OBJECTIVETo investigate the relationship between resting heart rate (RHR)and target organs damage in senile essential hypertension.

METHODSAll 206 elderly essential hypertensive patients (age: 60 - 85 years) were divided into three groups according to the levels of systolic blood pressure (SBP): SBP < 160 mm Hg, 160 mm Hg /= 180 mm Hg. Each of the groups mentioned above were divided into five groups according to the levels of RHR [RHR1 group: RHR < 65 beats/minute(bpm); RHR2: 65 bpm /= 80 bpm]. Electrocardiography, carotid ultrasonography, echocardiography, creatinine clearance rate (CCr) and quantitative test for 24 hours' urinary microalbuminuria (MAU) were performed.

RESULTS(1) Compared with RHR1-RHR4 groups, the RHR5 group showed with lower levels of MAU and left ventricular ejection fraction (LVEF) (P < 0.05 or P < 0.01). Compared with RHR1 and RHR2 groups, RHR5 or RHR4 group showed with higher levels of carotid intima-medial thickness (IMT) and carotid arterial diameter (CAD), lower CCr and MAU (P < 0.05 or P < 0.01). (2) The levels of IMT, CAD, LVMI, MAU were positively correlated to RHR (r = 0.312, 0.289, 0.630, 0.563, 0.576 respectively, all P < 0.01), however, the levels of LVEF, CCr were negatively correlated to RHR (r = -0.563, -0.510. all P < 0.01).

CONCLUSIONSTarget organ damage (TOD) seems not only related with PP, SBP, DBP, but also related with RHR in senile essential hypertension. RHR may be one of the important risk factors in TOD.

Aged ; Aged, 80 and over ; Blood Pressure ; Cardiovascular Diseases ; etiology ; Female ; Heart Rate ; Humans ; Hypertension ; complications ; diagnostic imaging ; physiopathology ; Hypertrophy, Left Ventricular ; Male ; Middle Aged ; Ultrasonography

BACKGROUND/AIMS: The blunted ventricular systolic and diastolic contractile responses to physical and pharmacological stress in cirrhosis are termed cirrhotic cardiomyopathy (CCM). CCM has been known to involve multiple defects in the beta-adrenergic signaling pathway. The aim of this study was to determine whether cirrhotic patients have blunted cardiac responses to catecholamine stimulation through dobutamine stress echocardiography (DSE). METHODS: Seventy-one cirrhotic patients with normal left ventricular (LV) chamber size and ejection fraction were enrolled. The LV systolic and diastolic functions were evaluated by two-dimensional and Doppler echocardiography at rest and during peak dobutamine infusion (40 microg/kg/min). An abnormal response was defined as a decrease of less than 10% in LV end-diastolic volume, a decrease of less than 20% in end-systolic volume, and an increase of less than 10% in LV ejection fraction (EF) at peak dobutamine infusion, based on previously used criteria. The early/late diastolic flow (E/A) ratio and diastolic parameters were also measured. RESULTS: A blunted LV response to dobutamine was observed in 18 of 71 cirrhotic patients (25.4%). The baseline EF was significantly higher in 18 patients with a blunted DSE response than that of those with a normal DSE response (P<0.05). The baseline and peak E/A ratios, which are common diastolic dysfunction markers, were higher in the cirrhosis group than in the control group (P<0.001). No adverse events associated with DSE were observed. CONCLUSIONS: Blunted cardiac responses to dobutamine stimulation, which are implicated in defects in the beta-adrenergic signaling pathway, might contribute to the pathogenesis of CCM in patients with cirrhosis.
Adrenergic beta-1 Receptor Agonists/*diagnostic use ; Adult ; Aged ; Dobutamine/*diagnostic use ; Echocardiography, Stress ; Female ; Heart Diseases/complications/physiopathology/*ultrasonography ; Humans ; Liver Cirrhosis/*complications/physiopathology ; Male ; Middle Aged ; Receptors, Adrenergic, beta-1/chemistry/metabolism ; Severity of Illness Index ; Ventricular Function, Left/physiology