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Prothrombotic factors, endothelial function and left ventricular hypertrophy in isolated systolic hypertension
G Y Lip1, A D Blann, D G Beevers
1University Department of Medicine, City Hospital, Birmingham, UK. g.y.h.lip@bham.ac.uk
Insights
Individuals with isolated systolic hypertension (ISH) show similar blood clotting and endothelial dysfunction markers as those with systolic-diastolic hypertension (SDH). This suggests ISH also increases the risk of thrombotic events like stroke and heart attack.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Hypertension Research
Background:
- Systolic-diastolic hypertension (SDH) increases thrombotic complication risk.
- Isolated systolic hypertension (ISH) also presents significant cardiovascular risk.
- ISH may involve a prothrombotic state similar to SDH.
Purpose of the Study:
- To investigate if ISH patients exhibit a prothrombotic state comparable to SDH patients.
- To compare echocardiographic parameters between ISH and SDH patients.
Main Methods:
- Measured hemorheology, endothelial dysfunction, thrombogenesis, and platelet activation in ISH, SDH, and control groups.
- Compared echocardiographic parameters between ISH and SDH patients.
Main Results:
- Plasma viscosity, von Willebrand factor, plasminogen activator inhibitor-1, and lipoprotein(a) were elevated in ISH and SDH versus controls.
- SDH patients showed higher plasma fibrinogen and hematocrit than controls.
- Echocardiographic parameters were similar between ISH and SDH patients.
Conclusions:
- Individuals with ISH demonstrate prothrombotic factor and endothelial dysfunction abnormalities similar to SDH.
- Echocardiographic parameters in ISH are comparable to those in SDH.
- These findings support the increased risk of thrombotic events in ISH patients.
Background:
Individuals with systolic-diastolic hypertension (SDH, systolic blood pressure (SBP) >160 mm Hg and diastolic blood pressure (DBP) >90 mm Hg) are at increased risk of thrombotic complications, such as stroke and heart attacks, which may be related to a hypercoagulable state. Individuals with only isolated systolic hypertension (ISH; i.e. SBP >160 mm Hg but DBP <90 mm Hg) are also at significant cardiovascular risk. We hypothesized that patients with ISH would exhibit a prothrombotic state similar to that seen in SDH. A secondary hypothesis was that individuals with ISH had similar echocardiographic parameters to those seen in SDH.
Methods:
We measured indices of haemorheology, endothelial dysfunction, thrombogenesis and platelet activation in 23 individuals with ISH (mean blood pressure 193/82 mm Hg), who were compared with 51 matched patients with SDH (mean blood pressure 198/112 mm Hg) and 34 age- and sex- matched normotensive healthy control individuals (mean blood pressure 130/78 mm Hg). Echocardiographic parameters in patients with ISH were compared to those from patients with SDH.
Results:
Mean plasma viscosity (an index of blood rheology, ANOVA, P = 0.001), von Willebrand factor (an index of endothelial damage, P = 0.013), plasminogen activator inhibitor-1 and lipoprotein (a) (both markers of thrombogenesis; Kruskal-Wallis test, both P<0.001) were all significantly raised in ISH and SDH relative to controls. Individuals with SDH also had high mean plasma fibrinogen (P = 0.018) and haematocrit (P = 0.010) levels compared with control individuals. There were no significant differences in levels of fibrin D-dimer or the platelet activation marker soluble P-selectin in the hypertensive patients (i.e. ISH and SDH) compared with control individuals. Patients with ISH had similar M-mode and Doppler echocardiographic parameters compared to patients with SDH.
Conclusions:
We conclude that individuals with ISH have abnormalities in plasma prothrombotic factors and markers of endothelial dysfunction, and echocardiographic parameters, broadly similar to that seen in SDH. This is consistent with the increased risk of thrombotic events (strokes and heart attacks) in patients with ISH.