Profile of new vascular damage biomarkers in middle-aged men with arterial hypertension

В статье рассмотрены вопросы развития фиброза и иммунного воспаления у больных артериальной гипертензией (АГ) с острым ишемическим инсультом (ИИ) в пожилом возрасте. Цель исследования - изучение возраст-ассоциированных особенностей концентрации маркеров фиброза (металлопротеиназы-9, тканевого ингибитора матриксных металлопротеиназ-1, их соотношения ММП-9/ТИМП-1), иммунного воспаления (TNF-α, IL-1β, INF-γ) у больных АГ с ИИ. В исследование были включены 86 больных АГ II степени, из которых 42 человека - среднего возраста (53±5 лет) и 44 - пожилого (66±5 лет), контрольную группу составили 22 пациента пожилого возраста с АГ без ИИ в анамнезе. Критерии включения - пациенты с АГ, поступившие в стационар в остром периоде первого церебрального инсульта. Установлено, что у пожилых больных АГ с ИИ показатели инфламэйджинга и маркеры фиброза были достоверно выше, чем у лиц среднего возраста. Уровень IL-1β был выше на 31,7 % (р<0,01), TNF-α - на 55,7 % (р<0,001), INF-γ - на 36,6 % (р<0,01), уровень ММП-9 - на 46,4 % (р<0,01), ТИМП-1 - на 21,2 % (р<0,01), ММП-9/ТИМП-1 - на 19,6 % (р<0,01) в пожилом возрасте по сравнению с больными среднего возраста с АГ и острым ИИ. Таким образом, установлено, что больные АГ с ИИ имеют нарушения процессов инфламейджинга, синтеза и деградации внеклеточного матрикса, особенно выраженные в пожилом возрасте. The article deals with the development of fibrosis and immune inflammation in patients with arterial hypertension and acute ischemic stroke in old age. The aim of the study was to study age-associated features of the concentration of fibrosis markers (metalloproteinase-9, tissue inhibitor of matrix metalloproteinases-1, their ratio MMP-9/TIMP-1), immune inflammation (TNF-α, IL-1β, INF-γ) in patients with arterial hypertension and ischemic stroke (AI). The study included 86 patients with arterial hypertension (AH) of the 2nd degree, of which 42 were middle-aged (53±5 years) and 44 elderly (66±5 years). The control group consisted of 22 elderly patients with AH without a history of AI. The criteria for inclusion in the study are patients with hypertension who were admitted to the hospital in the acute period of the first cerebral stroke. It was found that in elderly patients with hypertension with AI, the indicators of inflamaging and fibrosis markers were significantly higher than in middle-aged people. The level of IL-1β was 31,7 % higher (p<0,01), TNF-α by 55,7 % (p<0,001), INF-γ by 36,6 % (p<0,01), the level of MMP-9 was 46,4 % higher (p<0,01), TIMP-1 by 21,2 % (p<0,01), MMP-9/TIMP-1 by 19,6 % (p<0,01) in the elderly compared to middle-aged patients with hypertension and acute AI. Thus, it was found that patients with arterial hypertension and ischemic stroke have violations of the processes of inflamaging, synthesis and degradation of the extracellular matrix, especially pronounced in old age.

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P2642Optimal blood pressure control in relation to target organ physiology in hypertensive men with erectile dysfunction

European Heart Journal ◽

10.1093/eurheartj/ehz748.0963 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Angelis ◽

K Aggeli ◽

N Ioakeimidis ◽

Y Dimitroglou ◽

C Georgakopoulos ◽

...

Keyword(s):

Blood Pressure ◽

Erectile Dysfunction ◽

Essential Hypertension ◽

Systolic Blood Pressure ◽

Linear Regression Analysis ◽

Left Ventricular ◽

Target Organ ◽

Vascular Damage ◽

Middle Aged ◽

Ultrasound Evaluation

Abstract Background Target organ damage (TOD) in essential hypertension relates to an adverse prognosis. Middle aged men are considered a population group where cardiovascular risk typically augments and erectile dysfunction (ED) that frequently accompanies both entities refers to a subclinical vascular damage process. Purpose To identify the optimal blood pressure (BP) levels in middle aged hypertensive males with ED in relation to TOD. Methods 258 ED males (mean age: 56 yo) with essential hypertension under medical treatment enrolled the study. All underwent 2D echocardiography and carotid ultrasound evaluation to determine left ventricular mass index (LVMI) and intima – media thickness (IMT) respectively. Carotid – femoral pulse wave velocity (PWV) and augmentation index (AIx) were also assessed as indices of central vascular stiffness and wave reflection physiology (complior & sphygmocor devices). Office brachial blood pressure (BP) measurements where performed according to the current guidelines and an average of three consecutive values was computed. Erectile dysfunction was assessed by using the SHIM-5 score (range 0–25, lower values display a pronounced dysfunction). Results In bivariate analysis brachial systolic blood pressure (bSAP) was positively and strongly associated with LVMI (r=0,6), PWV (r=0,65), AIx (r=0,67, all p<0,001) and IMT (p<0,05, r=0,55). Erectile performance as assessed by the SHIM-5 score was negatively related to PWV, AIX and IMT (r=−0,58, r=−0,45 and r=−0,65 all p<0,001) pointing out the underlying vascular detriment. Interestingly, there were no such correlations regarding the diastolic blood pressure values. Multiple linear regression analysis was performed and the relation of bSAP with LVMI, PWV, AIx and IMT remained significant after adjustment for age, BMI, smoking habits and presence of diabetes mellitus (all p<0,05). We further subdivided our population into three groups according to the values of office bSAP for normal blood pressure (≤129mmHg, n=143,55%), high normal (130–139mmHg, n=59, 23%) and high (≥140mmHg, n=56,22%). In patients with high-normal bSAP, the parameters of PWV and LVMI were significantly higher than in patients with normal BP (independent sample t-test, p: 0,032 and 0,016 respectively). Patients of the high bSAP group as expected, had more extensive cardiac and vascular damage (LVMI, PWV and AIx). Conclusion In essential hypertensive middle aged men with erectile dysfunction, guiding therapy toward normal systolic blood pressure values as compared to the high normal benefits target organ physiology. It is clinically important to identify this vascular patients group in order to adjust regimens and further therapeutic strategies.

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Contribution of lipoprotein(a) to cardiovascular risk in patients under 40 years of age after acute myocardial infarction or acute cerebral circulation disorder

Clinical Medicine (Russian Journal) ◽

10.18821/0023-2149-2016-94-3-194-199 ◽

2016 ◽

Vol 94 (3) ◽

pp. 194-199 ◽

Cited By ~ 1

Author(s):

Viktoriya A. Korneva ◽

T. Yu. Kuznetsova ◽

A. S. Novitskaya ◽

A. N. Malygin ◽

T. A. Guseva ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiovascular Risk ◽

Arterial Hypertension ◽

Cerebral Circulation ◽

Age Groups ◽

Middle Aged ◽

Vascular Events ◽

Lipoprotein A ◽

Cerebral Circulation Disorders

Aim. To evaluate the importance of lipoprotein(a) for the evaluation of cardiovascular risk in patient under 40 years of age after acute myocardial infarction or acute cerebral circulation disorder. Materials and methods. We analysed the data from two departments of the Regional Vascular Centre for 2013-2015 including 90 case histories of patients of different age (mean 57.8±3.4 yr) and studied standard risk factors, such as age, sex, smoking habits, dyslipidemia, aggravated heredity, arterial hypertension (AH), obesity. Standard examination of 7 patients under 40 years of age was supplemented by measuring lipoprotein(a) by the immunoturbodimetric method regarding the levels over J. 3 g/l as abnormally elevated. Results. The study group was dominated by young and middle-aged men (85.2 and 84% respectively). The key riskfactors were increased LDLP level (88%) and smoking (70%) in patients under the age of 40 and AH in middle-aged men (100%, p<0.004). Arterial hypertension was also diagnosed in 59% of the younger subjects. Increased LDLP levels most frequently occurred in senior patients (90%). The group ofpatients under 40 yr included 15% of those having a single risk factor. In this group, 22% of the patients were at high risk calculated prior to the development of vascular events, 58% at moderate and 20% at low risk. 42.8% of the patients had elevated lipoprotein(a) levels. Conclusion. Based on the relative risk scoring scale, 22% of the patients under 40 years of age were at risk of myocardial infarction or cerebral circulation disorders prior to the development of vascular events. However, these patients like those of other age groups frequently had traditional riskfactors, such as smoking (67.5%), AH and dyslipidemia (66.6% each). Total cholesterol was elevated only in 47.6% of the patients while LDLP and LP(a) in 92 and 42.8% respectively.

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