypertension Clinic, Laiko Hospital, Athens, Greece, jimpapdoc@ yahoo.com
| | - C. Thomopoulos
- Department of Cardiology, Hypertension Clinic, Laiko Hospital, Athens, Greece
| | - D. Perrea
- Department of Cardiology, Hypertension Clinic, Laiko Hospital, Athens, Greece
| | - U. Papazachou
- Department of Cardiology, Hypertension Clinic, Laiko Hospital, Athens, Greece
| | - M. Daskalaki
- Department of Cardiology, Hypertension Clinic, Laiko Hospital, Athens, Greece
| | - C. Bourantas
- Department of Cardiology, Hypertension Clinic, Laiko Hospital, Athens, Greece
| | - V. Votteas
- Department of Cardiology, Hypertension Clinic, Laiko Hospital, Athens, Greece
| | - T.K. Makris
- Department of Cardiology, Hypertension Clinic, Laiko Hospital, Athens, Greece
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Papadopoulos DP, Makris TK. Masked hypertension definition, impact, outcomes: a critical review. J Clin Hypertens (Greenwich) 2008; 9:956-63. [PMID: 18046102 DOI: 10.1111/j.1524-6175.2007.07418.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The phenomenon of masked hypertension (MH) is defined as a clinical condition in which a patient's office blood pressure (BP) level is <140/90 mm Hg but ambulatory or home BP readings are in the hypertensive range. The prevalence in the population is about the same as that of isolated office hypertension; about 1 in 7 or 8 persons with a normal office BP level may fall into this category. The high prevalence of MH would suggest the necessity for measuring out-of-office BP in persons with apparently normal or well-controlled office BP. Reactivity to daily life stressors and behavioral factors such as smoking, alcohol use, contraceptive use in women, and sedentary habits can selectively influence MH. MH should be searched for in individuals who are at increased risk for cardiovascular complications including patients with kidney disease or diabetes. Individuals with MH have been shown to have a greater-than-normal prevalence of organ damage, particularly with an increased prevalence of metabolic risk factors, left ventricular mass index, carotid intima-media thickness, and impaired large artery distensibility compared with patients with a truly normal BP level in and out of the clinic or office. Also, outcome studies have suggested that MH increases cardiovascular risk, which appears to be close to that of in-office and out-of-office hypertension. The aim of this review was to define the entity of MH, to describe its prevalence in the general population, and to discuss its correlation with cardiovascular events.
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Antiendothelial cell antibody levels in patients with masked hypertension. Int J Cardiol 2008; 130:405-8. [PMID: 18234377 DOI: 10.1016/j.ijcard.2007.08.122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Accepted: 08/11/2007] [Indexed: 11/22/2022]
Abstract
UNLABELLED Recent evidence demonstrate that masked hypertension (MH) is a significant predictor of cardiovascular disease, while, elevated levels of circulating antibodies against endothelial cell surface antigens (antiendothelial cell antibodies - AECA) seem to play an important role at the early stages of atherosclerosis process and of borderline hypertension as well. Aim of this study was to investigate the presence of AECA in patients (pts) with MH and to compare the AECA title among pts with MH and healthy normotensives (HN), matched for age, sex and body mass index. METHODS One hundred-thirty (60 M, 70 F) healthy subjects mean age 45+/-12 yrs who had clinic blood pressure <140/90 mm Hg were studied. The whole study population underwent 24 hour ambulatory blood pressure monitoring (ABPM). According to the ABPM recordings, 24 individuals (8 M, 16 F) had MH (daytime systolic blood pressure >/=135 mm Hg or daytime diastolic blood pressure >/=85 mm Hg - group A) and the remainder 106 subjects (52 M, 54 F) had normal ABPM recordings, group B. IgG and IgM AECA levels were determined by ELISA method. AECA levels were expressed as mean value+/-SD. None of the study population had a history of connective tissue disease or any metabolic disorder. RESULTS Significantly increased titles of AECA class IgG were found in 8/24 pts of group A (30%) vs. 5/106 (4.6%) of group B (p<0,001). Significantly increased titles of AECA class IgM were also found in 6/24 pts of group A (25%) vs. 3/80 (3.8%) of group B (p<0,001). CONCLUSIONS Our results suggest that patients with MH have significantly higher AECA levels of both classes (IgG, IgM) compared to healthy normotensives. These findings may indicate a possible explanation of the increased cardiovascular risk in MH. The possibility that high AECA levels may be a driving mechanism for the development of MH needs further investigation.
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HORIKAWA T, OBARA T, OHKUBO T, ASAYAMA K, METOKI H, INOUE R, KIKUYA M, HASHIMOTO J, TOTSUNE K, IMAI Y. Difference between Home and Office Blood Pressures among Treated Hypertensive Patients from the Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) Study. Hypertens Res 2008; 31:1115-23. [DOI: 10.1291/hypres.31.1115] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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