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Mean IMTSD

Mean DiameterSD

Number of points

System I 2.0 - IdP, Paris, France

Estructura de la Pared Arterial

*

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CAROTID-FEMORAL PWV AND CAROTID COMPLIANCE

h

T

d

PWV (m/s) =L/T

L = Carotid-Femoral distance (m). T = Time (sec)

Dm:Mean diameter, d : blood density, Pm:Mean pressure, Piso: 110 mmHg

1

L

2

P

2

2

1334

PWV

D

C

m

m

=

d

P

C

C

m

m

=

P

iso

iso

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0.00

1.00

2.00

3.00

4.00

5.00

60

80

100

120

140

160

PAM (mmHg)

10-4 cm/mmHg

NT

HTpost

HTpre

Compliance Isobrica

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Relacin PA con Funcin Arterial

*

12.unknown

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IMT:

Compliance and Viscosity Relationship

R = 0.60

p < 0.05

0

2

4

6

8

10

0.4

0.6

0.8

1.0

1.2

IMT [mm]

Viscosity index

[mmHg.s/mm]

R = 0.57

p < 0.05

0

5

10

15

20

25

0.5

0.7

0.9

1.1

IMT [mm]

Compliance

[10

-4

cm/mmHg

]

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Indice de Desadaptacin e IMVI

*

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IMVI y PA

*

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IMVI y PA

*

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Dependencia del IMVI del la variabilidad de la PA pero no de los valores medios de PA.

In HT subjects, the relationship between LVMI and BP variability is independent of the BP values.

This is shown by the fact that in either group in which BP was separed in groups of 10mmHg, the higher the standard deviation the higher the LVMI.

*

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Rin e Hipertensin Arterial

Drawn from Laragh, JAMA, 1960

Renina

Angiotensina II

Angiotensina I

ECA

Atgeno Plasmatico

CORTEZA

ADRENAL

Aldosterona

ACTH

K+

Na+ retencin

K+ Prdida

PA

Vasoconstriccin

Vasculotoxicidad

Cerebro (ACV)

Retina (desprendimiento)

Corazn (IAM, IC, Arritmias)

Rin (IR)

Estrs Oxidativo

*

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Mecanismo de accin de los Bloqueantes de los Receptores de la Angiotensina II (BRA)

CIMASAS

ANGIOTENSINA I

ANGIOTENSINOGENO

ANGIOTENSINA II

BRA

INHIBIDOR

DE RENINA

BRADIKININA

PEPTIDOS

IECA

NO

AT1

AT2

*

Valsartan is a highly selective antagonists at the AT1 receptor, thereby selectively inhibiting only the deleterious effects of Ang II

ACE inhibitors have many substrates including bradykinin, substance P, neurotensin, enkephalin, LHRH, N-acetyl-Ser-Asp-Lys-Pro

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*

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Relacin entre el SRA y la formacin de xido Ntrico

Angiotensina II

Angiotensina I

Angiotensina (1-7)

Endopeptidasas

Receptor AT2

Receptor AT (1-7)

Bradiquinina

Receptor BK II

ON

Accin antiproliferativaDiferenciacin celularReparacin tisularVasodilatacinNatriuresisDiuresisAccin anti-remodelacin

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*

17.unknown

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*

18.unknown

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Obesidad

Reduccin

De

Peso

*

19.unknown

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*

20.unknown

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*

21.unknown

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HTA, Dao de Organo Blanco y
Riesgo Cardiovascular

Adapted from Willenheimer R et al Eur Heart J 1999; 20(14): 9971008, Dahlf B J Hum Hypertens 1995; 9(suppl 5): S37S44, Daugherty A et al J Clin Invest 2000; 105(11): 16051612, Fyhrquist F et al J Hum Hypertens 1995; 9(suppl 5): S19S24, Booz GW, Baker KM Heart Fail Rev 1998; 3: 125130, Beers MH, Berkow R, eds. The Merck Manual of Diagnosis and Therapy. 17th ed. Whitehouse Station, NJ: Merck Research Laboratories 1999: 16821704, Anderson S Exp Nephrol 1996; 4(suppl 1): 3440, Fogo AB Am J Kidney Dis 2000; 35(2):179188

*preclinical data. LV = left ventricular; MI = myocardial infarction; GFR = glomerular filtration rate

GFR

Proteinuria

Aldosterone release

Glomerular sclerosis

Atherosclerosis*

Vasoconstriction

Vascular hypertrophy

Endothelial dysfunction

LV hypertrophy

Fibrosis

Remodeling

Apoptosis

Stroke

DEATH

Hypertension

Heart failure

MI

Renal failure

*

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Gracias Por Vuestra Atencin

LUCES POR FAVOR

*

mmHg

50

75

100

125

150

bpm

50

60

70

80

bursts/min

20

30

40

50

60

bursts/100bpm

20

35

50

65

80

*

*

*

*

*

*

NT

Essential

Secondary

NT

Essential

Secondary

MBP

HR

MSNA

MSNA

Blood Pressure and HR Beat Series

7,000

6,000

5,000

4,000

3,000

2,000

1,000

0

200

180

160

140

120

100

80

60

40

20

0

480

400

320

240

160

80

0

Frecuencia de Distribucin

(135 Pts)

PAS (mmHg)

105

115

125

135

145

155

165

175

185

195

205

n=

0

5

10

15

20

25

30

35

Promedio

- DS

+ DS

Test de Fenilefrine

BRS (msec/mmHg)

5

6

7

8

9

10

11

12

13

14

Variabilidad de la PAM (mmHg)

2

4

6

8

10

Test Nitroglicerina

SBR (mseg/mmHg)

6

7

8

9

10

11

12

13

2

4

6

8

10

r=0.617; n=35; p