[PP.07.08] PULSE PRESSURE AND INHIBITION OF THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM IN ESSENTIAL HYPERTENSIVE PATIENTS ASSUMING ACE INHIBITORS OR ANGIOTENSIN RECEPTOR BLOCKERS
Paolo BaliettiFrancesco SpannellaF. GiuliettiElisabetta BorioniFrancesca LombardiGuido CocciRiccardo Sarzani
0
Citation
0
Reference
10
Related Paper
Abstract:
Objective: Increased levels of plasma aldosterone appear to associate with increased vascular fibrosis/reduced arterial compliance in hypertensive patients. Higher pulse pressure (PP) is considered a good index of reduced vascular elasticity. ACE inhibitors (ACE-I) and angiotensin receptor blockers (ARBs), reducing plasmatic aldosterone concentration (PAC) despite increase plasma renin activity (PRA), might reduce arterial stiffness. Our aim was to investigate the relationship between PP and inhibition of the RAAS, evaluated by the ratio of PRA on PAC, in a population of essential hypertensive patients in stable treatment with ACE-I or ARBs. Design and method: We recruited 183 consecutive patients with essential hypertension treated with ACE-I or ARB in the previous 6 months. For the analysis, PRA-PAC ratio (PRA/ PAC, PRA in ng/ml, PAC in ng/dl) was multiplied by 100 and divided into tertiles. An ambulatory blood pressure monitoring was performed just before the dosages of PRA-PAC, without changes in drug therapy. Results: Males: 115 (62.8%), mean age: 58.8 ± 11.7 years. PRA/PAC Tertiles (1st: 0.02–0.57; 2nd: 0.59–2.84; 3rd: 2.94–50.98). There was no difference in age, sex, BMI or anti-hypertensive drugs between PRA/ PAC tertiles. A linear association emerged between PP and PRA/PAC (24 h-PP: r = -231, p = 0.002; daytime-PP: r = -189, p = 0.01; nighttime-PP: r = -231, p = 0.002). Increasing PRA/PAC tertiles were associated to a reduction of all PPs that was statistically significant for the 24 h-PP (1st: 56.0 ± 12.2 mmHg; 2nd: 50.5 ± 10.1 mmHg; 3rd: 49.7 ± 12.6 mmHg; p = 0.006). In the multiple regression analysis, the association between 24 h-PP and PRA/PAC tertiles remained significant even after adjusting for sex, age, BMI, blood pressure control, diabetes, smoking and eGFR (b = -0.158; p = 0.017). Conclusions: Higher values of the PRA/PAC, that reflect adequate inhibition of the RAAS by ACE-I or ARBs at doses/molecules prescribed, are associated with lower PP values. These findings suggests that effective ACE-I/ARBs therapy is likely to reduce arterial stiffness.Keywords:
Plasma renin activity
Essential hypertension
Pulse pressure
The responses of blood pressure, plasma renin activity (PRA) and plasma aldosterone concentration (PAC) to infusion of either angiotensin II (10ng/Kg/min) or norepinephrine (100ng/Kg/min) were observed in 25 patients with essential hypertension. The difference in modes of response between low renin essential hypertension and normal or high renin essential hypertension was analyzed. For comparison, 5 patients with Conn's syndrome, 4 with renovascular hypertension, and 5 normotensive subjects were also studied.Following infusion of angiotensin II the changes in diastolic blood pressure (DBP) were +24±3.0mmHg in low renin essential hypertension and +25±3.1mmHg in normal or high renin essential hypertension, in PRA -0.28±0.06ng/ml/h in low renin essential hypertension and -0.69±0.02mg/ml/h in another and in PAC +3.7±1.4 and +7.6±1.8ng/100ml respectively. There was a significant difference in magnitude of response in PRA between the 2 groups of essential hypertension (p<0.05).Norepinephrine induced rise in DBP with decreases both in PRA and PAC. The mean changes in DBP were +6±1.4mmHg in low renin essential hypertension and +16±2.2mmHg in another and the pressor response in the later was significantly greater (p<0.01). The changes in PRA were-0.14±0.07ng/ml/h in low renin essential hypertension and -0.67±0.26ng/ml/h in normal or high renin essential hypertension, and in PAC -4.9±1.3 and -3.3±1.9ng/100ml respectively. The greater fall in PRA in normal or high renin essential hypertension was observed but the difference between the 2 groups of essential hypertension was not significant. The changes in PAC did not parallel the changes in PRA.Angiotensin II induced essentially similar effects on blood pressure in both groups but the greater feedback inhibition of PRA was produced by this peptide in normal or high renin essential hypertension than in low renin essential hypertension. Norepinephrine induced significantly greater pressor effect in normal or high renin essential hypertension. The adopted dose of norepinephrine suppressed both PRA and PAC and atendency to the greater fall in PRA was observed in normal or high renin essential hypertension. There was no difference in responses of PAC to both agents between the 2 groups of essential hypertension.
Essential hypertension
Plasma renin activity
Renovascular Hypertension
Pathophysiology of hypertension
Cite
Citations (2)
In recent years, studies have shown that parameters derived from the arterial pressure wave other than systolic and diastolic blood pressure provide important information on cardiovascular status. Among these parameters, pulse pressure, arterial stiffness and heart rate have emerged as independent markers of cardiovascular risk in different populations. Although a number of studies have used casual measurements of these parameters in a clinic setting, others have focused on their assessment under ambulatory conditions. The pulse pressure represents the amplitude of the pressure wave signal (systolic minus diastolic blood pressure), higher pulse pressure values having been reported in patients possessing cardiovascular risk factors. Close associations between a high pulse pressure and several surrogate end-points have been described. Furthermore, epidemiological studies have shown that a high pulse pressure is an independent predictor of hard end-points in several populations. Arterial stiffness represents one of the major haemodynamic factors determining pulse pressure. Pulse wave velocity, measured from the initial upstroke of the pressure wave, constitutes an established index of arterial stiffness. Studies have reported stiffer arteries in patients with cardiovascular pathology even at an early stage of disease. Close correlations between arterial stiffness and several surrogate markers have been reported, and arterial stiffness and its changes have recently been shown to be an independent predictor of hard end-points in patients with a high cardiovascular risk. Methods to evaluate arterial stiffness under ambulatory conditions are emerging. Heart rate represents the frequency of the cyclical strain of the arterial wall, clinical studies having shown that ambulatory heart rate is correlated to several surrogate markers. A few epidemiological studies have analysed the value of ambulatory heart rate as an independent predictor of hard end-points, but their positive findings need to be confirmed. The analysis of the pressure wave thus allows the determination of several haemodynamic indices other than systolic and diastolic blood pressure. Pulse pressure, arterial stiffness and heart rate constitute other outcomes that may be useful as additional factors in risk assessment for future therapeutic decision-making.
Pulse pressure
Prehypertension
Cite
Citations (21)
1. In 20 of 20 patients (100%) with borderline hypertension Visken normalized the labile blood pressure. The high renin values after stimulation due to orthostasis and saluresis decreased significantly (p less than 0,01). 2. In 3 of 12 patients (25%) with hyporeninemic essential hypertension Visken alone normalized the blood pressure. The low renin values increased to the normal range. 3. In 4 of 18 patients (22%) with normoreninemic essential hypertension Visken normalized the blood pressure. The normal renin values showed a decreasing tendency within the normal range. 4. In 4 of 10 patients (40%) with hyperreninemic essential hypertension Visken normalized the high blood pressure. In 3 of these patients renin decreased distinctly. 5. In 4 of 20 patients (20%) with renal hypertension a therapy with Visken alone normalized the blood pressure. In 3 patients the high renin values decreased to the normal range. 6. In the most other patients of the groups II to V the additional therapy with diuretics and reserpine normalized the blood pressure. In these cases the renin values showed different reactions corresponding to the different effects of betablocking agents, saluretics or reserpine on the plasma renin activity [7]. 7. It is interesting, that Visken not only suppresses high renin values (borderline hypertension [6], hyperreninemic essential hypertension), but also increases low renin values to the normal range in patients with hyporeninemic essential hypertension. Because in essential hypertension the high blood pressure per se may be responsible for the renin suppression [3,4], this increase of renin activity is possibly the consequence of blood pressure reduction, while the decrease of renin activity after Visken may be the cause of blood pressure reduction.
Plasma renin activity
Essential hypertension
Pindolol
Reserpine
Cite
Citations (0)
The immediate short-term effect on plasma renin activity of intravenous injection of propranolol was studied in 31 normal subjects and 166 hypertensive patients. In patients with essential hypertension and normal subjects plasma renin activity fell considerably within 15 minutes; the fall was directly proportional to initial plasma renin levels. In contrast, in patients with renal hypertension the fall was much less pronounced or totally absent. These differences in response to propranolol provide, though presently only on a group basis, a biochemical means of differentiating between patients with renal hypertension and those with essential hypertension. The observations also indicate that, unlike normal subjects and patients with essential hypertension, in patients with renal hypertension sympathetic activity plays no part in the control of basal plasma renin levels.
Plasma renin activity
Essential hypertension
Basal (medicine)
Pathophysiology of hypertension
Cite
Citations (16)
To compare 24 h ambulatory blood pressure changes between patients with renovascular hypertension and essential hypertension.The 24 h ambulatory blood pressure of patients with age and gender matched renovascular hypertension (RVH, n = 51) was compared with that of patients with essential hypertension (EH, n = 51).The 24 h, daytime and nighttime systolic blood pressures (SBP), diastolic blood pressures (DBP) and pulse pressures (PP) in RVH were significantly higher than in EH (all P < 0.05), especially the nocturnal SBP (P < 0.05). The SBP and DBP loads in RVH were 58.96% and 35.98% respectively, while blood pressure loads were around 20.00% in EH (P < 0.05). In patients with RVH, The nocturnal blood pressure fall was 5.39%, and only 27.50% patients were dippers, while the nocturnal blood pressure fall was 10.36% and 60.8% patients were dippers in EH.RVH patients have higher dynamic BP, PP, BP loads and blunted diurnal rhythm compared to those with EH.
Essential hypertension
Renovascular Hypertension
Pulse pressure
Cite
Citations (0)
Aim To study the characteristics of ambulatory blood pressure changes in essential hypertensive patients with different complications. Methods: 123 patients with essential hypertention(EH) were carried out 24-hour ambulatory blood pressure (ABPM)[EH, EH complicated by atrialfibrillation (EH-AF), EH complicated by lacunar infarction (EH-LI), EH complicated by left ventricular hypertrophy(EH-LVH)]. Analyzed the results. Results: The percentage of grade 3 EH in EH with complications is higher than that in EH without complications. Parameters of ABPM (including 24hSBP, 24hDB, dSBP, dDBP, nSBP, nPDB, d SBPL, d DBPL, n SBPL, d DBPL, abnormity in circadian rhythm of blood pressure) in EH with complications are higher than those in EH without complications. Parameters of ABPM (including 24hSBP, 24hDB, dSBP, dDBP, nSBP, nPDB, d SBPL, d DBPL, n SBPL, d DBPL, abnormity in circadian rhythm of blood pressure) in EH-LVH are higher than those in EH-AF and EH-LI. Conclusion: Blood pressure level, Blood pressure loading and abnormity in circadian rhythm of blood pressure may play a role in EH with complications. Parameters of ABPM are diference in essential hypertensive patients with different complications.
Essential hypertension
Dipper
Cite
Citations (0)
1. Supine plasma renin activity and its responsiveness to erect posture and frusemide were reduced in fifty-one patients with essential hypertension, compared with fifty-one age- and sex-matched control subjects. 2. Twenty-four hour urinary sodium excretion was similar in hypertensive patients nad control subjects. 2. Twenty-four hour urinary sodium excretion was similar in hypertensive patients and control subjects, but after intravenous frusemide hypertensive patients excreted significantly less sodium. 3. A significant inverse relationship between plasma renin activity and diastolic blood pressure was demonstrated in hypertensive patients and in normotensive control subjects. 4. A significant inverse relationship between plasma renin activity and age, independent of blood pressure, was shown in hypertensive patients and control subjects. 5. It is concluded that the reduced renin values found in essential hypertension are, in part, the result of the elevated blood pressure acting on the kidney.
Plasma renin activity
Essential hypertension
Supine position
Cite
Citations (19)
A nomogram for plasma renin activity (PRA), based on 31 normal volunteers, was constructed, and the 95% tolerance limits were computed to the regression line of PRA on 24-h urinary sodium excretion. On this nomogram, reproducibility of the PRA profile for the same patient with essential hypertension was good. Retrospectively, 20 essential hypertension patients with low PRA were matched for age and sex with essential hypertension patients with normal PRA. No statistically significant difference was found between the two groups in either the number of cardiovascular complications or in the blood pressure means. It is concluded that the incidence of cardiovascular complications tends to be similar in all cases of essential hypertension of a similar degree of severity.
Plasma renin activity
Nomogram
Essential hypertension
Cite
Citations (1)
The authors examined the plasma renin activity (PRA), serum uric acid and creatinine in 53 patients with essential hypertension (EH). They recorded low renin EH in 28%, normorenin EH in 53% and high-renin EH in 19% of the hypertensive patients. Assessment of basal PRA levels does not suffice for the classification of EH because the PRA response after stimulation is not related to its basal values. The authors found significantly higher levels of serum creatinine in low-renin EH. They did not confirm a relationship between PRA and the uric acid serum level in any form of EH.
Plasma renin activity
Essential hypertension
Basal (medicine)
Cite
Citations (1)
Increased ambulatory arterial stiffness index and blood pressure load in normotensive obese patients
It has been shown that blood pressure (BP) values measured in obese subjects are higher than the individuals with normal weight, even in normotensive limits. However, data concerning the Ambulatory Arterial Stiffness Index (AASI) and blood pressure load in normotensive obese subjects is lacking. This study was aimed to compare the ambulatory arterial stiffness index and blood pressure load in normotensive obese and healthy controls.One hundred normotensive obese and one hundred normal weight subjects were included in this study. All subjects underwent 24-hour ambulatory blood pressure monitoring. Ambulatory arterial stiffness index was calculated from 24-hour ambulatory blood pressure monitoring records. Ambulatory arterial stiffness index was defined as one minus the regression slope of unedited 24-h diastolic on systolic blood pressures. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) load values were calculated from 24-hour ambulatory blood pressure monitoring analysis.Ambulatory arterial stiffness index of the obese subjects was significantly higher than the healthy controls (0.48±0.2 vs. 0.33±0.11, p<0.001). 24-hours systolic blood pressure and diastolic blood pressure loads were significantly higher in obese subjects. Logistic regression analysis revealed that body mass index (BMI) was an independent predictor for an abnormal ambulatory arterial stiffness ındex (≥0.50) (OR: 1.137, 95% CI: 0.915-1.001, p=0.004).Blood pressure load and ambulatory arterial stiffness index are increased in normotensive obese patients. Moreover, body mass index is an independent predictor for an abnormal ambulatory arterial stiffness index. Our results indicate that obese subjects are at higher risk for future cardiovascular events despite normal office BP levels.
Cite
Citations (6)