Atrioventricular conduction in the hypertensive patient: influence of aging, pulse pressure, and arterial stiffness.

Atrioventricular (AV) conduction time (PR interval) lengthens with age. Hypertension is often presented as an accelerated aging of the heart and arteries. The principal marker of arterial aging is an increase in arterial stiffness and pulse pressure.

Impact of malignant arterial hypertension on the heart.

Objectives: To assess the consequences of malignant hypertension and its evolution with antihypertensive treatment.

Background: Malignant hypertension can be considered as a model of the effects of very high blood pressure and renin-angiotensin levels on target organs. However, the consequences on the heart have been little studied.

Long-term decline in renal function is linked to initial pulse pressure in the essential hypertensive.

Objectives: In the absence of malignant hypertension, the mechanisms for the decline in renal function in hypertensive patients are not well known. Several recent studies, essentially cross-sectional, point to a role for an increase in arterial stiffness and its corollary, the increased pulse pressure (PP), in barotrauma of the renal glomerulus.

Methods: We examined relations between the PP measured on consultation or by 24-h ambulatory blood pressure monitoring and the long-term decline in renal function in a population of essential hypertensive patients initially untreated, with normal renal function and without proteinuria.

Long-term influence of antihypertensive treatment on arterial stiffness assessed by ambulatory measurement of the QKD interval.

An increase in arterial stiffness is an important risk factor for cardiovascular events. However, there are few data on the long-term evolution of arterial stiffness in treated hypertensives. We evaluated the progression of arterial stiffness in 120 initially untreated hypertensive patients whose arterial stiffness was assessed by the ambulatory monitoring of the QKD interval measured at baseline and then more than 1 year later.

Can ambulatory blood-pressure monitoring provide reliable indices of arterial stiffness?

Background: The use of ambulatory recordings of blood pressure (BP) was proposed to estimate arterial stiffness (AS). We compared the relative value of the ambulatory AS index (AASI), and of the slope of pulse pressure (PP) according to mean BP (MBP) obtained from 24-h ambulatory BP monitoring, to the monitoring of the arrival time of Korotkoff sounds (QKD interval) in the prediction of cardiovascular (CV) events.

Methods: Twenty-four-hour ambulatory BP and QKD monitoring were recorded at baseline, before antihypertensive treatment of hypertensive patients in our Bordeaux cohort.

Arterial stiffness evaluated by measurement of the QKD interval is an independent predictor of cardiovascular events.

Background: The QKD interval is the time between the QRS wave on the electrocardiogram (ECG) and the detection of the last Korotkoff sound during BP measurement. Measurement of the QKD interval during ambulatory blood pressure (BP) monitoring provides an automatic evaluation of arterial stiffness. The objective of this longitudinal study was to examine the relationship between arterial stiffness assessed by this method and the occurrence of cardiovascular complications in a cohort of initially untreated hypertensive patients.

Blood pressure surge on rising.

Objectives: Since cardiovascular complications tend to occur more often in the morning, it is tempting to link this to the surge in blood pressure (BP) on rising. Our objective was to measure BP and heart rate (HR) on rising and compare values with those recorded immediately beforehand and seek variables related to marked changes in the two parameters in a cohort of initially untreated hypertensives.

Methods: The 24-h ambulatory BP measurement along with an accurate measurement of the BP on rising (either manually or automatically from the device coupled with a position sensor) was obtained in untreated hypertensives.