Arterial Compliance, Renal, Cardiac, Endocrine and Metabolic Disorders as a Predictors of Hypertension Syndrome

摘要

Hypertension is a late manifestation of a syndrome consisting of dyslipidemia, insulin resistance , endocrine and renal dysfunction, obesity, left ventricular hypertrophy and diastolic dysfunction. The aim of this research is to study the arterial compliance, renal, cardiac, endocrine and metabolic disorders as predictors of hypertension syndrome. Identification and treatment of these patients before the onset of high blood pressure may provide a better opportunity for reversing the disease progress and protecting patients from developing cardiovascular and renal diseases. This study was conducted on 130 cases, 50 patients with essential hypertension, 50 normotensive offspring of the hypertensive patients and 30 healthy subjects without family history of hypertension. All the subjects had electrocardiography, doppler and echocardiography examination for the measurement of arterial compliance, left ventricular diastolic function and left ventricular systolic function. Specific laboratory tests included lipid profile , serum insulin, plasma norepinephrine, plasma renin plasma homocysteine, plasma and urinary endothelin and urinary microalbumin. The results of the present study showed significant statistical increase of total cholesterol, triglyceride, LDL-c, microalbuminuria, insulin, norepinephrin, renin and homocysteine also significant statistical increase of left ventricular mass in hypertensive and offspring groups compared to control group and significant statistical decrease of HDL-c, urinary endothelin and of left ventricular diastolic function in hypertensive and offspring groups compared to control group. There is a significant 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. While ejection fraction was statistically decreased in hypertensive group compared to offspring and control groups and there was no difference between offspring and control group. Comparing the hypertensive and offspring groups, there is a negative correlation between arterial compliance and total cholesterol, triglyceride, LDL-c, insulin, renin, norepinephrine, microalbuminuria, homocysteine, plasma endothelin, left ventricular mass and a positive correlation with left ventricular function. There is also a positive correlation between left ventricular mass and cholesterol, triglyceride. LDL-c, insulin, renin, norepinephrine, microalbuminuria, homocysteine, plasma endothelin and negative correlation with left ventricular function. The present study suggested that many of the hypertension syndrome as lipid abnormalities, changes in renal and endocrine functions, insulin resistance and changes in the structure and function of the left ventricle and of vascular smooth muscle precede the onset of high blood pressure and impaired homocysteine metabolism may be considered as one component of the hypertension syndrome. The normotensive offspring with positive family history of hypertension have cardiovascular risk factors similar to that of the subjects with hypertension. Exercise and diet treatment are beneficial and could be the only modality for some patients, whereas early intervention with drug treatment may be necessary to the others to prevent the onset of high blood pressure .