Brachial-ankle pulse wave velocity (baPWV) is widely used as a marker of arterial stiffness, but there are no data regarding the usefulness of measuring baPWV in hypertensive patients after stroke. The purpose of this study was to examine the clinical significance of baPWV by assessing its correlation with echocardiographic parameters in hypertensive patients after stroke. The study enrolled 61 hypertensives after stroke (24 patients with cerebral infarction and 37 with cerebral hemorrhage) and 61 age-matched hypertensives without stroke. Left ventricular (LV) hypertrophy was evaluated by measuring LV mass index (LVMI) and relative wall thickness (RWT), and LV diastolic function was evaluated by measuring peak early mitral annular velocities (E') using echocardiography. Concentric LV hypertrophy showing increased RWT (0.50 +/- 0.12) was observed in hypertensives after stroke, but not in hypertensives without stroke. In hypertensives after stroke, elevated baPWV correlated with age (r = 0.60, p < 0.001), systolic blood pressure (r = 0.56, p < 0.001), increased LVMI (r = 0.47, p < 0.001), and decreased E' (r = -0.40, p = 0.002). Multiple regression analysis showed that age (beta coefficient = 0.43, p < 0.001), systolic blood pressure (beta coefficient = 0.40, p < 0.001), and LVMI (beta coefficient = 0.25, p = 0.008) were independent determinants of elevated baPWV. In conclusion, elevated baPWV is more closely associated with LV hypertrophy than with LV diastolic dysfunction. Elevated baPWV is independently associated with the severity of LV hypertrophy adjusted with systolic blood pressure and age in hypertensive patients after stroke.

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Scheie's classification regarding hypertensive and atherosclerotic lesions in retinal arteries is generally used to assess the severity of hypertensive retinopathy and the risks of cardiovascular events in hypertensive patients. However, the differences between these two types of retinal artery lesions have not been fully examined. Both arterial stiffness and aortic root diameter are increased in hypertensive patients. The aim of this study was to elucidate differences in the two types of lesions by comparing their relationships to arterial stiffness and aortic root diameter in hypertensive patients following stroke. Fifty-two hypertensive patients following stroke were divided into five stages according to Scheie's classification of hypertensive (H stage 0-4) and atherosclerotic (S stage 0-4) lesions by ophthalmologists. Arterial stiffness was measured as brachial-ankle pulse wave velocity (baPWV) using an automatic waveform analyzer. Aortic root diameter was measured using M-mode echocardiography. The H and S stages in retinal arteries correlated with each other (ρ = 0.443, p < 0.001). However, the S stage correlated with baPWV (ρ = 0.385, p = 0.005) and the aortic root diameter (ρ = 0.285, p = 0.043), while the H stage did not correlate with these parameters. Multiple stepwise regression analysis demonstrated that the aortic root diameter was independently associated with S stage (β = 0.373, p = 0.006), even though baPWV was independently associated with neither S stage nor H stage. In conclusion, hypertensive lesions (H stage) in retinal arteries are associated with atherosclerotic lesions (S stage) in retinal arteries. However, S stage may reflect arterial stiffening and aortic root dilatation better than H stage in hypertensive patients following stroke. This difference between H and S stages of Scheie's classification should be kept in mind when considering the association between retinal microcirculation and large vessel arteriosclerosis.

Although left ventricular (LV) hypertrophy and diastolic dysfunction assessed by echocardiography are established risk markers of cardiovascular events in hypertensive patients, relationships between these echocardiographic findings and atherosclerosis have not been fully elucidated. The purpose of this study was to examine the relationships between atherosclerosis of the retinal arteries and echocardiographic findings in hypertensive patients. Forty hypertensive patients were divided into two groups according to Scheie's classification by ophthalmologists: 20 patients with stage 1 changes (visible broadening of the light reflex from the artery with minimal arteriovenous compression) and 20 patients with stage 2 changes (more prominent than those in stage 1). Standard echocardiography was performed to measure LV mass index for evaluating LV hypertrophy and conventional diastolic transmitral flow velocities for assessing LV diastolic function. Mitral annular velocities were also measured for evaluating LV diastolic function using tissue Doppler echocardiography. The LV mass index was larger in stage 2 (130 +/- 39 g/m(2)) than stage 1 (96 +/- 16 g/m(2)) patients (p = 0.001). Peak early diastolic mitral annular velocity (E') was lower in stage 2 (5.9 +/- 0.9 cm/s) than stage 1 (7.9 +/- 1.7 cm/s) patients (p = 0.001). The optimal cutoff points for the diagnosis of Scheie stage 2 were 6.6 cm/sec for E' (sensitivity 75%, specificity 85%) and 111 g/m(2) for LV mass index (sensitivity 70%, specificity 90%). In conclusion, in hypertensive patients, the extent of atherosclerosis in the retinal arteries can be estimated by LV hypertrophy and diastolic dysfunction assessed by echocardiography.

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