The clinical value of 24-hour ambulatory blood pressure monitoring (ABPM) in terms of cardiovascular risk prediction is being increasingly recognized. ABPM is a powerful predictor of morbid or fatal cardiovascular events (CVEs) and is correlated stronger to hypertension-mediated organ damage (HMOD) as compared to conventional clinic blood pressure (BP). 1-3 The prognostic value of ABPM lies, among others, in its ability to unveil the physiological variance of BP throughout both day-and nighttime. These are largely reflected in the normal drop of nighttime BP values by 10%-20%, defined as "dipping," compared to nighttime BP values. 4
2This study investigates arterial stiffness changes after acute exercise in young patients with untreated, recently diagnosed grade I essential hypertension (UH) compared with normotensive (NT) individuals and the effect of antihypertensive treatment on this phenomenon. Study 1 consisted of 25 UH and 15 NT patients. UH patients who received treatment were included in study 2 and were followed-up after a 3-month treatment period with an angiotensin II receptor blocker. Aortic pulse wave velocity (PWV) was assessed at baseline, at maximal exercise, and at 10, 30, and 60 minutes later. In UH patients, PWV increased significantly at maximal exercise and 10 and 30 minutes of recovery, despite blood pressure fall to baseline levels. No significant PWV changes were observed in NT patients. Post-treatment PWV levels were significantly decreased and similar to those of NT patients. Arterial stiffness is impaired following high-intensity acute exercise even in the early stages of hypertension. Antihypertensive treatment ameliorates these effects. J Clin Hypertens (Greenwich).
Aim: To investigate the thrombotic microenvironment in early stages of type 2 diabetes mellitus measuring platelet-derived, endothelial-derived and erythrocyte-derived microvesicles. Methods: We recruited 50 newly diagnosed type 2 diabetes mellitus patients who did not receive glucose-lowering treatment except for metformin and 25 matched non-type 2 diabetes mellitus volunteers. Microvesicles were measured with flow cytometry, glycated haemoglobin with high-performance liquid chromatography and advanced glycation end products with enzyme-linked immunosorbent assay. Results: Type 2 diabetes mellitus patients showed significantly higher levels of platelet-derived microvesicles [195/μL (115–409) vs 110/μL (73–150), p = 0.001] and erythrocyte-derived microvesicles [26/μL (9–100) vs 9/μL (4–25), p = 0.007] compared to non-type 2 diabetes mellitus individuals. Platelet-derived microvesicles were positively associated with fasting blood glucose ( p = 0.026) and glycated haemoglobin ( p = 0.002). Erythrocyte-derived microvesicles were also positively associated with fasting blood glucose ( p = 0.018) but not with glycated haemoglobin ( p = 0.193). No significant association was observed between platelet-derived microvesicles ( p = 0.126) or erythrocyte-derived microvesicles ( p = 0.857) and advanced glycation end products. Erythrocyte-derived microvesicles predicted the presence of type 2 diabetes mellitus, independently of platelet-derived microvesicles. Conclusion: In newly diagnosed type 2 diabetes mellitus, ongoing atherothrombosis is evident during the early stages as evidenced by increased microvesicles levels. Furthermore, the association with glycemic profile suggests that microvesicles represent not only a novel mechanism by which hyperglycemia amplifies thrombotic tendency in type 2 diabetes mellitus but also early markers of thrombosis highlighting the need for earlier management of hyperglycemia.
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