Background. Some antihypertensive medications alter cellular energy production, presumably by modification of the mitochondrial function. In vivo studies of such effects are challenging in humans. We applied a noninvasive forearm skin measurement of the 460-nm fluorescence specific for the reduced form of nicotinamide adenine dinucleotide (NADH) to study the 6-week effects of four different antihypertensive medications on mitochondrial function using the Flow-Mediated Skin Fluorescence (FMSF). Methods. In a prospective open-label study, we compared the long-term effects of a 6-week treatment with either amlodipine (5 mg), perindopril (5 mg), nebivolol (5 mg), or metoprolol (50 mg) on the dynamic flow-mediated changes in the skin NADH content in 76 patients (29 women) with untreated primary arterial hypertension (HA). Patients underwent 24-hour ambulatory blood pressure monitoring. To study mitochondrial function, the FMSF was measured at rest, during 100-second ischemia and postischemic reperfusion. The control group consisted of 18 healthy people (7 women). Results. There were no significant differences in the FMSF parameters between the control and the study group before medication. After the 6-week treatment, all drugs similarly reduced blood pressure. Neither amlodipine, perindopril, nor nebivolol changed the flow-mediated 460-nm skin fluorescence significantly. However, metoprolol raised this fluorescence at rest, during ischemia and reperfusion ( P at most <0.05), indicating an increase in the total NADH skin content. Conclusion. Amlodipine, perindopril, and nebivolol appear neutral for the skin NADH content during the 6-week antihypertensive treatment. Similar treatment with metoprolol increased skin NADH at rest, during ischemia and reperfusion, probably due to an effect on microcirculation and altered mitochondrial function. Explanation of the potential mechanisms behind metoprolol influence on the skin NADH metabolism requires further investigation.
The reduced form of nicotinamide adenine dinucleotide (NADH) is crucial in cellular metabolism. During hypoxia, NADH accumulation results from anaerobic cytoplasmic glycolysis and impaired mitochondrial function. This study aimed to compare the dynamic changes in the 460-nm forearm skin fluorescence, which reflects cellular NADH content, during transient ischaemia between healthy individuals and patients with newly diagnosed, untreated essential hypertension (HA). Sixteen healthy volunteers and sixty-five patients with HA underwent non-invasive measurement of forearm skin NADH content using the Flow Mediated Skin Fluorescence (FMSF) method at rest and during a 100-s transient ischaemia induced by inflation of the brachial cuff. The fluorescent signal was sampled at 25 Hz. All samples were normalised to the end of the ischaemic phase, which is the most stable phase of the whole recording. Slope values of 1 s linear regressions were determined for every 25-sample neighbouring set. The 1-s slopes in the early phase of skin ischaemia, indicating quicker hypoxia-induced NADH accumulation in skin, were significantly higher in patients with HA than in healthy individuals. These findings suggest that some protecting mechanisms postponing the early consequences of early cellular hypoxia and premature NADH accumulation during skin ischaemia are impaired in patients with untreated HA. Further studies are needed to investigate this phenomenon.
Objective: If oxygen is available, then mitochondria oxidase the reduced form of nicotinamide adenine dinucleotide (NADH) and produce energy. Oxygen delivery to mitochondria in skin cells depends on the function of microvascular circulation. Antihypertensive medications can modify both energy metabolism (e.g. gain of body weight) and microvascular function (cold fingers and toes). In this prospective study, we compared the effects of amlodipine vs metoprolol on the skin content of NADH in hypertensive patients. Design and method: Patients with newly diagnosed hypertension were randomly allocated to the six-week treatment with either 5 mg of amlodipine (20 patients) or 25 mg of metoprolol (17 patients) once a day. The 460-nm forearm skin fluorescence measured the skin mitochondrial content of NADH at rest, during transient 100-second ischaemia (by occlusion of the brachial artery with the inflated arm blood pressure cuff), and the following reperfusion. This measurement was made before and after the treatment initiation. Results: Hypotensive effects of both treatment were comparable after the six-week therapy. For NADH, amlodipine showed no significant change in the 460-nm fluorescence at rest (791.6 ± 281.1 to 733.7 ± 261.9 [kU] (p = 0.119), during ischemia (850.2 ± 292.2 to 805.6 ± 294.8 [kU] (p = 0.307), and reperfusion (662.3 ± 228.4 to 624.1 ± 225.0 [kU] (p = 0.210). In contrast, treatment with metoprolol significantly increased the 460-nm fluorescence at rest (678.2 ± 284.0 to 797.3 ± 247.0 [kU] (p < 0.01), during ischemia (736.5 ± 302.1 to 859.7 ± 264.9 [kU] (p < 0.01), and reperfusion (571.5 ± 243.2 to 662.2 ± 204.7 [kU] (p < 0.01). Conclusions: Metoprolol significantly impairs the function of skin mitochondria, causing a significant increase in the NADH content. In contrast, amlodipine shows neutral effects on this function.
Objective:In hypertensive population are patients whose office blood pressure measurements differ from those in 24-hour ambulatory blood pressure measurements. They are patients with the white-coat effect (office blood pressure is higher than office measurements) and with the reverse white-coat effect (ambulatory measurements are higher than office blood pressure measurements). The cardiovascular risk and the prevalence of organ damages in both phenomena are unclear. There are studies showing that these phenomena could be clinically significant. The aim of the study was to assess the prevalence of white-coat effect and reverse white-coat effect in treated hypertensive patients, depending on gender and age.Design and method:The office and 24-hour ambulatory blood pressure measurements data were collected from 1465 hypertensive patients (771 men) with mean age 55.9 ± 15.2. The reverse white-coat effect was defined as: office systolic blood pressure – daytime systolic blood pressure mean < -10 mmHg. The white-coat effect was defined as: office systolic blood pressure – daytime systolic blood pressure mean > = 20 mmHg and/or office diastolic blood pressure – daytime diastolic blood pressure mean > = 10 mmHg. Patient data were sorted in accordance with gender and divided into age decades every 10 years. Statistica software (StatSoft) and Microsoft Excel were used to calculate phenomena prevalence.Results:300 (20.5%) patients met the reverse and 286 (19.5%) white-coat effect criteria. The prevalence of both phenomena was similar in the treated hypertensive population. The white-coat effect was more common in older patients, with the highest prevalence in the 65–74 age decade (26.3%). The reverse white-coat effect referred to younger patients - predominating was 25–34 age decade (31.9%). Depending on gender, the white-coat effect was dominant among women aged 75–84 (27.4%) and among men aged 65–74 (27.1%). The reverse white-coat effect was dominant among women and men aged 25–44 (appropriate 43.5% and 26.1%).Conclusions:The reverse white-coat effect occurs the most often in women and men in the 25–34 age decade. The white-coat effect is the most common among women in 75–84 and among men in the 65–74 age decade.
Arterial hypertension (HT) is one of the most common lifestyle diseases worldwide, including Poland. According to World Health Organization, as many as 1.28 billion adults worldwide were suffering from HT in 2011 -a half were unaware of their disease. It is claimed that approximately 10 million of deaths annually are the result of improperly high blood pressure values (BP) [1]. It is estimated that the number of HT patients will exceed 1.5 billion by 2025. Therefore, it classifies HT as a major global healthcare problem [2].According to the WOBASZ II study, more than 40% of the adult Polish population were diagnosed with HT. A constantly increasing trend of newly di-
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