The framingham risk score in chronic obstructive pulmonary disease (COPD)

The framingham risk score in chronic obstructive pulmonary disease (COPD)

e30 Abstracts / Journal of the American Society of Hypertension 9(4S) (2015) e29–e33 P-25 24h central blood pressure and pulse wave velocity in norm...

44KB Sizes 0 Downloads 25 Views


Abstracts / Journal of the American Society of Hypertension 9(4S) (2015) e29–e33

P-25 24h central blood pressure and pulse wave velocity in normotensive, hypertensive, white coat hypertension and masked hpertension young adults Rafael A. Faria,3 Annelise G. Paiva,3 Roberto Pozzan,3 Maria Eliane C. Magalhaes,3 Erika Maria G. Campana,3 Flavia L. Fonseca,3 Marco Antonio M. Gomes,1,2 Andrea A. Brandao.3 1 CESMAC, Maceio, Brazil; 2CPC/HCOR, Maceio, Brazil; 3State University of Rio de Janeiro, Rio de Janeiro, Brazil Background: Evaluation of 24h central blood pressure (CBP) and pulse wave velocity (PWV) in white coat hypertension (WCH), and masked hypertension (MH) could contribute to better stratification of cardiovascular risk and therapeutic decisions. Objective: To investigate CBP and PWV in 24 hours, awake and sleep periods in individuals 18 to 50 years classified according to the behavior of office BP and 24h monitoring brachial BP. Methods: A total of 104 subjects (60 females (57.7%) and 44 males (42.3%), 48 (46.2%) individuals were 18 to 35 years old and 56 (53.8%) individuals were 36 to 50 years old. Exclusion criteria were: use of antihypertensive drugs, body mass index35 kg/m2, eGFR<60ml/min, diabetes and smoking. All were submitted to clinical and laboratory evaluation, measurement of office BP with oscillometric sphygmomanometer OMRON, model HEM-705CP, and 24h monitoring of brachial BP, CBP, Augmentation Index (AIx) and PWV in with the Mobil-O-Graph equipment (DINA MAP cardios - ESI GmbH, Stolberg, Germany). They were classified in normotensives (N), hypertensives (H), WCH and MH, according to the presence or not of abnormal BP in office BP and/or awake brachial BP. Results: 1) Mean age was 36.998.53 years old; BMI mean was 25.803.82kg/m2; 2) There were 56.7% true normotensives (N), and 13.5% true hypertensives (H), 19.2% had WCH, and 10.6% MH; 3) Systolic CBP means (24h, awake and sleep periods) were different among the groups. For 24h and awake periods, group H showed higher means than N and WCH , but MH did not differ from H (p<0.001). For sleep period, H presented higher means than N. WCH and MH were not different from H (p¼0.001); 4) 24h and sleep diastolic CBP presented higher means in group H than in group N (p¼0.001), although WCH and MH groups did not differ from H. For awake diastolic CBP, higher means were observed in group H than N, WCH and MH (p<0.001); 5) Group H showed higher PWV means in 24h (p¼0.003) and awake (p¼0.002) periods than group N; WCH and MH were not different from H. MH showed higher sleep PWV mean than N (p<0.007). Conclusion: MH and WCH showed intermediate 24h, awake and sleep CBP and PWV means, between normotension and hypertension, and most comparisons did not show differences to true hypertension. These results suggest that central BP and PWV could contribute to risk stratification in WCH and MH young adults. Keywords: Central blood pressure; pulse wave velocity; masked hypertension

P-26 The framingham risk score in chronic obstructive pulmonary disease (COPD) Nichola S. Gale, Maggie M. Munnery, Niamh Chapman, Dennis J. Shale, John R. Cockcroft. Cardiff University, Cardiff, United Kingdom Background: Patients with chronic obstructive pulmonary disease (COPD) have increased risk of cardiovascular (CV) events and mortality beyond that attributable to smoking. Although identifying CV risk in COPD is difficult, aortic pulse wave velocity (aPWV), a validated measure of arterial stiffness and an independent predictor of cardiovascular (CV) outcomes, is elevated in patients with COPD. We hypothesised that patients with COPD would

have greater Framingham risk score and aPWV than controls and that aPWV would relate to Framingham risk score. Methods: At baseline 524 patients with COPD and 143 controls (free from lung disease) were assessed for; lung function (forced expiratory volume (FEV1), forced vital capacity (FVC) and their ratio), blood pressure (BP), BMI, aPWV and blood pressure (BP). In addition, medical and smoking history were recorded and used to calculate the Framingham risk score and vascular age. Results: Patients and controls were similar in age, gender and BMI, but patients had greater aPWV, Framingham risk score and vascular age (Table 1), which remained after adjustment for age, and MAP. In COPD, Framingham risk related to age r¼0.295, aPWV r¼2.34, SBP r¼0.194 and FEV1% predicted r¼0.112, (all p<0.01). In controls, Framingham risk score related only to age r¼383, aPWV r¼0.189 and systolic BP r¼0.195 p<0.05. Conclusions: The association between the Framingham risk score and aPWV suggests that either may be useful to identify individuals with COPD at risk of future CV events. The presence of increased vascular age which related to aPWV suggests that patients with COPD may have premature vascular aging which may explain the excess CV risk. Further follow-up of this cohort will evaluate the prognostic utility of these measures of CV risk. Keywords: Chronic lung disease; arterial stiffness; cardiovascular risk

P-27 The effect of reactive hyperemia on korotkoff sound timing: a potential measure of arterial vasodilation Muhammad Ihsan, Arismendy Nunez, Behram Mody, Navneet Sharma, Yang Liu, Magdalene Fiddler, Sahib Singh, Louis Salciccioli, Jason Lazar. Downstate Medical Center, Brooklyn, NY, United States For more than a century, the Korotkoff sound (KS) technique has been commonly used to measure blood pressure. The timing of KS may be assessed by simultaneous ECG and KS wave recording with an electronic stethoscope and may potentially reflect arterial stiffness. The objective of this study was to characterize the effects of hyperemia on KS timing in healthy subjects. We prospectively studied 10 healthy subjects (9 males, age 348 years) without cardiovascular disease or risk factors. Baseline KS recordings were obtained over the brachial artery with an electronic stethoscope (Thinklabs ds32a electronic stethoscope, Thinklabs Medical, Denver, Colorado) and a Hokanson cuff inflated to 20mmHg above diastolic BP on the upper arm, while simultaneously recording a single lead electrocardiogram for 7 minutes. In another sitting, the same procedure was repeated with a second Hokanson cuff placed around the forearm, which was inflated 50mmHg above systolic BP for 5 minutes and then rapidly deflated to induce hyperemia. Data were recorded before, during and after deflation and then digitalized and analyzed by determining the time from the QRS (onset of cardiac contraction) to the peak of the KS waveform (QKD interval). Inflation of the first cuff resulted in baseline variability in QKD of 4 msecs (2.5%). QKD values were not significantly correlated with corresponding RR values. Release of forearm cuff occlusion resulted in an increase of QKD from 17921 to 18526 msecs, p¼0.03. In conclusion, there is little variability in QKD during 7 minutes of recordings at rest. QKD is unrelated to cardiac cycle length. Hyperemia significantly increases QKD values. These preliminary data suggest that QKD may reflect arterial tone. While absolute changes are small, these data support that resting values of QKD may represent a cost effective method by which to assess arterial stiffness while determining BP by KS. Direct comparison to measures of arterial stiffness as well as the prognostic value of QKD merit further study. Keywords: Korotkoff; arterial stiffness