Obesity and daytime pulse pressure are predictors of left ventricular hypertrophy in true normotensive individuals

Kotsis, Vasilios; Stabouli, Stella; Toumanidis, Savvas; Tsivgoulis, George; Rizos, Zoë; Trakateli, Christine; Zakopoulos, Nikos; Sion, Michel

doi:10.1097/hjh.0b013e3283370e5e

Cited by 27 publications

(20 citation statements)

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“…In these patients echocardiographic evaluation of LV function and morphology can increase the prognostic value of PP. 14) Kotsis, et al 15) found that age and daytime PP as well as obesity were predictors of LVMI. In our study, PP and LVMI were higher in the EBPR group than in the other 3 groups.…”

Section: Discussionmentioning

confidence: 99%

“…Our results are consistent with previous studies. [13][14][15] In addition, Tsioufis, et al 12) demonstrated that hypertensives with EBPR compared to their counterparts without EBPR are characterized by more pronounced LV diastolic dysfunction (Em/Am), which was related with ambulatory PP. Trika, et al 16) revealed that in elderly hypertensive patients without LVH, a large PP at night may serve as an independent predictor of abnormal LV diastolic filling (E/A).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, we investigated the pulse pressure (PP) and plasma endothelin (ET)-1 level. It is well known that PP is associated with LVH [13][14][15] and diastolic dysfunction. 12,16) Increased ET-1 production has unfavorable effects on the arterial walls, 17) and endothelial dysfunction is related to the LVH and diastolic function.…”

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Left Ventricular Hypertrophy, Diastolic Dysfunction, Pulse Pressure, and Plasma ET-1 in Marathon Runners With Exaggerated Blood Pressure Response

et al. 2013

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SummaryThis study was conducted to study left ventricular hypertrophy (LVH), diastolic dysfunction, pulse pressure (PP), and plasma endothelin (ET)-1 level in amateur marathon runners with an exaggerated blood pressure response (EBPR) to exercise. The study participants included normotensive marathon runners (NM, n = 15), EBPR marathon runners (EBPR, n = 17), normotensive sedentary individuals (CON, n = 13), and hypertensive patients (HTN, n = 14). An integrated M-mode/2-dimensional echocardiographic analysis was performed. Plasma ET-1 levels at resting were measured using a commercial ELISA kit. LV wall thickness and end-diastolic dimensions as well as LV mass index (LVMI) were higher in EBPR than in CON. There were no differences in systolic function among the groups. Analysis of diastolic function, such as lower Em and higher E/Em ratio on TDI, showed a worse relaxation pattern in EBPR. Despite LVH, NM subjects showed no abnormality of LV diastolic dysfunction. HTN subjects in the early stage of their disease showed a slightly modified LV structural and diastolic function, but there was no statistical difference compared with CON. The E/Em ratio was significantly correlated with PP and LVMI. LVMI was significantly correlated with PP. There was a significant difference in plasma ET-1 concentration between marathon runners and hypertensive subjects. We demonstrated that marathon runners with EBPR showed an increase in LVMI and diastolic dysfunction more than HTN subjects in the early stage. PP was significantly related to these two variables. Caution should be exercised when connecting LVH and diastolic dysfunction with plasma ET-1 concentration in all marathon runners. (Int Heart J 2013; 54: 82-87)Key words: Endothelin-1, Marathon A thlete's heart is a well known condition characterized by structural, electrical, and functional adaptations of the myocardium consequent to regular physical training and consistent with the intensity, duration, and type of activity.1,2) To date, conflicting data have been reported concerning the nature (physiologic versus pathologic) of left ventricular hypertrophy (LVH) in master athletes and veterans. [3][4][5][6] Exaggerated blood pressure response (EBPR) during exercise is associated with increased risk of worsening hypertension in normotensives, as well as in subjects with high normal blood pressure (BP). 7,8) Moreover, EBPR might be related to adverse cardiovascular outcomes, partially due to its association with indices of target-organ damage such as LVH, abnormal geometry, or carotid atherosclerosis. [9][10][11] In addition, diastolic dysfunction of the LV frequently accompanies EBPR. 12)However, we do not know whether EBPR in athletes would show the same features associated with abnormal LV remodeling and diastolic dysfunction. Recently, we have unofficially found numerous cases of EBPR to exercise in Korean nonathletic marathon runners. Marathons have become a popular leisure activity in Korea during the last 2 decades and rank first in popularity as a public sport. We t...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Left Ventricular Hypertrophy, Diastolic Dysfunction, Pulse Pressure, and Plasma ET-1 in Marathon Runners With Exaggerated Blood Pressure Response

et al. 2013

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“…Obesity has also been shown to be a major factor in the development of congestive heart failure [109][110][111]. In true normotensive subjects, increased left ventricular mass corrected for body size has been reported in obese individuals [112]. Obese normotensive subjects had higher 24-h pulse pressure values than normal-weight normotensive ones suggesting an increased vasodilatation and reduced total peripheral resistance in obesity.…”

Section: Target Organ Damage In the Absence Of Hypertensionmentioning

confidence: 99%

New developments in the pathogenesis of obesity-induced hypertension

Kotsis

Nilsson

Grassı

et al. 2015

Journal of Hypertension

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Obesity is a disorder that develops from the interaction between genotype and environment involving social, behavioral, cultural, and physiological factors. Obesity increases the risk for type 2 diabetes mellitus, hypertension, cardiovascular disease, cancer, musculoskeletal disorders, chronic kidney and pulmonary disease. Although obesity is clearly associated with an increased prevalence of hypertension, many obese individuals may not develop hypertension. Protecting factors may exist and it is important to understand why obesity is not always related to hypertension. The aim of this review is to highlight the knowledge gap for the association between obesity, hypertension, and potential genetic and racial differences or environmental factors that may protect obese patients against the development of hypertension and other co-morbidities. Specific mutations in the leptin and the melaninocortin receptor genes in animal models of obesity without hypertension, the actions of α-melanocyte stimulating hormone, and SNS activity in obesity-related hypertension may promote recognition of protective and promoting factors for hypertension in obesity. Furthermore, gene-environment interactions may have the potential to modify gene expression and epigenetic mechanisms could also contribute to the heritability of obesity-induced hypertension. Finally, differences in nutrition, gut microbiota, exposure to sun light and exercise may play an important role in the presence or absence of hypertension in obesity.

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“…In extreme obese subjects, inactivity is more pronounced, as these patients have intolerance to minimal exercise due to cardiac systolic and diastolic dysfunction. 5 Obesity, essential hypertension and type 2 diabetes are twisted in a syndrome highly affected from lifestyle.…”

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Fitness, nighttime blood pressure and vascular ageing in type 2 diabetes

Kotsis

Stabouli

2011

Hypertens Res

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Obesity and daytime pulse pressure are predictors of left ventricular hypertrophy in true normotensive individuals

Abstract: Obesity may represent a significant cardiovascular risk factor even in normotensive individuals. Other predictors of LVMI were ageing and daytime PP.

Cited by 27 publications

References 50 publications

Left Ventricular Hypertrophy, Diastolic Dysfunction, Pulse Pressure, and Plasma ET-1 in Marathon Runners With Exaggerated Blood Pressure Response

Left Ventricular Hypertrophy, Diastolic Dysfunction, Pulse Pressure, and Plasma ET-1 in Marathon Runners With Exaggerated Blood Pressure Response

New developments in the pathogenesis of obesity-induced hypertension

Fitness, nighttime blood pressure and vascular ageing in type 2 diabetes

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