AstraZeneca, Biosensors, and The Medicines Company.

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Abstract-Arterial stiffness is a strong determinant of cardiovascular risk. Pulse wave velocity (PWV) is an index of arterial stiffness, and its prognostic value has been repeatedly emphasized. The purpose of the present study was to assess the effect of heart rate (HR) on PWV. Twenty-two subjects with a mean age of 77.8Ϯ8.4 (SD) years and permanent cardiac pacing were studied. In each subject, PWV was measured at 5 different pacing frequencies in the same session (60, 70, 80, 90, 100 bpm), the order of the various frequencies being randomly determined. Furthermore, to test the reproducibility, a repeat measurement of PWV was obtained in one randomly selected frequency. Blood pressure (BP) was measured by conventional means at each pacing frequency. PWV appeared fairly reproducible because no significant difference was disclosed between the 2 measurements obtained at the same HR level (Pϭ0.5) and both measurements were strongly correlated (rϭ0.87, PϽ0.001). No significant BP variation was observed during pacing. There was a highly significant effect of HR on PWV estimated by a one-way, within-subjects analysis of variance (Pϭ0.01). This study demonstrates that HR is an important factor in the intraindividual variation of PWV in elderly subjects. This raises methodological concern about the measurement of this parameter. Standardizing PWV for HR level seems mandatory if one wants to interpret PWV changes in clinical trials or in the follow-up of patients.

Abstract-Elements of a renin-angiotensin system expressed along the entire nephron, including angiotensinogen secreted by proximal tubule and renin expressed in connecting tubule, may participate in the regulation of sodium reabsorption at multiple sites of the nephron. The response of this tubular renin-angiotensin system to stepwise changes in dietary sodium was investigated in 2 mouse strains, the sodium-sensitive inbred C57BL/6 and the sodium-resistant CD1 outbred. Plasma angiotensinogen was not affected by sodium regimen, whereas plasma renin increased 2-fold under low sodium. In both strains, the variation in urinary parameters did not parallel the changes observed in plasma. Angiotensinogen and renin excretion were significantly higher under high sodium than under low sodium. Water deprivation, by contrast, induced significant activation in the tubular expression of angiotensinogen and renin. C57BL/6 exhibited significantly higher urinary excretion of angiotensinogen than did CD1 animals under both conditions of sodium intake. The extent to which these urinary parameters reflect systemic or tubular responses to challenges of sodium homeostasis may depend on the relative contribution of sodium restriction and volume depletion. Key Words: angiotensinogen Ⅲ renin Ⅲ sodium Ⅲ mouse Ⅲ genetics Ⅲ urine W e have advanced the hypothesis that a paracrine tubular renin-angiotensin system operates along the entire nephron. 1 Although angiotensinogen (AGT) is not filtered across the glomerular membrane, the protein 2 and its mRNA 3,4 have been detected in proximal tubule (PT), the protein is secreted to the apical side of PT cell monolayers, 1 has been detected in final urine under normal physiological conditions, 5 and was detected in luminal fluid of PT epithelium collected by micropuncture. 6 Systemic renin is filtered and reabsorbed in the PT. 7 Although not detected in situ, it may be expressed at low level in the PT. 8,9 We have found that renin was also synthesized and secreted in connecting tubule (CNT). 1 ACE and angiotensin (Ang) II receptors are expressed along the nephron. 10,11 High luminal Ang II has been observed in the PT, 12,13 where it stimulates sodium reabsorption. 14 Some observations support a similar role in terminal segments of the nephron. 15 The potential significance of this tubular renin-angiotensin system in blood pressure regulation is underlined by the observation that double transgenic animals overexpressing human renin systemically and human AGT in the PT develop hypertension. 16 The impact of dietary sodium on the expression of renin and tubular AGT and the significance of their urinary excretion as indicators of the activity of this tissue system were tested in the mouse. Two strains were investigated, C57BL/6 and CD1. The C57BL/6 inbred differs from other inbred lines in its response to dietary sodium 17 ; its sodium sensitivity has been demonstrated 18,19 and exploited in an attempt to map genetic determinants of the arterial pressure response to dietary sodium. 19 We have verified...

The present study supports the hypothesis that BRS could encompass the impact over time of several risk factors on the cardiovascular system. Thus, it may constitute a valuable parameter in assessing more precisely the risk of cardiovascular events.

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