Systemic Hypertension
Relation of Endothelium, Thrombogenesis, and Hemorheology in Systemic Hypertension to Ethnicity and Left Ventricular Hypertrophy

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Abstract

Although the arterial tree is exposed to increased pressure in hypertensive patients, paradoxically, the complications of hypertension (heart attacks, stroke) are mainly thrombotic rather than hemorrhagic. Patients with left ventricular (LV) hypertrophy are at high risk of the complications of hypertension. We performed a cross-sectional study of 178 patients attending a hypertension clinic in a city center teaching hospital, and measured plasma levels of the soluble adhesion molecule P-selectin (associated with platelet activity/function and atherosclerosis), the von Willebrand factor (vWf; a marker of endothelial dysfunction), fibrin D-dimer (an index of thrombogenesis), plasminogen activator inhibitor (PAI, an index of fibrinolysis), lipoprotein(a) (Lp(a), associated with thrombogenesis and atherogenesis) and hemorheological indexes (fibrinogen, hematocrit, plasma viscosity, hemoglobin) in patients with essential hypertension, in whom the LV mass and LV mass index were determined using echocardiography. The 178 patients (86 men, mean age 54 ± 15 years) were compared with 47 normotensive healthy controls (aged 56 ± 20 years). Hypertensive patients had higher P-selectin, PAI, vWf, fibrin D-dimer, Lp(a), plasma fibrinogen, and plasma viscosity when compared with controls. Black hypertensive patients had higher Lp(a) levels and LV septal and posterior wall thickness on echocardiography, but lower plasma PAI levels. Patients with LV hypertrophy (defined as a LV mass index >134 g/m2 in men or >110 g/m2 in women) had higher plasma fibrinogen compared with those without LV hypertrophy. Systolic blood pressures were significantly correlated to age, plasma viscosity, plasma fibrinogen, and vWf. Diastolic blood pressures were significantly correlated with age and plasma fibrinogen. Fibrinogen levels were correlated with LV mass, LV mass index, left atrial size, plasma viscosity, and vWf. Fibrin D-dimer levels were significantly correlated with vWf and fibrinogen levels. Thus, hypertensive patients have high plasma fibrinogen levels, thrombogenesis, and impaired fibrinolysis (as indicated by high D-dimer and PAI levels, respectively), platelet activation (raised soluble P-selectin), and endothelial dysfunction (high vWF). The high plasma fibrinogen levels were related to blood pressures, LV mass index (and LV hypertrophy), and left atrial size. These abnormalities in hemorheologic factors and markers of thrombogenesis and endothelial function may act synergistically to increase the risk of thrombogenesis and atherosclerosis in hypertensive patients.

Section snippets

Patient Group:

We conducted a cross-sectional study of patients with hypertension attending our blood pressure clinic. Patients with hypertension were defined as those with blood pressure >160/90 mm Hg on ≥2 clinic visits, requiring eventual treatment with antihypertensive drugs. Careful documentation of clinical history and any antihypertensive therapy was recorded. Blood pressures were measured after sitting and 10 minutes rest in a quiet room by a trained observer using a Hawksley Random Zero

Results

We studied 178 consecutive patients (86 men; mean age 54 ± 15 years) with essential hypertension, in whom the LV mass index was determined using echocardiography; 103 were white, 49 were black and/or Afro-Caribbean, and 26 were Indo-Asian. Levels were compared with 47 matched normotensive healthy controls (mean age 56 ± 20 years).

Mean blood pressures were significantly higher in hypertensive patients compared with controls. There were significant elevations in plasma soluble P-selectin, vWf,

Discussion

Among hypertensive patients, it is well recognized that alterations in blood rheology are not uncommon in the clinical setting.11, 12In the MONICA-Project Augsburg study,[13]for example, a positive association was found between hypertension and plasma viscosity, whereas in the Scottish Health Heart Study,[14]blood viscosity, hematocrit, and plasma viscosity were correlated with blood pressure, independently of age, body mass index, and smoking status. In the present study, we found significant

Acknowledgements

Acknowledgment:

We thank J. Zarifis, MD, D. D. Bareford, MD, and Sister Michéle Beevers, SRN, for assistance with data collection.

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    This study was supported by the British Heart Foundation (PG 94017), the Peel Medical Research Trust, London; and the Pulse Trust, Birmingham, United Kingdom.

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