Thursday I3 October 1994: Poster Abstracts Hypertension 273

Falaschi F, 1st Medical Clinic, IRCCS Policlinico San Matte0 and Univ. of Pavia, Piauale Go&i, 27100 Pavia, Italy

Ambulatory blood pressures seem to be more closely related to the target organ damage than values obtained in the doctor’s office. This study aimed to correlate the analysis of ambulatory BP monitoring (ABPM) data with ultrasonographic signs of ca- rotid and femoral atherosclerosis in hypertensive patients.

We studied 71 untreated mild to moderate hypertensive sub- jects (36 M, 46 f 7 years) without end organ damage. 24-h ABPM was performed by means of a SpaceLabs 90207-31 device. BP variability was expressed as the standard deviation (SD) of sys- tolic and diastolic blood pressure. Carotid and femoral arteries were examined by real-time ultrasound with a 7.5 probe by Nico- laides’s ultrasonic biopsy technique.

Mean ambulatory BP showed no correlation with ultrasound score and class or with intimal-medial thickness (IMT). Diastolic in the daytime correlates with SCOIY. (P<O.O5), class (P< 0.01) and both mean and maximal IMT (P < 0.01). The subjects in tbe upper tertile of maximal IMT distribution showed greater systolic and diastolic SDS in the daytime (P < 0.05 for both) than patients in the lowest tertile. The subjects with an ultrasound SCOIZ 24 had higher daytime systolic and diastolic SDS (P < 0.05 for both) than those with a 0 score.

BP variability seems to be at least as important as mean BP levels in the prediction of vascular damage in asymptomatic hy- pertensive patients.

1 Comparison of different long-acting ACE inhibitors (It-month treatment) on BP in the last hours of the dosing interval

mE, Ravetta V, Moscotto M, Traversa B, Catalan0 0, Bognetti P, 1st Medical Clinic, IRCCS Policlinico S. Matteo, Piazzale Go&i, 2, I-27100 Pavia, Italy

This open, randomized, parallel group study assessed the useful- ness of ambulatory blood pressure monitoring (ABPM) in differ- entiating between once daily Benazepril (Ben), Lisinopril (Lis) and Perindopril (Per) in terms of efficacy and duration of action. 23 patients (M 11, F 12; 43.6 * 4.9 years) with mild to moderate untreated essential hypertension, were randomly allocated to Ben 10 mg (n = 7), Lis 20 mg (n = 8) and Per 4 mg (n = 8) treatment. ABPM was performed at baseline and at the end of 12 months of active therapy by the SpaceLabs 90207-31 device. BP measured in the doctor’s office just before dosing was reduced to a similar extent by the drugs (Ben PAS -7%. PAD -8%; Lis PAS -17% PAD -15%; Per PAS -lo%, PAD -10%). No significant differ- ences in average ambulatory systolic (ASBP) and diastolic blood pressure (ADBP) were detected amongst different drugs (Ben AS- BP -9%, ADBP -9%; Lis ASBP -23%. ADBP -14%; Per ASBP -7%, ADBP -6%). However, Lis showed a significantly greater (P < 0.05) effect on systolic load from 57% to 16%; from 30% to 19% on Ben and from 37% to 14% on Per). Over the last 4 h of the dosing interval, Lis was more effective in lowering both sys- tolic (P < 0.01) and diastolic (P < 0.02) BP (-29% and -17% res- pectively) then either Ben (-6% and -6%) or Per (-7% and -6%).

Because of the high incidence of cardiovascular events, BP reduction in the early morning may be an appropriate goal of antihypertensive therapy. From this point of view, Lis seems to be more useful than other ACE inhibitors.

1501 Carotid atherosclerosis in the elderly with isolated systolic hypertension and left ventricular hypertro- phy: morphologic and functional study using B-mode ultrasonography and color-flow doppler

Feraco E, Grandinetti 0, Dept. of Cardiol., ltalian National Re- search Centre on Aging, c.da Muoio Piccolo, 87100 Cosenza, Italy

Hypertension is an independent risk factor for transient ischemic attacks and cerebral infarction. B-mode ultrasonography and color-flow Doppler permit a study of presymptomatic carotid atherosclerosis and thus provide the opportunity to relate hyper- tension to atherosclerosis in subjects with early lesions. The aim of the study was to evaluate the size and the extent of atheroscle- rosis lesions in carotid arteries (CA) in a population of elderly hypertensives with isolated systolic hypertension (ISH) and left ventricular hypertrophy (LVH) compared with a normotensive (N) aged group without LVH.

28 patients (18 M and 10 F; mean age 71.3f4years) with treated ISH and a pattern of LVH on the electrocardiogram and 28 normotensive patients (18 M and 10 F; mean age 70.5 + 4 years) were submitted to 2-D echocardiography and to B-mode ultra- sonography and color-flow Doppler of CA. Left ventricular mass (LVM) was calculated and common and internal CA were exam- ined in multiple views. Axial thickness measurements of plaques visualized were obtained at standard sizes. Patients who were smokers and/or with diabetes mellitus, hyperlipidemia, history of coronary disease, peripheral arterial disease or previous cere- brovascular attack were excluded from the study.

Intimal thickening, 71% (ISH) vs 11% (N), P < 0.01; soft plaque, 21% vs 7%, P< 0.01; mixed plaque, 18% vs 7%, P<O.Ol; hard plaque, 36% vs 14%, P<O.Ol; smooth surface, 75% vs 78%, NS; uneven surface, 25% vs 21%, NS; stenosis >50%, 43% vs O%, PcO.01; stenosis c50%, 57% vs lOO%, P < 0.01; single plaque, 64% vs 79%. P < 0.01; multiple plaque, 36% vs 21%. P < 0.01. Age and sex (male) were significantly associated with the extent of extracranial carotid lesions (Pi 0.01).

ISH associated with LVH appears as an important and inde- pendent risk factor for the progression of carotid atherosclerosis, and B-mode ultrasonography with color-flow Doppier allows identification of patients who have the highest risk and, therefore, require the most aggressive therapeutic intervention.

1 Effects of dietary salt restriction with or without cila- zapril on off& and ambulatory blood pressure

Raurm, Korhonen M, Litmanen H, Niskanen L, Uusitupa M, Kuopio Research Inst. of Exercise Med., Puistokatu 20, FIN- 70110 Kuopio, Finland

The aim of the study was to analyze the blood pressure responses to an initial I-week dietary salt restriction followed by additional 12-week placebo-controlled drug treatment with cilazapril, an angiotensin converting enzyme inhibitor, in patients (n = 41) with mild to moderate hypertension. Both conventional (random zero device) and 24-h ambulatory BP were measured before and after the salt restriction period as well as before, after 6 weeks and at the end of the drug treatment. Cilazapril (2.5 mg) or placebo was given once a day. Salt restriction was carried out by dietary coun- seling and by providing low-salt bread during the study. Urinary sodium excretion decreased by 42% (P < 0.001). During the 8- week salt-restriction period both systolic (6 mmHg, P = 0.004) and diastolic (4 mmHg; P = 0.001) office blood pressure de- creased. On the other hand, only a slight (2.4 mmHg) though statistically significant (P = 0.038) decrease in the daytime dia- stolic, and in evening systolic (3.8 mmHg; P = 0.032) ambulatory BP were observed. Addition of active drug treatment to dietary salt restriction was accompanied by net decreases of 15 mmHg (P < 0.001) and 7 mmHr! (P < 0.001) in svstolic and diastolic office BPS, respectiveiy.‘ Ambuiatorily s measured systolic (6 mmHg; P = 0.007) and diastolic (5 mmHg; P = 0.016) daytime BP were also lower in the patients receiving active drug treatment than in the placebo group. The data suggest that antihypertensive responses to both salt restriction per se and to drug therapy may be greater in conventional office BP measurements then in ambu- latory monitoring.

Atherosclerosis X, Montreal, October 1994