Effect Of Isradipine On Left Ventricular Diastolic Function、Plasma STWEAK Level And Blood Pressure Variability In Patients With Essential Hypertension

BackgroundEssential hypertension is a common disease in clinical cardiovascular medicine and an important risk factor increasing the morbidity or mortality in cardiovascular and cerebrovascular diseases. In addition to the blood pressure levels, blood pressure variability (BPV) plays an important role in hypertensive target-organ damage, and it should become a new therapeutic target. Impaired left ventricular diastolic function and increased left ventricular mass are common findings in hypertensive heart damage and was demonstrated to be closely associated with increased BPV. Recently researches found that inflammatory cytokine TWEAK/Fn14was associated with cardiac remodeling and progression of cardiac dysfunction. Limited data on the relationship between plasma sTWEAK level and hypertension exist. Whether the plasma sTWEAK level could be affected by BPV and the correlation between plasma sTWEAK level and left ventricular diastolic function are not clear.ObjectiveThe purpose of the present study was to explore the relationship between blood pressure variability (BPV)、LV diastolic function obtained by echocardiographic tissue Doppler imaging (TDI) and plasma sTWEAK level in essential hypertensive patients and the treatment effect of isradipine.MethodsForty two hypertensive subjects (20men and22women) who visited our hospital from August2012to February2013were enrolled if they met the criteria, and they were divided into two groups:non-left ventricular hypertrophy (NLVH) group including17patients while left ventricular hypertrophy (LVH) group including25patients. After2weeks of placebo, the participants meeting the entry criteria were treated with isradipine2.5mg twice a day for8weeks. If the medicine had not reduced diastolic pressure to<90mmHg after1month of treatment, the dose would be doubled. Patients were underwent echocardiographic assessment and24-h ambulatory blood pressure monitoring at baseline and at the end of the study. Blood samples were collected for routine laboratory screening and assessment of sTWEAK by ELISA.Statistical analyses were performed using SPSS18.0statistical software. The quantitative data are expressed as the means±SD. Paired t test was performed to compare the pre-and post-Isradipine data and Pearson correlation was used to determine correlations between variables. A p value of <0.05was considered statistically significant.Results1. Except the BP level,24h SBPSD and24h DBPSD of LVH group were also significantly higher than NLVH group (P<0.05).2. Left ventricular diastolic function seemed to be poorer in LVH group, as EDT, E/Ea significantly increased and E/A ratio decreased (P<0.05or P<0.01). No difference was shown in TEI index between the two groups (P>0.05).3. Compared with the NLVH group, plasma sTWEAK level were increased in LVH group (1285.0±75.5pg/ml vs1475.9±157.8pg/ml,p<0.05).4. After8weeks’ treatment, HDL was significantly higher and UA was lower (P<0.05for both), while blood pressures were significantly lower, both in office monitoring and24-h ABPM(P<0.01for all).5. Compared to baseline, the improvement of BPV was not remarkable, while LVMI was significantly decreased after8weeks’ treatment (123.0±19.9vs118.7±17.2;p<0.01). As for diastolic function and filling pressure, EDT, E/Ea significantly increased and E/A ratio decreased (P<0.05; P<0.01; P<0.05respectively). There were no significant change in IVRT and TEI index compared to baseline.6. Significant effect was found on plasma sTWEAK level between baseline and8weeks of treatment (1398.6±160.5vs1371.9±149.2; P<0.01).7. The LVMI was positively correlated to E/Ea(r=0.537,p<0.05) and plasma sTWEAK level (r=0.718,p<0.05), and plasma sTWEAK level was also positively correlated to E/Ea(r=0.484,p<0.05).Conclusion1. There were relationships between BPV and LV hypertrophy in essential hypertension and BPV is a important risk factor of cardiovascular diease;2. Left ventricular diastolic dysfunction was associated with left ventricular hypertrophy in patients with essential hypertension and TDI is a useful and reliable technology to obtain LV diastolic function.3. Plasma sTWEAK level may be an risk factor of cardiac remodeling and LV diastolic dysfunction;4. LV hypertrophy and LV diastolic dysfunction were improved after8weeks’treatment of isradipine and plasma sTWEAK level became smaller.5. The ambulatory blood pressure monitoring and echocardiography should be important implications for the development and prognosis of hypertension.