Prevalence of echo left ventricular structural alterations among essential hypertensives seen in primary care centres in Spain ranged from 70.3 to 79.2% depending on the threshold values used. Left ventricular hypertrophy ranged from 59.2 to 72.7% and age-adjusted concentric remodelling ranged from 6.5 to 11.4% depending on the criteria used. Only one-quarter of hypertensive patients were free from morphological alterations.
The aim of this work was to investigate the relationship between different lipids parameters with presence and severity of coronary obstruction angiographically evaluated. 897 patients (629 men and 268 women) underwent an angiography and blood extraction to determine concentrations of lipid markers: total cholesterol (TC), HDL cholesterol (HDLc), triglycerides, LDL cholesterol (LDLc), apolipoprotein A1 (apoA1), apolipoprotein B100 (apoB), non-HDL cholesterol and total cholesterol/HDLc, apoB100/apoA1 and LDLc/HDLc ratios. Multivariate analysis revealed that low HDLc levels were independently associated with the presence of coronary obstruction (OR: 0.982, 95% CI 0.969–0.996). In relation to severity of coronary stenosis, only apoA1 levels (OR: 0.990, 95% CI 0.980–1.000) and apoB/apoA1 ratio (OR: 3.243, 95% CI 1.095–9.608) were independent predictors. Our study demonstrated that HDLc was the only lipid parameter negatively and significantly associated with the presence of coronary obstruction, whereas apoA1 levels and apoB/apoA1 ratio were independent predictors of stenosis severity.
Objective: To determine the possible differences in lipid, thrombogenic and inflammatory marker concentrations and the presence of chronic and acute coronary artery disease (stable and unstable angina, respectively), comparing them with a group of control patients with normal coronary arteries. Material and Methods: This prospective cohort study included 125 patients with unstable angina, 189 with stable angina and a control group of 83 patients with normal coronary arteries. Marker concentrations were measured in all 3 groups. Logistic regression analysis was performed to determine whether such factors could predict unstable or stable angina. Results: Lipid parameter concentrations were similar in the 2 coronary disease groups and significantly lower than in controls. Haemostatic and inflammatory marker concentrations were higher in patients with coronary disease, but were statistically significant only when comparing unstable angina patients with normal controls. Unstable angina patients had significantly higher levels of lipoprotein (a) [Lp(a)], fibrinogen, C-reactive protein (CRP) and leucocytes. Multiple logistic regression analysis showed that CRP (OR 2.635, 95% CI 1.417–4.898), smoking (OR 3.416, 95% CI 1.773–6.584), leucocytes (OR 2.034, 95% CI 1.079–3.836) and Lp(a) (OR 2.269, 95% CI 1.188–4.334) were independent risk factors of unstable versus stable angina. Conclusions: Patients with unstable angina present a more atherogenic profile than patients with stable angina. Together with smoking, elevated Lp(a), CRP and leucocyte concentrations proved to be associated with the presence of unstable angina.
To analyze the determinants of impaired exercise tolerance in hypertensive
patients, a study was made of 45 patients (42% males, mean age 65 ± 4 years)
with systemic arterial hypertension, left ventricular hypertrophy (ventricular
mass ≥100 g/m^2), in sinus rhythm and having no prior history of ischemic
heart disease. Twenty had been hospitalized within the past 4 weeks for congestive
heart failure (dyspnea and chest x-ray verified pulmonary edema),
while 25 were asymptomatic. Following remission of symptoms after 2-5
days' treatment with diuretics, and withdrawal of antihypertensive drugs, testing
revealed impaired exercise tolerance (V(O2max)) (17 ± 3.1 vs. 23.5 ±
3.8 cm^3/kg/min, p < 0.001) and a lower peak ventricular filling rate (2.4 ±
0.4 vs. 3.6 ± 0.6 end-diastolic counts per second) evaluated using technetium-
99 (gated equilibrium method). Ejection fraction and peak ejection rates were
normal in both groups. Regional ischemia was ruled out (thallium-201-negative
in ergometrie tests) in 32 patients, 12 of whom had impaired (V(O2max))
(<20 cm^3/kg/min) while 20 were normal (>20 cm^3/kg/min). The group of 12
had a higher left ventricular mass per body surface (131 ± 21 vs. 119 ± 12 g/
m^2, p < 0.01). In a group of 26 patients having similar degrees of hypertrophy,
of which 9 were thallium-positive and 17 thallium-negative at peak stress,
was significantly lower in the first (18.4 ± 3.9 vs. 23.5 ± 4.8 cm^3/kg/min, p < 0.01). In conclusion, in hypertensive patients with left ventricular hypertrophy and normal ejection fraction, exercise tolerance depends on prior congestive heart failure, degree of left ventricular hypertrophy and the presence of regional myocardial ischemia.
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