Age- and Gender-Related Differences in the Hemodynamic Status of Patients with Mild or Moderate Hypertension

Purpose

The aim of this study was to use non-invasive impedance cardiography (ICG) to determine the hemodynamic status of patients with grade 1 and grade 2 hypertension in relation to gender and age.

Patients and Methods

We analyse prospectively collected data of 158 patients with grade 1 or grade 2 arterial hypertension. Patients were grouped according to age: 1) <50 years and 2) ≥50 years. Hemodynamic status of patients was assessed by using non-invasive ICG. For the purpose of this study two hemodynamic parameters were used: a) systemic vascular resistance index (SVRI) and b) left cardiac work index (LCWI). The primary endpoint was the hemodynamic status of patients. The secondary endpoint was hypertension-mediated organ damage.

Results

Increased SVRI was assessed in 80% of patients, more common in the ≥50 years group than in the <50 years group (88.5% vs 64.8%; p < 0.01). The occurrence of increased systemic vascular resistance correlates hierarchically with increasing age. Elevated LCWI (hypervolemia and/or hyperinotropy) was present in 63% of patients, more often in males than females (70.3% vs 57.1%; p < 0.05) as well in those <50 years than in older patients (70.4% vs 59.6%; p < 0.05). Patients with diabetes were less likely to have hypervolemia/hyperinotropy than those without diabetes (46.7% vs 67.2%; p < 0.01). Hypervolemia/hyperinotropy (46.7%) and hypovolemia/hypoinotropy (43.3%) were present in a similar percentage of diabetic patients. Left ventricular hypertrophy was found in 30 patients (19%). Patients with left ventricular hypertrophy were more commonly male (66.7% vs 42.2%; p = 0.016) and had increased systemic vascular resistance (96.7% vs 77.3%; p = 0.015) compared to the patients without left ventricular hypertrophy. Hypertensive retinopathy grade III was found in 14 patients (8.9%). Elevated daytime systolic pressure, diabetes and increased age are independent predictors of grade III hypertensive retinopathy. Patients with reduced renal function had higher mean systolic blood pressure (p < 0.05), were more commonly male (p < 0.01) and older (p < 0.01) than those without reduced renal function.

Conclusion

Although there are certain correlations between hemodynamic disorders and age and gender, specific hemodynamic status of an individual patient with hypertension cannot reliably be predicted on the basis of age and gender. The measurement of hemodynamic parameters by ICG can guide the clinician to select appropriate antihypertensive therapy to the patients’ hemodynamic pathophysiologic condition.

Abstract P370: The Efficacy of Fixed Combination Lisinopril and Hydrochlorothiazide in Obese Hypertensive Women

Objectives: The aim was to assess the effects of lisinopril combined with hydrochlorthiazide on blood pressure of hypertensive women with normal weight, overweight and obesity.

Methods: The study comprised 454 hypertensive women, aged 61.50±10.64 years. All patients were treated with fixed combination of 20 mg lisinopril and 12.5 mg hydrochlorthiazide. Body mass index (BMI) was calculated from body weight divided by squared body height. Normal weight was defined as BMI from 18.5 to 24.9 kg/m 2 , overweight as BMI from 25.0 to 29.9 kg/m 2 and obesity as BMI exceeding 30 kg/m 2 . Blood pressure (BP) was measured by an oscillometric device at the beginning of the study, and after three months of therapy. The differences between the groups were tested with one-way ANOVA. The differences from baseline values were tested with Student’s t test for paired samples.

Results: At the beginning of the study 124 women (27.9%) had normal weight, 217 women (48.8%) were overweight, and 104 (23.4%) were obese. All three groups of women had similar systolic (SBP) and diastolic pressures (DBP) at the beginning of the study as well as at the end of the study. Mean BMI remained stable during three months of antihypertensive therapy. Mean SBP for all patients at the beginning of the study was 161.90±13.26 mmHg, mean DBP was 97.48±8.78 mmHg. After three months of therapy, all women reduced their SBP significantly (mean decrease from baseline = 28.48±12.67 mmHg), as well as their DBP (mean decrease from baseline = 15.48±8.84 mmHg). The average decrease in SBP and DBP during therapy was similar among women with normal weight, overweight and obesity. Women with normal weight reduced their SBP by 29.61±12.33 mmHg, in comparison to overweight women (28.42±11.89 mmHg), and to obese women (26.54±12.74 mmHg), but the difference was not statistically significant.

Conclusion: Three-month therapy with lisinopril and hydrochlorthiazide is equally effective in hypertensive women with normal weight, overweight and obesity.

Effect of astaxanthin supplementation on paraoxonase 1 activities and oxidative stress status in young soccer players

The purpose of the study was to examine the effects of astaxanthin (Asx) on paraoxonase (PON1) activities and oxidative stress status in soccer players. Forty soccer players were randomly assigned in a double-blind fashion to Asx and placebo (P) group. Blood samples were obtained before, 45 and 90 days after supplementation. PON1 activity was assessed by using two substrates: paraoxon and diazoxon. The oxidative stress biomarkers were also examined: total sulphydryl group content (-SH groups), thiobarbituric acid-reactive substances (TBARS), advanced oxidation protein products and redox balance. The significant interaction effect of supplementation and training (p < 0.05) on PON1 activity toward paraoxon was observed. The PON1 activity toward diazoxon increased in Asx group after 90 days (p < 0.01), while there was no significant difference in P group. SH groups content rose from pre- to post-supplementation period only in Asx group (supplementation and training, p < 0.05; training, p < 0.01). TBARS levels decreased after 45 days and increased after 90 days of regular soccer training in both groups (training, p < 0.001). Redox balance decreased significantly in response to the regular training, regardless of treatment group (training, p < 0.001). Asx supplementation might increase total SH groups content and improve PON1 activity through protection of free thiol groups against oxidative modification.

Effect of astaxanthin supplementation on muscle damage and oxidative stress markers in elite young soccer players

AIM

The purpose of the current study was to examine the effect of Astaxanthin (Asx) supplementation on muscle enzymes as indirect markers of muscle damage, oxidative stress markers and antioxidant response in elite young soccer players.

METHODS

Thirty-two male elite soccer players were randomly assigned in a double-blind fashion to Asx and placebo (P) group. After the 90 days of supplementation, the athletes performed a 2 hour acute exercise bout. Blood samples were obtained before and after 90 days of supplementation and after the exercise at the end of observational period for analysis of thiobarbituric acid-reacting substances (TBARS), advanced oxidation protein products (AOPP), superoxide anion (O2•¯), total antioxidative status (TAS), sulphydril groups (SH), superoxide-dismutase (SOD), serum creatine kinase (CK) and aspartate aminotransferase (AST).

RESULTS

TBARS and AOPP levels did not change throughout the study. Regular training significantly increased O2•¯ levels (main training effect, P<0.01). O2•¯ concentrations increased after the soccer exercise (main exercise effect, P<0.01), but these changes reached statistical significance only in the P group (exercise x supplementation effect, P<0.05). TAS levels decreased significantly post- exercise only in P group (P<0.01). Both Asx and P groups experienced increase in total SH groups content (by 21% and 9%, respectively) and supplementation effect was marginally significant (P=0.08). Basal SOD activity significantly decreased both in P and in Asx group by the end of the study (main training effect, P<0.01). All participants showed a significant decrease in basal CK and AST activities after 90 days (main training effect, P<0.01 and P<0.001, respectively). CK and AST activities in serum significantly increased as result of soccer exercise (main exercise effect, P<0.001 and P<0.01, respectively). Postexercise CK and AST levels were significantly lower in Asx group compared to P group (P<0.05)

CONCLUSION

The results of the present study suggest that soccer training and soccer exercise are associated with excessive production of free radicals and oxidative stress, which might diminish antioxidant system efficiency. Supplementation with Asx could prevent exercise induced free radical production and depletion of non-enzymatic antioxidant defense in young soccer players.