Search

Background and Objective: Early alterations in retinal microcirculation are observed in most hypertensive patients seen in daily practice and the European guidelines consider it is necessary an objective method to quantify these alterations. We have previously described a semi-automatic computerized system to evaluate the calibre of retinal blood vessels that has shown high sensitivity and specificity to calculate the arteriovenous ratio (AVR), though with limitations. We describe a method based on the snakes model to calculate the arteriovenous ratio., Patients and Method: We had compared it with the previously reported lineal method, and we have analyzed 173 digital photographs from 96 hypertensive patients, most of them receiving treatment. Photos were made in two hospitals (A Coruña: 66 and Santiago de Compostela: 107), and were analysed by the same people in each Centre, by the lineal and snake method., Results: We have observed that the arithmetic mean and the differences in AVR between both methods were minimal and showed a normal distribution. Cronbach statistics was 0.974 and intraclass correlation coefficient 0.949 (p<0.001), for the images from Santiago and 0.923 with an intraclass correlation coefficient of 0.857 (p<0.001) for the images from A Coruña., Conclusion: This semiautomatic method to calculate the AVR ratio has a high sensitivity and a greater specificity than previous method, and the correlation between the results obtained with both is excellent., (Copyright © 2009 Elsevier España, S.L. All rights reserved.)

Background: To evaluate the possible relation between left ventricular hypertrophy and vascular changes in retine, in patients with mild hypertension., Patients and Methods: We established a group with 51 hypertensives (27 males and 24 females), with essential mild hypertension, which had never been treated. An ambulatory monitoring blood pressure, 24 hours electrocardiographic monitoring, echocardiography and funduscopy were realized to all of them., Results: Fifty-five per cent of the hypertensives had retinopathy grades I-II. We established two subgroups with and without retinopathy. The age, systolic, diastolic and mean blood pressures, so as body mass index higher in the group with retinovascular damage. No significant differences were observed in the ecographic parameters between two subgroups except the interventricular septal thickness (10.5 +/- 2.1 min in the subgroup without vs 11.1 +/- 2.3 mm in the subgroup with retinovascular damage) (p < 0.05). As 24-hour maximum and mean systolic and diastolic blood pressure, daytime mean systolic blood pressure (SBP) and diastolic blood pressure (DBP), daytime and night-time DBP load, as daytime SBP load were higher in the hypertensive patients with retinovascular changes. There was echocardiographic left ventricular hypertrophy in 51% of the hypertensive patients, without differences between both subgroups of hypertensive patients. Body mass index (g/m) correlated significantly (p < 0.01) with the retinovascular damage. In the multivariant analysis, male as well as female, the funduscopy correlated with left ventricular mass index (g/m2). We established a discriminant function to separate hypertensives with and without left ventricular hypertrophy and another to separate hypertensives with and without retinopathy. Both functions included body mass index and maximum SBP, so as daytime SBP load and nighttime mean DBP to the left ventricular hypertrophy function., Conclusions: Left ventricular hypertrophy and retinovascular damage appear early in the course of blood pressure elevation and both changes develop in parallel. Our results indicate that there exists a relation between both cardiac and vascular changes in the hypertension. Body mass index and maximum SBP, appear to be important determinants of structural adaptation in mild hypertension.

Background: To establish if the differences between male and female hypertensives, with similar characteristics, are associated with different cardiovascular damage., Patients and Methods: We compare a group of 27 mild hypertensive males with another one of 24 females with similar characteristics. A 24-hour ambulatory blood pressure monitoring, a 24-hour ECG holter, an echocardiography and eye funduscopy, were done to all the patients., Results: The mean of 24 hour-systolic blood pressure (p < 0.01), the daytime and night-time systolic blood pressure load (p < 0.05), and the mean of systolic blood pressure daytime, were significantly are not higher in male than in female hypertensives. Neither echocardiographic differences nor frequency of arrhythmias were observed between both groups. 66.7% of the women had left ventricular hypertrophy vs 37% of the men, without significant difference. 40.7% of the male had rethynopathy I-II vs 50% of the female. Left ventricular mass index correlated with different parameters of the ambulatory monitoring in the multivariate analysis. Body mass index and daytime systolic blood pressure load classified correctly 89% of the male-group in with or without hypertensive rethynopathy. The body mass index, age and 24-hour maximal systolic blood pressure, classified correctly 87.5% of female hypertensives in with and without hypertensive rethynopathy., Conclusions: The differences in the ambulatory blood pressure monitoring between male and female mild hypertensive patients, were not associated with different cardiovascular damage. We emphasize the importance of the body mass index in the development of hypertensive rethynopathy in both sexes.

Objective: To determine the clinical implications of mild white coat hypertension (WCH)., Subjects and Methods: We studied 102 subjects (54 men, 48 women), 51 of whom were normotensive and 51 slightly hypertensive. None had ever received antihypertensive therapy. An ambulatory blood pressure (ABP) record (Accutracker II), a 24-h electrocardiogram and an echocardiogram were obtained from each, and each was examined by funduscopy. WCH subjects were compared with sustained hypertension (SH) subjects and with normotensives., Results: Fifty-three percent of the hypertensives qualified as WCH. The ultrasonographic characteristics and the ABP variables of the WCH group differed significantly from those of normotensives, but not from those of the SH group. The prevalence of left ventricilar hypertrophy (LVH) in the SH group (62.5%) did not differ significantly from its prevalence in the WCH group (40.7%), but the prevalence among normotensives (17.6%) was significantly lower than in either of the other two groups. The WCH and SH groups did not differ significantly as regards the prevalence of hypertensive retinopathy (33.3% in the former, 58.3% in the latter). For no non-LVH, non-retinopathic subject, whether normotensive or hypertensive, were more than 18% of daytime diastolic ABP measurements > or = 90 mmHg. Ultrasonographic findings were no better correlated with ABP than with in-clinic BP measurements. Fundus findings correlated well with in-clinic BP and with numerous ABP parameters. Retinopathy, with or without LVH, was efficiently predictable among hypertensives on the basis of body mass index and the 24-h maximum of systolic BP., Conclusions: Myocardiac remodelling and vascular retinopathy develop early and in parallel in hypertensives, and both developments appear to involve determinants including body mass index and 24-h maximum systolic BP. WCH subjects, as defined by current ABP-based criteria, have cardiac and retinovascular characteristics different to normotensive subjects. Stricter criteria are needed to discriminate between hypertensives with and without the systemic developments that constitute the immediate source of risk to the hypertensives individual.

Background: The development of arrhythmias in patients with high blood pressure has been related to the presence of left ventricular hypertrophy. The aim of this study was to determine the presence and relationship between left ventricular hypertrophy and arrhythmias in patients with slight arterial hypertension., Methods: One hundred and two individuals (54 males and 48 females), 51 of whom were hypertensive and 51 normotensive, were included in the study. None of the subjects had received antihypertensive treatment. Twenty-four hour electrocardiographic registry, echocardiogram and ambulatory blood pressure monitorization were performed., Results: Fifty one percent of the hypertensive individuals had left ventricular hypertrophy (LVH) versus 18% of the normotensive subjects. Supraventricular and ventricular arrhythmias were equally frequent in the hypertensive and the normotensive subjects as were the episodes of ST depression (7.8% versus 9.8%, respectively). Both types of arrhythmias were correlated with the age of the hypertensive subject. Twenty-seven of the hypertensive subjects had white coat hypertension. The left ventricular mass in these subjects was similar to that of the hypertensive subjects with maintained hypertension and both were greater than the normotensive subjects. In regard to the frequency of LVH in the hypertensive subjects with maintained hypertension, 15 (62.5%) did not differ from either the LVH in white coat hypertensive subjects 11 (40.7%) or in regard to the frequency of supra and ventricular arrhythmias. On multivariate analysis both types of arrhythmias correlated with the index of ventricular mass in the hypertensive patients in both males and females., Conclusions: Left ventricular hypertrophy may develop early in hypertension although it is not related to a greater frequency of arrhythmias in patients with slight arterial hypertension.