Prehypertension – ABC CARDIOL

ABC

Research Letter

Acupuncture for Essential Hypertension and Endothelial Dysfunction: A Randomized Clinical Trial

Amanda Rodrigues Bitencourt et al. Ana Luiza Lima Sousa Priscila Valverde de Oliveira Vitorino Mikaelle Costa Correia … Alexandre Massao Yoshizumi Weimar Kunz Sebba Barroso

Introduction

Arterial hypertension (AH) is one of the main modifiable risk factors for cardiovascular diseases, as it causes increased arterial stiffness and endothelial dysfunction since early stages.

Sympathetic hyperactivity and activation of the renin-angiotensin-aldosterone system (RAAS) are among the major pathophysiological mechanisms of AH, in addition to an overproduction of reactive oxygen species (ROS) and imbalances in the nitric oxide (NO) availability. The increase in endothelial permeability in response to low NO synthesis explains the correlation of AH with atherosclerosis and makes the analysis of endothelial function a useful tool for clinical assessment.^,,

[…]

Read Full Article

ABCIC

Original Article

Echocardiography on Prehypertension and Stage I Hypertension

Carolina Bertoluci et al. Murilo Foppa Angela Barreto Santiago Santos Sandra C. Fuchs Flávio Danni Fuchs

Abstract

Background

Prehypertension and stage I hypertension are associated with left ventricular (LV) remodeling. In this study, we compared echocardiographic parameters of preclinical hypertensive target organ damage in individuals with prehypertension and stage I hypertension selected from the same population.

Methods

We compared baseline echocardiogram measurements of participants included in the PREVER study with prehypertension (PREVER-prevention; n=106) or stage I hypertension (PREVER-treatment; n=128). Sex-specific differences in echocardiographic parameters were also investigated.

Results

Mean systolic and diastolic BP were significantly higher in the stage I hypertension group (141.0/90.4 mmHg) than in the prehypertension group (129.3/81.5 mmHg, P<0,001 for both). Mean age was 55 years old (30 to 70), with an almost equal number of men and women, of which 80% were white and 7% had diabetes. Most parameters of LV mass, LA size and diastolic function were similar between the prehypertension and stage I hypertension groups. Hypertensive individuals had larger LA diameter and posterior wall thickness, and lower lateral e’ velocities, even after adjustment for age, sex and body mass index. Sex-specific analysis showed higher LV mass in stage I hypertension compared to prehypertension only in women (141.1 ± 34.1 g vs. 126.1 ± 29.1 g, P<0.05).

Conclusions

In middle-aged individuals with low cardiovascular risk, differences in echocardiographic parameters related to target organ damage are likely subtle between prehypertension and stage I hypertension, although women with stage I hypertension had significantly higher LV mass, which may indicate sex-specific adaptive response to blood pressure in earlier stages of hypertension.

Read Full Article

ABC

Editorial

Pre-Hypertension in Adolescents: A New Old Issue

Katya Rigatto

As there is no doubt that the risk of hypertension is proportional to the increase in blood pressure (BP) and has no specific threshold, the higher the pressure, the higher the risk. In this context, the identification of individuals with increased cardiovascular risk in the subclinical asymptomatic stage is of paramount importance in the future to improve patients’ quality of life and reduce the costs and burden of health services.

From the first attempt to measure the arterial pulse, performed by Santorio Sanctorius (1561 – 1636), to Riva-Rocci, who put an end to the search for a simple clinical method for BP assessment, BP control has gained more and more prominence among clinicians and researchers. Consequently, BP values considered to be normal have gradually become lower and lower.

[…]

Read Full Article

ABC

Original Article

Effects of added salt reduction on central and peripheral blood pressure

Ana Carolina Arantes et al. Ana Luiza Lima Sousa Priscila Valverde de O. Vitorino Paulo Cesar B. Veiga Jardim … Thiago de Souza Veiga Jardim Jeeziane Marcelino Rezende Ellen de Souza Lelis Rafaela Bernardes Rodrigues Antonio Coca Weimar Kunz Sebba Barroso

Abstract

Background

Although the effects of salt intake reduction on casual blood pressure have been extensively studied in hypertensive individuals, data on reductions of added salt on arterial stiffness in both normotensive and prehypertensive subjects are scarce.

Objective

To evaluate the effects of progressive reduction in added salt intake (from 6 grams to 4 grams per day) on peripheral and central blood pressure and arterial stiffness in normotensive, prehypertensive and hypertensive individuals.

Methods

This was a single-blinded clinical trial with 13 weeks of follow-up. Normotensive (≤ 130/85 mmHg), prehypertensive (≥ 130 e < 139/≥ 85 e < 90 mmHg) and stage 1 hypertensive individuals (< 139/≥ 85 and < 90 mmHg) were assessed. Casual blood pressure measurements and ambulatory blood pressure monitoring were performed using the automated OMRON 705CP device, and central blood pressure was measured using the Sphygmocor^®. Twenty-four-hour urinary sodium excretion and the amounts of added salt consumed were measured. Statistically significance level was set at p < 0.05 for all analysis.

Results

A total of 55 participants (18 normotensive, 15 prehypertensive and 22 hypertensive), median age 48 years (IQR:39-54) were studied. The groups were not different in age or sex. No difference was observed in blood pressure or sodium excretion levels before and after the intervention. No significant changes in arterial stiffness parameters were observed.

Conclusion

The progressive reduction in added salt intake during a period of 13 weeks did not cause significant reductions in peripheral and central blood pressure. (Arq Bras Cardiol. 2020; 114(3):554-561)

Read Full Article

ABC

Editorial

Cardiac Fibrosis Occurs before Arterial Hypertension Becomes Well Defined?

Claudio Pinho

Target organ damage (TOD) of systemic arterial hypertension (AH) in the heart modifies the cardiomyocyte, Interstice and its arteries. Alterations that occur in AH include cardiomyocyte hypertrophy, connective tissue hyperplasia and neovascularization stimulation, among others.^– These alterations depend essentially on the stimulus of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS)^– which may not homogeneously impact Kidneys, heart, brain and blood vessels. The response of the connective tissue to AH induces collagen production by fibroblasts and consequently interstitial fibrosis.^–

Since 2006 with the data published by Das MK et al., we have started to correlate the presence of notches that form the fragmented QRS (fQRS) with non-homogeneous electrical conduction resulting from myocardial fibrosis which can be restorative or reactive.

[…]

Read Full Article

ABC

Original Article

Association Between Non-Dipping and Fragmented QRS Complexes in Prehypertensive Patients

Mehmet Eyuboglu et al. Bahri Akdeniz

Abstract

Background:

Fragmented QRS (fQRS) is a sign of adverse cardiovascular events in various cardiovascular diseases. It is also associated with increased blood pressure and non-dipping in hypertensive patients. However, no study has investigated the importance of fQRS in prehypertensive patients.

Objectives:

The aim of our study is to investigate the relationship between fQRS and non-dipper status in prehypertensive patients.

Methods:

Two hundred and sixteen eligible, newly diagnosed prehypertensive patients who underwent 24-hour ambulatory blood pressure monitoring (ABPM) for further evaluation of blood pressure between June 2015 and July 2016 were included into the study. Patients were divided into three groups according to ABPM results: normotensives, dipper prehypertensives, and non-dipper prehypertensives. Groups were compared regarding presence of fQRS on electrocardiography. Additionally, multinomial logistic regression analysis was used to determine the relationship between fQRS and blood pressure pattern in prehypertensive patients.

Results:

According to ABPM recordings, 61 patients had normotensive blood pressure pattern (systolic blood pressure < 120 mmHg and diastolic blood pressure < 80 mmHg). Of the remaining 155 prehypertensive patients, 83 were dippers and 72 were non-dippers. Non-dipper prehypertensives had a significantly higher frequency of fQRS compared to normotensives (p = 0.048). Furthermore, multinomial logistic regression analysis revealed that fQRS is an independent predictor of non-dipping blood pressure pattern in prehypertensive patients (p = 0.017, OR: 4.071, 95% CI: 1.281-12.936).

Conclusions:

We found that fQRS is a predictor of non-dipping in prehypertensives. As a marker of fibrosis and higher fibrotic burden within myocardium, fQRS may be useful in identifying high-risk prehypertensive patients before the development of hypertension.

Read Full Article