الفهرس 
hypertension syndromeOnly 14 pages are availabe for public view
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Abstract
Hypertension is a late manifestation of a much broader syndrome of
cardiovascular risk factors such as abnormalities of lipid profile, insulin
resistance, changes in endocrine and renal function, obesity, left ventricular
hypertrophy and diastolic dysfunction. These associated risk factors may be
present for years before the onset of high blood pressure and may precipitate
coronary event either before or after the onset of high blood pressure. In
addition, it appears that many of the changes in vascular structure and
function occur before the onset of high blood pressure and may be
responsible for its ultimate development. In these patients, treatment of high
blood pressure will have very little impact on the outcome.
The development of high blood pressure in patients with
hypertension syndrome may represent an advanced or perhaps irreversible
stage of the disease process, and it is possible that treatment at this stage can
only control blood pressure and slows the progression to cardiovascular
disease. Identification and treatment of those patients hefore the onset of
high blood pressure may provide a better opportunity for reversing disease
process and protecting them from developing cardiovascular disease (CVD).
The aim of our research is to study the arterial compliance, renal,
cardiac, endocrine· and-metabelie- ctiseRIers···~~· -of hypertension
syndrome. Identification and treatment of these patients before the onset of
high blood pressun: may provide a better opportunity for reversing the
disease process and protecting patients from developing cardiovascular and
renal diseases.
This study was conducted on 50 patients with essential hypertension ,
50 nonnotensive offsprings of the hypertensive patients and 30 healthy
control subjects without family history of hypertension matched for age,
body mass index and blood pressun: with the offspring group.
Patients with secondary form of hypertension, proteinuria , chronic
renal or liver disease, peripheral vascular disease, heart disease other than
ischemic heart disease and diabetes mellitus were excluded from this study.
All the subjects were subjected to thorough history, complete clinical
examination, electrocardiography, echocardiography and body mass index
was calculated, and laboratory investigations including urine analysis,
complete blood picture , serum creatinine and blood urea, serum calcium,
serum sodium, serum potassium, serum uric acid and fasting blood sugar and
postprandial blood sugar.
Specific Iabontory test includes :
- Serum lipiJJs: Measured by standard enzymatic methods .
- MicrtHlllHlminuria : Measured by enzyme linked immunoassay (ELISA).
- Serum insulin: Measured by radioimmunoassay.
- PIas””, norepinephrine: Measured by radioimmunoassay.
- Pilmu I’eIfbr COIICelltratio,,: Measured by immunoradiometeric assay
(IRMA).
- PhIs_ IIomocysmne Measured by enzyme linked immunoassay
(ELISA).
- PhIs_ 011II IlrUuuuy endotllelin : Measured by enzyme linked
immunoassay (ELISA), with separation ofCl8 using column extraction
Doppler and edaoc:ardiographic exameaation
The arterial compliance was measured by non invasive doppler
ultrasound and calculated by the equation:
AC =66.7 (TILt
where:
AC =arterial compliance.
T =transit time =transit time of aorta - transit time of subclavian.
••
L = distance from the mouth of subclavian to the aortic bifurcation.
Echocardiography and doppler echocardiography used to measure
left ventricular structure and function
The results of the present study showed :
- Significant statistical increase of total cholesterol, triglycerides , LDL - c
and decrease of HDL - c in hypertensive and offspring groups compared
to control group.
- Significant statistical mcrease of microalbuminuria , insulin ,
norepinephrine , renin and homocysteine in hypertensive and offspring
groups compared to control group.
- Significant statistical increase of plasma endothelin in hypertensive group
compared to offspring and control groups . While non significant
statistical increase of plasma endothelin in offspring group compared to
control group.
- Significant statistical decrease of urinary endothelin in hypertensive and
offspring groups compared to control group.
- Significant statistical increase of left ventricular mass in hypertensive and
oflilpring groups compared to control group.
- Significant statistical decrease of arterial compliance in hypertensive and
oflilpring groups compared to control group.
- Significant statistical decrease of left ventricular diastolic function in
hypertensive and offspring groups compared to control group. While
ejection fraction Was statistically decreased in hypertensive group
compared to offspring and control groups, and there was no difference
between offspring and control groups.
Comparing the hypertensive and offspring groups , significant
statistical correlations were found:
- Negative correlation between arterial compliance and total cholesterol ,
triglycerides , LDL-c , insulin, renin , norepinephrine, microalbuminuria
, homocysteine , p.endothelin , left ventricular mass and positive
correlation with left ventricular function.
- Positive correlation between left ventricular mass and cholesterol,
triglycerides , LDL-c , insulin, renin, norepinephrine, microalbuminuria
, homocysteine , p.endothelin, and negative correlation with left
ventricular function.
COBclusioB
Finaly, the present study confirmed that, many of the components of
the hypertension syndrome as lipid abnormalities, changes in renal and
endocrine function, insulin resistance, and changes in the structure and
function of the left ventricle and of vascular smooth muscle in the
vascuIature precede the onset ofbigh blood pressure, and that impaired Hey
metabolism may be considered as one component of the hypertension
syndrome ..
In tenns of cardiovascular risk , the normotensive offspring with
positive family history of hypertension have cardiovascular risk factors
similar to that of the subjects with hypertension, the two groups are at
similar risk for cardiovascular disease, the only difference being that the
normotensive subjects have not yet developed high blood pressure, which
seems to be a late manifestation of this disease process. Identification and
treatment of these patients earlier in the disease process, before they develop
high blood pressure, then we might have a bigger impact on the course of the
disease and might protect them from developing high blood pressure and
perhaps thereby protect them from developing cardiovascular disease.