Abstracts e147
PP.8.323 BLOOD PRESSURE LEVEL AND DURATION OF PP.8.325 PHYSICAL TRAINING MAY IMPROVE SOME OF THE
HYPERTENSION AS PARAMETERS ASSOCIATED WITH
CEREBRAL HEMODYNAMICS IN HYPERTENSION
A. Kwater, J. Gasowski, J. Krolczyk, T. Grodzicki. Jagiellonian University -
Departament of Internal Medicine and Gerontology, Krakow, Poland
Objective: To check, in a group of hypertensive patients the association
between blood flow-related parameters of hemodynamics in middle cerebral
artery (MCA) and systolic (SBP), diastolic (DBP) blood pressure and
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duration of hypertension (HT-time) and age.
Design and Methods: The study was cross-sectional. Transcranial Doppler
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(TCD) examination was performed bilaterally. The MCAs were insonated
through transtemporal window, and pulsatility (PI), resistance (RI) indexes
and mean cerebral blood flow velocity (CBFV) were calculated. Blood
pressures were measured conventionally in accordance with current
guidelines.
Results: Mean
SD age of 96 patients was 58.7
11.9 years. The group
comprised 52.1% men, 18.9% smokers, 8.3% took nitrates (which in
exploratory analyses were the only class of medications influencing PI
and RI). Mean
SD SBP/DBP was 142.6
19.5/91.9
12.6 mm Hg,
mean PI was 0.97
0.21, RI 0.59
0.06 and CBFV 0.58
0.17 m/s.
The duration of hypertension averaged 9.5
8.6 years. In multiple
regression models adjusted for sex, age, smoking and use of nitrates,
with SBP, DBP and HT-time forced into one model, neither duration
of hypertension (p = 0.58) nor level of SBP(p = 0.60) or DBP (p = 0.58)
were associated with CBFV. However, SBP (â = 0.003, p = 0.02), DBP
(â = -0.007, p = 0.002), and HT-time (â = 0.006, p = 0.004) were signifi-
cantly associated with PI. In similar analyses SBP (â = 0.0009, p = 0.03),
DBP (â = -0.002, p = 0.004), and HT-time (â = 0.002, p = 0.006) were sig-
nificantly associated with RI. After adjustment for the confounders listed
above, HT-time independently explained 8.6% of variation in RI and
9.2% of variation in PI. When SBP or DBP were introduced separately,
the percentage of variance in PI or RI explained by HT-time increased to
over 11%.
Conclusion: SBP and DBP influence PI and RI of middle cerebral artery,
however, after adjustment for confounders, duration of hypertension plays a
major role explaining about 10% (1/4 of the models’ R-square) of variation in
PI and RI. This underlines the importance of early adequate treatment of
hypertension to protect against such cerebro-vascular complications as stroke
or dementia.
PP.8.324 TYPES OF INITIAL ORTHOSTATIC REACTIONS DURING
ACTIVE ORTHOSTATIC TEST IN PATIENTS WITH
ESSENTIAL HYPERTENSION
E. Oschepkova, N. Lazareva, Y. Kuzmina, S. Gorieva, A. Rogoza, T.
Polevaya. Russian Cardiology Research Complex, Moscow, Russia
Objective: the aim of our study was to investigate the initial orthostatic
reactions during active orthostatic test in patients (pts) with essential
hypertension (EH).
Design and method: 99 EH pts (30 M, 69F), 57,4
1,1 years, grade 1 or
2. During AOT blood pressure (beat to beat) and heart rate measured
continuously and non-invasively using the Task Force Monitor.
Daily rhythm of systolic blood pressure (BP) was assessed by BP-24
hour monitoring with 20 min day time intervals and 40 min at night
time. (BPLab, Russia). The statistical analysis was carried out by non-
parametric methods of Mann-Whitney and Fisher exact test with
Statistica 6.
Results: In all pts average hemodynamic BP (BP-ah) amplitude was 10–
30 mm Hg and was registered in the first 15 sec of orthostasis. All pts was
divided into the two groups by different types of the BP reaction. In the
Group I pts (n = 62) was found short-term decrease BP-ah. This type of BP
reaction was more 18,0
8,0 mm Hg after standing with restoration by 15 sec
on 75–100% from an initial baseline level. In the Group II pts (n = 37) we
found prolonged decrease BP reaction 22
9 mm Hg. - initial orthostatic
hypotension. In the Group II compared to group I pts was found higher day
DBP (92,0
1,9 vs 87,5
1,5 mm Hg, p < 0,05, respectively), rate of syncope
(24/37 vs 13/62, p < 0,001, respectively) and significant abnormal of nocturnal
fall of SBP (8,9
1,6 vs 12,4
1,1; p < 0,05, respectively). All groups was not
different by left ventricular mass index (169,9
6,1 vs 169,4
5,01; p = 0,5,
respectively).
Conclusions: In the EH pts with prolonged decrease BP reaction was found
significant association high rate syncope and disturbance of circadian BP
rhythm.
AMBULATORY BLOOD PRESSURE MONITORING
PARAMETERS
M. Iurciuc Mircea, A. Avram, S. Iurciuc, D. Gaita, A. Cimpean, D.
Duda-Seiman, G. Ciorica, S. Mancas. University of Medicine, Timisoara,
Romania
Background: Comprehensive rehabilitation programs are effective in low-
ering blood pressure (BP). Cardiovascular events have their greatest impact
in the morning period. This is thought to be associated with and dependent
on morning blood pressure surge (MBPS).
Objective: Our goal is to show that exercise training, may improve some of
the hemodynamic parameters of the ambulatory BP monitoring, the MBPS
and the ankle brachial index (ABI).
Design and Method: We selected 192patients with essential hypertension,
aged: 45–70years. They were under unchanged medication at least
2months and at target BPvalue. We evaluate these patients before and
after a 3months physical training. We studied the ambulatory blood pres-
sure monitoring/24 h parameter: systolic blood pressure(SBP), diastolic
blood pressure(DBP), mean blood pressure(MBP), pulse pressure(PP),
heart rate(HR), ambulatory arterial stiffness index(AASI) defined as 1-a
(a= regression slope between TAD and TAS), MBPS1 = mean SBP in the
first 2 h after awaken - the average of the lowest 3nocturnal values,
MBPS2 = mean SBP in the first 2 h after awaken¨ C mean SBP value
in the first 2 h pre awake (before awake), daytimeSBP - nighttimeSBP
(D-NSBP). We divided these 198patients into to groups: patients with
ABI < 1; and patients with ABI>1.
Results: The SBP has decreased from 124,52 to 118,13mmHg (p,0001); the
DBP has decreased from 71,34 to 70,25mmHg(p,1625); the MBP has
decreased from 89,16–87,47mmHg(p,0416); the PP has decreased from
56,78–52,98mmHg(p,0011); the HR has decreased from 71,29–64,39b/
min (p,0010); the AASI has decreased from 0,682–0,583(p,0066); MABS1
has decreased from 13,92–10.17mmHg(p,0015); MABS2 has decreased from
11,49–7,39mmHg(p,0008), D-NSBP has decreased from 15,91–
13.27mmHg(p,0029). The ABI has increased from 0,941–0,979(p,0008);
ABI has decreased from 1,179–1,067(p,0015).
Conclusion: Exercise training programs can improve some of the hemody-
namic parameters: SBP, MBP, and HR. Physical training, part of the cardio-
vascular rehabilitation plays an important role in decreasing MBPS. The
parameters that describe arterial stiffness: AASI and PP can also be improved.
Rehabilitation programs are also a safe and effective method for reducing car-
diovascular risk in hypertensive patients, expressed in our study through ABI.
PP.8.326 CARDIAC REMODELLING AND DIASTOLIC FUNCTION
IN HYPERTENSIVE MARATHON RUNNERS
C. Goh1, Y. Kim2, Y. Byun1, K. Rhee1, Y. Lee2, C. Kim2. 1Dept of Cardiology,
Sangg-Paik Hospital, Inje University, Seoul, South Korea, 2Dept of Rehabilitation,
Sangg-Paik Hospital, Inje University, Seoul, South Korea
Aim: The purpose of this study was to evaluate the left ventricular
morphology and function in hypertensive amateur marathon runners.
Methods: We studied 17 normotensive marathon runners (MA), 25 hyper-
tensive marathon runners (MHTN), 15 hypertensive controls (HTN), and 14
normal individuals (CON). An integrated M-mode/two-dimensional echo-
cardiographic analysis was performed to determine chambers dimension,
wall thickness and left ventricular mass (LVM), LVM index (LVMI). In
addition, we measured indiceexes of global systolic performance and indexes
of global diastolic function.
Results: Intver-ventricular septal thickness (IVST), LV end-diastolic dimen-
sion (LVEDD), and LV end-diastolic volume (LVEDV) were significantly
higher larger in MA and MHTN than CON. LV mass and LVMI were
increased significantly in MA and MHTN than CON. Systolic function
(fractional shorting, and ejection fraction) were normal and there were no
significant differences between groups. Analysis of diastolic function did not
show an abnormal relaxation pattern in all marathon runners, or showed an
improvement without statistical significant. The E rate () and Am rate () were
significantly greater in MA compared to CON. HTN did not show any
significant difference in the morphologic variables of LV, but there was an
increment compared with CON. Systolic function was normal in HTN, but
diastolic function was reduced.
Conclusion: Despite an abnormal cardiac remodeling, MHTN did not show
any hypertensive pathological dysfunction, on the contrary, HTN had
impaired LV diastolic function.