Target organ damage in hypertensive patients: correlation between retinal arteriovenular ratio and left ventricular geometric patterns

Abstract Background Circulating monocytes and tissue macrophages play complex roles in the pathogenesis of hypertension and the resulting target organ damage. In this study, we observed alterations in the monocyte phenotype and inflammatory state of hypertensive patients with left ventricular hypertrophy (LVH) and studied the effects of irbesartan in these patients. This study might reveal a novel mechanism by which irbesartan alleviates LVH, and it could provide new targets for the prevention and treatment of hypertensive target organ damage. Methods CD163 and CD206 expression on monocytes and IL-10 and TNF-α levels in the serum of hypertensive patients with or without LVH and of healthy volunteers were detected. Furthermore, we treated monocytes from the LVH group with different concentrations of irbesartan, and then, CD163, CD206, IL-10 and TNF-α expression was detected. Results We found, for the first time, that the expression of CD163, CD206 and IL-10 in the LVH group was lower than that in the non-LVH group and healthy control group, but the TNF-α level in the LVH group was significantly higher. Irbesartan upregulated the expression of CD163 and CD206 in hypertensive patients with LVH in a concentration-dependent manner. Irbesartan also increased the expression of IL-10 and inhibited the expression of TNF-α in monocyte culture supernatants in a concentration-dependent manner. Conclusions Our data suggest that inflammation was activated in hypertensive patients with LVH and that the monocyte phenotype was mainly proinflammatory. The expression of proinflammatory factors increased while the expression of anti-inflammatory factors decreased. Irbesartan could alter the monocyte phenotype and inflammatory status in hypertensive patients with LVH. This previously unknown mechanism may explain how irbesartan alleviates LVH. Trail registration The study protocols were approved by the Ethical Committee of the Second Affiliated Hospital of Dalian Medical University. Each patient signed the informed consent form.

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P61 PSYCHOLOGICAL DETERMINANTS OF TARGET ORGAN DAMAGE IN HYPERTENSIVE PATIENTS: FOCUS ON TYPE A PERSONALITY AND LEFT VENTRICULAR MASS INDEX

Artery Research ◽

10.1016/j.artres.2017.10.083 ◽

2017 ◽

Vol 20 (C) ◽

pp. 71

Author(s):

Andrea Greco ◽

Alessandro Maloberti ◽

Paola Sormani ◽

Giulia Colombo ◽

Luca Giupponi ◽

...

Keyword(s):

Left Ventricular Mass ◽

Left Ventricular Mass Index ◽

Target Organ Damage ◽

Organ Damage ◽

Left Ventricular ◽

Target Organ ◽

Hypertensive Patients ◽

Ventricular Mass Index ◽

Psychological Determinants ◽

Type A Personality

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Evaluation of Subclinical Target Organ Damage for Risk Assessment and Treatment in the Hypertensive Patients: Left Ventricular Hypertrophy

Journal of the American Society of Nephrology ◽

10.1681/asn.2005121336 ◽

2006 ◽

Vol 17 (4 suppl 2) ◽

pp. S104-S108 ◽

Cited By ~ 33

Author(s):

Enrico Agabiti-Rosei ◽

Maria Lorenza Muiesan ◽

Massimo Salvetti

Keyword(s):

Risk Assessment ◽

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Target Organ Damage ◽

Organ Damage ◽

Left Ventricular ◽

Target Organ ◽

Hypertensive Patients ◽

Assessment And Treatment

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Effects of inhibition of the renin-angiotensin system on hypertension-induced target organ damage: clinical and experimental evidence

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2021.1570 ◽

2021 ◽

Vol 91 (1) ◽

Author(s):

Maria Rosaria De Luca ◽

Daniela Sorriento ◽

Domenico Massa ◽

Valeria Valente ◽

Federica De Luise ◽

...

Keyword(s):

Angiotensin Ii ◽

Ace Inhibitors ◽

Ventricular Hypertrophy ◽

Target Organ Damage ◽

Renin Angiotensin System ◽

Organ Damage ◽

Left Ventricular ◽

Target Organ ◽

Angiotensin System ◽

Hypertensive Patients

The dysregulation of renin-angiotensin-system (RAS) plays a pivotal role in hypertension and in the development of the related target organ damage (TOD). The main goal of treating hypertension is represented by the long-term reduction of cardiovascular (CV) risk. RAS inhibition either by angiotensin converting enzyme (ACE)-inhibitors or by type 1 Angiotensin II receptors blockers (ARBs), reduce the incidence of CV events in hypertensive patients. Actually, ACE-inhibitors and ARBs have been demonstrated to be effective to prevent, or delay TOD like left ventricular hypertrophy, chronic kidney disease, and atherosclerosis. The beneficial effects of RAS blockers on clinical outcome of hypertensive patients are due to the key role of angiotensin II in the pathogenesis of TOD. In particular, Angiotensin II through an inflammatory-mediated mechanism plays a role in the initiation, progression and vulnerability of atherosclerotic plaque. In addition, Angiotensin II can be considered the hormonal transductor of the pressure overload in cardiac myocytes, and through an autocrine-paracrine mechanism plays a role in the development of left ventricular hypertrophy. Angiotensin II by modulating the redox status and the immune system participates to the development of chronic kidney disease. The RAS blocker should be considered the first therapeutic option in patients with hypertension, even if ACE-inhibitors and ARBs have different impact on CV prevention. ARBs seem to have greater neuro-protective effects, while ACE-inhibitors have greater cardio-protective action.

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SERUM URIC ACID AND TARGET ORGAN DAMAGE IN ESSENTIAL HYPERTENSION AT MEDICINE DEPARTMENT OF GMC, BETTIAH, BIHAR

10.36106/ijsr/9723342 ◽

2020 ◽

pp. 1-3

Author(s):

Mahendra Kumar ◽

Dharmendra Prasad ◽

Parshuram Yugal ◽

Debarshi Jana

Keyword(s):

Uric Acid ◽

Essential Hypertension ◽

Left Ventricular Hypertrophy ◽

Serum Uric Acid ◽

Ventricular Hypertrophy ◽

Target Organ Damage ◽

Organ Damage ◽

Left Ventricular ◽

Target Organ ◽

Hypertensive Patients

Background Hypertension is a major risk factor for cardiovascular mortality, as it acts through its effects on target organs, such as the heart and kidneys. Hyperuricemia increases cardiovascular risk in patients with hypertension. Objective To assess the relationship between serum uric acid and target organ damage (left ventricular hypertrophy and microalbuminuria) in untreated patients with essential hypertension. Patients and methods: A cross-sectional study was carried out in 130 (85 females, 45 males) newly diagnosed, untreated patients with essential hypertension. Sixty-five healthy age- and sex-matched non-hypertensive individuals served as controls for comparison. Left ventricular hypertrophy was evaluated by cardiac ultrasound scan, and microalbuminuria was assessed in an early morning midstream urine sample by immunoturbidimetry. Blood samples were collected for assessing uric acid levels. Results Mean serum uric acid was significantly higher among the patients with hypertension (379.7±109.2 μmol/L) than in the controls (296.9±89.8 μmol/L; P<0.001), and the prevalence of hyperuricemia was 46.9% among the hypertensive patients and 16.9% among the controls (P<0.001). Among the hypertensive patients, microalbuminuria was present in 54.1% of those with hyperuricemia and in 24.6% of those with normal uric acid levels (P=0.001). Similarly, left ventricular hypertrophy was more common in the hypertensive patients with hyperuricemia (70.5% versus 42.0%, respectively; P=0.001). There was a significant linear relationship between mean uric acid levels and the number of target organ damage (none versus one versus two: P=0.012). Conclusion These results indicate that serum uric acid is associated with target organ damage in patients with hypertension, even at the time of diagnosis; thus, it is a reliable marker of cardiovascular damage in our patient population.

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P804The significance of 24h blood pressure variability improvement regarding target organ damage indices three years after medical treatment initiation in essential hypertension

European Heart Journal ◽

10.1093/eurheartj/ehz747.0403 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H Triantafyllidi ◽

A Schoinas ◽

D Benas ◽

D Birba ◽

D Voutsinos ◽

...

Keyword(s):

Blood Pressure ◽

Medical Treatment ◽

Blood Pressure Variability ◽

Treatment Initiation ◽

Target Organ Damage ◽

Organ Damage ◽

Left Ventricular ◽

Target Organ ◽

Hypertensive Patients ◽

Damage Indices

Abstract Background Blood pressure variability (BPV) has been associated with development, progression and severity of cardiac and vascular organ damage and with an increased risk of cardiovascular events and mortality, independently adding to cardiovascular risk, over and above the contribution of elevated mean BP levels. We aimed to explore any correlation between differences in BPV and target organ damage indices (TOD) in hypertensive patients three years after medical treatment initiation. Methods At baseline and before medical treatment initiation, we measured 24h average SBP and DBP as well as 24h systolic BPV after 24h ambulatory blood pressure monitoring (ABPM) in newly diagnosed and never treated hypertensive patients (n=171, mean age=52+12 years, 110 males, 24h average SBP/DBP=138+10/87+9 mmHg, 24h systolic BPV=15+3) who were also subjected to arterial stiffness by carotid-femoral pulse wave velocity (PWV), left ventricular hypertrophy by left ventricular mass index (LVMI) and coronary flow reserve (CFR) estimations. All the above tests were repeated approximately three years later after treatment initiation. Results Patients were characterized as controlled (n=113, mean age=54+12 years, 62 males, 24h average SBP/DBP=118+6/71+6 mmHg) or non-controlled hyperensives (n=58, mean age=48+11 years, 48 males, 24h average SBP/DBP=133+8/83+7 mmHg) based on ABPM results three years later (controlled BP=24h average BP<130/80 mmHg). In the whole population, 24h average SBP/DBP, systolic BPV (p<0.001) and LVMI (p=0.01) were decreased while systolic BPV difference was related with LVMI difference (r=0.27, p<0.001). In controlled hypertensives, 24h average SBP/DBP, systolic BPV (p<0.001) and LVMI (p=0.02) were decreased while systolic BPV difference was related with LVMI difference (r=0.35, p<0.001). In non-controlled hypertensives, 24h average SBP (p=0.001), DBP p<0.001) and systolic BPV (p=0.04) were decreased while PWV was increased (p=0.03) and no correlations were found between systolic BPV and TOD. Correlation between BPV and LVMI Conclusions It seems that antihypertensive-induced systolic BPV improvement relate with cardiovascular risk decrease occur only in the setting of blood pressure treated within normal limits and confirmed by ABPM. Our study confirms that left ventricular mass between other TOD primarily improves due to successful antihypertensive treatment.

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Study of correlation of presence of microalbuminuria to target organ damage in essential hypertension cases

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20184764 ◽

2018 ◽

Vol 5 (6) ◽

pp. 1498

Author(s):

Pragati Bhole ◽

Archana Aher

Keyword(s):

Essential Hypertension ◽

Cardiovascular Events ◽

Urinary Albumin Excretion ◽

Target Organ Damage ◽

Organ Damage ◽

Left Ventricular ◽

Urinary Albumin ◽

Target Organ ◽

Hypertensive Patients ◽

Albumin Excretion

Background: Critical amount of urinary albumin excretion has long been reported to be one strong predictor of cardiovascular events in hypertensive patients. Very few studies have been conducted till now depicting correlation of microalbuminuria and target organ damage in patients with essential hypertension, except cardiovascular events. We evaluated the prevalence of microalbuminuria in patients with essential hypertension and its relationship with target organ damage.Methods: Total 120 patients of essential hypertension were studied. Prevalence of urinary albumin excretion and its correlation to target organ damage (left ventricular hypertrophy, retinopathy and stroke) was analysed. Urinary albumin excretion was assessed by turbidimetry method and microalbuminuria was assessed by urine albumin to creatinine ratio.Results: Microalbuminuria was found to be present in 57.7% patients. Target organ damage was observed in 62.5% (75) patients, out of which 78.66% patients had associated microalbuminuria (p <0.05). Amongst them, higher prevalence was observed in patients with longer duration and greater severity of hypertension, increased body mass index and dyslipidemia.Conclusions: Microalbuminuria assessment in hypertensive patients is an important test for the evaluation of target organ damage. Optimal management of hypertension, weight control, and maintenance of normal lipid levels leads to decreased risk of microalbuminuria.

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Creatinine clearance and subclinical target organ damage in primary hypertension

Journal of Institute of Medicine ◽

10.3126/jiom.v32i3.4957 ◽

1970 ◽

Vol 32 (3) ◽

pp. 30-33

Author(s):

SK Das ◽

SC Jha

Keyword(s):

Left Ventricular Hypertrophy ◽

Creatinine Clearance ◽

Ventricular Hypertrophy ◽

Target Organ Damage ◽

Organ Damage ◽

Left Ventricular ◽

Target Organ ◽

Primary Hypertension ◽

Control Group ◽

Hypertensive Patients

Introduction: Despite the widely recognized dangers of uncontrolled hypertension, the disease remains inadequately treated in the majority of patients. This may be, in large part, because of the asymptomatic nature of the disease for the first 15 to 20 years, even as it progressively damages the cardiovascular system. Therefore, assessment of hypertension related subclinical target-organ damage represents a key diagnostic procedure for the risk stratification of hypertensive patients. Methods: A prospective case control study of 40 cases (hypertensive patients with CCR<60) and 40 controls (hypertensive patients with CCR>60) was conducted in Tribhuvan University Teaching Hospital (TUTH). Renal function was estimated by the Cockcroft-Gault formula. Left ventricular hypertrophy was determined by echocardiography. Retinal vascular changes were evaluated by direct ophthalmoscopy. Microalbumin in urine was measured from spot morning sample. Results: The prevalence of Left ventricular hypertrophy (LVH), microalbuminuria and retinopathy in cases and control group was 55% VS 20% (P=.001), 50% VS 20% (P=.004) and 92.5% VS 52.5% (P=.001). Patients with microalbuminuria showed prevalence of LVH, CCR<60 and retinopathy as 78.57%, 71.43% and 100% respectively. There was high prevalence of grade I and grade II retinopathy in patients with low CCR Conclusions: Results show that a reduction in creatinine clearance and/or presence of microalbuminuria is a marker of subclinical organ damage in patients with primary hypertension and normal serum creatinine irrespective of BP load and other traditional risk factors. Keywords: Creatinine clearance; primary hypertension; subclinical; target organ damage. DOI: http://dx.doi.org/10.3126/joim.v32i3.4957 Journal of Institute of Medicine, December, 2010; 32:3 30-33

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Uric Acid Is Not Associated With Blood Pressure Phenotypes and Target Organ Damage According to Blood Pressure Phenotypes

American Journal of Hypertension ◽

10.1093/ajh/hpaa130 ◽

2020 ◽

Author(s):

Anping Cai ◽

Lin Liu ◽

Mohammed Siddiqui ◽

Dan Zhou ◽

Jiyan Chen ◽

...

Keyword(s):

Blood Pressure ◽

Uric Acid ◽

Arterial Stiffness ◽

Blood Pressure Monitoring ◽

Target Organ Damage ◽

Organ Damage ◽

Left Ventricular ◽

Target Organ ◽

Uncontrolled Hypertension ◽

Hypertensive Patients

Abstract BACKGROUND Hypertensive patients with increased serum uric acid (SUA) are at increased cardiovascular (CV) risks. Both the European and American hypertension guidelines endorse the utilization of 24 h-ambulatory blood pressure monitoring (24 h-ABPM) for hypertensive patients with increased CV risk. While there is difference in identifying uric acid as a CV risk factor between the European and American guidelines. Therefore, it is unknown whether 24 h-ABPM should be used routinely in hypertensive patients with increased SUA. METHODS To address this knowledge gap, we investigated (i) the correlation between SUA and 24 h-ABP; (ii) the association between SUA and blood pressure (BP) phenotypes (controlled hypertension [CH], white-coat uncontrolled hypertension [WCUH], masked uncontrolled hypertension [MUCH], and sustained uncontrolled hypertension [SUCH]); (iii) the association between SUA and target organ damage (TOD: microalbuminuria, left ventricular hypertrophy [LVH], and arterial stiffness) according to BP phenotypes. RESULTS In 1,336 treated hypertensive patients (mean age 61.2 and female 55.4%), we found (i) there was no correlation between SUA and 24 h, daytime, and nighttime systolic blood pressure/diastolic blood pressure, respectively; (ii) in reference to CH, SUA increase was not associated WCUH (odds ratio [OR] 0.968, P = 0.609), MUCH (OR 1.026, P = 0.545), and SUCH (OR 1.003, P = 0.943); (iii) the overall prevalence of microalbuminuria, LVH, and arterial stiffness was 2.3%, 16.7%, and 23.2%, respectively. After adjustment for covariates, including age, sex, smoking, body mass index, diabetes mellitus, and estimated glomerular filtration rate, there was no association between SUA and TOD in all BP phenotypes. CONCLUSIONS These preliminary findings did not support routine use of 24 h-ABPM in treated hypertensive patients with increased SUA.

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