[Assessment of the intima and media of carotid arteries in the course of hypertension in the elderly]

According to the position of the European Society of Hypertension in 2009, the thickening of the inner and middle membrane complex of the carotid arteries (I-M CCA), or the finding of atherosclerotic plaques is associated with high cardiovascular risk. The increase in I-M CCA thickness, assessed within the carotid artery, is considered the initial stage of atherosclerosis. According to the concept of parallel development of atherosclerosis in many arterial areas I-M CCA is a recognized marker of the process involving other arteries, such as coronary arteries, kidney or lower limbs.

AIM

The aim of the study was evaluation of the intima and media of carotid arteries - I-M in the course of hypertension in the elderly.

MATERIALS AND METHODS

The study involved 63 women and 17 men, aged from 75 to 93 years, who were diagnosed with arterial hypertension in accordance with the guidelines of the Polish Society of Hypertension. Patients were divided into two groups. The first pair consisted of a group of 1 hypertensive patients (HA) lasting up to 10 years of age over 85 years and a group of 2 patients with HA lasting up to 10 years at the age of 75-85 years. The second pair is group I - patients with HA over 10 years of age over 85 years and group II - patients with HA lasting over 10 years at the age of 75-85. Carotid artery examination was performed using the Aloka SSD-1100 ultrasound machine. The measurements were made within the left and right carotid wall of the common carotid artery in the anterior and lateral-posterior projection. The maximum thickness of the inner and middle membranes was measured in three places within two segments of the common carotid artery.

RESULTS

It was observed that in the group of patients treated longer due to hypertension, the thickness of the intima-media complex is significantly higher than in patients with shorter duration. Moreover, in the examined group of patients in the analysis of individual correlations, life expectancy was influenced, among others, by significantly on the thickness of I-M CCA.

CONCLUSIONS

Both the older age of patients and the longer duration of hypertension caused thickening of the intima-media complex. The duration of hypertension greater than 10 years had a greater impact on the thickness of this complex than the age of the patients.

[Oxidative-reductive balance in patients after acute coronary syndrome that undergo cardiac rehabilitation]

Cardiac rehabilitation is essential part of acute coronary syndrome (ACS) treatment. Controlled physical activity (both aerobic exercise and muscle-strengthening activities) is the most important part of cardiac rehabilitation (CR). There is a close relationship between regular physical exercise and secondary prevention in patients after ACS. However, influence of physical activity on antioxidative protection mechanisms and free radical reactions is not yet fully known. The aim of study was to evaluate CR effects (the second phase) on oxidative-reductive balance in patients after ACS hospitalised for CR.

MATERIAL AND METHODS

Our study comprised 50 patients (32 male, 18 female), aged 42-75 years (56.42 +/- 8.34) after ACS treated by percutaneous transluminal coronary angioplasty (PTCA), that subsequently underwent the second phase of CR. Interval cycloergometer training was performed five times a week (in total 15 training sessions). In addition to interval training, patients underwent individual breathing exercises, relaxation exercises, isometric exercises of particular muscle groups and general rehabilitation twice a day. Thiobarbituric acid reactive substances (TBARS) level in erythrocytes, total antioxidant status (TAS) of plasma, superoxide dysmutase-1 (SOD-1), catalase (CAT) and glutathione peroxidase (GSH-Px) activity in erythrocytes were determined before and after CR programme. Statistical analysis of physical activity influence on oxidative-reductive balance was performed by Wilcoxon matched pairs test. P < 0.05 was acknowledged as statistically significant.

RESULTS

After rehabilitation programme in patients after ACS following significant results were found: increase in SOD-1 activity compared to baseline values (3624.22 +/- 1003.38 U/gHb vs 3086.71 +/- 683.14 U/gHb; p = 0.007), increase in GSH-Px activity compared to baseline values (41.27+/- 13.87 U/gHb vs. 38.02 +/- 13.98 U/gHb; p = 0.006), decrease in CAT activity compared to baseline values (17.30 +/- 4.87 U/gHb vs. 19.64 +/- 4.36 U/gHb; p = 0.001), increase in TAS level compared to baseline values (2.00 +/- 0.75 mM/L vs. 1.66 +/- 0.71 mM/L; p = 0.003), increase in TBARS level compared to baseline values (0.21 +/- 0.05 microM/gHb vs. 0.19 +/- 0.03 microM/gHb; p = 0.0006).

CONCLUSIONS

Improvement of antioxidative protection in patients after ACS was observed after cardiac rehabilitatiom programme. Increase in SOD-1 and GSH-Px activity in erythrocytes and TAS plasma level was found. Increase of TBARS level in erythrocytes in patients after ACS and subsequent cardiac rehabilitation is associated with intensification of free-radical chain reaction related to physical activity.