Early structural and functional left ventricular disorders in young patients with hypertension: a role of insulin resistance

Cardiac remodeling refers to factors that increase the risk of cardiovascular events in patients with hypertension (HTN). Changes in myocardial structure and function can be caused not only by hemodynamic causes, but also a number of metabolic disorders.Aim. To analyze the associations of insulin resistance and left ventricular (LV) remodeling in a cohort of young patients with untreated uncomplicated hypertension and high normal blood pressure (BP).Material and methods. The presented cohort cross-sectional study included 105 subjects. We analyzed clinical, demographic and anthropometric characteristics, performed a biochemical panel (creatinine, potassium, lipid profile, glucose, insulin, uric acid) with the estimation of insulin resistance scores (HOMA-IR, METs-IR, TyG), a glycosylated hemoglobin test. Urine albumin-to-creatinine ratio was determined. Office and 24-hour ambulatory BP measurement and two-dimensional speckletracking echocardiography were performed in all patients.Results. The median age was 23 years (men — 85%); 51% of participants were overweight or obese, 39% had dyslipidemia, 21% — insulin resistance. Signs of LV remodeling were observed in 38 (40%) subjects: 32 (34%) — concentric remodeling, 5 (5%) — concentric LV hypertrophy (LVH), 1 (1%) — eccentric LVH. Defects of LV systolic global longitudinal strain (GLS) were observed in 44 (47%) young patients with HTN and preHTN. Stepwise multivariate regression analysis revealed that the TyG index was an independent predictor of LV GLS defects (b=0,38, p=0,001).Conclusion. In a cohort of young patients with HTN and high normal blood pressure, there is a high prevalence of insulin resistance, metabolic disorders, and early signs of LV remodeling and subclinical systolic dysfunction. The TyG index, available for estimation by routine biochemical tests, is an independent factor affecting the LV GLS.

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HIGH NORMAL BLOOD PRESSURE AND ABNORMAL LEFT VENTRICULAR GEOMETRIC PATTERNS

Journal of Hypertension ◽

10.1097/01.hjh.0000571484.35876.89 ◽

2019 ◽

Vol 37 ◽

pp. e114-e115

Author(s):

E. Gherbesi ◽

C. Cuspidi ◽

C. Sala ◽

M. Tadic ◽

R. Facchetti ◽

...

Keyword(s):

Blood Pressure ◽

Left Ventricular ◽

Normal Blood ◽

Normal Blood Pressure ◽

Geometric Patterns

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Psychosomatic aspects in individuals with normal blood pressure and left ventricular hypertrophy

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2016-22-1-86-93 ◽

2016 ◽

Vol 22 (1) ◽

pp. 86-93

Author(s):

O. Yu. Bastrikov ◽

E. A. Grigoricheva ◽

V. V. Belov ◽

K. V. Nikushkina ◽

E. A. Mezentseva

Keyword(s):

Blood Pressure ◽

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Normal Blood ◽

Normal Blood Pressure ◽

Psychosomatic Aspects

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P5466Exaggerated exercise blood pressure response is accompanied by increased sympathetic activity and arterial stiffness in subjects with high normal blood pressure

European Heart Journal ◽

10.1093/eurheartj/ehz746.0420 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Kalos ◽

C Tsioufis ◽

K Dimitriadis ◽

N Vogiatzakis ◽

A Kasiakogias ◽

...

Keyword(s):

Blood Pressure ◽

Waist Circumference ◽

Arterial Stiffness ◽

Sympathetic Nerve ◽

Muscle Sympathetic Nerve Activity ◽

Left Ventricular ◽

Normal Blood ◽

Peak Exercise ◽

Normal Blood Pressure ◽

Arterial Stiffening

Abstract Background/Introduction The clinical importance of a hypertensive response to exercise (HRE) in subjects with high normal blood pressure (BP) is not fully elucidated, while sympathetic overactivity and arterial stiffening are linked with adverse cardiovascular prognosis. Purpose The aim of this study was to assess the relation of HRE with sympathetic drive as assessed by muscle sympathetic nerve activity (MSNA) and arterial stiffness in subjects with high normal BP. Methods 42 subjects with high normal office BP [defined as office systolic BP=130–139 mmHg and office diastolic BP=85–89 mmHg (age: 53±9 years, 29 males, office BP: 134/84 mmHg, 24-hour BP: 114/72 mmHg)] with a negative treadmill exercise test (Bruce protocol) were divided into those with HRE (n=12) (peak exercise systolic BP ≥210mmHg in men and ≥190 mmHg in women) and those without HRE (n=30). Arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV) values. In all participants sympathetic drive was assessed by MSNA estimations based on established methodology (microneurography). Results Subjects with a HRE compared to those without exhibited higher waist circumference (108.2±5.3 vs 94.7±9.2 cm, p=0.001) and were characterized by greater levels of carotid to femoral PWV (8.5±0.8 vs 7.0±0.9 m/sec, p<0.001) and sympathetic nerve traffic as reflected by MSNA levels (41.1±1.5 vs 32.1±1.9 bursts per 100 heart beats, p<0.001), while did not differ regarding metabolic profile and left ventricular mass index (p=NS). In the total population, peak exercise systolic BP was related to 24-h systolic BP (r=0.229, p<0.05), PWV (r=0.218, p=0.002), and MSNA (r=0.214, p<0.05). Moreover, MSNA was related to waist circumference (r=0.33, p=0.004) and office systolic BP levels (r=0.31, p<0.05) but there was no association with PWV values (p=NS). Conclusion In subjects with high normal BP, a HRE identifies a state of arterial stiffening and sympathetic overdrive, as reflected by increased PWV and MSNA levels respectively. These finding suggest that exercise testing provides additional clinical information regarding the vascular status and modulation of sympathetic tone in this setting.

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